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O'Callaghan KM, Nowak KG, Dalrymple KV, Poston L, Rigutto-Farebrother J, Quotah OF, White SL, Flynn AC. Vitamin D status of pregnant women with obesity in the United Kingdom and its association with pregnancy outcomes: a secondary analysis of the UPBEAT study. Br J Nutr 2024:1-28. [PMID: 38634258 DOI: 10.1017/s0007114524000862] [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]
Abstract
Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI≥30kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17±1 weeks' gestation were assessed using multivariable linear regression and reported as percent differences in serum hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67% had 25(OH)D <50nmol/L and 26% had concentrations <25nmol/L. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = -33; 95%CI: -39 to -27), Asian (% difference= -43; 95%CI: -51 to -35) and other non-White (% difference= -26; 95%CI: -35 to -14) ethnicity compared to women of White ethnicity (n=1086; P<0.001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D <25nmol/L compared to ≥50nmol/L (OR=1.58; 95%CI: 1.09 to 2.31), but the magnitude of effect estimates was attenuated in the multivariable model (OR=1.33; 95%CI: 0.88 to 2.00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth, or SGA or LGA delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.
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Affiliation(s)
- Karen M O'Callaghan
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Katarzyna G Nowak
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Kathryn V Dalrymple
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | | | - Ola F Quotah
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, United Kingdom
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, London, United Kingdom
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Lorthe E, Severo M, Hamwi S, Rodrigues T, Teixeira C, Barros H. Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal. Int J Public Health 2024; 69:1606296. [PMID: 38577390 PMCID: PMC10991787 DOI: 10.3389/ijph.2024.1606296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
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Affiliation(s)
- Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sousan Hamwi
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Teresa Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Cristina Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Sacchi C, Girardi P, Buri A, De Carli P, Simonelli A. The perinatal health secondary to pandemic: association between women's delivery concerns and infant's behavioral problems. J Reprod Infant Psychol 2024:1-16. [PMID: 38493474 DOI: 10.1080/02646838.2024.2330662] [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] [Received: 08/30/2023] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND COVID-19 pandemic characterised a unique and vulnerable social, emotional, and health environment for pregnancy, with potential long-lasting risks to maternal and child health outcomes. In women who were pregnant at the peak of COVID-19 pandemic, we investigated the association between pandemic-related concerns about pregnancy and delivery and both the parent's (i.e. maternal parenting stress) and the infant's (i.e. emotional-behavioral problems) outcomes 12 months after birth. METHODS A sample of 352 Italian pregnant women completed a web-based survey from 8 April to 4 May 2020 and a follow-up at 12 months after delivery. Maternal assessment in pregnancy covered prenatal measures for: pandemic-related concerns about pregnancy and childbirth, COVID-19 stressful events exposure, pandemic psychological stress, and mental-health symptoms (i.e. depression, anxiety). The 12 months' assessment covered post-partum measures of social support, parenting stress and maternal reports of infants' behavioral problems. RESULTS The results of the Quasi-Poisson regression models on the association between COVID-19 related influencing factors and parenting stress and infant's behavioral problems showed that the presence of higher pandemic-related concerns about pregnancy and childbirth scores was associated with greater total and internalising behavioral problems but not with parenting stress levels. CONCLUSION Perinatal mother-infant health has been sensitively threatened by pandemic consequences with maternal concerns about childbirth in pregnancy being associated with 12 months' children's behavioral outcomes. There is a need to invest in psychological support for perinatal women throughout the transition to parenthood to protect risk conditions before they get chronic or severe and influence offspring development.
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Affiliation(s)
- Chiara Sacchi
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venezia, Italy
| | - Alice Buri
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Pietro De Carli
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
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Wagijo MA, Crone M, Bruinsma-van Zwicht B, van Lith J, Billings D, Rijnders M. The Effect of CenteringPregnancy Group Antenatal Care on Maternal, Birth, and Neonatal Outcomes Among Low-Risk Women in the Netherlands: A Stepped-Wedge Cluster Randomized Trial. J Midwifery Womens Health 2024; 69:191-201. [PMID: 38339816 DOI: 10.1111/jmwh.13582] [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] [Revised: 08/10/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands. METHODS A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes. RESULTS Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group. CONCLUSION Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
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Affiliation(s)
- Mary-Ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | | | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Billings
- Group Care Global, Philadelphia, Pennsylvania
- University of South Carolina, Columbia, South Carolina
| | - Marlies Rijnders
- Department of Child Health, Dutch Organization of Applied Scientific Research, Leiden, The Netherlands
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Moinester M, Stanhope KK. Extending Driver's Licenses to Undocumented Immigrants: Comparing Perinatal Outcomes Following This Policy Shift. J Health Soc Behav 2024:221465241230839. [PMID: 38404178 DOI: 10.1177/00221465241230839] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Research shows that restrictive immigration policies and practices are associated with poor health, but far less is known about the relationship between inclusive immigration policies and health. Using data from the United States natality files, we estimate associations between state laws granting undocumented immigrants access to driver's licenses and perinatal outcomes among 4,047,067 singleton births to Mexican and Central American immigrant birthing people (2008-2021). Fitting multivariable log binomial and linear models, we find that the implementation of a license law is associated with improvements in low birthweight and mean birthweight. Replicating these analyses among U.S.-born non-Hispanic White birthing people, we find no association between the implementation of a license law and birthweight. These findings support the hypothesis that states' extension of legal rights to immigrants improves the health of the next generation.
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Daalderop LA, Lagendijk J, Steegers EAP, El Marroun H, Posthumus AG. Psychological distress during pregnancy and adverse maternal and perinatal health outcomes: The role of socioeconomic status. Int J Gynaecol Obstet 2023; 163:920-930. [PMID: 37259252 DOI: 10.1002/ijgo.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To study the contribution of socioeconomic status (SES) to the prevalence of psychological distress during pregnancy, and to investigate the association between psychological distress and maternal and perinatal health among different SES groups. METHODS This study was embedded in the Generation R study. Multiple self-reported questionnaires were used to measure psychological distress. Prevalence differences between SES groups were tested with the χ2 test. Linear and logistic regression analyses were used to examine the associations between psychological distress and maternal and perinatal health outcomes. RESULTS Women of low SES experience symptoms of psychopathology distress 4.5 times as often and symptoms of stress 2.5 times as often as women with of high SES. Women of low SES experiencing symptoms of psychopathology are at greater risk of delivering preterm. We also found associations between psychological distress and adverse perinatal health outcomes among women of middle and high SES. CONCLUSION The present study shows that the associations between SES, psychological distress, and maternal and perinatal health are complex, but do exist. To provide a better understanding of these associations, it is important to include mental health information in the standard national data collection on pregnant women, as this allows population-based studies.
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Affiliation(s)
- Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, University Medical Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anke G Posthumus
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Gailey S. Changes in Residential Greenspace and Birth Outcomes among Siblings: Differences by Maternal Race. Int J Environ Res Public Health 2023; 20:6790. [PMID: 37754649 PMCID: PMC10531468 DOI: 10.3390/ijerph20186790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023]
Abstract
Growing research investigates the perinatal health benefits of greenspace in a mother's prenatal environment. However, evidence of associations between residential greenspace and birth outcomes remains mixed, limiting the relevance this work holds for urban policy and greening interventions. Past research relies predominantly on cross-sectional designs that are vulnerable to residential selection bias, and rarely tests effect modification by maternal race/ethnicity, which may contribute to heterogeneous findings. This study uses a rigorous, longitudinal sibling comparison design and maternal fixed effect analyses to test whether increases in maternal exposure to residential greenspace between pregnancies precede improved birth outcomes among non-Hispanic (NH) white (n = 247,285) and Black (n = 54,995) mothers (mean age = 28 years) who had at least two consecutive live births in California between 2005 and 2015. Results show that increases in residential greenspace correspond with higher birthweight (coef. = 75.49, 95% CI: 23.48, 127.50) among Black, but not white (coef. = -0.51, 95% CI: -22.90, 21.90), infants. Additional analyses suggest that prior evidence of perinatal benefits associated with residential greenspace among white mothers may arise from residential selection; no such bias is observed for Black mothers. Taken together, these findings support urban greening initiatives in historically under-resourced neighborhoods. Efforts to evenly distribute residential greenspace may reduce persistent racial disparities in birth outcomes, an important step towards promoting health equity across the life course.
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Affiliation(s)
- Samantha Gailey
- Department of Forestry, Michigan State University, East Lansing, MI 48824, USA;
- Department of Public Health, Michigan State University, Flint, MI 48502, USA
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Strout N, Pasic L, Hicks C, Chua XY, Tashvighi N, Butler P, Liu Z, El-Assaad F, Holmes E, Susic D, Samaras K, Craig ME, Davis GK, Henry A, Ledger WL, El-Omar EM. The MothersBabies Study, an Australian Prospective Cohort Study Analyzing the Microbiome in the Preconception and Perinatal Period to Determine Risk of Adverse Pregnancy, Postpartum, and Child-Related Health Outcomes: Study Protocol. Int J Environ Res Public Health 2023; 20:6736. [PMID: 37754596 PMCID: PMC10531411 DOI: 10.3390/ijerph20186736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
The microbiome has emerged as a key determinant of human health and reproduction, with recent evidence suggesting a dysbiotic microbiome is implicated in adverse perinatal health outcomes. The existing research has been limited by the sample collection and timing, cohort design, sample design, and lack of data on the preconception microbiome. This prospective, longitudinal cohort study will recruit 2000 Australian women, in order to fully explore the role of the microbiome in the development of adverse perinatal outcomes. Participants are enrolled for a maximum of 7 years, from 1 year preconception, through to 5 years postpartum. Assessment occurs every three months until pregnancy occurs, then during Trimester 1 (5 + 0-12 + 6 weeks gestation), Trimester 2 (20 + 0-24 + 6 weeks gestation), Trimester 3 (32 + 0-36 + 6 weeks gestation), and postpartum at 1 week, 2 months, 6 months, and then annually from 1 to 5 years. At each assessment, maternal participants self-collect oral, skin, vaginal, urine, and stool samples. Oral, skin, urine, and stool samples will be collected from children. Blood samples will be obtained from maternal participants who can access a study collection center. The measurements taken will include anthropometric, blood pressure, heart rate, and serum hormonal and metabolic parameters. Validated self-report questionnaires will be administered to assess diet, physical activity, mental health, and child developmental milestones. Medications, medical, surgical, obstetric history, the impact of COVID-19, living environments, and pregnancy and child health outcomes will be recorded. Multiomic bioinformatic and statistical analyses will assess the association between participants who developed high-risk and low-risk pregnancies, adverse postnatal conditions, and/or childhood disease, and their microbiome for the different sample types.
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Affiliation(s)
- Naomi Strout
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Lana Pasic
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Chloe Hicks
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Xin-Yi Chua
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Niki Tashvighi
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Phoebe Butler
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Zhixin Liu
- UNSW Stats Central, Biological Sciences South Building (E26), Level 2 Kensington, UNSW Sydney, Sydney, NSW 2052, Australia
- Healthdirect Australia, Level 4, 477 Pitt Street, Sydney, NSW 2000, Australia
| | - Fatima El-Assaad
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
| | - Elaine Holmes
- The Australian National Phenome Centre, Harry Perkins Institute, Murdoch University, Perth, WA 6150, Australia;
| | - Daniella Susic
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
- Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW 2217, Australia; (G.K.D.); (A.H.)
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; (M.E.C.); (W.L.L.)
| | - Katherine Samaras
- Complex Diseases Program, Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia;
- Department of Endocrinology, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- St Vincent’s Clinical Campus, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Maria E. Craig
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; (M.E.C.); (W.L.L.)
| | - Gregory K. Davis
- Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW 2217, Australia; (G.K.D.); (A.H.)
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; (M.E.C.); (W.L.L.)
| | - Amanda Henry
- Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW 2217, Australia; (G.K.D.); (A.H.)
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; (M.E.C.); (W.L.L.)
| | - William L. Ledger
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; (M.E.C.); (W.L.L.)
| | - Emad M. El-Omar
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, UNSW Sydney, Sydney, NSW 2052, Australia; (N.S.); (L.P.); (C.H.); (X.-Y.C.); (F.E.-A.); (D.S.)
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Tailor LS, Fajardo RG, Ray JG, Malhamé I, Grandi SM. Accuracy of aspirin prophylaxis for preeclampsia prevention documentation within a large administrative dataset. Paediatr Perinat Epidemiol 2023. [PMID: 37587742 DOI: 10.1111/ppe.13003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Low-dose aspirin prophylaxis is recommended for women at risk of preeclampsia. Capturing aspirin prophylaxis within administrative databases can be challenging since it is an over-the-counter medication. The Better Outcome Registry and Network (BORN) database, a perinatal health registry in Ontario, Canada, includes a formal variable that captures aspirin prophylaxis for preeclampsia. This variable has not been formally validated. OBJECTIVES To assess the accuracy of the aspirin prophylaxis variable in the BORN database against an electronic medical record (EMR). METHODS This validation study comprised 200 randomly selected women who had a livebirth at St. Michael's Hospital (SMH) in Toronto, Ontario, from January 2018 to July 2022. Recorded aspirin prophylaxis in pregnancy and maternal sociodemographic characteristics were independently extracted by two abstractors. Accuracy of aspirin prophylaxis use in the BORN database was compared to that in the SMH EMR, expressed as sensitivity, specificity, positive (PPV) and negative predictive values (NPV), Cohen's kappa (κ), and overall percent agreement, with 95% confidence intervals (CI). Sensitivity analyses were performed to account for missing or unclear aspirin prophylaxis use. RESULTS Among 200 women, 24 (12.0%) received aspirin prophylaxis - 12.5% within the SMH EMR and 8.0% in the BORN database. Women using aspirin were older (37.0 vs 33.0 years) and had higher median gravidity (3 vs. 2). Sensitivity and specificity of the BORN aspirin prophylaxis variable were 62.5% (95% CI 40.6, 81.2) and 100.0% (95% CI 97.3, 100.0), respectively. The corresponding positive and negative predictive values were 100.0% (95% CI 78.2, 100.0), and 93.8% (95% CI 88.6, 97.1), respectively. Cohen's κ was 0.74 (95% CI 0.58, 0.90), and overall percent agreement was 94.4% (95% CI 87.1, 100.0). CONCLUSIONS Aspirin use within the BORN database, based on a standard variable field, appears accurate enough for the potential use in epidemiological studies of aspirin prophylaxis for preeclampsia or as a covariate in related studies.
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Affiliation(s)
- Lauren S Tailor
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Child Health Evaluative Sciences, Ontario, Toronto, Canada
| | - Renee G Fajardo
- The Hospital for Sick Children, Child Health Evaluative Sciences, Ontario, Toronto, Canada
- Faculty of Science and the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joel G Ray
- The Hospital for Sick Children, Child Health Evaluative Sciences, Ontario, Toronto, Canada
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynaecology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Malhamé
- McGill University, McGill University Health Centre, Quebec, Montreal, Canada
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
| | - Sonia M Grandi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Child Health Evaluative Sciences, Ontario, Toronto, Canada
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Foti TR, Watson C, Adams SR, Rios N, Staunton M, Wei J, Sterling SA, Ridout KK, Young-Wolff KC. Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use. Int J Environ Res Public Health 2023; 20:6289. [PMID: 37444136 PMCID: PMC10341286 DOI: 10.3390/ijerph20136289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by resilience. The sample comprised pregnant patients in two pilot studies screened for eight ACEs and resilience during standard prenatal care in Kaiser Permanente Northern California from 1 March 2016 to 30 July 2016 (Study 1, medical centers A, B) and from 1 April 2018 to 31 March 2019 (Study 2, medical centers A, C). Early pregnancy outcomes included anxiety and depressive disorders, depression symptoms, intimate partner violence (IPV), and substance use. Multivariable logistic regression was used in this cross-sectional study to examine associations between maternal ACEs (0, 1-2, ≥3) and mental/behavioral health outcomes overall and among those with low and high resilience. Patients (n = 1084) averaged 30.8 years (SD 5.1); 41.7% were non-Hispanic White; 41.7% experienced ≥1 ACE, and 40.3% had low resilience. Patients with 1-2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use (OR 1.44-4.40, p < 0.05). Each individual ACE was associated with ≥2 mental/behavioral health outcomes. In stratified analyses, having ≥1 ACE (vs. 0) was associated with a greater number of mental/behavioral health outcomes among patients with low versus high resilience. ACEs were associated with prenatal mental/behavioral health conditions, particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.
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Affiliation(s)
- Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Carey Watson
- Obstetrics and Gynecology, Kaiser Permanente, Antioch Medical Center, Antioch, CA 94531, USA
| | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Normelena Rios
- Obstetrics and Gynecology, Kaiser Permanente, Dublin Medical Center, Dublin, CA 94568, USA
| | - Mary Staunton
- Department of Psychiatry, Kaiser Permanente, Walnut Creek Medical Center, Walnut Creek, CA 94596, USA
| | - Julia Wei
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kathryn K. Ridout
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry, Kaiser Permanente, Santa Rosa Medical Center, Santa Rosa, CA 95403, USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
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Moore MD, Hall AG, Wingate MS, Ford EW. Achieving Consensus Among Stakeholders Using the Nominal Group Technique: A Perinatal Quality Collaborative Approach. Qual Manag Health Care 2023; 32:161-169. [PMID: 36007140 PMCID: PMC9950289 DOI: 10.1097/qmh.0000000000000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Public health systems exhibiting strong connections across the workforce experience substantial population health improvements. This is especially important for improving quality and achieving value among vulnerable populations such as mothers and infants. The purpose of this research was to demonstrate how Alabama's newly formed perinatal quality collaborative (Alabama Perinatal Quality Collaborative [ALPQC]) used evidenced-based processes to achieve consensus in identifying population quality improvement (QI) initiatives. METHODS This multiphase quantitative and qualitative study engaged stakeholders (n = 44) at the ALPQC annual meeting. Maternal and neonatal focused QI project topics were identified and catalogued from active perinatal quality collaborative websites. The Delphi method and the nominal group technique (NGT) were used to prioritize topics using selected criteria ( impact , enthusiasm , alignment , and feasibility ) and stakeholder input. RESULTS Using the Delphi method, 11 of 27 identified project topics met inclusion criteria for stakeholder consideration. Employing the NGT, maternal projects received more total votes (n = 535) than neonatal projects (n = 313). Standard deviations were higher for neonatal projects (SD: feasibility = 10.9, alignment = 17.9, enthusiasm = 19.2, and impact = 22.1) than for maternal projects (SD: alignment = 5.9, enthusiasm = 7.3, impact = 7.9, and feasibility = 11.1). Hypertension in pregnancy (n = 117) and neonatal abstinence syndrome (n = 177) achieved the most votes total and for impact (n = 35 and n = 54, respectively) but variable support for feasibility . CONCLUSIONS Together, these techniques achieved valid consensus across multidisciplinary stakeholders in alignment with state public health priorities. This model can be used in other settings to integrate stakeholder input and enhance the value of a common population QI agenda.
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Affiliation(s)
- Matthew D. Moore
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Allyson G. Hall
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham
| | - Martha S. Wingate
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Eric W. Ford
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
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12
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Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. Int J Environ Res Public Health 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
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Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
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13
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Vilcassim MJR, Stowe S, Majumder R, Subramaniam A, Sinkey RG. Electronic Cigarette Use during Pregnancy: Is It Harmful? Toxics 2023; 11:278. [PMID: 36977043 PMCID: PMC10058591 DOI: 10.3390/toxics11030278] [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] [Received: 03/01/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
Although combustible cigarette smoking rates have declined in recent years, alternative tobacco product use, particularly electronic cigarette use ("vaping"), has increased among young adults. Recent studies indicate that vaping during pregnancy is on the rise, possibly due to the perception that it is a safer alternative to combustible cigarette smoking. However, e-cigarette aerosols may contain several newer, potentially toxic compounds, including some known developmental toxicants that may adversely impact both the mother and the fetus. However, there is paucity of studies that have examined the effects of vaping during pregnancy. While the adverse perinatal outcomes of cigarette smoking during pregnancy are well established, the specific risks associated with inhaling vaping aerosols during pregnancy requires more research. In this article, we discuss the existing evidence and knowledge gaps on the risks of vaping during pregnancy. Studies that investigate vaping-associated systemic exposure and its effects (i.e., biomarker analyses) and maternal and neonatal clinical health outcomes are needed to reach more robust conclusions. We particularly emphasize the need to go beyond comparative studies with cigarettes, and advocate for research that objectively evaluates the safety of e-cigarettes and other alternative tobacco products.
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Affiliation(s)
- M. J. Ruzmyn Vilcassim
- Department of Environmental Health Sciences, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Samuel Stowe
- Department of Environmental Health Sciences, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Rachel Majumder
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Akila Subramaniam
- Center for Women’s Reproductive Health, Division of Maternal Fetal Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.S.); (R.G.S.)
| | - Rachel G. Sinkey
- Center for Women’s Reproductive Health, Division of Maternal Fetal Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.S.); (R.G.S.)
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14
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Foti TR, Cragun D, Mackie J, Agu N, Bell M, Marshall J. Personas of pregnant and parenting women with substance use and their barriers and pathways to system engagement. Birth 2023; 50:99-108. [PMID: 36625522 DOI: 10.1111/birt.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with prenatal substance use have been identified as at-risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing. METHODS To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member-checking sessions were transcribed verbatim and analyzed manually. RESULTS Six journey-mapping workshops and two member-checking meetings with mothers in-recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in-recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified. CONCLUSIONS While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed-member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations.
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Affiliation(s)
- Tara R Foti
- Kaiser Permanente of Northern California, Oakland, California, USA
| | - Deborah Cragun
- University of South Florida College of Public Health, Tampa, Florida, USA
| | | | - Ngozichukwuka Agu
- University of South Florida College of Public Health, Tampa, Florida, USA
| | - Megan Bell
- InSync Healthcare Solutions, Tampa, Florida, USA
| | - Jennifer Marshall
- University of South Florida College of Public Health, Tampa, Florida, USA
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15
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Mavragani A, Eysenbach G, Li Q, Su T, Yang J, Chen J, Peng Y, Zhou S, Bao H, Luo S, Wang H, Liu J, Han N, Guo Y, Ji Y. Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study. JMIR Public Health Surveill 2023; 9:e41442. [PMID: 36689262 PMCID: PMC9903185 DOI: 10.2196/41442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). OBJECTIVE We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. METHODS Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure-reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. RESULTS A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 μg/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. CONCLUSIONS Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs.
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Affiliation(s)
| | | | - Qin Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Tao Su
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Jie Yang
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Junjun Chen
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Heling Bao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Na Han
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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16
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Malange VNE, Hedermann G, Lausten-Thomsen U, Hoffmann S, Voldstedlund M, Aabakke AJM, Eltvedt AK, Jensen JS, Breindahl M, Krebs L, Christiansen M, Hedley PL. The perinatal health challenges of emerging and re-emerging infectious diseases: A narrative review. Front Public Health 2023; 10:1039779. [PMID: 36684933 PMCID: PMC9850110 DOI: 10.3389/fpubh.2022.1039779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
The world has seen numerous infectious disease outbreaks in the past decade. In many cases these outbreaks have had considerable perinatal health consequences including increased risk of preterm delivery (e.g., influenza, measles, and COVID-19), and the delivery of low birth weight or small for gestational age babies (e.g., influenza, COVID-19). Furthermore, severe perinatal outcomes including perinatal and infant death are a known consequence of multiple infectious diseases (e.g., Ebola virus disease, Zika virus disease, pertussis, and measles). In addition to vaccination during pregnancy (where possible), pregnant women, are provided some level of protection from the adverse effects of infection through community-level application of evidence-based transmission-control methods. This review demonstrates that it takes almost 2 years for the perinatal impacts of an infectious disease outbreak to be reported. However, many infectious disease outbreaks between 2010 and 2020 have no associated pregnancy data reported in the scientific literature, or pregnancy data is reported in the form of case-studies only. This lack of systematic data collection and reporting has a negative impact on our understanding of these diseases and the implications they may have for pregnant women and their unborn infants. Monitoring perinatal health is an essential aspect of national and global healthcare strategies as perinatal life has a critical impact on early life mortality as well as possible effects on later life health. The unpredictable nature of emerging infections and the potential for adverse perinatal outcomes necessitate that we thoroughly assess pregnancy and perinatal health implications of disease outbreaks and their public health interventions in tandem with outbreak response efforts. Disease surveillance programs should incorporate perinatal health monitoring and health systems around the world should endeavor to continuously collect perinatal health data in order to quickly update pregnancy care protocols as needed.
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Affiliation(s)
| | - Gitte Hedermann
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Lausten-Thomsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steen Hoffmann
- Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | | | - Anna J. M. Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Holbæk, Holbæk, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna K. Eltvedt
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Global Health Unit, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen S. Jensen
- Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Breindahl
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Krebs
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Michael Christiansen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Paula L. Hedley
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Brazen Bio, Los Angeles, CA, United States
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17
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Hoang TMH, Wong A. Exploring the Application of Intersectionality as a Path toward Equity in Perinatal Health: A Scoping Review. Int J Environ Res Public Health 2022; 20:685. [PMID: 36613005 PMCID: PMC9819722 DOI: 10.3390/ijerph20010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To conduct a scoping review to determine how past studies have applied the theory of intersectionality, a critical feminist research paradigm, to understand the physical health and mental health outcomes of perinatal people as a step toward addressing maternal health disparities and injustice. The study includes a review of existing research on maternal physical and mental health outcomes, presents the strengths and limitations of existing studies, and provides recommendations on best practices in applying intersectionality in research to address systemic issues and improve outcomes for the perinatal population. METHODS We conducted an extensive literature search across four search engines, yielding 28 publications using the intersectionality framework that focused on the outcomes of perinatal people, with a total sample of 9,856,042 participants. We examined how these studies applied intersectionality and evaluated them based on three areas: conceptualization, research method, and interpretation/findings. RESULTS Our findings indicate that maternal health researchers have provided good descriptions of the interaction of systemic inequalities and have used analysis that allows for the examination of interlocking and mutually reinforcing social positions or systems. We find that improvement is needed in the areas of conceptualization, reflexivity, and understanding of power structure. Recommendations are provided in the form of a checklist to guide future research toward an impactful approach to addressing perinatal health disparities. RELEVANCE Our scoping review has implications for improving applied health research to address perinatal health disparities, mortality, and morbidity. Recommendations are given along with references to other tools, and a guidance checklist is provided to support scholars in creating an impactful approach to applying intersectionality in the goal of addressing maternal health disparities.
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Affiliation(s)
- Tuyet-Mai H. Hoang
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Ainslee Wong
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
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18
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Sasaki N, Akiyama H, Kawakami N, Nishi D. Preconception menstrual cycle disorder and antenatal depression: a cross-sectional study with prerecorded information. J Psychosom Obstet Gynaecol 2022; 43:411-418. [PMID: 34882063 DOI: 10.1080/0167482x.2021.2010699] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between pre-pregnancy menstrual cycle characteristics (i.e. cycle-length variability and cycle length) and antenatal depression. METHODS This study retrieved the data from the baseline survey of the randomized controlled trial with pregnant women at 16-20 weeks gestation who used a pregnancy tracking app. The antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 16-20 weeks gestation, and the cutoff point of 10/11 was adopted. Pre-conceptional menstrual cycle information was obtained via a prerecorded period tracking app. Cycle-length variability was defined as the average difference in the lengths between cycles, dichotomized into regular (≤6 days) and irregular (>6 days). Cycle length was coded as a categorical variable: <25 days, 25-26 days, 27-29 days (regular), 30-31 days, 32-33 days, and 34+ days. The associations of cycle disorders with EPDS scores were examined using regression analysis and a multiple logistic regression model adjusted for covariates. RESULTS The total of 3473 participants were analyzed in this study. Irregular cycle variability (>6 days) was significantly associated with high EPDS scores (adjusted: standardized beta = 0.049, p = 0.003) and with high cutoff EPDS scores (over 11) (adjusted OR = 1.40 [1.02-1.94], p = 0.038) but not with cycle length. CONCLUSION Irregular menstrual cycle before pregnancy was associated with depression during pregnancy. The health of the menstrual cycle during preconception needs to be further explored to promote healthy maternal mental health.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroto Akiyama
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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19
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Souza RT, Brasileiro M, Ong M, Delaney L, Vieira MC, Dias MAB, Pasupathy D, Cecatti JG. Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade. Int J Gynaecol Obstet 2022; 161:711-725. [PMID: 36373189 DOI: 10.1002/ijgo.14573] [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] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Melissa Ong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Louisa Delaney
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK.,Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
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20
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Headen IE, Elovitz MA, Battarbee AN, Lo JO, Debbink MP. Racism and perinatal health inequities research: where we have been and where we should go. Am J Obstet Gynecol 2022; 227:560-570. [PMID: 35597277 PMCID: PMC9529822 DOI: 10.1016/j.ajog.2022.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
For more than a century, substantial racial and ethnic inequities in perinatal health outcomes have persisted despite technical clinical advances and changes in public health practice that lowered the overall incidence of morbidity. Race is a social construct and not an inherent biologic or genetic reality; therefore, racial differences in health outcomes represent the consequences of structural racism or the inequitable distribution of opportunities for health along racialized lines. Clinicians and scientists in obstetrics and gynecology have a responsibility to work to eliminate health inequities for Black, Brown, and Indigenous birthing people, and fulfilling this responsibility requires actionable evidence from high-quality research. To generate this actionable evidence, the research community must realign paradigms, praxis, and infrastructure with an eye directed toward reproductive justice and antiracism. This special report offers a set of key recommendations as a roadmap to transform perinatal health research to achieve health equity. The recommendations are based on expert opinion and evidence presented at the State of the Science Research Symposium at the 41st Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine in 2021. Recommendations fall into 3 broad categories-changing research paradigms, reforming research praxis, and transforming research infrastructure-and are grounded in a historic foundation of the advances and shortcomings of clinical, public health, and sociologic scholarship in health equity. Changing the research paradigm requires leveraging a multidisciplinary perspective on structural racism; promoting mechanistic research that identifies the biologic pathways perturbed by structural racism; and utilizing conceptual models that account for racism as a factor in adverse perinatal outcomes. Changing praxis approaches to promote and engage multidisciplinary teams and to develop standardized guidelines for data collection will ensure that paradigm shifts center the historically marginalized voices of Black, Brown, and Indigenous birthing people. Finally, infrastructure changes that embed community-centered approaches are required to make shifts in paradigm and praxis possible. Institutional policies that break down silos and support true community partnership, and also the alignment of institutional, funding, and academic publishing objectives with strategic priorities for perinatal health equity, are paramount. Achieving health equity requires shifting the structures that support the ecosystem of racism that Black, Brown, and Indigenous birthing people must navigate before, during, and after childbearing. These structures extend beyond the healthcare system in which clinicians operate day-to-day, but they cannot be excluded from research endeavors to create the actionable evidence needed to achieve perinatal health equity.
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Affiliation(s)
- Irene E Headen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Michal A Elovitz
- Center for Research in Reproduction and Women's health, Department of Obstetrics and Gynecology and Microbiology, University of Pennsylvania, Philadelphia, PA
| | - Ashley N Battarbee
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Michelle P Debbink
- Department of Obstetrics and Gynecology, The University of Utah Health, Salt Lake City, UT.
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21
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Gemmill A, Casey JA, Catalano R, Karasek D, Margerison CE, Bruckner T. Changes in preterm birth and caesarean deliveries in the United States during the SARS-CoV-2 pandemic. Paediatr Perinat Epidemiol 2022; 36:485-489. [PMID: 34515360 PMCID: PMC8662112 DOI: 10.1111/ppe.12811] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Preliminary studies suggest that the SARS-CoV-2 pandemic and associated social, economic and clinical disruptions have affected pregnancy decision-making and outcomes. Whilst a few US-based studies have examined regional changes in birth outcomes during the pandemic's first months, much remains unknown of how the pandemic impacted perinatal health indicators at the national-level throughout 2020, including during the 'second wave' of infections that occurred later in the year. OBJECTIVES To describe changes in monthly rates of perinatal health indicators during the 2020 pandemic for the entire US. METHODS For the years 2015 to 2020, we obtained national monthly rates (per 100 births) for four perinatal indicators: preterm (<37 weeks' gestation), early preterm (<34 weeks' gestation), late preterm (34-36 weeks' gestation) and caesarean delivery. We used an interrupted time-series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred for March through December of 2020. RESULTS Observed rates of preterm birth fell below expectation across several months of the 2020 pandemic. These declines were largest in magnitude in early and late 2020, with a 5%-6% relative difference between observed and expected occurring in March and November. For example, in March 2020, the observed preterm birth rate of 9.8 per 100 live births fell below the 95% prediction interval (PI) of the rate predicted from history, which was 10.5 preterm births per 100 live births (95% PI 10.2, 10.7). We detected no changes from expectation in the rate of caesarean deliveries. CONCLUSIONS Our findings provide nationwide evidence of unexpected reductions in preterm delivery during the 2020 SARS-CoV-2 pandemic in the US. Observed declines below expectation were differed by both timing of delivery and birth month, suggesting that several mechanisms, which require further study, may explain these patterns.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Joan A. Casey
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Ralph Catalano
- School of Public HealthUniversity of California, BerkeleyBerkeleyCAUSA
| | - Deborah Karasek
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCAUSA,California Preterm Birth InitiativeUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Claire E. Margerison
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
| | - Tim Bruckner
- Program in Public HealthUniversity of California, IrvineIrvineCAUSA
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22
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Gemmill A, Casey JA, Margerison CE, Zeitlin J, Catalano R, Bruckner TA. Patterned Outcomes, Unpatterned Counterfactuals, and Spurious Results: Perinatal Health Outcomes Following COVID-19. Am J Epidemiol 2022; 191:1837-1841. [PMID: 35762139 PMCID: PMC9278230 DOI: 10.1093/aje/kwac110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
The epidemiologic literature estimating the indirect or secondary effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant people and gestation continues to grow. Our assessment of this scholarship, however, leads us to suspect that the methods most commonly used may lead researchers to spurious inferences. This suspicion arises because the methods do not account for temporal patterning in perinatal outcomes when deriving counterfactuals, or estimates of the outcomes had the pandemic not occurred. We illustrate the problem in 2 ways. First, using monthly data from US birth certificates, we describe temporal patterning in 5 commonly used perinatal outcomes. Notably, for all but 1 outcome, temporal patterns appear more complex than much of the emerging literature assumes. Second, using data from France, we show that using counterfactuals that ignore this complexity produces spurious results. We recommend that subsequent investigations on COVID-19 and other perturbations use widely available time-series methods to derive counterfactuals that account for strong temporal patterning in perinatal outcomes.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States,Correspondence to Alison Gemmill, Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Room E4148, Baltimore, MD 21205 (e-mail: )
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, United States
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Université de Paris and Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, Berkeley, California, United States
| | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, Irvine, California, United States
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23
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García MH, Petersen JM, Parker SE, Rubenstein E, Werler MM. Medication use during pregnancy among women with congenital physical disabilities. Birth Defects Res 2022; 114:785-796. [PMID: 35652163 DOI: 10.1002/bdr2.2048] [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] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication use during pregnancy is common, with up to 90% of pregnant women taking at least one medication. Women with congenital physical disabilities often report co-occurring conditions during pregnancy that may warrant pharmaceutical treatment, however, research is limited. We aim to describe medication use during pregnancy including: pain, psychotropic, and antibacterial medication, among women with and without congenital physical disabilities. METHODS We used data from the Slone Birth Defects Study (1976-2015), a case-control study that collected information on pre-pregnancy health conditions and exposures among participating mothers. Women with congenital physical disabilities (n = 132) included women with spina bifida, cerebral palsy, muscular dystrophy, limb deficiencies, and other skeletal/connective tissue conditions and were matched by interview year and study site to women without congenital physical disabilities (n = 528). Proportions and difference in proportions for each medication were compared between groups. Simple proportions were also calculated for duration and multiple medication use variables. RESULTS Women with congenital physical disabilities more frequently reported use of pain (acetaminophen and opioids), psychotropic (antidepressants), and antibacterial medications during pregnancy. Women with congenital physical disabilities used pain and psychotropic medications for longer, frequent durations, and more frequently reported haven taken multiple medications during pregnancy. CONCLUSION Women with congenital physical disabilities report higher medication use during pregnancy compared to women without physical disabilities. Patterns may be attributable to co-occurring conditions or increased risk of pregnancy complications in this population. Further research is needed to describe the patterns of medication use for clinical decisions regarding treatment of pregnant women with disabilities.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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24
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Wagijo MR, Crone MR, van Zwicht BS, van Lith JMM, Schindler Rising S, Rijnders MEB. CenteringPregnancy in the Netherlands: Who engages, who doesn't, and why. Birth 2022; 49:329-340. [PMID: 35092071 PMCID: PMC9306804 DOI: 10.1111/birt.12610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. METHODS Data from a stepped-wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. RESULTS A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%-53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. CONCLUSION A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.
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Affiliation(s)
| | | | | | - Jan M. M. van Lith
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
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25
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Talmont E, Vitale TR. Telehealth Readiness Assessment of Perinatal Nurses. Nurs Womens Health 2022; 26:86-94. [PMID: 35143778 DOI: 10.1016/j.nwh.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess telehealth readiness among perinatal nurses in New Jersey. DESIGN Cohort survey study. SETTING/LOCAL PROBLEM New Jersey was one of the hardest hit areas in the early months of the COVID-19 pandemic. Telehealth represented an opportunity to provide continuity of perinatal care at a time when health care was significantly disrupted. PARTICIPANTS Perinatal nurses in New Jersey. INTERVENTION/MEASUREMENTS The intervention was a five-part, 90-question online survey provided via e-mail invitation to New Jersey State Nursing Association members. Data were collected from June 25 to July 9, 2020. Descriptive statistics, frequency analyses, a Mann-Whitney test on nonparametric measures of groups by age, and a one-tailed t test were completed. Results of the Telehealth Readiness Assessment tool were calculated. Open-text responses were organized and used to illustrate the findings. RESULTS Fifty-two perinatal nurses responded to the survey. Twenty-two (42%) completed all 90 questions. Partial answers were accepted. Synchronous live telehealth expanded 66% in the wake of COVID-19. Results showed that 37% (n = 15) of participants used telehealth at work, and 27% (n = 11) used it in getting care for themselves or a family member (M = 2.0, SD = 0.86; one-tailed t test, p = .25). In comparing nervousness in using technology with age, scores for those younger than 45 years (Mdn = 3) and those older than 45 years (Mdn = 2) showed no statistically significant difference, U(n<45years = 15, n≥45 years = 17) = 11, z = -0.02, p < .83. Overall, 46% (n = 26) indicated that telehealth could be extremely helpful or very helpful in reducing health care disparities and improving quality. Overall, telehealth readiness was ranked almost ready. CONCLUSION A telehealth readiness assessment may identify barriers and opportunities that can predict success and failure. Nurses generally accept technology and believe that telehealth could be useful in reducing poor maternal health outcomes and health care disparities.
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Tankink JB, Verschuuren AEH, Postma IR, van der Lans PJA, de Graaf JP, Stekelenburg J, Mesman AW. Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph182412933. [PMID: 34948540 PMCID: PMC8700803 DOI: 10.3390/ijerph182412933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy.
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Affiliation(s)
- Julia B. Tankink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Anouk E. H. Verschuuren
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Ineke R. Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Peggy J. A. van der Lans
- Department of Obstetrics and Gynecology, Hospital Twente ZGT/MST, 7512 KZ Enschede, The Netherlands;
| | - Johanna P. de Graaf
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Annelies W. Mesman
- Netherlands Association for Community Health Services (GGD GHOR Nederland), Zwarte Woud 2, 3524 SJ Utrecht, The Netherlands;
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Kinge JM, Grytten J. The impact of primary care physician density on perinatal health: Evidence from a natural experiment. Health Econ 2021; 30:2974-2994. [PMID: 34498332 DOI: 10.1002/hec.4426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
We examined the impact of primary care physician density on perinatal health outcomes in Norway. From 1992 and onwards, primary care physicians who chose to work in selected remote municipalities were given an annual reduction in their student loan. This reduction, combined with increased supply of physicians, led to an increase in the density of primary care physicians in these selected municipalities. Our register-based population study showed that this increase in physician density significantly improved perinatal health in terms of fewer fetal deaths and increased birth weight. The richness of the data allowed us to perform several robustness tests.
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Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health and University of Oslo, Oslo, Norway
| | - Jostein Grytten
- University of Oslo, Norway and Akershus University Hospital, Lørenskog, Norway
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28
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Das R, Farzana FD, Sultana Z, Mukherji K, Baayo A, Sultana M, Ali N, Chisti MJ, Sarker SA, Ahmed T, Faruque A. Evaluation of SIMESON, a training program to improve access to quality health care for pregnant women and newborn in different healthcare facilities of northern Bangladesh. Nurs Open 2021; 9:801-815. [PMID: 34784452 PMCID: PMC8685868 DOI: 10.1002/nop2.1131] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 01/02/2023] Open
Abstract
Aim The study aims to explore the current knowledge and skills of healthcare providers already trained by SIMESON (simulation for essential skills for obstetrical and neonatal care), in reviewing perinatal health situations including current status of healthcare facilities and cost estimation. Design It was an observational study. Methods Cost estimation following both quantitative and qualitative approaches was also attempted. Result Knowledge and skills of 88 healthcare providers about the provision of normal delivery and immediate postpartum care, management of postpartum haemorrhage (PPH), retained placenta and use of bag and mask ventilation to help a baby breathe were found to be considerably strengthened following SIMESON training. During the 6 months after training, there were 477 PPH cases managed successfully with only one death; neonatal deaths observed were 6.6/1,000 live births; twice the number of facility deliveries; and 80% use rate of Ambu bag for helping baby breathe. The estimated cost per trainee was 395.68 USD, and 5.85 USD per beneficiary.
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Affiliation(s)
- Rina Das
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Fahmida Dil Farzana
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Zakia Sultana
- Terre des hommes foundation (Tdh), Dhaka, Bangladesh
| | | | - Adnan Baayo
- Terre des hommes foundation (Tdh), Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | | | - Shafiqul Alam Sarker
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Asg Faruque
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Skelton KR, Benjamin-Neelon SE. Characteristics Associated with Prenatal Cannabis Use Vary with Legality of Recreational Cannabis. J Womens Health (Larchmt) 2021; 30:1565-1572. [PMID: 34449272 DOI: 10.1089/jwh.2021.0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Increasing prenatal cannabis use over recent years has been associated with changes in state-level cannabis policies. Yet, how correlates of prenatal cannabis use differ by recreational cannabis legality has not been examined. We aim to estimate prenatal cannabis use prevalence and examine how maternal factors associated with use vary across states with and without recreational cannabis legalization. Methods: In 2020, we performed a cross-sectional analysis using 2018 Pregnancy Risk Assessment Monitoring System data, providing population-level estimates of prenatal cannabis use among included states. Across 14 states, we examined characteristics of prenatal cannabis users via chi-square tests and multivariate logistic regression models. We present odds ratios (ORs) of prenatal cannabis use, stratified by recreational cannabis legality. Results: Self-reported prenatal cannabis use in states with and without legalized recreational cannabis were 6.29% and 5.22%, respectively. Adjusted analyses found that regardless of recreational cannabis legalization, women who were unmarried, reported Medicaid as their prenatal care insurer, did not receive first trimester prenatal care, or reported having prenatal depression or anxiety were 1-4 times more likely to report prenatal cannabis use. Women residing in states where recreational cannabis was legal were significantly more likely to report concurrent cannabis and tobacco use while pregnant (OR: 8.66, 95% confidence interval [CI], 5.40-13.86) compared with women in states yet to legalize (OR: 5.49, 95% CI, 3.97-7.59). Conclusions: Our findings suggest a need for focused cannabis prevention efforts for nonpregnant women of reproductive age to stop initial uptake of the drug. Additionally, as women in these states were three times more likely to report concurrent cannabis and tobacco use during pregnancy, we recommend that states with recreational cannabis focus on prevention and intervention of cosubstance use among pregnant women.
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Affiliation(s)
- Kara R Skelton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Blount AJ, Adams CR, Anderson-Berry AL, Hanson C, Schneider K, Pendyala G. Biopsychosocial Factors during the Perinatal Period: Risks, Preventative Factors, and Implications for Healthcare Professionals. Int J Environ Res Public Health 2021; 18:8206. [PMID: 34360498 PMCID: PMC8346061 DOI: 10.3390/ijerph18158206] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022]
Abstract
Women face risks to their wellbeing during the perinatal period of pregnancy. However, there is a dearth of information on perinatal risk factors within the biopsychosocial paradigm. Emphasis is often placed on biological components associated with pregnancy and women's health. However, psychological and social determinants of health are integral during the perinatal period, and mental wellness is often a determinant for positive maternal and neonatal health outcomes. This article reviews risk factors of perinatal wellness (e.g., physical and nutritional concerns, trauma, discrimination, adverse childhood events) and highlights protective factors for women in their perinatal period. Healthcare professionals can support perinatal health by focusing on culturally and contextually appropriate research and prevention, providing equal access to sexual and reproductive healthcare information and services, providing quality education and training for helping professionals, and supporting policies for positive sexual and reproductive women's healthcare.
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Affiliation(s)
- Ashley J. Blount
- Department of Counseling, University of Nebraska Omaha, Omaha, NE 68182, USA; (C.R.A.); (K.S.)
| | - Charmayne R. Adams
- Department of Counseling, University of Nebraska Omaha, Omaha, NE 68182, USA; (C.R.A.); (K.S.)
| | - Ann L. Anderson-Berry
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198, USA;
- Department of Anesthesiology, University of Nebraska Medical Center Omaha, Omaha, NE 68198, USA;
| | - Corrine Hanson
- Medical Nutrition Education Division, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Kara Schneider
- Department of Counseling, University of Nebraska Omaha, Omaha, NE 68182, USA; (C.R.A.); (K.S.)
| | - Gurudutt Pendyala
- Department of Anesthesiology, University of Nebraska Medical Center Omaha, Omaha, NE 68198, USA;
- Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Abstract
Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.
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Affiliation(s)
- Lorraine Poncet
- PhD Candidate in Public Health, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France; French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- Research Engineer, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| | - Armelle Andro
- Professor, Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France; French Collaborative Institute on Migration, Paris, France
| | - Virginie Ringa
- Researcher (INSERM), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
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Fox H, Topp SM, Lindsay D, Callander E. Ethnic, socio-economic and geographic inequities in maternal health service coverage in Australia. Int J Health Plann Manage 2021; 36:2182-2198. [PMID: 34270134 DOI: 10.1002/hpm.3277] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. METHODS This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n = 186,789), plus their resultant babies (n = 189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. RESULTS The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. CONCLUSION Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.
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Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Connolly M, Phung L, Farrington E, Scoullar MJL, Wilson AN, Comrie-Thomson L, Homer CSE, Vogel JP. Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review. Asia Pac J Public Health 2021; 33:489-501. [PMID: 34165364 DOI: 10.1177/10105395211026099] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.
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Affiliation(s)
- Mairead Connolly
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Laura Phung
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Elise Farrington
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Michelle J L Scoullar
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | | | - Liz Comrie-Thomson
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Ghent University, Ghent, Belgium
| | | | - Joshua P Vogel
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
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Mosley EA, Pratt M, Besera G, Clarke LS, Miller H, Noland T, Whaley B, Cochran J, Mack A, Higgins M. Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia. Front Glob Womens Health 2021; 2:655409. [PMID: 34816209 PMCID: PMC8593936 DOI: 10.3389/fgwh.2021.655409] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Abstract
Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.
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Affiliation(s)
- Elizabeth A. Mosley
- Georgia State University School of Public Health, Atlanta, GA, United States,Emory University Rollins School of Public Health, Atlanta, GA, United States,*Correspondence: Elizabeth A. Mosley
| | | | - Ghenet Besera
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Lasha S. Clarke
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Heidi Miller
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Tracy Noland
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Bridget Whaley
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Amber Mack
- Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
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35
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Willis MD, Hill EL, Kile ML, Carozza S, Hystad P. Assessing the effectiveness of vehicle emission regulations on improving perinatal health: a population-based accountability study. Int J Epidemiol 2021; 49:1781-1791. [PMID: 33485273 DOI: 10.1093/ije/dyaa137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the 1990s, extensive regulations to reduce traffic-related air pollution (TRAP) have been implemented, yet the effectiveness of these regulations has not been assessed with respect to improving infant health. In this study, we evaluate how infant health risks associated with maternal residences near highways during pregnancy have changed over time. METHODS We created a population-based retrospective birth cohort with geocoded residential addresses in Texan metropolitan areas from 1996 through 2009 (n = 2 259 411). We compared term birthweight (37-42 weeks of gestation) among maternal residences <300 m from a highway (high TRAP exposure) (n = 394 346) and 500-3500 m from a highway (comparison group) (n = 1 865 065). We implemented linear regressions to evaluate interactions between high TRAP exposure and birth year, adjusting for demographics, socioeconomic status and neighbourhood context. In addition, we used propensity score matching to further reduce residual confounding. RESULTS From 1996 to 2009, outdoor NO2 decreased by 51.3%, based on regulatory monitoring data in Texas. Among pregnant women who resided in the high TRAP zone during pregnancy, interaction terms between residential location and birth year show that birthweight increased by 1.1 g [95% confidence interval CI): 0.7, 1.5) in unadjusted models and 0.3 g (95% CI: 0.0, 0.6) in matched models. Time-stratified models also show decreasing impacts of living in high TRAP areas on birthweight when comparing infants born in 1996-97 with 2008-09. Sensitivity analyses with alternative exposure and control groups show consistent results. CONCLUSIONS Infant health risks associated with maternal residence near highways have reduced over time, paralleling regulatory measures to improve exhaust pipe emissions.
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Affiliation(s)
- Mary D Willis
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Elaine L Hill
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, NY, USA
| | - Molly L Kile
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Susan Carozza
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Hansen A, Moloney ME, Li J, Chavan NR. Preterm Birth Prevention in Appalachia: Restructuring Prenatal Care to Address Rural Health Disparities and Establish Perinatal Health Equity. Health Equity 2021; 5:203-209. [PMID: 33937606 PMCID: PMC8080929 DOI: 10.1089/heq.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: This perspective piece reflects off previously published qualitative work to explore (1) themes surrounding equitable prenatal care in Appalachia and (2) strategies to restructure care delivery in a population with disparate rates of preterm birth (PTB). Methods: This study reflects in-depth interviews with 22 Appalachian women who experienced PTB and 14 obstetric providers. Results: Our findings underscore the need for greater cultural humility in prenatal care, heightened awareness of social determinants of health, and strategic planning to establish equity in birth outcomes. Conclusion: Prenatal care must undergo a paradigm shift to include a comprehensive discussion of cultural humility, social disparities, and health equity.
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Affiliation(s)
- Anna Hansen
- Department of Sociology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Mairead E. Moloney
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Jing Li
- Center for Health Services Research (CHSR), University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Niraj R. Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Goin DE, Casey JA, Kioumourtzoglou MA, Cushing LJ, Morello-Frosch R. Environmental hazards, social inequality, and fetal loss: Implications of live-birth bias for estimation of disparities in birth outcomes. Environ Epidemiol 2021; 5:e131. [PMID: 33870007 PMCID: PMC8043739 DOI: 10.1097/ee9.0000000000000131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 11/12/2022] Open
Abstract
Restricting to live births can induce bias in studies of pregnancy and developmental outcomes, but whether this live-birth bias results in underestimating disparities is unknown. Bias may arise from collider stratification due to an unmeasured common cause of fetal loss and the outcome of interest, or depletion of susceptibles, where exposure differentially causes fetal loss among those with underlying susceptibility. METHODS We conducted a simulation study to examine the magnitude of live-birth bias in a population parameterized to resemble one year of conceptions in California (N = 625,000). We simulated exposure to a non-time-varying environmental hazard, risk of spontaneous abortion, and time to live birth using 1000 Monte Carlo simulations. Our outcome of interest was preterm birth. We included a social vulnerability factor to represent social disadvantage, and estimated overall risk differences for exposure and preterm birth using linear probability models and stratified by the social vulnerability factor. We calculated how often confidence intervals included the true point estimate (CI coverage probabilities) to illustrate whether effect estimates differed qualitatively from the truth. RESULTS Depletion of susceptibles resulted in a larger magnitude of bias compared with collider stratification, with larger bias among the socially vulnerable group. Coverage probabilities were not adversely affected by bias due to collider stratification. Depletion of susceptibles reduced coverage, especially among the socially vulnerable (coverage among socially vulnerable = 46%, coverage among nonsocially vulnerable = 91% in the most extreme scenario). CONCLUSIONS In simulations, hazardous environmental exposures induced live-birth bias and the bias was larger for socially vulnerable women.
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Affiliation(s)
- Dana E. Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, California
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | | | - Lara J. Cushing
- Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, & Management and School of Public Health, University of California, Berkeley, Berkeley, California
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38
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Ramakrishnan R, Rao S, He JR. Perinatal health predictors using artificial intelligence: A review. Womens Health (Lond) 2021; 17:17455065211046132. [PMID: 34519596 PMCID: PMC8445524 DOI: 10.1177/17455065211046132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Advances in public health and medical care have enabled better pregnancy and birth outcomes. The rates of perinatal health indicators such as maternal mortality and morbidity; fetal, neonatal, and infant mortality; low birthweight; and preterm birth have reduced over time. However, they are still a public health concern, and considerable disparities exist within and between countries. For perinatal researchers who are engaged in unraveling the tangled web of causation for maternal and child health outcomes and for clinicians involved in the care of pregnant women and infants, artificial intelligence offers novel approaches to prediction modeling, diagnosis, early detection, and monitoring in perinatal health. Machine learning, a commonly used artificial intelligence method, has been used to predict preterm birth, birthweight, preeclampsia, mortality, hypertensive disorders, and postpartum depression. Real-time electronic health recording and predictive modeling using artificial intelligence have found early success in fetal monitoring and monitoring of women with gestational diabetes especially in low-resource settings. Artificial intelligence-based methodologies have the potential to improve prenatal diagnosis of birth defects and outcomes in assisted reproductive technology too. In this scenario, we envision artificial intelligence for perinatal research to be based on three goals: (1) availability of population-representative, routine clinical data (rich multimodal data of large sample size) for perinatal research; (2) modification and application of current state-of-the-art artificial intelligence for prediction and classification in health care research to the field of perinatal health; and (3) development of methods for explaining the decision-making processes of artificial intelligence models for perinatal health indicators. Achieving these three goals via a multidisciplinary approach to the development of artificial intelligence tools will enable trust in these tools and advance research, clinical practice, and policies to ensure optimal perinatal health.
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Affiliation(s)
- Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shishir Rao
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Jian-Rong He
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Kattan W, Avigan L, Hayton B, Barkin JL, St-André M, Nguyen TV, Schwartz H, Poulin MJ, Stikarovska I, Wolde-Giorghis R, Arafah M, Zelkowitz P. Creating a Multisite Perinatal Psychiatry Databank: Purpose and Development. Int J Environ Res Public Health 2020; 17:E9352. [PMID: 33327576 DOI: 10.3390/ijerph17249352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among six perinatal mental health services in Quebec, Canada, to create an electronic databank that captures longitudinal patient data over the course of the perinatal period. The collaborating sites met to identify research interests and to select a standardized set of variables to be collected during clinical appointments. Procedures were implemented for creating a databank that serves both research and clinical purposes. The resulting databank allows pregnant and postpartum patients to complete self-report questionnaires on medical and psychosocial variables during their intake appointment in conjunction with their clinicians who fill in relevant medical information. All participants are followed until 6 months postpartum. The databank represents an opportunity to examine illness trajectories and to study rare mental disorders and the relationship between biological and psychosocial variables.
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Daniel L, Michot M, Esvan M, Guérin P, Chauvet G, Pelé F. Perceptions, Knowledge, and Practices Concerning Indoor Environmental Pollution of Parents or Future Parents. Int J Environ Res Public Health 2020; 17:E7669. [PMID: 33096680 DOI: 10.3390/ijerph17207669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
Indoor pollutants can have short- and long-term health effects, especially if exposure occurs during prenatal life or early childhood. This study describe the perceptions, knowledge, and practices of adults concerning indoor environmental pollution. Adults of 18 to 45 years of age were recruited in the department of Ille-et-Vilaine (Brittany-France) in 2019 through a stratified random draw in the waiting rooms of general practitioners (GPs) (n = 554) who completed a self-questionnaire. The 71% who had already heard of this type of pollution were older (p = 0.001), predominantly women (p = 0.007), not expecting a baby (p = 0.005), and had a higher knowledge score (p < 0.001). The average knowledge score was 6.6 ± 6.6 out of 11, which was higher for participants living in a couple and with a higher level of education (p < 0.001). Some practices were well implemented (>80% of participants) (aeration during renovation) whereas others were insufficiently practiced (<60% of participants) (paying attention to the composition of cosmetic products). Factors associated differed depending on the frequency of integration: living in a couple and having a child for well implemented practices and educational level, knowledge level, and perception for those under implemented. Knowledge must be improved to modify perceptions and certain practices, making sure not to increase social inequalities in health.
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Ahrens KA, Hutcheon JA. Time for Better Access to High-Quality Abortion Data in the United States. Am J Epidemiol 2020; 189:640-647. [PMID: 32219373 DOI: 10.1093/aje/kwaa048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/03/2023] Open
Abstract
Despite considerable lay attention on the regulation and legislation of abortion in the United States, important gaps remain in our understanding of its incidence and health and social consequences since its legalization in 1973. Many of these gaps in knowledge can be attributed to a lack of access to high-quality, individual-level abortion data over the past 46 years. Herein, we review the strengths and limitations of different, currently available methods for enumerating abortions in the United States and discuss how lack of access to high-quality data limits our surveillance and research activities of not only abortion but other important reproductive and perinatal health outcomes. We conclude by discussing some potential opportunities for improved access to high-quality abortion data in the United States.
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Legare CH, Akhauri S, Chaudhuri I, Hashmi FA, Johnson T, Little EE, Lunkenheimer HG, Mandelbaum A, Mandlik H, Mondal S, Mor N, Saldanha N, Schooley J, Sharda P, Subbiah S, Swarup S, Tikkanen M, Burger O. Perinatal risk and the cultural ecology of health in Bihar, India. Philos Trans R Soc Lond B Biol Sci 2020; 375:20190433. [PMID: 32594881 PMCID: PMC7423251 DOI: 10.1098/rstb.2019.0433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The objective of the current study is to examine the cultural ecology of health associated with mitigating perinatal risk in Bihar, India. We describe the occurrences, objectives and explanations of health-related beliefs and behaviours during pregnancy and postpartum using focus group discussions with younger and older mothers. First, we document perceived physical and supernatural threats and the constellation of traditional and biomedical practises including taboos, superstitions and rituals used to mitigate them. Second, we describe the extent to which these practises are explained as risk-preventing versus health-promoting behaviour. Third, we discuss the extent to which these practises are consistent, inconsistent or unrelated to biomedical health practises and describe the extent to which traditional and biomedical health practises compete, conflict and coexist. Finally, we conclude with a discussion of the relationships between traditional and biomedical practises in the context of the cultural ecology of health and reflect on how a comprehensive understanding of perinatal health practises can improve the efficacy of health interventions and improve outcomes. This article is part of the theme issue ‘Ritual renaissance: new insights into the most human of behaviours’.
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Affiliation(s)
- Cristine H Legare
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | - Emily E Little
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | - Nachiket Mor
- Banyan Academy of Leadership in Mental Health at Kanchipuram, Tamil Nadu, India
| | - Neela Saldanha
- Centre for Social and Behaviour Change, Ashoka University, Sonipat, Haryana, India
| | | | | | | | | | | | - Oskar Burger
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
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Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
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Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Accepted: 01/19/2021] [Indexed: 11/15/2023] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S. Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D. Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M. Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
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Cawley C, Buckenmeyer H, Jellison T, Rinaldi JB, Vartanian KB. Effect of a Health System-Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e17183. [PMID: 32628123 PMCID: PMC7380997 DOI: 10.2196/17183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 01/17/2023] Open
Abstract
Background Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.
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Affiliation(s)
| | | | - Trina Jellison
- Women and Children's Institute, Providence St Joseph Health, Renton, WA, United States
| | - Joseph B Rinaldi
- Center for Outcomes Research and Education, Providence Portland Medical Center, Portland, OR, United States
| | - Keri B Vartanian
- Center for Outcomes Research and Education, Providence Portland Medical Center, Portland, OR, United States
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Islam MZ, Johnston J, Sly PD. Green space and early childhood development: a systematic review. Rev Environ Health 2020; 35:189-200. [PMID: 32167931 DOI: 10.1515/reveh-2019-0046] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Background The urban environment presents significant health challenges for children, such as discouraging physical exercise and increasing exposure to air pollution, excessive noise and higher temperatures. Reducing exposures to these negative environmental factors can have great benefits on a child's well-being and lower their risk of developing chronic diseases later in life. There is increasing evidence that suggests that the presence of urban green space can offer benefits to human health and well-being. While studies have reported the impact green space exposure has on the individual health outcomes of children, few have paid attention to the link between green space and the child's development. This review aims to synthesise the evidence of the effect green space exposure has on early childhood development. Objectives To explore the relationship between green space and early childhood development. Methods An online search was conducted using pre-identified keywords related to green space and early childhood development using search engines such as PubMed, MEDLINE, Web of Science, MeSH and PsycINFO. Peer-reviewed papers published in the past 10 years were included in this review. Papers were selected, extracted, analysed and interpreted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fifty-one papers were identified, of which 28 were excluded due to duplications or irrelevance, yielding a total of 23 papers to be reviewed. Articles were categorised based on reported outcomes: perinatal health, physical health, psychological health and respiratory health. An increase in green space during pregnancy was associated with increased birth weight and a decreased risk for low birth weight (LBW). Further, higher greenness exposure during childhood was associated with increased levels of physical activity and a lower risk of obesity and neurodevelopmental issues such as inattentiveness. While green space exposure was negatively associated with wheezing and bronchitis in some cohorts, certain plant species increase asthmatic symptoms during childhood, indicating that plant species type is an important determinant. Conclusion The extant literature on green space exposure and early childhood development is small. Regardless, the existing research provides promising insights into the benefits of green space exposure on children's health and well-being in an ever-increasing urban world. Further research is needed on the causal relationships between both quantity and quality of green space to early childhood development.
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Affiliation(s)
- Mohammad Zahirul Islam
- Children's Health and Environment Program, Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
- L7 Centre for Children's Health Research, 62 Graham St, South Brisbane, 4101 QLD, Australia
| | - Jessika Johnston
- Children's Health and Environment Program, Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
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Barclay K, Baranowska-Rataj A, Kolk M, Ivarsson A. Interpregnancy intervals and perinatal and child health in Sweden: A comparison within families and across social groups. Popul Stud (Camb) 2020; 74:363-378. [PMID: 32052701 DOI: 10.1080/00324728.2020.1714701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A large body of research has shown that children born after especially short or long birth intervals experience an elevated risk of poor perinatal outcomes, but recent work suggests this may be explained by confounding by unobserved family characteristics. We use Swedish population data on cohorts born 1981-2010 and sibling fixed effects to examine whether the length of the birth interval preceding the index child influences the risk of preterm birth, low birth weight, and hospitalization during childhood. We also present analyses stratified by salient social characteristics, such as maternal educational level and maternal country of birth. We find few effects of birth intervals on our outcomes, except for very short intervals (less than seven months) and very long intervals (>60 months). We find few differences in the patterns by maternal educational level or maternal country of origin after stratifying by the mother's highest educational attainment.
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Affiliation(s)
- Kieron Barclay
- Max Planck Institute for Demographic Research.,Stockholm University
| | | | - Martin Kolk
- Stockholm University.,Institute for Futures Studies
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Skelton KR, Hecht AA, Benjamin-Neelon SE. Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods. Int J Environ Res Public Health 2020; 17:E909. [PMID: 32024173 DOI: 10.3390/ijerph17030909] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/01/2023]
Abstract
In the United States (US), recreational cannabis use is on the rise. Since 2011, 11 states and the District of Columbia have legalized cannabis for adult recreational use. As additional states consider legalizing, there is an urgent need to assess associations between recreational cannabis legalization and maternal use in the preconception, prenatal, and postpartum periods—all critical windows for maternal and child health. Using cross-sectional data from the 2016 Pregnancy Risk Assessment Monitoring System, we assessed associations between state cannabis legalization and self-reported maternal cannabis use. Using logistic regression, we estimated the adjusted prevalence ratio (PR) of cannabis use during the preconception, prenatal, and postpartum period for women delivering a live-born infant in three states that had legalized recreational cannabis (Alaska, Colorado, and Washington) and three states that had not legalized (Maine, Michigan, and New Hampshire) by 2016. Our final sample size was 7258 women. We utilized 95% confidence intervals (CI) and a significance level of alpha = 0.05. After adjustment for potential confounders, women who resided in states with legalized recreational cannabis were significantly more likely to use cannabis during the preconception (PR 1.52; 95%CI ranging from 1.28–1.80; p < 0.001), prenatal (PR 2.21; 95% CI ranging from 1.67–2.94; p < 0.001), and postpartum (PR 1.73; 95%CI ranging from 1.30–2.30; p < 0.001) periods, compared to women who resided in states without legalized recreational cannabis. Although evidence about the effect of marijuana use during these periods is nascent, these findings show potential for increased incidence of child exposure to cannabis. Longitudinal research is needed to assess immediate and sustained impacts of maternal use before and after state legalization of recreational cannabis.
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Zilversmit Pao L, Harville EW, Wickliffe JK, Shankar A, Buekens P. The Cumulative Risk of Chemical and Nonchemical Exposures on Birth Outcomes in Healthy Women: The Fetal Growth Study. Int J Environ Res Public Health 2019; 16:E3700. [PMID: 31581440 DOI: 10.3390/ijerph16193700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Metals, stress, and sociodemographics are commonly studied separately for their effects on birth outcomes, yet often jointly contribute to adverse outcomes. This study analyzes two methods for measuring cumulative risk to understand how maternal chemical and nonchemical stressors may contribute to small for gestational age (SGA). SGA was calculated using sex-specific fetal growth curves for infants of pregnant mothers (n = 2562) enrolled in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Study. The exposures (maternal lead, mercury, cadmium, Cohen’s perceived stress, Edinburgh depression scores, race/ethnicity, income, and education) were grouped into three domains: metals, psychosocial stress, and sociodemographics. In Method 1 we created cumulative risk scores using tertiles. Method 2 employed weighted quantile sum (WQS) regression. For each method, logistic models were built with three exposure domains individually and race/ethnicity, adjusting for age, parity, pregnancy weight gain, and marital status. The adjusted effect of overall cumulative risk with three domains, was also modeled using each method. Sociodemographics was the only exposure associated with SGA in unadjusted models ((odds ratio) OR: 1.35, 95% (confidence interval) CI: 1.08, 1.68). The three cumulative variables in adjusted models were not significant individually, but the overall index was associated with SGA (OR: 1.17, 95% CI: 1.02, 1.35). In the WQS model, only the sociodemographics domain was significantly associated with SGA. Sociodemographics tended to be the strongest risk factor for SGA in both risk score and WQS models.
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50
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Daalderop LA, de Groot MW, van der Meer L, Steegers EAP, Bertens LCM. Non-medical determinants of perinatal health: protocol for a systematic review with meta-analysis. BMJ Open 2019; 9:e031437. [PMID: 31562159 PMCID: PMC6773282 DOI: 10.1136/bmjopen-2019-031437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Research focusing on the associations between non-medical determinants and unfavourable perinatal health outcomes is increasing. Despite increasing knowledge on this theme, it still remains unclear to what extent social, environmental and lifestyle factors contribute to these unfavourable outcomes. Therefore, we aim to provide a systematic review, preferably with meta-analysis, in order to provide insight into the associations between non-medical determinants and perinatal mortality, preterm birth and being small for gestational age (SGA). METHODS AND ANALYSIS Observational studies performed in European countries studying the associations between non-medical determinants and unfavourable perinatal health outcomes will be included. Primary outcomes of interest are perinatal mortality, preterm birth and SGA. To retrieve potential eligible articles, a systematic literature search was performed in the following online databases on 5 October 2018: MEDLINE, Embase, Web of Science, Cochrane and Google Scholar. Additionally, a reference list check and citation search will be performed. Data of the included articles will be extracted using a standardised and piloted data extraction form. Risk of bias will be assessed using the Newcastle-Ottawa Scale. The study selection and data extraction process will be performed by two reviewers independently. Disagreements will be resolved through discussion with a third reviewer. The pooled effects will be calculated separately for each association found between one of the outcome measures and the non-medical determinants using a random effects model. Heterogeneity of the studies will be assessed using the I2 statistic. ETHICS AND DISSEMINATION No ethical approval is necessary for a systematic review with meta-analysis. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018056105.
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Affiliation(s)
- Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
- Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marjolein W de Groot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Lindsey van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
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