Search

Objective: To compare composite maternal and neonatal adverse outcomes among women with at least a bachelor's degree by racial and ethnic groups.Methods: This was a retrospective cohort study using the U.S. vital statistics data sets. We included women with at least a bachelor's degree who delivered a nonanomalous live singleton neonate at 24-40 weeks. The primary outcome, composite maternal adverse outcome, included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure after delivery. The secondary outcome, composite neonatal adverse outcome, included 5-minute Apgar score less than 5, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Multivariable regression models were used to estimate the association between maternal race and adverse outcomes.Results: Of 11.8 million live births, 2.2 million (19%) met the inclusion criteria; 81.5% were to non-Hispanic white women, 8.5% to non-Hispanic black women, and 10% Hispanic women. The overall rate of composite maternal adverse outcome was 5.3 per 1,000 live births. Compared with non-Hispanic white women, the risk of the composite maternal adverse outcome was significantly higher among non-Hispanic black women (adjusted relative risk [aRR] 1.20; 95% CI 1.13-1.27), but lower among Hispanic women (aRR 0.69; 95% CI 0.64-0.74), a pattern which varied among different gestational age groups. The overall rate of composite neonatal adverse outcome was 11.6 per 1,000 live births. The risk of composite neonatal adverse outcome was significantly higher among neonates with non-Hispanic black mothers (aRR 1.25; 95% CI 1.20-1.30), but lower among neonates with Hispanic mothers (aRR 0.71; 95% CI 0.68-0.75), compared with neonates delivered by non-Hispanic white mothers and varied across gestational age.Conclusion: Among women with at least a bachelor's degree, small but measurable racial and ethnic disparities in composite maternal and neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine risk factors and adverse outcomes for neonatal-maternal dyads among low-risk pregnancies at term with subsequent neonatal seizures.Methods: United States vital statistics data sets were used for this retrospective study. Inclusion criteria were low-risk women (without hypertensive disease or diabetes) with nonanomalous singleton pregnancies, who delivered after labor at 37-41 weeks of gestation. The primary composite neonatal adverse outcome included 5-minute Apgar score less than 5, assisted ventilation longer than 6 hours, and neonatal death. A secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used, with adjusted relative risk (aRR) and 95% CI reported.Results: Of 19.76 million live births during the study interval, 11.7 million (59.4%) met inclusion criteria. The rate of neonatal seizures after low-risk pregnancies delivered at term was 0.2 per 1,000 live births. The maternal risks factors associated with neonatal seizures included no prenatal care, smoking during pregnancy, being overweight or obese, and gestational age of 41 weeks. The strongest risk factors for neonatal seizures were chorioamnionitis (relative risk [RR] 5.04, 95% CI 4.40-5.77; aRR 3.27, 95% CI 2.84-3.76) and route of delivery, with operative vaginal (RR 3.62, 95% CI 3.20-4.09; aRR 3.02, 95% CI 2.66-3.43) and cesarean (RR 4.13, 95% CI 3.81-4.48; aRR 3.14, 95% CI 2.86-3.45) higher than spontaneous vaginal. Compared with neonates without seizures, those with seizures had higher risk of composite neonatal adverse outcome (RR 64.55, 95% CI 61.83-67.39; aRR 37.09, 95% CI 35.20-39.08). Compared with women who delivered neonates without seizures, those who delivered neonates with seizures had higher risk of composite maternal adverse outcome (RR 16.27, 95% CI 13.66-19.37; aRR 9.70, 95% CI 8.15-11.53).Conclusion: We identified modifiable maternal risk factors associated with neonatal seizures among low-risk pregnancies at term. Though infrequent, neonatal seizures are associated with higher risk of adverse outcomes in neonatal-maternal dyads. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate temporal trends of stroke in the peripartum period and to assess the relationship between stroke and maternal adverse outcomes vis-à-vis timing and hypertension. METHODS: We conducted a retrospective, cross-sectional study using the National Inpatient Sample to identify hospitalizations with pregnancy-associated stroke in the United States (2016–2019). Temporal trends in pregnancy-associated stroke were examined according to timing of stroke (antepartum vs postpartum) and both prepregnancy and pregnancy hypertensive disorders (yes vs no). Multivariable Poisson regression models with robust error variance were used to examine the association among maternal adverse outcomes, timing of stroke, and hypertensive disorders. RESULTS: Among 15,977,644 pregnancy hospitalizations, 6,100 hospitalizations (38.2/100,000 hospitalizations) were with pregnancy-associated stroke. Of these, 3,635 (59.6%) had antepartum pregnancy-associated stroke and 2,465 (40.4%) had postpartum pregnancy-associated stroke; alternatively, 2,640 (43.3%) had hypertensive disorders, and 3,460 (56.7%) were without hypertensive disorders. From 2016 to 2019, the overall rate of pregnancy-associated stroke (37.5 to 40.8/ 100,000 pregnancy hospitalizations, P=.028), rate of postpartum pregnancy-associated stroke (14.6 to 17.6/ 100,000 pregnancy hospitalizations, P=.005), and rate of pregnancy-associated stroke with hypertensive disorders (14.9 to 17.2/100,000 pregnancy hospitalizations, P=.013) increased. Antepartum pregnancy-associated stroke and pregnancy-associated stroke without hypertensive disorders, however, remained stable. Despite higher risk of maternal morbidity in postpartum stroke hospitalizations, including mechanical ventilation and pneumonia, there was no significant difference in in-hospital mortality between antepartum and postpartum stroke. Similarly, between pregnancy-associated stroke with hypertensive disorders and stroke without hypertensive disorders, an increased risk of mechanical ventilation, seizure, and prolonged hospital stay was seen for stroke with hypertensive disorders without an increase in mortality. CONCLUSION: A nationally representative sample of hospitalizations in the United States indicates an increasing trend in the rate of postpartum stroke. Almost half of hospitalizations with pregnancy-associated stroke have concomitant hypertensive disorders. Risk of adverse outcomes, but not mortality, is elevated in patients with stroke occurring in the postpartum period and stroke associated with hypertensive disorders. [ABSTRACT FROM AUTHOR]

Background: Central obesity is a major risk factor for cardiometabolic diseases. The prevalence of central obesity has not been reported fully among Asian adults in the United States (US).Methods: Cross-sectional data of 1288 Asian adults aged 20 years or over was selected from the US National Health and Nutrition Examination Survey with a stratified multi-stage sampling design. The prevalence of central obesity was calculated with 95% confidence intervals (CIs) and Chi-square tests were conducted to test the significance of the prevalence differences across characteristic groups.Results: The overall prevalence of central obesity among US Asian adults was 58.1% in 2011-2014. The prevalence of central obesity was higher in older adults (73.5%) than in young adults (45.4%) (p < 0.0001). Women had 13.4% higher prevalence than men (64.4% vs 51.0%, p < 0.0001). The prevalence increased over time (2011-2012 vs 2013-2014) in young adults (39.2% vs 51.5%), men (45.4% vs 56.6%), adults with college education or above (54.2% vs 61.7%) and non-poor adults (55.4% vs 62.4%). Compared with men, women had higher prevalence in each subgroup of age, education, poverty, and length of time (except for the subgroup of "born in the US") (all p < 0.05) and in the subgroup of "married or living with partner" for marital status (p < 0.0001).Conclusion: Central obesity is prevalent in Asian adults, particularly in older adults and women. More efforts are needed to prevent and treat obesity in Asian adults as Asians are incurring the greatest increase in type 2 diabetes in parallel with the rising rate of central adiposity. [ABSTRACT FROM AUTHOR]

Purpose: Polycyclic aromatic hydrocarbons (PAHs) are known for their carcinogenic and teratogenic properties. However, little is known about the effect of PAH on our immune and respiratory systems. Hence, we investigated associations (1) between PAH exposure and IgE levels and asthma in children and (2) between PAH exposure and the oxidative stress marker 8OHdG potentially involved in disease pathogenesis stratifying by (3) sex-based differences. Methods: A total of 453 kindergarten children were recruited and provided samples. Urine biomarker of PAH exposure (1-OHP levels) was measured by UPLC-MS/MS and a marker of oxidative stress (8OHdG) was measured by ELISA. Serum IgE were assessed and information on asthma was collected. Associations between 1-OHP levels, 8OHdG, IgE and asthma were analyzed by multivariate linear and logistic regression. A mediation analysis was conducted to evaluate whether the risk of increased IgE and asthma related to PAH exposure is explained by 8OHdG changes. Results: Urine 1-OHP levels were positively related to 8OHdG levels (per ln-unit: β = 0.30kU/l, p = 0.002). Similar results were also found for 1-OHP levels with IgE levels (per ln-unit: β = 0.27 kU/l, p = 0.027). 1-OHP levels (per ln-unit) were significantly associated with asthma, with an OR (95% CI) of 1.42 (1.18-1.70). In addition, 1-OHP levels were associated with asthma. It is estimated that 35% of the effect of PAH exposure on asthma is mediated by 8OHdG levels. Conclusion: Exposure to PAH may enhance oxidative stress and may induce asthma. The effect of PAH exposure on asthma may be mediated by oxidative stress. [ABSTRACT FROM AUTHOR]

This study synthesizes two different methods for estimating hydraulic conductivity (K) at large scales. We derive analytical approaches that estimate K and apply them to the contiguous United States. We then compare these analytical approaches to three‐dimensional, national gridded K data products and three transmissivity (T) data products developed from publicly available sources. We evaluate these data products using multiple approaches: comparing their statistics qualitatively and quantitatively and with hydrologic model simulations. Some of these datasets were used as inputs for an integrated hydrologic model of the Upper Colorado River Basin and the comparison of the results with observations was used to further evaluate the K data products. Simulated average daily streamflow was compared to daily flow data from 10 USGS stream gages in the domain, and annually averaged simulated groundwater depths are compared to observations from nearly 2000 monitoring wells. We find streamflow predictions from analytically informed simulations to be similar in relative bias and Spearman's rho to the geologically informed simulations. R‐squared values for groundwater depth predictions are close between the best performing analytically and geologically informed simulations at 0.68 and 0.70 respectively, with RMSE values under 10 m. We also show that the analytical approach derived by this study produces estimates of K that are similar in spatial distribution, standard deviation, mean value, and modeling performance to geologically‐informed estimates. The results of this work are used to inform a follow‐on study that tests additional data‐driven approaches in multiple basins within the contiguous United States. [ABSTRACT FROM AUTHOR]

Objective We assessed the association among gestational age (GA) at birth, timing of death, and risk status of the pregnancy and racial/ethnic disparities in infant mortality rate in the United States. Study Design We utilized U.S. 2000 to 2004 birth cohort-linked birth and infant death data restricted to nonanomalous singleton live births. Multivariable log-binomial regression models were fit to evaluate racial/ethnic disparities in infant mortality while adjusting for potential confounders. Results Compared with whites, blacks had a higher adjusted infant mortality rate (IMR) (risk ratio [RR] 1.96, 95% confidence interval [CI] 1.91, 2.01), and Hispanics had a lower adjusted IMR (RR 0.79, 95% CI 0.76, 0.82). When categorized by GA, at 24 to 31 weeks, the adjusted early neonatal mortality (ENM) is significantly lower for black than whites, similar at 32 to 36 weeks, and at 37 weeks or more, blacks have significantly higher ENM. Conclusions The racial/ethnic disparities in infant mortality in the United States persist and vary across GA. These disparities may largely be driven by the excess post-neonatal deaths among blacks. [ABSTRACT FROM AUTHOR]

Objective: To assess whether racial and ethnic disparities in adverse infant and maternal outcomes exist among low-risk term pregnancies.Methods: This population-based retrospective cohort study used U.S. vital statistics data from 2014 to 2017. Women with low-risk, nonanomalous singleton pregnancies who labored and delivered at 37-41 weeks of gestation were included and categorized by maternal race and ethnicity: non-Hispanic white (white), non-Hispanic black (black), Hispanic, and non-Hispanic Asian (Asian). Multivariable Poisson regression models were used to estimate the associations of composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, or neonatal death), infant mortality, and composite maternal adverse outcome (blood transfusion, admission to the intensive care unit, uterine rupture, or unplanned hysterectomy) with maternal race and ethnicity.Results: Of 9,205,873 women included, 55.5% were white, 13.7% were black, 24.3% were Hispanic, and 6.5% were Asian. Risk for the composite neonatal adverse outcome was higher among neonates of black women (unadjusted relative risk [uRR] 1.16, 95% CI 1.13-1.18; adjusted relative risk [aRR] 1.07, 95% CI 1.05-1.10), and lower for neonates of Hispanic and Asian women compared with neonates of white women. A similar pattern of disparity was observed for infant mortality; the risk for infants of black women was significantly increased (uRR 1.89, 95% CI 1.81-1.98; aRR 1.33, 95% CI 1.26-1.39). For the composite maternal adverse outcome, the risk was highest for Asian mothers (uRR 1.09, 95% CI 1.03-1.14; aRR 1.12, 95% CI 1.06-1.18), lowest for Hispanic mothers, and similar for black mothers when compared with white mothers after adjustment for confounders.Conclusion: Among low-risk term pregnancies, the risk for adverse outcomes varied by maternal race and ethnicity. Infants of black women were at the highest risk for neonatal morbidity and infant mortality, and Asian mothers were most likely to experience maternal adverse outcomes. [ABSTRACT FROM AUTHOR]

Since September 11, 2001, over 2 million U.S. service members have been deployed to Iraq or Afghanistan, resulting in hundreds of thousands of military-connected children (MCC) having experienced a parental deployment. Although parental deployments have significantly burdened these children, few evidence-based interventions designed to support their resilience to these stressors are available. To address this gap, we developed a civilian school-based intervention to promote resilience in MCC living in the community. Our intervention, Staying Strong With Schools (SSWS), aims to deliver: a training to all school professionals early in the school year to educate them about challenges for children and families experiencing parental deployment and signs of deployment-related distress; and a year-long training for the school guidance counselor who coordinates communication and provides psychosocial support to MCC within the school community. We piloted SSWS in two civilian elementary schools and found promising feasibility and acceptability. [ABSTRACT FROM AUTHOR]

Objective: To determine factors associated with active duty military women being within Navy weight standards 6 months following childbirth. Methods: Inclusion criteria for this study were active duty women who delivered a nonanomalous fetus at a Naval Hospital and who remained in the area and their weight was recorded 6 months following childbirth. Multivariate logistic regressions, adjusted for 14 covariates, determined the factors for achieving acceptable weight. Results: Among 1,009 women who participated in this prospective cohort study, 68% began within Navy body weight standards and 52% had a normal body mass index (BMI) (<25). Six months after childbirth, 48% were within Navy body weight standards and 32% had a BMI <25. Only 2 factors, BMI at first visit and cesarean delivery, significantly influenced the percentage of women who met the weight standards at 6 months. Conclusions: Lowering the prepregnancy BMI and avoiding a cesarean delivery may improve the percentage of active duty women who meet weight standards 6 months after childbirth. [ABSTRACT FROM AUTHOR]