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Quesada O, Kulandavelu S, Vladutiu CJ, DeFranco E, Minissian MB, Makarem N, Bello NA, Wong MS, Pabón MA, Chandra AA, Avilés-Santa L, Rodríguez CJ, Bairey Merz CN, Sofer T, Hurwitz BE, Talavera GA, Claggett BL, Solomon SD, Cheng S. Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy. Hypertension 2024; 81:255-263. [PMID: 38047358 PMCID: PMC10793810 DOI: 10.1161/hypertensionaha.123.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 03/20/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks for cardiovascular disease for reasons that remain incompletely understood. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy). RESULTS. The study cohort included 5168 Hispanic/Latina women with an average age (SD) of 58.7 (9.7) years at time of echocardiogram. Prior de novo HDP was reported by 724 (14%) of the women studied and was associated with lower left ventricle (LV) ejection fraction -0.66 (95% confidence interval [CI], -1.21 to -0.11), higher LV relative wall thickness 0.09 (95% CI, 0-0.18), and 1.39 (95% CI, 1.02-1.89) higher risk of abnormal LV geometry after adjusting for blood pressure and other confounders. The proportion of the association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI, 0.03-0.45), LV relative wall thickness was 0.28 (95% CI, 0.16-0.51), abnormal LV geometry was 0.14 (95% CI, 0.12-0.48), concentric left ventricular hypertrophy was 0.31 (95% CI, 0.19-0.86), and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26-0.79). CONCLUSIONS. In a large cohort of Hispanic/Latina women those with history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension.
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Affiliation(s)
- Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.)
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q.)
| | | | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (C.J.V.)
| | - Emily DeFranco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH (E.D.)
| | - Margo B. Minissian
- Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.B.M.)
| | - Nour Makarem
- Mialman School of Public Health, Columbia University Irving Center, NY (N.M.)
| | - Natalie A. Bello
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melissa S. Wong
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (M.S.W.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Maria A. Pabón
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alvin A. Chandra
- University of Texas Southwestern Medical Center, Dallas (A.A.C.)
| | - Larissa Avilés-Santa
- National Institute on Minority Health and Health Disparities, Bethesda, MD (L.A.-S.)
| | | | - C. Noel Bairey Merz
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
- Barbra Streisand Women’s Heart Center (C.N.B.M.)
| | - Tamar Sofer
- Department of Medicine (T.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Gregory A. Talavera
- South Bay Latino Research Center, Department of Psychology, San Diego State University, CA (G.A.T.)
| | - Brian L. Claggett
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Scott D. Solomon
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Susan Cheng
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
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Herrera CA, McPherson JA, Vladutiu CJ, Smid MC. Neonatal morbidity associated with maternal Group B Streptococcal colonization in individuals undergoing planned cesarean delivery. J Matern Fetal Neonatal Med 2023; 36:2183740. [PMID: 36851857 DOI: 10.1080/14767058.2023.2183740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To examine the association between unknown maternal Group B Streptococcal (GBS) colonization and the risk of severe neonatal morbidity among individuals undergoing planned cesarean delivery. METHODS We performed a secondary analysis of a multicenter, prospective observational study of individuals with singleton gestations and planned cesarean delivery ≥37 weeks gestation with cervical dilation ≤3 cm, intact membranes, and no evidence of labor or induction. GBS status was categorized as positive, negative, or unknown. The primary outcome was a composite of severe neonatal morbidity, including clinical or culture-proven sepsis, ventilator support in the first 24 h, respiratory distress syndrome, hypotension requiring treatment, intubation, necrotizing enterocolitis, hypoxic-ischemic encephalopathy, or death. We compared individuals with unknown GBS status to those with positive and negative GBS status. RESULTS In this cohort, 4,963 individuals met inclusion criteria; 72% had unknown GBS status, 25% were GBS negative and 3% were GBS positive. Among individuals with unknown GBS status, 208 (5.9%) had the primary composite neonatal outcome, compared with 75 (6%) of GBS negative individuals and 6 (4%) of GBS positive individuals. There was no difference in composite severe neonatal morbidity among GBS unknown, GBS negative, and GBS positive individuals (5.9% vs 6% vs 4%, p = .61). After adjusting for male sex and intrapartum antibiotic exposure, unknown GBS status was not associated with severe neonatal morbidity (adjusted risk ratio, 0.95; 95% confidence interval, 0.73-1.22). CONCLUSION GBS status at time of planned cesarean delivery does not appear to be associated with composite severe neonatal morbidity. The cost effectiveness and clinical utility of GBS screening among individuals undergoing planned cesarean delivery requires further investigation.
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Affiliation(s)
| | | | | | - Marcela C Smid
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.,Intermountain Healthcare Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
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Hirai AH, Vladutiu CJ, Main EK, Moore J. State Variation in Severe Maternal Morbidity Among Individuals with Medicaid Insurance. Obstet Gynecol 2023; 142:989. [PMID: 37734096 DOI: 10.1097/aog.0000000000005356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
| | - Catherine J Vladutiu
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Moore
- Institute for Medicaid Innovation, Washington, DC, and the Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Bonner AN, Jayawickreme S, Malek AM, Vladutiu CJ, Oliver-Williams C, Cortés YI, Tanaka H, Meyer ML. Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study. Front Cardiovasc Med 2023; 10:1172828. [PMID: 37288258 PMCID: PMC10242178 DOI: 10.3389/fcvm.2023.1172828] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood. Methods We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors. Results Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change. Discussion In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.
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Affiliation(s)
- Alison N. Bonner
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Shantal Jayawickreme
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clare Oliver-Williams
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Central Bedfordshire Council, Chicksands, Bedfordshire, United Kingdom
| | - Yamnia I. Cortés
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Mallampati DP, Talati AN, Fitzhugh C, Enayet N, Vladutiu CJ, Menard MK. Statewide assessment of telehealth use for obstetric care during the COVID-19 pandemic. Am J Obstet Gynecol MFM 2023; 5:100941. [PMID: 36965697 PMCID: PMC10035794 DOI: 10.1016/j.ajogmf.2023.100941] [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: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic started a period of rapid transition to telehealth in obstetric care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. While there is considerable literature on the use of telehealth in obstetric care, there are limited data on wide-spread telehealth use among different practice types and patient populations during the pandemic and whether these are preferable technologies. OBJECTIVES The objective of this study is to describe variations in telehealth use for obstetric care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aims to delineate telehealth use among rural/micropolitan and metropolitan practices to better understand if telehealth use varies by practice location. STUDY DESIGN A web-based survey was distributed to practice managers of obstetric practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through the assistance of the Community Care of North Carolina Pregnancy Medical Home Program. Practice location was defined as rural, micropolitan, or metropolitan based upon the county population. The survey assessed telehealth use prior to and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location. RESULTS A total of 295 practice managers were sent a web-based survey and 98 practices responded. Responding practices represented 66/100 counties in NC with 50 practices from rural/micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%) and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. Forty percent of practices endorsed a preference to continue telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continued telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in preferences for telehealth continuation or future needs by practice location. CONCLUSIONS Telehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location for modalities used, future preferences, or needs. To the best of our knowledge, this is one of few studies that assesses statewide uptake of and differences in obstetric telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetric care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.
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Affiliation(s)
- Divya P Mallampati
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
| | - Asha N Talati
- University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC
| | - Chelsea Fitzhugh
- Department of Obstetrics and Gynecology, Atrium Health, Carolinas Medical Center, Charlotte, NC
| | - Nafiah Enayet
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC
| | - Catherine J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD
| | - M Kathryn Menard
- University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, NC
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Vladutiu CJ, Butera NM, Sotres-Alvarez D, Stuebe AM, Aviles-Santa L, Daviglus ML, Gellman MD, Isasi CR, Cordero C, Talavera GA, Van Horn L, Siega-Riz AM. Preconception Cardiometabolic Markers and Birth Outcomes Among Women in the Hispanic Community Health Study/Study of Latinos. J Womens Health (Larchmt) 2022; 31:1727-1735. [PMID: 35796721 PMCID: PMC9805846 DOI: 10.1089/jwh.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Associations between preconception cardiometabolic markers and birth outcomes have been noted, but data are scarce for Hispanics/Latinos. We examined the association between preconception cardiometabolic markers, birthweight and preterm birth among U.S. Hispanic/Latina women. Materials and Methods: The Hispanic Community Health Study/Study of Latinos is a cohort study of U.S. adults 18-74 years of age, including 3,798 women of reproductive age (18-44 years) from four field centers representing Hispanic/Latino backgrounds of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American. A baseline clinic examination (2008-2011) and a second clinic examination (2014-2017), including ascertainment of birth outcomes, allowed for identification of 517 singleton live births between the exams. Preconception cardiometabolic markers included abdominal obesity (waist circumference ≥88 cm), body mass index >30 kg/m2, high blood pressure (systolic ≥120 mmHg and diastolic ≥80 mmHg), elevated triglycerides (≥150 mg/dL), low high-density lipoprotein cholesterol (<50 mg/dL), elevated fasting glucose (≥100 mg/dL), and insulin. Complex survey linear regression modeled the association between cardiometabolic markers and birthweight-for-gestational age z-score; complex survey logistic regression modeled the association with preterm birth. Analyses adjusted for Hispanic/Latina background, field center, years between baseline and birth, age, and nulliparity. Results: In adjusted linear regression models, elevated fasting glucose was associated with higher birthweight z-scores (β = 0.56, 95% confidence interval [95% CI] 0.14 to 0.99), even after further adjustment for maternal percent body fat (β = 0.53, 95% CI 0.10 to 0.95). In adjusted logistic regression models, high blood pressure (odds ratio [OR] = 2.57, 95% CI 1.13 to 5.88) and increased insulin (OR = 1.50, 95% CI 1.06 to 2.14, for a 10 mU/L increase) were associated with higher odds for preterm birth. Conclusions: Infant birthweight and preterm birth may be influenced by selected cardiometabolic risk factors before pregnancy among Hispanic/Latina women.
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Affiliation(s)
- Catherine J. Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicole M. Butera
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
- Department of Biostatistics and the Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics and the Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alison M. Stuebe
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Larissa Aviles-Santa
- National Institute on Minority Health and Health Disparities, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christina Cordero
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Gregory A. Talavera
- Department of Psychology, South Bay Latino Research Center, San Diego State University, San Diego, California, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anna Maria Siega-Riz
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
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Busse CE, Donney JF, Busse KR, Ghandour RM, Vladutiu CJ. Household food insufficiency and flourishing in a nationally representative sample of young children in the U.S. Ann Epidemiol 2022; 76:91-97. [PMID: 36283627 PMCID: PMC10150385 DOI: 10.1016/j.annepidem.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined the association between household food insufficiency and flourishing among young children (6 months-5 years) in the U.S. and assessed whether sleep adequacy modifies this association. METHODS We used data from the 2018-2020 National Surveys of Children's Health. Adjusted prevalence differences and 95% confidence intervals (CI) for the association between household food insufficiency and flourishing were modeled using average marginal predictions from logistic regression models. Sleep adequacy was assessed as an effect measure modifier on the additive scale. RESULTS Evidence supports additive scale effect measure modification of the food insufficiency-flourishing association by sleep adequacy (Likelihood Ratio Test statistic = 12.4, degrees of freedom = 2, P < .05). Adjusted for potential confounders, the prevalence of flourishing was 13.2 percentage points lower (95% CI: -22.6, -3.7) for children in households with insufficient food and inadequate sleep compared to those with sufficient food and adequate sleep. CONCLUSIONS Our findings suggest that having enough food and enough sleep are associated with greater wellbeing. These modifiable factors should be targeted by public health interventions to facilitate flourishing among young children in the U.S.
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Affiliation(s)
- Clara E Busse
- Oak Ridge Institute for Science and Education (ORISE), Office of Science, U.S. Department of Energy, Oak Ridge, TN; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Julie Fife Donney
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Kyle R Busse
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Reem M Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Catherine J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
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Hirai AH, Owens PL, Reid LD, Vladutiu CJ, Main EK. Associations Between State-Level Severe Maternal Morbidity and Other Perinatal Indicators. JAMA Netw Open 2022; 5:e2224621. [PMID: 35900765 PMCID: PMC9335140 DOI: 10.1001/jamanetworkopen.2022.24621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines state-level associations between severe maternal morbidity and other perinatal indicators, including prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, and maternal and infant mortality.
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Affiliation(s)
- Ashley H. Hirai
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Pamela L. Owens
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Lawrence D. Reid
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Catherine J. Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Elliott K. Main
- California Maternal Quality Care Collaborative, Stanford University, Palo Alto
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Abstract
IMPORTANCE Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts. OBJECTIVE To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022. EXPOSURES Time, ICD-10-CM/PCS coding system, and state. MAIN OUTCOMES AND MEASURES SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator. RESULTS From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, -3.2; 95% CI, -6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, -0.1; 95% CI, -1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, -12.8 to -7.5), with a significant drop associated with ICD transition (RD, -7.9; 95% CI, -10.2 to -5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied. CONCLUSIONS AND RELEVANCE In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.
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Affiliation(s)
- Ashley H. Hirai
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Pamela L. Owens
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Lawrence D. Reid
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Catherine J. Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Elliott K. Main
- California Maternal Quality Care Collaborative, Stanford University, Palo Alto, California
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Donahue AP, Glover AV, Strauss RA, Goodnight WH, Vladutiu CJ, Manuck TA. Elevated midtrimester maternal plasma cytokines and preterm birth in patients with cerclage. Am J Obstet Gynecol MFM 2022; 4:100624. [PMID: 35346888 DOI: 10.1016/j.ajogmf.2022.100624] [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: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cerclage is used for the prevention of spontaneous preterm birth; however, many patients at high risk of spontaneous preterm birth who have a cerclage in place eventually deliver before term. Although inflammation, measured by biomarkers (eg, cytokines), is a known risk factor for preterm delivery, evaluation of inflammation to determine pregnancy outcomes among patients with cerclage is poorly understood. OBJECTIVE We sought to examine levels of maternal plasma inflammatory cytokines in the midtrimester among asymptomatic patients with a cervical cerclage (placed for any indication, including history, ultrasound, and examination indications) to evaluate the association between cytokine levels and preterm birth. STUDY DESIGN This was a prospective cohort study of singleton, nonanomalous pregnancies who had a cerclage placed at <24 weeks of gestation from 2015 to 2018 at a single tertiary institution. Maternal plasma was collected perioperatively whenever possible. A custom magnetic bead Luminex cytokine assay was used to measure plasma inflammatory cytokine levels from these stored samples. The primary outcome was preterm birth at <37 weeks of gestation. A statistical cut point was calculated for each cytokine level to assess its optimal sensitivity and specificity for spontaneous preterm birth prediction. Patients were classified as having a "high" or "low" result for each cytokine based on this cut point. Receiver operating characteristic curve analysis was performed to estimate sensitivity, specificity, and positive and negative predictive values for spontaneous preterm birth prediction. Cox proportional-hazards regression modeled the association between the number of "high" inflammatory cytokines and gestational age at delivery, adjusting for confounders. Additional analyses were performed on the subgroup of patients with history-indicated cerclage and those with an ultrasound- or examination-indicated cerclage. RESULTS A total of 43 patients participated in this study: 20 (46.5%) had spontaneous preterm birth (median, 30.9 weeks of gestation; interquartile range, 28.4-35.0). Plasma samples were collected at a median of 0 (interquartile range, -2 to 17) days concerning cerclage placement and a median of 18 (interquartile range, 13-21) weeks of gestation. Based on the statistical cut point for each cytokine level, 7% of patients had zero, 20.9% had 1, 18.6% had 2, 20.9% had 3, and 32.6% had ≥4 "high" cytokine results. Each additional "high" cytokine level was associated with earlier delivery (hazard ratio, 1.51; 95% confidence interval, 1.25-1.81) even after controlling for ultrasound- or examination-indication for cerclage (hazard ratio, 1.73; 95% confidence interval, 0.95-3.15). The presence of ≥4 "high" cytokine levels was 70% sensitive and 74% specific for predicting spontaneous preterm birth (area under the curve, 0.846; 95% confidence interval, 0.728-0.964; positive predictive value, 70%; negative predictive value, 73.9%). CONCLUSION Among patients with a cervical cerclage, elevated midtrimester maternal plasma cytokine profiles were associated with subsequent preterm birth and can estimate the probability of preterm birth. Confirmation and refinement of this noninvasive panel may provide insight into improved selection of individuals who may benefit from cerclage placement and investigation of therapeutic strategies to mitigate midpregnancy inflammation.
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Affiliation(s)
- Abbey P Donahue
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck)
| | - Angelica V Glover
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck)
| | - Robert A Strauss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck)
| | - William H Goodnight
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck)
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck)
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Donahue, Glover, Strauss, Goodnight, Vladutiu, and Manuck); Carolina Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Manuck).
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Linares DE, Kandasamy V, Vladutiu CJ. Lifecourse factors associated with flourishing among US children aged 1-5 years. Child Care Health Dev 2022; 48:298-310. [PMID: 34791734 DOI: 10.1111/cch.12930] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/17/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to examine the association between lifecourse factors and flourishing among children ages 1-5 years. STUDY DESIGN Using data from the combined 2016 and 2017 National Survey of Children's Health (N = 18 007 children aged 1-5 years), flourishing was defined as parent-reported child's affection, resilience, curiosity about learning, and affect. Multivariable logistic regression modelled the associations between lifecourse factors and flourishing. These factors were identified according to the lifecourse health development model. RESULTS Approximately 63% of children aged 1-5 years were flourishing. Children who were female (vs. male, adjusted prevalence ratio [APR]: 1.06, 95% confidence interval [CI]: 1.00-1.11), White, non-Hispanic (vs. Black, non-Hispanic, APR: 1.13, 95% CI: 1.01-1.26), not having a special health care need (vs. special health care need, APR: 1.15, 95% CI: 1.03-1.26), not having an emotional, developmental or behavioural disorder (EBD) (vs. EBD, APR 1.66, 95% CI:1.23-2.10), spoke English at home (vs. other language, APR: 1.30, 95% CI: 1.06-1.54), parents received emotional social support (vs. no emotional social support, APR: 1.11, 95% CI: 1.01-1.21) and who lived in a supportive neighbourhood (vs. not in supportive neighbourhood, APR: 1.12, 95% CI:1.05-1.18) were more likely to flourish. Children from households within 0%-99% of the federal poverty level (APR: 0.89, 95% CI: 0.79-0.98) were less likely to be flourishing compared with their counterparts from households within 400% of the federal poverty level. CONCLUSIONS Findings indicate that several lifecourse factors are associated with young children's flourishing, including being female, White, non-Hispanic, not having a special health care need or EBD, English as a primary language, parents receiving emotional social support, having neighbourhood support and a lower household income. Our findings promote the continuation of programmes supporting diverse and low-income children's families and communities such as home visiting and Head Start, which provide avenues for bolstering children's health and development across the lifespan.
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Affiliation(s)
- Deborah E Linares
- National Institute on Minority Health and Health Disparities, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - Veni Kandasamy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine J Vladutiu
- Division of Epidemiology, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
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12
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Oliver-Williams C, Johnson JD, Vladutiu CJ. Maternal Cardiovascular Disease After Pre-Eclampsia and Gestational Hypertension: A Narrative Review. Am J Lifestyle Med 2021; 17:8-17. [PMID: 36636385 PMCID: PMC9830232 DOI: 10.1177/15598276211037964] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Previous literature has highlighted that women who have a pregnancy affected by gestational hypertension or preeclampsia are at higher risk of cardiovascular disease (CVD) in later life. However, CVD is a composite of multiple outcomes, including coronary heart disease, heart failure, and stroke, and the risk of both CVD and hypertensive disorders of pregnancy varies by the population studied. We conducted a narrative review of the risk of cardiovascular outcomes for women with prior gestational hypertension and pre-eclampsia. Previous literature is summarized by country and ethnicity, with a higher risk of CVD and coronary heart disease observed after gestational hypertension and a higher risk of CVD, coronary heart disease and heart failure observed after pre-eclampsia in most of the populations studied. Only one study was identified in a low- or middle-income country, and the majority of studies were conducted in white or mixed ethnicity populations. We discuss potential interventions to mitigate cardiovascular risk for these women in different settings and highlight the need for a greater understanding of the epidemiology of CVD risk after gestational hypertension and pre-eclampsia outside of high-income, white populations.
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Affiliation(s)
- Clare Oliver-Williams
- Clare Oliver-Williams, Strangeways Research
Laboratory, Department of Public Health and Primary Care, University of
Cambridge, Cambridge CB1 8RN, United Kingdom; e-mail:
| | - Jasmine D. Johnson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Vladutiu CJ, Mobley SC, Ji X, Thomas S, Kandasamy V, Sutherland D, Inglett S, Li R, Cox S. A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS, Birth Records and Program Data. Matern Child Health J 2021; 25:1516-1525. [PMID: 34417685 PMCID: PMC10425706 DOI: 10.1007/s10995-021-03205-4] [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] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation. METHODS ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes. RESULTS 107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes. DISCUSSION Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration (HRSA), Rockville, MD, USA.
| | - Sandra C Mobley
- Department of Obstetrics & Gynecology (Retired), Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Suzanne Thomas
- CSRA Nursing Associates, PC and Augusta University College of Nursing (Adjunct), Augusta, GA, USA
| | - Veni Kandasamy
- Oak Ridge Institute for Science and Education, Oak Ridge Affiliated Universities, Oak Ridge, TN, USA
| | - Don Sutherland
- Enterprise Community Healthy Start, The Perinatal Center, Augusta University, Augusta, GA, USA
| | - Sandra Inglett
- Enterprise Community Healthy Start, College of Nursing, Augusta University, Augusta, GA, USA
| | - Rui Li
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Shanna Cox
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA, USA
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Venkatesh KK, Vladutiu CJ, Glover AV, Strauss RA, Stringer JSA, Stamilio DM, Hughes B, Dotters-Katz S. Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis? Am J Perinatol 2021; 38:e262-e268. [PMID: 32446262 DOI: 10.1055/s-0040-1709666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to assess whether colonization with group B streptococcus (GBS) is associated with maternal peripartum infection in an era of routine prophylaxis. STUDY DESIGN This study presented a secondary analysis of women delivering ≥37 weeks who underwent a trial of labor from the U.S. Consortium on Safe Labor (CSL) study. The exposure was maternal GBS colonization and the outcome was a diagnosis of chorioamnionitis, and secondarily, analyses were restricted to deliveries not admitted in labor and measures of postpartum infection (postpartum fever, endometritis, and surgical site infection). Logistic regression with generalized estimating equations was used accounting for within-woman correlations. Models adjusted for maternal age, parity, race, prepregnancy body mass index, pregestational diabetes, insurance status, study site/region, year of delivery, number of vaginal exams from admission to delivery, and time (in hours) from admission to delivery. RESULTS Among 170,804 assessed women, 33,877 (19.8%) were colonized with GBS and 5,172 (3.0%) were diagnosed with chorioamnionitis. While the frequency of GBS colonization did not vary by chorioamnionitis status (3.0% in both groups), in multivariable analyses, GBS colonization was associated with slightly lower odds of chorioamnionitis (adjusted odds ratio [AOR]: 0.89; 95% confidence interval [CI]: 0.83-0.96). In secondary analyses, this association held regardless of spontaneous labor on admission; and the odds of postpartum infectious outcomes were not higher with GBS colonization. CONCLUSION In contrast to historical data, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis. KEY POINTS · Data in an era prior to routine group B streptococcus (GBS) screening and prophylaxis showed that maternal GBS colonization was associated with a higher frequency of maternal peripartum infection.. · In the current study, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis.. · The results highlight potential benefits of GBS screening and intrapartum antibiotic prophylaxis beyond neonatal disease prevention, including mitigating the risk of maternal infectious morbidity..
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Angelica V Glover
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Robert A Strauss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey S A Stringer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - David M Stamilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Brenna Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Sarah Dotters-Katz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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15
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Kenney MK, Lebrun-Harris LA, Vladutiu CJ, Kogan MD. Parental Concerns About Child Weight Among 10-17-Year Olds With Overweight/Obesity: A Family Ecological Model. Acad Pediatr 2021; 21:1055-1066. [PMID: 33387678 DOI: 10.1016/j.acap.2020.12.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify child, family/household, organization (provider), and neighborhood/community factors associated with parental concern about weight among children with overweight/obesity in order to inform effective interventions for improving health in this pediatric population. METHODS Prevalence of parental concern about child weight was estimated and factors identified within an adapted family ecological framework. Using cross-sectional data from the 2018 National Survey of Children's Health, we conducted bivariate and multivariable analyses of 10 to 17-year olds (N = 15,427) for whom height and weight information was reported by parents or primary caregivers. RESULTS There were 4287 children, aged 10 to 17 years, with overweight/obesity (31%). Approximately 34% of parents of children with overweight/obesity reported being concerned about their child's weight, with the remainder being not concerned. In adjusted analyses, 23% of children with overweight and 45% of children with obesity had parents who reported being concerned. Factors associated with parental concern among children with overweight/obesity included child weight status, female gender, peer social difficulties, the extent of the child's daily activities affected by health conditions, poorer parental coping, and having been told the child was overweight by a provider. CONCLUSIONS Only one in three parents of children with overweight/obesity reported being concerned about their child's weight, although parental concern was more common among children affected by obesity more so than overweight. A combination of child, family, and organization (provider) factors were associated with parental concern. Provider feedback about child overweight may improve parental awareness of a weight-related health issue.
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Affiliation(s)
- Mary Kay Kenney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md.
| | - Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
| | - Catherine J Vladutiu
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
| | - Michael D Kogan
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Md
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Green CA, Johnson JD, Vladutiu CJ, Manuck TA. The association between maternal and paternal race and preterm birth. Am J Obstet Gynecol MFM 2021; 3:100353. [PMID: 33757934 DOI: 10.1016/j.ajogmf.2021.100353] [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] [Received: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Non-Hispanic black maternal race is a known risk factor for preterm birth. However, the contribution of paternal race is not as well established. OBJECTIVE We sought to evaluate the risk of preterm birth among non-Hispanic black, non-Hispanic white, and mixed non-Hispanic black and non-Hispanic white dyads. STUDY DESIGN This was a population-based cohort study of all live births in the United States from 2015 to 2017, using live birth records from the National Vital Statistics System. Singleton, nonanomalous infants whose live birth record included maternal and paternal self-reported race as either non-Hispanic white or non-Hispanic black were included. The primary outcome was preterm birth at <37 weeks' gestation; secondary outcomes included preterm birth at <34 and <28 weeks' gestation and delivery gestational age (as a continuous variable). Data were analyzed using chi-square, t test, analysis of variance, and logistic regression. A Kaplan-Meier survival curve was also generated. RESULTS There were 11,809,599 live births during the study period; 4,008,622 births met the inclusion criteria. Of included births, 291,647 (7.3%) occurred at <37 weeks' gestation. Using the convention of maternal race first followed by paternal race, preterm birth at <37 weeks' gestation was most common among non-Hispanic black and non-Hispanic black dyads (n=70,987 [10.8%]), followed by non-Hispanic black and non-Hispanic white (n=3137 [9.5%]), non-Hispanic white and non-Hispanic black (n=9136 [8.3%]), and non-Hispanic white and non-Hispanic white dyads (n=209,387 [6.5%]; P<.001 for trend). Births at <34 weeks' (n=74,474) and <28 weeks' gestation (n=18,474) were also more common among non-Hispanic black and non-Hispanic black dyads. Specifically, 24,351 (3.7%) non-Hispanic black and non-Hispanic black, 1017 (3.1%) non-Hispanic black and non-Hispanic white, 2408 (2.2%) non-Hispanic white and non-Hispanic black, and 46,698 non-Hispanic white and non-Hispanic white dyads delivered at <34 weeks' gestation, and 7988 non-Hispanic black and non-Hispanic black (1.2%), 313 (1.0%) non-Hispanic black and non-Hispanic white, 584 (0.5%) non-Hispanic white and non-Hispanic black, and 9589 (0.3%) non-Hispanic white and non-Hispanic white dyads delivered at <28 weeks' gestation. Non-Hispanic white and non-Hispanic white dyads delivered at a mean 38.8± standard deviation of 1.7 weeks' gestation, although non-Hispanic white and non-Hispanic black, non-Hispanic black and non-Hispanic white, and non-Hispanic black and non-Hispanic black dyads delivered at 38.6±2.0, 38.5±2.3, and 38.3±2.4 weeks' gestation, respectively (P<.001). Adjusted odds ratios for the association between maternal or paternal race and preterm birth were highest for non-Hispanic black and non-Hispanic black dyads at each gestational age cutoff: adjusted odds ratio, 1.60 (95% confidence interval, 1.11-1.19) (<37 weeks' gestation); adjusted odds ratio, 2.47 (95% confidence interval, 2.41-2.53) (<34 weeks' gestation); and adjusted odds ratio, 4.22 (95% confidence interval, 4.04-4.41) (<28 weeks' gestation) compared with the non-Hispanic white referent group. Models adjusted for insurance status, chronic hypertension, tobacco use during pregnancy, history of previous preterm birth, and male fetus. In the Kaplan-Meier survival analysis, non-Hispanic black and non-Hispanic black dyads delivered the earliest across the range of delivery gestational ages compared with all other combinations of dyads. CONCLUSION Non-Hispanic black paternal race is a risk factor for preterm birth and should be considered when evaluating maternal a priori risk of prematurity. Future research should investigate the mechanisms behind this finding, including determining the contribution of factors, such as racism, maternal and paternal genetics, and epigenetics to an individual's risk of preterm birth.
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Affiliation(s)
- Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (Drs Green, Johnson, Vladutiu, and Manuck)
| | - Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (Drs Green, Johnson, Vladutiu, and Manuck)
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (Drs Green, Johnson, Vladutiu, and Manuck)
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (Drs Green, Johnson, Vladutiu, and Manuck); Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC (Dr Manuck).
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Siega-Riz AM, Vladutiu CJ, Butera NM, Daviglus M, Gellman M, Isasi CR, Stuebe AM, Talavera GA, Van Horn L, Sotres-Alvarez D. Preconception Diet Quality Is Associated with Birth Weight for Gestational Age Among Women in the Hispanic Community Health Study/Study of Latinos. J Acad Nutr Diet 2021; 121:458-466. [PMID: 33187928 PMCID: PMC10807347 DOI: 10.1016/j.jand.2020.09.039] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The nutritional status of women in the preconception period is of paramount importance due to its role in reproduction. OBJECTIVE Our aim was to assess overall diet quality during the preconception period and its association with infant birth weight adjusted for gestational age (GA). DESIGN This is an observational longitudinal cohort of Hispanic people living in the United States. PARTICIPANTS/SETTING Data are from the Hispanic Community Health Study/Study of Latinos baseline (2008-2011) and second clinic examinations (2014-2017). Included are the first 497 singleton live-born infants among the 2,556 women (younger than 45 years) who attended the second visit. Field sites were located in Miami, FL; Bronx, NY; Chicago, IL; and San Diego, CA, and represent individuals with heritage from Cuba, Dominican Republic, Mexico, Puerto Rico, and Central and South America. MAIN EXPOSURE Diet assessment included two 24-hour recalls from baseline. The 2010 Healthy Eating Index (HEI-2010) was used to measure diet quality, with higher scores indicating better quality. STATISTICAL ANALYSES PERFORMED Complex survey linear regression estimated the association between HEI-2010 scores (continuous variable and categorized into tertiles) and birth-weight z score and birth weight for GA percentile. RESULTS Mean (standard deviation) age of women was 25.8 (5.2) years and 36.4% were classified as underweight or normal weight, 30.0% were overweight, and 33.6% had obesity at baseline. Mean (standard deviation) HEI-2010 score was 56.5 (13.4), and by weight classifications was 54.4 (14.1) for underweight or normal weight and 57.7 (12.8) for overweight or obesity. Median (interquartile range) birth-weight z score was 0.5 (interquartile range [IQR], -0.2 to 1.3) overall and 0.2 (IQR, -0.5 to 1.0), 0.6 (IQR, -0.2 to 1.3), and 0.5 (IQR, -0.2 to 1.4) for the first, second, and third HEI-2010 tertile, respectively. Median birth weight for GA percentile was 68.2 (IQR, 40.2 to 89.7) overall, and 56.8 (IQR, 29.6 to 85.0), 71.5 (IQR, 42.8 to 90.0), and 70.1 (IQR, 42.9 to 91.2) by HEI-2010 tertile. In adjusted models, the highest tertile of the HEI-2010 score was associated with a higher birth-weight z score and birth weight for GA percentile, and the continuous HEI-2010 score was only associated with birth weight for GA percentile. Preconception body mass index (calculated as kg/m2) did not modify these associations. CONCLUSIONS Overall diet quality, as measured by the HEI-2010, in the preconception period is associated with infant birth weight adjusted for GA among US Hispanic and Latina women.
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Affiliation(s)
- Anna Maria Siega-Riz
- Department of Nutrition, and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
| | - Catherine J Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nicole M Butera
- Department of Biostatistics and the Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
| | - Martha Daviglus
- Department of Preventive Medicine, University of Illinois at Chicago, IL
| | - Marc Gellman
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Carmen R Isasi
- Department of Epidemiology and Population Health. Albert Einstein College of Medicine, Bronx, NY
| | - Alison M Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniela Sotres-Alvarez
- Department of Biostatistics and the Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
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Ahn R, Gonzalez GP, Anderson B, Vladutiu CJ, Fowler ER, Manning L. Initiatives to Reduce Maternal Mortality and Severe Maternal Morbidity in the United States : A Narrative Review. Ann Intern Med 2020; 173:S3-S10. [PMID: 33253021 DOI: 10.7326/m19-3258] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Maternal mortality and severe maternal morbidity are critical health issues in the United States, with unacceptably high rates and racial, ethnic, and geographic disparities. Various factors contribute to these adverse maternal health outcomes, ranging from patient-level to health system-level factors. Furthermore, a majority of pregnancy-related deaths are preventable. This review briefly describes the epidemiology of maternal mortality and severe maternal morbidity in the United States and discusses selected initiatives to reduce maternal mortality and severe maternal morbidity in the areas of data and surveillance; clinical workforce training and patient education; telehealth; comprehensive models and strategies; and clinical guidelines, protocols, and bundles. Related Health Resources and Services Administration initiatives are also described.
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Affiliation(s)
- Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois (R.A., G.P.G., B.A.)
| | - Grace P Gonzalez
- NORC at the University of Chicago, Chicago, Illinois (R.A., G.P.G., B.A.)
| | - Britta Anderson
- NORC at the University of Chicago, Chicago, Illinois (R.A., G.P.G., B.A.)
| | - Catherine J Vladutiu
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, Maryland (C.J.V.)
| | - Erin R Fowler
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Global Health, Rockville, Maryland (E.R.F.)
| | - Leticia Manning
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland (L.M.)
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Abstract
Background: Folate depletion in the postpartum period may increase the risk of adverse pregnancy outcomes for women with a short interpregnancy interval following a live birth. We sought to examine folate levels by time since last live birth among U.S. women. Materials and Methods: Data were from 4,809 U.S. women, 20-44 years of age, participating in the National Health and Nutrition Examination Survey, 2007-2016. Red blood cell (RBC) folate was measured using microbiological assay on whole blood samples. Dietary folate intake and folic acid supplementation were measured during a 24-hour dietary recall. Prevalence of supplementation by time since last live birth was estimated from logistic regression models; mean levels of RBC folate and mean intake of dietary folate equivalent were estimated from linear regression models. Models were adjusted for maternal sociodemographic characteristics. Results: In adjusted models, supplementation (±standard error) was highest among women in the first year postpartum (31.7% ± 3.2) compared with nulliparous women (23.7% ± 1.9) and those 2-3 years (15.6% ± 1.9) and ≥3 years (18.4% ± 1.6) after last live birth. Mean RBC folate was highest among women in the first year postpartum, regardless of supplementation, with overall mean levels of 606 ± 15 ng/mL, compared with 484 ± 9, 477 ± 11, and 474 ± 7 among women in the aforementioned groups, respectively. Mean dietary folate intake was also highest among postpartum women: 542 ± 23 mcg/day, compared with 474 ± 12, 486 ± 21, and 467 ± 12. Conclusions: Folate levels are highest in the first year postpartum compared with other time periods within a woman's reproductive lifespan. These findings do not support the idea that postpartum U.S. women are depleted in folate, on average.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Veni Kandasamy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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Battarbee AN, Grant JH, Vladutiu CJ, Menard MK, Clark M, Manuck TA, Venkatesh KK, Boggess KA. Hemoglobin A1c and Early Gestational Diabetes. J Womens Health (Larchmt) 2020; 29:1559-1563. [PMID: 32678995 DOI: 10.1089/jwh.2019.8203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Screening for diabetes in early pregnancy is recommended for high-risk women, however, the optimal test for the diagnosis of early gestational diabetes mellitus (GDM) is unknown. Thus, the objective of this study was to evaluate hemoglobin A1c (HbA1c) as a diagnostic test for early GDM compared with two-step testing. Materials and Methods: Retrospective cohort of women with prior GDM or obesity who had HbA1c and two-step testing <21 weeks' gestation. Early GDM was diagnosed by 1 hour, 50 g oral glucose challenge test (GCT) ≥135 mg/dL and ≥2 abnormal values on 3 hour, 100 g oral glucose tolerance test or GCT >200 mg/dL. The area under the receiver operating characteristic curve (AUC) evaluated HbA1c for diagnosis of early GDM. Results: Of 243 women, 14 (5.8%) had early GDM by two-step testing. Median HbA1c levels were higher among women with GDM versus those without GDM (5.8% vs. 5.3%, p < 0.001). The AUC for HbA1c compared with two-step testing was 0.80 (95% CI 0.69-0.91). The optimal HbA1c threshold was 5.6% (64% sensitivity, 84% specificity). Conclusions: HbA1c is moderately predictive of early GDM compared with two-step testing, and a threshold lower than that used for diabetes diagnosis among nonpregnant adults is justified.
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Affiliation(s)
- Ashley N Battarbee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jacqueline H Grant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine J Vladutiu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Kathryn Menard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Clark
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tracy A Manuck
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kim A Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Lo CCW, Lo ACQ, Leow SH, Fisher G, Corker B, Batho O, Morris B, Chowaniec M, Vladutiu CJ, Fraser A, Oliver‐Williams C. Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e013991. [PMID: 32578465 PMCID: PMC7670531 DOI: 10.1161/jaha.119.013991] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random-effects meta-analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17-1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23-1.73), but not stroke (RR, 1.26; 95% CI, 0.96-1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73-1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42-2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33-2.51), and heart failure (RR, 1.77; 95% CI, 1.47-2.13), but not stroke (RR, 1.50; 95% CI, 0.75-2.99). Conclusions Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42018119031.
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Affiliation(s)
- Charmaine Chu Wen Lo
- Faculty of Health and MedicineUniversity of NewcastleNew South WalesAustralia
- Liverpool HospitalLiverpoolNew South WalesAustralia
| | | | - Shu Hui Leow
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Grace Fisher
- Hills Road Sixth Form CollegeCambridgeUnited Kingdom
| | - Beth Corker
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Olivia Batho
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Bethan Morris
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | | | - Catherine J. Vladutiu
- Department of Obstetrics & GynecologySchool of MedicineUniversity of North CarolinaChapel HillNC
| | - Abigail Fraser
- Population Health SciencesBristol Medical SchoolUniversity of BristolUnited Kingdom
| | - Clare Oliver‐Williams
- Homerton CollegeUniversity of CambridgeUnited Kingdom
- Cardiovascular Epidemiology UnitDepartment of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
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Venkatesh KK, Vladutiu CJ, Strauss RA, Thorp JM, Stringer JSA, Stamilio DM, Hughes BL, Dotters-Katz S. Association Between Maternal Obesity and Group B Streptococcus Colonization in a National U.S. Cohort. J Womens Health (Larchmt) 2020; 29:1507-1512. [PMID: 32364822 DOI: 10.1089/jwh.2019.8139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the association between maternal obesity as measured by prepregnancy body mass index (BMI) and group B streptococcus (GBS) colonization. Methods: We conducted a secondary analysis from the Consortium on Safe Labor Study (CSL) in the United States cohort study (2002-2008). Pregnant women with deliveries at ≥37 weeks of gestation who attempted labor were included (115,070 assessed deliveries). The association between maternal prepregnancy BMI, categorized as normal weight or below (<25 kg/m2), overweight (25 to <30 kg/m2), class I obesity (30 to <35 kg/m2), class II obesity (35 to <40 kg/m2), and class III obesity (≥40 kg/m2), and GBS colonization was modeled using logistic regression with generalized estimating equations. Models adjusted for maternal age, parity, race, pregestational diabetes, insurance status, study site/region, and year of delivery. Results: The overall prevalence of GBS colonization was 20.5% (23,625/115,070), which increased with rising maternal BMI, normal weight 19.3% (13,543/70,098), overweight 20.8% (5,353/25,733), class I obesity 23.0% (2,596/11,275), class II obesity 26.1% (1,270/4,850), and class III obesity 27.7% (863/3,114). In multivariable analysis, increasing maternal obesity severity was associated with higher odds of GBS colonization, namely overweight (adjusted odds ratio [AOR]: 1.09, 95% confidence interval [CI]: 1.05-1.13), class I obesity (AOR: 1.20, 95% CI: 1.15-1.26), class II obesity (AOR: 1.42, 95% CI: 1.33-1.51), and class III obesity (AOR: 1.50; 95% CI: 1.38-1.62) compared with normal weight. In secondary analyses, these associations persisted when stratified by maternal race. Conclusions: In a national U.S. sample, increasing maternal obesity severity as assessed by prepregnancy BMI was associated with a higher likelihood of maternal GBS colonization during pregnancy.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert A Strauss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John M Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeffrey S A Stringer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David M Stamilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brenna L Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Sarah Dotters-Katz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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Abstract
Objectives Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
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24
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Cordero C, Schieve LA, Croen LA, Engel SM, Maria Siega-Riz A, Herring AH, Vladutiu CJ, Seashore CJ, Daniels JL. Neonatal jaundice in association with autism spectrum disorder and developmental disorder. J Perinatol 2020; 40:219-225. [PMID: 31388117 PMCID: PMC7031756 DOI: 10.1038/s41372-019-0452-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the association between neonatal jaundice and autism spectrum disorder (ASD) and non-ASD developmental disorder (DD). STUDY DESIGN We analyzed data from the Study to Explore Early Development, a US multisite, case-control study conducted from 2007 to 2011. Developmental assessment classified children aged 2-5 years into: ASD (n = 636), DD (n = 777), or controls (POP; n = 926). Neonatal jaundice (n = 1054) was identified from medical records and maternal interviews. We examined associations between neonatal jaundice and ASD and DD using regression models to obtain adjusted odds ratios (aOR). RESULTS Our results showed interaction between gestational age and neonatal jaundice. Neonatal jaundice was associated with ASD at 35-37 weeks (aOR = 1.83, 95%CI 1.05, 3.19), but not ≥38 weeks gestation (aOR = 0.97, 95%CI 0.76, 1.24). Similar results were observed with DD. CONCLUSIONS Further exploration of timing and severity of neonatal jaundice and ASD/DD is warranted.
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Affiliation(s)
- Christina Cordero
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Maria Siega-Riz
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Family, Community & Mental Health Systems, University of Virginia, Charlottesville, VA, USA
| | - Amy H Herring
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Statistical Science, Duke University, Durham, NC, USA
| | | | - Carl J Seashore
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Julie L Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Vladutiu CJ, Minnaert JJ, Sosa S, Menard MK. Levels of Maternal Care in the United States: An Assessment of Publicly Available State Guidelines. J Womens Health (Larchmt) 2019; 29:353-361. [PMID: 31634038 DOI: 10.1089/jwh.2019.7743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: Recent increases in maternal mortality and severe maternal morbidity highlight the need to improve systems for safe maternity care. We sought to identify whether publicly available state perinatal guidelines incorporate levels of maternal care (LoMC) criteria. Materials and Methods: We searched websites for 50 U.S. states and Washington, D.C. for LoMC guidelines. The Health Resources and Services Administration's Title V Program directors confirmed/updated search results through January 2018. Data abstracted included: (1) definitions of levels; (2) provider types; (3) facility capabilities and services; and (4) programmatic responsibilities as promoted in the 2015 Society for Maternal/Fetal Medicine and American College of Obstetricians and Gynecologists consensus document on LoMC. Results: LoMC guidelines were identified for 17 states; 12 defined four levels and five defined three levels of care. In Level I, 14/17 states specified obstetric provider availability for every birth and five specified an available surgeon to perform emergency cesareans. Fourteen states specified the availability of blood bank and laboratory services at all times. In the highest level (III or IV), 16/17 state guidelines specified a maternal/fetal medicine specialist; all but two specified anesthesia providers or services. Ten states referenced availability of an onsite intensive care unit in their highest level. All 17 state guidelines specified maternal transport and referral systems. Conclusions: Only one-third of states have publicly available perinatal guidelines incorporating LoMC criteria. Definitions, criteria, and nomenclature varied. Lack of LoMC guidelines with standardized criteria limits monitoring and evaluation of regionalized systems of maternal care.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland.,Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jessica J Minnaert
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Sylvia Sosa
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - M Kathryn Menard
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Battarbee AN, Glover AV, Vladutiu CJ, Gyamfi-Bannerman C, Aliaga S, Manuck TA, Boggess KA. Sex-Specific Differences in Late Preterm Neonatal Outcomes. Am J Perinatol 2019; 36:1223-1228. [PMID: 30991441 DOI: 10.1055/s-0039-1683886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To estimate sex-specific differences in late preterm outcomes and evaluate whether betamethasone modifies this association. STUDY DESIGN We conducted a secondary analysis of a multicenter trial of women at risk for late preterm birth randomized to receive betamethasone or placebo. We included women who delivered at 34 to 37 weeks and excluded major fetal anomalies. The primary outcome was severe neonatal morbidity (mechanical ventilation, respiratory distress syndrome, bronchopulmonary dysplasia, sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). Maternal characteristics were compared using chi-square test, t-test, or Mann-Whitney U-test. Multivariable logistic regression estimated the association between sex and morbidity, and likelihood ratio testing assessed for effect modification by betamethasone. RESULTS Of 2,831 women in the primary trial, 2,331 met the inclusion criteria: 1,236 delivered males and 1,095 delivered females. Betamethasone modified the association between sex and severe morbidity (p = 0.047). Among those who received betamethasone, male sex was associated with higher odds of severe morbidity (adjusted odds ratio: 1.95, 95% confidence interval: 1.25-3.05), compared with female sex. Among those who did not receive betamethasone, there was no significant association between sex and morbidity. CONCLUSION Male sex is a risk factor for adverse late preterm outcomes, including severe neonatal morbidity after betamethasone receipt.
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Affiliation(s)
- Ashley N Battarbee
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Angelica V Glover
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Catherine J Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Sofia Aliaga
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tracy A Manuck
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kim A Boggess
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Kogan MD, Vladutiu CJ, Perrin JM. Caution About Displaying State-Level Differences in the Prevalence of Autism Spectrum Disorder. JAMA Pediatr 2019; 173:887-888. [PMID: 31260067 DOI: 10.1001/jamapediatrics.2019.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael D Kogan
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Catherine J Vladutiu
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - James M Perrin
- Harvard Medical School, Harvard University, Boston, Massachusetts
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28
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Malek AM, Vladutiu CJ, Meyer ML, Cushman M, Newman R, Lisabeth LD, Kleindorfer D, Lakkur S, Howard VJ. The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status. Prev Med Rep 2019; 15:100955. [PMID: 31367516 PMCID: PMC6651856 DOI: 10.1016/j.pmedr.2019.100955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/17/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022] Open
Abstract
While a mean age at menopause of 51 years has been reported in the United States (U.S.), some U.S. women experience menopause before age 45, possibly increasing risk of cardiovascular mortality; however, the role in all-cause and cerebrovascular-related mortality is unclear. The purpose of this study was to investigate the association between age at menopause and all-cause and cause-specific mortality by race, hormone replacement therapy (HRT) use, and smoking status. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a population-based study of 30,239 participants aged ≥45 years enrolled between 2003 and 2007 of whom 14,361 were postmenopausal women. Age at menopause was defined as <45 (early) or ≥45. All-cause and cause-specific mortality were ascertained through 2013. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between age at menopause and mortality, adjusting for baseline measures. Of 11,287 eligible women (6403 white; 4884 black), mean menopause age was 45.2 (SD 7.9) with 1524 deaths over 7.1 years. Significant interactions were detected between early age at menopause (39%) and HRT use in association with all-cause mortality (p < 0.01), mortality from coronary heart disease (p = 0.06), and mortality from all other causes (p = 0.04). An association between early age at menopause and all-cause mortality was observed among ever-HRT users (HR = 1.31, 95% CI: 1.10–1.56), but not never-HRT users (HR = 1.01, 95% CI: 0.85–1.20). There were no differences in associations examined by race or smoking status. Increased all-cause mortality risk was observed for ever-HRT users with menopause before age 45. Increased all-cause mortality risk in ever-HRT users with menopause before age 45 HRT use modified the association of menopause before age 45 and CHD mortality. There were no differences in associations examined by race or smoking status.
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Key Words
- Age
- BMI, body mass index
- BWHS, Black Women's Health Study
- CHD, coronary heart disease
- CI, confidence interval
- CVD, cardiovascular disease
- Coronary heart disease
- ECG, electrocardiogram
- FDA, Food and Drug Administration
- HR, hazard ratio
- HRT, hormone replacement therapy
- MI, myocardial infarction
- MRR, mortality rate ratio
- Menopause
- Mortality
- NAMS, North American Menopause Society
- NDI, National Death Index
- REGARDS
- REGARDS, REasons for Geographic and Racial Differences in Stroke
- RR, relative risk
- Race
- SD, standard deviation
- Smoking
- U.S., United States
- Women
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine J Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Cushman
- Department of Med-Hematology Oncology, University of Vermont, Burlington, VT, USA.,Department of Pathology & Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sindhu Lakkur
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Vladutiu CJ, Lebrun-Harris LA, Carlos MP, Petersen DN. Assessing Child Health and Health Care in the U.S. Virgin Islands Using the National Survey of Children's Health. Matern Child Health J 2019; 23:1271-1280. [PMID: 31228141 DOI: 10.1007/s10995-019-02767-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize the health and health care experiences of children in the U.S. Virgin Islands (USVI), assess differences by household poverty status, and provide comparisons to the general U.S. child population. METHODS Data are from the 2011-2012 National Survey of Children's Health, which included 2342 USVI children, aged 0-17 years. Parent-reported measures of health status and health conditions, behavioral characteristics, and health care access and utilization were assessed. Weighted prevalence estimates were calculated and compared by household poverty status using Chi square tests. RESULTS Overall, 31.3% of USVI children lived in households below 100% of the federal poverty level (FPL). Children in these low-income households were more likely to have public insurance (33.0% vs. 8.4%) and unmet health needs (11.6% vs. 6.3%) as compared to those in households with incomes ≥ 100% FPL (all p < 0.01). They were also less likely to have a medical home (22.5% vs. 42.2%), including a usual source of sick care (p < 0.01). Compared with U.S. children in general, USVI children had lower rates of preventive medical visits, preventive dental visits, and care received in a medical home. CONCLUSIONS USVI children experience challenges in accessing and utilizing health care services, particularly those in low-income households, and fare worse than U.S. children on many of these measures. These findings will serve as a baseline comparison for an upcoming survey of maternal and child health to be conducted in eight U.S. territories including the USVI.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA.
| | - Lydie A Lebrun-Harris
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Maria P Carlos
- Division of State and Community Health, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Derval N Petersen
- U.S. Virgin Islands Department of Health, Christiansted, St. Croix, USA
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Battarbee AN, Glover AV, Vladutiu CJ, Gyamfi-Bannerman C, Aliaga S, Manuck TA, Boggess KA. Risk factors associated with prolonged neonatal intensive care unit stay after threatened late preterm birth. J Matern Fetal Neonatal Med 2019; 34:1042-1047. [PMID: 31170845 DOI: 10.1080/14767058.2019.1623777] [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: 10/26/2022]
Abstract
OBJECTIVE To identify risk factors associated with neonatal intermediate or intensive care unit (NICU) stay ≥3 days among women with threatened late preterm birth (PTB). STUDY DESIGN Secondary analysis of women with nonanomalous, singleton gestations enrolled in multicenter trial of betamethasone versus placebo for late PTB. Maternal and obstetric characteristics at time of presentation with threatened PTB were compared between those with and without NICU stay ≥3 days. Multivariable logistic regression identified risk factors for NICU stay ≥3 days. RESULT Of 2795 eligible mother-neonate dyads, 962 (34%) had NICU stay ≥3 days. Gestational age and fetal growth restriction as the reason for threatened PTB had the strongest association with NICU stay ≥3 days in the final model (AUC 0.76). CONCLUSION Maternal and obstetric characteristics at the time of admission for threatened late PTB should be considered when counseling patients about the probability of NICU stay ≥3 days.
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Affiliation(s)
- Ashley N Battarbee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Angelica V Glover
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Sofia Aliaga
- Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kim A Boggess
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Oliver-Williams C, Vladutiu CJ, Loehr LR, Rosamond WD, Stuebe AM. The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study. J Womens Health (Larchmt) 2019; 28:721-727. [PMID: 30481103 PMCID: PMC6537113 DOI: 10.1089/jwh.2018.7161] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment. Materials and Methods: Data were from 8,583 White and African American women, 45-64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding. Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1-2 (36.2%), 3-4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1-2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14-2.42) and heart failure risk (1.46, 1.04-2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10-1.52) and hospitalized MI (1.38, 1.13-1.69), after adjustment for baseline characteristics and breastfeeding. Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.
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Affiliation(s)
- Clare Oliver-Williams
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Homerton College, Hills Road, University of Cambridge, Cambridge, United Kingdom
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Laura R. Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Alison M. Stuebe
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Cordero C, Windham GC, Schieve LA, Fallin MD, Croen LA, Siega-Riz AM, Engel SM, Herring AH, Stuebe AM, Vladutiu CJ, Daniels JL. Maternal diabetes and hypertensive disorders in association with autism spectrum disorder. Autism Res 2019; 12:967-975. [PMID: 30969030 DOI: 10.1002/aur.2105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/15/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Previous studies have shown complications of pregnancy, often examined in aggregate, to be associated with autism spectrum disorder (ASD). Results for specific complications, such as maternal diabetes and hypertension, have not been uniformly consistent and should be investigated independently in relation to ASD in a large community-based sample. The Study to Explore Early Development (SEED), a US multisite case-control study, enrolled children born in 2003-2006 at 2-5 years of age. Children were classified into three groups based on confirmation of ASD (n = 698), non-ASD developmental delay (DD; n = 887), or controls drawn from the general population (POP; n = 979). Diagnoses of any diabetes or hypertensive disorder during pregnancy were identified from prenatal medical records and maternal self-report. Logistic regression models estimated adjusted odds ratios (aOR) and confidence intervals (CI) adjusting for maternal age, race/ethnicity, education, smoking during pregnancy, and study site. Models for hypertension were additionally adjusted for parity and plurality. Among 2,564 mothers, we identified 246 (9.6%) with any diabetes and 386 (15.1%) with any hypertension in pregnancy. After adjustment for covariates, any diabetes during pregnancy was not associated with ASD (aOR = 1.10 [95% CI 0.77, 1.56]), but any hypertension was associated with ASD (aOR = 1.69 [95% CI 1.26, 2.26]). Results were similar for DD, and any diabetes (aOR = 1.29 [95% CI 0.94, 1.78]) or any hypertension (aOR = 1.71 [95% CI 1.30, 2.25]). Some pregnancy complications, such as hypertension, may play a role in autism etiology and can possibly serve as a prompt for more vigilant ASD screening efforts. Autism Res 2019, 12: 967-975. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We studied if common complications in pregnancy are associated with autism spectrum disorder (ASD) in a large sample of mothers and children. Our results show an association between conditions marked by high blood pressure and ASD, but no association with conditions marked by high blood sugar and ASD. Associations were similar for children who had a developmental disorder that was not ASD, suggesting that this relationship may not be specific to ASD.
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Affiliation(s)
| | - Gayle C Windham
- California Department of Public Health, Richmond, California
| | - Laura A Schieve
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Alison M Stuebe
- The University of North Carolina, Chapel Hill, North Carolina
| | | | - Julie L Daniels
- The University of North Carolina, Chapel Hill, North Carolina
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Martin CL, Vladutiu CJ, Zikry TM, Grace MR, Siega-Riz AM. Maternal lipid levels during pregnancy and child weight status at 3 years of age. Pediatr Obes 2019; 14:e12485. [PMID: 30516000 PMCID: PMC6545288 DOI: 10.1111/ijpo.12485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/21/2018] [Accepted: 09/30/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The intrauterine environment is critical in the development of child obesity. OBJECTIVE To investigate the association between maternal lipid levels during pregnancy and child weight status. METHODS Maternal lipid levels (total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides) collected from fasting blood samples collected at less than 20 and 24-29 weeks' gestation and child weight status at age 3 were examined prospectively among 183 mother-child dyads enrolled in the Pregnancy, Infection, and Nutrition. Measured height and weight at 3 years were used to calculate age- and sex-specific body mass index z-scores. Child risk of overweight/obesity was defined as body mass index greater than or equal to 85th percentile for age and sex. Regression models estimated the association between maternal lipid levels and child body mass index z-score and risk of being affected by overweight/obesity, respectively. RESULTS Higher triglyceride levels at less than 20 and 24-29 weeks of pregnancy were associated with higher body mass index z-scores (β = 0.23; 95% CI: 0.07-0.38 and β = 0.15; 95% CI: 0.01-0.29; respectively) after adjusting for confounders. There was no evidence of an association between total or low-density lipoprotein cholesterol and child weight status at age 3. CONCLUSIONS Early childhood body mass index may be influenced by maternal triglyceride levels during pregnancy.
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Affiliation(s)
- Chantel L. Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Tarek M. Zikry
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Matthew R. Grace
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Obstetric and Gynecology, University of Tennessee Health Sciences Center College of Medicine, Nashville, TN
| | - Anna Maria Siega-Riz
- School of Nursing and Departments of Public Health Sciences and Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville, VA
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Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ. Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. J Pediatr 2019; 206:256-267.e3. [PMID: 30322701 PMCID: PMC6673640 DOI: 10.1016/j.jpeds.2018.09.021] [Citation(s) in RCA: 507] [Impact Index Per Article: 101.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.
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Affiliation(s)
- Reem M Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD.
| | - Laura J Sherman
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Catherine J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Mir M Ali
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Sean E Lynch
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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Venkatesh KK, Glover AV, Vladutiu CJ, Stamilio DM. Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study. BJOG 2019; 126:719-727. [PMID: 30485648 DOI: 10.1111/1471-0528.15565] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery. DESIGN A retrospective cohort study. SETTING Data from the Consortium on Safe Labor Study in the USA (2002-2008). POPULATION Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section). METHODS The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery. MAIN OUTCOME MEASURES The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death. RESULTS Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97-2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes. CONCLUSIONS Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis. TWEETABLE ABSTRACT Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery.
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Affiliation(s)
- K K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - A V Glover
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - C J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - D M Stamilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
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Ahrens KA, Hutcheon JA, Ananth CV, Basso O, Briss PA, Ferré CD, Frederiksen BN, Harper S, Hernández‐Díaz S, Hirai AH, Kirby RS, Klebanoff MA, Lindberg L, Mumford SL, Nelson HD, Platt RW, Rossen LM, Stuebe AM, Thoma ME, Vladutiu CJ, Moskosky S. Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research. Paediatr Perinat Epidemiol 2019; 33:O5-O14. [PMID: 30300948 PMCID: PMC6378402 DOI: 10.1111/ppe.12504] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based. METHODS To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health. RESULTS Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work. CONCLUSIONS This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting.
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Affiliation(s)
- Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cande V. Ananth
- Department of Obstetrics and GynecologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew York,Department of EpidemiologyJoseph L. Mailman School of Public HealthColumbia UniversityNew YorkNew York
| | - Olga Basso
- Department of Obstetrics and GynecologyRoyal Victoria HospitalResearch Institute of McGill University Health CentreMontrealQuebecCanada,Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Peter A. Briss
- National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and PreventionAtlantaGeorgia
| | - Cynthia D. Ferré
- Maternal and Infant Health BranchDivision of Reproductive HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgia
| | - Brittni N. Frederiksen
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Sonia Hernández‐Díaz
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMassachusetts
| | - Ashley H. Hirai
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Russell S. Kirby
- Department of Community and Family HealthUniversity of South Florida College of Public HealthTampaFlorida
| | - Mark A. Klebanoff
- Center for Perinatal ResearchDepartments of Pediatrics and Obstetrics and Gynecology and Division of EpidemiologyThe Research Institute at Nationwide Children's HospitalThe Ohio State UniversityColumbusOhio
| | | | - Sunni L. Mumford
- Division of Intramural Population Health Research, Epidemiology BranchNational Institute of Child Health and Human DevelopmentBethesdaMaryland
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lauren M. Rossen
- Reproductive Statistics BranchDivision of Vital StatisticsNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsvilleMaryland
| | - Alison M. Stuebe
- Department of Obstetrics and GynecologyDepartment of Maternal and Child HealthGillings School of Global Public HealthUniversity of North Carolina School of MedicineChapel HillNorth Carolina
| | - Marie E. Thoma
- Department of Family ScienceUniversity of MarylandCollege ParkMaryland
| | - Catherine J. Vladutiu
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
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Johnson JD, Talati AN, Honart AW, Vladutiu CJ, Goodnight W, Manuck TA. 553: Recurrent spontaneous preterm birth phenotype and delivery gestational age. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hutcheon JA, Moskosky S, Ananth CV, Basso O, Briss PA, Ferré CD, Frederiksen BN, Harper S, Hernández‐Díaz S, Hirai AH, Kirby RS, Klebanoff MA, Lindberg L, Mumford SL, Nelson HD, Platt RW, Rossen LM, Stuebe AM, Thoma ME, Vladutiu CJ, Ahrens KA. Good practices for the design, analysis, and interpretation of observational studies on birth spacing and perinatal health outcomes. Paediatr Perinat Epidemiol 2019; 33:O15-O24. [PMID: 30311958 PMCID: PMC6378590 DOI: 10.1111/ppe.12512] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 06/01/2018] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Meta-analyses of observational studies have shown that women with a shorter interpregnancy interval (the time from delivery to start of a subsequent pregnancy) are more likely to experience adverse pregnancy outcomes, such as preterm delivery or small for gestational age birth, than women who space their births further apart. However, the studies used to inform these estimates have methodological shortcomings. METHODS In this commentary, we summarise the discussions of an expert workgroup describing good practices for the design, analysis, and interpretation of observational studies of interpregnancy interval and adverse perinatal health outcomes. RESULTS We argue that inferences drawn from research in this field will be improved by careful attention to elements such as: (a) refining the research question to clarify whether the goal is to estimate a causal effect vs describe patterns of association; (b) using directed acyclic graphs to represent potential causal networks and guide the analytic plan of studies seeking to estimate causal effects; (c) assessing how miscarriages and pregnancy terminations may have influenced interpregnancy interval classifications; (d) specifying how key factors such as previous pregnancy loss, pregnancy intention, and maternal socio-economic position will be considered; and (e) examining if the association between interpregnancy interval and perinatal outcome differs by factors such as maternal age. CONCLUSION This commentary outlines the discussions of this recent expert workgroup, and describes several suggested principles for study design and analysis that could mitigate many potential sources of bias.
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Affiliation(s)
- Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Cande V. Ananth
- Department of Obstetrics and GynecologyIrving College of Physicians and SurgeonsColumbia UniversityNew YorkNew York,Department of EpidemiologyJoseph L. Mailman School of Public HealthColumbia UniversityNew YorkNew York
| | - Olga Basso
- Department of Obstetrics and GynecologyRoyal Victoria HospitalResearch Institute of McGill University Health CentreMontrealQuebecCanada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Peter A. Briss
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgia
| | - Cynthia D. Ferré
- Maternal and Infant Health BranchDivision of Reproductive HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgia
| | - Brittni N. Frederiksen
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Sonia Hernández‐Díaz
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMassachusetts
| | - Ashley H. Hirai
- US Department of Health and Human ServicesHealth Resources and Services AdministrationMaternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Russell S. Kirby
- Department of Community and Family HealthUniversity of South Florida College of Public HealthTampaFlorida
| | - Mark A. Klebanoff
- Division of EpidemiologyDepartments of Pediatrics and Obstetrics and GynecologyCenter for Perinatal ResearchThe Research Institute at Nationwide Children's HospitalThe Ohio State UniversityColumbus Ohio
| | | | - Sunni L. Mumford
- Epidemiology BranchDivision of Intramural Population Health ResearchNational Institute of Child Health and Human DevelopmentBethesdaMaryland
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health and Science UniversityPortlandOregon
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lauren M. Rossen
- Reproductive Statistics BranchDivision of Vital StatisticsCenters for Disease Control and PreventionNational Center for Health StatisticsHyattsvilleMaryland
| | - Alison M. Stuebe
- Department of Obstetrics and GynecologyUniversity of North Carolina School of MedicineChapel HillNorth Carolina,Department of Maternal and Child HealthGillings School of Global Public HealthChapel HillNorth Carolina
| | - Marie E. Thoma
- Department of Family ScienceUniversity of MarylandCollege ParkMaryland
| | - Catherine J. Vladutiu
- US Department of Health and Human ServicesHealth Resources and Services AdministrationMaternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
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Kogan MD, Vladutiu CJ, Schieve LA, Ghandour RM, Blumberg SJ, Zablotsky B, Perrin JM, Shattuck P, Kuhlthau KA, Harwood RL, Lu MC. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics 2018; 142:peds.2017-4161. [PMID: 30478241 PMCID: PMC6317762 DOI: 10.1542/peds.2017-4161] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2018] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5839990273001PEDS-VA_2017-4161Video Abstract OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children's Health (NSCH). METHODS The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD diagnosis by a care provider, current ASD status, health care use, access and challenges, and methods of treatment. We calculated weighted prevalence estimates of ASD, compared health care experiences of children with ASD to other children, and examined factors associated with increased likelihood of medication and behavioral treatment. RESULTS Parents of an estimated 1.5 million US children aged 3 to 17 years (2.50%) reported that their child had ever received an ASD diagnosis and currently had the condition. Children with parent-reported ASD diagnosis were more likely to have greater health care needs and difficulties accessing health care than children with other emotional or behavioral disorders (attention-deficit/hyperactivity disorder, anxiety, behavioral or conduct problems, depression, developmental delay, Down syndrome, intellectual disability, learning disability, Tourette syndrome) and children without these conditions. Of children with current ASD, 27% were taking medication for ASD-related symptoms, whereas 64% received behavioral treatments in the last 12 months, with variations by sociodemographic characteristics and co-occurring conditions. CONCLUSIONS The estimated prevalence of US children with a parent-reported ASD diagnosis is now 1 in 40, with rates of ASD-specific treatment usage varying by children's sociodemographic and co-occurring conditions.
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Affiliation(s)
- Michael D. Kogan
- Health Resources and Services Administration,
Maternal and Child Health Bureau, Rockville, Maryland
| | - Catherine J. Vladutiu
- Health Resources and Services Administration,
Maternal and Child Health Bureau, Rockville, Maryland
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental
Disabilities and
| | - Reem M. Ghandour
- Health Resources and Services Administration,
Maternal and Child Health Bureau, Rockville, Maryland
| | - Stephen J. Blumberg
- National Center for Health Statistics, Centers for
Disease Control and Prevention, Hyattsville, Maryland
| | - Benjamin Zablotsky
- National Center for Health Statistics, Centers for
Disease Control and Prevention, Hyattsville, Maryland
| | - James M. Perrin
- Department of Pediatrics, Harvard Medical School,
Harvard University and MassGeneral Hospital for Children, Boston,
Massachusetts
| | - Paul Shattuck
- AJ Drexel Autism Institute, School of Public Health,
Drexel University, Philadelphia, Pennsylvania; and
| | - Karen A. Kuhlthau
- Department of Pediatrics, Harvard Medical School,
Harvard University and MassGeneral Hospital for Children, Boston,
Massachusetts
| | - Robin L. Harwood
- Health Resources and Services Administration,
Maternal and Child Health Bureau, Rockville, Maryland
| | - Michael C. Lu
- Office of the Dean, Milken Institute School of Public
Health, George Washington University, Washington, District of Columbia
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Vladutiu CJ, Ahrens KA, Verbiest S, Menard MK, Stuebe AM. Cardiovascular Health of Mothers in the United States: National Health and Nutrition Examination Survey 2007-2014. J Womens Health (Larchmt) 2018; 28:1227-1236. [PMID: 30457931 DOI: 10.1089/jwh.2018.7204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pregnancy and childrearing can impact women's health and alter chronic disease trajectories in later life, including cardiovascular disease. The purpose of this study was to assess measures of women's cardiovascular health by time since last live birth. Materials and Methods: Data were from 4,021 nonpregnant U.S. women, 20-44 years of age, participating in the 2007-2014 National Health and Nutrition Examination Survey (NHANES). Cardiovascular health was assessed using physical measures, laboratory measures, self-reported behaviors, medical conditions, and selected psychosocial factors by time since last live birth. Results: Women reported their last live birth within the past 12 months ("mothers of infants"; 7.4%), >12 months, but <3 years ago ("mothers of toddlers"; 10.0%), or ≥3 years ago ("mothers of older children"; 45.2%); 37.3% were nulliparous. Compared with nulliparous women, mothers of older children had a higher prevalence of selected cardiovascular risk factors, including unhealthy diet (75.6% vs. 68.8%) and smoking (28.1% vs. 21.9%), after adjustment for sociodemographics (including age). Mothers of toddlers had a higher prevalence of unhealthy diet (78.0% vs. 68.8%). Mothers also had poorer metabolic health as indicated by a higher prevalence of low HDL cholesterol among mothers of toddlers and older children (44.2% and 40.4%, respectively, vs. 33.6%), and a higher prevalence of high waist circumference among mothers of infants (65.6% vs. 53.8%). Some mothers also had a higher prevalence of other cardiovascular risk factors, including low physical activity and poor sleep. Conclusion: Prior pregnancy and childrearing may be associated with selected cardiovascular risk factors among nonpregnant reproductive-aged U.S. women.
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Affiliation(s)
- Catherine J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Katherine A Ahrens
- Office of Population Affairs, Office of the Assistant Secretary for Health, Rockville, Maryland
| | - Sarah Verbiest
- Department of Obstetrics & Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina.,School of Social Work, University of North Carolina, Chapel Hill, North Carolina
| | - M Kathryn Menard
- Department of Obstetrics & Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Department of Obstetrics & Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Grant JH, Handwerk K, Baker K, Milling V, Barlow S, Vladutiu CJ. Implementing Group Prenatal Care in Southwest Georgia Through Public-Private Partnerships. Matern Child Health J 2018; 22:1535-1542. [PMID: 30047079 DOI: 10.1007/s10995-018-2576-0] [Citation(s) in RCA: 2] [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: 10/28/2022]
Abstract
Introduction CenteringPregnancy® is well-regarded as an innovative group model of prenatal care. In 2009, Georgia's Southwest Public Health District partnered with local obstetricians and medical centers to expand prenatal care access and improve perinatal outcomes for low-income women by implementing Georgia's first public health administered CenteringPregnancy program. This paper describes the successful implementation of CenteringPregnancy in a public health setting with no prior prenatal services; assesses the program's first 5-year perinatal outcomes; and discusses several key lessons learned. Methods Prenatal and hospital medical records of patients were reviewed for the time period from October 2009 through October 2014. Descriptive analyses were conducted to examine demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session. Results Six hundred and six low-income women initiated prenatal care; 55.4 and 36.4% self-identified as non-Hispanic black and Hispanic, respectively. The median age was 23 years (IQR 20, 28). Nearly 69% initiated prenatal care in the first trimester. Perinatal outcomes were examined among 338 singleton live births. The 2010-2014 preterm birth rate (% of births < 37 weeks gestation at delivery) and low birth weight rate (% of births < 2500 g) were 9.1 and 8.9%, respectively. Nearly 77% of women initiated breastfeeding. Discussion CenteringPregnancy administered via public-private partnership may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings.
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Affiliation(s)
- Jacqueline H Grant
- Georgia Department of Public Health, Southwest District, Albany, Georgia. .,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB #7516, Chapel Hill, NC, 27599-7516, USA.
| | - Katherine Handwerk
- Georgia Department of Public Health, Southwest District, Albany, Georgia
| | - Karen Baker
- Dougherty County Health Department, Albany, Georgia
| | | | | | - Catherine J Vladutiu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB #7516, Chapel Hill, NC, 27599-7516, USA.,Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
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Grace MR, Vladutiu CJ, Nethery RC, Siega-Riz AM, Manuck TA, Herring AH, Savitz D, Thorp JT. Lipoprotein particle concentration measured by nuclear magnetic resonance spectroscopy is associated with gestational age at delivery: a prospective cohort study. BJOG 2018; 125:895-903. [PMID: 28886230 PMCID: PMC6582364 DOI: 10.1111/1471-0528.14927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To estimate the association between lipoprotein particle concentrations in pregnancy and gestational age at delivery. DESIGN Prospective cohort study. SETTING The study was conducted in the USA at the University of North Carolina. POPULATION We assessed 715 women enrolled in the Pregnancy, Infection, and Nutrition study from 2001 to 2005. METHODS Fasting blood was collected at two time points (<20 and 24-29 weeks of gestation). Nuclear magnetic resonance (NMR) quantified lipoprotein particle concentrations [low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low density lipoprotein (VLDL)] and 10 subclasses of lipoproteins. Concentrations were assessed as continuous measures, with the exception of medium HDL which was classified as any or no detectable level, given its distribution. Cox proportional hazards models estimated hazard ratios (HR) for gestational age at delivery adjusting for covariates. MAIN OUTCOME MEASURES Gestational age at delivery, preterm birth (<37 weeks of gestation), and spontaneous preterm birth. RESULTS At <20 weeks of gestation, three lipoproteins were associated with later gestational ages at delivery [large LDLNMR (HR 0.78, 95% CI 0.64-0.96), total VLDLNMR (HR 0.77, 95% CI 0.61-0.98), and small VLDLNMR (HR 0.78, 95% CI 0.62-0.98], whereas large VLDLNMR (HR 1.19, 95% CI 1.01-1.41) was associated with a greater hazard of earlier delivery. At 24-28 weeks of gestation, average VLDLNMR (HR 1.25, 95% CI 1.03-1.51) and a detectable level of medium HDLNMR (HR 1.90, 95% CI 1.19-3.02) were associated with earlier gestational ages at delivery. CONCLUSION In this sample of pregnant women, particle concentrations of VLDLNMR , LDLNMR , IDLNMR , and HDLNMR were each independently associated with gestational age at delivery for all deliveries or spontaneous deliveries <37 weeks of gestation. These findings may help formulate hypotheses for future studies of the complex relationship between maternal lipoproteins and preterm birth. TWEETABLE ABSTRACT Nuclear magnetic resonance spectroscopy may identify lipoprotein particles associated with preterm delivery.
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Affiliation(s)
- Matthew R. Grace
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rachel C. Nethery
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Anna Maria Siega-Riz
- Departments of Public Health Sciences and Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| | - Tracy A. Manuck
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Amy H. Herring
- Department of Statistical Science and Duke Global Health Institute, Duke University, Durham, NC
| | - David Savitz
- Departments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, RI
| | - John T. Thorp
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
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Glover AV, Battarbee AN, Gyamfi-Bannerman C, Vladutiu CJ, Boggess KA, Manuck TA. 592: Adverse outcomes of late preterm infants according to route of delivery. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Battarbee AN, Glover AV, Vladutiu CJ, Gyamfi-Bannerman C, Manuck TA, Boggess KA. 275: Factors associated with NICU admission at term following threatened late preterm birth. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grant JH, Vladutiu CJ, Manuck TA. Racial Disparities in Delivery Gestational Age among Twin Pregnancies. Am J Perinatol 2017; 34:1065-1071. [PMID: 28591904 DOI: 10.1055/s-0037-1603764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective This study aims to estimate the association between maternal race and delivery gestational age among women with twin gestations.
Study Design Secondary analysis of a prospective, randomized control trial of 17-α hydroxyprogesterone caproate versus placebo for preterm birth (PTB) prevention in twin gestations. Non-Hispanic (NH) black and whites were included. Demographic and antenatal characteristics were compared. The primary outcome was delivery gestational age. Secondary outcomes included a composite of major neonatal morbidity. Kaplan–Meier curves estimated survival probabilities for delivery gestational age by race. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI).
Results A total of 535 women with twin gestations were included; 150 were NH black. NH blacks delivered earlier than NH whites (33.6 ± 4.8 weeks vs. 35.1 ± 3.5 weeks, p < 0.001). Differences in delivery gestational age between NH blacks and whites were consistent across gestation. In adjusted analyses, NH black race (HR: 1.24, 95% CI: 1.02–1.51), prior PTB (HR: 1.59, 95% CI: 1.15–2.19), and cerclage (HR: 3.90, 95% CI: 2.00–7.60) were associated with an increased risk of earlier delivery. Major neonatal morbidity was higher for NH blacks compared with NH whites (12.7 vs. 7.0%, p = 0.036).
Conclusion NH blacks with twin gestations have an increased risk of early delivery and neonatal morbidity compared with NH whites.
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Affiliation(s)
- Jacqueline H Grant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Smid MC, Vladutiu CJ, Dotters-Katz SK, Boggess KA, Manuck TA, Stamilio DM. Maternal obesity and major intraoperative complications during cesarean delivery. Am J Obstet Gynecol 2017; 216:614.e1-614.e7. [PMID: 28209495 DOI: 10.1016/j.ajog.2017.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/23/2016] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple studies have demonstrated an association between maternal obesity and postoperative complications, but there is a dearth of information about the impact of obesity on intraoperative complications. OBJECTIVE To estimate the association between maternal obesity at delivery and major intraoperative complications during cesarean delivery (CD). METHODS This is a secondary analysis of the deidentified Maternal-Fetal Medicine Unit Cesarean Registry of women with singleton pregnancies. Maternal body mass index (BMI) at delivery was categorized as BMI 18.5 to 29.9 kg/m2, BMI 30 to 39.9 kg/m2, BMI 40 to 49.9 kg/m2, and BMI ≥ 50 kg/m2. The primary outcome, any intraoperative complication, was defined as having at least 1 major intraoperative complication, including perioperative blood transfusion, intraoperative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, repeat laparotomy, and hysterectomy. Log-binomial models were used to estimate risk ratios of intraoperative complication in 2 models: model 1 adjusting for maternal race, and preterm delivery <37 weeks; and model 2 adjusting for confounders in Model 1 as well as emergency CD, and type of skin incision. RESULTS A total of 51,218 women underwent CD; 38% had BMI 18.5 to 29.9 kg/m2, 47% BMI 30 to 39.9 kg/m2, 12% BMI 40 to 49.9 kg/m2 and 3% BMI ≥ 50 kg/m2. Having at least 1 intraoperative complication was uncommon (3.4%): 3.8% for BMI 18.5 to 29.9 kg/m2, 3.2% BMI 30 to 39.9 kg/m2, 2.6% BMI 40 to 49.9 kg/m2 and 4.3% BMI ≥ 50 kg/m2 (P < .001). In the fully adjusted model 2, women with BMI 40 to 49.9 kg/m2 had a lower risk of any intraoperative complication (adjusted risk ratio [ARR], 0.76; 95% confidence interval [CI], 0.64 to 0.89) compared with women with BMI 18.5 to 29.9 kg/m2. Women with BMI 30 to 39.9 kg/m2 (ARR, 0.93; 95% CI, 0.84 to 1.03) had a similar risk of any intraoperative complication compared with nonobese women. Among super obese women, there was evidence of effect modification by emergency CD. Compared with nonobese women, neither super obese women undergoing nonemergency CD (ARR, 1.13; 95% CI, 0.84 to 1.52) nor those undergoing emergency CD (ARR, 0.59; 95% CI, 0.32 to 1.10) had an increased risk of intraoperative complication. CONCLUSION In contrast to the risk for postcesarean complications, the risk of intraoperative complication does not appear to be increased in obese women, even among those with super obesity.
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Affiliation(s)
- Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC.
| | - Catherine J Vladutiu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Kim A Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - David M Stamilio
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Smid MC, Dotters-Katz SK, Vaught AJ, Vladutiu CJ, Boggess KA, Stamilio DM. Maternal super obesity and risk for intensive care unit admission in the MFMU Cesarean Registry. Acta Obstet Gynecol Scand 2017; 96:976-983. [PMID: 28382734 DOI: 10.1111/aogs.13145] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obesity is a risk factor for intensive care unit (ICU) admission in nonpregnant populations. Less is known about maternal obesity and ICU admission risk. The objective of this study was to estimate the association between maternal obesity and ICU admission among women who delivered via cesarean section or vaginal birth after cesarean section (VBAC). MATERIAL AND METHODS This is a retrospective cohort analysis of women who delivered via VBAC or cesarean section in the Maternal-Fetal Medicine Unit (MFMU) Cesarean Registry. We defined exposure as body mass index (BMI) at delivery stratified as non-obese (BMI 18.5-29.9 kg/m2 ), class I or II obese (BMI 30-39.9 kg/m2 ), morbidly obese (BMI 40-49.9 kg/m2 ), and super obese (BMI ≥ 50 kg/m2 ). The primary outcome was ICU admission. Modified Poisson regression models estimated relative risk (RR) of ICU admission by obesity strata, after adjusting for confounders. Mediation analysis was used to estimate the proportion of ICU admission risk attributable specifically to obesity. RESULTS We included 68 455 women; 40% non-obese, 46% class I or II obese, 12% morbidly obese, and 2% super obese. Super obese women were at higher risk for ICU admission compared with non-obese women (0.7 vs. 1.3%, adjusted RR 1.61; 95% CI 1.01-2.65), after adjusting for confounders. Among super obese women, medical comorbidities mediated 58% of ICU admission risk, suggesting that a significant proportion of ICU admission is driven by maternal obesity. CONCLUSIONS Super obese women who deliver by cesarean section or VBAC are at increased risk of peripartum ICU admission. Obstetricians and critical care specialists should consider possible ICU admission during delivery planning.
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Affiliation(s)
- Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Arthur J Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine J Vladutiu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Kim A Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - David M Stamilio
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
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Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
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Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
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Vladutiu CJ, Siega-Riz AM, Sotres-Alvarez D, Stuebe AM, Ni A, Tabb KM, Gallo LC, Potter JE, Heiss G. Parity and Components of the Metabolic Syndrome Among US Hispanic/Latina Women: Results From the Hispanic Community Health Study/Study of Latinos. Circ Cardiovasc Qual Outcomes 2016; 9:S62-9. [PMID: 26908862 DOI: 10.1161/circoutcomes.115.002464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Physiological adaptations occurring across successive pregnancies may increase the risk of adverse cardiovascular health outcomes in later life. METHODS AND RESULTS The association between parity and metabolic syndrome was examined among 7467 Hispanic/Latina women of diverse backgrounds, aged 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from 2008 to 2011. Metabolic syndrome components were defined according to American Heart Association/National Heart, Lung, and Blood Institute criteria and included abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and elevated fasting glucose. Logistic regression models estimated odds ratios (ORs) adjusting for sociodemographic, behavioral, and reproductive characteristics. At HCHS/SOL baseline, women reported none (21.1%), 1 (19.9%), 2 (25.7%), 3 (18.6%), 4 (8.8%), and ≥ 5 (5.9%) live births. When compared with women with 1 birth, those with 4 births had the highest odds of abdominal obesity (OR, 2.0; 95% confidence interval, 1.5-2.8) and overall metabolic syndrome (OR, 1.4; 95% confidence interval, 1.0-2.0) and those with ≥ 5 births had the highest odds of low high-density lipoprotein cholesterol (OR, 1.5; 95% confidence interval, 1.2-2.0) and elevated fasting glucose (OR, 1.6; 95% confidence interval, 1.1-2.4), after adjusting for age, background, education, marital status, income, nativity, smoking, physical activity, menopause, oral contraceptive use, hormone therapy, and field center. Further adjustment for percent body fat attenuated these associations. No associations were observed between parity and elevated triglycerides or high blood pressure. CONCLUSIONS Higher parity is associated with an increased prevalence of selected components of the metabolic syndrome among Hispanic/Latina women in the US. High parity among Hispanics/Latinas with a high prevalence of abdominal obesity suggests high risk for metabolic dysregulation.
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Affiliation(s)
- Catherine J Vladutiu
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.).
| | - Anna Maria Siega-Riz
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Daniela Sotres-Alvarez
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Alison M Stuebe
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Andy Ni
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Karen M Tabb
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Linda C Gallo
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - JoNell E Potter
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Gerardo Heiss
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
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Vladutiu CJ, Meyer ML, Malek AM, Stuebe AM, Mosher A, Aggarwal S, Kleindorfer D, Howard VJ. Racial Differences in the Association between Parity and Incident Stroke: Results from the REasons for Geographic and Racial Differences in Stroke Study. J Stroke Cerebrovasc Dis 2016; 26:749-755. [PMID: 27839767 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Circulatory and vascular changes across consecutive pregnancies may increase the risk of later-life cerebrovascular health outcomes. METHODS The association between parity and incident stroke was assessed among 7674 white and 6280 black women, aged 45 years and older, and enrolled in the REasons for Geographic and Racial Differences in Stroke Study from 2003 to 2007. Parity was assessed at baseline, and incident stroke was ascertained from physician-adjudicated medical records through September 2014. Cox proportional hazards models were used to estimate hazard ratios (HR) for the association between parity and stroke, adjusting for baseline measures. RESULTS At baseline, 12.7% of white women and 16.2% of black women reported 1 live birth, while 8.2% and 19.0%, respectively, reported 5 or more live births. Mean follow-up time was 7.5 years (standard deviation = 2.8); there were 447 incident strokes. A significant interaction between race and parity was detected (P = .05). Among white women, those with 5 or more live births had a higher stroke risk than those with 1 live birth (HR = 1.57; 95% confidence interval [CI] .93-2.65). However, the association was eliminated after adjustment for baseline characteristics (HR = 1.00, 95% CI .59-1.71). For black women, those with 5 or more live births had the highest stroke risk compared with those with 1 live birth (HR = 1.91, 95% CI 1.25-2.93), but the association was attenuated and no longer statistically significant after adjustment for confounders (HR = 1.40, 95% CI .89-2.18). CONCLUSIONS In adjusted models, no statistically significantassociations were observed between parity and stroke risk in a diverse cohort of U.S. women. Further studies are needed to elucidate the role of lifestyle and psychosocial factors in the race-specific associations that were observed.
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Affiliation(s)
- Catherine J Vladutiu
- Department of Epidemiology, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina; Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina.
| | - Michelle L Meyer
- Department of Epidemiology, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina
| | - Angela M Malek
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
| | - Alison M Stuebe
- Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina
| | - Aleena Mosher
- Department of Biostatistics, UAB School of Public Health, Birmingham, Alabama
| | - Shivani Aggarwal
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Virginia J Howard
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
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