Evaluation of low birthweight in African Americans

This study evaluates risk factors associated with low birthweight in an African-American population. Records of 225 women delivering liveborn, nonanomalous singletons weighing < 2500 g were reviewed. The next parturient, matched for race only, of a similar infant weighing > or = 2500 g constituted the control. This case-control study was conducted among women delivering at University Hospital in New Orleans during 1996-1997. Mothers of infants weighing < 2500 g were more likely to not have finished high school (49% versus 38%), to have received no prenatal care (26% versus 7%), or to have five or fewer visits if care was obtained (52% versus 33%). The mother was more likely to weigh < 60 kg (49% versus 32%), to smoke (24% versus 11%), or to have used cocaine (18% versus 5%) or alcohol (11% versus 5%). Parturients of low birthweight newborns were more likely to have had a prior low birthweight infant (44% versus 19%) and themselves to have had a birthweight < 2500 g (30% versus 13%). Regression analysis confirmed the importance of three parameters as associated with low birthweight: no prenatal care (odds ratio [OR] = 6.0 [1.1-31.4]), alcohol use (OR = 5.2 [1.1-24.8], and low maternal birthweight (OR = 3.9 [1.9-7.9]. These results indicate that evaluations of low birthweight in African Americans should consider maternal birthweight and that efforts to improve pregnancy outcome should be structured in terms of generations.     

Influence of medical conditions on executive and memory functions in low socioeconomic status African Americans.

We examined the association of total comorbid score and specific chronic conditions including cardiovascular diseases, musculoskeletal conditions, diabetes mellitus, stroke, hypertension, and cancer with several cognitive domains across four different age groups: young adults (ages 18-34), young middle-aged adults (ages 35-50), middle-aged adults (ages 51-64), and older adults (ages >64). Cognitive tests measuring global ability, executive function, memory function, and perceptual speed ability were administered to 384 African Americans. Total comorbid score was computed by summing up the number of chronic conditions. Results showed an inverse association between total comorbid scores and executive and memory functions in the total sample. With the exception of the youngest group, stroke was the only prominent predictor of poor performance for all age groups, but the impact was greater in the younger age groups compared with older adults. These results suggest that the impact of medical conditions on domain specific tasks may be modified by age.     

Proinflammatory cytokine polymorphisms and the risk of preterm birth and low birthweight in a Japanese population

Pregnancy and parturition involve a complex and poorly understoodmolecular and biological interplay between mother and fetus.Inflammatory cytokines have been reported to be associated withfetal growth and parturition. The aim of this study was to examinewhether common proinflammatory cytokine polymorphisms are associatedwith preterm birth (PTB), low birthweight or intrauterine growthrestriction in a Japanese population. We assessed a consecutiveseries of 414 women who had singleton deliveries in Sapporo,Japan between 2001 and 2005. Genotyping of IL1A –889C/T,+4845G/T (A114S), IL1B –511C/T, –31C/T, IL2 –384T/Gand IL6 –634C/G polymorphisms was determined by an allelicdiscrimination assay. The risk of PTB significantly increasedin women carrying the IL1A –889T allele (CC genotype [reference];CT genotype, odds ratios (OR): 2.5; 95% confidence intervals(95% CI): 1.4–4.8; CT+TT genotypes [dominant genotypemodel], OR: 2.5, 95% CI: 1.3–4.6). Similarly, the riskof PTB significantly increased in women carrying the IL1A +4845Tallele (GG genotype [reference]; GT genotype, OR: 2.4, 95% CI:1.3–4.4; GT+TT genotypes [dominant genotype model], OR:2.3, 95% CI: 1.2–4.2). The frequency of the IL1A TT haplotypein mothers with PTB was significantly higher than in motherswho had a term birth (P < 0.001), whereas the frequency ofthe IL1A CG haplotype in mothers who had a PTB was significantlylower (P < 0.001). Our findings suggest that the polymorphismsand haplotypes in the IL1A gene are associated with PTB in Japanesewomen.     

Characteristics of social support networks of low socioeconomic status African American,Anglo American,and Mexican American mothers of full-term and preterm infants

This study examined the relation of ethnicity to two aspects of mothers' social support: structure (friends vs. family) and quality (satisfaction vs. aggravation) for mothers from low socioeconomic (SES) backgrounds in three ethnic groups—Anglo American (n = 53), African American (n = 50), and Mexican American (n = 42). Mothers of both preterm (n = 81) and full-term infants (n = 64) were included. Mothers from Mexican American backgrounds had fewer friends in their networks when compared with mothers in the African American and Anglo American groups. While there were no significant effects for ethnicity on support satisfaction, mothers overall reported more satisfaction with support received from friends rather than family. African American mothers reported significantly more aggravation in their support systems than the other two groups. This was not due to differences for these mothers in their SES or marital status, and are discussed in relation to community differences that appear to be present for this ethnic group. The clinical importance of considering ethnic backgrounds when serving mothers with young children are discussed. © 1998 John Wiley & Sons, Inc.     

Low birthweight in African Americans: does intergenerational well-being improve outcome?

The primary antecedent of infant mortality is low birthweight. Vital statistics data have shown that women of low socioeconomic status, regardless of race, are at greater risk for delivering low birthweight infants; however, prevailing data show that black women of the same socioeconomic status as white women have a twofold higher risk of giving birth to an infant weighing < 2500 g and a threefold risk of delivering a very low birthweight infant weighing < 1500 g. There is also evidence that intergenerational effects on birth outcome exist. However, virtually all studies of the effect of socioeconomic status on perinatal outcome have been cross-sectional; the effect of sustained intergenerational well-being has not been measured. To address this gap, this study was designed to demonstrate that in an African-American population with sustained high socioeconomic status and equal risk factors, the birthweight distribution and other reproductive outcomes are the same as those for comparable US white populations. Preliminary findings are reported here.     

Biopsychosocial profiles of pregnant women at high or low risk to encounter preterm birth

A battery of questionnaires consisting of biopsychosocial indices was administered prospectively to a sample of 734 pregnant women in their 12–27th weeks of gestation in prenatal clinics in the community. The purpose of the study was to identify predictors of preterm birth defined by either week of gestation, weight of infant at birth, or both. The findings suggest that the strongest medical predictor of preterm birth defined by week of gestation is risk factors in previous pregnancies, whereas the strongest and most consistent psychological predictor of preterm birth defined by either weight of infant at birth or both week of gestation and weight is the readiness of the pregnant woman to change her life-style during pregnancy to safeguard the well-being of the fetus. It is suggested that this scale is a reliable indirect measure of the desirability of pregnancy. Furthermore the profiles of highland low-risk women to encounter preterm birth, as suggested by cluster analysis and implications for community psychology, are discussed.     

Umbilical vein serum amino acid levels in African Americans: relationship to birthweight and maternal variables.

Compared with other racial groups, African-American women show a disproportionately high risk of delivering low birthweight babies. In a retrospective study of African-American infants born at Meharry Hubbard Hospital, which predominantly serves the underprivileged inner-city poor, free amino acid concentrations were measured in umbilical venous serum from infants born following 34 to 42 weeks gestation. Significant reductions in levels of glycine, serine, alanine, the branched-chain amino acids, and the sum of the so-called dispensable amino acids were associated with decreased birthweight. Glycine, a quantitatively important residue in collagen and a component of reduced glutathione (gamma-glutamyl-cysteinyl-glycine), which is featured in the gamma-glutamyl amino acid transport cycle, was most consistently and severely affected. This study not only indicated that selective reduction in transplacental amino acid transport may be an important factor in intrauterine growth retardation in African Americans, but also confirmed the dietary necessity of the structurally simple amino acid glycine during pregnancy.     

Sex differences in cardiovascular disease: are women with low socioeconomic status at high risk?

BACKGROUND: Cardiovascular disease is still portrayed as a typical male disease, and men are more often submitted to invasive procedures or referred earlier. AIM: To explore sex differences in morbidity and referral patterns in cardiovascular disease in general practice, and the role of age and socioeconomic status. METHOD: Data were obtained from a continuous morbidity registration project in the Netherlands from 1986 to 1995 in which 12,000 patients were followed over 10 years. The effects of sex, age, and socioeconomic status on morbidity of cardiovascular disease and the referral patterns were established. RESULTS: The sex difference in morbidity becomes smaller with increasing age. Morbidity was highest in the lower socioeconomic status in general and for angina pectoris in particular. Women with angina pectoris with low socioeconomic status have a relative risk of 2.24 (CI = 1.17-3.26) compared with women with high socioeconomic status. In men, no significant difference was found between the socioeconomic status groups. For angina pectoris the sex difference in referral to the specialist was most significant: 50.6% and 26.6% (P = 0.002) for men and women respectively. CONCLUSION: For women, low socioeconomic status was associated with relatively higher morbidity of angina pectoris and myocardial infarction than for men. Women are less likely to be referred than men are, in particular for angina pectoris.     

Provider communication effects medication adherence in hypertensive African Americans

Objective

To evaluate the effect of patients’ perceptions of providers’ communication on medication adherence in hypertensive African Americans.

Methods

Cross-sectional study of 439 patients with poorly controlled hypertension followed in community-based healthcare practices in the New York metropolitan area. Patients’ rating of their providers’ communication was assessed with a perceived communication style questionnaire,while medication adherence was assessed with the Morisky self-report measure.

Results

Majority of participants were female, low-income, and had high school level educations, with mean age of 58 years. Fifty-five percent reported being nonadherent with their medications; and 51% rated their provider's communication to be non-collaborative. In multivariate analysis adjusted for patient demographics and covariates (depressive symptoms, provider degree), communication rated as collaborative was associated with better medication adherence (β = −.11, p = .03). Other significant correlates of medication adherence independent of perceived communication were age (β = .13, p = .02) and depressive symptoms (β = −.18, p = .001).

Conclusion

Provider communication rated as more collaborative was associated with better adherence to antihypertensive medications in a sample of low-income hypertensive African-American patients.

Practice implications

The quality of patient–provider communication is a potentially modifiable element of the medical relationship that may affect health outcomes in this high-risk patient population.     

Lower rates of low birthweight and preterm births in the California Black Infant Health Program

OBJECTIVES: The objective of this study was to determine the impact of prenatal interventions in the California Black Infant Health (BIH) Program on low birthweight (LBW) and preterm births (PTB) outcomes. METHODS: A prospective observational study design with a comparison group was used. BIH participants with a delivery recorded between July 1996 and September 1998 were included in the birthweight and PTB analyses. These outcomes for BIH participants who entered the BIH program prior to 32 weeks' gestation (n=1,553) were compared to those of all African-American women in the BIH Program targeted ZIP codes (n=11,633). RESULTS: No statistically significant differences in LBW and PTB were found between the BIH population and the comparison group. However, a comparison of the BIH infant VLBW (<1,500 g) rate (1.9%) with the VLBW rate for the comparison group (3.0%) shows that the BIH rate is 63% of the comparison group rate. For very PTB (<32 weeks), the BIH rate (3.5%) is 81% of the comparison group rate (4.3%). BIH participants had higher risk profiles (pregnancy history, current pregnancy, and psychosocial; p=<0.01) than women in the comparison group. CONCLUSIONS: The BIH Program retained high-risk women in the program to delivery and assisted them with maintenance of prenatal care. Even though the program participants were higher risk, their LBW and PTB outcomes were comparable to the geographic area overall. More importantly, there was a trend among women in the BIH Program toward better outcomes than the comparison group in both VLBW and VPTB.     

Positive social interaction offsets impact of low socioeconomic status on stress

Background

Stress is associated with unhealthy behaviors and premature morbidity and mortality, especially among those of low socioeconomic status (SES). Clarifying the roles of stress-related risk and protective factors can guide interventions designed to reduce stress and improve health among socioeconomically disadvantaged populations.

Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants

OBJECTIVE: To assess whether medical complications mediate the relationship between birth status (i.e., birth weight and gestational age) and developmental outcome of preterm, very low birth weight (VLBW) infants, as well as the role of the early social environment (maternal distress and social support) in infant development. METHOD: Birth status and medical complication information was collected during the child's NICU stay. Maternal distress was assessed with the Beck Depression Inventory and the Parenting Stress Index at 4 months corrected infant age. Social support was measured with the Dunst Scales at 4 months corrected age. Child development measures were collected at 4 and 13 months corrected age (Bayley MDI and PDI), and at 36 months chronological age (PPVT-R and Achenbach CBCL). RESULTS: Medical complications mediated the birth status-outcome relationship at 4 and 13 months, but not at 36 months. The 36-month outcomes were predicted by 4-month maternal distress and social support. CONCLUSIONS: Prematurity and VLBW are indirectly related to early developmental outcome through their association with medical complications. However, by 36 months, developmental outcomes are more closely related to aspects of the early social environment than to early physiological factors.     

Research issues in the study of very low birthweight and preterm delivery among African-American women.

Very low birthweight and preterm delivery explain two thirds of the excess deaths experienced by African-American infants. Although comprehensive, good quality services for all African-American women will help to reduce the twofold higher rate of infant mortality experienced by African-American infants compared with white infants, the infant mortality gap will not be closed until prevention research is conducted that incorporates the social, cultural, and political context of life for African-American women; the environmental stressors and the physiologic responses associated with stress; and the protective mechanisms available in the community for responding to stress. Discrimination may be an important stressor that influences a woman''s susceptibility to a poor pregnancy outcome. Strategies already exist in the community to cope with discrimination and other environmental stressors. To capture the effects of discrimination and other environmental factors and the protective factors important for prevention, the research approach must involve African-American women and their communities as collaborators in the research. Such collaboration will help to avoid problems with scientific racism.     

Pathways between socioeconomic status and modifiable risk factors among African American smokers

Although socioeconomic status is a major contributing factor to health disparities, the mechanisms through which socioeconomic status influences health remain unclear. The purpose of the present study was to evaluate an a priori conceptual model of the pathways between socioeconomic status and modifiable health risk factors in a sample of 399 African Americans seeking smoking cessation treatment. A latent variable modeling approach was utilized to characterize the interrelationships among socioeconomic status, neighborhood disadvantage, social support, negative affect/perceived stress, and three specific modifiable risk factors (i.e., overweight/obesity, insufficient physical activity, at-risk drinking). Findings indicated that neighborhood disadvantage, social support, and negative affect/perceived stress function as pathways linking socioeconomic status and modifiable risk factors among African American smokers, and negative affect/perceived stress appears to play a key mediating role. Policy, community, and individual-level interventions may attenuate the impact of socioeconomic status on health by targeting intermediate psychosocial, environmental, and behavioral pathways.     

The relationship between health status and blood pressure in urban African Americans.

African Americans have higher rates of hypertension and poorer health status than their white counterparts. This study assessed the relationship between health status, cardiovascular risk factors, and measured blood pressure. Free blood pressure screenings were performed at businesses and organizations located in west Baltimore. All individuals with cardiovascular risk factors were offered health education. Also, participants with a measured blood pressure of > or = 140/90 mm Hg were referred for free medical treatment. Participants completed a questionnaire that included demographics, cardiovascular risk factors, the Medical Outcomes Study SF 36, and two tests on cholesterol and heart disease knowledge. A total of 1389 African-American men and women were screened; 20% were found to have high normal blood pressure and 31% had stage 1 hypertension or higher. Those with hypertension reported lower physical functioning and poorer general health than those without high blood pressure. When compared with US normative data, participants reported higher levels in vitality and physical and emotional role functioning, more bodily pain, and poorer general health, but they were similar in physical functioning, social functioning, and mental health. Preliminary data suggest that hypertension does have an effect on health function.     

Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis

Background  

Although neuroanatomical and cognitive sequelae of low birthweight and preterm birth have been investigated, little is understood as to the likely prevalence of a history of low birthweight or preterm birth, or neuroanatomical correlates of such a history, within the special educational needs population. Our aim was to address these issues in a sample of young people receiving additional learning support.     

早产儿及低体重儿四种支原体感染状况研究

为了解早产儿、低体重儿人型支原体 (Mh)、解脲脲原体 (Uu)、生殖支原体 (Mg) ,发酵支原体 (Mf)等 4种支原体的感染状况 ,我们于 1997年～ 1998年分别收集了 2 7例早产儿和 2 1例低体重儿的咽拭子标本应用套式PCR (nPCR)法进行上述 4种支原体特异性核酸检测。结果早产儿和低体重儿的Mh阳性率分别为 92 6 %、95 2 % ;Uu阳性率分别为 5 5 5 %、38 1%。Mh Uu合并感染状况严重 ,分别为 5 5 5 %、33 3%。Mg只有 1例阳性 ,Mf无阳性病例发现。无论是早产儿 ,还是低体重儿 ,剖宫产与阴道产的各种支原体检出率无差别 (P均 <0 0 5 )。剖宫产娩出儿咽部查出支原体可确认为宫内感染 ,由此可见 ,支原体宫内感染状况严重。本文并就支原体感染与早产和新生儿出生低体重的发生原因进行了讨论。     

Variation in total and specific IgE: effects of ethnicity and socioeconomic status

BACKGROUND: Asthma is common in minority and disadvantaged populations, whereas atopic disorders other than asthma appear to be less prevalent. It is unclear whether the same holds true for objective markers of sensitization. OBJECTIVE: To determine the association of asthma, atopic disorders, and specific sensitization with race and socioeconomic factors. METHODS: We analyzed total and specific IgE among 882 women (577 white, 169 black, and 136 Hispanic) who delivered a child at a large tertiary hospital in Boston, Mass, and who were screened for participation in a family and birth cohort study. Race/ethnicity and other characteristics were obtained from screening questionnaires. Addresses were geocoded, and 3 census-based geographic area socioeconomic variables were derived from block group information from the 1990 US Census. RESULTS: Black and Hispanic women were more likely to come from areas with low socioeconomic indicators and were more likely to have asthma than white women. However, these women were less likely to have hay fever and eczema than their white counterparts. Compared with white women, black women had higher mean total IgE levels; had greater proportions of sensitization to indoor, outdoor, and fungal allergens; and were more than twice as likely to be sensitized to > or =3 aeroallergens. CONCLUSION: The racial/ethnic disparities in atopic disorders may represent either underdiagnosis or underreporting and suggest that allergy testing may be underused in some populations. Differences in total IgE levels and specific allergen sensitization are likely a result of the complex interplay between exposures associated with socioeconomic disadvantage.