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Smith AJB, Howell EA, Ko EM. Ovarian Cancer Isn't Just a White Woman's Disease. JAMA Oncol 2024:2817119. [PMID: 38573626 DOI: 10.1001/jamaoncol.2024.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
This Viewpoint highlights the need for recognition that ovarian cancer affects women from racial and ethnic minority groups worldwide and that the rates of ovarian cancer are increasing in those populations while decreasing among White women.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Grobman WA, Entringer S, Headen I, Janevic T, Kahn RS, Simhan H, Yee LM, Howell EA. Social determinants of health and obstetric outcomes: A report and recommendations of the workshop of the Society for Maternal-Fetal Medicine. Am J Obstet Gynecol 2024; 230:B2-B16. [PMID: 37832813 DOI: 10.1016/j.ajog.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
This article is a report of a 2-day workshop, entitled "Social determinants of health and obstetric outcomes," held during the Society for Maternal-Fetal Medicine 2022 Annual Pregnancy Meeting. Participants' fields of expertise included obstetrics, pediatrics, epidemiology, health services, health equity, community-based research, and systems biology. The Commonwealth Foundation and the Alliance of Innovation on Maternal Health cosponsored the workshop and the Society for Women's Health Research provided additional support. The workshop included presentations and small group discussions, and its goals were to accomplish the following.
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Sofaer S, Glazer KB, Balbierz A, Kheyfets A, Zeitlin J, Howell EA. Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality. J Pediatr X 2023; 10:100094. [PMID: 38186750 PMCID: PMC10769867 DOI: 10.1016/j.ympdx.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.
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Affiliation(s)
| | - Kimberly B. Glazer
- Department of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Balbierz
- New York University Grossman School of Medicine, New York, NY
| | - Anna Kheyfets
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, Inrae, Paris, France
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Janevic T, Tomalin LE, Glazer KB, Boychuk N, Kern-Goldberger A, Burdick M, Howell F, Suarez-Farinas M, Egorova N, Zeitlin J, Hebert P, Howell EA. Development of a prediction model of postpartum hospital use using an equity-focused approach. Am J Obstet Gynecol 2023:S0002-9378(23)00769-X. [PMID: 37879386 PMCID: PMC11035486 DOI: 10.1016/j.ajog.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Racial inequities in maternal morbidity and mortality persist into the postpartum period, leading to a higher rate of postpartum hospital use among Black and Hispanic people. Delivery hospitalizations provide an opportunity to screen and identify people at high risk to prevent adverse postpartum outcomes. Current models do not adequately incorporate social and structural determinants of health, and some include race, which may result in biased risk stratification. OBJECTIVE This study aimed to develop a risk prediction model of postpartum hospital use while incorporating social and structural determinants of health and using an equity approach. STUDY DESIGN We conducted a retrospective cohort study using 2016-2018 linked birth certificate and hospital discharge data for live-born infants in New York City. We included deliveries from 2016 to 2017 in model development, randomly assigning 70%/30% of deliveries as training/test data. We used deliveries in 2018 for temporal model validation. We defined "Composite postpartum hospital use" as at least 1 readmission or emergency department visit within 30 days of the delivery discharge. We categorized diagnosis at first hospital use into 14 categories based on International Classification of Diseases-Tenth Revision diagnosis codes. We tested 72 candidate variables, including social determinants of health, demographics, comorbidities, obstetrical complications, and severe maternal morbidity. Structural determinants of health were the Index of Concentration at the Extremes, which is an indicator of racial-economic segregation at the zip code level, and publicly available indices of the neighborhood built/natural and social/economic environment of the Child Opportunity Index. We used 4 statistical and machine learning algorithms to predict "Composite postpartum hospital use", and an ensemble approach to predict "Cause-specific postpartum hospital use". We simulated the impact of each risk stratification method paired with an effective intervention on race-ethnic equity in postpartum hospital use. RESULTS The overall incidence of postpartum hospital use was 5.7%; the incidences among Black, Hispanic, and White people were 8.8%, 7.4%, and 3.3%, respectively. The most common diagnoses for hospital use were general perinatal complications (17.5%), hypertension/eclampsia (12.0%), nongynecologic infections (10.7%), and wound infections (8.4%). Logistic regression with least absolute shrinkage and selection operator selection retained 22 predictor variables and achieved an area under the receiver operating curve of 0.69 in the training, 0.69 in test, and 0.69 in validation data. Other machine learning algorithms performed similarly. Selected social and structural determinants of health features included the Index of Concentration at the Extremes, insurance payor, depressive symptoms, and trimester entering prenatal care. The "Cause-specific postpartum hospital use" model selected 6 of the 14 outcome diagnoses (acute cardiovascular disease, gastrointestinal disease, hypertension/eclampsia, psychiatric disease, sepsis, and wound infection), achieving an area under the receiver operating curve of 0.75 in training, 0.77 in test, and 0.75 in validation data using a cross-validation approach. Models had slightly lower performance in Black and Hispanic subgroups. When simulating use of the risk stratification models with a postpartum intervention, identifying high-risk individuals with the "Composite postpartum hospital use" model resulted in the greatest reduction in racial-ethnic disparities in postpartum hospital use, compared with the "Cause-specific postpartum hospital use" model or a standard approach to identifying high-risk individuals with common pregnancy complications. CONCLUSION The "Composite postpartum hospital use" prediction model incorporating social and structural determinants of health can be used at delivery discharge to identify persons at risk for postpartum hospital use.
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Affiliation(s)
- Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
| | - Lewis E Tomalin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly B Glazer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Boychuk
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Adina Kern-Goldberger
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Micki Burdick
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Mayte Suarez-Farinas
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Research in Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Paul Hebert
- School of Public Health, University of Washington, Seattle, WA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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McCoy EE, Katz R, Louden DKN, Oshima E, Murtha A, Gyamfi-Bannerman C, Santoro N, Howell EA, Halvorson L, Reed SD, Goff BA. Scholarly activity following National Institutes of Health Women's Reproductive Health Research K12 training-a cohort study. Am J Obstet Gynecol 2023; 229:425.e1-425.e16. [PMID: 37437707 PMCID: PMC10584274 DOI: 10.1016/j.ajog.2023.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND National Institutes of Health funding to address basic reproductive health for common female conditions remains disproportionately low, in part because of low success rates of grant applications by obstetrician-gynecologists. OBJECTIVE This study aimed to evaluate the scholarly productivity of individuals supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Women's Reproductive Health Research K12 career development award, created to advance careers of obstetrician-gynecologist physician-scientists. STUDY DESIGN We performed a cohort study of individuals who completed at least 2 years of Women's Reproductive Health Research training by June 30, 2015, and had at least 5-year follow-up. Earliest training start date was December 1, 1998. Primary outcomes from public data sources (National Institutes of Health RePORTER, PubMed, iCite) were (1) number of total and R01 National Institutes of Health grants as principal investigator; (2) numbers of total and first and last author publications; and (3) median and highest publication impact factor measured by the relative citation ratio. Secondary outcomes from an email survey subcohort were total number of research grants, federally funded grants, and number of National Institutes of Health grants as coinvestigator; institutional promotions and academic appointments, national and National Institutes of Health leadership roles; and career and mentorship satisfaction. Outcomes were recorded at 5, 10, and 15 years postgraduation, and aggregate anonymized data were divided into 3 groups using Women's Reproductive Health Research completion dates: June 30 of 2005, 2010, and 2015. Temporal trends were assessed. Results were stratified by gender, number of awarded grant cycles (1-2 vs 3-4), and specialty type. Analyses used Fisher exact or Pearson chi-square tests, and Mantel-Haenszel tests of trend. RESULTS The distribution of the cohort (N=178) by graduation completion date was: on or before June 30, 2005 (57 [32%]); July 1, 2005 to June 30, 2010 (60 [34%]); and July 1, 2010 to June 30, 2015 (61 [34%]). Most participants were female (112 [64%]) and maternal-fetal medicine trained (53 [30%]), followed by no fellowship (50 [28%]). Of the 178 participants, 72 (40%) received additional National Institutes of Health funding as a principal investigator, 45 (25%) received at least 1 R01, and 23 (13%) received 2 to 5 R01s. There were 52 (31%) scholars with >10 first author publications, 66 (39%) with >10 last author publications, and 108 (63%) with ≥25 publications. The highest relative citation ratio was a median of 8.07 (interquartile range, 4.20-15.16). There were 121 (71%) scholars with relative citation ratio ≥5, indicating >5-fold greater publication impact than that of other National Institutes of Health-funded scientists in similar areas of research. No differences by gender, institution, or temporal trends were observed. Of the full cohort, 69 (45.7%) responded to the survey; most self-identified as women (50 [73%]) and White (51 [74%]). CONCLUSION Our findings suggest that the infrastructure provided by an institutional K award is an advantageous career development award mechanism for obstetrician-gynecologists, a group of predominantly women surgeons. It may serve as a corrective for the known inequities in National Institutes of Health funding by gender.
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Affiliation(s)
- Erin E McCoy
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Diana K N Louden
- University of Washington Libraries, University of Washington, Seattle, WA
| | - Emiko Oshima
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Amy Murtha
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | | | - Susan D Reed
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA.
| | - Barbara A Goff
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
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Vieira L, McCarthy K, Liu SH, Huynh M, Kennedy J, Chan HT, Mayer VL, Tabaei B, Howell F, Wye GV, Howell EA, Janevic T. Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017. Am J Perinatol 2023. [PMID: 37604202 DOI: 10.1055/a-2157-2944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity. KEY POINTS: · First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017 in New York City.. · The likelihood of screening became less targeted to high-risk patients over time.. · The prevalence of gestational diabetes mellitus increased, while testing became less discriminate..
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Affiliation(s)
- Luciana Vieira
- Department of Obstetrics and Gynecology, Stamford Health System, Stamford, Connecticut
| | - Katharine McCarthy
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Mary Huynh
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Joseph Kennedy
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Hiu Tai Chan
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Victoria L Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City
| | - Bahman Tabaei
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Gretchen Van Wye
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
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Mari KE, Yang N, Boland MR, Meeker JR, Ledyard R, Howell EA, Burris HH. Assessing racial residential segregation as a risk factor for severe maternal morbidity. Ann Epidemiol 2023; 83:23-29. [PMID: 37146923 PMCID: PMC10330880 DOI: 10.1016/j.annepidem.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To measure associations of area-level racial and economic residential segregation with severe maternal morbidity (SMM). METHODS We conducted a retrospective cohort study of births at two Philadelphia hospitals between 2018 and 2020 to analyze associations of segregation, quantified using the Index of Concentration at the Extremes (ICE), with SMM. We used stratified multivariable, multilevel, logistic regression models to determine whether associations of ICE with SMM varied by self-identified race or hospital catchment. RESULTS Of the 25,979 patients (44.1% Black, 35.8% White), 1381 (5.3%) had SMM (Black [6.1%], White [4.4%]). SMM was higher among patients residing outside (6.3%), than inside (5.0%) Philadelphia (P < .001). Overall, ICE was not associated with SMM. However, ICErace (higher proportion of White vs. Black households) was associated with lower odds of SMM among patients residing inside Philadelphia (aOR 0.87, 95% CI: 0.80-0.94) and higher odds outside Philadelphia (aOR 1.12, 95% CI: 0.95-1.31). Moran's I indicated spatial autocorrelation of SMM overall (P < .001); when stratified, autocorrelation was only evident outside Philadelphia. CONCLUSIONS Overall, ICE was not associated with SMM. However, higher ICErace was associated with lower odds of SMM among Philadelphia residents. Findings highlight the importance of hospital catchment area and referral patterns in spatial analyses of hospital datasets.
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Affiliation(s)
- Katey E Mari
- Department of Anthropology, University of Pennsylvania, Philadelphia, PA; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA
| | - Nancy Yang
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; The Center for Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
| | - Jessica R Meeker
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA; Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
| | - Rachel Ledyard
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Heather H Burris
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.
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McCarthy KJ, Liu SH, Huynh M, Kennedy J, Chan HT, Mayer VL, Vieira L, Tabaei B, Howell F, Lee A, Van Wye G, Howell EA, Janevic T. Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Retrospective Population-Based Cohort. Diabetes Care 2023:dc221676. [PMID: 37341505 PMCID: PMC10369124 DOI: 10.2337/dc22-1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Racial/ethnic-specific estimates of the influence of gestational diabetes mellitus (GDM) on type 2 diabetes remain underexplored in large population-based cohorts. We estimated racial/ethnic differences in the influence of GDM on diabetes risk and glycemic control in a multiethnic, population-based cohort of postpartum women. RESEARCH DESIGN AND METHODS Hospital discharge and vital registry data for New York City (NYC) births between 2009 and 2011 were linked with NYC A1C Registry data between 2009 and 2017. Women with baseline diabetes (n = 2,810) were excluded for a final birth cohort of 336,276. GDM on time to diabetes onset (two A1C tests of ≥6.5% from 12 weeks postpartum onward) or glucose control (first test of A1C <7.0% following diagnosis) was assessed using Cox regression with a time-varying exposure. Models were adjusted for sociodemographic and clinical factors and stratified by race/ethnicity. RESULTS The cumulative incidence for diabetes was 11.8% and 0.6% among women with and without GDM. The adjusted hazard ratio (aHR) of GDM status on diabetes risk was 11.5 (95% CI 10.8, 12.3) overall, with slight differences by race/ethnicity. GDM was associated with a lower likelihood of glycemic control (aHR 0.85; 95% CI 0.79, 0.92), with the largest negative influence among Black (aHR 0.77; 95% CI 0.68, 0.88) and Hispanic (aHR 0.84; 95% CI 0.74, 0.95) women. Adjustment for screening bias and loss to follow-up modestly attenuated racial/ethnic differences in diabetes risk but had little influence on glycemic control. CONCLUSIONS Understanding racial/ethnic differences in the influence of GDM on diabetes progression is critical to disrupt life course cardiometabolic disparities.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women's Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Huynh
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Joseph Kennedy
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Hiu Tai Chan
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Victoria L Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Luciana Vieira
- Blavatnik Family Women's Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Maternal and Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bahman Tabaei
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women's Health Research Institute, New York, NY
| | - Alison Lee
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gretchen Van Wye
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women's Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
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Daw JR, Howell EA. Defining Goals and Investing in Data to Improve Postpartum Health and Health Equity. JAMA Netw Open 2023; 6:e2316542. [PMID: 37266944 DOI: 10.1001/jamanetworkopen.2023.16542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Jamie R Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Marshall CL, Kaplowitz E, Ibroci E, Chung K, Gigase FAJ, Lieber M, Graziani M, Ohrn S, Lynch J, Castro J, Tubassum R, Mutawakil F, Jessel R, Molenaar N, Rommel AS, Sperling RS, Howell EA, Feldman H, Krammer F, Stadlbauer D, de Witte LD, Bergink V, Stone J, Janevic T, Dolan SM, Lieb W. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Titer Levels in Pregnant Individuals After Infection, Vaccination, or Both. Obstet Gynecol 2023; 141:1199-1202. [PMID: 37141599 DOI: 10.1097/aog.0000000000005172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
We examined differences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody responses in pregnant individuals with natural, vaccine-induced, or combined immunity. Participants had live or nonlive births between 2020 and 2022, were seropositive (SARS-CoV-2 spike protein, anti-S), and had available mRNA vaccination and infection information (n=260). We compared titer levels among three immunity profiles: 1) natural immunity (n=191), 2) vaccine-induced immunity (n=37), and 3) combined immunity (ie, natural and vaccine-induced immunity; n=32). We applied linear regression to compare anti-S titers between the groups, controlling for age, race and ethnicity, and time between vaccination or infection (whichever came last) and sample collection. Anti-S titers were 57.3% and 94.4% lower among those with vaccine-induced and natural immunity, respectively, compared with those with combined immunity ( P <.001, P =.005).
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Affiliation(s)
- Christina L Marshall
- Department of Obstetrics, Gynecology and Reproductive Science, the Department of Population Health Science and Policy, the Department of Psychiatry, the Blavatnik Family Women's Health Research Institute, the Department of Medicine, Infectious Diseases, and the Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York; and the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Kern-Goldberger AR, Howell EA, Srinivas SK, Levine LD. What we talk about when we talk about severe maternal morbidity: a call to action to critically review severe maternal morbidity as an outcome measure. Am J Obstet Gynecol MFM 2023; 5:100882. [PMID: 36736823 PMCID: PMC10121757 DOI: 10.1016/j.ajogmf.2023.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Severe maternal morbidity has historically functioned as an umbrella term to define major, potentially life-threatening obstetrical, medical, and surgical complications of pregnancy. There is no overarching or consensus definition of the constellation of conditions that have been used variably to define severe maternal morbidity, although it is clear that having a well-honed definition of severe maternal morbidity is important for research, quality improvement, and health policy purposes. Although severe maternal morbidity may ultimately elude a single unifying definition because different features may be relevant depending on context and modality of data acquisition, it is valuable to explore the intellectual frameworks and various applications of severe maternal morbidity in current practice, and to consider the potential benefit of more consolidated terminology for maternal morbidity.
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Affiliation(s)
- Adina R Kern-Goldberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Elizabeth A Howell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sindhu K Srinivas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa D Levine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Rao MG, Stone J, Glazer KB, Howell EA, Janevic T. Postpartum hospital use among survivors of intimate partner violence. Am J Obstet Gynecol MFM 2023; 5:100848. [PMID: 36638867 DOI: 10.1016/j.ajogmf.2022.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE More than 1 in 3 individuals who identify as female, experience either intimate partner violence (IPV) or sexual assault during their lifetime, and sexual violence committed by an intimate partner is at its highest during their reproductive years.1 As many as 20% of pregnant individuals may experience IPV, and IPV during pregnancy has been associated with an increased risk for adverse maternal and neonatal outcomes, making pregnant individuals an especially vulnerable population.1 In fact, >50% of pregnancy-associated suicides and >45% of pregnancy-associated homicides are associated with IPV and these often occur during the postpartum period.2 Although >50% of maternal deaths occur postpartum,3 little research has examined whether IPV is associated with markers of postpartum maternal morbidity, including hospital readmission and emergency department (ED) visits.4 In addition, few studies have examined the feasibility of ascertaining IPV at the delivery hospitalization using billing codes. Although the International Classification of Diseases, Tenth Revision (ICD-10) codes include factors related to social determinants of health, ICD-10 codes are largely underutilized for the purpose of understanding risk of disease and adverse outcomes.5 The primary objective of this study was to investigate the association of IPV screening at delivery with the incidence of postpartum hospital use. Another objective was to examine the possibility of using ICD-10 codes at the delivery hospitalization to identify IPV in pregnant individuals. STUDY DESIGN This was a retrospective cohort of birth data linked with inpatient and outpatient hospital claims data, including deliveries of individuals residing in the New York City metropolitan area between 2016 and 2018. Thirty-day hospital use was ascertained by either a readmission or an ED visit within 30 days of discharge. We identified the incidence of IPV from the delivery hospital discharge records using 36 IPV-related ICD-10 codes that we identified in the literature, including those defined for adult psychological and sexual abuse. We estimated the associations between IPV identified during the delivery hospitalization and postpartum hospital use using a multivariable logistic regression and separately adjusting for demographic and structural determinants of health, psychosocial factors, comorbidities, and obstetrical complications. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). This study was approved by our institutional review board. RESULTS IPV was indicated on the discharge records of 348 individuals (0.11%). As shown in the Table, the overall incidence of ED visits among individuals with an IPV-related diagnosis was 12.9%. The incidence of a postpartum ED visit was significantly higher among individuals with an IPV diagnosis than among those without (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.1-3.9), and this was true after sequentially adjusting for demographic and structural determinants of health (OR, 2.0; 95% CI, 1.4-2.7), comorbidities and pregnancy complications (OR, 1.9; 95% CI, 1.4-2.6), psychosocial factors (OR, 1.5; 95% CI, 1.1-2.0), and obstetrical complications (OR, 1.5; 95% CI, 1.1-2.0). The incidence of either a postpartum ED visit or readmission was also higher among those patients with an IPV-related diagnosis (OR, 2.7; 95% CI, 2.0-3.6). However, there was no significant difference in postpartum readmissions alone among patients with or without an IPV-related diagnosis. CONCLUSION This study established that postpartum ED visits are significantly higher among individuals with an IPV-related diagnosis during the delivery hospitalization in a large citywide database, even after adjusting for established risk factors for postpartum ED use. Because ED visits have been identified as a possible marker of maternal morbidity and mortality,4 this finding may suggest that individuals affected by IPV could benefit from screening throughout pregnancy, including during the delivery hospitalization, to prevent adverse postpartum outcomes. However, as established in this study, IPV identified solely by ICD-10 codes during the delivery hospitalization is rare and likely underreported. It is possible that underdetection of IPV is because of insufficient clinician screening, a lack of documentation in the medical records using ICD-10 codes, and the medical status of the pregnant individual at the time of delivery. This finding demonstrates a need to screen and record findings thoroughly during the pregnancy period, including at delivery hospitalization, for any IPV-related diagnoses. A limitation of our data is that we were not able to ascertain hospital use outside of New York City and did not include other time points during an individual's pregnancy. Future research should identify at which time points IPV screening occurs during care of a pregnant individual and whether this may affect postpartum ED visit rates. As a clinical outcome, maternal mortality is preventable and screening for risk factors such as IPV throughout the perinatal period, including at delivery admission and during the postpartum period, is imperative for comprehensive obstetrics care.
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Affiliation(s)
- Manasa G Rao
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 5 E. 98th St., Floor 2, New York, NY 10029.
| | - Joanne Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 5 E. 98th St., Floor 2, New York, NY 10029
| | - Kimberly B Glazer
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Krishnamoorthi M, Balbierz A, Arena DL, Howell EA. Addressing the National Crisis Facing Black and Latina Women, Birthing People, and Infants: The Maternal and Child Health Equity Summit. Obstet Gynecol 2023; 141:467-472. [PMID: 36735384 PMCID: PMC9974748 DOI: 10.1097/aog.0000000000005067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023]
Abstract
To address the national crisis of maternal and infant health disparities, especially outcomes experienced by Black and Latina women and birthing people, The New York Academy of Medicine, the Icahn School of Medicine at Mount Sinai, the Blavatnik Family Women's Health Research Institute, and the University of Pennsylvania Health System and Perelman School of Medicine hosted the Maternal and Child Health Equity Summit. The primary purpose of the summit was to disseminate findings to a national audience of two National Institutes of Health-funded mixed-methods studies that investigated the contribution of hospital quality to disparities in maternal and infant Health in New York City (R01MD007651 and R01HD078565). In addition, the summit showcased factors in maternal and infant health inequity from leading diverse experts in both fields and identified outstanding challenges to reducing maternal and infant morbidity and mortality disparities and strategies to address them. Summit presenters and participants identified five primary areas of focus in proposed clinical actions and approaches for maternal and neonatal health care based on discussions during the summit: 1) quality and standardization of care; 2) adjustment of care strategy based on patient-reported experience; 3) health care professional and institutional accountability to patients; 4) commitment to building trust; and 5) anti-racism practices in education, training, and hiring. Recommendations from this conference should inform hospital care and public policy changes and frame a national agenda to address perinatal health disparities for Black, Indigenous, and other women and birthing people of color.
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Affiliation(s)
| | - Amy Balbierz
- Office of Science and Research Sponsored Program Administration, New York University Grossman School of Medicine
| | | | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Leonard David Institute of Health Economics
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Grobman WA, Entringer S, Headen I, Janevic T, Kahn RS, Simhan H, Yee LM, Howell EA. Executive summary: Workshop on social determinants of health and obstetrical outcomes, February 1-2, 2022, cosponsored by the Society for Maternal-Fetal Medicine, the Commonwealth Foundation, and the Alliance for Innovation on Maternal Health, with support from the Society for Women's Health Research. Am J Obstet Gynecol 2023; 228:B18-B24. [PMID: 36473505 DOI: 10.1016/j.ajog.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ibroci E, Liu X, Lieb W, Jessel R, Gigase FAJ, Chung K, Graziani M, Lieber M, Ohrn S, Lynch J, Castro J, Marshall C, Tubassum R, Mutawakil F, Kaplowitz ET, Ellington S, Molenaar N, Sperling RS, Howell EA, Janevic T, Dolan SM, Stone J, De Witte LD, Bergink V, Rommel AS. Impact of prenatal COVID-19 vaccination on delivery and neonatal outcomes: Results from a New York City cohort. Vaccine 2023; 41:649-656. [PMID: 36526507 PMCID: PMC9749885 DOI: 10.1016/j.vaccine.2022.09.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
Research suggest prenatal vaccination against coronavirus disease-19 (COVID-19) is safe. However, previous studies utilized retrospectively collected data or examined late pregnancy vaccinations. We investigated the associations of COVID-19 vaccination throughout pregnancy with delivery and neonatal outcomes. We included 1,794 mother-neonate dyads enrolled in the Generation C Study with known prenatal COVID-19 vaccination status and complete covariate and outcome data. We used multivariable quantile regressions to estimate the effect of prenatal COVID-19 vaccination on birthweight, delivery gestational age, and blood loss at delivery; and Poisson generalized linear models for Caesarean delivery (CD) and Neonatal Intensive Care Unit (NICU) admission. Using the above methods, we estimated effects of trimester of vaccine initiation on these outcomes. In our sample, 13.7% (n = 250) received at least one prenatal dose of any COVID-19 vaccine. Vaccination was not associated with birthweight (β = 12.42 g [-90.5, 114.8]), gestational age (β = 0.2 days [-1.1, 1.5]), blood loss (β = -50.6 ml [-107.0, 5.8]), the risks of CD (RR = 0.8; [0.6, 1.1]) or NICU admission (RR = 0.9 [0.5, 1.7]). Trimester of vaccine initiation was also not associated with these outcomes. Our findings suggest that there is no associated risk between prenatal COVID-19 vaccination and adverse delivery and neonatal outcomes in a cohort sample from NYC.
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Affiliation(s)
- Erona Ibroci
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus 8000, Denmark
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rebecca Jessel
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Frederieke A J Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Kyle Chung
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Mara Graziani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Molly Lieber
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Jezelle Lynch
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Juliana Castro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Christina Marshall
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rushna Tubassum
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Farida Mutawakil
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Elianna T Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Sascha Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta 30329, GA, USA
| | - Nina Molenaar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Rhoda S Sperling
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA; Department of Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 109104, PA, USA
| | - Teresa Janevic
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Lotje D De Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA.
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Akinade T, Kheyfets A, Piverger N, Layne TM, Howell EA, Janevic T. The influence of racial-ethnic discrimination on women's health care outcomes: A mixed methods systematic review. Soc Sci Med 2023; 316:114983. [PMID: 35534346 DOI: 10.1016/j.socscimed.2022.114983] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the U.S, a wide body of evidence has documented significant racial-ethnic disparities in women's health, and growing attention has focused on discrimination in health care as an underlying cause. Yet, there are knowledge gaps on how experiences of racial-ethnic health care discrimination across the life course influence the health of women of color. Our objective was to summarize existing literature on the impact of racial-ethnic health care discrimination on health care outcomes for women of color to examine multiple health care areas encountered across the life course. METHODS We systematically searched three databases and conducted study screening, data extraction, and quality assessment. We included quantitative and qualitative peer-reviewed literature on racial-ethnic health care discrimination towards women of color, focusing on studies that measured patient-perceived discrimination or differential treatment resulting from implicit provider bias. Results were summarized through narrative synthesis. RESULTS In total, 84 articles were included spanning different health care domains, such as perinatal and cancer care. Qualitative studies demonstrated the existence of racial-ethnic discrimination across care domains. Most quantitative studies reported a mix of positive and null associations between discrimination and adverse health care outcomes, with variation by the type of health care outcome. For instance, over three-quarters of the studies exploring associations between discrimination/bias and health care-related behaviors or beliefs found significant associations, whereas around two-thirds of the studies on clinical interventions found no significant associations. CONCLUSIONS This review shows substantial evidence on the existence of racial-ethnic discrimination in health care and its impact on women of color in the U.S. However, the evidence on how this phenomenon influences health care outcomes varies in strength by the type of outcome investigated. High-quality, targeted research using validated measures that is grounded in theoretical frameworks on racism is needed. This systematic review was registered [PROSPERO ID: CRD42018105448].
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Affiliation(s)
- Temitope Akinade
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Anna Kheyfets
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Naissa Piverger
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Tracy M Layne
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa Janevic
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
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Kern-Goldberger AR, Srinivas SK, Howell EA, Harhay M, Levine LD. Does utilizing EHR in addition to administrative data better identify risk factors for maternal morbidity? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kern-Goldberger AR, Srinivas SK, Howell EA, Harhay M, Levine LD. Validation of maternal co-morbidity diagnoses using differential data extraction strategies across a large health system. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kern-Goldberger AR, Srinivas SK, Howell EA, Harhay M, Levine LD. Predicting non-transfusion severe maternal morbidity by race using the obstetric co-morbidity index. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kern-Goldberger AR, Hirshberg A, James A, Levine LD, Howell EA, Harbuck E, Harhay M, Srinivas SK. Trends in severe maternal morbidity following an institutional team goal strategy for disparity reduction. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Li W, Kim CS, Howell EA, Janevic T, Liu B, Shi L, Li Y. Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review. Value Health 2022; 25:2062-2080. [PMID: 35989155 PMCID: PMC9669139 DOI: 10.1016/j.jval.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research. METHODS Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. RESULTS Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP. CONCLUSIONS Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.
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Affiliation(s)
- Weixin Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi-Son Kim
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lizheng Shi
- Department of Global Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Bogaert KC, Lieb WE, Glazer KB, Wang E, Stone JL, Howell EA. Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers. Am J Perinatol 2022; 29:1596-1604. [PMID: 35640618 DOI: 10.1055/s-0042-1748315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic. STUDY DESIGN We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers. RESULTS A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0-89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7-95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1-80.3%]). CONCLUSION OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers. KEY POINTS · COVID-19 led to stress amongst OB/GYN providers.. · Some stressors were unique to providing obstetric care.. · Nurses and trainees were more affected by this stress..
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Affiliation(s)
- Kelly C Bogaert
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - Whitney E Lieb
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly B Glazer
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eileen Wang
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne L Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A Howell
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Glazer KB, Harrell T, Balbierz A, Howell EA. Postpartum Hospital Readmissions and Emergency Department Visits Among High-Risk, Medicaid-Insured Women in New York City. J Womens Health (Larchmt) 2022; 31:1305-1313. [PMID: 35100055 PMCID: PMC9639235 DOI: 10.1089/jwh.2021.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To describe the incidence of and characteristics associated with postpartum emergency department (ED) visits and hospital readmissions among high-risk, low-income, predominantly Black and Latina women in New York City (NYC). Methods: We conducted a secondary analysis of detailed survey and medical chart data from an intervention to improve timely postpartum visits among Medicaid-insured, high-risk women in NYC from 2015 to 2016. Among 380 women who completed surveys at baseline (bedside postpartum) and 3 weeks after delivery, we examined the incidence of having an ED visit or readmission within 3 weeks postpartum. We used logistic regression to examine unadjusted and adjusted associations between patient demographic, clinical, and psychosocial characteristics and the odds of postpartum hospital use. Results: In total, 12.8% (n = 48) of women reported an ED visit or readmission within 3 weeks postpartum. Unadjusted odds of postpartum hospital use were higher among women who self-identified as Black versus Latina, U.S. born versus foreign born, and English versus Spanish speaking. Clinical and psychosocial characteristics associated with increased unadjusted odds of postpartum hospital use included cesarean delivery, hypertensive disorders of pregnancy, and positive depression or anxiety screen, and we found preliminary evidence of decreased hospital use among women breastfeeding at three weeks postpartum. The odds of seeking postpartum hospital care remained roughly 2.5 times higher among women with hypertension or depression/anxiety in adjusted analyses. Conclusions: We identified characteristics associated with ED visits and hospital readmissions among a high-risk subset of postpartum women in NYC. These characteristics, including depressive symptoms and hypertension, suggest women who may benefit from additional postpartum support to prevent maternal complications and reduce health disparities.
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Affiliation(s)
- Kimberly B. Glazer
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Taylor Harrell
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Balbierz
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Elizabeth A. Howell
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Lesseur C, Jessel RH, Ohrn S, Ma Y, Li Q, Dekio F, Brody RI, Wetmur JG, Gigase FA, Lieber M, Lieb W, Lynch J, Afzal O, Ibroci E, Rommel AS, Janevic T, Stone J, Howell EA, Galang RR, Dolan SM, Bergink V, De Witte LD, Chen J. Gestational SARS-CoV-2 infection is associated with placental expression of immune and trophoblast genes. Placenta 2022; 126:125-132. [PMID: 35797939 PMCID: PMC9242701 DOI: 10.1016/j.placenta.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Maternal SARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes and can have effects on the placenta, even in the absence of severe disease or vertical transmission to the fetus. This study aimed to evaluate histopathologic and molecular effects in the placenta after SARS-CoV-2 infection during pregnancy. METHODS We performed a study of 45 pregnant participants from the Generation C prospective cohort study at the Mount Sinai Health System in New York City. We compared histologic features and the expression of 48 immune and trophoblast genes in placentas delivered from 15 SARS-CoV-2 IgG antibody positive and 30 IgG SARS-CoV-2 antibody negative mothers. Statistical analyses were performed using Fisher's exact tests, Spearman correlations and linear regression models. RESULTS The median gestational age at the time of SARS-CoV-2 IgG serology test was 35 weeks. Two of the IgG positive participants also had a positive RT-PCR nasal swab at delivery. 82.2% of the infants were delivered at term (≥37 weeks), and gestational age at delivery did not differ between the SARS-CoV-2 antibody positive and negative groups. No significant differences were detected between the groups in placental histopathology features. Differential expression analyses revealed decreased expression of two trophoblast genes (PSG3 and CGB3) and increased expression of three immune genes (CXCL10, TLR3 and DDX58) in placentas delivered from SARS-CoV-2 IgG positive participants. DISCUSSION SARS-CoV-2 infection during pregnancy is associated with gene expression changes of immune and trophoblast genes in the placenta at birth which could potentially contribute to long-term health effects in the offspring.
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Affiliation(s)
- Corina Lesseur
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rebecca H. Jessel
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Yula Ma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Qian Li
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Fumiko Dekio
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rachel I. Brody
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - James G. Wetmur
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, Box 1054, 1 Gustave Levy Place, New York, NY, USA
| | - Frederieke A.J. Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Molly Lieber
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jezelle Lynch
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Omara Afzal
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Erona Ibroci
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Teresa Janevic
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elizabeth A. Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Romeo R. Galang
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Veerle Bergink
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lotje D. De Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jia Chen
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Corresponding author. Department of Environmental Medicine and Public Heath, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
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25
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Janevic T, Lieb W, Ibroci E, Lynch J, Lieber M, Molenaar NM, Rommel AS, de Witte L, Ohrn S, Carreño JM, Krammer F, Zapata LB, Snead MC, Brody RI, Jessel RH, Sestito S, Adler A, Afzal O, Gigase F, Missall R, Carrión D, Stone J, Bergink V, Dolan SM, Howell EA. The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes. Am J Obstet Gynecol MFM 2022; 4:100649. [PMID: 35462058 PMCID: PMC9022447 DOI: 10.1016/j.ajogmf.2022.100649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Structural racism and pandemic-related stress from the COVID-19 pandemic may increase the risk of adverse birth outcomes. OBJECTIVE Our objective was to examine associations between neighborhood measures of structural racism and pandemic stress with 3 outcomes: SARS-CoV-2 infection, preterm birth, and delivering small-for-gestational-age newborns. Our secondary objective was to investigate the joint association of SARS-CoV-2 infection during pregnancy and neighborhood measures with preterm birth and delivering small-for-gestational-age newborns. STUDY DESIGN We analyzed data of 967 patients from a prospective cohort of pregnant persons in New York City, comprising 367 White (38%), 169 Black (17%), 293 Latina (30%), and 87 Asian persons (9%), 41 persons of other race or ethnicity (4%), and 10 of unknown race or ethnicity (1%). We evaluated structural racism (social/built structural disadvantage, racial-economic segregation) and pandemic-related stress (community COVID-19 mortality, community unemployment rate increase) in quartiles by zone improvement plan code. SARS-CoV-2 serologic enzyme-linked immunosorbent assay was performed on blood samples from pregnant persons. We obtained data on preterm birth and small-for-gestational-age newborns from an electronic medical record database. We used log-binomial regression with robust standard error for clustering by zone improvement plan code to estimate associations of each neighborhood measure separately with 3 outcomes: SARS-CoV-2 infection, preterm birth, and small-for-gestational-age newborns. Covariates included maternal age, parity, insurance status, and body mass index. Models with preterm birth and small-for-gestational-age newborns as the dependent variables additionally adjusted for SARS-CoV-2 infection. RESULTS A total of 193 (20%) persons were SARS-CoV-2-seropositive, and the overall risks of preterm birth and small-for-gestational-age newborns were 8.4% and 9.8%, respectively. Among birthing persons in neighborhoods in the highest quartile of structural disadvantage (n=190), 94% were non-White, 50% had public insurance, 41% were obese, 32% were seropositive, 11% delivered preterm, and 12% delivered a small-for-gestational-age infant. Among birthing persons in neighborhoods in the lowest quartile of structural disadvantage (n=360), 39% were non-White, 17% had public insurance, 15% were obese, 9% were seropositive, 6% delivered preterm, and 10% delivered a small-for-gestational-age infant. In adjusted analyses, structural racism measures and community unemployment were associated with both SARS-CoV-2 infection and preterm birth, but not small-for-gestational-age infants. High vs low structural disadvantage was associated with an adjusted relative risk of 2.6 for infection (95% confidence interval, 1.7-3.9) and 1.7 for preterm birth (95% confidence interval, 1.0-2.9); high vs low racial-economic segregation was associated with adjusted relative risk of 1.9 (95% confidence interval, 1.3-2.8) for infection and 2.0 (95% confidence interval, 1.3-3.2) for preterm birth; high vs low community unemployment increase was associated with adjusted relative risk of 1.7 (95% confidence interval, 1.2-1.5) for infection and 1.6 (95% confidence interval, 1.0-2.8) for preterm birth. COVID-19 mortality rate was associated with SARS-CoV-2 infection but not preterm birth or small-for-gestational-age infants. SARS-CoV-2 infection was not independently associated with birth outcomes. We found no interaction between SARS-CoV-2 infection and neighborhood measures on preterm birth or small-for-gestational-age infants. CONCLUSION Neighborhood measures of structural racism were associated with both SARS-CoV-2 infection and preterm birth, but these associations were independent and did not have a synergistic effect. Community unemployment rate increases were also associated with an increased risk of preterm birth independently of SARS-CoV-2 infection. Mitigating these factors might reduce the impact of the pandemic on pregnant people.
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Affiliation(s)
- Teresa Janevic
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch).
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch)
| | - Erona Ibroci
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Jezelle Lynch
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch)
| | - Molly Lieber
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Nina M Molenaar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Lotje de Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Juan Manuel Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer)
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer)
| | - Lauren B Zapata
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA (Drs Zapata and Snead)
| | - Margaret Christine Snead
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA (Drs Zapata and Snead)
| | - Rachel I Brody
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Brody)
| | - Rebecca H Jessel
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Stephanie Sestito
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Alan Adler
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Omara Afzal
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Frederieke Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Roy Missall
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Daniel Carrión
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (Dr Carrión)
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan)
| | - Veerle Bergink
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink)
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan)
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Howell)
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- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer)
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26
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Molenaar NM, Rommel A, de Witte L, Dolan SM, Lieb W, Ibroci E, Ohrn S, Lynch J, Capuano C, Stadlbauer D, Krammer F, Zapata LB, Brody RI, Pop VJ, Jessel RH, Sperling RS, Afzal O, Gigase F, Missall R, Janevic T, Stone J, Howell EA, Bergink V. SARS-CoV-2 during pregnancy and associated outcomes: Results from an ongoing prospective cohort. Paediatr Perinat Epidemiol 2022; 36:466-475. [PMID: 34806193 PMCID: PMC9011518 DOI: 10.1111/ppe.12812] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic is an ongoing global health threat, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Questions remain about how SARS-CoV-2 impacts pregnant individuals and their children. OBJECTIVE To expand our understanding of the effects of SARS-CoV-2 infection during pregnancy on pregnancy outcomes, regardless of symptomatology, by using serological tests to measure IgG antibody levels. METHODS The Generation C Study is an ongoing prospective cohort study conducted at the Mount Sinai Health System. All pregnant individuals receiving obstetrical care at the Mount Sinai Healthcare System from 20 April 2020 onwards are eligible for participation. For the current analysis, we included participants who had given birth to a liveborn singleton infant on or before 22 September 2020. For each woman, we tested the latest prenatal blood sample available to establish seropositivity using a SARS-CoV-2 serologic enzyme-linked immunosorbent assay. Additionally, RT-PCR testing was performed on a nasopharyngeal swab taken during labour. Pregnancy outcomes of interest (i.e., gestational age at delivery, preterm birth, small for gestational age, Apgar scores, maternal and neonatal intensive care unit admission, and length of neonatal hospital stay) and covariates were extracted from medical records. Excluding individuals who tested RT-PCR positive at delivery, we conducted crude and adjusted regression models to compare antibody positive with antibody negative individuals at delivery. We stratified analyses by race/ethnicity to examine potential effect modification. RESULTS The SARS-CoV-2 seroprevalence based on IgG measurement was 16.4% (95% confidence interval 13.7, 19.3; n=116). Twelve individuals (1.7%) were SARS-CoV-2 RT-PCR positive at delivery. Seropositive individuals were generally younger, more often Black or Hispanic, and more often had public insurance and higher pre-pregnancy BMI compared with seronegative individuals. None of the examined pregnancy outcomes differed by seropositivity, overall or stratified by race/ethnicity. CONCLUSION Seropositivity for SARS-CoV-2 without RT-PCR positivity at delivery (suggesting that infection occurred earlier during pregnancy) was not associated with selected adverse maternal or neonatal outcomes among live births in a cohort sample from New York City.
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Affiliation(s)
- Nina M. Molenaar
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Anna‐Sophie Rommel
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Lotje de Witte
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Blavatnik Family Women's Health Research InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Blavatnik Family Women's Health Research InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Erona Ibroci
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Sophie Ohrn
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Jezelle Lynch
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Christina Capuano
- Department of MicrobiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Daniel Stadlbauer
- Department of MicrobiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Florian Krammer
- Department of MicrobiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Lauren B. Zapata
- Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Rachel I. Brody
- Department of Pathology, Molecular and Cell Based MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Victor J. Pop
- Department of Medical and Clinical PsychologyCenter of Research in Psychological and Somatic Disorders (CoRPS)Tilburg UniversityTilburgThe Netherlands
| | - Rebecca H. Jessel
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Rhoda S. Sperling
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Medicine, Infectious DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Omara Afzal
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Frederieke Gigase
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Roy Missall
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Teresa Janevic
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Blavatnik Family Women's Health Research InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Elizabeth A. Howell
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Obstetrics and GynecologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Veerle Bergink
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Blavatnik Family Women's Health Research InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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Monk C, Dimidjian S, Galinsky E, Gregory KD, Hoffman MC, Howell EA, Miller ES, Osborne C, Rogers CE, Saxbe DE, D'Alton ME. The Transition to Parenthood in Obstetrics: Enhancing Prenatal Care for Two Generation Impact. Am J Obstet Gynecol MFM 2022; 4:100678. [PMID: 35728782 DOI: 10.1016/j.ajogmf.2022.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Obstetrics, the specialty overseeing infant and parent health before birth, could be expanded to address the inter-related areas of parents' prenatal impact on children's brain development and their own psychosocial needs during a time of immense change and neuroplasticity. Obstetrics is primed for the shift that is happening in pediatrics, which is moving from its traditional focus on physical health to a coordinated, whole child, two or multi-generation approach. Pediatric care now includes developmental screening, parenting education, parent coaching, access to developmental specialists, brain-building caregiving skills, linkages to community resources, and tiered interventions with psychologists. Drawing on decades of Developmental Origins of Health and Disease research highlighting the prenatal beginnings of future health and new studies on the transition to parenthood describing adult development from pregnancy to early postpartum, we propose that, similar to pediatrics, the integration of education and intervention strategies into the prenatal care ecosystem should be tested for its potential to improve child cognitive and social-emotional development and parental mental health. Pediatric care programs can serve as models of change for the systematic development, testing and, incorporation of new content into prenatal care as universal, first-tier treatment as well as evidenced-based, triaged interventions according to level of need. To promote optimal beginnings for the whole family, we propose an augmented prenatal care ecosystem that aligns with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health.
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Affiliation(s)
- Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University Colorado, Boulder
| | | | | | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora; Department of Psychiatry, University of Colorado School of Medicine, Aurora
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Health Sciences, Northwestern University, Chicago, IL
| | - Cynthia Osborne
- Department of Leadership, Policy, and Organizations, Peabody College, Vanderbilt University, Nashville, TN
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
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Jackson FM, Bryant A, Gregory KD, Hardeman R, Howell EA. Introduction: The Quest for Birth Equity and Justice-Now is the Time. Matern Child Health J 2022; 26:659-660. [PMID: 35378666 PMCID: PMC8979722 DOI: 10.1007/s10995-022-03436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
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MacDorman MF, Thoma M, Declercq E, Howell EA. The relationship between obstetrical interventions and the increase in U.S. preterm births, 2014-2019. PLoS One 2022; 17:e0265146. [PMID: 35353843 PMCID: PMC8967025 DOI: 10.1371/journal.pone.0265146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022] Open
Abstract
We examined the relationship between obstetrical intervention and preterm birth in the United States between 2014 and 2019. This observational study analyzed 2014-2019 US birth data to assess changes in preterm birth, cesarean delivery, induction of labor, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention (no labor cesarean or induction) after risk adjustment. The percentage of singleton preterm births in the United States increased by 9.4% from 2014-2019. The percent of singleton, preterm births delivered by cesarean increased by 6.0%, while the percent with induction of labor increased by 39.1%. The percentage of singleton preterm births where obstetrical intervention (no labor cesarean or induction) potentially impacted the gestational age at delivery increased from 47.6% in 2014 to 54.9% in 2019. Preterm interventions were 13% more likely overall in 2019 compared to 2014 and 17% more likely among late preterm births, after controlling for demographic and medical risk factors. Compared to non-Hispanic White women, Non-Hispanic Black women had a higher risk of preterm obstetric interventions. Preterm infants have higher morbidity and mortality rates than term infants, thus any increase in the preterm birth rate is concerning. A renewed effort to understand the trends in preterm interventions is needed to ensure that obstetrical interventions are evidence-based and are limited to those cases where they optimize outcomes for both mothers and babies.
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Affiliation(s)
- Marian F. MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
| | - Marie Thoma
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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30
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Glazer KB, Vieira L, Weber E, Stone J, Stern T, Bianco A, Wagner B, Nowlin S, Dolan SM, Howell EA, Janevic T. COVID-19 pandemic-related change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery hospitalization: a differences-in-differences analysis. BMC Pregnancy Childbirth 2022; 22:225. [PMID: 35305590 PMCID: PMC8934049 DOI: 10.1186/s12884-022-04570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Exclusive breastmilk feeding during the delivery hospitalization, a Joint Commission indicator of perinatal care quality, is associated with longer-term breastfeeding success. Marked racial and ethnic disparities in breastfeeding exclusivity and duration existed prior to COVID-19. The pandemic, accompanied by uncertainty regarding intrapartum and postpartum safety practices, may have influenced disparities in infant feeding practices. Our objective was to examine whether the first wave of the COVID-19 pandemic in New York City was associated with a change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery stay. METHODS We conducted a cross-sectional study of electronic medical records from 14,964 births in two New York City hospitals. We conducted a difference-in-differences (DID) analysis to compare Black-white, Latina-white, and Asian-white disparities in exclusive breastmilk feeding in a pandemic cohort (April 1-July 31, 2020, n=3122 deliveries) to disparities in a pre-pandemic cohort (January 1, 2019-February 28, 2020, n=11,842). We defined exclusive breastmilk feeding as receipt of only breastmilk during delivery hospitalization, regardless of route of administration. We ascertained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status from reverse transcription-polymerase chain reaction tests from nasopharyngeal swab at admission. For each DID model (e.g. Black-white disparity), we used covariate-adjusted log binomial regression models to estimate racial and ethnic risk differences, pandemic versus pre-pandemic cohort risk differences, and an interaction term representing the DID estimator. RESULTS Exclusive breastmilk feeding increased from pre-pandemic to pandemic among white (40.8% to 46.6%, p<0.001) and Asian (27.9% to 35.8%, p=0.004) women, but not Black (22.6% to 25.3%, p=0.275) or Latina (20.1% to 21.4%, p=0.515) women overall. There was an increase in the Latina-white exclusive breastmilk feeding disparity associated with the pandemic (DID estimator=6.3 fewer cases per 100 births (95% CI=-10.8, -1.9)). We found decreased breastmilk feeding specifically among SARS-CoV-2 positive Latina women (20.1% pre-pandemic vs. 9.1% pandemic p=0.013), and no change in Black-white or Asian-white disparities. CONCLUSIONS We observed a pandemic-related increase in the Latina-white disparity in exclusive breastmilk feeding, urging hospital policies and programs to increase equity in breastmilk feeding and perinatal care quality during and beyond this health emergency.
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Affiliation(s)
- Kimberly B Glazer
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Luciana Vieira
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Ellerie Weber
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Joanne Stone
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Toni Stern
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Angela Bianco
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Brian Wagner
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Sarah Nowlin
- Center for Nursing Research & Innovation, Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Siobhan M Dolan
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Janevic
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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Affiliation(s)
- Lawrence C Kleinman
- Division of Population Health, Quality, and Implementation Sciences, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; and
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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32
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Hardeman RR, Kheyfets A, Mantha AB, Cornell A, Crear-Perry J, Graves C, Grobman W, James-Conterelli S, Jones C, Lipscomb B, Ortique C, Stuebe A, Welsh K, Howell EA. Correction to: Developing Tools to Report Racism in Maternal Health for the CDC Maternal Mortality Review Information Application (MMRIA): Findings from the MMRIA Racism & Discrimination Working Group. Matern Child Health J 2022; 26:670-673. [PMID: 35181850 DOI: 10.1007/s10995-022-03381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rachel R Hardeman
- Center for Antiracism Research for Health Equity, Division of Health Policy Management, School of Public Health, University of Minnesota, 420 Delaware St SE MMC 729, Minneapolis, MN, 55455, USA.
| | - Anna Kheyfets
- Tufts University School of Medicine, Boston, MA, USA
| | - Allison Bryant Mantha
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Andria Cornell
- Association of Maternal &, Child Health Programs, Washington, DC, USA
| | | | - Cornelia Graves
- Tennessee Maternal Fetal Medicine, PLCDivision of Perinatal Services, Baptist Hospital, Nashville, TN, USA
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sascha James-Conterelli
- Yale School of Nursing, Yale University, New Haven, CT, USA.,New York State Association of Licensed Midwives, New York, NY, USA
| | | | | | - Carla Ortique
- Department of Obstetrics, Texas Children's Hospital, Houston, TX, USA
| | - Alison Stuebe
- Division of Maternal-Fetal MedicineSchool of Medicine, Department of Obstetrics and Gynecology, School of Medicine, Department of Maternal and Child HealthGillings School of Global Public Health, University of North Carolina Carolina Global Breastfeeding InstituteUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kaprice Welsh
- Georgia OBGyn Society, Atlanta, GA, USA.,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology in the Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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33
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Harrell T, Howell EA, Balbierz A, Guel L, Pena J, Janevic T, Gorbenko K. Improving Postpartum Care: Identifying Opportunities to Reduce Postpartum Emergency Room Visits Among Publicly-Insured Women of Color. Matern Child Health J 2022; 26:913-922. [PMID: 34982328 PMCID: PMC8724640 DOI: 10.1007/s10995-021-03282-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/24/2022]
Abstract
Background/Objectives The purpose of this study was to explore the postpartum experiences of publicly-insured women of color, and identify how postpartum care can be improved to reduce hospital emergency department usage after delivery. Methods We conducted four focus groups with 18 publicly-insured women who primarily self-identified as Black and/or Latina and gave birth between June 1, 2019 and May 1, 2020. We used inductive qualitative analysis to identify prominent themes from focus group discussions. Results We identified four domains: (1) lack of access to and communication with a medical team; (2) lack of preparation; (3) value of social support; and (4) participant-identified opportunities for improvement. Conclusions for Practice This study describes the postpartum experiences of publicly-insured women of color with the objective of identifying areas for intervention to reduce postpartum emergency department usage. Our findings suggest that focused efforts on enhancing continuity of care to increase healthcare access, strengthening patient-provider communication by training providers to recognize unconscious bias, increasing postpartum preparation by adapting teaching materials to an online format, and engaging women’s caregivers throughout the pregnancy course to bolster social support, may be beneficial.
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Affiliation(s)
- Taylor Harrell
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Amy Balbierz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Grossman School of Medicine, New York University, New York, NY, 10016, USA
| | - Luz Guel
- Department of Environmental Medicine & Public Health, The Mount Sinai Transdisciplinary Center on Early Environmental Exposures, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street, New York, NY, 10029, USA
| | - Juan Pena
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA
| | - Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.,Health Care Delivery Science, Mount Sinai Health System, New York, NY, 10029, USA
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Hardeman RR, Kheyfets A, Mantha AB, Cornell A, Crear-Perry J, Graves C, Grobman W, James-Conterelli S, Jones C, Lipscomb B, Ortique C, Stuebe A, Welsh K, Howell EA. Developing Tools to Report Racism in Maternal Health for the CDC Maternal Mortality Review Information Application (MMRIA): Findings from the MMRIA Racism & Discrimination Working Group. Matern Child Health J 2022; 26:661-669. [PMID: 34982327 DOI: 10.1007/s10995-021-03284-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this report from the field is to describe the process by which an multidisciplinary workgroup, selected by the CDC Foundation in partnership with maternal health experts, developed a definition of racism that would be specifically appropriate for inclusion on the Maternal Mortality Review Information Application (MMRIA) form. DESCRIPTION In the United States Black women are nearly 4 times more likely to experience a pregnancy-related death. Recent evidence points to racism as a fundamental cause of this inequity. Furthermore, the CDC reports that 3 of 5 pregnancy related deaths are preventable. With these startling facts in mind, the CDC created the Maternal Mortality Review Information Application (MMRIA) for use by Maternal Mortality Review Committees (MMRC) to support standardized data abstraction, case narrative development, documentation of committee decisions, and analysis on maternal mortality to inform practices and policies for preventing maternal mortality. ASSESSMENT Charged with the task of defining racism and discrimination as contributors to pregnancy related mortality, the work group established four goals to define their efforts: (1) the desire to create a product that was inclusive of all forms of racism and discrimination experienced by birthing people; (2) an acknowledgement of the legacy of racism in the U.S. and the norms in health care delivery that perpetuate racist ideology; (3) an acknowledgement of the racist narratives surrounding the issue of maternal mortality and morbidity that often leads to victim blaming; and (4) that the product would be user friendly for MMRCs. CONCLUSION The working group developed three definitions and a list of recommendations for action to help MMRC members provide suggested interventions to adopt when discrimination or racism were contributing factors to a maternal death. The specification of these definitions will allow the systematic tracking of the contribution of racism to maternal mortality through the MMRIA and allow a greater standardization of its identification across participating jurisdictions with MMRCs that use the form.
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Affiliation(s)
- Rachel R Hardeman
- Center for Antiracism Research for Health Equity, Division of Health Policy Management, School of Public Health, University of Minnesota, 420 Delaware St SE MMC 729, Minneapolis, MN, 55455, USA.
| | - Anna Kheyfets
- Tufts University School of Medicine, Boston, MA, USA
| | - Allison Bryant Mantha
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Andria Cornell
- Association of Maternal &, Child Health Programs, Washington, DC, USA
| | | | - Cornelia Graves
- Tennessee Maternal Fetal Medicine, PLCDivision of Perinatal Services, Baptist Hospital, Nashville, TN, USA
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sascha James-Conterelli
- Yale School of Nursing, Yale University, New Haven, CT, USA.,New York State Association of Licensed Midwives, New York, NY, USA
| | | | | | - Carla Ortique
- Department of Obstetrics, Texas Children's Hospital, Houston, TX, USA
| | - Alison Stuebe
- Division of Maternal-Fetal MedicineSchool of Medicine, Department of Obstetrics and Gynecology, School of Medicine, Department of Maternal and Child HealthGillings School of Global Public Health, University of North Carolina Carolina Global Breastfeeding InstituteUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kaprice Welsh
- Georgia OBGyn Society, Atlanta, GA, USA.,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Elizabeth A Howell
- Tufts University School of Medicine, Boston, MA, USA.,Department of Obstetrics and Gynecology in the Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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35
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Kern-Goldberger AR, Fatuzzo M, Applebaum J, Howell EA, Srinivas SK, Levine LD. Evaluating the OB-CMI as a Predictive Tool for Severe Maternal Morbidity by Race and Ethnicity. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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36
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Glazer KB, Zeitlin J, Egorova NN, Janevic T, Balbierz A, Hebert PL, Howell EA. Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications. Pediatrics 2021; 148:peds.2020-024091. [PMID: 34429339 PMCID: PMC9708325 DOI: 10.1542/peds.2020-024091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. METHODS We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. RESULTS The unexpected complications rate was 48.0 per 1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3-1.9]; odds ratio: 1.2 [95% confidence interval 1.1-1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from 25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with 10% of white and Asian American women (P < .001). CONCLUSIONS Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes.
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Affiliation(s)
- Kimberly B. Glazer
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Zeitlin
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Université de Paris and Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Natalia N. Egorova
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Teresa Janevic
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy Balbierz
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Grossman School of Medicine, New York University, New York, New York
| | - Paul L. Hebert
- School of Public Health, University of Washington, Seattle, Washington
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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MacDorman MF, Thoma M, Declcerq E, Howell EA. Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017. Am J Public Health 2021; 111:1673-1681. [PMID: 34383557 PMCID: PMC8563010 DOI: 10.2105/ajph.2021.306375] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016-2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable.
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Affiliation(s)
- Marian F MacDorman
- Marian F. MacDorman is with the Maryland Population Research Center, University of Maryland, College Park. Marie Thoma is with the School of Public Health, University of Maryland. Eugene Declercq is with the Boston University School of Public Health, Boston, MA. Elizabeth A. Howell is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - Marie Thoma
- Marian F. MacDorman is with the Maryland Population Research Center, University of Maryland, College Park. Marie Thoma is with the School of Public Health, University of Maryland. Eugene Declercq is with the Boston University School of Public Health, Boston, MA. Elizabeth A. Howell is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - Eugene Declcerq
- Marian F. MacDorman is with the Maryland Population Research Center, University of Maryland, College Park. Marie Thoma is with the School of Public Health, University of Maryland. Eugene Declercq is with the Boston University School of Public Health, Boston, MA. Elizabeth A. Howell is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - Elizabeth A Howell
- Marian F. MacDorman is with the Maryland Population Research Center, University of Maryland, College Park. Marie Thoma is with the School of Public Health, University of Maryland. Eugene Declercq is with the Boston University School of Public Health, Boston, MA. Elizabeth A. Howell is with the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
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Janevic T, Zeitlin J, Egorova NN, Hebert P, Balbierz A, Stroustrup AM, Howell EA. Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm. J Pediatr 2021; 235:116-123. [PMID: 33794221 PMCID: PMC9582630 DOI: 10.1016/j.jpeds.2021.03.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the influence of racial and economic residential segregation of home or hospital neighborhood on very preterm birth morbidity and mortality in neonates born very preterm. STUDY DESIGN We constructed a retrospective cohort of n = 6461 infants born <32 weeks using 2010-2014 New York City vital statistics-hospital data. We calculated racial and economic Index of Concentration at the Extremes for home and hospital neighborhoods. Neonatal mortality and morbidity was defined as death and/or severe neonatal morbidity. We estimated relative risks for Index of Concentration at the Extremes measures and neonatal mortality and morbidity using log binomial regression and the risk-adjusted contribution of delivery hospital using Fairlie decomposition. RESULTS Infants whose mothers live in neighborhoods with the greatest relative concentration of Black residents had a 1.6 times greater risk of neonatal mortality and morbidity than those with the greatest relative concentration of White residents (95% CI 1.2-2.1). Delivery hospital explained more than one-half of neighborhood differences. Infants with both home and hospital in high-concentration Black neighborhoods had a 38% adjusted risk of neonatal mortality and morbidity compared with 25% of those with both home and hospital high-concentration White neighborhoods (P = .045). CONCLUSIONS Structural racism influences very preterm birth neonatal mortality and morbidity through both the home and hospital neighborhood. Quality improvement interventions should incorporate a framework that includes neighborhood context.
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Affiliation(s)
- Teresa Janevic
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jennifer Zeitlin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University
| | - Natalia N. Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul Hebert
- University of Washington School of Public Health, Seattle, WA
| | - Amy Balbierz
- Blavatnik Family Women’s Health Research Institute,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anne Marie Stroustrup
- Department of Pediatrics, Division of Neonatology, Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennslyvania
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MacDorman MF, Thoma M, Declercq E, Howell EA. Causes contributing to the excess maternal mortality risk for women 35 and over, United States, 2016-2017. PLoS One 2021; 16:e0253920. [PMID: 34185810 PMCID: PMC8241083 DOI: 10.1371/journal.pone.0253920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
To better understand age-related disparities in US maternal mortality, we analyzed 2016-2017 vital statistics mortality data with cause-of-death literal text (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths which had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. Age-related disparities were examined both overall and by primary cause. Compared to women <35, the 2016-2017 US maternal mortality rate was twice as high for women aged 35-39, four times higher for women aged 40-44, and 11 times higher for women aged 45-54 years. Obstetric hemorrhage was the leading cause of death for women aged 35+ with rates 4 times higher than for women <35, followed by postpartum cardiomyopathy with a 3-fold greater risk. Obstetric embolism, eclampsia/preeclampsia, and Other complications of obstetric surgery and procedures each had a two-fold greater risk of death for women aged 35+. Together these 5 causes of death accounted for 70.9% of the elevated maternal mortality risk for women aged 35+. The excess maternal mortality risk for women aged 35+ was focused among a few causes of death and much of this excess mortality is preventable. Early detection and treatment, as well as continued care during the postpartum year is critical to preventing these deaths. The Alliance for Innovation on Maternal Health has promulgated patient safety bundles with specific interventions that health care systems can adopt in an effort to prevent these deaths.
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Affiliation(s)
- Marian F. MacDorman
- Maryland Population Research Center, University of Maryland, College Park, MD, United States of America
| | - Marie Thoma
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, United States of America
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States of America
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Abstract
Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.
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Affiliation(s)
- Kimberly B Glazer
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Jennifer Zeitlin
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Elizabeth A Howell
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Janevic T, Maru S, Nowlin S, McCarthy K, Bergink V, Stone J, Dias J, Wu S, Howell EA. Pandemic Birthing: Childbirth Satisfaction, Perceived Health Care Bias, and Postpartum Health During the COVID-19 Pandemic. Matern Child Health J 2021; 25:860-869. [PMID: 33909205 PMCID: PMC8079857 DOI: 10.1007/s10995-021-03158-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
Objective To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health. Study Design We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery. Results Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD. Conclusion Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.
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Affiliation(s)
- Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
- Blavatnik Family Women's Health Research Institute, New York, USA.
| | - Sheela Maru
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
- New York City Health+Hospitals/Elmhurst, New York, USA
| | - Sarah Nowlin
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Department of Nursing, Center for Nursing Research & Innovation, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Katharine McCarthy
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Blavatnik Family Women's Health Research Institute, New York, USA
| | - Veerle Bergink
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
- Blavatnik Family Women's Health Research Institute, New York, USA
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Jennifer Dias
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Stephanie Wu
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Isseroff D, Lin JY, Kwon CS, Agarwal P, Mazumdar M, Dhamoon M, Howell EA, Jetté N. Postpartum psychiatric readmissions: A nationwide study in women with and without epilepsy. Epilepsia 2021; 62:1148-1157. [PMID: 33689181 DOI: 10.1111/epi.16865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether epilepsy is associated with increased odds of 30-day readmission due to psychiatric illness during the postpartum period. METHODS The 2014 Nationwide Readmissions Database and the International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify postpartum women up to 50 years old in the United States, including the subgroup with epilepsy. The primary outcome was 30-day readmission and was categorized as (1) readmission due to psychiatric illness, (2) readmission due to all other causes, or (3) no readmission. Secondary outcome was diagnosis at readmission. The association of the primary outcome and presence of epilepsy was examined using multinomial logistic regression. RESULTS Of 1 558 875 women with admissions for delivery identified, 6745 (.45%) had epilepsy. Thirteen of every 10 000 women had 30-day psychiatric readmissions in the epilepsy group compared to one of every 10 000 in the no-epilepsy group (p < .0001). Of every 10 000 women with epilepsy, 256 had 30-day readmissions due to other causes compared to 115 of every 10 000 women in the no-epilepsy group (p < .0001). The odds ratio for readmission due to psychiatric illness was 10.13 (95% confidence interval = 5.48-18.72) in those with epilepsy compared to those without. Top psychiatric causes for 30-day readmissions among women with epilepsy were mood disorders, schizophrenia and other psychotic disorders, and substance-related disorders. SIGNIFICANCE This large-scale study demonstrated that postpartum women with epilepsy have higher odds of readmission due to a psychiatric illness compared to women without epilepsy. Postpartum treatment strategies and interventions to prevent psychiatric readmissions are necessary in this vulnerable population.
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Affiliation(s)
- Devora Isseroff
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jung-Yi Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA
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Glazer KB, Sofaer S, Balbierz A, Wang E, Howell EA. Perinatal care experiences among racially and ethnically diverse mothers whose infants required a NICU stay. J Perinatol 2021; 41:413-421. [PMID: 32669647 PMCID: PMC7886019 DOI: 10.1038/s41372-020-0721-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/28/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To learn how diverse mothers whose babies required a neonatal intensive care unit (NICU) stay evaluate their obstetric and neonatal care. STUDY DESIGN We conducted three focus groups stratified by race/ethnicity (Black, Latina, White, and Asian women, n = 20) who delivered infants at <32 weeks gestation or <1500 g with a NICU stay. We asked women to assess perinatal care and applied classic qualitative analysis techniques to identify themes and make comparisons across groups. RESULTS Predominant themes were similar across groups, including thoroughness and consistency of clinician communication, provider attentiveness, and barriers to closeness with infants. Care experiences were largely positive, but some suggested poorer communication and responsiveness toward Black and Latina mothers. CONCLUSION Feeling consulted and included in infant care is critical for mothers of high-risk neonates. Further in-depth research is needed to remediate differences in hospital culture and quality that contribute to disparities in neonatal care and outcomes.
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Affiliation(s)
- Kimberly B Glazer
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, DC, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Amy Balbierz
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Janevic T, Glazer KB, Vieira L, Weber E, Stone J, Stern T, Bianco A, Wagner B, Dolan SM, Howell EA. Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e211816. [PMID: 33729505 PMCID: PMC7970336 DOI: 10.1001/jamanetworkopen.2021.1816] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic may exacerbate existing racial/ethnic inequities in preterm birth. OBJECTIVE To assess whether racial/ethnic disparities in very preterm birth (VPTB) and preterm birth (PTB) increased during the first wave of the COVID-19 pandemic in New York City. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 8026 Black, Latina, and White women who gave birth during the study period. A difference-in-differences (DID) analysis of Black vs White disparities in VPTB or PTB in a pandemic cohort was compared with a prepandemic cohort by using electronic medical records obtained from 2 hospitals in New York City. EXPOSURES Women who delivered from March 28 to July 31, 2020, were considered the pandemic cohort, and women who delivered from March 28 to July 31, 2019, were considered the prepandemic cohort. Reverse transcription-polymerase chain reaction tests for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were performed using samples obtained via nasopharyngeal swab at the time of admission. MAIN OUTCOMES AND MEASURES Clinical estimates of gestational age were used to calculate VPTB (<32 weeks) and PTB (<37 weeks). Log binomial regression was performed to estimate Black vs White risk differences, pandemic cohort vs prepandemic cohort risk difference, and an interaction term representing the DID estimator. Covariate-adjusted models included age, insurance, prepregnancy body mass index, and parity. RESULTS Of 3834 women in the pandemic cohort, 492 (12.8%) self-identified as Black, 678 (17.7%) as Latina, 2012 (52.5%) as White, 408 (10.6%) as Asian, and 244 (6.4%) as other or unspecified race/ethnicity, with approximately half the women 25 to 34 years of age. The prepandemic cohort comprised 4192 women with similar sociodemographic characteristics. In the prepandemic cohort, VPTB risk was 4.4% (20 of 451) and PTB risk was 14.4% (65 of 451) among Black infants compared with 0.8% (17 of 2188) VPTB risk and 7.1% (156 of 2188) PTB risk among White infants. In the pandemic cohort, VPTB risk was 4.3% (21 of 491) and PTB risk was 13.2% (65 of 491) among Black infants compared with 0.5% (10 of 1994) VPTB risk and 7.0% (240 of 1994) PTB risk among White infants. The DID estimators indicated that no increase in Black vs White disparities were found (DID estimator for VPTB, 0.1 additional cases per 100 [95% CI, -2.5 to 2.8]; DID estimator for PTB, 1.1 fewer case per 100 [95% CI, -5.8 to 3.6]). The results were comparable in covariate-adjusted models when limiting the population to women who tested negative for SARS-CoV-2. No change was detected in Latina vs White PTB disparities during the pandemic. CONCLUSIONS AND RELEVANCE In this cross-sectional study of women who gave birth in New York City during the COVID-19 pandemic, no evidence was found for increased racial/ethnic disparities in PTB, among women who tested positive or tested negative for SARS-CoV-2.
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Affiliation(s)
- Teresa Janevic
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly B. Glazer
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luciana Vieira
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellerie Weber
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Toni Stern
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Bianco
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian Wagner
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A. Howell
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Howell EA, Janevic T, Blum J, Zeitlin J, Egorova NN, Balbierz A, Hebert PL. Double Disadvantage in Delivery Hospital for Black and Hispanic Women and High-Risk Infants. Matern Child Health J 2021; 24:687-693. [PMID: 32303940 DOI: 10.1007/s10995-020-02911-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether delivery hospitals that perform poorly for women also perform poorly for high-risk infants and to what extent Black and Hispanic women receive care at hospitals that perform poorly for both women and infants. METHODS We examined the correlation between hospital rankings for severe maternal morbidity and very preterm morbidity and mortality in New York City Hospitals using linked birth certificate and state discharge data for 2010-2014. We used mixed-effects logistic regression with a random hospital-specific intercept to generate risk standardized severe maternal morbidity rates and very preterm birth neonatal morbidity and mortality rates for each hospital. We ranked hospitals separately by these risk-standardized rates. We used k-means cluster analysis to categorize hospitals based on their performance on both metrics and risk-adjusted multinomial logistic regression to estimate adjusted probabilities of delivering in each hospital-quality cluster by race/ethnicity. RESULTS Hospital rankings for severe maternal morbidity and very preterm neonatal morbidity-mortality were moderately correlated (r = .32; p = .05). A 5-cluster solution best fit the data and yielded the categories for hospital performance for women and infants: excellent, good, fair, fair to poor, poor. Black and Hispanic versus White women were less likely to deliver in an excellent quality cluster (adjusted percent of 11%, 18% vs 28%, respectively, p < .001) and more likely to deliver in a poor quality cluster (adjusted percent of 28%, 20%, vs. 4%, respectively, p < .001). CONCLUSIONS FOR PRACTISE Hospital performance for maternal and high-risk infant outcomes is only moderately correlated but Black and Hispanic women deliver at hospitals with worse outcomes for both women and very preterm infants.
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Affiliation(s)
- Elizabeth A Howell
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA. .,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA.,Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - James Blum
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1002, New York, NY, 10029, USA
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Natalia N Egorova
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Amy Balbierz
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Paul L Hebert
- University of Washington School of Public Health, Seattle, WA, USA
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Crump C, Sundquist J, Howell EA, McLaughlin MA, Stroustrup A, Sundquist K. Pre-Term Delivery and Risk of Ischemic Heart Disease in Women. J Am Coll Cardiol 2021; 76:57-67. [PMID: 32616164 DOI: 10.1016/j.jacc.2020.04.072] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women who deliver pre-term have been reported to have increased future risks of cardiometabolic disorders. However, their long-term risks of ischemic heart disease (IHD) and whether such risks are due to shared familial factors are unclear. A better understanding of these risks may help improve long-term clinical follow-up and interventions to prevent IHD in women. OBJECTIVES The purpose of this study was to determine the long-term risks of IHD in women by pregnancy duration. METHODS A national cohort study was conducted of all 2,189,190 women with a singleton delivery in Sweden from 1973 to 2015, who were followed up for IHD through the end of 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for IHD associated with pregnancy duration, and cosibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. RESULTS In 47.5 million person-years of follow-up, 49,955 (2.3%) women were diagnosed with IHD. In the 10 years following delivery, the aHR for IHD associated with pre-term delivery (<37 weeks) was 2.47 (95% confidence interval [CI]: 2.16 to 2.82), and further stratified was 4.04 (95% CI: 2.69 to 6.08) for extremely pre-term (22 to 27 weeks), 2.62 (95% CI: 2.09 to 3.29) for very pre-term (28 to 33 weeks), 2.30 (95% CI: 1.97 to 2.70) for late pre-term (34 to 36 weeks), and 1.47 (95% CI: 1.30 to 1.65) for early-term (37 to 38 weeks), compared with full-term (39 to 41 weeks). These risks declined but remained significantly elevated after additional follow-up (pre-term vs. full-term, 10 to 19 years: aHR: 1.86; 95% CI: 1.73 to 1.99; 20 to 29 years: aHR: 1.52; 95% CI: 1.45 to 1.59; 30 to 43 years: aHR: 1.38; 95% CI: 1.32 to 1.45). These findings did not appear attributable to shared genetic or environmental factors within families. Additional pre-term deliveries were associated with further increases in risk. CONCLUSIONS In this large national cohort, pre-term delivery was a strong independent risk factor for IHD. This association waned over time but remained substantially elevated up to 40 years later. Pre-term delivery should be recognized as a risk factor for IHD in women across the life course.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Ann McLaughlin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annemarie Stroustrup
- The Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Departments of Pediatrics and of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Wang E, Glazer KB, Sofaer S, Balbierz A, Howell EA. Racial and Ethnic Disparities in Severe Maternal Morbidity: A Qualitative Study of Women's Experiences of Peripartum Care. Womens Health Issues 2021; 31:75-81. [PMID: 33069559 PMCID: PMC7769930 DOI: 10.1016/j.whi.2020.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity. METHODS We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20). We organized three focus groups by self-identified race/ethnicity ([1] Black, [2] Latina, and [3] White or Asian) to detect any within- and between-group differences. Discussions were audiotaped and transcribed. The research team coded the transcripts and used content analysis to identify key themes and to compare findings across racial and ethnic groups. RESULTS Participants reported distressing experiences and lasting emotional consequences after having a severe childbirth complication. Many women appreciated the life-saving care they received. However, poor continuity of care, communication gaps, and a perceived lack of attentiveness to participants' physical and emotional needs led to substantial concern and disappointment in care. Black and Latina women in particular emphasized these themes. CONCLUSIONS This study highlights missed opportunities for improved clinician communication and continuity of care to address emotional trauma when severe obstetric complications occur, particularly for Black and Latina women. Enhancing communication to ensure that women feel heard and informed throughout the birth process and addressing implicit bias, as a part of the more systemic issue of institutionalized racism, could both decrease disparities in obstetric care quality and improve the patient experience for women of all races and ethnicities.
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Affiliation(s)
- Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Kimberly B Glazer
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, District of Columbia; Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Amy Balbierz
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Sly JR, Miller SJ, Thelemaque L, Yazdanie F, Sperling R, Sasan F, Howell EA, Loudon H, Jandorf L. Knowledge of the Relationship Between Breastfeeding and Breast Cancer Risk Among Racial and Ethnic Minority Women. J Cancer Educ 2020; 35:1193-1196. [PMID: 31338810 PMCID: PMC6980917 DOI: 10.1007/s13187-019-01580-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research indicates breastfeeding can reduce the risk of breast cancer in women. Black and Hispanic women are more likely to die from breast cancer than non-Hispanic white women and are least likely to breastfeed. The current study was designed to evaluate women's knowledge of the link between breastfeeding and decreased breast cancer risk among a racially diverse cohort of pregnant women. Pregnant women 18 and older (N = 89; 48.4% black; 28% Hispanic) were recruited during a prenatal visit to complete a survey. Women indicated limited understanding of the association between breastfeeding and breast cancer risk reduction; less than 40% of black and white women indicated knowledge, while 64.7% of Hispanic women were aware of the association. These findings underscore the need for interventions to educate women about the protective benefits of breastfeeding as a strategy to reduce their breast cancer incidence and mortality.
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Affiliation(s)
- Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Linda Thelemaque
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Fahd Yazdanie
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fahimeh Sasan
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Holly Loudon
- Department of Obstetrics, Gynecology and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
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Abstract
Recent literature has focused on the impact of the differential adoption by states of the Affordable Care Act's Medicaid expansion. However, additional Medicaid policy dimensions exist where state-level trends in coverage have varied, including eligibility, benefits, and administrative burden, both before and after implementation of the Affordable Care Act.
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Affiliation(s)
- Ashley M Fox
- Ashley M. Fox is an assistant professor of public administration and policy at the Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, in Albany, New York
| | - Wenhui Feng
- Wenhui Feng is an assistant professor in the Department of Public Health and Community Medicine at Tufts University Medical School, in Boston, Massachusetts
| | - Jennifer Zeitlin
- Jennifer Zeitlin is a senior research scientist in the Center for Epidemiology and Biostatistics, Inserm UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Paris Descartes University, in Paris, France
| | - Elizabeth A Howell
- Elizabeth A. Howell is a professor at the Blavatnik Family Women's Health Research Institute, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, in New York, New York
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Fitzsimmons E, Arany Z, Howell EA, Lewey J. Differential Outcomes for African-American Women with Cardiovascular Complications of Pregnancy. Curr Treat Options Cardio Med 2020. [DOI: 10.1007/s11936-020-00863-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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