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Kwapong YA, Boyer T, Adebowale O, Ogunwole SM, Vaught AJ, Ndumele CE, Hays AG, Blumenthal RS, Michos ED, Selvin E, Coresh J, Minhas AS. Association of Prepregnancy Cardiometabolic Health With Hypertensive Disorders of Pregnancy Among Historically Underrepresented Groups in the United States. J Am Heart Assoc 2024:e035526. [PMID: 39424428 DOI: 10.1161/jaha.124.035526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 09/20/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Prepregnancy diabetes and obesity are associated with hypertensive disorders of pregnancy (HDPs). However, the proportion of cases of HDP in the population explained by diabetes and obesity (population attributable fraction), especially among American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander, is not well characterized. METHODS AND RESULTS We conducted a cross-sectional analysis of data on individuals with a live singleton birth from the US National Vital Statistics System between 2016 and 2019. We used adjusted logistic regression to estimate the prevalence odds ratios of HDPs and tested interaction for race and ethnicity. We calculated the population attributable fraction for the effect of obesity and diabetes on HDPs. Among 13 201 338 birthing individuals, (mean age, 29±6 years), 7% had HDP. The prevalence of HDP was highest among American Indian and Alaska Native individuals (9.1%). Prepregnancy diabetes (prevalence odds ratio, 2.63 [95% CI, 2.59-2.67]) and obesity (prevalence odds ratio, 2.95 [95% CI, 2.93-2.97]) were associated with HDPs. Compared with non-Hispanic White individuals, the association of diabetes with HDPs was strongest among Native Hawaiian and Other Pacific Islander (prevalence odds ratio, 3.05 [95% CI, 2.48-3.77]), and the association of obesity with HDP was strongest among Asian individuals (prevalence odds ratio, 3.44 [95% CI, 3.35-3.54]; all P for interaction <0.05). Population attributable fractions for diabetes and obesity were highest among Native Hawaiian and Other Pacific Islander individuals (diabetes, 3.7% [95% CI, 3.3%-4.0%]; and obesity, 45% [95% CI, 41.9%-47.8%]). CONCLUSIONS Prepregnancy diabetes and obesity are associated with HDP across all racial and ethnic groups. Diabetes and obesity have highest population attributable fractions among Native Hawaiian and Other Pacific Islander individuals and should be aggressively targeted during childhood, adolescence, and young adulthood to reduce risk of HDPs.
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Affiliation(s)
- Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
| | - Theresa Boyer
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | | | - S Michelle Ogunwole
- Division of General Internal Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics Johns Hopkins University Baltimore MD USA
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA
| | - Allison G Hays
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA
| | - Elizabeth Selvin
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Josef Coresh
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Anum S Minhas
- Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University Baltimore MD USA
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA
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Anyiam S, Woo J, Spencer B. Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment. J Midwifery Womens Health 2024; 69:653-662. [PMID: 38689459 DOI: 10.1111/jmwh.13635] [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] [Revised: 02/01/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. METHODS Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. RESULTS The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatal health care. DISCUSSION The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.
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Affiliation(s)
- Shalom Anyiam
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Jennifer Woo
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Becky Spencer
- College of Nursing, Texas Woman's University, Dallas, Texas
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Mapari SA, Shrivastava D, Dave A, Bedi GN, Gupta A, Sachani P, Kasat PR, Pradeep U. Revolutionizing Maternal Health: The Role of Artificial Intelligence in Enhancing Care and Accessibility. Cureus 2024; 16:e69555. [PMID: 39421118 PMCID: PMC11484738 DOI: 10.7759/cureus.69555] [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: 09/05/2024] [Accepted: 09/16/2024] [Indexed: 10/19/2024] Open
Abstract
Maternal health remains a critical global health challenge, with disparities in access to care and quality of services contributing to high maternal mortality and morbidity rates. Artificial intelligence (AI) has emerged as a promising tool for addressing these challenges by enhancing diagnostic accuracy, improving patient monitoring, and expanding access to care. This review explores the transformative role of AI in maternal healthcare, focusing on its applications in the early detection of pregnancy complications, personalized care, and remote monitoring through AI-driven technologies. AI tools such as predictive analytics and machine learning can help identify at-risk pregnancies and guide timely interventions, reducing preventable maternal and neonatal complications. Additionally, AI-enabled telemedicine and virtual assistants are bridging healthcare gaps, particularly in underserved and rural areas, improving accessibility for women who might otherwise face barriers to quality maternal care. Despite the potential benefits, challenges such as data privacy, algorithmic bias, and the need for human oversight must be carefully addressed. The review also discusses future research directions, including expanding AI applications in maternal health globally and the need for ethical frameworks to guide its integration. AI holds the potential to revolutionize maternal healthcare by enhancing both care quality and accessibility, offering a pathway to safer, more equitable maternal outcomes.
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Affiliation(s)
- Smruti A Mapari
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepti Shrivastava
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gautam N Bedi
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aman Gupta
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratiksha Sachani
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Paschyanti R Kasat
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Utkarsh Pradeep
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Yada FN, Huber LRB, Brown CS, Olorunsaiye CZ, Glass TS, Amutah-Onukhaga N. Labor and Delivery Characteristics by Detailed Maternal Nativity Across the Black Diaspora: Place and Method of Delivery. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02120-y. [PMID: 39143451 DOI: 10.1007/s40615-024-02120-y] [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: 06/18/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE This study aimed to examine the associations between detailed maternal nativity (DMN) and two labor and delivery (L&D) characteristics among US-born, Latin American and Caribbean-born, and SSA-born Black women in the US. L&D characteristics included the place of delivery (i.e., hospital, birthing center, or home) and the method of delivery (i.e., vaginal or cesarean). METHODS Using Natality data, the authors examined the associations between detailed maternal nativity (DMN) and two L&D characteristics among US-born, Latin American and Caribbean-born, and SSA-born Black women in the USA who had a live delivery between 2016 and 2020 (N = 2,041,880). The main predictor was DMN (i.e., maternal country of birth) and the outcomes of interest were the place of delivery and the method of delivery. Associations were evaluated using multivariate multinominal and multivariate logistic regression models. RESULTS Findings indicated that foreign-born Black women overall had decreased odds of delivering in birthing centers or at home, except for Ghanaian-born women who had increased odds of having an unintended home delivery. All Latin American and Caribbean-born and most SSA-born women had increased odds of delivering via cesarean. CONCLUSIONS The findings underscore the importance of considering DMN in exploring L&D characteristics. Specifically, increased odds of cesarean delivery among Latin American and Caribbean-born women highlight a potential area for interventions. Further research is warranted to understand the underlying factors driving the observed differences and the diverse needs of the growing population of foreign-born Black women in the US, and to develop effective strategies to promote equitable and optimal birthing experiences for all.
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Affiliation(s)
- Farida N Yada
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, USA.
| | - Larissa R Brunner Huber
- Department of Epidemiology and Community Health, College of Health and Human Services, UNC Charlotte, Charlotte, NC, USA
| | - Candace S Brown
- Department of Epidemiology and Community Health, College of Health and Human Services, UNC Charlotte, Charlotte, NC, USA
| | - Comfort Z Olorunsaiye
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA, USA
| | - Tehia Starker Glass
- Department of Reading and Elementary Education, Cato College of Education, UNC Charlotte, Charlotte, NC, USA
| | - Ndidiamaka Amutah-Onukhaga
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, USA
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Toval CA, Darivemula SM, Wilson TD, Conklin JL, Young OM. Interventions to mitigate pregnancy-related mortality and morbidity in Black birthing people: a systematic review. Am J Obstet Gynecol MFM 2024; 6:101464. [PMID: 39147362 DOI: 10.1016/j.ajogmf.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To conduct a systematic review of interventions to improve perinatal outcomes to mitigate pregnancy-related mortality and morbidity in Black birthing people. DATA SOURCES We searched 5 databases from 2000 through the final search date of April 5, 2023: Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (EBSCOhost), Embase (Elsevier), PubMed, and Scopus (Elsevier) and ClinicalTrials.gov. STUDY ELIGIBILITY CRITERIA Only quantitative studies were eligible including observational and randomized controlled trials. All participants in selected studies must identify as Black or study results must be stratified by race that includes Black birthing people. The study must (1) measure a perinatal outcome of interest (2) occur in the United States and (3) be written in the English language. Studies were excluded if they were published prior to 2000, not published in the English language, or did not meet the criteria above. STUDY APPRAISAL AND SYNTHESIS METHODS A data extraction template identified intervention type and perinatal outcome. Perinatal outcomes included but were not limited to: cardiovascular disorders, mortality, or preterm delivery. Interventions included: community programs, educational enhancement, individual counseling, medical intervention, or policy. Risk of bias was assessed using the Mixed Method Appraisal Tool. Three investigators assessed studies individually and group consensus was used for a final decision. RESULTS From 4,302 unique studies, 41 studies met inclusion criteria. Community programs such as the Supplemental Program for Women, Infants, and Children (WIC) and Healthy Start (n=17, 41.5%) were the most common interventions studied. Individual counseling closely followed (n=15, 36.6%). Medical interventions were not among the more commonly used intervention types (n=9, 21.9%). Most articles focused on preterm delivery (n=28, 68.3%). Few articles studied cardiovascular disorders (n=4, 9.8%) or hemorrhage (n=3, 7.3%). No articles studied pregnancy-related morbidity. CONCLUSIONS Despite current conversations on Black maternal mortality, there is currently limited literature examining interventions addressing perinatal morbidity and mortality in Black birthing people in the United States. These interventions do not address how to mitigate perinatal outcomes of interest. Patient-centered outcomes research is warranted to better understand as well as to resolve inequities related to Black maternal health.
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Affiliation(s)
- Christina A Toval
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (Toval)
| | - Shilpa M Darivemula
- Division of General Obstetrics, Gynecology, and Midwifery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Darivemula)
| | - Tenisha D Wilson
- University of North Carolina at Chapel Hill, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC (Wilson, Young)
| | - Jamie L Conklin
- University of North Carolina at Chapel Hill Health Sciences Library, Chapel Hill, NC (Conklin)
| | - Omar M Young
- University of North Carolina at Chapel Hill, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC (Wilson, Young).
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Xu S, Puttock EJ, Zeiger RS, Vollmer WM, Schatz M, Crawford WW, Xie F, Chen W. Neighborhood Deprivation and Crime on Asthma Exacerbations and Utilization in Mild Adult Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00831-6. [PMID: 39147276 DOI: 10.1016/j.jaip.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Social determinants of health have a significant impact on asthma outcomes, and factors such as income level and neighborhood environment have crucial roles. OBJECTIVE This study aimed to assess the impact of the Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related emergency department and urgent care (ED/UC) visits in adults with mild asthma. METHODS This retrospective cohort study used administrative data from Kaiser Permanente Southern California among 198,873 adult patients with mild asthma between January 1, 2013 and December 31, 2018. We employed robust Poisson regression models, adjusted for age and sex, to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and body mass index categories to explore potential disparities in asthma outcomes. RESULTS Among the cohort, 12,906 patients (6.5%) experienced AAE in 1 year, and Black patients had the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (adjusted risk ratio = 1.11-1.27), with similar trends across body mass index categories and race or ethnicity, except for Black patients. The TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within 1 year. Higher NDI quintiles were associated with higher ED/UC visit risk (adjusted risk ratio = 1.23-1.75) whereas TCI associations were weaker. CONCLUSION Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing health care use, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma.
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Affiliation(s)
- Stanley Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Eric J Puttock
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | | | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - William W Crawford
- Department of Allergy, Kaiser Permanente Southern California, Harbor City, Calif
| | - Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Chyu J, Alimi O, Popat S, Smith-Mathus G, Lee UJ. Experiences of Black Women With Pelvic Floor Disorders-A Qualitative Analysis Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00246. [PMID: 38954608 DOI: 10.1097/spv.0000000000001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
IMPORTANCE Disparities research in Black women with pelvic floor disorders (PFDs) has primarily focused on epidemiology or surgical outcomes, but little is known about the patient perspective on seeking PFD care. OBJECTIVE To provide quality and equitable care to Black women with PFDs, we conducted a qualitative study to hear their perspectives and lived health care experiences. STUDY DESIGN Black women seeking care for PFDs at a tertiary care institution were invited to participate in qualitative interviews. Open-ended questions explored participants' knowledge, attitudes, and health care experiences. Interviews were transcribed verbatim and coded line-by-line. Inductive content analysis was performed to identify key themes, and consensus was achieved among the research team. RESULTS Eight Black women aged 21-83 years consented to participate. Patients noted a stigma surrounding PFDs, both among health care professionals and their community. They noted several barriers to care: financial, logistical, and racial bias. They cited difficulties in patient-health care professional communication, including not feeling heard or treated as an individual. They preferred gender and racial concordance with their physicians. These women expressed both a desire for more knowledge and to share this knowledge and advocate for other women. CONCLUSIONS Black women expressed distinct obstacles in their PFD health care. They reported not feeling heard or treated as a unique individual. The themes derived from this study identify complex patient-centered needs that can serve as the basis for future quality improvement work and/or hypothesis-driven research. By grounding health disparities research in patient perspectives, we can improve the health care experiences of Black women.
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Affiliation(s)
- Jennifer Chyu
- From the Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
| | - Oriyomi Alimi
- From the Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
| | - Shreeya Popat
- From the Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
| | | | - Una J Lee
- From the Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
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Saadat N, Aguate F, Nowak AL, Hyer S, Lin AB, Decot H, Koch H, Walker DS, Lydic T, Padmanabhan V, Campos GDL, Misra D, Giurgescu C. Changes in Lipid Profiles with the Progression of Pregnancy in Black Women. J Clin Med 2024; 13:2795. [PMID: 38792337 PMCID: PMC11122055 DOI: 10.3390/jcm13102795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Lipid metabolism plays an important role in maternal health and fetal development. There is a gap in the knowledge of how lipid metabolism changes during pregnancy for Black women who are at a higher risk of adverse outcomes. We hypothesized that the comprehensive lipidome profiles would show variation across pregnancy indicative of requirements during gestation and fetal development. Methods: Black women were recruited at prenatal clinics. Plasma samples were collected at 8-18 weeks (T1), 22-29 weeks (T2), and 30-36 weeks (T3) of pregnancy. Samples from 64 women who had term births (≥37 weeks gestation) were subjected to "shotgun" Orbitrap mass spectrometry. Mixed-effects models were used to quantify systematic changes and dimensionality reduction models were used to visualize patterns and identify reliable lipid signatures. Results: Total lipids and major lipid classes showed significant increases with the progression of pregnancy. Phospholipids and glycerolipids exhibited a gradual increase from T1 to T2 to T3, while sphingolipids and total sterol lipids displayed a more pronounced increase from T2 to T3. Acylcarnitines, hydroxy acylcarnitines, and Lyso phospholipid levels significantly decreased from T1 to T3. A deviation was that non-esterified fatty acids decreased from T1 to T2 and increased again from T2 to T3, suggestive of a potential role for these lipids during the later stages of pregnancy. The fatty acids showing this trend included key fatty acids-non-esterified Linoleic acid, Arachidonic acid, Alpha-linolenic acid, Eicosapentaenoic acid, Docosapentaenoic acid, and Docosahexaenoic acid. Conclusions: Mapping lipid patterns and identifying lipid signatures would help develop intervention strategies to reduce perinatal health disparities among pregnant Black women.
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Affiliation(s)
- Nadia Saadat
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48019, USA;
| | - Fernando Aguate
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
| | | | - Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, FL 32826, USA
| | - Anna B. Lin
- Molecular Metabolism and Disease Mass Spectrometry Core, Michigan State University, East Lansing, MI 48824, USA
| | - Hannah Decot
- Molecular Metabolism and Disease Mass Spectrometry Core, Michigan State University, East Lansing, MI 48824, USA
| | - Hannah Koch
- Molecular Metabolism and Disease Mass Spectrometry Core, Michigan State University, East Lansing, MI 48824, USA
| | | | - Todd Lydic
- Molecular Metabolism and Disease Mass Spectrometry Core, Michigan State University, East Lansing, MI 48824, USA
| | | | - Gustavo de los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
| | - Dawn Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL 32826, USA
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Tarlazzi E, Bertini V. Black pregnant women's mother-father relationships and depressive symptoms. Evid Based Nurs 2024:ebnurs-2023-103886. [PMID: 38575207 DOI: 10.1136/ebnurs-2023-103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Elena Tarlazzi
- DIMEC, University of Bologna, Bologna, Italy
- AUSL della Romagna, Ravenna, Italy
| | - Virginia Bertini
- Policlinico di Sant'Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Università di Bologna, Bologna, Italy
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10
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Hernandez-Green N, Davis MV, Beshara MS, Hernandez-Spalding K, Francis S, Parker A, Farinu O, Chandler R. Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review. Health Promot Pract 2024:15248399241234636. [PMID: 38556711 DOI: 10.1177/15248399241234636] [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: 04/02/2024]
Abstract
Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.
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Marshall CJ, Nguyen A, Arteaga S, Hubbard E, Armstead M, Peprah-Wilson S, Britt S, McLemore MR, Gomez AM. Building Capacity for Research on Community Doula Care: A Stakeholder-Engaged Process in California. Matern Child Health J 2024; 28:400-408. [PMID: 38265635 PMCID: PMC10914894 DOI: 10.1007/s10995-023-03883-2] [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] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE In an effort to address persistent inequities in maternal and infant health, policymakers and advocates have pushed to expand access to doula care. Several states, including California, now cover doula services through Medicaid. As coverage expands, research on the impact of doula care will likely increase. To develop best practices for research, it is critical to engage community doulas, clients, and other key stakeholders. DESCRIPTION Our overarching goal was to build capacity for future doula- and client-centered research on community doula care. First, we established a Steering Committee with members from seven relevant stakeholder groups: community doulas, former or potential doula clients, clinicians, payers, advocates, researchers, and public health professionals. Second, we conducted a needs assessment to identify and understand stakeholders' needs and values for research on community doula care. Findings from the needs assessment informed our third step, conducting a research prioritization to develop a shared research agenda related to community doula care with the Steering Committee. We adapted the Research Prioritization by Affected Communities protocol to guide this process, which resulted in a final list of 21 priority research questions. Lastly, we offered a training to increase capacity among community doulas to engage in research on community doula care. ASSESSMENT Our findings provide direction for those interested in conducting research on doula care, as well as policymakers and funders. CONCLUSION The findings of our stakeholder-engaged process provide a roadmap that will lead to equity-oriented research centering clients, doulas, and their communities.
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Affiliation(s)
- Cassondra J Marshall
- School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA.
| | - Ashley Nguyen
- School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, 120 Haviland Hall, Berkeley, CA, 94720-7400, USA
| | - Erin Hubbard
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, 10490 Illinois St., San Francisco, CA, 94143, USA
| | - Marna Armstead
- SisterWeb San Francisco Community Doula Network, 1912 Keith St., San Francisco, CA, 94124, USA
| | - Sayida Peprah-Wilson
- Diversity Uplifts, Inc., 6371 Haven Ave., Suite 3, #265, Rancho Cucamonga, CA, 91737, USA
| | - Starr Britt
- Starr Public Relations Group, 1630 Center St., Oakland, CA, 94607, USA
| | - Monica R McLemore
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, 120 Haviland Hall, Berkeley, CA, 94720-7400, USA
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12
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DaCosta MC, Mogaka J, Gebhardt L, Goff SL, Qasba N, Attanasio L. Readiness to Implement a Doula-Hospital Partnership Program. J Obstet Gynecol Neonatal Nurs 2024; 53:197-206. [PMID: 38145632 DOI: 10.1016/j.jogn.2023.12.001] [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: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To assess obstetric clinicians' and leaders' baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula-hospital partnership program. DESIGN Survey of obstetric clinicians and leaders before implementation of the doula program. SETTING/LOCAL PROBLEM Academic medical center in Western Massachusetts that was preparing to pilot a doula-hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. PARTICIPANTS Obstetric clinicians and leaders (N = 48). INTERVENTION/MEASUREMENTS We used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants' knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. RESULTS Forty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. CONCLUSION Our findings suggested strong support for and readiness to implement the doula-hospital partnership program.
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Scott M, Qamar Z. Navigating Nutrition Inequities: BIPOC Maternal Health and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)'s Fruit and Vegetable Voucher. J Perinat Neonatal Nurs 2024; 38:18-24. [PMID: 38278640 DOI: 10.1097/jpn.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
INTRODUCTION The proposal to administer cuts for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could create deficiencies in nutrition for already food insecure, low-income Black, Indigenous, and Persons of Color (BIPOC) pregnant, postpartum women, and children. WIC is a US Department of Agriculturefunded nutritional program for women, infants, and children. The current proposal is to cut the funding by $800 million for the 2024 fiscal year, affecting 75% of its low-income recipients and predominantly BIPOC. METHODS Relevant websites and journal articles were analyzed to determine how the proposed cuts would create barriers within the social determinants of health that contribute to disparities in health outcomes of WIC recipients. RESULTS Many studies have demonstrated that nutrition in the first 1000 days is critical for the healthy development of newborns. Prior research suggests that maternal health outcomes for BIPOC populations are contingent upon the increased allocation of nutritional support programs such as WIC and SNAP (Supplemental Nutrition Assistance Program). Nutrients provided by the cash benefit voucher have been proven to contribute to participants' health outcomes, and allotment increases can benefit maternal and infant health outcomes. CONCLUSION AND FUTURE DIRECTIONS Neonatal nurses can help advocate for more robust policies that support the health of their patients. Future directions call for systematic changes in policies and legislation that directly affect maternal health outcomes, supportive breastfeeding policies, and applied research on solutions to improve maternal health outcomes of BIPOC populations in addition to increased awareness, education, and implementation of VeggieRx programs, investment in affordable, sustainable grassroots urban agriculture solutions.
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Affiliation(s)
- Monique Scott
- Public Health Department, San Francisco State University (SFSU), San Francisco, California; and Family, Interiors, Nutrition, and Apparel (FINA), San Francisco State University (SFSU), San Francisco, California
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Bose-Brill S, Gillespie SL, Venkatesh KK. Can We Implement Multispecialty Mother-Infant Dyadic Care to Systematize Interpregnancy Services After a Preterm Birth? WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:651-655. [PMID: 38155872 PMCID: PMC10754421 DOI: 10.1089/whr.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Seuli Bose-Brill
- Combined Internal Medicine and Pediatrics Section, Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shannon L. Gillespie
- The Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K. Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Obeng CS, Jackson F, Brandenburg D, Byrd KA. Black/African American Women's Woes: Women's Perspectives of Black/African American Maternal Mortality in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01883-0. [PMID: 38051429 DOI: 10.1007/s40615-023-01883-0] [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: 09/18/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Despite advances in perinatal care in the USA, maternal mortality is on the rise, and maternal death is higher than in any other high-income country. Maternal mortality in the USA is a persistent public health concern. This issue disproportionately affects Black/African American women, with their likelihood of pregnancy-related death being three times more likely compared to White women. This study aimed to explore the resources needed for Black/African American women to address the relatively higher maternal mortality rates recorded for them. METHODS An anonymous link with demographic and open-ended questions was sent to US women 18 years and older to participate in the study. A total of 140 participants responded to the survey. We retained a final sample of 118 responses after eliminating responses with missing data. Descriptive statistics are reported for closed-ended items. Open-ended responses were analyzed using content analysis procedures, where we coded and categorized the data into themes. RESULTS Six themes were identified from the study data: (1) Diversity, Equity, and Inclusion (DEI) training for health providers focused on racial bias and discrimination, (2) Advocacy, (3) Provider selection, (4) Researching doctors and delivery hospitals to inform women's birthing decision-making, (5) Women's care-seeking behaviors, and (6) Addressing the Social Determinants of Health. CONCLUSION Based on the study's findings, we recommend DEI training for healthcare professionals providing direct care to pregnant and postpartum women, advocacy and resource-awareness training for pregnant Black/African American women and their spouses/partners, or a family member, to assist them in their pregnancy and birthing journeys.
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Affiliation(s)
- Cecilia S Obeng
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Frederica Jackson
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Dakota Brandenburg
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Kourtney A Byrd
- College of Pharmacy, Center for Health Equity and Innovation (CHEqI), Purdue University, Indianapolis, IN, USA
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Schiavo R. The Promise and Reality of Gender Equity: Implications for Health, Society, and Communication. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:225-227. [PMID: 37859461 DOI: 10.1080/17538068.2023.2258682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Renata Schiavo
- Editor-in-Chief a Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
- Health Equity Initiative, New York, NY, USA
- Strategies for Equity and Communication ImpactSM, New York, NY, USA
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17
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Ruiz L, Torres A, Jepson L, Howell M, Carlson A, Stacey J, Hammonds K, Hofkamp MP. Effect of the COVID-19 pandemic on racial disparities in postpartum visits at a Texas level IV maternal center. Proc AMIA Symp 2023; 36:582-585. [PMID: 37614862 PMCID: PMC10443978 DOI: 10.1080/08998280.2023.2230541] [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: 05/15/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background The primary aim of our study was to determine the attendance of postpartum visits stratified by race and if the COVID-19 pandemic affected racial disparities in postpartum visit attendance. Methods We searched our labor and delivery records from July 1, 2019 to December 31, 2019 and from July 1, 2020 to December 31, 2020 and included patients who delivered liveborn infants. The final analysis was restricted to patients who identified as White or Caucasian only, Black or African American only, or Hispanic. We then performed joint tests on the logistic regression with an interaction term of race and year of delivery to determine the final model. Results The odds ratio of Black or African American and Hispanic patients attending a postpartum visit was 0.589 (95% CI 0.456, 0.760; P < .001) and 0.836 (95% CI 0.676, 1.034; P = 0.099), respectively, compared to White or Caucasian patients. The interaction term of race and year of delivery was not statistically significant. Conclusion Black or African American patients at our hospital had a clinically and statistically significant lower utilization of postpartum visits compared to White or Caucasian patients and this disparity was not exacerbated by the COVID-19 pandemic.
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Affiliation(s)
- Luis Ruiz
- Department of Obstetrics and Gynecology, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
| | - Abigail Torres
- Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA
| | - Logan Jepson
- Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, Missouri, USA
| | - Megan Howell
- Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, Missouri, USA
| | - Alexandra Carlson
- Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA
| | - Joanna Stacey
- Department of Obstetrics and Gynecology, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
| | - Kendall Hammonds
- Biostatistics Core, Baylor Scott & White Research Institute, Temple, Texas, USA
| | - Michael P. Hofkamp
- Department of Anesthesiology, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
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