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Ibrahim Sous C, Moravec W, DeFranco E, Kelly EA, Rossi RM. Factors Associated with Maternal Morbidity among Black Women in the United States. Am J Perinatol 2024. [PMID: 38531390 DOI: 10.1055/a-2295-4058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). STUDY DESIGN This is a population-based retrospective case-control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. RESULTS Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. CONCLUSION The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. KEY POINTS · The rate of SMM in NHBP may be modifiable.. · NHBP have a three-fold higher rate of maternal mortality.. · Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity..
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Affiliation(s)
- Catrine Ibrahim Sous
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - William Moravec
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth A Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Rossi
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Morrow AL, Payne DC, Conrey SC, McMorrow M, McNeal MM, Niu L, Burrell AR, Schlaudecker EP, Mattison C, Burke RM, DeFranco E, Teoh Z, Wrammert J, Atherton LJ, Thornburg NJ, Staat MA. Endemic coronavirus infections are associated with strong homotypic immunity in a US cohort of children from birth to 4 years. J Pediatric Infect Dis Soc 2024:piae016. [PMID: 38442245 DOI: 10.1093/jpids/piae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The endemic coronaviruses OC43, HKU1, NL63 and 229E cause cold-like symptoms and are related to SARS-CoV-2, but their natural histories are poorly understood. In a cohort of children followed from birth to 4 years, we documented all coronavirus infections, including SARS-CoV-2, to understand protection against subsequent infections with the same virus (homotypic immunity) or a different coronavirus (heterotypic immunity). METHODS Mother-child pairs were enrolled in metropolitan Cincinnati during the third trimester of pregnancy in 2017-18. Mothers reported their child's socio-demographics, risk factors, and weekly symptoms. Mid-turbinate nasal swabs were collected weekly. Blood was collected at 6 weeks, 6, 12, 18, 24 months and annually thereafter. Infections were detected by testing nasal swabs by an RT-PCR multi-pathogen panel and by serum IgG responses. Health care visits were documented from pediatric records. Analysis was limited to 116 children with high sample adherence. Re-consent for monitoring SARS-CoV-2 infections from June 2020 through November 2021 was obtained for 74 (64%) children. RESULTS We detected 345 endemic coronavirus infections (1.1 infections/child-year) and 21 SARS-CoV-2 infections (0.3 infections/child-year). Endemic coronavirus and SARS-CoV-2 infections were asymptomatic or mild. Significant protective homotypic immunity occurred after a single infection with OC43 (77%) and HKU1 (84%), and after two infections with NL63 (73%). No heterotypic protection against endemic coronaviruses or SARS-CoV-2 was identified. CONCLUSIONS Natural coronavirus infections were common and resulted in strong homotypic immunity but not heterotypic immunity against other coronaviruses, including SARS-CoV-2. Endemic coronavirus and SARS-CoV-2 infections in this US cohort were typically asymptomatic or mild.
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Affiliation(s)
- Ardythe L Morrow
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shannon C Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Meredith McMorrow
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica M McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Liang Niu
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison R Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claire Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel M Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily DeFranco
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jens Wrammert
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lydia J Atherton
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary A Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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3
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Cardemil CV, Cao Y, Posavad CM, Badell ML, Bunge K, Mulligan MJ, Parameswaran L, Olson-Chen C, Novak RM, Brady RC, DeFranco E, Gerber JS, Pasetti M, Shriver M, Coler R, Berube B, Suthar MS, Moreno A, Gao F, Richardson BA, Beigi R, Brown E, Neuzil KM, Munoz FM. Maternal COVID-19 Vaccination and Prevention of Symptomatic Infection in Infants. Pediatrics 2024; 153:e2023064252. [PMID: 38332733 PMCID: PMC10904887 DOI: 10.1542/peds.2023-064252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Maternal vaccination may prevent infant coronavirus disease 2019 (COVID-19). We aimed to quantify protection against infection from maternally derived vaccine-induced antibodies in the first 6 months of an infant's life. METHODS Infants born to mothers vaccinated during pregnancy with 2 or 3 doses of a messenger RNA COVID-19 vaccine (nonboosted or boosted, respectively) had full-length spike (Spike) immunoglobulin G (IgG), pseudovirus 614D, and live virus D614G, and omicron BA.1 and BA.5 neutralizing antibody (nAb) titers measured at delivery. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by verified maternal-report and laboratory confirmation through prospective follow-up to 6 months of age between December 2021 and July 2022. The risk reduction for infection by dose group and antibody titer level was estimated in separate models. RESULTS Infants of boosted mothers (n = 204) had significantly higher Spike IgG, pseudovirus, and live nAb titers at delivery than infants of nonboosted mothers (n = 271), and were 56% less likely to acquire infection in the first 6 months (P = .03). Irrespective of boost, for each 10-fold increase in Spike IgG titer at delivery, the infant's risk of acquiring infection was reduced by 47% (95% confidence interval 8%-70%; P = .02). Similarly, a 10-fold increase in pseudovirus titers against Wuhan Spike, and live virus nAb titers against D614G, and omicron BA.1 and BA.5 at delivery were associated with a 30%, 46%, 56%, and 60% risk reduction, respectively. CONCLUSIONS Higher transplacental binding and nAb titers substantially reduced the risk of SARS-CoV-2 infection in infants, and a booster dose amplified protection during a period of omicron predominance. Until infants are age-eligible for vaccination, maternal vaccination provides passive protection against symptomatic infection during early infancy.
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Affiliation(s)
- Cristina V. Cardemil
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Yi Cao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Christine M. Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Martina L. Badell
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University Hospital Midtown Perinatal Center, Atlanta, Georgia
| | - Katherine Bunge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women’s Hospital, Pittsburgh, Pennsylvania
| | - Mark J. Mulligan
- New York University Langone Vaccine Center, and Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Lalitha Parameswaran
- New York University Langone Vaccine Center, and Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Richard M. Novak
- Division of Infectious Diseases, University of Illinois, Chicago, Illinois
| | - Rebecca C. Brady
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey S. Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marcela Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mallory Shriver
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rhea Coler
- Seattle Children’s Research Institute, Center for Global Infectious Disease Research, Seattle, Washington
| | - Bryan Berube
- Seattle Children’s Research Institute, Center for Global Infectious Disease Research, Seattle, Washington
| | - Mehul S. Suthar
- Emory Vaccine Center, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Alberto Moreno
- Emory Vaccine Center, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Fei Gao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Barbra A. Richardson
- Departments of Biostatistics and Global Health, University of Washington, Divisions of Vaccine and Infectious Disease and Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Richard Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women’s Hospital, Pittsburgh, Pennsylvania
| | - Elizabeth Brown
- Departments of Biostatistics and Global Health, University of Washington, Divisions of Vaccine and Infectious Disease and Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kathleen M. Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Flor M. Munoz
- Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, and Texas Children’s Hospital, Houston, Texas
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Quesada O, Kulandavelu S, Vladutiu CJ, DeFranco E, Minissian MB, Makarem N, Bello NA, Wong MS, Pabón MA, Chandra AA, Avilés-Santa L, Rodríguez CJ, Bairey Merz CN, Sofer T, Hurwitz BE, Talavera GA, Claggett BL, Solomon SD, Cheng S. Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy. Hypertension 2024; 81:255-263. [PMID: 38047358 PMCID: PMC10793810 DOI: 10.1161/hypertensionaha.123.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks for cardiovascular disease for reasons that remain incompletely understood. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy). RESULTS. The study cohort included 5168 Hispanic/Latina women with an average age (SD) of 58.7 (9.7) years at time of echocardiogram. Prior de novo HDP was reported by 724 (14%) of the women studied and was associated with lower left ventricle (LV) ejection fraction -0.66 (95% confidence interval [CI], -1.21 to -0.11), higher LV relative wall thickness 0.09 (95% CI, 0-0.18), and 1.39 (95% CI, 1.02-1.89) higher risk of abnormal LV geometry after adjusting for blood pressure and other confounders. The proportion of the association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI, 0.03-0.45), LV relative wall thickness was 0.28 (95% CI, 0.16-0.51), abnormal LV geometry was 0.14 (95% CI, 0.12-0.48), concentric left ventricular hypertrophy was 0.31 (95% CI, 0.19-0.86), and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26-0.79). CONCLUSIONS. In a large cohort of Hispanic/Latina women those with history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension.
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Affiliation(s)
- Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.)
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q.)
| | | | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (C.J.V.)
| | - Emily DeFranco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH (E.D.)
| | - Margo B. Minissian
- Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.B.M.)
| | - Nour Makarem
- Mialman School of Public Health, Columbia University Irving Center, NY (N.M.)
| | - Natalie A. Bello
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melissa S. Wong
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (M.S.W.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Maria A. Pabón
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alvin A. Chandra
- University of Texas Southwestern Medical Center, Dallas (A.A.C.)
| | - Larissa Avilés-Santa
- National Institute on Minority Health and Health Disparities, Bethesda, MD (L.A.-S.)
| | | | - C. Noel Bairey Merz
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
- Barbra Streisand Women’s Heart Center (C.N.B.M.)
| | - Tamar Sofer
- Department of Medicine (T.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Gregory A. Talavera
- South Bay Latino Research Center, Department of Psychology, San Diego State University, CA (G.A.T.)
| | - Brian L. Claggett
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Scott D. Solomon
- Division of Cardiovascular Medicine (M.A.P., B.L.C., S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Susan Cheng
- Smidt Heart Institute (N.A.B, C.N.B.M, S.C.), Cedars-Sinai Medical Center, Los Angeles, CA
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Fresch R, Stephens K, DeFranco E. The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery. AJP Rep 2024; 14:e51-e56. [PMID: 38269123 PMCID: PMC10805565 DOI: 10.1055/s-0043-1777996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/22/2023] [Indexed: 01/26/2024] Open
Abstract
Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery. Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery. Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery. Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78-1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34-3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN. Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.
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Affiliation(s)
- Robert Fresch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kendal Stephens
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Mahajan S, Alexander A, Koenig Z, Saba N, Prasanphanich N, Hildeman DA, Chougnet CA, DeFranco E, Andorf S, Tilburgs T. Antigen-specific decidual CD8+ T cells include distinct effector memory and tissue-resident memory cells. JCI Insight 2023; 8:e171806. [PMID: 37681414 PMCID: PMC10544202 DOI: 10.1172/jci.insight.171806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023] Open
Abstract
Maternal decidual CD8+ T cells must integrate the antithetical demands of providing immunity to infection while maintaining immune tolerance for fetal and placental antigens. Human decidual CD8+ T cells were shown to be highly differentiated memory T cells with mixed signatures of dysfunction, activation, and effector function. However, no information is present on how specificity for microbial or fetal antigens relates to their function or dysfunction. In addition, a key question, whether decidual CD8+ T cells include unique tissue-resident memory T cells (Trm) or also effector memory T cell (Tem) types shared with peripheral blood populations, is unknown. Here, high-dimensional flow cytometry of decidual and blood CD8+ T cells identified 2 Tem populations shared in blood and decidua and 9 functionally distinct Trm clusters uniquely found in decidua. Interestingly, fetus- and virus-specific decidual CD8+ Trm cells had similar features of inhibition and cytotoxicity, with no significant differences in their expression of activation, inhibitory, and cytotoxic molecules, suggesting that not all fetus-specific CD8+ T cell responses are suppressed at the maternal-fetal interface. Understanding how decidual CD8+ T cell specificity relates to their function and tissue residency is crucial in advancing understanding of their contribution to placental inflammation and control of congenital infections.
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Affiliation(s)
- Shweta Mahajan
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Immunobiology
| | - Aria Alexander
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Immunobiology
| | - Zachary Koenig
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Immunobiology
| | | | - Nina Prasanphanich
- Division of Immunobiology
- Division of Infectious disease, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | | | | | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sandra Andorf
- Division of Biomedical Informatics, and
- Department of Pediatrics, and
- Division of Allergy & Immunology, and
| | - Tamara Tilburgs
- Division of Immunobiology
- Department of Pediatrics, and
- Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Hamilton I, Martin N, Liu J, DeFranco E, Rossi R. Gestational Age and Birth Outcomes in Term Singleton Pregnancies Conceived With Infertility Treatment. JAMA Netw Open 2023; 6:e2328335. [PMID: 37566418 PMCID: PMC10422180 DOI: 10.1001/jamanetworkopen.2023.28335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Despite the increased perinatal risks associated with pregnancies conceived with infertility treatment, there are no recommendations for timing of delivery among this at-risk population. Objective To identify the gestational age at which the ongoing risks of stillbirth are optimally balanced with the risks of neonatal comorbidities and infant deaths in term singleton pregnancies conceived with infertility treatment. Design, Setting, and Participants This cohort study used birth and death data from January 1, 2014, to December 31, 2018, in the US obtained from the National Center for Health Statistics. Singleton pregnancies conceived with infertility treatment delivered at term (37-42 weeks' gestation) were eligible for inclusion. The exclusion criteria were deliveries at less than 37 weeks' or at least 43 weeks' gestation and pregnancies with unknown history of infertility treatment, congenital anomalies, pregestational diabetes, pregestational hypertension, gestational hypertension, and preeclampsia. Data were analyzed from July 22, 2022, to June 24, 2023. Exposure Gestational age at delivery between 37 and 42 weeks. Main Outcomes and Measures The primary outcome was optimal timing of delivery. To ascertain this timing, the risk of delivery (rate of neonatal morbidity and infant death) at a given gestational week was compared with the risk of delivery in the subsequent week of gestation for an additional week (rate of stillbirth during the given week per 10 000 ongoing pregnancies plus rate of neonatal morbidity and infant death in the subsequent week of gestation per 10 000 deliveries). The rates of stillbirth, neonatal morbidity, and infant death (within 1 year of life) were compared at each week. Neonatal morbidity included an Apgar score of 3 or lower at 5 minutes, requirement of ventilation for 6 hours or more, neonatal intensive care unit admission, and seizures. Results Of the 178 448 singleton term pregnancies conceived with infertility treatment (maternal mean [SD] age, 34.2 [5.2] years; mean [SD] gestational age, 39.2 [1.2] weeks; 130 786 [73.5%] were non-Hispanic White patients). The risk of delivery in the subsequent week of gestation was lower than the risk of delivery at both 37 weeks (628 [95% CI, 601-656] vs 1005 [95% CI, 961-1050] per 10 000 live births) and 38 weeks (483 [95% CI, 467-500 vs 625 [95% CI, 598-652] per 10 000 live births). The risks of delivery in subsequent week of gestation significantly exceeded the risk of delivery at 39 weeks (599 [95% CI, 576-622] vs 479 [95% CI, 463-495] per 10 000 live births) and were not significant at 40 weeks (639 [95% CI, 605-675] vs 594 [95% CI, 572-617] per 10 000 live births) and 41 weeks (701 [95% CI, 628-781] vs 633 [95% CI, 599-669] per 10 000 live births). Conclusions and Relevance Results of this study suggest that, in pregnancies conceived with infertility treatment, delivery at 39 weeks provided the lowest perinatal risk when comparing risk of delivery at this week of gestation vs the subsequent week of gestation.
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Affiliation(s)
- Ira Hamilton
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicole Martin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Liu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert Rossi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Keet C, Sicherer SH, Bunyavanich S, Visness C, Fulkerson PC, Togias A, Davidson W, Perry S, Hamrah S, Calatroni A, Robinson K, Dunaway L, Davis CM, Anvari S, Leong-Kee SM, Hershey GK, DeFranco E, Devonshire A, Kim H, Joseph C, Davidson B, Strong NK, Tsuang AJ, Groetch M, Wang J, Dantzer J, Mudd K, Aina A, Shreffler W, Yuan Q, Simmons V, Leung DY, Hui-Beckman J, Ramos JA, Chinthrajah S, Winn V, Sindher T, Jones SM, Manning NA, Scurlock AM, Kim E, Stuebe A, Gern JE, Singh AM, Krupp J, Wood RA. The SunBEAm birth cohort: Protocol design. J Allergy Clin Immunol Glob 2023; 2:100124. [PMID: 37771674 PMCID: PMC10509956 DOI: 10.1016/j.jacig.2023.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 09/30/2023]
Abstract
Background Food allergy (FA) and atopic dermatitis (AD) are common conditions that often present in the first year of life. Identification of underlying mechanisms and environmental determinants of FA and AD is essential to develop and implement effective prevention and treatment strategies. Objectives: We sought to describe the design of the Systems Biology of Early Atopy (SunBEAm) birth cohort. Methods Funded by the National Institute of Allergy and Infectious Diseases (NIAID) and administered through the Consortium for Food Allergy Research (CoFAR), SunBEAm is a US population-based, multicenter birth cohort that enrolls pregnant mothers, fathers, and their newborns and follows them to 3 years. Questionnaire and biosampling strategies were developed to apply a systems biology approach to identify environmental, immunologic, and multiomic determinants of AD, FA, and other allergic outcomes. Results Enrollment is currently underway. On the basis of an estimated FA prevalence of 6%, the enrollment goal is 2500 infants. AD is defined on the basis of questionnaire and assessment, and FA is defined by an algorithm combining history and testing. Although any FA will be recorded, we focus on the diagnosis of egg, milk, and peanut at 5 months, adding wheat, soy, cashew, hazelnut, walnut, codfish, shrimp, and sesame starting at 12 months. Sampling includes blood, hair, stool, dust, water, tape strips, skin swabs, nasal secretions, nasal swabs, saliva, urine, functional aspects of the skin, and maternal breast milk and vaginal swabs. Conclusions The SunBEAm birth cohort will provide a rich repository of data and specimens to interrogate mechanisms and determinants of early allergic outcomes, with an emphasis on FA, AD, and systems biology.
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Affiliation(s)
- Corinne Keet
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Patricia C. Fulkerson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wendy Davidson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Susan Perry
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sanaz Hamrah
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Lars Dunaway
- Rho Inc, Federal Research Operations, Durham, NC
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Susan M. Leong-Kee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
| | | | | | | | | | | | | | | | | | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Dantzer
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kim Mudd
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Abimbola Aina
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Qian Yuan
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | - Virginia Simmons
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | | | | | | | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Virginia Winn
- Division Maternal Fetal Medicine and Obstetrics, Stanford University, Palo Alto, Calif
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | | | - Amy M. Scurlock
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | - Edwin Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis
| | | | - Jennifer Krupp
- Maternal and Fetal Medicine, Obstetrics and Gynecology, SSM Health, Madison, Wis
| | - Robert A. Wood
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
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Springman A, Forde B, Tolusso L, DeFranco E, Swarr DT, Wright ED, Habli M. Twin-twin transfusion syndrome recipient with arterial calcification and heterozygous variant in ABCC6: Evidence of a gene-environment interaction? Prenat Diagn 2023. [PMID: 37309085 DOI: 10.1002/pd.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
We report a case of a twin-twin transfusion syndrome (TTTS) recipient who, after successful fetoscopic surgery, developed a large pericardial effusion and calcifications of the aorta and main pulmonary artery. The donor fetus never had cardiac strain and never developed cardiac calcifications. A heterozygous likely pathogenic variant in ABCC6 (c.2018T>C, p.Leu673Pro) was identified in the recipient twin. While TTTS recipient twins are at risk of arterial calcifications and right heart failure secondary to the disease, calcifications of the great vessels are also observed in general calcification of infancy (GACI), a Mendelian genetic disorder with associated biallelic pathogenic variations in ABCC6 or ENPP1, which can result in significant pediatric morbidity or mortality. The recipient twin in this case had some degree of cardiac strain prior to TTTS surgery; however, the progressive calcification of the aorta and pulmonary trunk occurred weeks after resolution of the TTTS. This case raises the possibility of a gene-environment interaction and emphasizes the need for genetic evaluation in the setting of TTTS and calcifications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andrea Springman
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Braxton Forde
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, USA
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Leandra Tolusso
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Medical Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Daniel T Swarr
- Department of Medical Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Division of Neonatology & Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - E Deah Wright
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Mounira Habli
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, USA
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Abstract
OBJECTIVE Food insecurity is a prominent problem and has been implicated in adverse maternal and neonatal outcomes. This study aims to describe the food insecure population in an urban academic health center perinatal cohort. STUDY DESIGN We enrolled 451 postpartum inpatients at the University of Cincinnati Medical Center who completed a questionnaire and were then categorized as food insecure based on U.S. Department of Agriculture standardized survey questions. Generalized linear models estimated the relative influence of maternal characteristics on food insecurity. RESULTS Among the study population (n = 426), 18.6% (95% confidence interval: 15.2-22.4%) were classified as food insecure. Factors with increased adjusted relative risk on food insecurity include annual household income <$40,000, obesity, and smoking. Food insecure women also reported lower levels of love, satisfaction, and joy, and higher levels of despair. CONCLUSION We recommend the use of a validated screening tool on all pregnant women with the associated psychosocial stressors and social determinants of health. KEY POINTS · Food insecurity is prevalent among pregnant women.. · Nearly one in five women (18.6%) in the study cohort were classified as food insecure.. · Food insecure pregnant women were more likely to have additional risks for adverse health outcomes..
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Affiliation(s)
- Kirby Sullivan
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meghan St John
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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11
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Munoz FM, Posavad CM, Richardson BA, Badell ML, Bunge K, Mulligan MJ, Parameswaran L, Kelly C, Olsen-Chen C, Novak RM, Brady RC, Pasetti M, DeFranco E, Gerber JS, Shriver M, Suthar MS, Moore K, Coler R, Berube B, Kim SH, Piper JM, Miller A, Cardemil C, Neuzil KM, Beigi R. COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn (DMID 21-0004). medRxiv 2022:2022.06.13.22276354. [PMID: 35734087 PMCID: PMC9216723 DOI: 10.1101/2022.06.13.22276354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
IMPORTANCE COVID-19 vaccination is recommended during pregnancy for the protection of the mother. Little is known about the immune response to booster vaccinations during pregnancy. OBJECTIVE To measure immune responses to COVID-19 primary and booster mRNA vaccination during pregnancy and transplacental antibody transfer to the newborn. DESIGN Prospective cohort study of pregnant participants enrolled from July 2021 to January 2022, with follow up through and up to 12 months after delivery. SETTING Multicenter study conducted at 9 academic sites. PARTICIPANTS Pregnant participants who received COVID-19 vaccination during pregnancy and their newborns. EXPOSURES Primary or booster COVID-19 mRNA vaccination during pregnancy. MAIN OUTCOMES AND MEASURES SARS-CoV-2 binding and neutralizing antibody (nAb) titers after primary or booster COVID-19 mRNA vaccination during pregnancy and antibody transfer to the newborn. Immune responses were compared between primary and booster vaccine recipients in maternal sera at delivery and in cord blood, after adjusting for days since last vaccination. RESULTS In this interim analysis, 167 participants received a primary 2-dose series and 73 received a booster dose of mRNA vaccine during pregnancy. Booster vaccination resulted in significantly higher binding and nAb titers, including to the Omicron BA.1 variant, in maternal serum at delivery and cord blood compared to a primary 2-dose series (range 0.55 to 0.88 log 10 higher, p<0.0001 for all comparisons). Although levels were significantly lower than to the prototypical D614G variant, nAb to Omicron were present at delivery in 9% (GMT ID50 12.7) of Pfizer and 22% (GMT ID50 14.7) of Moderna recipients, and in 73% (GMT ID50 60.2) of boosted participants (p<0.0001). Transplacental antibody transfer was efficient regardless of vaccination regimen (median transfer ratio range: 1.55-1.77 for binding IgG and 1.00-1.78 for nAb). CONCLUSIONS AND RELEVANCE COVID-19 mRNA vaccination during pregnancy elicited robust immune responses in mothers and efficient transplacental antibody transfer to the newborn. A booster dose during pregnancy significantly increased maternal and cord blood antibody levels, including against Omicron.Findings support continued use of COVID-19 vaccines during pregnancy, including booster doses. TRIAL REGISTRATION clinical trials.gov; Registration Number: NCT05031468 ; https://clinicaltrials.gov/ct2/show/NCT05031468. KEY POINTS Question: What is the immune response after COVID-19 booster vaccination during pregnancy and how does receipt of a booster dose impact transplacental antibody transfer to the newborn?Findings: Receipt of COVID-19 mRNA vaccines during pregnancy elicited robust binding and neutralizing antibody responses in the mother and in the newborn. Booster vaccination during pregnancy elicited significantly higher antibody levels in mothers at delivery and cord blood than 2-dose vaccination, including against the Omicron BA.1 variant.Meaning: COVID-19 vaccines, especially booster doses, should continue to be strongly recommended during pregnancy.
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12
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Munoz FM, Beigi RH, Posavad CM, Richardson BA, Chu HY, Bok K, Campbell J, Cardemil C, DeFranco E, Frenck RW, Makhene M, Piper JM, Sheffield J, Miller A, Neuzil KM. Multi-site observational maternal and infant COVID-19 vaccine study (MOMI-vax): a study protocol. BMC Pregnancy Childbirth 2022; 22:402. [PMID: 35550037 PMCID: PMC9096328 DOI: 10.1186/s12884-022-04500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 12/26/2022] Open
Abstract
Background Pregnant women were excluded from investigational trials of COVID-19 vaccines. Limited data are available to inform pregnant and postpartum women on their decisions to receive a COVID-19 vaccine. Methods The goal of this observational, prospective cohort study is to evaluate the immunogenicity and safety of various Emergency Use Authorization (EUA) or licensed COVID-19 vaccines administered to pregnant or lactating women and describe the transplacental antibody transfer and kinetics of antibodies in mothers and infants. The study is adaptive, allowing additional groups to be added as new vaccines or vaccine regimens are authorized. Up to 20 clinical research institutions in the United States (U.S.) will be included. Approximately 200 pregnant women and 65 postpartum women will be enrolled per EUA or licensed COVID-19 vaccine formulation in the U.S. This study will include pregnant and postpartum women of all ages with and without chronic medical conditions. Their infants will be enrolled and followed beginning at birth in the pregnant cohort and beginning at the earliest possible time point in the postpartum cohort. Blood samples will be collected for immunogenicity outcomes and pregnancy and birth outcomes assessed among women and infants. Primary analyses will be descriptive and done by vaccine type and/or platform. Discussion Given the long-standing and legitimate challenges of enrolling pregnant individuals into clinical trials early in the vaccine development pipeline, this study protocol describes our current study and provides a template to inform the collection of data for pregnant individuals receiving COVID-19 or other vaccines. Trial registration NCT05031468. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04500-w.
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Affiliation(s)
- Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Section of Infectious Diseases, Baylor College of Medicine, 1102 Bates St. Suite 1150, Houston, TX, 77030, USA.
| | - Richard H Beigi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Christine M Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, and Department of Laboratory Medicine and Pathology, University of Washington, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Helen Y Chu
- Department of Epidemiology, University of Washington School of Public Health, 750 Republican St, Seattle, WA, 98109, USA
| | - Karin Bok
- Office of Director, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 40 Convent Drive, Bethesda, MD, 20892, USA
| | - James Campbell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Baltimore, MD, 21201, USA
| | - Cristina Cardemil
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, 20892, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0526, USA
| | - Robert W Frenck
- Department of Pediatrics, University of Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 6014, Cincinnati, OH, 45229, USA
| | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, 20892, USA
| | - Jeanna M Piper
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rm 8B68, MSC 9831, Rockville, MD, 20892, USA
| | - Jeanne Sheffield
- Department of Gynecology and Obstetrics, Johns Hopkins University, 600 N Wolfe St., Nelson Building 2nd floor, Baltimore, MD, 21287, USA
| | - Ashley Miller
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Baltimore, MD, 21201, USA
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13
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Patel KS, Bakk J, Pensak M, DeFranco E. Influence of Medicaid expansion on short interpregnancy interval rates in the United States. Am J Obstet Gynecol MFM 2021; 3:100484. [PMID: 34517145 DOI: 10.1016/j.ajogmf.2021.100484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Short interpregnancy intervals have been associated with poor maternal and infant outcomes. Contraception access could affect the short interpregnancy interval rates. OBJECTIVE To assess the influence of Medicaid on short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy intervals. STUDY DESIGN Using the United States birth certificate data, we performed a population-based retrospective cohort study including multiparous women who had live births in 2012 and 2016, which is before and after Medicaid expansion had been implemented in 2014. Multivariate logistic regression estimated the influence of Medicaid expansion on short interpregnancy intervals (<12 months). The rate differences of short interpregnancy intervals in 2012 and 2016 were compared between Medicaid expansion vs non-Medicaid expansion states. RESULTS There were a total of 7,916,908 live births in 2012 and 2016 in the United States, of which 3,362,904 (42.5%) were in multiparous women with data on interpregnancy intervals (n=1,961,683 [58.3%]) in Medicaid expansion states and in non-Medicaid expansion states (n=1,401,221 [41.7%]). The rate of short interpregnancy intervals in the United States was slightly lower in 2016 (17.3%) than in 2012 (17.4%), P=.0006; rate difference 0.13% (95% confidence interval, 0.05-0.20). Short interpregnancy intervals occurred more frequently in non-Medicaid expansion states than in Medicaid expansion states in both 2012 (18.1% vs 16.6%, respectively; P<.001) and 2016 (18.1% vs 16.4%, respectively; P<.001). The rate of short interpregnancy intervals decreased by 0.11% (95% confidence interval, 0.01-0.22) in Medicaid expansion states and increased by 0.04% (95% confidence interval, 0.09-0.17) in non-Medicaid expansion states. In 2016, living in a Medicaid expansion state was associated with a modestly decreased risk of short interpregnancy intervals (adjusted relative risk, 0.97; 95% confidence interval, 0.97-0.98), even after adjustment for coexisting risks. CONCLUSION The risk of short interpregnancy intervals decreased in the Medicaid expansion states even after adjusting for risk factors. Moreover, the short interpregnancy interval rates increased in nonexpansion states but decreased in Medicaid expansion states. If non-Medicaid expansion states had experienced the same rate of decrease in short interpregnancy intervals as Medicaid expansion states, 1122 fewer women would have had a short interpregnancy interval in 2016. Considering the known association between short interpregnancy intervals and adverse maternal and infant outcomes, these findings indicate that Medicaid expansion could improve perinatal outcomes.
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Affiliation(s)
- Kriya S Patel
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juliana Bakk
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Meredith Pensak
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH.
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14
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Madzia J, McKinney D, Kelly E, DeFranco E. Influence of Gestational Weight Gain on the Risk of Preterm Birth for Underweight Women Living in Food Deserts. Am J Perinatol 2021; 38:e77-e83. [PMID: 32131115 DOI: 10.1055/s-0040-1705168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Preterm birth (PTB) and food insecurity are two of the most significant public health crises in the United States. Effects of being underweight among populations with low food security are not well understood. We assess whether the protective effect of gestational weight gain (GWG) for women with low prepregnancy body mass index (BMI) differs by accessibility to sources of healthy food. STUDY DESIGN Population-based retrospective cohort study using Ohio birth records analyzing all live births, 2006 to 2015. Analyses were stratified by maternal BMI (underweight, normal, overweight, and obese), Institute of Medicine (IOM) recommended GWG (under vs. met), and whether the U.S. Department of Agriculture (USDA) classified the residential census tract for each birth as a food desert. Food access data were retrieved from the USDA's 2018 Food Access Research Atlas. Covariates were selected using least absolute shrinkage and selection operator regression. Logistic regression models estimated the risk ratio (RR) of PTB for each group based on under or exceeded recommended GWG (reference = met), adjusting for coexisting risk factors. RESULTS Analysis was performed on 1,124,299 births. PTB risk was highest for underweight women below GWG recommendations (no food desert: 21.3%, RR = 2.15, 95% confidence interval [CI]: 1.81-2.57; food desert: 21.0%, RR = 1.46, 95% CI: 0.96-2.21). Underweight women living in food deserts who exceeded GWG recommendations had lower PTB risk than those who met GWG recommendations (13.5 vs. 14.3%, RR = 0.85, 95% CI: 0.51-1.41). Factors other than GWG significantly associated with PTB included in the adjusted analysis include maternal age and race, education, marital status, interpregnancy interval, and presence of prepregnancy diabetes or hypertension. CONCLUSION Underweight women who do not meet GWG recommendations are at high risk for PTB. Increasing pregnancy weight gain to a level that exceeds IOM recommendations was not associated with a reduction in PTB risk for underweight women who reside in food deserts compared with women who met GWG recommendations. KEY POINTS · Women with low prepregnancy BMI are at high risk of PTB.. · Food insecurity increases the risk of PTB for underweight women.. · Excessive GWG for underweight women in food deserts does not reduce PTB risk..
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Affiliation(s)
- Juliana Madzia
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David McKinney
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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Payne DC, McNeal M, Staat MA, Piasecki AM, Cline A, DeFranco E, Goveia MG, Parashar UD, Burke RM, Morrow AL. Persistence of Maternal Anti-Rotavirus Immunoglobulin G in the Post-Rotavirus Vaccine Era. J Infect Dis 2021; 224:133-136. [PMID: 33211872 DOI: 10.1093/infdis/jiaa715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
To assess whether titers of anti-rotavirus immunoglobulin G persist during the post-rotavirus vaccine era, the Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) Cohort analyzed serum samples collected from Cincinnati-area mothers and young infants in 2017-2018. Rotavirus-specific antibodies continue to be transferred from US mothers to their offspring in the post-rotavirus vaccine era, despite dramatic decreases in childhood rotavirus gastroenteritis.
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Affiliation(s)
- Daniel C Payne
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mary Allen Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra M Piasecki
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison Cline
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Emily DeFranco
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel M Burke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ardythe L Morrow
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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16
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Morrow AL, McClain J, Conrey SC, Niu L, Kinzer A, Cline AR, Piasecki AM, DeFranco E, Ward L, Ware J, Payne DC, Staat MA, Nommsen-Rivers LA. Breastfeeding Disparities and Their Mediators in an Urban Birth Cohort of Black and White Mothers. Breastfeed Med 2021; 16:452-462. [PMID: 33733869 PMCID: PMC8418439 DOI: 10.1089/bfm.2020.0327] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Black mothers in the United States have shorter breastfeeding (BF) durations and less exclusive breastfeeding (EBF) than others. The factors underlying these disparities require investigation. Methods: Using longitudinal data from a CDC-sponsored birth cohort in Cincinnati, Ohio, we analyzed the factors mediating racial disparity in BF outcomes. Study mothers were enrolled in prenatal clinics associated with two large birth hospitals. Analysis was restricted to racial groups with sufficient numbers in the cohort, non-Hispanic Black (n = 92) and White (n = 113) mothers, followed to at least 6 months postpartum. Results: Black mothers were 25 times more likely to reside in socioeconomically deprived neighborhoods and 20 times more likely to have an annual household income <$50,000/year than White mothers (p < 0.001). The gap in EBF for 6 weeks was 45 percentage points by racial group (13%-Black mothers versus 58%-White mothers, p < 0.001); in any BF at 6 months was 37 percentage points (28%-Black mothers versus 65%-White mothers, p < 0.001); and in mothers meeting their own intention to BF at least 6 months was 51 percentage points (29%-Black mothers versus 80%-White mothers, p < 0.001). Racial disparity in EBF at 6 weeks was mediated in logistic regression models by inequities in socioeconomic position, maternal hypertension, and BF intention. Racial disparities in BF at 6 months or meeting 6-month BF intention were mediated by inequities in socioeconomic position, maternal obesity, and EBF at 6 weeks. Not all BF disparities could be explained by models used in these analyses. Conclusions: Efforts to lessen BF disparities should address the underlying structural inequities that disproportionately affect Black mothers and children, should incorporate maternal health, and focus on breastfeeding exclusivity and duration. Few Black mothers achieved EBF at 6 weeks, which contributed to disparity in BF duration. Greater attention to Black mother-infant pairs is a public health priority.
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Affiliation(s)
- Ardythe L. Morrow
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Janelle McClain
- Breastfeeding Outreach for Our Beautiful Sisters, Cincinnati, Ohio, USA
| | - Shannon C. Conrey
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Liang Niu
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexandra Kinzer
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison R. Cline
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexandra M. Piasecki
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily DeFranco
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Ward
- Division of Neonatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julie Ware
- Division of Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel C. Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laurie A. Nommsen-Rivers
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
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Czarny H, Forde B, hall E, DeFranco E, Rossi RM. 126 Association of mode of delivery on infant survival at 22 and 23 weeks of gestation. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Fresch R, Habli M, Forde B, Tabbah S, McKinney D, Masters HR, DeFranco E. 331 Correlation between MRI and transvaginal-ultrasound cervical length measurements in pregnancies complicated by twin-twin transfusion syndrome. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Forde B, Fresch R, Masters HR, DeFranco E, McKinney D, Tabbah S, Habli M. 546 Natural history of previable and periviable rupture of membranes after treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fresch R, Forde B, Habli M, Tabbah S, McKinney D, Masters HR, DeFranco E. 333 Prediction of preterm birth by transvaginal-ultrasound and MRI cervical length measurement in pregnancies treated SFLP. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Mort CM, Forde B, Fresch R, Masters HR, DeFranco E, Habli M, McKinney D, Lim FY, Peiro J, Tabbah S. 338 The impact of total laser energy during selective-fetoscopic-laser-photocoagulation on outcomes of pregnancies affected by twin-twin-transfusion-syndrome. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fresch R, Forde B, Habli M, Tabbah S, McKinney D, Masters HR, DeFranco E. 332 Influence of body mass index on outcomes in pregnancies with twin-twin-transfusion treated with laser surgery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Rossi RM, DeFranco E, hall E. 209 Association of antenatal corticosteroid exposure and infant survival at 22 and 23 weeks. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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DiNapoli M, DeFranco E. 861 Racial and ethnic differences in contribution of premature rupture of membranes to preterm birth. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Beecham M, Hajdu SA, Rossi RM, DeFranco E. 652 Contemporary changes in utilization of maternal and neonatal interventions for periviable births in the U.S. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fresch R, Forde B, Habli M, McKinney D, Tabbah S, Masters HR, DeFranco E. 334 Influence of cervical length change after laser surgery for twin-twin transfusion syndrome on pregnancy outcomes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Forde B, Fresch R, Masters HR, DeFranco E, Tabbah S, McKinney D, Lim FY, Peiro J, Habli M. 543 Does the time of laser usage during surgery for twin-twin transfusion syndrome impact pregnancy outcomes? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Liu J, Markham K, DeFranco E. 718 Comparison of growth curves for predicting small for gestational age infants among contemporary US populations. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Hamilton IS, Liu J, DeFranco E. 846 Risk of stillbirth with history of prior cesarean deliveries. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Carr R, McKinney D, Cherry A, DeFranco E. 319 Maternal age-specific drivers of severe maternal morbidity. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Masters HR, Czarny H, Fresch R, Forde B, Tabbah S, DeFranco E, Lim FY, Peiro J, McKinney D. 985 Influence of gestational age of treatment of twin-twin transfusion syndrome on latency-to-delivery and outcomes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Forde B, Czarny H, Dufendach K, hall E, DeFranco E, Warshak C, Rossi RM. 629 A new predictive model for periviable infant survival. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Sinclair S, Masters HR, DeFranco E, Rountree S, Warshak CR. Universal transvaginal cervical length screening during pregnancy increases the diagnostic incidence of low-lying placenta and placenta previa. Am J Obstet Gynecol MFM 2020; 3:100255. [PMID: 33451594 DOI: 10.1016/j.ajogmf.2020.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Universal transvaginal cervical length screening has been increasingly implemented with both positive and negative consequences. OBJECTIVE In this study, we described the diagnostic incidence of low-lying placenta and placenta previa with the implementation of universal transvaginal cervical length screening. STUDY DESIGN This is a retrospective cohort study of women undergoing midtrimester universal transvaginal cervical length screening. The primary outcome was the rate of transvaginal diagnosis of low-lying placenta or placenta previa using midtrimester universal transvaginal cervical length screening. RESULTS This study included 1982 midtrimester ultrasounds, of which 211 indicated a low-lying placenta or placenta previa on either transabdominal or transvaginal ultrasound. With transvaginal ultrasound, a low-lying placenta or placenta previa was diagnosed in 211 women (10.6% of the study population). Of the 211 patients with a low-lying placenta or placenta previa, 90 (42.6%) had a false-negative result, diagnosed using only transvaginal ultrasound; 112 (53.1%) had a true-positive result; and 9 (4.3%) had a false-positive result. The relative risk of having an abnormal finding on ultrasound with the addition of universal transvaginal cervical length screening was 9.2 (95% confidence interval, 4.6-18.1). Of the low-lying placenta or placenta previa diagnosed using midtrimester universal transvaginal cervical length screening, 98.9% resolved (95% confidence interval, 93.7-99.97). CONCLUSION Implementation of universal transvaginal cervical length screening increases the diagnostic incidence of low-lying placenta or placenta previa without an increase in the diagnoses that persist to term, which comes at the cost of increased follow-up ultrasounds and potentially increased anxiety for the patient.
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Affiliation(s)
- Samantha Sinclair
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Heather R Masters
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sara Rountree
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Carri R Warshak
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
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Masters HR, Warshak C, Sinclair S, Rountree S, DeFranco E. Time required to complete transvaginal cervical length in women receiving universal cervical length screening for preterm birth prevention. J Matern Fetal Neonatal Med 2020; 35:3114-3118. [PMID: 32862742 DOI: 10.1080/14767058.2020.1811666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preterm birth contributes to over one-third of infant deaths, and although there are several risk factors for preterm birth few tests predict this obstetric complication. Midtrimester transvaginal cervical length (TVCL) screening is currently the best clinical predictor of spontaneous preterm birth and has been suggested to be applied universally. Although several studies have examined the cost-efficacy of universal screening, the time consumption and resultant time management has not been examined. OBJECTIVE We aim to quantitate the time requirement for transvaginal cervical length (TVCL) screening with the implementation of universal TVCL screening. Study design: This is a retrospective cohort study of women undergoing cervical length screening after implementation of universal Transvaginal Cervical Length (TVCL) screening at a university setting over a 1-year period. The primary outcome was time in minutes for TVCL screening from completion of transabdominal to completion of transvaginal ultrasound. RESULTS This study included 2803 ultrasounds, 1673 of which involved completion of a TVCL after completion of abdominal imaging between 16 0/7 and 23 6/7 weeks of gestation. The mean duration of cervical length screening was 9.8 min (standard deviation [SD], 4.0 min). The time range was less than 1 min to 48 min. For women obtaining cervical lengths, 4.2% required less than 5 additional minutes to perform cervical length screening, 52.1% (872), required less than 10 additional minutes. The majority, 91.8%, of ultrasounds required less than 15 min to complete. Ultrasounds performed in private practice sites required less time compared to those at teaching sites (8.2 ± 3.1 min versus 10.2 ± 4.1 min, p < .001). No significant time improvement occurred after 6 months of universal TVCL screening, with the first 6 months average of 10.1 min versus 9.6 min in the later half, p = .61. CONCLUSION Implementation of a universal TVCL program adds an average of 10 min to each ultrasound exam. This additional time does diminish with increasing experience with TVCL, but not to a significant degree.
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Affiliation(s)
- Heather R Masters
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carri Warshak
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samantha Sinclair
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Rountree
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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35
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Polen-De C, Kamath-Rayne BD, Goyal N, DeFranco E. Regional and practitioner variations in reporting infant mortality. J Matern Fetal Neonatal Med 2020; 35:1278-1285. [PMID: 32228090 DOI: 10.1080/14767058.2020.1749589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Assess regional differences in categorization of preterm delivery outcomes and impact on variation in reported infant mortality rates.Study design: A 27-item questionnaire was distributed to 1072 practitioners associated with U.S. birth hospitals. Five clinical scenarios were created to identify how participants classify delivery outcomes. Statistical analysis included Chi-square analysis and multinomial logistic regression.Results: 234 questionnaires were completed (response rate 22%). While >90% respondents classified a 14-week pregnancy loss with no sign of life as a miscarriage, only 22% would provide a fetal death certificate. Likewise, 37% would provide a certificate of live birth for a loss at 16 weeks with signs of life. There was notable regional variation in classifying these as live births (Northeast: 41%, Midwest: 44%, South: 13%, and West: 18%, p = .003).Conclusion: Regional practice variation in recording both live births and stillbirths was noted. Greater standardization in reporting practices may be warranted to improve the accuracy of reported birth outcomes in the U.S.
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Affiliation(s)
| | - Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Division of Neonatology, Cincinnati, OH, USA.,American Academy of Pediatrics, Itasca, IL, USA
| | - Neera Goyal
- Department of Pediatrics, Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, USA.,Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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36
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Anderson S, DeFranco E, Rossi R, Divanovic A, Cnota J. SEVERE MATERNAL MORBIDITY IN PREGNANCIES COMPLICATED BY FETAL CYANOTIC CONGENITAL HEART DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Forde B, DeFranco E. 376: Impact of prior cesarean delivery on early term delivery and neonatal morbidity. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Kulkarni N, Kanapathipillai M, DeFranco E. 952: Risk of fetal growth restriction in US live births with isolated cleft lip and palate. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Gordon A, Madzia J, DeFranco E. 1207: The impact of food insecurity on fetal growth restriction for women in Ohio food deserts. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Irihamye A, DeFranco E. 653: Influence of maternal characteristics on short interpregnancy interval in the US. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Hajdu SA, Rossi RM, DeFranco E. 213: Maternal characteristics associated with withholding interventions for births at 22-23 weeks of gestation. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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42
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Hamilton IS, DeFranco E. 479: Gender differences in risk of major birth defects in relation to maternal body mass index. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Lee MZ, DeFranco E. 594: Serious maternal complications associated with tobacco smoking in pregnancy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Gregory EJ, DeFranco E. 405: Racial disparity in rate of rise of no prenatal care in the US. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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French A, Le Q, DeFranco E, Habli M, Lim FY, McKinney D, Tabbah S. Reproductive Outcomes following Laser Surgery for Twin-Twin Transfusion Syndrome. Fetal Diagn Ther 2019; 47:464-470. [PMID: 31722342 DOI: 10.1159/000503993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited studies describing future reproductive outcomes in women who have had selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS). OBJECTIVE Our study aims to compare reproductive outcomes following monochorionic multiple gestational pregnancies complicated by TTTS requiring SFLP to those not requiring SFLP. METHODS This is a retrospective cohort study that analyzed records of patients who were evaluated at the Cincinnati Fetal Center (2007-2014) for monochorionic multiple gestations. A questionnaire regarding reproductive, obstetric, gynecologic, and psychological outcomes following the index pregnancy was administered to consented participants by electronic distribution. The data was compared between pregnancies with prior SFLP versus no prior SFLP. RESULTS There was a higher response rate in the SFLP group (219/474, 46.2%) versus the referent group (62/187, 33.2%). The median interval between the index pregnancy and survey completion was 74 months and 46 months in the SFLP and referent groups, respectively. Approximately 38 and 37% of the women in the SFLP and referent groups attempted conception after the index pregnancy with a >90% pregnancy success rate in both groups. Use of assisted reproductive technology was highly prevalent in both the index and subsequent pregnancies, with no significant difference between the groups. Over 60% of the women in each group did not attempt future pregnancy. Of those, approximately 1 in 3 cited the outcome of the index pregnancy as the primary reason for not pursuing future conception. There were no significant differences in selected maternal-fetal complications and new-onset gynecologic problems. More than 1 in 4 women in both groups were diagnosed with a mental health disorder following the index pregnancy. CONCLUSION SFLP does not appear to be associated with adverse reproductive, obstetric, or gynecologic outcomes. The data may help facilitate evidence-based counseling for this patient population.
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Affiliation(s)
- Ashley French
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Quoc Le
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mounira Habli
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA.,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Foong-Yen Lim
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David McKinney
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sammy Tabbah
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, .,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
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Lee M, Hall ES, DeFranco E. Contribution of previable births to infant mortality rate racial disparity in the United States. J Perinatol 2019; 39:1190-1195. [PMID: 31089258 DOI: 10.1038/s41372-019-0394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify racial differences in contribution of previable live births (<20 weeks gestational age (GA)) to United States (US) Infant Mortality Rates (IMR). METHODS Population-based retrospective cohort of US live births (2007-14) using CDC WONDER database stratified by maternal race/ethnicity. We compared the contribution of previable births to IMR and calculated modified IMRs (≥20 weeks GA) excluding previable live births in each group. Contingency tables and chi-square calculations were performed to detect differences between groups. RESULTS Previable deaths represented 4.1%, 7.7%, and 5.0% of total deaths for nonHispanic white, nonHispanic black, and Hispanic, respectively. Previable contribution to total IMR are 0.21, 0.89, and 0.26 per 1000 live births (P < 0.0001). Modified IMRs are 4.98, 10.85, and 4.69 deaths per 1000 live births. CONCLUSION IMR standardization with a minimum GA may obscure the disproportionate contribution of previable births to IMRs among the black population, which has the largest proportion of previable births.
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Affiliation(s)
- MacKenzie Lee
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Gertz B, DeFranco E. Predictors of breastfeeding non-initiation in the NICU. Matern Child Nutr 2019; 15:e12797. [PMID: 30767426 PMCID: PMC7198952 DOI: 10.1111/mcn.12797] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 01/29/2023]
Abstract
This study compared predictors of breastfeeding non-initiation between infants who were and were not admitted to the NICU so that interventions can target high-risk mothers whose infants desperately need breastmilk. This was a population-based retrospective cohort study of singleton Ohio live births using birth certificates, 2006-2015. In babies who were and were not admitted to the NICU, a multivariable logistic regression model assessed the association between breastfeeding non-initiation and predictors relating to the mother, neonate, and labour and delivery events while adjusting for covariables. Of 1,463,506 births, 76,855 infants were admitted to the NICU (5.8% of study population), and breastfeeding was not initiated in 39.4% of them, compared with 31.5% of infants in the newborn nursery, p < 0.001. Apart from abnormal newborn conditions, smoking during pregnancy was the most significant risk factor for not breastfeeding in the NICU (RR 1.91 [95% CI 1.82-2.02]) and newborn nursery (RR 2.10 [95% CI 2.08-2.13]), followed by socioeconomic factors and multiparity. Limited prenatal visits (≤5) were a significantly higher risk factor in the NICU (RR 1.41 [95% CI 1.34-1.49]) than in the newborn nursery (RR 1.24 [95% CI 1.22-1.26]). Intentional home birth and use of infertility treatment were associated with breastfeeding initiation. The rate of breastfeeding initiation is lower in infants admitted to the NICU than those who are not, especially among mothers with limited prenatal care. Interventions should target mothers who smoke because they are least likely to breastfeed, and their babies, who are prone to serious health conditions, could especially benefit from breastmilk.
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Affiliation(s)
- Brooke Gertz
- OB/GYN DepartmentUniversity of CincinnatiCincinnati OHUSA
| | - Emily DeFranco
- OB/GYN DepartmentUniversity of CincinnatiCincinnati OHUSA
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Percy Z, DeFranco E, Xu F, Hall ES, Haynes EN, Jones D, Muglia LJ, Chen A. Trimester specific PM 2.5 exposure and fetal growth in Ohio, 2007-2010. Environ Res 2019; 171:111-118. [PMID: 30660917 PMCID: PMC6382528 DOI: 10.1016/j.envres.2019.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Exposure to particulate matter, particularly with aerodynamic diameter < 2.5 µm (PM2.5), may increase inflammation and oxidative stress in pregnant women and affect fetal growth. We examined trimester specific PM2.5 exposure levels and small for gestational age (SGA) using the statewide birth registry of Ohio from 2007 to 2010. METHODS Exposure to PM2.5 in each trimester and for each gestational week was determined using data from 57 Environmental Protection Agency network monitoring stations across the state of Ohio. We restricted the data to 224,921 singleton live births, with a gestational age of 20-42 weeks, no genetic disorders or congenital abnormalities, and who had home addresses within a 10 km radius of any PM2.5 monitoring station. We estimated odds ratios of SGA using Generalized Linear Models (GLMs) and Distributed Lag Models (DLMs), and adjustment for maternal age, race, education, parity, body mass index, insurance type, tobacco use, prenatal care initiation, birth year, season of birth, and sex of the baby. RESULTS Mean PM2.5 levels during the entire pregnancy were 13.03 µg/m3 with a standard deviation of 1.57 µg/m3. Covariates adjusted odds ratios and 95% confidence intervals of a 10 µg/m3 increase in PM2.5 levels with a 10 km buffer radius for SGA and trimesters modeled separately were 0.94 (0.88, 1.00) for the first trimester, 0.93 (0.86, 1.00) for the second trimester, 1.07 (1.00, 1.15) for the third trimester, and 0.92 (0.81, 1.06) for the entire pregnancy. When a 5 km buffer radius was used, adjusted odds ratios and 95% confidence intervals for SGA were 0.97 (0.89, 1.05) for the first trimester, 0.96 (0.88, 1.05) for the second trimester, 1.09 (1.02, 1.17) for the third trimester, and 0.99 (0.85, 1.14) for the overall pregnancy, indicating sensitivity to buffer choice. DLMs showed gestational weeks 30-35 to be a particular window of vulnerability. CONCLUSION Increasing exposure to PM2.5 during the third trimester of pregnancy was associated with a small increase in risk of SGA in this population-based study. Selection of a buffer radius significantly impacted our results in the first trimester, but not in the third trimester.
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Affiliation(s)
- Zana Percy
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Emily DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Fan Xu
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Erin N Haynes
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - David Jones
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Louis J Muglia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Rossi RM, Brackett E, Hall E, DeFranco E. 725: Identifiable risk factors associated with early stillbirth. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rossi RM, Brackett E, Hall E, DeFranco E. 366: Risk factors associated with early stillbirth in women with chronic hypertension. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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