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Cameron NA, Birdsell H, Niznik CM, Michon R, Donelan E, Yee LM, Dolan BM. An Enhanced Postpartum Transition Program to Primary Care. J Womens Health (Larchmt) 2024. [PMID: 38634543 DOI: 10.1089/jwh.2023.0465] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are risk factors for future cardiovascular disease, yet few individuals receive postpartum care with primary care clinicians (PCP). To facilitate transitions of care to PCPs and improve cardiovascular health monitoring within the first 13 months postpartum, we developed and piloted an enhanced postpartum referral pathway for patients with GDM or HDP. Methods: Eligible patients included those who received perinatal care at a large, urban, academic medical center, experienced GDM or HDP during their most recent pregnancy, and lacked an existing PCP. Resident, faculty, and advanced practitioners referred patients during antenatal, delivery-related, or postpartum visits. A dedicated scheduler contacted patients to schedule an appointment with a women's health-focused resident or faculty PCP. The percent of patients who attended a postpartum PCP visit, who had an HbA1c and cholesterol panel checked within the first 13 months postpartum, were compared between patients referred and not referred to the program using adjusted odds ratios (aOR). Results: Of 129 individuals referred, 48.1% attended a PCP visit, 31.8% completed cholesterol screening, and 41.9% completed HbA1c screening within 13 months postpartum. After adjusting for age, parity, insurance, and referral indication, referred individuals had greater odds for each outcome (PCP visit: aOR = 6.0, 95% CI 4.0-9.0; cholesterol: aOR = 2.4, 95% 1.6-3.9; HbA1c: aOR = 2.5, 95% CI 1.7-3.7) compared with nonreferred individuals in the same time period. Discussion: A enhanced postpartum PCP referral pathway pilot for birthing individuals was associated with improved follow-up in the first year postpartum.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather Birdsell
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charlotte M Niznik
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruth Michon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Dartmouth University, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brigid M Dolan
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cameron NA, Khan SS. Common risk factors in the shadow of rare pregnancy complications: Spotlighting the role of cardiovascular health in placental abruption. Paediatr Perinat Epidemiol 2024; 38:287-289. [PMID: 38450795 DOI: 10.1111/ppe.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Natalie A Cameron
- Department of Preventive Medicine, Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Hammond MM, Cameron NA, Shah NS, Khan SS. An Age-Period-Cohort Analysis of Cardiovascular Disease Mortality in the United States from 1999 to 2018. Am J Med 2024:S0002-9343(24)00108-6. [PMID: 38401673 DOI: 10.1016/j.amjmed.2024.02.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Although cardiovascular disease mortality rates in the United States declined from the 1970s to 2010s, they have now plateaued. The independent effects of age, period, and birth year (cohort) on cardiovascular disease mortality have not previously been defined. METHODS We used data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research to examine the effects of age, period, and cohort on cardiovascular disease mortality among individuals aged 20-84 years from 1999 to 2018, prior to the onset of the coronavirus disease 2019 pandemic. Age effects were described as cardiovascular disease-related mortality rates in each 5-year age group adjusted for year of death (period) and year of birth (cohort). Period and cohort effects were quantified as adjusted rate ratios (RRs) comparing cardiovascular disease mortality rates in each period and cohort to the reference periods and reference cohort (ie, 1919 birth cohort), respectively. RESULTS Between 1999 to 2018, there were 10,404,327 cardiovascular disease deaths among US adults. In each individual birth cohort, the age-specific cardiovascular disease mortality rates were stable between ages 20 through 39 years. Age-specific rates were higher for each year older between ages 40 through 84 years adjusting for period effects. The period cardiovascular disease mortality rates were lower in later periods (2004-2008 period RR 0.87, 95% confidence interval [CI] 0.85 to 0.88; 2009-2013 period RR 0.78, 95% CI 0.76 to 0.80) compared with the reference period (1999 to 2003) and plateaued thereafter. The cohort cardiovascular disease mortality rates were progressively lower in more recent birth cohorts (1924 birth cohort RR 0.85, 95% CI 0.83 to 0.87; 1974 birth cohort RR 0.29, 95% CI 0.27 to 0.32) compared with the reference cohort (1919 cohort) and plateaued thereafter. CONCLUSION Although cardiovascular disease mortality rates declined rapidly among those born between 1919 and 1974, improvements plateaued in birth cohorts thereafter even adjusted for period effects.
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Affiliation(s)
- Michael M Hammond
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Natalie A Cameron
- Department of Medicine (General Internal Medicine and Geriatrics), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Nilay S Shah
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sadiya S Khan
- Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Venkatesh KK, Huang X, Cameron NA, Petito LC, Joseph J, Landon MB, Grobman WA, Khan SS. Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12 million pregnancies. BJOG 2024; 131:26-35. [PMID: 37366023 PMCID: PMC10751384 DOI: 10.1111/1471-0528.17587] [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: 02/22/2023] [Revised: 05/24/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural-urban disparities in adverse pregnancy outcomes. DESIGN Serial, cross-sectional analysis. SETTING US National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019. POPULATION A total of 12 401 888 singleton live births to nulliparous women aged 15-44 years. METHODS We calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age-adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban-Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification). MAIN OUTCOME MEASURES The outcomes (modelled separately) were diagnoses of DM and GDM. RESULTS From 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%-3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%-3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%-4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%-4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%-1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%-1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural-urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural-urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all). CONCLUSIONS The frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural-urban disparities existed for DM and GDM, and increased over time for GDM. These rural-urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.
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Affiliation(s)
- Kartik K. Venkatesh
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Xiaoning Huang
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Natalie A. Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics (Chicago, IL)
| | - Lucia C. Petito
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Joshua Joseph
- The Ohio State University College of Medicine, Department of Medicine (Columbus, OH)
| | - Mark B. Landon
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - William A. Grobman
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Sadiya S. Khan
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology (Chicago, IL)
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5
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Khan SS, Grobman WA, Cameron NA. Cardiovascular Health in the Postpartum Period. JAMA 2023; 330:2115-2116. [PMID: 37966864 DOI: 10.1001/jama.2023.19192] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
This article in the Women’s Health series discusses recent increases in US maternal death rates, disparities in rates by race and ethnicity, poor cardiovascular health (CVH) as one of the multifactorial causes, and clinical approaches to assessing and treating poor CVH postpartum.
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Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Natalie A Cameron
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mehta PM, Wang MC, Cameron NA, Freaney PM, Perak AM, Shah NS, Grobman WA, Greenland P, Kershaw KN, Vupputuri S, Khan SS. Association of Prepregnancy Risk Factors With Racial Differences in Preterm Birth Rates. Am J Prev Med 2023; 65:1184-1186. [PMID: 37552145 PMCID: PMC10800638 DOI: 10.1016/j.amepre.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Priya M Mehta
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C Wang
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Natalie A Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Priya M Freaney
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M Perak
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Philip Greenland
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Suma Vupputuri
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Cameron NA, Khan SS, Brewer AN, Tsigas EZ, Ness RB, Roberts JM. Recruiting and retaining nulliparous individuals with a family history of hypertensive disorders of pregnancy to participate in scientific research prior to pregnancy: The Sisterhood Study. Am Heart J Plus 2023; 34:100319. [PMID: 38328773 PMCID: PMC10847978 DOI: 10.1016/j.ahjo.2023.100319] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Introduction Recruiting women with a family history (FH) of hypertensive disorders of pregnancy (HDP) to participate in research before pregnancy could offer insight into genetic and lifestyle factors that incur higher risk of cardiovascular disease during pregnancy and throughout the life course. Methods The Sisterhood Study piloted low-touch, remote recruitment strategies that relied on women with a history of preeclampsia to share study information with family and friends. It aimed to enroll 150 women with a FH of HDP and 150 controls. Results The study recruited 328 women (104 with a FH of HDP, 131 without a FH, and 93 with unknown FH) prior to pregnancy. The majority identified as non-Hispanic White (74.7%) and had > high school education (91.8%). Discussion Although the population was enriched with nulliparous women with a FH of HDP, it was not sufficient to recruit a diverse cohort large enough to meet the study aim.
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Affiliation(s)
- Natalie A Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine
| | - Sadiya S Khan
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine
| | | | | | - Roberta B Ness
- University of Texas School of Public Health (Former Dean)
| | - James M Roberts
- Magee-Womens Research Institute, Obstetrics Gynecology and Reproductive Sciences, epidemiology and Clinical and Translational Research University of Pittsburgh
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8
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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9
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Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
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Abstract
Oral contraceptive pills (OCPs) have been used as effective and popular forms of contraception since the middle of the last century. By 2019, over 150 million reproductive-aged individuals were using OCPs to prevent unintended pregnancies worldwide. Safety concerns regarding the effects of OCPs on blood pressure were reported soon after these pills gained approval. Although OCP doses were subsequently reduced, epidemiologic evidence continued to support a smaller, but significant association between OCPs and hypertension. Given the rising prevalence of hypertension, as well as the adverse effects of cumulative exposure to blood pressure elevations on cardiovascular disease risk, understanding the nature of the association between OCPs and hypertension is important for clinicians and patients to assess the risks and benefits of use, and make individualized decisions regarding contraception. Therefore, this review summarizes the current and historical evidence describing the association between OCP use and blood pressure elevations. Specifically, it identifies the pathophysiologic mechanisms linking OCPs to hypertension risk, describes the magnitude of the association between OCPs and blood pressure elevations, and distinguishes the effects of various OCP types on blood pressure. Finally, it describes current recommendations regarding hypertension and OCP use, as well as identifies strategies, such as over-the-counter OCP prescribing, to safely and equitably improve access to oral contraception.
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Affiliation(s)
- Natalie A Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Chicago, Illinois
| | - Ciantel A. Blyler
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalie A Bello
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
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Hammond MM, Cameron NA, Ning H, Bah I, Beltrame K, Khan SS, Shah NS. Statin Use and Eligibility for Primary Prevention of Atherosclerotic Cardiovascular Disease Among Adults at Borderline or Intermediate Risk in the United States. J Am Heart Assoc 2023; 12:e029263. [PMID: 37026554 DOI: 10.1161/jaha.122.029263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Michael M Hammond
- Department of Medicine (Cardiology) Northwestern University Feinberg School of Medicine Chicago IL
| | - Natalie A Cameron
- Department of Medicine (General Internal Medicine) Northwestern University Feinberg School of Medicine Chicago IL
| | - Hongyan Ning
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Imani Bah
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Kaitlyn Beltrame
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Medicine (Cardiology) Northwestern University Feinberg School of Medicine Chicago IL
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Nilay S Shah
- Department of Medicine (Cardiology) Northwestern University Feinberg School of Medicine Chicago IL
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
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Cameron NA, Everitt IK, Lee KA, Yee LM, Khan SS. Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention. Hypertension 2023; 80:1162-1170. [PMID: 36960717 DOI: 10.1161/hypertensionaha.122.19317] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine. (N.A.C.)
| | - Ian K Everitt
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine. (I.K.E.)
| | - Kristen A Lee
- Department of Medicine, McGaw Medical Center of Northwestern University (K.A.L.)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine. (L.M.Y.)
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine. (S.S.K.)
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine. (S.S.K.)
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Harrington KA, Cameron NA, Culler K, Grobman WA, Khan SS. Rural-Urban Disparities in Adverse Maternal Outcomes in the United States, 2016-2019. Am J Public Health 2023; 113:224-227. [PMID: 36652639 PMCID: PMC9850610 DOI: 10.2105/ajph.2022.307134] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
Objectives. To describe differences in maternal admissions to the intensive care unit (ICU) and mortality in rural versus urban areas in the United States. Methods. We performed a nationwide analysis and calculated age-standardized rates and rate ratios (RRs) of maternal ICU admission and mortality per 100 000 live births between 2016 and 2019 in rural versus urban areas. Results. From 2016 to 2019, there was no significant increase in age-standardized rates of maternal ICU admissions in rural (170.6-192.3) or urban (161.7-172.4) areas, with a significantly higher rate, albeit a relatively small difference, in rural versus urban areas (2019 RR = 1.14; 95% confidence interval [CI] = 1.04, 1.20). Maternal mortality increased in both rural (66.9-81.7 deaths per 100 000 live births) and urban (38.1-42.3) areas and was nearly 2 times higher in rural areas (2019 RR = 1.93; 95% CI = 1.71, 2.17). Conclusions. Pregnant individuals in rural areas are at higher risk for ICU admission and mortality than are their urban counterparts. Significant increases in maternal mortality occurred in rural and urban areas. Public Health Implications. Public health efforts need to focus on resource-limited rural areas to mitigate geographic disparities in maternal morbidity and mortality. (Am J Public Health. 2023;113(2): 224-227.https://doi.org/10.2105/AJPH.2022.307134).
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Affiliation(s)
- Katharine A Harrington
- Katharine A. Harrington is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Natalie A. Cameron is with the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine. Kasen Culler is with the Department of Medicine, Northwestern University Feinberg School of Medicine. William A. Grobman is with the Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus. Sadiya S. Khan is with the Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - Natalie A Cameron
- Katharine A. Harrington is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Natalie A. Cameron is with the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine. Kasen Culler is with the Department of Medicine, Northwestern University Feinberg School of Medicine. William A. Grobman is with the Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus. Sadiya S. Khan is with the Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - Kasen Culler
- Katharine A. Harrington is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Natalie A. Cameron is with the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine. Kasen Culler is with the Department of Medicine, Northwestern University Feinberg School of Medicine. William A. Grobman is with the Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus. Sadiya S. Khan is with the Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - William A Grobman
- Katharine A. Harrington is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Natalie A. Cameron is with the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine. Kasen Culler is with the Department of Medicine, Northwestern University Feinberg School of Medicine. William A. Grobman is with the Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus. Sadiya S. Khan is with the Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - Sadiya S Khan
- Katharine A. Harrington is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Natalie A. Cameron is with the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine. Kasen Culler is with the Department of Medicine, Northwestern University Feinberg School of Medicine. William A. Grobman is with the Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus. Sadiya S. Khan is with the Division of Cardiology, Northwestern University Feinberg School of Medicine
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Shah NS, Huang X, Petito LC, Bancks MP, Ning H, Cameron NA, Kershaw KN, Kandula NR, Carnethon MR, Lloyd-Jones DM, Khan SS. Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population. Circulation 2023; 147:190-200. [PMID: 36334260 PMCID: PMC9852071 DOI: 10.1161/circulationaha.122.061991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities. METHODS In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. RESULTS Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P<0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants; P<0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively; P<0.05). CONCLUSIONS Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.
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Affiliation(s)
- Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Natalie A. Cameron
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Namratha R. Kandula
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Venkatesh KK, Harrington K, Cameron NA, Petito LC, Powe CE, Landon MB, Grobman WA, Khan SS. Trends in gestational diabetes mellitus among nulliparous pregnant individuals with singleton live births in the United States between 2011 to 2019: an age-period-cohort analysis. Am J Obstet Gynecol MFM 2023; 5:100785. [PMID: 36280146 DOI: 10.1016/j.ajogmf.2022.100785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The rate of gestational diabetes mellitus has increased over the past decade. An age, period, and cohort epidemiologic analysis can be used to understand how and why disease trends have changed over time. OBJECTIVE This study aimed to estimate the associations of age (at delivery), period (delivery year), and cohort (birth year) of the pregnant individual with trends in the incidence of gestational diabetes mellitus in the United States. STUDY DESIGN We conducted an age, period, and cohort analysis of nulliparous pregnant adults aged 18 to 44 years with singleton live births from the National Vital Statistics System from 2011 to 2019. Generalized linear mixed models were used to calculate the adjusted rate ratios for the incidence of gestational diabetes mellitus for each 3-year maternal age span, period, and cohort group compared with the reference group for each. We repeated the analyses with stratification according to self-reported racial and ethnic group (non-Hispanic Asian-Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic White) because of differences in the incidence of and risk factors for gestational diabetes mellitus by race and ethnicity. RESULTS Among 11,897,766 pregnant individuals, 5.2% had gestational diabetes mellitus. The incidence of gestational diabetes mellitus was higher with increasing 3-year maternal age span, among those in the more recent delivery period, and among the younger birth cohort. For example, individuals aged 42 to 44 years at delivery had a 5-fold higher risk for gestational diabetes mellitus than those aged 18 to 20 years (adjusted rate ratio, 5.57; 95% confidence interval, 5.43-5.72) after adjusting for cohort and period. Individuals who delivered between 2017 and 2019 were at higher risk for gestational diabetes mellitus than those who delivered between 2011 and 2013 (adjusted rate ratio, 1.24; 95% confidence interval, 1.23-1.25) after adjusting for age and cohort. Individuals born between 1999 and 2001 had a 3-fold higher risk for gestational diabetes mellitus than those born between 1969 and 1971 (adjusted rate ratio, 3.12; 95% confidence interval, 2.87-3.39) after adjusting for age and period. Similar age, period, and cohort effects were observed for the assessed racial and ethnic groups, with the greatest period effects observed among Asian and Pacific Islander individuals. CONCLUSION Period and birth cohort effects have contributed to the rising incidence of gestational diabetes mellitus in the United States from 2011 to 2019.
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Affiliation(s)
- Kartik K Venkatesh
- From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
| | - Katharine Harrington
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natalie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lucia C Petito
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Camille E Powe
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Mark B Landon
- From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - William A Grobman
- From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Cameron NA, Hughes ZH, Petito LC, Lloyd-Jones DM, Bello NA, Grobman WA, Khan SS. Abstract 135: Contribution Of Maternal Age To Trends In Pre-pregnancy Hypertension Prevalence In The United States From 1995-2019: A Kitagawa Decomposition Analysis. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.135] [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: 11/16/2022]
Abstract
Introduction:
Prevalence of pre-pregnancy hypertension (HTN) has increased concurrently with maternal age in the US. We sought to understand the contribution of changes in maternal age vs. age-related HTN prevalence to trends in pre-pregnancy HTN.
Methods:
We included individuals aged 15-44 years old with a singleton first live birth in 1995-1999 and 2015-2019 from the National Vital Statistics System. We calculated the prevalence of pre-pregnancy HTN per 1,000 live births in 1995-1999 and 2015-2019, overall and in each 5-year age group. Using a Kitagawa analysis, we decomposed change in prevalence into two parts: (1) change in maternal age distribution and (2) change in age-specific prevalence of pre-pregnancy HTN (rate component). Analyses were repeated by self-identified race and ethnicity.
Results:
From 1995-1999 to 2015-2019, the proportion of first births decreased from 53% to 39% in 15-24 year olds and increased from 47% to 61% in 25-44 year olds. Pre-pregnancy HTN prevalence increased from 6.4 in 1995-1999 to 16.7 in 2015-2019 per 1,000 live births (
TABLE
). Changes in maternal age distribution and age-specific prevalence were associated with 16% and 84% of the increase in pre-pregnancy HTN, respectively. While prevalence differed by race and ethnicity, changes in age-specific prevalence accounted for the majority of changes in pre-pregnancy HTN in each group.
Conclusions:
Adverse trends in pre-pregnancy HTN were driven primarily by increasing age-specific prevalence overall, and in all race and ethnicity groups. Public health efforts are needed to identify and target the cardiovascular risk factors driving these age-specific trends and improve maternal health.
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Affiliation(s)
| | | | | | | | | | - William A Grobman
- The Ohio State Univ Wexner Med Cntr Dept of Obstetrics and Gynecology, Columbus, OH
| | - Sadiya S Khan
- Northwestern Univ, Feinberg Sch of Medicine, Chicago, IL
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Cameron NA, Kushner RF. Development of a telehealth obesity OSCE and reliable checklist for assessment of resident physicians: a pilot study. BMC Med Educ 2022; 22:630. [PMID: 35986272 PMCID: PMC9389479 DOI: 10.1186/s12909-022-03672-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obesity is a major public health problem, yet residents undergo little formal training and assessment in obesity-related care. Given the recent growth of telehealth, physicians must further learn to apply these skills using a virtual platform. Therefore, we aimed to develop an objective structured clinical examination (OSCE) with reliable checklists to assess resident ability to take a patient-centered obesity-focused history that was feasible over telehealth based on published obesity competencies for medical education. METHODS We developed a 15-minute telehealth OSCE to simulate an obesity-related encounter for residents modified from a script used to assess medical student obesity competencies. We designed three checklists to assess resident skills in history taking, communication and professionalism during the obesity-related encounter. Resident performance was assessed as the percentage of obesity-related history taking questions asked during the encounter and as the mean communication and professionalism scores on a scale of 1 through 5 with 1 representing unacceptable/offensive behavior and 5 representing excellent skills. Encounters and assessments were completed by two commissioned actors (standardized patients) and 26 internal medicine residents over a secure online platform. We assessed the reliability of each checklist by calculating the percent agreement between standardized patients and the kappa (κ) statistic on each checklist overall and by each checklist item. RESULTS Overall agreement between standardized patients on the history taking, communication and professionalism checklists were 83.2% (κ = 0.63), 99.5% (κ = 0.72) and 97.8% (κ =0.44), respectively. On average, residents asked 64.8% of questions on the history taking checklist and scored 3.8 and 3.9 out of 5 on the communication and professionalism checklists, respectively. CONCLUSIONS Results from this pilot study suggest that our telehealth obesity OSCE and checklists are moderately reliable for assessing key obesity competencies among residents on a virtual platform. Integrating obesity OSCEs and other educational interventions into residency curricula are needed to improve resident ability to take an obesity-focused history.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - Robert F Kushner
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA.
- Departments of Medicine and Medical Education, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 645 North Michigan Avenue, Suite 530, Chicago, USA.
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Cameron NA, Petito LC, Shah NS, Perak AM, Catov JM, Bello NA, Capewell S, O’Flaherty M, Lloyd-Jones DM, Greenland P, Grobman WA, Khan SS. Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019. JAMA Netw Open 2022; 5:e2228093. [PMID: 36001318 PMCID: PMC9403773 DOI: 10.1001/jamanetworkopen.2022.28093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Hypertensive disorders of pregnancy are leading causes of morbidity and mortality among pregnant individuals as well as newborns, with increasing incidence during the past decade. Understanding the individual associations of advancing age of pregnant individuals at delivery, more recent delivery year (period), and more recent birth year of pregnant individuals (cohort) with adverse trends in hypertensive disorders of pregnancy could help guide public health efforts to improve the health of pregnant individuals. OBJECTIVE To clarify the independent associations of delivery year and birth year of pregnant individuals, independent of age of pregnant individuals, with incident rates of hypertensive disorders of pregnancy. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study of 38 141 561 nulliparous individuals aged 15 to 44 years with a singleton, live birth used 1995-2019 natality data from the National Vital Statistics System. EXPOSURES Year of delivery (period) and birth year (cohort) of pregnant individuals. MAIN OUTCOMES AND MEASURES Rates of incident hypertensive disorders of pregnancy, defined as gestational hypertension, preeclampsia, or eclampsia, recorded on birth certificates. Generalized linear mixed models were used to calculate adjusted rate ratios (aRRs) comparing the incidence of hypertensive disorders of pregnancy in each delivery period (adjusted for age and cohort) and birth cohort (adjusted for age and period) with the baseline group as the reference for each. Analyses were additionally stratified by the self-reported racial and ethnic group of pregnant individuals. RESULTS Of 38 141 561 individuals, 20.2% were Hispanic, 0.8% were non-Hispanic American Indian or Alaska Native, 6.5% were non-Hispanic Asian or Pacific Islander, 13.9% were non-Hispanic Black, and 57.8% were non-Hispanic White. Among pregnant individuals who delivered in 2015 to 2019 compared with 1995 to 1999, the aRR for the incidence of hypertensive disorders of pregnancy was 1.59 (95% CI, 1.57-1.62), adjusted for age and cohort. Among pregnant individuals born in 1996 to 2004 compared with 1951 to 1959, the aRR for the incidence of hypertensive disorders of pregnancy was 2.61 (95% CI, 2.41-2.84), adjusted for age and period. The incidence was higher among self-identified non-Hispanic Black individuals in each birth cohort, with similar relative changes for period (aRR, 1.76 [95% CI, 1.70-1.81]) and cohort (aRR, 3.26 [95% CI, 2.72-3.91]) compared with non-Hispanic White individuals (period: aRR, 1.60 [95% CI, 1.57-1.63]; cohort: aRR, 2.53 [95% CI, 2.26-2.83]). CONCLUSIONS AND RELEVANCE This cross-sectional study suggests that more recent birth cohorts of pregnant individuals have experienced a doubling of rates of hypertensive disorders of pregnancy, even after adjustment for age and delivery period. Substantial racial and ethnic disparities persisted across generations.
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Affiliation(s)
- Natalie A. Cameron
- Division of Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie A. Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Cameron NA, Bello NA, Khan SS. Bringing the Cuff Home: Challenges and Opportunities Associated With Home Blood Pressure Monitoring Among Reproductive-Aged Individuals. Am J Hypertens 2022; 35:688-690. [PMID: 35695260 PMCID: PMC9340642 DOI: 10.1093/ajh/hpac074] [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] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Natalie A Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Chicago, Illinois, USA
| | - Natalie A Bello
- Smidt Heart Institute, Cedars Sinai Medical Center, Department of Cardiology, Chicago, Illinois, USA
| | - Sadiya S Khan
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, USA
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Shah NS, Harrington KA, Huang X, Cameron NA, Yee LM, Khan SS. Trends in De Novo Hypertensive Disorders of Pregnancy Among Asian and Hispanic Population Subgroups in the United States, 2011 to 2019. JAMA Cardiol 2022; 7:742-746. [PMID: 35675084 DOI: 10.1001/jamacardio.2022.1378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/17/2023]
Abstract
Importance De novo hypertensive disorders of pregnancy (HDP) are associated with adverse maternal and offspring outcomes. Heterogeneity among racial and ethnic subgroups may be masked with aggregate reporting of race and ethnicity, such as Asian or Pacific Islander or Hispanic. Objective To determine patterns in de novo HDP rates among individuals in Asian and Hispanic subgroups with a first live birth in the United States in the period 2011 through 2019. Design, Setting, and Participants This serial cross-sectional analysis used data from 2011 through 2019 for individuals aged 15 to 44 years with singleton first live births obtained from the US National Center for Health Statistics natality database. Exposures Stratification by self-report of maternal race and ethnicity: Hispanic/Latina (overall and Hispanic/Latina subgroups [Central/South American, Cuban, Mexican, and Puerto Rican]), non-Hispanic Asian and Pacific Islander (overall and non-Hispanic Asian subgroups [Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese]), non-Hispanic Black, non-Hispanic White. Main Outcomes and Measures De novo HDP was defined as new-onset hypertension during pregnancy (gestational hypertension or preeclampsia). Age-standardized rates of HDP (per 1000 live births) and respective mean annual percent change in race and ethnicity groups and subgroups were calculated. Results Among 13 238 918 individuals, the mean (SD) age was 26.3 (5.8) years. Overall, HDP rates increased 7.3% per year (95% CI, 6.5%-8.1%), from 57.2 (95% CI, 56.8-57.6) per 1000 live births in 2011 to 99.7 (95% CI, 99.2-100.2) per 1000 live births in 2019. Rates of HDP significantly increased in all racial and ethnic groups and subgroups over the study period. The highest HDP prevalence among non-Hispanic Asian subgroups in 2019 was in Filipina individuals (92.5 [95% CI, 86.3-98.8] per 1000 live births), and the highest among Hispanic/Latina subgroups in 2019 was in Puerto Rican individuals (98.6 [95% CI, 94.2-102.9] per 1000 live births) with significant heterogeneity observed among subgroups across the study period. Conclusions and Relevance Rates of HDP among individuals with a singleton first live birth increased in the United States from 2011 to 2019 across all race and ethnicity subgroups, with considerable heterogeneity in HDP rates in non-Hispanic Asian and Hispanic/Latina subgroups.
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Affiliation(s)
- Nilay S Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine A Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Natalie A Cameron
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Natalie A Cameron
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Affiliation(s)
- Natalie A Cameron
- Division of General Internal Medicine and Geriatrics (N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S Khan
- Division of Cardiology (S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Medicine and Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Cameron NA, Freaney PM, Wang MC, Perak AM, Dolan BM, O’Brien MJ, Tandon SD, Davis MM, Grobman WA, Allen NB, Greenland P, Lloyd-Jones DM, Khan SS. Geographic Differences in Prepregnancy Cardiometabolic Health in the United States, 2016 Through 2019. Circulation 2022; 145:549-551. [PMID: 35157521 PMCID: PMC9071179 DOI: 10.1161/circulationaha.121.057107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Natalie A. Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Internal Medicine and Geriatrics, Chicago, Illinois, Unites States
| | - Priya M. Freaney
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, Illinois, Unites States
| | - Michael C. Wang
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Internal Medicine and Geriatrics, Chicago, Illinois, Unites States
| | - Amanda M. Perak
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, Unites States
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, Unites States
| | - Brigid M. Dolan
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Internal Medicine and Geriatrics, Chicago, Illinois, Unites States
| | - Matthew J. O’Brien
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Internal Medicine and Geriatrics, Chicago, Illinois, Unites States
| | - S Darius Tandon
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, Unites States
| | - Matthew M. Davis
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, Unites States
| | - William A. Grobman
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Chicago, Illinois, Unites States
| | - Norrina B. Allen
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, Unites States
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, Illinois, Unites States
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, Unites States
| | - Donald M. Lloyd-Jones
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, Illinois, Unites States
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, Unites States
| | - Sadiya S. Khan
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, Illinois, Unites States
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois, Unites States
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Cameron NA, Everitt I, Seegmiller LE, Yee LM, Grobman WA, Khan SS. Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019. J Am Heart Assoc 2022; 11:e023791. [PMID: 35014858 PMCID: PMC9238536 DOI: 10.1161/jaha.121.023791] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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] [Indexed: 11/16/2022]
Abstract
Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural‐urban differences in maternal cardiovascular health, we described contemporary trends in new‐onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross‐sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age‐adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new‐onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0–49.2] to 83.9 [83.1–84.7]) and urban (37.0 [36.8–37.2] to 77.2 [76.8–77.6]) areas. The rate of annual increase in new‐onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new‐onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30–1.33) in 2007 to 1.09 (1.08–1.10) in 2019. Conclusions Incidence of new‐onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural‐urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring.
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Affiliation(s)
- Natalie A Cameron
- Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Ian Everitt
- Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Laura E Seegmiller
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lynn M Yee
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - William A Grobman
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
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Cameron NA, Freaney PM, Wang MC, Perak AM, Dolan BM, O'Brien MJ, Grobman WA, Allen NB, Greenland P, Lloyd-Jones DM, Khan SS. Abstract 015: Geographic Variation In Pre-pregnancy Cardiometabolic Health In The United States, 2016-2018. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
Introduction:
Poor cardiometabolic health is a major contributor to growing rates of maternal morbidity and mortality. Given known state-level variation in maternal outcomes, we sought to describe the geographic distribution of pre-pregnancy cardiometabolic health as it could inform policy changes to optimize maternal and offspring outcomes.
Hypothesis:
We hypothesized that pre-pregnancy cardiometabolic health has declined over time and varies by state.
Methods:
We conducted a nationwide, serial cross-sectional analysis using maternal birth record data from the CDC Natality Files 2016-2018, which include all live births in the US. We included all live births to women aged 20-44 years (N= 10,693,708). Pre-pregnancy cardiometabolic health was quantified by number of pre-pregnancy risk factors: overweight or obesity (body mass index > 25 kg/m
2
), diabetes, and/or hypertension. We calculated annual age-standardized prevalence of favorable (no risk factors), suboptimal (any single risk factor), or poor ( > 2 risk factors) pre-pregnancy cardiometabolic health and quantified percentage change between 2016-2018 by state.
Results:
From 2016-2018, the percentage of live births to women with favorable cardiometabolic health decreased from 43.5% (43.4, 43.6) to 41.3% (41.2, 41.3), suboptimal health increased from 51.1% (51.1, 51.2) to 53.3% (53.3, 53.4), and poor health increased from 2.1% (2.1, 2.1) to 2.4% (2.4, 2.4). All states experienced declines in favorable cardiometabolic health. There was significant geographic variation with prevalence of favorable pre-pregnancy cardiometabolic health ranging from 32.7% (32.2, 33.3) in Mississippi to 48.2% (47.7, 48.6) in Utah in 2018
(FIGURE)
; poor health ranged from 1.3% (1.3, 1.4) in California to 4.6% (4.4, 4.8) in Louisiana in 2018.
Conclusions:
Less than half of women had favorable pre-pregnancy cardiometabolic health between 2016-2018, with significant geographic heterogeneity. Public health efforts to improve pre-conception cardiometabolic health are needed.
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Affiliation(s)
- Natalie A Cameron
- Dept of Medicine, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Priya M Freaney
- Div of Cardiology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | | | - Amanda M Perak
- Ann & Robert H. Lurie Children’s Hosp of Chicago and Dept of Preventive Medicine, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Brigid M Dolan
- Dept of Medicine, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Matthew J O'Brien
- Dept of Medicine, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - William A Grobman
- Dept of Obstetrics and Gynecology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Norrina B Allen
- Dept of Preventive Medicine, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Philip Greenland
- Dept of Preventive Medicine and Div of Cardiology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Dept of Preventive Medicine and Div of Cardiology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Sadiya S Khan
- Dept of Preventive Medicine and Div of Cardiology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
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Cameron NA, Petito LC, McCabe M, Allen NB, O'Brien MJ, Carnethon MR, Khan SS. Quantifying the Sex-Race/Ethnicity-Specific Burden of Obesity on Incident Diabetes Mellitus in the United States, 2001 to 2016: MESA and NHANES. J Am Heart Assoc 2021; 10:e018799. [PMID: 33563002 PMCID: PMC7955335 DOI: 10.1161/jaha.120.018799] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Indexed: 12/24/2022]
Abstract
Background Given the increasing prevalence of diabetes mellitus (DM) in the United States, estimating the effects of population‐level increases in obesity on incident DM has substantial implications for public health policy. Therefore, we determined the population attributable fraction, which accounts for the prevalence and excess risk of DM associated with obesity. Methods and Results We included non‐Hispanic White, non‐Hispanic Black, and Mexican American participants without DM at baseline from MESA (Multi‐Ethnic Study of Atherosclerosis) with available data on body mass index and key covariates from 2000 to 2017 to calculate unadjusted and adjusted (age, study site, physical activity, diet, income, and education level) hazard ratios (HR) for obesity‐attributable DM. We calculated national age‐adjusted prevalence estimates for obesity using data from NHANES (National Health and Nutrition Examination Survey) in 4 pooled cycles (2001–2016) among adults with similar characteristics to MESA participants. Last, we calculated unadjusted and adjusted population attributable fractions from the race/ethnic and sex‐specific HR and prevalence estimates. Of 4200 MESA participants, the median age was 61 years, 46.8% were men, 53.9% were non‐Hispanic White, 32.9% were non‐Hispanic Black, and 13.3% were Mexican. Among MESA participants, incident DM occurred in 11.6% over a median follow‐up of 9.2 years. The adjusted HR for obesity‐related DM was 2.7 (95% CI, 2.2–3.3). Adjusted population attributable fractions were 0.35 (95% CI, 0.29–0.40) in 2001 to 2004 and 0.41 (95% CI, 0.36–0.46) in 2013 to 2016, and greatest among non‐Hispanic White women. Conclusions The contribution of obesity towards DM in the population remains substantial and varies significantly by race/ethnicity and sex, highlighting the need for tailored public health interventions to reduce obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NC00005487, NCT00005154.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lucia C Petito
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Megan McCabe
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Norrina B Allen
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Matthew J O'Brien
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Mercedes R Carnethon
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
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Cameron NA, Molsberry R, Pierce JB, Perak AM, Grobman WA, Allen NB, Greenland P, Lloyd-Jones DM, Khan SS. Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States. J Am Coll Cardiol 2020; 76:2611-2619. [PMID: 33183896 PMCID: PMC7704760 DOI: 10.1016/j.jacc.2020.09.601] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes. OBJECTIVES The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies. METHODS We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas. RESULTS Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018. CONCLUSIONS Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Molsberry
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, Texas
| | - Jacob B Pierce
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M Perak
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Green RJ, Feldman C, Schoub B, Richards GA, Madhi SA, Zar HJ, Lalloo U, Klugman K, Phillips D, Cameron NA, Eggers RR. Influenza guideline for South Africa--update 2008. S Afr Med J 2008; 98:224-230. [PMID: 18652399] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE The South African Thoracic Society, in conjunction with interested stakeholders, published a Guideline for Influenza Management in Adults in 1999. This year the South African Thoracic Society (SATS) identified the need to revise that guideline for the following reasons: * To indicate the viral strains that are to be incorporated into the vaccine for the 2008 season * To add important new data regarding treatment of influenza * To add a section on influenza in children * To clarify issues in managing and preventing influenza in HIV-infected individuals. INFLUENZA VIRUS The influenza virus genus belongs to the family orthomyxoviridae. The haemagglutinin (HA) protein is the outermost protein, responsible for attachment to the host receptor, and is critical in determining the host's immune response to the virus. Changes in the antigenic epitopes of HA therefore allow the virus to escape the host's specific immune response. The genus is classified into three types, A, B and C, on the basis of the antigenic epitopes of the nucleoprotein (NP). Type A, which is widespread in nature in birds and mammals, is the most important type clinically and epidemiologically. It is further divided into subtypes on the basis of the antigenic epitopes of the HA and neuraminidase (NA) proteins. Each of the human subtypes H1N1, H2N2 and H3N2 are further subdivided into strains on the basis of more subtle antigenic properties of the HA protein. INFLUENZA VACCINATION Influenza vaccine is the mainstay of influenza prevention strategies. All persons who are at high risk of influenza and its complications because of underlying medical conditions or who are receiving regular medical care for conditions such as chronic pulmonary and cardiac disease, chronic renal diseases, neuromuscular diseases, diabetes mellitus and similar metabolic disorders, and individuals who are immunosuppressed (including HIV-infected persons with CD4 counts above 100 cells/microl and HIV-infected children with CD4 counts >15%), should be vaccinated. Vaccines should be given from at least 2 months prior to the onset of autumn (March in South Africa). The recommended vaccine formulation for 2008 is: * A/Solomon Islands/3/2006 (H1N1) (IVR-145) * A/Brisbane/10/2007 (H3N2) (IVR-147) * B/Florida/4/2006 or B/Brisbane/3/2007. TREATMENT OF INFLUENZA Influenza illness is characterised by the acute onset of systemic and respiratory signs occurring in autumn or winter. Recommendations for the Prevention and Control of Influenza have indicated that neither amantadine nor rimantadine should be used for the treatment or chemoprophylaxis of influenza A. NA inhibitors are an important adjunct to influenza vaccination, in both the prevention and treatment of influenza. Because of concerns about the possibility of the development of viral resistance with overuse of these agents, it is recommended that NA inhibitors in the treatment of influenza should be reserved for high-risk or sicker influenza patients.
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Affiliation(s)
- R J Green
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria.
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Schoub BD, Eggers R, Cameron NA, Coovadia HM. The winter 1996 mass immunisation campaign--is it the best strategy for South Africa at this time? S Afr Med J 1996; 86:1129-30; author reply 1131. [PMID: 8888786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Delport SD, Ballard RC, Cameron NA, Rothberg AD. Prevention of congenital syphilis by effective maternal screening at antenatal clinics. S Afr Med J 1993; 83:710-1. [PMID: 8191313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Cameron NA. Population dynamics and the AIDS epidemic. S Afr Med J 1992; 82:205. [PMID: 1519146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Donald PR, Bezuidenhout CJ, Cameron NA. An educational campaign in the Cape Town area to prevent paraffin poisoning. S Afr Med J 1991; 79:281-2. [PMID: 2011810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Mathews C, Kuhn L, Metcalf CA, Joubert G, Cameron NA. Knowledge, attitudes and beliefs about AIDS in township school students in Cape Town. S Afr Med J 1990; 78:511-6. [PMID: 2237683] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Students (N = 377) from four Cape Town township high schools were surveyed to obtain information on their knowledge of and attitudes towards the acquired immunodeficiency syndrome (AIDS), and on their sexual behaviour. The study was undertaken to provide information for planning an AIDS education intervention. Three-quarters of students reported that they had had sexual intercourse. Most students had heard of AIDS, and the majority of these knew that it was infectious. More than half of the students were confused or lacked knowledge about the modes of transmission. Two-thirds of the students believed AIDS could be prevented, but knowledge of prevention strategies was superficial. Of the sexually active students only 11.4% had ever used a condom, and of all students 39.6% stated that they would use a condom in the future. Two-thirds of the students were not aware that there is no cure for AIDS. Students did not acknowledge that AIDS could affect them directly, and attributed the problem to prostitutes and 'promiscuous' people in 36.4% of responses, and to 'white' people in 23.8% of responses. Students expressed intolerance, fear and rejection of people with AIDS, and only 6.4% would accept an affected person into their class. Almost all the students wanted AIDS education at school, and most of these requested that the school nurse facilitate this education. It is concluded that appropriate AIDS prevention education is urgently required for both high school and junior school students.
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Affiliation(s)
- C Mathews
- Centre for Epidemiological Research in South African Medical Research Council, Parowvallei, CP
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Cameron NA. The child health card--a cornerstone of preventive and promotive paediatrics. S Afr Med J 1984; 65:949-50. [PMID: 6729641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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