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Shah LM, Patel H, Faisaluddin M, Kwapong YA, Patel BA, Choi E, Satti DI, Oyeka CP, Hegde S, Dani SS, Sharma G. Rural/urban disparities in the trends and outcomes of peripartum cardiomyopathy in delivery hospitalizations. Curr Probl Cardiol 2024; 49:102433. [PMID: 38301915 DOI: 10.1016/j.cpcardiol.2024.102433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Rural-urban disparities in peripartum cardiomyopathy (PPCM) are not well known. We examined rural-urban differences in maternal, fetal, and cardiovascular outcomes in PPCM during delivery hospitalizations. METHODS We used 2003-2020 data from the National Inpatient Sample for delivery hospitalizations in individuals with PPCM. The 9th and 10th editions of the International Classification of Diseases were used to identify PPCM and cardiovascular, maternal, and fetal outcomes. Rural and urban hospitalizations for PPCM were 1:1 propensity score-matched using relevant clinical and sociodemographic variables. Odds of in-hospital mortality were assessed using logistic regression. RESULTS Among 72,880 delivery hospitalizations with PPCM, 4,571 occurred in rural locations, while 68,309 occurred in urban locations. After propensity matching, there were a total of 4,571 rural-urban pairs. There was significantly higher in-hospital mortality in urban compared to rural hospitalizations (adjusted OR 1.54, 95% CI 1.10-1.89). Urban PPCM hospitalizations had significantly higher cardiogenic shock (2.9% vs. 1.3%), mechanical circulatory support (1.0% vs. 0.6%), cardiac arrest (2.3% vs. 0.9%), and VT/VF (4.5% vs. 2.1%, all p <.05). Additionally, urban PPCM hospitalizations had worse maternal and fetal outcomes as compared to rural hospitalizations, including higher preterm delivery, gestational diabetes, and fetal death (all p<.05). Notably, significantly more rural individuals were transferred to a short-term hospital (including tertiary care centers) compared to urban individuals (13.5% vs. 3.2%, p<.0001). CONCLUSIONS There are significant rural-urban disparities in delivery hospitalizations with PPCM. Worse outcomes were associated with urban hospitalizations, while rural PPCM hospitalizations were associated with increased transfers, suggesting inadequate resources and advanced sickness.
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Affiliation(s)
- Lochan M Shah
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Harsh Patel
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | | | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Bhavin A Patel
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI, United States
| | - Eunjung Choi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Danish Iltaf Satti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Shruti Hegde
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | - Sourbha S Dani
- Lahey Hospital & Medical Center, Boston, MA, United States
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States; Inova Schar Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, United States.
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Nagata C, Suto M, Morisaki N, Kobayashi T, Takehara K. Annual numbers of diagnoses and medical expenses for obstetric diseases in Japan: A report from the National Database of Health Insurance Claims. J Obstet Gynaecol Res 2024; 50:596-603. [PMID: 38273716 DOI: 10.1111/jog.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
AIM The present study aimed to estimate the total numbers of obstetric diseases diagnosed, total amounts of medical expenses claimed for obstetric diseases, their averages per livebirth, and yearly trends in Japan. METHODS This is a secondary analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (data from 2015 to 2019). The target population was women of reproductive age (15-49 years old) with diseases in pregnancy, childbirth, and the puerperium, defined by having O codes according to the International Classification of Diseases 10th Revision. We calculated the numbers of obstetric diseases diagnosed, amounts of medical expenses claimed for obstetric diseases marked with the "main injury/disease decision flag," and the totals divided by the annual numbers of livebirths, by year and women's age group. RESULTS From 2015 to 2019, both the numbers of obstetric diseases diagnosed and amounts of medical expenses claimed for obstetric diseases per livebirth were on an upward trend, whereas the total numbers of obstetric diseases diagnosed were decreased. Women in advanced age groups had a higher number of diagnoses and a higher amount of medical expenses for obstetric diseases per livebirth. "Preterm labour without delivery" had the highest amounts of medical expenses claimed for and the second highest numbers of diagnoses throughout the study period. CONCLUSIONS This study suggests that pregnant women in Japan would have an increasing number of obstetric complications and necessary medical expenses year by year. Further study is warranted to elucidate these trends and identify possible mitigation measures.
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Affiliation(s)
- Chie Nagata
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Maiko Suto
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tohru Kobayashi
- Department of Data Science, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Johnson HM. Count From Zero: Pregnancy History and Heart Risk. J Am Heart Assoc 2024; 13:e032973. [PMID: 38410965 PMCID: PMC10944081 DOI: 10.1161/jaha.123.032973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 02/28/2024]
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Quesada O, Kulandavelu S, Vladutiu CJ, DeFranco E, Minissian MB, Makarem N, Bello NA, Wong MS, Pabón MA, Chandra AA, Avilés-Santa L, Rodríguez CJ, Bairey Merz CN, Sofer T, Hurwitz BE, Talavera GA, Claggett BL, Solomon SD, Cheng S. Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy. Hypertension 2024; 81:255-263. [PMID: 38047358 PMCID: PMC10793810 DOI: 10.1161/hypertensionaha.123.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks for cardiovascular disease for reasons that remain incompletely understood. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy). RESULTS. The study cohort included 5168 Hispanic/Latina women with an average age (SD) of 58.7 (9.7) years at time of echocardiogram. Prior de novo HDP was reported by 724 (14%) of the women studied and was associated with lower left ventricle (LV) ejection fraction -0.66 (95% confidence interval [CI], -1.21 to -0.11), higher LV relative wall thickness 0.09 (95% CI, 0-0.18), and 1.39 (95% CI, 1.02-1.89) higher risk of abnormal LV geometry after adjusting for blood pressure and other confounders. The proportion of the association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI, 0.03-0.45), LV relative wall thickness was 0.28 (95% CI, 0.16-0.51), abnormal LV geometry was 0.14 (95% CI, 0.12-0.48), concentric left ventricular hypertrophy was 0.31 (95% CI, 0.19-0.86), and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26-0.79). CONCLUSIONS. In a large cohort of Hispanic/Latina women those with history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension.
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Affiliation(s)
- Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.)
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q.)
| | | | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (C.J.V.)
| | - Emily DeFranco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH (E.D.)
| | - Margo B. Minissian
- Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.B.M.)
| | - Nour Makarem
- Mialman School of Public Health, Columbia University Irving Center, NY (N.M.)
| | - Natalie A. Bello
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melissa S. Wong
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (M.S.W.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Maria A. Pabón
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alvin A. Chandra
- University of Texas Southwestern Medical Center, Dallas (A.A.C.)
| | - Larissa Avilés-Santa
- National Institute on Minority Health and Health Disparities, Bethesda, MD (L.A.-S.)
| | | | - C. Noel Bairey Merz
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
- Barbra Streisand Women’s Heart Center (C.N.B.M.)
| | - Tamar Sofer
- Department of Medicine (T.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Gregory A. Talavera
- South Bay Latino Research Center, Department of Psychology, San Diego State University, CA (G.A.T.)
| | - Brian L. Claggett
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Scott D. Solomon
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Susan Cheng
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
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Wolfova K, Miller EC. Impact of adverse pregnancy outcomes on brain vascular health and cognition. Res Pract Thromb Haemost 2024; 8:102331. [PMID: 38404945 PMCID: PMC10884518 DOI: 10.1016/j.rpth.2024.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
A State of the Art lecture titled "Impact of Adverse Pregnancy Outcomes on Brain Vascular Health and Cognition" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. Adverse pregnancy outcomes, encompassing conditions such as gestational hypertension, eclampsia, preeclampsia, preterm birth, fetal growth restriction, stillbirth, and gestational diabetes, may form part of an underrecognized pathway from early adulthood reproductive health factors to later-life vascular cognitive impairment and dementia in women. Adverse pregnancy outcomes are caused by dysregulated vascular and metabolic adaptations during pregnancy, and these pathophysiological changes may persist after delivery. Adverse pregnancy outcomes may contribute to the increased risk of cognitive impairment and dementia directly through vascular and metabolic dysregulation and subsequent development of cardiovascular diseases, or other biological processes may be at play, such as shared maternal risk factors. Extensive epidemiologic evidence has shown that many cognitive impairment and dementia cases may be prevented or delayed by strategies targeting midlife cardiovascular health. Despite the recognized importance of adverse pregnancy outcomes for cardiovascular health, the literature on associated long-term health outcomes is limited. In this State of the Art review article, we summarize the current epidemiologic evidence on the relationship between adverse pregnancy outcomes and cognitive impairment and dementia and provide an overview of the potential pathophysiological mechanisms. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Katrin Wolfova
- Department of Neurology, Columbia University, New York, New York, USA
- Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliza C. Miller
- Department of Neurology, Columbia University, New York, New York, USA
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Cosi Bento GF, Guimarães da Silva M, Menon R, Richardson LS. Feto-Maternal Interface Organ-on-Chip: A New Technology to Study Ascending Infection. Methods Mol Biol 2024; 2781:105-117. [PMID: 38502447 DOI: 10.1007/978-1-0716-3746-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Modeling human pregnancy is challenging as two subjects, the mother and fetus, must be evaluated in tandem. To understand pregnancy, parturition, and adverse pregnancy outcomes, the two feto-maternal interfaces (FMi) that form during gestation (i.e., the placenta and fetal membrane) need to be investigated to understand their biological roles, and organ dysfunction can lead to adverse outcomes. Adverse pregnancy outcomes such as preterm rupture of the membranes, spontaneous preterm birth, preeclampsia, intra-uterine growth restriction, and gestational diabetes rates are on the rise worldwide, highlighting the need for future studies and a better understanding of molecular and cellular pathways that contribute to disease onset. Current in vivo animal models nor in vitro cell culture systems can answer these questions as they do not model the function or structure of human FMis. Utilizing microfabrication and soft-lithography techniques, microfluidic organ-on-chip (OOC) devices have been adapted by many fields to model the anatomy and biological function of complex organs and organ systems within small in vitro platforms.These techniques have been adapted to recreate the fetal membrane FMi (FMi-OOC) using immortalized cells and collagen derived from patient samples. The FMi-OOC is a four-cell culture chamber, concentric circle system, that contains both fetal (amniochorion) and maternal (decidua) cellular layers and has been validated to model physiological and pathological states of pregnancy (i.e., ascending infection, systemic oxidative stress, and maternal toxicant exposure). This platform is fully compatible with various analytical methods such as microscopy and biochemical analysis. This protocol will outline this device's fabrication, cell loading, and utility to model ascending infection-related adverse pregnancy outcomes.
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Affiliation(s)
- Giovana Fernanda Cosi Bento
- Department of Pathology, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
- Department of Obstetrics & Gynecology, Division of Basic Science and Translational Medicine , The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | | | - Ramkumar Menon
- Department of Obstetrics & Gynecology, Division of Basic Science and Translational Medicine , The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Lauren S Richardson
- Department of Obstetrics & Gynecology, Division of Basic Science and Translational Medicine , The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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Wang S, Mitsunami M, Ortiz-Panozo E, Leung CW, Manson JE, Rich-Edwards JW, Chvarro JE. Prepregnancy Healthy Lifestyle and Adverse Pregnancy Outcomes. Obstet Gynecol 2023; 142:1278-1290. [PMID: 37826849 PMCID: PMC10840639 DOI: 10.1097/aog.0000000000005346] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate the association of healthy lifestyle factors before pregnancy (body mass index [BMI] 18.5-24.9, nonsmoking, 150 min/wk or more of moderate-to-vigorous physical activity, healthy eating [top 40% of Dietary Approaches to Stop Hypertension score], no or low-to-moderate alcohol intake [less than 15 g/d], and use of multivitamins) with risk of adverse pregnancy outcomes. METHODS We conducted a secondary analysis of prospectively collected data for women without chronic diseases who are participating in an ongoing cohort in the United States (the NHSII [Nurses' Health Study II]). Healthy lifestyle factors preceding pregnancy were prospectively assessed every 2-4 years from 1991 to 2009 with validated measures. Reproductive history was self-reported in 2001 and 2009. A composite outcome of adverse pregnancy outcomes that included miscarriage, ectopic pregnancy, gestational diabetes, gestational hypertension, preeclampsia, preterm birth, stillbirth, or low birth weight was assessed. RESULTS Overall, 15,509 women with 27,135 pregnancies were included. The mean maternal age was 35.1±4.2 years. Approximately one in three pregnancies (n=9,702, 35.8%) was complicated by one or more adverse pregnancy outcomes. The combination of six low-risk factors was inversely associated with risk of adverse pregnancy outcomes in a dose-dependent manner ( P for trend <.001). Compared with women who had zero or one healthy lifestyle factor, those with six had a 37% lower risk of adverse pregnancy outcomes (relative risk 0.63, 95% CI 0.55-0.72), driven primarily by lower risks of gestational diabetes, gestational hypertension, and low birth weight. All prepregnancy healthy lifestyle factors, except avoiding harmful alcohol consumption and regular physical activity, were independently associated with lower risk of adverse pregnancy outcomes after mutual adjustment for each other. Healthy BMI, high-quality diet, and multivitamin supplementation showed the strongest inverse associations with adverse pregnancy outcomes. If the observed relationships were causal, 19% of adverse pregnancy outcomes could have been prevented by the adoption of all six healthy lifestyle factors (population attributable risk 19%, 95% CI 13-26%). CONCLUSION Prepregnancy healthy lifestyle is associated with a substantially lower risk of adverse pregnancy outcomes and could be an effective intervention for the prevention of adverse pregnancy outcomes.
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Affiliation(s)
- Siwen Wang
- Department of Nutrition and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, the Division of Women's Health, the Division of Preventive Medicine, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Khan SS, Vaughan AS, Harrington K, Seegmiller L, Huang X, Pool LR, Davis MM, Allen NB, Capewell S, O’Flaherty M, Miller GE, Mehran R, Vogel B, Kershaw KN, Lloyd-Jones DM, Grobman WA. US County-Level Variation in Preterm Birth Rates, 2007-2019. JAMA Netw Open 2023; 6:e2346864. [PMID: 38064212 PMCID: PMC10709777 DOI: 10.1001/jamanetworkopen.2023.46864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Preterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level. Objective To estimate age-standardized preterm birth rates by US county from 2007 to 2019. Design, Setting, and Participants This serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022. Main Outcomes and Measures Age-standardized preterm birth (<37 weeks' gestation) and secondarily early preterm birth (<34 weeks' gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models. Results Between 2007 and 2019, there were 51 044 482 live births in 2383 counties. In 2007, the national age-standardized preterm birth rate was 12.6 (95% CI, 12.6-12.7) per 100 live births. Preterm birth rates varied significantly among counties, with an absolute difference between the 90th and 10th percentile counties of 6.4 (95% CI, 6.2-6.7). The gap between the highest and lowest counties for preterm births was 20.7 per 100 live births in 2007. Several counties in the Southeast consistently had the highest preterm birth rates compared with counties in California and New England, which had the lowest preterm birth rates. Although there was no statistically significant change in preterm birth rates between 2007 and 2019 at the national level (percent change, -5.0%; 95% CI, -10.7% to 0.9%), increases occurred in 15.4% (95% CI, 14.1%-16.9%) of counties. The absolute and relative geographic inequalities were similar across all maternal age groups. Higher quartile of the Social Vulnerability Index was associated with higher preterm birth rates (quartile 4 vs quartile 1 risk ratio, 1.34; 95% CI, 1.31-1.36), which persisted across the study period. Similar patterns were observed for early preterm birth rates. Conclusions and Relevance In this serial cross-sectional study of county-level preterm and early preterm birth rates, substantial geographic disparities were observed, which were associated with place-based social disadvantage. Stability in aggregated rates of preterm birth at the national level masked increases in nearly 1 in 6 counties between 2007 and 2019.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam S. Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura Seegmiller
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoning Huang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R. Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew M. Davis
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Simon Capewell
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Gregory E. Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Roxana Mehran
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | - Birgit Vogel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus
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Lewis JV, Knapp EA, Bakre S, Dickerson AS, Bastain TM, Bendixsen C, Bennett DH, Camargo CA, Cassidy-Bushrow AE, Colicino E, D'Sa V, Dabelea D, Deoni S, Dunlop AL, Elliott AJ, Farzan SF, Ferrara A, Fry RC, Hartert T, Howe CG, Kahn LG, Karagas MR, Ma TF, Koinis-Mitchell D, MacKenzie D, Maldonado LE, Merced-Nieves FM, Neiderhiser JM, Nigra AE, Niu Z, Nozadi SS, Rivera-Núñez Z, O'Connor TG, Osmundson S, Padula AM, Peterson AK, Sherris AR, Starling A, Straughen JK, Wright RJ, Zhao Q, Kress AM. Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis. ENVIRONMENTAL RESEARCH 2023; 236:116772. [PMID: 37517496 PMCID: PMC10592196 DOI: 10.1016/j.envres.2023.116772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Drinking water is a common source of exposure to inorganic arsenic. In the US, the Safe Drinking Water Act (SDWA) was enacted to protect consumers from exposure to contaminants, including arsenic, in public water systems (PWS). The reproductive effects of preconception and prenatal arsenic exposure in regions with low to moderate arsenic concentrations are not well understood. OBJECTIVES This study examined associations between preconception and prenatal exposure to arsenic violations in water, measured via residence in a county with an arsenic violation in a regulated PWS during pregnancy, and five birth outcomes: birth weight, gestational age at birth, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). METHODS Data for arsenic violations in PWS, defined as concentrations exceeding 10 parts per billion, were obtained from the Safe Drinking Water Information System. Participants of the Environmental influences on Child Health Outcomes Cohort Study were matched to arsenic violations by time and location based on residential history data. Multivariable, mixed effects regression models were used to assess the relationship between preconception and prenatal exposure to arsenic violations in drinking water and birth outcomes. RESULTS Compared to unexposed infants, continuous exposure to arsenic from three months prior to conception through birth was associated with 88.8 g higher mean birth weight (95% CI: 8.2, 169.5), after adjusting for individual-level confounders. No statistically significant associations were observed between any preconception or prenatal violations exposure and gestational age at birth, preterm birth, SGA, or LGA. CONCLUSIONS Our study did not identify associations between preconception and prenatal arsenic exposure, defined by drinking water exceedances, and adverse birth outcomes. Exposure to arsenic violations in drinking water was associated with higher birth weight. Future studies would benefit from more precise geodata of water system service areas, direct household drinking water measurements, and exposure biomarkers.
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Affiliation(s)
- Jonathan V Lewis
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shivani Bakre
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Casper Bendixsen
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Deborah H Bennett
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Viren D'Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Sean Deoni
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, SD, USA; Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Tina Hartert
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin G Howe
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Teng-Fei Ma
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | | | - Debra MacKenzie
- Community Environmental Health Program, University of New Mexico College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Luis E Maldonado
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Francheska M Merced-Nieves
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Zhongzheng Niu
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sara S Nozadi
- Community Environmental Health Program, College of Pharmacy, Health Sciences Center, Albuquerque, NM, USA
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Thomas G O'Connor
- Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Sarah Osmundson
- Department of OB/GYN, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amy M Padula
- Department of Gynecology, Obstetrics and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Alicia K Peterson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Allison R Sherris
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Anne Starling
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Amii M Kress
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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10
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Prakash P, Dua A, Blumenfeld Y, Chen PH, Parian AM, Limketkai BN. Longitudinal Trends in Pregnancy Outcomes Among Women With Inflammatory Bowel Disease in the Era of Biologics: A 20-Year Nationwide Analysis. Inflamm Bowel Dis 2023:izad250. [PMID: 37857421 DOI: 10.1093/ibd/izad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Many women with inflammatory bowel disease (IBD) are diagnosed by their reproductive years. Prior literature suggests that women with IBD may be at increased risk of adverse pregnancy outcomes. Biologics have revolutionized IBD treatment, and current evidence favors continuation during pregnancy. We sought to examine trends in pregnancy outcomes over 20 years with the evolution of IBD treatment. METHODS Using the National Inpatient Sample, IBD and non-IBD obstetric hospitalizations were identified between 1998 and 2018 using International Classification of Diseases 9 and 10 codes. Outcomes of interest included cesarean delivery, gestational diabetes, preeclampsia/eclampsia, premature rupture of membranes (PROM), preterm delivery, fetal growth restriction (FGR), fetal distress, and stillbirth. Stratified by Crohn's disease (CD), ulcerative colitis (UC), and non-IBD deliveries, temporal trends and multivariable logistic regression were analyzed. RESULTS There were 48 986 CD patients, 30 998 UC patients, and 69 963,805 non-IBD patients. Between 1998 and 2018, CD deliveries increased from 3.3 to 12.9 per 10 000 deliveries (P < 0.001) and UC deliveries increased from 2.3 to 8.6 per 10 000 deliveries (P < 0.001). Cesarean deliveries, gestational diabetes, preeclampsia/eclampsia, PROM, FGR, and fetal distress increased over time for IBD and non-IBD women, while preterm deliveries decreased (P < 0.001). Multivariable analyses demonstrated that IBD patients had higher risk of cesarean delivery, preeclampsia/eclampsia, PROM, and preterm delivery compared with non-IBD patients. CONCLUSION Over a 20-year period, live deliveries amongst women with IBD have increased. Trends in pregnancy outcomes have followed a similar trajectory in patients with and without IBD. However, there is still demonstrable risk of adverse pregnancy outcomes in patients with IBD.
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Affiliation(s)
- Preeti Prakash
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anoushka Dua
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yair Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Berkeley N Limketkai
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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11
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Thomas G, Syngelaki A, Hamed K, Perez-Montaño A, Panigassi A, Tuytten R, Nicolaides KH. Preterm preeclampsia screening using biomarkers: combining phenotypic classifiers into robust prediction models. Am J Obstet Gynecol MFM 2023; 5:101110. [PMID: 37752025 DOI: 10.1016/j.ajogmf.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Preeclampsia screening is a critical component of antenatal care worldwide. Currently, the most developed screening test for preeclampsia at 11 to 13 weeks' gestation integrates maternal demographic characteristics and medical history with 3 biomarkers-serum placental growth factor, mean arterial pressure, and uterine artery pulsatility index-to identify approximately 75% of women who develop preterm preeclampsia with delivery before 37 weeks of gestation. It is generally accepted that further improvements to preeclampsia screening require the use of additional biomarkers. We recently reported that the levels of specific metabolites and metabolite ratios are associated with preterm preeclampsia. Notably, for several of these markers, preterm preeclampsia prediction varied according to maternal body mass index class. These findings motivated us to study whether patient classification allowed for combining metabolites with the current biomarkers more effectively to improve prediction of preterm preeclampsia. OBJECTIVE This study aimed to investigate whether metabolite biomarkers can improve biomarker-based preterm preeclampsia prediction in 3 screening resource scenarios according to the availability of: (1) placental growth factor, (2) placental growth factor+mean arterial pressure, and (3) placental growth factor+mean arterial pressure+uterine artery pulsatility index. STUDY DESIGN This was an observational case-control study, drawn from a large prospective screening study at 11 to 13 weeks' gestation on the prediction of pregnancy complications, conducted at King's College Hospital, London, United Kingdom. Maternal blood samples were also collected for subsequent research studies. We used liquid chromatography-mass spectrometry to quantify levels of 50 metabolites previously associated with pregnancy complications in plasma samples from singleton pregnancies. Biomarker data, normalized using multiples of medians, on 1635 control and 106 preterm preeclampsia pregnancies were available for model development. Modeling was performed using a methodology that generated a prediction model for preterm preeclampsia in 4 consecutive steps: (1) z-normalization of predictors, (2) combinatorial modeling of so-called (weak) classifiers in the unstratified patient set and in discrete patient strata based on body mass index and/or race, (3) selection of classifiers, and (4) aggregation of the selected classifiers (ie, bagging) into the final prediction model. The prediction performance of models was evaluated using the area under the receiver operating characteristic curve, and detection rate at 10% false-positive rate. RESULTS First, the predictor development methodology itself was evaluated. The patient set was split into a training set (2/3) and a test set (1/3) for predictor model development and internal validation. A prediction model was developed for each of the 3 different predictor panels, that is, placental growth factor+metabolites, placental growth factor+mean arterial pressure+metabolites, and placental growth factor+mean arterial pressure+uterine artery pulsatility index+metabolites. For all 3 models, the area under the receiver operating characteristic curve in the test set did not differ significantly from that of the training set. Next, a prediction model was developed using the complete data set for the 3 predictor panels. Among the 50 metabolites available for modeling, 26 were selected across the 3 prediction models; 21 contributed to at least 2 out of the 3 prediction models developed. Each time, area under the receiver operating characteristic curve and detection rate were significantly higher with the new prediction model than with the reference model. Markedly, the estimated detection rate with the placental growth factor+mean arterial pressure+metabolites prediction model in all patients was 0.58 (95% confidence interval, 0.49-0.70), a 15% increase (P<.001) over the detection rate of 0.43 (95% confidence interval, 0.33-0.55) estimated for the reference placental growth factor+mean arterial pressure. The same prediction model significantly improved detection in Black (14%) and White (19%) patients, and in the normal-weight group (18.5≤body mass index<25) and the obese group (body mass index≥30), with respectively 19% and 20% more cases detected, but not in the overweight group, when compared with the reference model. Similar improvement patterns in detection rates were found in the other 2 scenarios, but with smaller improvement amplitudes. CONCLUSION Metabolite biomarkers can be combined with the established biomarkers of placental growth factor, mean arterial pressure, and uterine artery pulsatility index to improve the biomarker component of early-pregnancy preterm preeclampsia prediction tests. Classification of the pregnant women according to the maternal characteristics of body mass index and/or race proved instrumental in achieving improved prediction. This suggests that maternal phenotyping can have a role in improving the prediction of obstetrical syndromes such as preeclampsia.
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Affiliation(s)
- Grégoire Thomas
- SQU4RE, Lokeren, Belgium (Dr Thomas); Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten)
| | - Argyro Syngelaki
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Karam Hamed
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Anais Perez-Montaño
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Ana Panigassi
- Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten)
| | - Robin Tuytten
- Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten).
| | - Kypros H Nicolaides
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
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12
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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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13
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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14
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Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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15
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Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
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16
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Antihypertensives in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:39-78. [PMID: 36822710 DOI: 10.1016/j.ogc.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) can result in significant maternal morbidity and even mortality. Available data suggest that many antihypertensives can be safely used in pregnant patients, albeit with close supervision of parameters like fetal growth and amniotic fluid volume. This article summarizes current guidelines on the diagnosis and treatment of hypertension in pregnancy and provides an in-depth guide to the available safety and efficacy data for antihypertensives during pregnancy and postpartum.
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17
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Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e76-e91. [PMID: 36780391 PMCID: PMC10080475 DOI: 10.1161/cir.0000000000001124] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.
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