Interpregnancy Interval and Childbirth Outcomes in California, 2007–2009

Objectives The goals of interconception care are to optimize women’s health and encourage adequate spacing between pregnancies. Our study calculated trends in interpregnancy interval (IPI) patterns and measured the association of differing intervals with birth outcomes in California. Methods Women with “non-first birth” deliveries in California hospitals from 2007 to 2009 were identified in a linked birth certificate and patient discharge dataset and divided into three IPI birth categories: <6, 6–17, and 18–50 months. Trends over the study period were tested using the Cochran-Armitage two-sided linear trend test. Chi square tests were used to test the association between IPI and patient characteristics and selected singleton adverse birth outcomes. Results Of 645,529 deliveries identified as non-first births, 5.6 % had an IPI <6 months, 33.1 % had an IPI of 6–17 months, and 61.3 % had an IPI of 18–50 months. The prevalence of IPI <6 months declined over the 3-year period (5.8 % in 2007 to 5.3 % in 2009, trend p value <0.0001).Women with an IPI <6 months had a significantly higher prevalence of early preterm birth (<34 weeks), low birthweight (<2500 g), neonatal complications, neonatal death and severe maternal complications than women with a 6–17 month or 18–50 month IPI (p < 0.005). Comparing those with a 6–17 month vs 18–50 month IPI, there were increased early preterm births and decreased maternal complications, complicated delivery, and stillbirth/intrauterine fetal deaths among those with a shorter IPI. Conclusions for Practice In California, women with an IPI <6 months were at increased risk for several birth outcomes, including composite morbidity measures.

     

Prevalence of Risk Factors for Adverse Pregnancy Outcomes During Pregnancy and the Preconception Period—United States, 2002–2004

Objectives: To assess the prevalence of risk factors for adverse pregnancy outcome during the preconception stage and during pregnancy, and to assess differences between women in preconception and pregnancy. Methods: Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System, United States, were used to estimate the prevalence of selected risk factors among women 18–44 in the preconception period (women who wanted a baby in the next 12 months, and were not using contraception, not sterile and not already pregnant) with women who reported that they were pregnant at the time of interview. Results: Major health risks were reported by substantial proportions of women in the preconceptional period and were also reported by many pregnant women, although pregnant women tended to report lower levels of risk than preconception women. For example, 54.5% of preconception women reported one or more of 3 risk factors (frequent drinking, current smoking, and absence of an HIV test), compared with 32.0% of pregnant women (p < .05). The difference in the prevalence of these three risk factors between preconception and pregnancy was significant for women with health insurance (52.5% in preconception vs. 29.4% in pregnancy, p < .05), but not for women without insurance (63.4% vs. 52.7%, p > .05). Conclusions: Women appear to be responding to messages regarding behaviors that directly affect pregnancy such as smoking, alcohol consumption and taking folic acid, but many remain unaware of the benefits of available interventions to prevent HIV transmission and birth defects. Although it appears that some women reduce their risk for adverse pregnancy outcomes after learning of their pregnancy, the data suggest that a substantial proportion of women do not. Furthermore, if such change occurs it is often too late to affect outcomes, such as birth defects resulting from alcohol consumption during the periconception period. Preconception interventions are recommended to achieve a more significant reduction in risk and further improvement in perinatal outcomes.     

Interpregnancy Intervals and the Risk for Infant Mortality: A Case Control Study of Arizona Infants 2003–2007

There is well-documented evidence on how interpregnancy interval (IPI) is associated with adverse perinatal outcomes and how short and long IPIs are associated with increased risk for preterm birth, low birth weight, and intra-uterine growth restriction. However, the extremes of IPI on infant mortality are less well documented. The current study builds on the existing evidence on IPI to examine if extremes of IPI are associated with infant mortality, and also examines if IPI is associated with both neonatal and post-neonatal mortality after adjusting for several known confounders. Matched birth and death certificate data for Arizona resident infants was drawn for 2003–2007 cohorts. The analysis was restricted to singleton births among resident mothers with a previous live birth (n = 1,466) and a randomly selected cohort of surviving infants during the same time-frame was used as a comparison group (n = 2,000). Logistic regression models were utilized to assess the odds for infant mortality at monthly interpregnancy intervals (<6, 6–11, 12–17, 18–23, 24–59, ≥60), while adjusting for established predictors of infant mortality (i.e., preterm birth, low birth weight, and small for gestational age), and other potential confounders. Unadjusted analysis showed greater clustering at extreme IPIs of <6 months and ≥60 months for infants that died (32 %) compared to infants that survived (24.7 %). Shorter IPI (i.e., <6 months, 6–11 months, and 12–17 months) compared to ‘ideal’ IPI (i.e., 18–23 months), were associated with infant mortality even after adjusting for confounders. Short intervals were significantly associated with neonatal, but not post-neonatal deaths. IPI above 23 months were not associated with infant mortality in our analyses. Shorter IPIs (18 months or less) significantly increases the risk for neonatal infant mortality even after controlling for known confounders, and our study adds to the existing evidence on adverse perinatal outcomes. Counseling women of reproductive age on the benefits of spacing pregnancies to at least 18 months addresses one preventable risk for early infant mortality.     

Socioeconomic Disparities in Ectopic Pregnancy: Predictors of Adverse Outcomes from Illinois Hospital-Based Care, 2000–2006

This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000–2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients’ neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P < 0.0005) or no insurance (OR 1.35, P < 0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P < 0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P < 0.0005) and of hospitalization longer than 2 days (OR 0.57, P < 0.0005). With time, hospitalizations became shorter (OR 0.53, P < 0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes.     

Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005–2010

Objective The purpose of this study was to examine the association between prenatal smoking and small for gestational age (SGA) infants among adolescent women in West Virginia, taking into account sociodemographic and health-related factors. Methods Secondary data analysis was conducted using the 2005–2010 West Virginia Pregnancy Risk Assessment and Monitoring Systems weighted dataset. The study population using complete case analysis procedure consisted of 886 adolescent women ages 19 and younger who delivered a live singleton infant in West Virginia. Results The prevalence of smoking among adolescents during the last 3 months of pregnancy was 67 %. Nearly a quarter (22.0 %) of the adolescents gave birth to SGA infants. Results from the logistic regression analysis showed that after controlling for sociodemographic and health-related variables, adolescents who smoked during the last 3 months of pregnancy were more likely to have SGA infants than those who did not smoke during the last 3 months of pregnancy (OR = 1.86, 95 % CI 1.06–3.27, P = 0.0307). Conclusion This study highlights the importance of recognizing that prenatal smoking is an issue among West Virginia adolescents and the need for evidence-based, culturally, and developmentally appropriate interventions for this Appalachian population.     

Vitamin D Status and Risk of Breast Cancer in Iranian Women: A Case–Control Study

Objective: Considering the rising incidence of breast cancer and high prevalence of vitamin D deficiency in Iran, this case–control study aimed to investigate the relationship between serum concentration and intake of vitamin D and risk of breast cancer.

Methods: A total of 135 incident breast cancer cases at the Cancer Research Center of Shahid Beheshti University of Medical Sciences were matched with 135 controls by age and menopausal status. A validated and reliable 168-item food frequency questionnaire was completed by participant interviews. To determine the vitamin D content of foods we used the U.S. Department of Agriculture (USDA) nutrient database. To analyze the food frequency questionnaires we used the data collected in the Iranian Household Food Pattern Study, conducted by the National Nutrition and Food Technology Research Institute and the Iranian Ministry of Agriculture. Five-milliliter blood samples were collected to measure serum 25-hydroxyvitamin D (25(OH)D) using an enzyme-linked immunosorbent assay method.

Results: Women in the fourth quartile of serum 25(OH)D level had 3 times lower risk of developing breast cancer compared to those in the first quartile. In the adjusted model the inverse relationship remained significant (odds ratio [OR] = 0.269; 95% confidence interval [CI], 0.122–0.593). In the stratified model by menopausal status the inverse association was only seen in premenopausal women (OR = 0.25; 95% CI, 0.094–0.687).

Dietary intake of vitamin D was inversely associated with risk of breast cancer (OR fourth quartile [Q4] vs first quartile [Q1] = 0.39; 95% CI, 0.196–0.784; p = 0.008). After adjusting for the confounding factors, this inverse association remained significant.

Conclusion: Results from this case–control study support the protective effect of higher serum concentration of 25(OH)D against breast cancer. Moreover, dietary but not total intake of vitamin D was associated with decreased risk of breast cancer.     

Traffic-Related Air Pollution and Parkinson’s Disease in Denmark: A Case–Control Study

Background

Very little is currently known about air pollutants’ adverse effects on neurodegenerative diseases even though recent studies have linked particulate exposures to brain pathologies associated with Parkinson’s and Alzheimer’s disease.

Objective

In the present study, we investigated long-term exposure to traffic-related air pollution and Parkinson’s disease.

Methods

In a case–control study of 1,696 Parkinson’s disease (PD) patients identified from Danish hospital registries and diagnosed 1996–2009 and 1,800 population controls matched by sex and year of birth, we assessed long-term traffic-related air pollutant exposures (represented by nitrogen dioxide; NO₂) from a dispersion model, using residential addresses from 1971 to the date of diagnosis or first cardinal symptom for cases and the corresponding index date for their matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for matching factors and potential confounders.

Results

We found ambient air pollution from traffic sources to be associated with risk of PD, with a 9% higher risk (95% CI: 3, 16.0%) per interquartile range increase (2.97 μg/m³) in modeled NO₂. For participants living for ≥ 20 years in the capital city, ORs were larger (OR = 1.21; 95% CI: 1.11, 1.31) than in provincial towns (OR = 1.10; 95% CI: 0.97, 1.26), whereas there was no association among rural residents.

Conclusions

Our findings raise concerns about potential effects of air pollution from traffic and other sources on the risk of PD, particularly in populations with high or increasing exposures.

Citation

Ritz B, Lee PC, Hansen J, Funch Lassen C, Ketzel M, Sørensen M, Raaschou-Nielsen O. 2016. Traffic-related air pollution and Parkinson’s disease in Denmark: a case–control study. Environ Health Perspect 124:351–356; http://dx.doi.org/10.1289/ehp.1409313     

Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?

Objective To examine the association between gestational weight gain and adverse maternal and infant outcomes among overweight women [body mass index (BMI) 26.0–29.0 kg/m²]. Methods A population-based cohort study using birth certificate data (1990–2004) from 34,143 singleton, full-term deliveries to nulliparous, Missouri residents ages 18–35. Gestational weight gain was divided into three categories: below Institute of Medicine (IOM) recommendations (<15 lbs), within IOM recommendations (15–25 lbs), and above IOM recommendations (>25 lbs). Categories of 10-lb increments were also evaluated. The primary outcomes were preeclampsia, cesarean section, macrosomia, low birth weight (LBW), and perinatal death. Adjusted relative risks and 95% confidence intervals (CI) were calculated using Mantel–Haenszel pooled estimator. Results Compared to women who gained 15–25 lbs, women who gained <15 lbs were 0.8 (95% CI 0.6–1.0), 0.9 (0.8–1.0), 0.6 (0.5–0.8), and 1.7 (1.4–2.2) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. Conversely, women who gained >25 lbs were 1.7 (1.5–1.9), 1.3 (1.2–1.4), 2.1 (1.9–2.3), and 0.6 (0.5–0.7) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. The lowest risk of adverse outcomes was for women who gained in the 6–14 and 15–24 lb categories. There was no association between gestational weight gain and perinatal death. Conclusions Increasing gestational weight gain appears to decrease the risk of LBW but elevates the risks of preeclampsia, cesarean section, and macrosomia. Overweight women should gain within current IOM recommendations.     

Alignment between Desires and Outcomes among Women Wanting to Avoid Pregnancy: A Global Comparative Study of “Conditional” Unintended Pregnancy Rates

Since childbearing desires, and trends in these desires, differ across populations, the inclusion of women who want to become pregnant in the denominator for unintended pregnancy rates complicates interpretation of intercountry differences and trends over time. To address this limitation, we propose a rate that is the ratio of the number of unintended pregnancies to the number of women wanting to avoid pregnancy; we term these conditional rates. We computed conditional unintended pregnancy rates for five-year periods from 1990 to 2019. In 2015–2019, these conditional rates per 1,000 women per year wanting to avoid pregnancy ranged from 35 in Western Europe to 258 in Middle Africa. Rates with all women of reproductive age in the denominator have concealed stark global disparities in the ability of women to avoid unintended pregnancies, and they have understated progress in regions where the fraction of women wanting to avoid pregnancy has increased.     

Longitudinal Assessment of Effort–Reward Imbalance and Job Strain Across Pregnancy: A Preliminary Study

Objectives

To assess longitudinal changes in occupational effort–reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy.

Methods

A pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models.

Results

ERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (b = 8.8; p < 0.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment.

Conclusions

Self-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes.

     

Examining the Influence of Racial Discrimination on Adverse Birth Outcomes: An Analysis of the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS), 2016–2018

Maternal and Child Health Journal - In Virginia, Black women experience higher rates of adverse birth and labor outcomes that may not be explained solely by risky behaviors or social standing....     

Sources of Fine Particulate Matter and Risk of Preterm Birth in Connecticut, 2000–2006: A Longitudinal Study

Background: Previous studies have examined fine particulate matter (≤ 2.5 μm; PM_2.5) and preterm birth, but there is a dearth of longitudinal studies on this topic and a paucity of studies that have investigated specific sources of this exposure.Objectives: Our aim was to assess whether anthropogenic sources are associated with risk of preterm birth, comparing successive pregnancies to the same woman.Methods: Birth certificates were used to select women who had vaginal singleton live births at least twice in Connecticut during 2000–2006 (n = 23,123 women, n = 48,208 births). We procured 4,085 daily samples of PM_2.5 on Teflon filters from the Connecticut Department of Environmental Protection for six cities in Connecticut. Filters were analyzed for chemical composition, and Positive Matrix Factorization was used to determine contributions of PM_2.5 sources. Risk estimates were calculated with conditional logistic regression, matching pregnancies to the same women.Results: Odds ratios of preterm birth per interquartile range increase in whole pregnancy exposure to dust, motor vehicle emissions, oil combustion, and regional sulfur PM_2.5 sources were 1.01 (95% CI: 0.93, 1.09), 1.01 (95% CI: 0.92, 1.10), 1.00 (95% CI: 0.89, 1.12), and 1.09 (95% CI: 0.97, 1.22), respectively.Conclusion: This was the first study of PM_2.5 sources and preterm birth, and the first matched analysis, that better addresses individual-level confounding potentially inherent in all past studies. There was insufficient evidence to suggest that sources were statistically significantly associated with preterm birth. However, elevated central estimates and previously observed associations with mass concentration motivate the need for further research. Future studies would benefit from high source exposure settings and longitudinal study designs, such as that adopted in this study.Citation: Pereira G, Bell ML, Lee HJ, Koutrakis P, Belanger K. 2014. Sources of fine particulate matter and risk of preterm birth in Connecticut, 2000–2006: a longitudinal study. Environ Health Perspect 122:1117–1122; http://dx.doi.org/10.1289/ehp.1307741     

Women’s Perspectives of Needs Surrounding Adverse Birth Outcomes: A Qualitative Assessment of the Neighborhood Impact of Adverse Birth Outcomes

Objectives African Americans are two times more likely to suffer adverse birth outcomes (i.e., low birth weight, preterm birth, and infant mortality) when compared to all other ethnic groups and this pattern is no different for Douglas County, Nebraska, where the majority of African Americans in Nebraska reside. Our goal was to identify factors, as described by local women, that contribute to adverse birth outcomes in the predominantly African American community of Northeast Douglas County in Omaha, NE, to ensure that these women’s voices were included in the development of interventions to improve their neighborhood’s birth outcomes. The paper describes the results of a qualitative needs assessment of these women which will aid in the design and implementation of neighborhood-based solutions. Methods We brought together a group of women with varying levels of birthing experience, time spent living in the neighborhood, and overall community involvement. Individual in-depth, in person, and telephone interviews were used to collect participants’ perceptions of birth outcomes, neighborhood resources for pregnant women, and neighborhood strengths and weaknesses. Results The needs assessment identified that, although women in this neighborhood have experience with adverse birth outcomes, these experiences are not discussed resulting in a lack of awareness of the wide spread racial disparities in birth outcomes and the efforts and resources to address this public health problem. Conclusions for Practice This study reveals the power of direct conversations with women impacted by adverse birth outcomes, as they must be primary partners in any efforts to improve birth outcomes.     

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

To evaluate the prevalence, trends, timing and duration of exposure to antiviral medications during pregnancy within a US cohort of pregnant women and to evaluate the proportion of deliveries with a viral infection diagnosis among women given antiviral medication during pregnancy. Live-born deliveries between 2001 and 2007, to women aged 15–45 years, were included from the Medication Exposure in Pregnancy Risk Evaluation Program, a collaborative research program between the U.S. Food and Drug Administration and eleven health plans. They were evaluated for prevalence, timing, duration, and temporal trends of exposure to antiviral medications during pregnancy. We also calculated the proportion of deliveries with a viral infection diagnosis among those exposed to antiviral medications. Among 664,297 live births, the overall prevalence of antiviral exposure during pregnancy was 4 % (n = 25,155). Between 2001 and 2007, antiviral medication exposure during pregnancy doubled from 2.5 to 5 %. The most commonly used antiviral medication was acyclovir, with 3 % of the deliveries being exposed and most of the exposure occurring after the 1st trimester. Most deliveries exposed to antiviral medications were exposed for less than 30 days (2 % of all live births). Forty percent of the women delivering an infant exposed to antiviral medications had a herpes diagnosis. Our findings highlight the increased prevalence of women delivering an infant exposed to antiviral medications over time. These findings support the need for large, well-designed studies to assess the safety and effectiveness of these medications during pregnancy.     

Pregnancy Intendedness and Physical Abuse Around the Time of Pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System, 1996–1997

Objective: This study examines whether unintended pregnancy is associated with physical abuse of women occurring around the time of pregnancy, independent of other factors. Methods: In 1996–1997, state-specific population-based data were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 39,348 women in 14 states who had delivered a live-born infant within the previous 2–6 months. The study questionnaire asked about maternal behaviors and characteristics around the time of pregnancy. Results: Women who had mistimed or unwanted pregnancies reported significantly higher levels of abuse at any time during the 12 months before conception or during pregnancy (12.6% and 15.3%, respectively) compared with those with intended pregnancies (5.3%). Higher rates of abuse were reported by women who were younger, Black, unmarried, less educated, on Medicaid, living in crowded conditions, entering prenatal care late, or smoking during the third trimester. Overall, women with unintended pregnancies had 2.5 times the risk of experiencing physical abuse compared with those whose pregnancies were intended. This association was modified by maternal characteristics; the association was strongest among women who were older, more educated, White, married, not on Medicaid, not living in crowded conditions, receiving first trimester prenatal care, or nonsmoking during the third trimester. Conclusions: Women with unintended pregnancies are at increased risk of physical abuse around the time of pregnancy compared with women whose pregnancies are intended. Prenatal care can provide an important point of contact where women can be screened for violence and referred to services that can assist them.The Pregnancy Risk Assessment Monitoring System (PRAMS) Working Group comprises the following state collaborators:L. Albert Woolbright, Alabama; Kathy Perham-Hester, Alaska; Gina Redford, Arkansas; Darci Cherry, Colorado; Richard Hopkins, Florida; Leslie Lipscomb, Georgia; Martha Henson, Maine; Yasmina Bouraoui, Michigan; Michael Medvesky, New York; Michelle Beck-Warden, North Carolina; Richard Lorenz, Oklahoma; Kriisten Helms, South Carolina; Linda Lohdefink, Washington; and Melissa Baker, West Virginia     

Motoric Cognitive Risk Syndrome: Prevalence and Risk of Cognitive Impairment in a Population Studied in the Mexican Health and Aging Study 2012–2015

The journal of nutrition, health & aging - The aim of this study was to determine the prevalence of Motoric Cognitive Risk (MCR) syndrome, describe associated risk factors and to determine the...     

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

PURPOSE

We set out to compare patients’ expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings.

METHODS

Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients’ expectations of involvement in decision making immediately before the consultation and patients’ perceptions of their general practitioners’ empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods.

RESULTS

Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups.

CONCLUSIONS

Patients’ expectations, GPs’ behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients’ perceptions of the physicians’ empathy predict health outcomes. These findings are discussed in the context of inequalities and the “inverse care law.”