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Wändell P, Crump C, Li X, Stattin NS, Carlsson AC, Sundquist J, Sundquist K. Hypertension in Pregnancy Among Immigrant and Swedish Women: A Cohort Study of All Pregnant Women in Sweden. J Am Heart Assoc 2024; 13:e031125. [PMID: 38366326 PMCID: PMC10944082 DOI: 10.1161/jaha.123.031125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Little is known about risks of hypertensive disorders of pregnancy in both first- and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first- and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy. METHODS AND RESULTS A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66-0.72), and among second-generation immigrant women, it was 0.88 (0.86-0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18-1.43) and 1.12 (1.07-1.17), respectively. CONCLUSIONS Both first- and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Casey Crump
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
| | - Xinjun Li
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
| | - Nouha Saleh Stattin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic Primary Health Care CentreStockholmSweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic Primary Health Care CentreStockholmSweden
| | - Jan Sundquist
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
- Center for Community‐Based Healthcare Research and Education, Department of Functional PathologySchool of Medicine, Shimane UniversityMatsueJapan
| | - Kristina Sundquist
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
- Center for Community‐Based Healthcare Research and Education, Department of Functional PathologySchool of Medicine, Shimane UniversityMatsueJapan
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Baiden D, Nerenberg K, Hillan EM, Dogba MJ, Adombire S, Parry M. A Scoping Review of Risk Factors of Hypertensive Disorders of Pregnancy in Black Women Living in High-Income Countries: An Intersectional Approach. J Cardiovasc Nurs 2024:00005082-990000000-00171. [PMID: 38424670 DOI: 10.1097/jcn.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are maternity-related increases in blood pressure (eg, gestational hypertension, preeclampsia, and eclampsia). Compared with women of other races in high-income countries, Black women have a comparatively higher risk of an HDP. Intersectionality helps to provide a deeper understanding of the multifactorial identities that affect health outcomes in this high-risk population. OBJECTIVE In this review, we sought to explore the literature on HDP risk factors in Black women living in high-income countries and to assess the interaction of these risk factors using the conceptual framework of intersectionality. METHODS We conducted this review using the Arksey and O'Malley methodology with enhancements from Levac and colleagues. Published articles in English on HDP risk factors with a sample of not less than 10% of Black women in high-income countries were included. Six databases, theses, and dissertations were searched from January 2000 to July 2021. A thematic analysis was used to summarize the results. RESULTS A final total of 36 studies were included from the 15 480 studies retrieved; 4 key themes of HDP risks were identified: (1) biological; (2) individual traditional; (3) race and ethnicity, geographical location, and immigration status; and (4) gender related. These intersectional HDP risk factors intersect to increase the risk of HDP among Black women living in high-income countries. CONCLUSION Upstream approaches are recommended to lower the risks of HDP in this population.
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Fu R, Li Y, Li X, Jiang W. Hypertensive Disorders in Pregnancy: Global Burden From 1990 to 2019, Current Research Hotspots and Emerging Trends. Curr Probl Cardiol 2023; 48:101982. [PMID: 37479005 DOI: 10.1016/j.cpcardiol.2023.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
Hypertensive disorders in pregnancy (HDP) constitute a worldwide health problem for pregnant women and their infants. This study provided HDP burden over 1990 to 2019 by region and age distribution, and predicted changes in related values for the next 25 years. We then conducted an econometric analysis of the author distribution, collaborative networks, keyword burst clustering, and spatio-temporal analysis of HDP-related publications from 2012 to 2022 to access current scientific developments and hotspots. The number of pregnant women with HDP has been increasing over the past 30 years, with regional and age-stratified differences in the burden of disease. Additionally, projections suggest an increase of deaths due to maternal HDP among adolescents younger than 20 years. Current research is mostly centered on pre-eclampsia, with hot keywords including trophoblast, immune tolerance, frozen-thawed embryo transfer, aspirin, gestational diabetes association, and biomarkers. Researches on the pathological mechanism, classification, and subtypes of HDP need to be further advanced.
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Affiliation(s)
- Ru Fu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yihui Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
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Mæland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Risk of Subsequent Preeclampsia by Maternal Country of Birth: A Norwegian Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4109. [PMID: 36901120 PMCID: PMC10001690 DOI: 10.3390/ijerph20054109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
In this nationwide population-based study, we investigated the associations of preeclampsia in the first pregnancy with the risk of preeclampsia in the second pregnancy, by maternal country of birth using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study population included 101,066 immigrant and 544,071 non-immigrant women. Maternal country of birth was categorized according to the seven super-regions of the Global Burden of Disease study (GBD). The associations between preeclampsia in the first pregnancy with preeclampsia in the second pregnancy were estimated using log-binomial regression models, using no preeclampsia in the first pregnancy as the reference. The associations were reported as adjusted risk ratios (RR) with 95% confidence intervals (CI), adjusted for chronic hypertension, year of first childbirth, and maternal age at first birth. Compared to those without preeclampsia in the first pregnancy, women with preeclampsia in the first pregnancy were associated with a considerably increased risk of preeclampsia in the second pregnancy in both immigrant (n = 250; 13.4% vs. 1.0%; adjusted RR 12.9 [95% CI: 11.2, 14.9]) and non-immigrant women (n = 2876; 14.6% vs. 1.5%; adjusted RR 9.5 [95% CI: 9.1, 10.0]). Immigrant women from Latin America and the Caribbean appeared to have the highest adjusted RR, followed by immigrant women from North Africa and the Middle East. A likelihood ratio test showed that the variation in adjusted RR across all immigrant and non-immigrant groups was statistically significant (p = 0.006). Our results suggest that the association between preeclampsia in the first pregnancy and preeclampsia in the second pregnancy might be increased in some groups of immigrant women compared with non-immigrant women in Norway.
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Affiliation(s)
- Karolina S. Mæland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, 5007 Bergen, Norway
- Center for Fertility and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Department of Obstetrics and Gynecology, Haukeland, University Hospital Bergen, 5021 Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
- Center for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Roy M. Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
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Osafo C, Thomford NE, Coleman J, Carboo A, Guure C, Okyere P, Adu D, Adanu R, Parekh RS, Burke D. APOL1 genotype associated risk for preeclampsia in African populations: Rationale and protocol design for studies in women of African ancestry in resource limited settings. PLoS One 2022; 17:e0278115. [PMID: 36580463 PMCID: PMC9799323 DOI: 10.1371/journal.pone.0278115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Women of African ancestry are highly predisposed to preeclampsia which continues to be a major cause of maternal death in Africa. Common variants in the APOL1 gene are potent risk factor for a spectrum of kidney disease. Recent studies have shown that APOL1 risk variants contribute to the risk of preeclampsia. The aim of the study is to understand the contribution of APOL1 risk variants to the development of preeclampsia in pregnant women in Ghana. METHODS The study is a case-control design which started recruitment in 2019 at the Korle Bu Teaching Hospital in Ghana. The study will recruit pregnant women with a target recruitment of 700 cases of preeclampsia and 700 normotensives. Clinical and demographic data of mother- baby dyad, with biospecimens including cord blood and placenta will be collected to assess clinical, biochemical and genetic markers of preeclampsia. The study protocol was approved by Korle Bu Teaching Hospital Institutional Review Board (Reference number: KBTH-IRB/000108/2018) on October 11, 2018. PRELIMINARY RESULTS As of December 2021, a total of 773 mother-baby pairs had been recruited and majority of them had complete entry of data for analysis. The participants are made up of 384 preeclampsia cases and 389 normotensive mother-baby dyad. The mean age of participants is 30.69 ± 0.32 years for cases and 29.95 ± 0.32 for controls. Majority (85%) of the participants are between 20-30years. At booking, majority of cases had normal blood pressure compared to the time of diagnosis where 85% had a systolic BP greater than 140mmHg and a corresponding 82% had diastolic pressure greater than 90mmHg. CONCLUSION Our study will ultimately provide clinical, biochemical and genotypic data for risk stratification of preeclampsia and careful monitoring during pregnancy to improve clinical management and outcomes.
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Affiliation(s)
- Charlotte Osafo
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
- The Bank Hospital, Cantonment, Accra, Ghana
| | - Nicholas Ekow Thomford
- Pharmacogenomics and Genomic Medicine Group, Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jerry Coleman
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Abraham Carboo
- School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Chris Guure
- School of Medical Sciences, KNUST, Kumasi, Ghana
| | | | - Dwomoa Adu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard Adanu
- Ghana College of Physicians and Surgeon, Accra, Ghana
| | - Rulan S. Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University of Health Network, University of Toronto, Toronto, Canada
| | - David Burke
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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Larrea-Schiavon S, Vázquez-Quesada LM, Bartlett LR, Lam-Cervantes N, Sripad P, Vieitez I, Coutiño-Escamilla L. Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100418. [PMID: 36562449 PMCID: PMC9771456 DOI: 10.9745/ghsp-d-21-00418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations. METHODS We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality. RESULTS Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs. CONCLUSION Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.
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Evaluating the quality of care for postpartum hemorrhage with a new quantitative tool: a population-based study. Sci Rep 2022; 12:18626. [PMID: 36329149 PMCID: PMC9633766 DOI: 10.1038/s41598-022-23201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
To develop a new tool to assess the global quality of care for post-partum hemorrhage (PPH)-the leading preventable cause of maternal mortality worldwide-and to identify characteristics of maternity units associated with inadequate PPH management. This is a secondary analysis of the EPIMOMS population-based study conducted in 2012-2013 in 119 french maternity units (182,309 women who gave birth). We included women with severe PPH. We first developed a score to quantify the quality of care for PPH. Then, we identified characteristics of the maternity units associated with "inadequate care" defined by a score below the 25th percentile, with multi-level logistic regression adjusted for individual characteristics. The score combined 8 key components of care and took into account delivery mode and PPH cause. For PPH after vaginal delivery, the risk of inadequate care was increased in low versus high-volume maternity units (< 1000 deliveries/year: aOR-2.20 [1.12-4.32], [1000-2000 [deliveries/year: aOR-1.90 [1.02-3.56] compared to ≥ 3500 deliveries/year), in private versus public units (aOR-1.72 [1.00-2.97]), and in low versus high-level of care units (aOR-2.04 [1.24-3.35]). For PPH after cesarean, the only characteristic associated with an increased risk of inadequate care was the absence of 24/24-onsite anesthesiologist (aOR-4.34 [1.41-13.31]). These results indicate where opportunities for improvement are the greatest.
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Iradukunda F, Harper KM, Paterno MT, Poudel-Tandukar K. Dietary transition among Sub-Saharan Africa women post-immigration and during pregnancy. ETHNICITY & HEALTH 2022; 27:1329-1344. [PMID: 33565334 DOI: 10.1080/13557858.2021.1879027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Black immigrant women experience high risks for maternal complications, and some of these complications are related to dietary outcomes. This study aimed to explore Sub-Saharan African (SSA) pregnant women's dietary patterns and dietary transition post-immigration and during pregnancy. METHODS We used a narrative design with a Photovoice approach and collected data through semi-structured interviews, digital food diaries, and Photovoice interviews. We recruited eleven participants (n = 11) through community gatekeepers and analyzed data using a constructivist grounded theory approach with constant comparative methods. RESULTS The changes in food processes and participants' reactions to these changes generated a dietary transition model with three stages: perplexity, deliberation, and acceptance. (1) Perplexity was caused by different food characteristics such as taste, texture, and options. (2) Participants described deliberation as a process of deciding the kind of foods/cooking styles that would be an integral part of their regular diet. All participants opted for what they referred to as the 'African diet.' (3) Acceptance was characterized by participants' resolve to figure out how to make their chosen types of food and eating habits 'work' for themselves and their families. CONCLUSION This study emphasizes the importance of having a sense of self-efficacy, a positive attitude, and community support in enabling migrant women to navigate dietary transition until they are satisfied with newly constructed eating habits. This determination, along with community support and persistent connection to their home culture, might help immigrants resist dietary acculturation and maintain healthy cultural eating habits, which is particularly important during pregnancy, given the impact of diet on maternal and neonatal outcomes. These findings underscore the need for collaborating with migrants from SSA to develop culturally tailored dietary interventions focused on each stage of dietary transition. Future studies should include focus group discussions to leverage women's shared experiences and create knowledge/information exchange opportunities.
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Affiliation(s)
| | - Krista M Harper
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mary T Paterno
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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Burger RJ, Delagrange H, van Valkengoed IGM, de Groot CJM, van den Born BJH, Gordijn SJ, Ganzevoort W. Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review. Front Cardiovasc Med 2022; 9:933822. [PMID: 35837605 PMCID: PMC9273843 DOI: 10.3389/fcvm.2022.933822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Pregnancy is often considered to be a "cardiometabolic stress-test" and pregnancy complications including hypertensive disorders of pregnancy can be the first indicator of increased risk of future cardiovascular disease. Over the last two decades, more evidence on the association between hypertensive disorders of pregnancy and cardiovascular disease has become available. However, despite the importance of addressing existing racial and ethnic differences in the incidence of cardiovascular disease, most research on the role of hypertensive disorders of pregnancy is conducted in white majority populations. The fragmented knowledge prohibits evidence-based targeted prevention and intervention strategies in multi-ethnic populations and maintains the gap in health outcomes. In this review, we present an overview of the evidence on racial and ethnic differences in the occurrence of hypertensive disorders of pregnancy, as well as evidence on the association of hypertensive disorders of pregnancy with cardiovascular risk factors and cardiovascular disease across different non-White populations, aiming to advance equity in medicine.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
| | - Hannelore Delagrange
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
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Baiden D, Parry M, Nerenberg K, Hillan EM, Dogba MJ. Connecting the Dots: Structural Racism, Intersectionality, and Cardiovascular Health Outcomes for African, Caribbean, and Black Mothers. Health Equity 2022; 6:402-405. [PMID: 35801154 PMCID: PMC9257546 DOI: 10.1089/heq.2021.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
African, Caribbean, and Black (ACB) women globally experience health inequities that impact on their cardiovascular health outcomes during the perinatal period, and for years after. Aside from being at a high risk of having and dying from hypertensive disorders of pregnancy, ACB women who survive face a lifelong risk of cardiovascular disease years after the diagnosis. Racism as a determinant of health intersects with gender, societal structures, and immigration status to contribute to cardiovascular health and access to quality health care services for ACB women. Equitable policies and culturally appropriate programs are needed to improve the cardiovascular health of ACB women.
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Affiliation(s)
- Deborah Baiden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kara Nerenberg
- Department of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, Canada
| | - Edith M. Hillan
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Quebec, Canada
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11
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Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland. J Migr Health 2022; 6:100122. [PMID: 35677660 PMCID: PMC9168177 DOI: 10.1016/j.jmh.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Migrants from conflict-affected areas had a 3.5-fold risk for delayed prenatal care. Less prenatal visits prior to term birth compared with country-born parturients. No differences in prepartum hospitalization between migrants and country-born parturients.
Background The 2015 refugee crisis led into a forced migration of millions of people globally. As a consequence, many countries experienced a quick change in the proportion of conflict-area born migrants. This group being stated as an especially vulnerable group for suboptimal maternal health, a timely inspection of preventive maternity care was required. This study investigated prenatal care in terms of gestation trimester at the first prenatal visit, number of check-ups prior to birth, and prepartum hospitalization in conflict-country born migrants and Finnish parturients in Finland. Material and methods Cross-sectional study included all pregnancies of migrants born in conflict-affected countries (n = 3 155) and country-born parturients (n = 93 600) in Finland in 2015–16. The data were obtained through Medical Birth Registry and Population Information System. Statistical analysis employed T-test, Chi-square test, and logistic regression analysis. Odds ratios with 95% Confidence Intervals (CI) were adjusted for sociodemographic and health-related background variables. Results Migrant parturients had a higher probability for delayed enter in prenatal care compared with Finnish-born parturients (adjusted odds ratio aOR = 3.46; 95% Confidence Interval CI 3.06, 3.91). Recommended minimum number of check-ups was participated by 95.3% of the migrant, and 96.4% of the Finnish-born group (P <0.000). Migrants’ probability for more than ten visits prior to term birth was significantly lower (aOR = 0.58; 95% CI 0.51, 0.66). No significant differences in prepartum hospitalization yielded between the groups. Conclusions Migrant parturients had significantly smaller number of check-ups and later entry in care compared with the country-born parturients. These findings add to earlier reported challenges in the organizing of conflict-affected country born migrants’ prenatal care in a high-income setting, in which the proportion of conflict-area born migrants has risen rapidly and unexpectedly.
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Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Corresponding author.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Kuopio University Hospital, Finland
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12
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Kragelund Nielsen K, Andersen GS, Damm P, Nybo Andersen AM. Migration, Gestational Diabetes, and Adverse Pregnancy Outcomes: A Nationwide Study of Singleton Deliveries in Denmark. J Clin Endocrinol Metab 2021; 106:e5075-e5087. [PMID: 34272865 DOI: 10.1210/clinem/dgab528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT It remains unclear if migrants have different odds for adverse outcomes associated with gestational diabetes mellitus (GDM). OBJECTIVE We investigated if the associations between GDM and adverse pregnancy outcomes are modified by country of origin and examined the odds of these outcomes according to GDM status and country of origin. METHODS Data were extracted from a nationwide register-based study of singleton deliveries in Denmark, 2004-2015. We used logistic regression models and tested for interaction. RESULTS Among the 710 413 singleton deliveries, 2.6% had GDM and 14.4% were immigrants. Country of origin modified the association between GDM and pre-eclampsia, large for gestational age (LGA), and small for gestational age (SGA) but not between GDM and planned or emergency cesarean section and preterm delivery. GDM increased the risk of pre-eclampsia among women from Denmark (OR 1.28; 95% CI, 1.18-1.39), Lebanon (OR 3.34; 95% CI, 1.35-8.26), and Morocco (OR 2.28; 95% CI, 1.16-6.88). GDM was associated with increased odds of LGA among women from most countries, particularly women from Sri Lanka (OR 4.20; 95% CI, 2.67-6.61), and was associated with reduced odds of SGA in some countries. Compared with Danish-born women with GDM, the odds of LGA were significantly lower and the odds of SGA higher among women with GDM from India, Lebanon, Pakistan, Iraq, and Somalia. CONCLUSIONS Our study documents that different immigrant groups have higher odds of different GDM-associated adverse pregnancy outcomes and also among countries of origin often grouped together. This highlights the importance of increased awareness to both immigrant background and GDM status in the clinical assessment.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Danish Diabetes Academy, 5000 Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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Remaeus K, Johansson K, Granath F, Stephansson O, Hellgren K. Pregnancy outcomes in women with psoriatic arthritis with respect to presence and timing of antirheumatic treatment. Arthritis Rheumatol 2021; 74:486-495. [PMID: 34668647 DOI: 10.1002/art.41985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 06/24/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate pregnancy outcomes in relation to antirheumatic treatment before and during pregnancy as a proxy of disease severity in PsA-pregnancies as compared to non-PsA-pregnancies. METHODS Swedish nationwide register-based cohort study of 921 PsA- pregnancies and 9210 non-PSA-pregnancies (matched 1:10 on maternal age, year, and parity) 2007-2017. We estimated adjusted odds ratios (aOR) overall and stratified by presence, timing, and type of antirheumatic treatment. Adjustments were made for BMI, smoking, educational level and country of birth. The outcome preterm birth was also stratified by parity. RESULTS Women with PsA vs. non-PsA-pregnancies were more obese, more often smokers and had a diagnosis of pre-gestational hypertension and diabetes more often. Increased risks in PsA vs. non-PsA-pregnancies were foremost preterm birth (aOR 1.69, 95% CI 1.27-2.24) and cesarean delivery, (aOR 1.77, 95% CI 1.43-2.20 for elective and aOR 1.42, 95% CI 1.10-1.84 for emergency cesarean delivery). The risks differed with presence, timing, and type of antirheumatic treatment with the most increased risks in PsA-pregnancies (vs. non-PsA) with antirheumatic treatment during pregnancy, aOR preterm birth; 2.30, 95% CI 1.49-3.56. Corresponding aOR for biologics exposed PsA-pregnancies was 4.49, 95% CI 2.60-7.79. Risk of preterm birth was primarily increased in first pregnancies. CONCLUSION In comparison with non-PsA-pregnancies risks of preterm birth and cesarean delivery were mostly increased in those exposed to antirheumatic treatment during pregnancy, especially biologics. As parity influences the risk of preterm birth in PsA pregnancies special attention to first pregnancies is warranted. Women with PsA, should receive individualized monitoring during pregnancy.
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Affiliation(s)
- Katarina Remaeus
- Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Kari Johansson
- Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Fredrik Granath
- Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden
| | - Olof Stephansson
- Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden.,Karolinska Universitetssjukhuset, Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Karin Hellgren
- Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden.,Karolinska University Hospital, Rheumatology, Theme Inflammation and Infection, Stockholm, Sweden
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14
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Maeland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Placental abruption in immigrant women in Norway: A population-based study. Acta Obstet Gynecol Scand 2021; 100:658-665. [PMID: 33341933 DOI: 10.1111/aogs.14067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. MATERIAL AND METHODS We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. RESULTS The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. CONCLUSIONS Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.
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Affiliation(s)
- Karolina S Maeland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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15
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Iradukunda F, Poudel-Tandukar K. Healthy Diet Perceptions of Pregnant Women from Sub-Saharan Africa Residing in the U.S. Ecol Food Nutr 2021; 60:682-696. [PMID: 33467928 DOI: 10.1080/03670244.2021.1875457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several consumers lack a clear understanding of what makes a healthy diet. This uncertainty may be worsened by immigration due to socio-cultural differences. The purpose of this study was to explore Sub-Saharan African (SSA) pregnant women's perceptions of a healthy diet and the sources of dietary information available to them in the context of immigration. We used narrative interviews and photo-food diaries, followed by photo-elucidated interviews to obtain data. Participants defined and illustrated a healthy diet as having four characteristics: (a) Familiar, (b) balanced, (c) made of fresh and organically grown ingredients, and (d) able to build the consumer's body. Participants indicated that the overwhelming nature of dietary information made it difficult to navigate. Participants trusted dietary recommendations offered by family and peers the most, while those offered by health care providers were reported to be difficult to understand or incorporate due to not being culturally specific. This paper highlights the importance of considering consumers' socio-cultural backgrounds and building partnerships between health care providers and the communities they serve to design culturally relevant dietary education.
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16
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Schmengler H, Cohen D, Tordjman S, Melchior M. Autism Spectrum and Other Neurodevelopmental Disorders in Children of Immigrants: A Brief Review of Current Evidence and Implications for Clinical Practice. Front Psychiatry 2021; 12:566368. [PMID: 33815159 PMCID: PMC8012490 DOI: 10.3389/fpsyt.2021.566368] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.
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Affiliation(s)
- Heiko Schmengler
- INSERM U1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,École des Hautes Études en Santé Publique, Rennes, France.,Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Reference Centre for Rare Psychiatric Diseases, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France.,Institute for Intelligent Systems and Robotics, CNRS UMR 7222, Sorbonne Université, Paris, France
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume-Régnier, Rennes, France.,Integrative Neuroscience and Cognition Center, CNRS UMR 8002 and University of Paris, Paris, France
| | - Maria Melchior
- INSERM U1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
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17
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Hong X, Rosenberg AZ, Zhang B, Binns-Roemer E, David V, Lv Y, Hjorten RC, Reidy KJ, Chen TK, Wang G, Ji Y, Simpson CL, Davis RL, Kopp JB, Wang X, Winkler CA. Joint Associations of Maternal-Fetal APOL1 Genotypes and Maternal Country of Origin With Preeclampsia Risk. Am J Kidney Dis 2020; 77:879-888.e1. [PMID: 33359152 DOI: 10.1053/j.ajkd.2020.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/24/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE & OBJECTIVES Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia. STUDY DESIGN Nested case-control study. SETTING & PARTICIPANTS 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort. EXPOSURE Maternal and fetal APOL1 risk alleles. OUTCOMES Preeclampsia. ANALYTICAL APPROACH Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin. RESULTS Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P<0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P=0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P=0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P<0.001) in African Americans. LIMITATIONS Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study. CONCLUSIONS This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Boyang Zhang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Binns-Roemer
- Molecular Genetic Epidemiology Section, Frederick National Laboratory for Cancer Research in the Basic Research Laboratory, National Cancer Institute, Frederick, MD
| | - Victor David
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD
| | - Yiming Lv
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca C Hjorten
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA
| | - Kimberly J Reidy
- Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Teresa K Chen
- Department of Medicine, Division of Nephrology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Claire L Simpson
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN
| | - Robert L Davis
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Jeffrey B Kopp
- Kidney Diseases Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Frederick National Laboratory for Cancer Research in the Basic Research Laboratory, National Cancer Institute, Frederick, MD.
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18
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Fasanya HO, Hsiao CJ, Armstrong-Sylvester KR, Beal SG. A Critical Review on the Use of Race in Understanding Racial Disparities in Preeclampsia. J Appl Lab Med 2020; 6:247-256. [PMID: 33227139 DOI: 10.1093/jalm/jfaa149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Preeclampsia is a significant cause of maternal morbidity and mortality, affecting up to 8% of pregnancies globally. Although the precise etiology is still under study, the literature suggests that vascular changes reduce placental perfusion and affect the remodeling of spiral arteries to create the hallmark feature of preeclampsia: elevated blood pressure. Screening for preeclampsia is currently recommended for all pregnant women, particularly if risk factors exist. A noted risk factor codified in guidelines is "African-American race." CONTENT We summarize the racial disparities in preeclampsia incidence, morbidity, and mortality. We consider the limitations of using race to understand disparities by also examining multiethnic, immigration, and international studies. We then critically evaluate laboratory analytes associated with racial disparities of preeclampsia and explore other mechanisms of action, such as socioeconomic status, stress, and access to care. SUMMARY Black and African-American women are consistently at higher risk of preeclampsia incidence, morbidity, and mortality than their white counterparts. Asian women are consistently at lower risk of preeclampsia, whereas the association for Hispanic women remains unclear. When these broad racial categories are subdivided by geographic or cultural origin, preeclampsia disparities within racial groups are identified. The limited literature suggests that sub-Saharan African immigrants tend to have a higher risk of preeclampsia than US-born white populations but a lower risk than US-born Black women. Existing studies seeking to identify racial differences in analytes have limited research designs and tend to operationalize race as a proxy for biologically inherent (i.e., genetic) differences between races despite a plethora of other possible explanatory mechanisms.
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Affiliation(s)
- Henrietta O Fasanya
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL.,Genetics Institute, University of Florida, Gainesville, FL.,MD-PhD Program, University of Florida College of Medicine, Gainesville, FL.,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Chu J Hsiao
- Genetics Institute, University of Florida, Gainesville, FL.,MD-PhD Program, University of Florida College of Medicine, Gainesville, FL.,Department of Anthropology, University of Florida College of Liberal Arts and Sciences, Gainesville, FL
| | - Kendra R Armstrong-Sylvester
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Stacy G Beal
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL
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Sanapo L, Donofrio MT, Ahmadzia HK, Gimovsky AC, Mohamed MA. The association of maternal hypertensive disorders with neonatal congenital heart disease: analysis of a United States cohort. J Perinatol 2020; 40:1617-1624. [PMID: 32859942 DOI: 10.1038/s41372-020-00795-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association of any type of maternal hypertensive disorders of pregnancy (HDP) and neonatal congenital heart diseases (CHD). STUDY DESIGN We compared the prevalence of CHD between neonates born to mothers with HDP to those delivered to mothers without HDP among 24,525,889 hospital records of living infants, from a national database. We controlled for multiple confounding factors by using multiple logistic regression analysis. RESULTS Infants delivered to mothers with HDP had higher prevalence of CHD compared to infants born to mothers without HDP [5.20% vs. 1.47%; aOR: 2.51(2.38-2.64), p < 0.001]. Maternal diabetes was more frequent among infants born to mothers with HDP and was independently associated with CHD [aOR 5.14 (5.04-5.23), p < 0.001]. CONCLUSION Infants born to mothers with hypertension had almost a threefold increase in CHD compared with those born to mothers without hypertension. Further studies are needed to investigate the underlying mechanism and direction of this association.
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Affiliation(s)
- Laura Sanapo
- Women's Medicine Collaborative-Division of Research, The Miriam Hospital, Providence, RI, USA.
| | - Mary T Donofrio
- Division of Fetal and Translational Medicine, Children's National Hospital, Washington, DC, USA.,Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alexis C Gimovsky
- Women & Infants Hospital, Brown University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Providence, RI, USA
| | - Mohamed A Mohamed
- Division of Newborn Services, The George Washington University Hospital, Washington, DC, USA
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20
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Eslier M, Morello R, Azria E, Dreyfus M. Comparative study of changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014 in France. Eur J Obstet Gynecol Reprod Biol 2020; 253:76-82. [DOI: 10.1016/j.ejogrb.2020.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
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21
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De Freitas C, Massag J, Amorim M, Fraga S. Involvement in maternal care by migrants and ethnic minorities: a narrative review. Public Health Rev 2020; 41:5. [PMID: 32280558 PMCID: PMC7137324 DOI: 10.1186/s40985-020-00121-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Guidelines for improving the quality of maternal health services emphasise women's involvement in care. However, evidence about migrant and ethnic minorities' preferences for participation in maternal care remains unsystematised. Understanding these populations' experiences with and preferred forms of involvement in care provision is crucial for imbuing policies and guidelines with sensitivity to diversity and for implementing people-centred care. This paper presents a narrative synthesis of empirical studies of involvement in maternal health care by migrants and ethnic minorities based on four key dimensions: information, communication, expression of preferences and decision-making. METHODS Studies indexed in PubMed and Scopus published until December 2019 were searched. Original quantitative, qualitative and mixed methods studies written in English and reporting on migrant and ethnic minority involvement in maternal care were included. Backward reference tracking was carried out. Three researchers conducted full-text review of selected publications. RESULTS In total, 22 studies met the inclusion criteria. The majority of studies were comparative and addressed only one or two dimensions of involvement, with an emphasis on the information and communication dimensions. Compared to natives, migrants and ethnic minorities were more likely to (1) lack access to adequate information as a result of health care staff's limited time, knowledge and misconceptions about women's needs and preferences; (2) report suboptimal communication with care staff caused by language barriers and inadequate interpreting services; (3) be offered fewer opportunities to express preferences and to have preferences be taken less into account; and (4) be less involved in decisions about their care due to difficulties in understanding information, socio-cultural beliefs and previous experiences with care provision less attuned with playing an active role in decision-making and care staff detracting attitudes. CONCLUSION Constraints to adequate and inclusive involvement in maternal care can hinder access to quality care and result in severe negative health outcomes for migrant and ethnic minority women. More research is needed into how to tailor the dimensions of involvement to migrant and ethnic minorities' needs and preferences, followed by provision of the resources necessary for effective implementation (e.g. sufficient time for consultations, optimal interpreter systems, health care staff training).
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Affiliation(s)
- Cláudia De Freitas
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centre for Research and Studies in Sociology, University Institute of Lisbon (ISCTE-IUL), Lisbon, Portugal
| | - Janka Massag
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Mariana Amorim
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Sílvia Fraga
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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22
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Siddiqui A, Deneux-Tharaux C, Luton D, Schmitz T, Mandelbrot L, Estellat C, Howell EA, Khoshnood B, Bertille N, Azria E. Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis. Sci Rep 2020; 10:5215. [PMID: 32251320 PMCID: PMC7089990 DOI: 10.1038/s41598-020-62032-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
We investigated the extent to which pre-pregnancy obesity mediates the association between maternal place of birth and severe pre-eclampsia in the PreCARE cohort of pregnant women in Paris (n = 9,579). Adjusted path analysis logistic regression models were used to assess the role of pre-pregnancy obesity as a mediator in the association between maternal place of birth and the development of severe pre-eclampsia. We calculated 1. adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components 2. the indirect/obesity-mediated effect. Ninety-five (0.99%) women developed severe pre-eclampsia, 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese (BMI > = 30 kg/m2). Women experiencing severe pre-eclampsia were more likely to be from Sub-Saharan Africa (p = 0.023) and be obese (p = 0.048). Mothers from Sub-Saharan Africa had an increased risk of severe pre-eclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58) and the obesity-mediated indirect effect was 18% of the total risk (aOR 1.18, 95%CI 1.03-1.35). In conclusion, Sub-Saharan African immigrant women have a two-fold higher risk of developing severe pre-eclampsia as compared to European-born women, one-fifth of which is mediated by pre-pregnancy obesity. Our results quantify the potential benefit of decreasing obesity among at-risk women.
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Affiliation(s)
- Ayesha Siddiqui
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France.
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Catherine Deneux-Tharaux
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Paris Diderot University, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Colombes, France
| | - Candice Estellat
- Pitié-Salpêtrière Hospital - Charles Foix; Department of Biostatistics, Public Health and Medical Information, Clinical Research Unit, Pharmacoepidemiology Center (Céphépi), Sorbonne University; INSERM UMR-S 1136 - Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Babak Khoshnood
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Nathalie Bertille
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Elie Azria
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
- Maternity Unit, Notre Dame de Bon Secours -Paris Saint Joseph Hospital/ University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France
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23
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Serrano NC, Quintero-Lesmes DC, Dudbridge F, Leon LJ, Hingorani AD, Williams DJ, Casas JP. Family history of pre-eclampsia and cardiovascular disease as risk factors for pre-eclampsia: the GenPE case-control study. Hypertens Pregnancy 2020; 39:56-63. [PMID: 31910697 DOI: 10.1080/10641955.2019.1704003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To determine whether family history of pre-eclampsia and cardiovascular disease is consistently associated with the occurrence of pre-eclampsia sub-phenotypes and fetal growth restriction (FGR).Material and Methods: We conducted a case-control study in which cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight Colombian cities between 2000 and 2012. Odds of pre-eclampsia among women with a positive family history of pre-eclampsia or cardiovascular disease were compared to women without affected relatives (logistic regression modeling and multinomial logistic regression model [Ajusted]).Results: A total of 3510 pre-eclampsia cases and 4512 controls with data on family history of pre-eclampsia were included in analyses. A subsample of 3086 cases and 3888 controls also provided information on family history of cardiovascular disease. Women whose mothers had pre-eclampsia had 3.38 (95% CI 2.89, 3.96) higher odds than those who did not, and having an affected sister increased pre-eclampsia odds by 2.43 (95% CI 2.02, 2.93). The effect of having both mother and sister affected with pre-eclampsia was stronger than the two independent risk factors (OR 4.17 [95% CI 2.60, 6.69]). Women with parental history of cardiovascular disease also had an increased risk of pre-eclampsia (OR 1.58 [95% CI 1.24, 2.01]).Conclusions: Family history of pre-eclampsia increased the risk of PE. The impact of family history of cardiovascular disease on pre-eclampsia was more conservative, but serves to support the hypothesis that pre-eclampsia may reflect the premature exposure of underlying cardiovascular dysfunction, precipitated by the stress test of pregnancy.
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Affiliation(s)
- Norma C Serrano
- Fundación Cardiovascular de Colombia FCV.,Universidad Autónoma de Bucaramanga, Colombia
| | | | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lydia J Leon
- Genetics & Genomic Medicine, University College London, London, UK
| | | | - David J Williams
- Institute for Women's Health, University College London Hospital, London, UK
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
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24
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Brown J, Kapurubandara S, McGee TM. Confounding effect of ethnic diversity on booking-in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997-2016. Aust N Z J Obstet Gynaecol 2019; 60:369-375. [PMID: 31591712 DOI: 10.1111/ajo.13077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maternal obesity is a key risk factor for morbidity in pregnancy. Accurate data on trends in obesity are required in high-risk populations such as in western Sydney to implement effective policy. AIMS This study examines multi-site public hospital data on maternal ethnicity, body mass index (BMI), gestational diabetes mellitus (GDM) and hypertension across 20 years in Western Sydney Local Health District (WSLHD). MATERIALS AND METHODS This is a retrospective cohort study of all women who delivered a live birth beyond 20 weeks at Westmead, Blacktown and Auburn Hospitals (WSLHD) between 1 January 1997 and 31 December 2016. RESULTS There were 112 308 pregnant women included. Between 1997 and 2006, mean booking-in BMI climbed from 24.9 (median 23.9) to peak at 26.2 (24.9). It then fell to 25.3 (24.1) in 2012 before rising to 25.6 (24.4) in 2016. Rates of hypertensive disorders changed little over the period, with a small fall in pre-eclampsia. In contrast, there was a progressive upward trend in the prevalence of GDM, accelerating considerably after 2010. These trends were associated with a shifting ethnic profile with proportions of Australia/New Zealand-born women falling from 56.9% to 36.8%, while those from South Asia increased from 4.5% to 26.3%. CONCLUSIONS Western Sydney booking-in BMI fluctuated between 1997 and 2016, reaching its peak in 2006. Despite this, rates of GDM progressively rose, with one in six mothers in western Sydney now diagnosed with some form of the condition. Both patterns are associated with a notable shift in the ethnic profile of patients booking-in to antenatal care in the region.
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Affiliation(s)
- James Brown
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Therese M McGee
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
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25
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Al-Rubaie ZTA, Malcolm Hudson H, Jenkins G, Mahmoud I, Ray JG, Askie LM, Lord SJ. The association between ethnicity and pre-eclampsia in Australia: A multicentre retrospective cohort study. Aust N Z J Obstet Gynaecol 2019; 60:396-404. [PMID: 31583696 DOI: 10.1111/ajo.13069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rates of pre-eclampsia vary between countries and certain ethnic groups. However, there is limited evidence about the impact of ethnicity on risk of pre-eclampsia, beyond established clinical risk factors. AIMS To assess the association between ethnicity and pre-eclampsia in Australia's diverse multi-ethnic population. MATERIALS AND METHODS We conducted a retrospective cohort study using the ObstetriX database. We included all women with a birth between January 2011 and December 2014, at Auburn, Blacktown/Mount-Druitt and Westmead Hospitals in the Western Sydney Local Health District. We estimated the pre-eclampsia rate overall, and by maternal ethnic group, defined by country of birth and primary language. We developed multivariable logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CIs) for pre-eclampsia, adjusting for maternal age, body mass index, autoimmune disease, chronic hypertension, chronic renal disease, diabetes mellitus (type 1 or 2), and multiple pregnancy. A secondary analysis was restricted to nulliparous women. RESULTS There were 40 824 women evaluated, including 12 743 nulliparous women. Of these, 1448 (3.5%) developed pre-eclampsia (range: Australian/New Zealand-born English speakers 735/15 422 (4.8%); North-East Asian women 51/4470 (1.1%)). Relative to Australian/New Zealand-born English speakers, immigrants had a lower risk of pre-eclampsia overall (adjusted OR 0.67; 95% CI 0.60-0.75); as did the three largest immigrant groups examined: Southern Asian (0.73; 0.62-0.85), Middle-Eastern/African (0.55; 0.47-0.66) and North-East Asian (0.33; 0.25-0.45) women. Findings were similar for nulliparous women. CONCLUSIONS Certain immigrant groups are at lower risk of pre-eclampsia than Australian/New Zealand-born English-speaking women. Understanding why this is so may lead to better screening and preventive strategies in higher-risk women.
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Affiliation(s)
- Ziad T A Al-Rubaie
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Harold Malcolm Hudson
- NHMRC Clinical Trial Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Statistics, Macquarie University, Sydney, New South Wales, Australia
| | - Gregory Jenkins
- Department of Obstetrics, Westmead Hospital, Sydney, New South Wales, Australia
| | - Imad Mahmoud
- Department of Obstetrics, Auburn and Mount-Druitt and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M Askie
- NHMRC Clinical Trial Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia.,NHMRC Clinical Trial Centre, University of Sydney, Sydney, New South Wales, Australia
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Remaeus K, Stephansson O, Johansson K, Granath F, Hellgren K. Maternal and infant pregnancy outcomes in women with psoriatic arthritis: a Swedish nationwide cohort study. BJOG 2019; 126:1213-1222. [DOI: 10.1111/1471-0528.15836] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Affiliation(s)
- K Remaeus
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - O Stephansson
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
- Department of Women's and Children's Health Karolinska Institutet Solna Sweden
| | - K Johansson
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - F Granath
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - K Hellgren
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
- Rheumatology Unit Department of Medicine Karolinska Institutet Solna Sweden
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Nilsen RM, Vik ES, Rasmussen SA, Small R, Moster D, Schytt E, Aasheim V. Preeclampsia by maternal reasons for immigration: a population-based study. BMC Pregnancy Childbirth 2018; 18:423. [PMID: 30367607 PMCID: PMC6204029 DOI: 10.1186/s12884-018-2034-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/27/2018] [Indexed: 02/04/2023] Open
Abstract
Background To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration. Methods We included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990–2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education. Results Preeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49–0.62]), followed by family immigrants (0.62 [0.59–0.65]), immigrant students (0.75 [0.65–0.86]), refugees (0.81 [0.75–0.88]), and immigrants from other Nordic countries (0.87 [0.80–0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02–1.36], and < 34 weeks: 1.41 [1.15–1.72]). Conclusions The occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia. Electronic supplementary material The online version of this article (10.1186/s12884-018-2034-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway.
| | - Eline S Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Svein A Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Australia.,Reproductive Health, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Dag Moster
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Erica Schytt
- Reproductive Health, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
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28
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Al-Rubaie ZT, Askie LM, Hudson HM, Ray JG, Jenkins G, Lord SJ. Assessment of NICE and USPSTF guidelines for identifying women at high risk of pre-eclampsia for tailoring aspirin prophylaxis in pregnancy: An individual participant data meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 229:159-166. [DOI: 10.1016/j.ejogrb.2018.08.587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
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Sole KB, Staff AC, Laine K. The association of maternal country of birth and education with hypertensive disorders of pregnancy: A population-based study of 960 516 deliveries in Norway. Acta Obstet Gynecol Scand 2018; 97:1237-1247. [PMID: 29873810 DOI: 10.1111/aogs.13393] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Previous studies estimating the association of maternal country of birth and education with hypertensive disorders of pregnancy (HDP) have shown conflicting results. The aim of the study was to assess the prevalence of HDP and estimate the association of maternal country of birth and education level with preeclampsia/eclampsia and gestational hypertension in Norway. MATERIAL AND METHODS We performed a population-based observational cohort study linking two population datasets: The Medical Birth Registry of Norway and Statistics Norway (SSB). Singleton deliveries in Norway between 1999 and 2014 (907 048 deliveries) were stratified by parity. Multiple regression analysis was performed. RESULTS In 20% of the deliveries the woman was born outside of Norway. Foreign-born women had lower risk of preeclampsia/eclampsia and gestational hypertension compared with Norwegian-born women. High education reduced the risk for preeclampsia/eclampsia by 34% (adjusted odds ratio 0.66, 95% CI 0.62-0.69), compared with women with secondary education among nulliparous women, and by 39% (adjusted odds ratio 0.61, 95% CI 0.57-0.65) among parous women. Poorly educated women had no increased risk of HDP compared with women with secondary education. Among highly educated nulliparous women the risk of preeclampsia/eclampsia was lower but the risk of gestational hypertension higher compared with women of similar parity with secondary education. Adjustment for confounding variables had minimal effect on these estimates. CONCLUSIONS Maternal country of birth and education were associated with HDP. Women with higher education had the lowest risk of HDP, and Norwegian-born women had the highest risk of HDP, regardless of parity and other confounding factors.
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Affiliation(s)
- Kristina Baker Sole
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,County Governor of Oslo and Akershus, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway.,Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway
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30
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[Hypertension in black patients]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:213-217. [PMID: 29754732 DOI: 10.1016/j.jdmv.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022]
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Giachini FR, Galaviz-Hernandez C, Damiano AE, Viana M, Cadavid A, Asturizaga P, Teran E, Clapes S, Alcala M, Bueno J, Calderón-Domínguez M, Ramos MP, Lima VV, Sosa-Macias M, Martinez N, Roberts JM, Escudero C. Vascular Dysfunction in Mother and Offspring During Preeclampsia: Contributions from Latin-American Countries. Curr Hypertens Rep 2017; 19:83. [PMID: 28986756 DOI: 10.1007/s11906-017-0781-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pregnancy is a physiologically stressful condition that generates a series of functional adaptations by the cardiovascular system. The impact of pregnancy on this system persists from conception beyond birth. Recent evidence suggests that vascular changes associated with pregnancy complications, such as preeclampsia, affect the function of the maternal and offspring vascular systems, after delivery and into adult life. Since the vascular system contributes to systemic homeostasis, defective development or function of blood vessels predisposes both mother and infant to future risk for chronic disease. These alterations in later life range from fertility problems to alterations in the central nervous system or immune system, among others. It is important to note that rates of morbi-mortality due to pregnancy complications including preeclampsia, as well as cardiovascular diseases, have a higher incidence in Latin-American countries than in more developed countries. Nonetheless, there is a lack both in the amount and impact of research conducted in Latin America. An impact, although smaller, can be seen when research in vascular disorders related to problems during pregnancy is analyzed. Therefore, in this review, information about preeclampsia and endothelial dysfunction generated from research groups based in Latin-American countries will be highlighted. We relate the need, as present in many other countries in the world, for increased effective regional and international collaboration to generate new data specific to our region on this topic.
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Affiliation(s)
- Fernanda Regina Giachini
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | | | - Alicia E Damiano
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina.,Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquimica, UBA, Buenos Aires, Argentina
| | - Marta Viana
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Angela Cadavid
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | | | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Sonia Clapes
- Universidad de Ciencias Médicas de La Habana, Havana, Cuba
| | - Martin Alcala
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Julio Bueno
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | - María Calderón-Domínguez
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - María P Ramos
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Victor Vitorino Lima
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | - Martha Sosa-Macias
- Pharmacogenomics Academia, Instituto Politécnico Nacional-CIIDIR Durango, Durango, Mexico
| | - Nora Martinez
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina
| | - James M Roberts
- Magee-Womens Research Institute, Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlos Escudero
- Vascular Physiology Laboratory Group of Investigation in Tumor Angiogenesis (GIANT) Group of Research and Innovation in Vascular Health (GRIVAS Health) Basic Sciences Department Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile.
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Cosson E, Baz B, Gary F, Pharisien I, Nguyen MT, Sandre-Banon D, Jaber Y, Cussac-Pillegand C, Banu I, Carbillon L, Valensi P. Poor Reliability and Poor Adherence to Self-Monitoring of Blood Glucose Are Common in Women With Gestational Diabetes Mellitus and May Be Associated With Poor Pregnancy Outcomes. Diabetes Care 2017; 40:1181-1186. [PMID: 28724718 DOI: 10.2337/dc17-0369] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/14/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the compliance with self-monitoring of blood glucose (SMBG) and the reliability of diabetes logbooks in women with gestational diabetes mellitus (GDM), as well as the associated determinants and outcomes. RESEARCH DESIGN AND METHODS We prospectively selected French-speaking women with newly diagnosed GDM who had been referred to our diabetes management program and understood SMBG principles. At the next follow-up visit, we collected SMBG results from glucose meters and logbooks. We analyzed pregnancy outcomes. RESULTS Data were analyzed over 13 ± 3 days in 91 women. Only 61.5% had performed ≥80% of the required tests. Poor compliance was associated with a family history of diabetes, social deprivation, and non-European origin. The average time between pre- and postprandial tests was 141 ± 20 min, with 46.5% of women performing ≥80% of postprandial measurements 100-140 min after meals. Inadequate timing was associated with ethnicity and higher HbA1c at baseline. A total of 23.1% of women had <90% matched values in diary and meter memory, and a poor concordance was associated with a family history of diabetes. Poor adherence was associated with more preeclampsia (12.2 vs. 1.9%, P = 0.049), and inadequate postprandial test timing with a higher HbA1c at delivery (5.3 ± 0.4 vs. 5.0 ± 0.3% [34 ± 2 vs. 31 ± 2 mmol/mol], P < 0.01), despite more frequent insulin therapy. CONCLUSIONS Although women with GDM are considered to be highly motivated, SMBG adherence and reliability are of concern and may be associated with poor gestational prognosis, suggesting that caregivers should systematically check the glucose meter memory to improve GDM management.
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Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France .,UMR U1153 INSERM/U11125 INRA/CNAM, Unité de Recherche Epidémiologique Nutritionnelle, Université Paris 13, Bobigny, France
| | - Baz Baz
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Françoise Gary
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Isabelle Pharisien
- Department of Gynecology-Obstetrics, Jean Verdier Hospital, AP-HP, Paris 13 University, Bondy, France
| | - Minh Tuan Nguyen
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Dorian Sandre-Banon
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Yahya Jaber
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Camille Cussac-Pillegand
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Isabela Banu
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
| | - Lionel Carbillon
- Department of Gynecology-Obstetrics, Jean Verdier Hospital, AP-HP, Paris 13 University, Bondy, France
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, CRNH-IdF, CINFO, Bondy, France
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Kantor E, Guglielminotti J, Azria E, Luton D, Laurent M, Oury JF, Mahieu-Caputo D, Ravaud P, Estellat C. Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery. Anesth Analg 2017; 125:925-933. [DOI: 10.1213/ane.0000000000002275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Soma-Pillay P, Louw MC, Adeyemo AO, Makin J, Pattinson RC. Cardiac diastolic function after recovery from pre-eclampsia. Cardiovasc J Afr 2017; 29:26-31. [PMID: 28906533 PMCID: PMC6002791 DOI: 10.5830/cvja-2017-031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. METHODS This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. RESULTS At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks' gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11-10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. CONCLUSION Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
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Affiliation(s)
- P Soma-Pillay
- Cardiac Obstetric Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
| | - M C Louw
- Department of Cardiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - A O Adeyemo
- MediClinic Heart Hospital, Pretoria, South Africa
| | - J Makin
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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Minsart AF, Liu H, Moffett S, Chen C, Ji N. Salmon Bias and Preterm Birth Among Western Immigrants in China. Matern Child Health J 2017; 21:1861-1866. [PMID: 28755040 DOI: 10.1007/s10995-017-2347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction Immigrants from Western industrialized countries are rarely found in immigrant studies. Our primary objective was to calculate the rate of cesarean delivery, 5-min Apgar score <7, and preterm birth among Chinese and Western women. Our secondary objective was to examine whether there are significant differences in terms of risk factors between Western immigrants who chose to deliver in their country of citizenship compared to those who chose to deliver in China. Methods Single-center retrospective cohort study in Shanghai, China. Multivariate logistic regression models used delivery outcome, and place of delivery (China vs. country of citizenship) as outcome variables. Results Preterm birth occurred at a rate of 3.82% among Chinese citizens, 4.12% among Chinese-born Western citizens, and 6.54% among non-Chinese-born Western citizens. After adjustment, preterm birth <37 weeks was more frequent among non-Chinese-born Western citizens compared with Chinese citizens, with an odds ratio of 1.82 (Confidence Interval 1.20-2.78), p = 0.005. Variables statistically associated with giving birth in China were maternal age ≥35 years and being Chinese-born Western, as well as the absence of medical or obstetrical conditions. Discussion Western immigrants have overall good obstetrical outcomes in China, and this could be partly explained by selective immigration, but also by the Salmon bias, as women with risk factors tend to return to their country of citizenship for the delivery. However, the preterm birth rate was higher among Western women than in their Chinese counterparts, and further research is needed.
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Affiliation(s)
- Anne-Frederique Minsart
- Department of Obstetrics and Gynecology, Shanghai United Family Hospital, 1139 Xianxia Lu, Changning District, Shanghai, 200336, People's Republic of China.
| | - Hau Liu
- Department of Obstetrics and Gynecology, Shanghai United Family Hospital, 1139 Xianxia Lu, Changning District, Shanghai, 200336, People's Republic of China
| | - Shannon Moffett
- Department of Obstetrics and Gynecology, Shanghai United Family Hospital, 1139 Xianxia Lu, Changning District, Shanghai, 200336, People's Republic of China
| | - Crystal Chen
- Department of Obstetrics and Gynecology, Shanghai United Family Hospital, 1139 Xianxia Lu, Changning District, Shanghai, 200336, People's Republic of China
| | - Ninni Ji
- Department of Obstetrics and Gynecology, Shanghai United Family Hospital, 1139 Xianxia Lu, Changning District, Shanghai, 200336, People's Republic of China
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Gonthier C, Estellat C, Deneux-Tharaux C, Blondel B, Alfaiate T, Schmitz T, Oury JF, Mandelbrot L, Luton D, Ravaud P, Azria E. Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study. BMC Pregnancy Childbirth 2017; 17:126. [PMID: 28506217 PMCID: PMC5433136 DOI: 10.1186/s12884-017-1310-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Maternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 (N = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation (N = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level. Results Attendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5–1.8], 2.3 [2.1–2.6], and 3.1 [2.8–3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother’s country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy. Conclusion Social deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1310-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clémentine Gonthier
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France.,Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France
| | - Candice Estellat
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France.,CIC 1425-EC, UMR 1123, INSERM, Paris, France
| | - Catherine Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Béatrice Blondel
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Toni Alfaiate
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, DHU Risks in Pregnancy, AP-HP, Paris Diderot University, 178 Rue des Renouillers, 92700, Colombes, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France.,UMR676, Paris Diderot University - INSERM, Paris, France
| | - Philippe Ravaud
- UMR1153 - Méthodes de l'évaluation thérapeutique des maladies chroniques (METHOS research team), INSERM, 1 Place du Parvis de Notre-Dame, 75004, Paris, France
| | - Elie Azria
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France. .,Department of Obstetrics and Gynecology, Groupe Hospitalier Paris Saint Joseph, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
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Sauvegrain P, Azria E, Chiesa-Dubruille C, Deneux-Tharaux C. Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study. BJOG 2017; 124:1858-1865. [DOI: 10.1111/1471-0528.14658] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 12/14/2022]
Affiliation(s)
- P Sauvegrain
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Department of Obstetrics and Gynecology; Hôpital de la Pitié-Salpêtrière; AP-HP; Paris France
| | - E Azria
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Notre Dame de Bon Secours Maternity Unit; Groupe Hospitalier Paris Saint-Joseph; DHU Risks in Pregnancy; Paris France
| | - C Chiesa-Dubruille
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Department of Obstetrics and Gynecology; Groupe Hospitalier de Rambouillet; Rambouillet France
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
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Preterm preeclampsia in relation to country of birth. J Perinatol 2016; 36:718-22. [PMID: 27149056 PMCID: PMC5007604 DOI: 10.1038/jp.2016.73] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the association between maternal country of birth and the risk of preeclampsia+preterm birth (PTB). STUDY DESIGN We completed a population-based study in the entire province of Ontario, where there is universal access to obstetrical care. We included 881 700 singleton livebirths among Canadian-born mothers and 305 547 births among immigrant mothers. Adjusted risk ratios (aRRs) were adjusted for maternal age, parity and income quintile. RESULTS Compared with a rate of preeclampsia+PTB of 4.0 per 1000 among Canadian-born mothers, the aRR of preeclampsia+PTB at 24 to 36 weeks was significantly higher for immigrant women from Nigeria (1.79, 95% confidence interval (CI) 1.12 to 2.84), the Philippines (1.54, 95% CI 1.30 to 1.86), Colombia (1.68, 95% CI 1.04 to 2.73), Jamaica (2.06, 95% CI 1.66 to 2.57) and Ghana (2.12, 95% CI 1.40 to 3.21). The aRRs generally followed a similar pattern for secondary outcomes. Specifically, women from Ghana were at highest risk of preeclampsia+very PTB (4.55, 95% CI 2.57 to 8.06), and women from Jamaica at the highest risk of preeclampsia+indicated PTB (1.89, 95% CI 1.43 to 2.50). CONCLUSION The risk of preeclampsia+PTB is highest among women from a select number of countries. This information can enhance initiatives aimed at reducing the risk of PTB related to preeclampsia.
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Ajah LO, Ozonu NC, Ezeonu PO, Lawani LO, Obuna JA, Onwe EO. The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria. J Clin Diagn Res 2016; 10:QC18-QC21. [PMID: 27790527 DOI: 10.7860/jcdr/2016/21078.8499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. AIM This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. MATERIALS AND METHODS This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. RESULTS A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. CONCLUSION Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment.
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Affiliation(s)
- Leonard Ogbonna Ajah
- Lecturer, Department of Obstetrics, Faculty of Medical Sciences, University of Nigeria , Enugu Campus
| | - Nelson Chukwudi Ozonu
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki
| | - Paul Olisaemeka Ezeonu
- Associate Professor, Department of Obstetrics and Gynaecology, Ebonyi State University /Federal Teaching Hospital , Abakaliki
| | - Lucky Osaheni Lawani
- Lecturer, Department of Obstetrics and Gynaecology, Ebonyi State University/ Federal Teaching Hospital , Abakaliki
| | - Johnson Akuma Obuna
- Senior Lecturer, Department of Obstetrics and Gynaecology, Ebonyi State University/Federal TeachingHospital, Abakaliki
| | - Emeka Ogah Onwe
- Lecturer, Department of Paediatrics, Ebonyi State University/Federal Teaching Hospital , Abakaliki
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Racape J, Schoenborn C, Sow M, Alexander S, De Spiegelaere M. Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status. BMC Pregnancy Childbirth 2016; 16:75. [PMID: 27059448 PMCID: PMC4826554 DOI: 10.1186/s12884-016-0860-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing studies show that immigrants have different perinatal health outcomes compared to native women. Nevertheless, we lack a systematic examination of the combined effects of immigrant status and socioeconomic factors on perinatal outcomes. Our objectives were to analyse national Belgian data to determine 1) whether socioeconomic status (SES) modifies the association between maternal nationality and perinatal outcomes (low birth weight and perinatal mortality); 2) the effect of adopting the Belgian nationality on the association between maternal foreign nationality and perinatal outcomes. METHODS This study is a population-based study using the data from linked birth and death certificates from the Belgian civil registration system. Data are related to all singleton births to mothers living in Belgium between 1998 and 2010. Perinatal mortality and low birth weight (LBW) were estimated by SES (maternal education and parental employment status) and by maternal nationality (at her own birth and at her child's birth). We used logistic regression to estimate the odds ratios for the associations between nationality and perinatal outcomes after adjusting for and stratifying by SES. RESULTS The present study includes, for the first time, all births in Belgium; that is 1,363,621 singleton births between 1998 and 2010. Compared to Belgians, we observed an increased risk of perinatal mortality in all migrant groups (p < 0.0001), despite lower rates of LBW in some nationalities. Immigrant mothers with the Belgian nationality had similar rates of perinatal mortality to women of Belgian origin and maintained their protection against LBW (p < 0.0001). After adjustment, the excess risk of perinatal mortality among immigrant groups was mostly explained by maternal education; whereas for sub-Saharan African mothers, mortality was mainly affected by parental employment status. After stratification by SES, we have uncovered a significant protective effect of immigration against LBW and perinatal mortality for women with low SES but not for high SES. CONCLUSIONS Our results show a protective effect of migration in relation to perinatal mortality and LBW among women of low SES. Hence, the study underlines the importance of taking into account socioeconomic status in order to understand more fully the relationship between migration and perinatal outcomes. Further studies are needed to analyse more finely the impact of socio-economic characteristics on perinatal outcomes.
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Affiliation(s)
- Judith Racape
- Research centre in Epidemiology, Biostatistics and Clinical research, Ecole de Santé Publique, Université Libre de Bruxelles(ULB), CP598. Route de Lennik 808, Bruxelles, 1070, Belgium.
| | - Claudia Schoenborn
- Research centre in Epidemiology, Biostatistics and Clinical research, Ecole de Santé Publique, Université Libre de Bruxelles(ULB), CP598. Route de Lennik 808, Bruxelles, 1070, Belgium
| | - Mouctar Sow
- Research centre in Health Policies and Health Systems, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, 1070, Belgium.,Ecole de Santé Publique, Université de Montréal, Montréal, H3N 1X9, Québec, Canada
| | - Sophie Alexander
- Research centre in Epidemiology, Biostatistics and Clinical research, Ecole de Santé Publique, Université Libre de Bruxelles(ULB), CP598. Route de Lennik 808, Bruxelles, 1070, Belgium.,Research centre in Health Policies and Health Systems, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, 1070, Belgium
| | - Myriam De Spiegelaere
- Research centre in Health Policies and Health Systems, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, 1070, Belgium
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Pregnancy-Related Hypertensive Disorders and Immigrant Status: A Systematic Review and Meta-analysis of Epidemiological Studies. J Immigr Minor Health 2016; 19:1488-1497. [DOI: 10.1007/s10903-016-0410-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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van den Akker T, van Roosmalen J. Maternal mortality and severe morbidity in a migration perspective. Best Pract Res Clin Obstet Gynaecol 2015; 32:26-38. [PMID: 26427550 DOI: 10.1016/j.bpobgyn.2015.08.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022]
Abstract
Among migrants in high-income countries, maternal mortality and severe morbidity generally occur more frequently as compared to host populations. There is marked variation between groups of migrants and host countries, with much elevated risks in some groups and no elevated risk at all in others. Those without a legal resident permit are most vulnerable. A reason for these elevated risks could be a different risk profile in migrants, but risk factors are unevenly distributed and not always present. Another reason is substandard care, which is identified more frequently in migrants, and comprises patient delays, for example, due to a lack of knowledge about the health system in the host country, and health worker delays, often compounded by communication barriers. Improvements in family planning and antenatal services are needed, and audits and confidential enquiries should be extended to include maternal morbidity and ethnic background. This requires scientific and political efforts.
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Affiliation(s)
- Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Postbus 9600, 2300RC Leiden, The Netherlands.
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Postbus 9600, 2300RC Leiden, The Netherlands; Athena Institute, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085-1087, 1081HV Amsterdam, The Netherlands
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