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Stearns K, Tsaih SW, Palatnik A. Racial and Ethnic Disparities in Maternal and Neonatal Outcomes among Women with Chronic Hypertension. Am J Perinatol 2022; 39:1033-1041. [PMID: 35045577 DOI: 10.1055/a-1745-2902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this study was to compare maternal and neonatal outcomes in women with chronic hypertension by maternal race and ethnicity. METHODS A retrospective cohort study of women with chronic hypertension was performed from the Consortium on Safe Labor (2002-2008). Maternal self-reported race and ethnicity were analyzed as non-Hispanic White, non-Hispanic Black, and Hispanic. Maternal outcomes included cesarean birth, postpartum hemorrhage, blood transfusion, placental abruption, eclampsia, maternal intensive care unit admission, and death. Neonatal outcomes included preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), 5-minute Apgar <7, respiratory distress syndrome, hypoxic-ischemic encephalopathy, intraventricular hemorrhage, neonatal intensive care unit admission, sepsis, and death. Univariable and multivariable analyses were performed to examine the association between maternal race and ethnicity and perinatal outcomes. RESULTS A total of 2,729 women were included. In unadjusted analysis, non-Hispanic White women had higher rates of placental abruption and Hispanic women had higher rates of placental abruption and eclampsia. In multivariable analysis, non-Hispanic Black continued to have higher odds of placental abruption (adjusted odds ratio 4.16, 95% confidence interval 1.29-18.70), but the rest of the maternal outcomes did not differ between the groups. When comparing neonatal outcomes, PTB, SGA, and LBW were more frequent in, 5-minute Apgar <7 non-Hispanic Black and Hispanic women compared with non-Hispanic White women. In addition, 5-minute Apgar <7 and neonatal sepsis were more frequent in non-Hispanic Black neonates and neonatal death was more frequent in Hispanic neonates compared with non-Hispanic White women. In multivariable regression, neonates of non-Hispanic Black women had higher odds of PTB, SGA, LBW, 5-minute Apgar < 7, and sepsis compared with non-Hispanic White women. Similarly, neonates of Hispanic women had higher odds of SGA, LBW, and death. CONCLUSION Significant racial and ethnic disparities were identified mainly in neonatal outcomes of women with chronic hypertension. KEY POINTS · Non-Hispanic Black women with chronic hypertension had higher rates of placental abruption.. · Neonates of non-Hispanic Black women with chronic hypertension had higher odds of PTB, SGA, and LBW.. · Neonates of Hispanic women with chronic hypertension had higher odds of SGA, LBW, and neonatal death..
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Affiliation(s)
- Kristen Stearns
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
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Unique Cardiovascular Disease Risk Factors in Hispanic Individuals. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:53-61. [PMID: 35669678 PMCID: PMC9161759 DOI: 10.1007/s12170-022-00692-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review summarizes contemporary data on unique cardiovascular disease (CVD) risk factors in Hispanic individuals in the USA, and how addressing these factors is important in addressing health equity. Recent Findings Recent studies have shown high rates of traditional CVD risk factors in Hispanic individuals such as obesity, hypertension, diabetes, hyperlipidemia, and emerging CVD risk factors like hypertensive disorders of pregnancy, psychological stress, and occupational exposures. However, most studies fail to consider the significant heterogeneity in risk factor burden and outcomes in atherosclerotic CVD by Hispanic subgroup. Heart failure and rhythm disorders are less well studied in Hispanic adults, making risk assessment for these conditions difficult. High levels of CVD risk factors in Hispanic youth given an aging Hispanic population overall highlight the importance of risk mitigation among these individuals. Summary In brief, these data highlight the significant, unique burden of CVD risk among Hispanic individuals in the USA and predict a rising burden of disease among this growing and aging population. Future CVD research should focus on including robust, diverse Hispanic cohorts as well as specifically delineating results for disaggregated Hispanic groups across CVDs. This will allow for better risk assessment, prevention, and treatment decisions to promote health equity for Hispanic patients.
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Mattsson K, Juárez S, Malmqvist E. Influence of Socio-Economic Factors and Region of Birth on the Risk of Preeclampsia in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074080. [PMID: 35409763 PMCID: PMC8998104 DOI: 10.3390/ijerph19074080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023]
Abstract
Objectives: To investigate the association between socio-economic factors and the risk of preeclampsia in Sweden, specifically investigating if this relationship is confounded by maternal region of birth. Study design: All singleton births between 1999 and 2009 in an ethnically diverse area in southern Sweden, totaling 46,618 pregnancies, were included in this study. The data on maternal pregnancy outcomes were retrieved from a regional birth register and socio-economic variables from Statistics Sweden. The risk ratios for preeclampsia were calculated for educational level and household disposable income, adjusting for maternal region of birth, maternal age, body mass index, parity, and smoking. Results: Low income levels were associated with a higher risk for preeclampsia, adjusted risk ratio (aRR) = 1.25 (95% confidence interval [CI]: 0.99, 1.59) and aRR = 1.36 (95% CI: 1.10, 1.68) for the two lowest quintiles, respectively, compared to the highest. There was an educational gradient in preeclampsia risk, although not all categories reached statistical significance: aRR = 1.16, (95% CI: 0.89–1.50) for low educational attainment and aRR = 1.23 (95% CI: 1.08, 1.41) for intermediate educational attainment compared to women with highest education. The socio-economic gradient remained after adjusting for region of birth. There was a lower risk for preeclampsia for women born in Asia, aRR = 0.60 (95% CI: 0.47, 0.75), regardless of socio-economic position. Conclusion: An increased risk for preeclampsia was seen for women with measures of lower socio-economic position, even in a universal, government-funded healthcare setting. The relationship was not explained by region of birth, indicating that the excess risk is not due to ethnically differential genetic pre-disposition but rather due to modifiable factors.
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Affiliation(s)
- Kristina Mattsson
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, SE-223 83 Lund, Sweden;
- Correspondence: ; Tel.: +46-(0)70-826-32-36
| | - Sol Juárez
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, SE-114 19 Stockholm, Sweden;
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, SE-223 83 Lund, Sweden;
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Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
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5
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Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol 2022; 226:S876-S885. [PMID: 32717255 DOI: 10.1016/j.ajog.2020.07.038] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022]
Abstract
The burden of preeclampsia, a substantial contributor to perinatal morbidity and mortality, is not born equally across the population. Although the prevalence of preeclampsia has been reported to be 3% to 5%, racial and ethnic minority groups such as non-Hispanic Black women and American Indian or Alaskan Native women are widely reported to be disproportionately affected by preeclampsia. However, studies that add clarity to the causes of the racial and ethnic differences in preeclampsia are limited. Race is a social construct, is often self-assigned, is variable across settings, and fails to account for subgroups. Studies of the genetic structure of human populations continue to find more variations within racial groups than among them. Efforts to examine the role of race and ethnicity in biomedical research should consider these limitations and not use it as a biological construct. Furthermore, the use of race in decision making in clinical settings may worsen the disparity in health outcomes. Most of the existing data on disparities examine the differences between White and non-Hispanic Black women. Fewer studies have enough sample size to evaluate the outcomes in the Asian, American Indian or Alaskan Native, or mixed-race women. Racial differences are noted in the occurrence, presentation, and short-term and long-term outcomes of preeclampsia. Well-established clinical risk factors for preeclampsia such as obesity, diabetes, and chronic hypertension disproportionately affect non-Hispanic Black, American Indian or Alaskan Native, and Hispanic populations. However, with comparable clinical risk factors for preeclampsia among women of different race or ethnic groups, addressing modifiable risk factors has not been found to have the same protective effect for all women. Abnormalities of placental formation and development, immunologic factors, vascular changes, and inflammation have all been identified as contributing to the pathophysiology of preeclampsia. Few studies have examined race and the pathophysiology of preeclampsia. Despite attempts, a genetic basis for the disease has not been identified. A number of genetic variants, including apolipoprotein L1, have been identified as possible risk modifiers. Few studies have examined race and prevention of preeclampsia. Although low-dose aspirin for the prevention of preeclampsia is recommended by the US Preventive Service Task Force, a population-based study found racial and ethnic differences in preeclampsia recurrence after the implementation of low-dose aspirin supplementation. After implementation, recurrent preeclampsia reduced among Hispanic women (76.4% vs 49.6%; P<.001), but there was no difference in the recurrent preeclampsia in non-Hispanic Black women (13.7 vs 18.1; P=.252). Future research incorporating the National Institute on Minority Health and Health Disparities multilevel framework, specifically examining the role of racism on the burden of the disease, may help in the quest for effective strategies to reduce the disproportionate burden of preeclampsia on a minority population. In this model, a multilevel framework provides a more comprehensive approach and takes into account the influence of behavioral factors, environmental factors, and healthcare systems, not just on the individual.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
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Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, Magee LA, Rana S, Vermunt JV, August P. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e21-e41. [PMID: 34905954 PMCID: PMC9031058 DOI: 10.1161/hyp.0000000000000208] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.
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Palatnik A, Garacci E, Walker RJ, Ozieh MN, Williams JS, Egede LE. The Association of Paternal Race and Ethnicity with Adverse Pregnancy Outcomes in a Contemporary U.S. Cohort. Am J Perinatol 2021; 38:698-706. [PMID: 31858501 PMCID: PMC7292746 DOI: 10.1055/s-0039-3400995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Maternal racial and ethnic disparities exist in obstetric outcomes. The contribution of paternal race and ethnicity toward obstetric outcomes has been less well documented. The objective of this study was to investigate the association between paternal race and ethnicity and several adverse pregnancy outcomes. STUDY DESIGN This was a retrospective cohort of birth data from the CDC National Vital Statistics, years 2013-2017. All singleton live births were included in the analysis. Records with missing paternal race and ethnicity were excluded. The primary dependent variables were the following adverse maternal and perinatal outcomes: gestational diabetes, hypertensive disorder of pregnancy, preterm birth <37 weeks, cesarean delivery, low birth weight <2,500 g, 5-minute Apgar's score <7, admission to neonatal intensive care unit (NICU), and assisted ventilation at > 6 hours of life. The main exposure was paternal race and ethnicity, which was grouped into non-Hispanic white, non-Hispanic black, Hispanic, and other. Other race and ethnicity category included: American Indian, Alaskan Native, Asian, Native Hawaiian, or other Pacific Islander. Univariable and multivariable analyses were done to determine whether paternal race and ethnicity was independently associated with adverse pregnancy outcomes. RESULTS A total of 16,482,745 births were included. In univariable analysis, all adverse obstetric outcomes were significantly associated with paternal race and ethnicity. In multivariable analysis, controlling for maternal and paternal demographic characteristics and maternal clinical factors, paternal race and ethnicity remained significantly associated with the majority of the adverse pregnancy outcomes. The strongest association was seen with: (1) paternal non-Hispanic black race and ethnicity, and higher rates of LBW and preterm birth (Odds ratio [OR] = 1.25, 95% CI: 1.24-1.27 and OR = 1.14, 95% CI: 1.13-1.15, respectively); (2) paternal Hispanic race and ethnicity and lower rates of 5-minute Apgar's score <7, and assisted ventilation at >6 hours of life (OR = 0.78, 95% CI: 0.77-0.79, and OR = 0.77, 95% CI: 0.75-0.78, respectively); and (3) other paternal race and ethnicity and higher rates of gestational diabetes, but lower rates of hypertensive disorder of pregnancy and assisted ventilation >6 hours of life (OR = 1.26, 95% CI: 1.25-1.27; OR = 0.79, 95% CI: 0.78-0.80; and OR = 0.80, 95% CI: 0.78-0.82, respectively). All associations were in comparison to paternal non-Hispanic white race and ethnicity. CONCLUSION Paternal race and ethnicity has an independent association with adverse obstetric outcomes. The pathway and the extent of the paternal racial influence are not fully understood and deserve additional research.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joni S. Williams
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Stafford IA, Turrentine MA, Ostovar-Kermani T, Moustafa ASZ, Berra A, Sangi-Haghpeykar H. Disparities between US Hispanic and non-Hispanic women in obesity-related perinatal outcomes: a prospective cohort study. J Matern Fetal Neonatal Med 2021; 35:6172-6179. [PMID: 33843401 DOI: 10.1080/14767058.2021.1909559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mortality figures and national health surveillance data have demonstrated that Hispanics have a 24% lower risk of all-cause mortality compared to their non-Hispanic counterparts despite increased rates of obesity and related illnesses. OBJECTIVE The aim of this study is to evaluate if this paradox exists for obesity-related perinatal outcomes in otherwise low-risk Hispanic women. MATERIALS AND METHODS A prospective cohort study of low-risk women across all BMI classes with a singleton, non-anomalous term pregnancy admitted in active labor or undergoing induction of labor between May 2014 and April 2017. All demographic, obstetric, and neonatal outcomes were recorded, and the body mass index (BMI) closest to delivery was used for analysis. Data including composites of adverse maternal and neonatal outcomes were compared across BMI classes and between individuals of Hispanic and non-Hispanic ethnicity. Women with antenatal complications, prior cesarean delivery, and cesarean for non-reassuring fetal status were excluded. RESULTS Of the 11,369 women who met inclusion criteria, 6303 (55%) were Hispanic. Eight percent of Hispanic women were normal weight (BMI: 18.5-24.9), 34% were overweight (BMI: 25-29.9), and 58% were obese (BMI > 30). Fourteen percent of non-Hispanic women were normal weight, 42% were overweight, and 44% were obese. The majority (65%) of women were multiparous. Rate of induction and birthweight increased across BMI for Hispanic and non-Hispanic groups, however the route of delivery was not significantly different (p = .22, 0.16, respectively). Although the association between BMI and composite perinatal complications did not differ by BMI class and ethnicity, the newborns of non-Hispanic women were more likely to be admitted to the neonatal intensive care unit with increasing maternal weight class (<0.001), even after adjusting for age, parity, marital status, prenatal visits, current tobacco use, type of labor, mode of delivery, and birthweight. CONCLUSION There were no demonstrable differences in composite adverse maternal or neonatal outcomes between Hispanic and non-Hispanic obese women. However, newborns of non-Hispanic obese women were more likely to be transferred to the neonatal intensive care unit with increasing maternal BMI.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center/McGovern Medical School, Houston, TX, USA
| | - Mark A Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Ahmed S Z Moustafa
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Alexandra Berra
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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9
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Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:75. [PMID: 33223802 PMCID: PMC7669491 DOI: 10.1007/s11936-020-00869-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Purpose of review Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds. Recent findings Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions. Summary Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.
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Richardson DM, Andrea SB, Ziring A, Robinson C, Messer LC. Pregnancy Outcomes and Documentation Status Among Latina Women: A Systematic Review. Health Equity 2020; 4:158-182. [PMID: 32440614 PMCID: PMC7241052 DOI: 10.1089/heq.2019.0126] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The impression that Latinas experience paradoxically good pregnancy outcomes in the United States persists, despite evidence showing that these outcomes are not enjoyed by all Latina subgroups. We conducted this systematic literature review to examine the relationship between documentation status and pregnancy outcomes among Latinas. Methods: This review synthesizes empirical evidence on this relationship; examines how these studies define and operationalize documentation status; and makes recommendations of how a more comprehensive methodological approach can guide public health research on the impact of documentation status on Latina immigrants to the United States. We searched the literature within PubMed, Web of Science, Academic Search Premier, and Google Scholar in 2017 for relevant studies. Results: Based on stringent inclusion criteria, we retained nine studies for analysis. Conclusion: We found that evidence for the impact of documentation status on pregnancy outcomes among Latinas is not conclusive. We believe the divergence in our findings is, in part, due to variation in: conceptualization of how documentation status impacts pregnancy outcomes, sample populations, definitions of exposures and outcomes, and contextual factors included in models. Specific analytic challenges around sampling, measurement, and data analysis are identified. Suggestions for future research are offered regarding measurement of documentation status. Findings highlight the need for increased attention to documentation as an influence on Latina pregnancy outcomes.
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Affiliation(s)
- Dawn M Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Amber Ziring
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Cassandra Robinson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Lynne C Messer
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
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11
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Wang E, Glazer KB, Howell EA, Janevic TM. Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review. Obstet Gynecol 2020; 135:896-915. [PMID: 32168209 PMCID: PMC7104722 DOI: 10.1097/aog.0000000000003762] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research. DATA SOURCES We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. METHODS OF STUDY SELECTION Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. TABULATION, INTEGRATION, AND RESULTS Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. CONCLUSION Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42018102415.
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Affiliation(s)
- Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Kimberly B. Glazer
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A. Howell
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & 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
| | - Teresa M. Janevic
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Einav S, Leone M. Epidemiology of obstetric critical illness. Int J Obstet Anesth 2019; 40:128-139. [PMID: 31257034 DOI: 10.1016/j.ijoa.2019.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Obstetric intensive care unit (ICU) admissions comprise only a small part of severe maternal morbidity. The incidence rate of both remains relatively unclear due to inconsistent definitions across publications, although this has begun to be addressed. There is a relative paucity of information regarding disease-specific survival following obstetric ICU admission, but outcomes are clearly related to the cause of admission and the quality of care. The ratio between maternal near-miss cases (many of whom are admitted to ICUs) and maternal death may provide insight into the preventability of death. Hemorrhage and pre-eclampsia constitute the leading causes of ICU admission and have relatively low mortality rates, perhaps demonstrating the impact of informed care in managing obstetric critical illness. Obstetric sepsis, heart disease and anesthesia complications should be the focus of future research. The incidence of obstetric sepsis has been increasing in the last decade, with mortality rates remaining relatively high. The incidence of obstetric heart disease is increasing and maternal complications have been attributed to fractionated care of mothers within this category. Anesthesia complications remain a predominant cause of maternal death and likely intensive care admission. Data are lacking regarding the relative proportion of cases per disease that remain treated outside the ICU; and the outcomes of various management strategies. The only study of the health status of survivors of obstetric ICU admission revealed that six months after hospital discharge, one in five women still had a poorer health-related quality of life than those of a reference age- and sex-matched cohort.
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Affiliation(s)
- S Einav
- Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University School of Medicine, Jerusalem, Israel.
| | - M Leone
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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13
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Heath LJ, Hyde H, Miller C, Norris JM. Investigation of elevation as a risk factor for hypertensive disorders of pregnancy among Colorado women between 2007 and 2015. Hypertens Pregnancy 2018; 38:1-12. [PMID: 30384782 DOI: 10.1080/10641955.2018.1538378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the association between high elevation and hypertensive disorders of pregnancy (HDP). METHODS Retrospective cohort study using Colorado birth certificate data to compare HDP at high (≥8,000 ft), moderate (4,501-7,999 ft), or low (≤4,500 ft) elevation using logistic regression. RESULTS Among the cohort (n = 314,431), 3.4% of women developed a HDP. High or moderate elevation was not significantly associated with HDP relative to low elevation (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.93-1.43; aOR 1.14, 95% CI 0.98-1.31, respectively). CONCLUSION Women living at high or moderate elevation do not have higher odds of HDP.
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Affiliation(s)
- Lauren J Heath
- a Department of Pharmacotherapy , University of Utah College of Pharmacy , Salt Lake City , Utah , USA
| | - Hailey Hyde
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
| | - Christin Miller
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
| | - Jill M Norris
- b Department of Epidemiology , Colorado School of Public Health , Aurora , Colorado , USA
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14
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Tamblyn JA, Jenkinson C, Larner DP, Hewison M, Kilby MD. Serum and urine vitamin D metabolite analysis in early preeclampsia. Endocr Connect 2018; 7:199-210. [PMID: 29217650 PMCID: PMC5793806 DOI: 10.1530/ec-17-0308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Vitamin D deficiency is common in pregnant women and may contribute to adverse events in pregnancy such as preeclampsia (PET). To date, studies of vitamin D and PET have focused primarily on serum concentrations vitamin D, 25-hydroxyvitamin D3 (25(OH)D3) later in pregnancy. The aim here was to determine whether a more comprehensive analysis of vitamin D metabolites earlier in pregnancy could provide predictors of PET. Using samples from the SCOPE pregnancy cohort, multiple vitamin D metabolites were quantified by liquid chromatography-tandem mass spectrometry in paired serum and urine prior to the onset of PET symptoms. Samples from 50 women at pregnancy week 15 were analysed, with 25 (50%) developing PET by the end of the pregnancy and 25 continuing with uncomplicated pregnancy. Paired serum and urine from non-pregnant women (n = 9) of reproductive age were also used as a control. Serum concentrations of 25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 24,25(OH)2D3 and 3-epi-25(OH)D3 were measured and showed no significant difference between women with uncomplicated pregnancies and those developing PET. As previously reported, serum 1,25(OH)2D3 was higher in all pregnant women (in the second trimester), but serum 25(OH)D2 was also higher compared to non-pregnant women. In urine, 25(OH)D3 and 24,25(OH)2D3 were quantifiable, with both metabolites demonstrating significantly lower (P < 0.05) concentrations of both of these metabolites in those destined to develop PET. These data indicate that analysis of urinary metabolites provides an additional insight into vitamin D and the kidney, with lower urinary 25(OH)D3 and 24,25(OH)2D3 excretion being an early indicator of a predisposition towards developing PET.
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Affiliation(s)
- J A Tamblyn
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - C Jenkinson
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - D P Larner
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - M Hewison
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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15
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Stohl HE, Lee RH, Manetta J, Kikly K, Korst LM, Stohl W. Maternal Serum B-Cell Activating Factor Levels. Hypertension 2017; 70:1007-1013. [DOI: 10.1161/hypertensionaha.117.09775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/07/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022]
Abstract
Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Early suppression of B-cell lymphopoiesis is necessary for a normal pregnancy. Dysregulation of factors critical to B-cell survival may result in pregnancy complications, including hypertension. In this prospective observational study at a single medical center, serum levels of BAFF (B-cell activating factor) were measured in pregnant participants at each trimester, at delivery, and postpartum and in nonpregnant controls at a single time point. Comparisons were made between nonpregnant and pregnant subjects and between time periods of pregnancy. First-trimester serum BAFF levels were further tested for association with hypertensive disorders of pregnancy. The study included 149 healthy pregnant women, 25 pregnant women with chronic hypertension, and 48 nonpregnant controls. Median first-trimester serum BAFF level (ng/mL) for healthy women (0.90) was lower than median serum BAFF levels for women with chronic hypertension (0.96;
P
=0.013) and controls (1.00;
P
=0.002). Serum BAFF levels steadily declined throughout pregnancy, with the median second-trimester level lower than the corresponding first-trimester level (0.77;
P
=0.003) and the median third-trimester level lower than the corresponding second-trimester level (0.72;
P
=0.025). The median first-trimester serum BAFF level was elevated in women who subsequently developed hypertension compared with women who remained normotensive (1.02 versus 0.85;
P
=0.012), with the area under the receiver operating characteristic curve being 0.709. First-trimester serum BAFF level may be an early and clinically useful predictor of hypertensive disorders of pregnancy.
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Affiliation(s)
- Hindi E. Stohl
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
| | - Richard H. Lee
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
| | - Joseph Manetta
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
| | - Kristine Kikly
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
| | - Lisa M. Korst
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
| | - William Stohl
- From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis,
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16
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Premji SS, Yim IS, Dosani (Mawji) A, Kanji Z, Sulaiman S, Musana JW, Samia P, Shaikh K, Letourneau N, MiGHT Group. Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450309. [PMID: 26413524 PMCID: PMC4564601 DOI: 10.1155/2015/450309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/03/2015] [Indexed: 12/19/2022]
Abstract
Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.
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Affiliation(s)
- Shahirose S. Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6
| | - Ilona S. Yim
- Department of Psychology and Social Behavior, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Aliyah Dosani (Mawji)
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, Canada T3E 6K6
| | - Zeenatkhanu Kanji
- School of Nursing and Midwifery, Aga Khan University-East Africa, Opposite Aga Khan Primary School Plot (9/11), Colonel Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
| | - Salima Sulaiman
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Joseph W. Musana
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Aga Khan University-Nairobi, 3rd Parklands Avenue off Limuru Road, P.O. Box 30270, Nairobi 00100, Kenya
| | - Pauline Samia
- Department of Pediatrics, Aga Khan University-Nairobi, 2nd Parklands Avenue, East Tower Block, Room 505, Nairobi 00100, Kenya
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
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17
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Li Y, Zhu M, Hu R, Yan W. The effects of gene polymorphisms in angiotensin II receptors on pregnancy-induced hypertension and preeclampsia: a systematic review and meta-analysis. Hypertens Pregnancy 2015; 34:241-60. [PMID: 25816156 DOI: 10.3109/10641955.2015.1009543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND To assess whether the polymorphisms of angiotensin II type 1 and type 2 receptors (AT1R, AT2R) are associated with pregnancy-induced hypertension (PIH) and preeclampsia. METHODS Studies were searched from PubMed, ISI Web of Science and HuGE Navigator. RESULTS The A1166C polymorphism of AT1R, A1675G and C3123A polymorphisms of AT2R were analyzed. Significant association was found in recessive model (OR = 1.581, 95% confidence interval (CI): 1.054-2.371) and co-dominant (GG versus AG) model (OR = 1.900, 95%CI: 1.001-3.604) between the A1675G polymorphism and preeclampsia. No association was found between the other polymorphisms and PIH or preeclampsia. CONCLUSIONS The A1675G polymorphism might be associated with preeclampsia, but the A1166C and C3123A polymorphisms had no effect on PIH or preeclampsia.
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Affiliation(s)
- Yingxue Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei , China
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18
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Stillbirth in an Anglophone minority of Canada. Int J Public Health 2015; 60:353-62. [PMID: 25588815 DOI: 10.1007/s00038-015-0650-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority. METHODS We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR) by decade from 1981 to 2010, adjusting for maternal characteristics. We analyzed temporal trends by gestational interval and cause of fetal death. RESULTS Stillbirth rates decreased in Quebec during the three decades, due to improved rates in Francophones. Rates decreased for Anglophones in 1991-2000, but increased in 2001-2010 at term, during the second trimester, and for most causes of fetal death. In the 2000s, the hazard of stillbirth for Anglophones was nearly the same as the hazard for Francophones in the 1980s (HR 0.93, 95 % confidence interval 0.82, 1.05). CONCLUSIONS Stillbirth rates declined in both Francophones and Anglophones before the turn of the century, but increased thereafter for Anglophones, suggesting that linguistic inequalities in stillbirth may be emerging in Quebec. Linguistic status may be a useful marker for surveillance of inequalities in stillbirth.
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19
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Kazemier BM, Ravelli ACJ, de Groot CJM, Mol BWJ. Optimal timing of near-term delivery in different ethnicities: a national cohort study. BJOG 2014; 121:1274-82; discussion 1283. [DOI: 10.1111/1471-0528.12938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- BM Kazemier
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - ACJ Ravelli
- Department of Medical Informatics; Academic Medical Centre; Amsterdam the Netherlands
| | - CJM de Groot
- Department of Obstetrics and Gynaecology; VU Medical Centre; Amsterdam the Netherlands
| | - BWJ Mol
- The Robinson Institute; School of Paediatrics and Reproductive Health University of Adelaide; Adelaide Australia
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