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Kouba I, Del Pozzo J, Lesser ML, Shahani D, Gulersen M, Bracero LA, Blitz MJ. Socioeconomic and clinical factors associated with excessive gestational weight gain. Arch Gynecol Obstet 2024; 309:1295-1303. [PMID: 36930325 PMCID: PMC10021048 DOI: 10.1007/s00404-023-07000-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/12/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Excessive gestational weight gain (EGWG) is associated with adverse maternal and offspring outcomes but efforts to identify women at high risk for EGWG have been limited. The objective of this study is to identify socioeconomic and clinical factors associated with EGWG. METHODS This retrospective cohort included pregnant patients who delivered live, term, singleton newborns between January 2018 and February 2020 at seven hospitals within a large health system in New York. Patients were stratified by pre-pregnancy body mass index and then classified based on whether they exceeded the Institute of Medicine guidelines for gestational weight gain (GWG) and whether they gained more than 50 pounds in pregnancy. RESULTS A total of 44,872 subjects were included for analysis: 48% had EGWG and 17% had GWG exceeding 50 pounds. Patients with EGWG were more likely to be Black race, English speakers, overweight or obese pre-pregnancy, and have a mood disorder diagnosis. Patients who were underweight, multiparous, and those with gestational diabetes were less likely to have EGWG. CONCLUSION Sociodemographic and clinical findings associated with GWG > 50 pounds were similar but only overweight and not obese patients were at increased risk. Patients at risk for EGWG may benefit from early nutrition counseling and education on lifestyle changes.
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Affiliation(s)
- Insaf Kouba
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Maternal-Fetal Medicine, South Shore University Hospital, 376 E Main St, Suite 202, Bay Shore, NY, 11706, USA.
| | - Jaclyn Del Pozzo
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin L Lesser
- Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, USA
| | - Disha Shahani
- Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, USA
| | - Moti Gulersen
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Luis A Bracero
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew J Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Del Pozzo J, Kouba I, Alvarez A, O'Sullivan-Bakshi T, Krishnamoorthy K, Blitz MJ. Environmental Justice Index and adverse pregnancy outcomes. AJOG Glob Rep 2024; 4:100330. [PMID: 38586614 PMCID: PMC10994970 DOI: 10.1016/j.xagr.2024.100330] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The Environmental Justice Index is a tool released by the Centers for Disease Control and Prevention that quantifies and ranks the environmental burden and social vulnerability of each census tract. Racial and ethnic disparities in adverse pregnancy outcomes are well established. The relative contributions of individual (person-level) and environmental (neighborhood-level) risk factors to disease prevalence remain poorly understood. OBJECTIVE This study aimed to determine whether the Environmental Justice Index is associated with adverse pregnancy outcomes after adjustment for individual clinical and sociodemographic risk factors. STUDY DESIGN This was a retrospective cross-sectional study of all patients who delivered a singleton newborn at ≥23 weeks of gestation between January 2019 and February 2022 at 7 hospitals within a large academic health system in New York. Patients were excluded if their home address was not available, if the address could not be geocoded to a census tract, or if the census tract did not have corresponding Environmental Justice Index data. Patients were also excluded if they had preexisting diabetes or hypertension. For patients who had multiple pregnancies during the study period, only the first pregnancy was included for analysis. Clinical and demographic data were obtained from the electronic medical record. Environmental Justice Index score, the primary independent variable, ranges from 0 to 1. Higher Environmental Justice Index scores indicate communities with increased cumulative environmental burden and increased social vulnerability. The primary outcome was adverse pregnancy outcome, defined as the presence of ≥1 of any of the following conditions: hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth restriction, low birthweight, small for gestational age newborn, placental abruption, and stillbirth. Multivariable logistic regression was performed to investigate the relationship between Environmental Justice Index score and adverse pregnancy outcome, adjusting for potential confounding variables, including body mass index group, race and ethnicity group, advanced maternal age, nulliparity, public health insurance, and English as the preferred language. RESULTS A total of 65,273 pregnancies were included for analysis. Overall, adverse pregnancy outcomes occurred in 37.6% of pregnancies (n=24,545); hypertensive disorders of pregnancy (13.4%) and gestational diabetes (12.2%) were the most common adverse pregnancy outcome conditions. On unadjusted analysis, the strongest associations between Environmental Justice Index score and individual adverse pregnancy outcome conditions were observed for stillbirth (odds ratio, 1.079; 95% confidence interval, 1.025-1.135) and hypertensive disorders of pregnancy (odds ratio, 1.052; 95% confidence interval, 1.042-1.061). On multivariable logistic regression, every 0.1 increase in Environmental Justice Index score was associated with 1.4% higher odds of adverse pregnancy outcome (adjusted odds ratio, 1.014; 95% confidence interval, 1.007-1.021). The strongest associations with adverse pregnancy outcomes were observed with well-established clinical and social risk factors, including class 3 obesity (adjusted odds ratio, 1.710; 95% confidence interval, 1.580-1.849; reference: body mass index <25 kg/m2) and certain race and ethnicity groups (reference: non-Hispanic White), particularly Asian and Pacific Islander (adjusted odds ratio, 1.817; 95% confidence interval, 1.729-1.910), and non-Hispanic Black (adjusted odds ratio, 1.668; 95% confidence interval, 1.581-1.760) people. CONCLUSION Environmental Justice Index score is positively associated with adverse pregnancy outcomes, and most strongly associated with stillbirth and hypertensive disorders of pregnancy. Geospatial analysis with Environmental Justice Index may help to improve our understanding of health inequities by identifying neighborhood characteristics that increase the risk of pregnancy complications.
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Affiliation(s)
- Jaclyn Del Pozzo
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
| | - Insaf Kouba
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
| | - Alejandro Alvarez
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Biostatistics, Office of Academic Affairs, Northwell Health (Mr Alvarez), New Hyde Park, NY
| | - Tadhg O'Sullivan-Bakshi
- Feinstein Institutes for Medical Research, Northwell Health (Mr. O'Sullivan-Bakshi and Ms. Krishnamoorthy), Manhasset, NY
| | - Kaveri Krishnamoorthy
- Feinstein Institutes for Medical Research, Northwell Health (Mr. O'Sullivan-Bakshi and Ms. Krishnamoorthy), Manhasset, NY
| | - Matthew J. Blitz
- Northwell Health, New Hyde Park (Drs Del Pozzo and Kouba, Mr Alvarez, and Dr Blitz), NY
- Department of Obstetrics and Gynecology, South Shore University Hospital (Drs Del Pozzo, Kouba, and Blitz), Bay Shore, NY
- Zucker School of Medicine (Drs Del Pozzo, Kouba, and Blitz), Hempstead, NY
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health (Dr Blitz), Manhasset, NY
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Kouba I, Pozzo JD, Alvarez A, Keller NA, Gulersen M, Bracero LA, Blitz MJ. Severity of excessive gestational weight gain and risk of severe maternal morbidity. Am J Obstet Gynecol MFM 2024; 6:101247. [PMID: 38061551 DOI: 10.1016/j.ajogmf.2023.101247] [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: 09/18/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Both obesity and excessive gestational weight gain are associated with severe maternal morbidity, but there is limited literature evaluating whether the risk of severe maternal morbidity is further increased by the degree or severity of excessive gestational weight gain. OBJECTIVE This study aimed to determine whether pregnant patients with excessive gestational weight gain who gained more than 50 lb were at increased risk of severe maternal morbidity compared with those who only moderately exceeded recommended gestational weight gain guidelines. A secondary objective was to determine whether patients who gained 10 lb more than the recommended upper limit of total weight gain for a given prepregnancy body mass index group were at increased risk of severe maternal morbidity compared with those who exceeded that upper limit by a lesser amount. STUDY DESIGN This was a retrospective cohort study of all patients with live, term, singleton deliveries with excessive gestational weight gain from 7 hospitals within a large health system in New York between January 2019 and February 2020. Excessive gestational weight gain was defined as exceeding the recommended upper limit of total weight gain for a given prepregnancy body mass index category using the National Academy of Medicine gestational weight gain guidelines: >40 lb for a body mass index of <18.5 kg/m2, >35 lb for a body mass index of 18.5 to 24.9 kg/m2, >25 lb for a body mass index of 25.0 to 29.9 kg/m2, and >20 lb for a body mass index of ³30.0 kg/m2. Patient height and weight data were self-reported at the time of delivery hospitalization and retrieved from the electronic medical record system. Patients were classified into 2 excessive gestational weight gain groups: moderate (≤50 lb) or severe (>50 lb). Patients with missing body mass index or gestational weight gain were excluded. The primary exposure was severe excessive gestational weight gain. The primary outcome was severe maternal morbidity, defined using the Centers for Disease Control and Prevention criteria. Logistic regression was used to model the likelihood of severe maternal morbidity, adjusting for race and ethnicity, nulliparity, advanced maternal age, gestational diabetes mellitus, and maternal mood disorder. For the secondary analysis, severe maternal morbidity rates were compared between patients who exceeded their body mass index-specific upper limit of total weight gain by ≥10 lb and those who exceeded it by <10 lb. RESULTS A total of 11,506 patients were included for analysis, and 1965 patients (17.1%) had severe excessive gestational weight gain. The overall rate of severe maternal morbidity was 3.3%. Severe maternal morbidity occurred in 85 of 1965 patients (4.3%) with severe excessive gestational weight gain and 292 of 9541 patients (3.1%) with moderate excessive gestational weight gain. On regression analysis, after adjustment for covariate factors, patients with a severe excessive gestational weight gain were 39% more likely to experience severe maternal morbidity than those with moderate excessive gestational weight gain (adjusted odds ratio, 1.39; 95% confidence interval, 1.08-1.79). Patients with excessive gestational weight gain of ≥10 lb above the recommended body mass index-specific upper limit for gestational weight gain were 32% more likely (adjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.62) to experience severe maternal morbidity than patients who exceeded that upper limit by <10 lb. CONCLUSION Patients with live, term, singleton pregnancies who gain more than 50 lb are at increased risk of severe maternal morbidity compared with those who only moderately exceed gestational weight gain guidelines. Similarly, patients who gain ≥10 lb above the recommended body mass index-specific upper limit for gestational weight gain are at increased risk. Further study is warranted to determine the most effective interventions to manage gestational weight gain and mitigate maternal risk.
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Affiliation(s)
- Insaf Kouba
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz); Division of Maternal-Fetal Medicine, South Shore University Hospital, Bay Shore, NY (Dr Kouba).
| | - Jaclyn Del Pozzo
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz)
| | - Alejandro Alvarez
- Office of Academic Affairs, Northwell Health, New Hyde Park, NY (Mr Alvarez)
| | - Nathan A Keller
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz)
| | - Moti Gulersen
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA (Dr Gulersen)
| | - Luis A Bracero
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz); Katz Institute for Women's Health, Northwell Health, Bay Shore, NY (Drs Bracero and Blitz)
| | - Matthew J Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Drs Kouba, Del Pozzo, Keller, Gulersen, Bracero, and Blitz); Katz Institute for Women's Health, Northwell Health, Bay Shore, NY (Drs Bracero and Blitz); Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY (Dr Blitz)
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Del Pozzo J, Kouba I, Goldman T, Muscat J. Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy. J Hematol 2023; 12:114-117. [PMID: 37435416 PMCID: PMC10332860 DOI: 10.14740/jh1131] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Aplastic anemia (AA) poses a significant threat to maternal and fetal health throughout the perinatal period. Diagnosis is based on complete blood count (CBC) and bone marrow biopsy with treatment varying based on severity of disease. This report highlights a case of AA incidentally identified by the third trimester CBC drawn in the outpatient office. Patient was referred for inpatient management to mobilize a multidisciplinary team of healthcare professionals including obstetricians, hematologists, and anesthesiologists to optimize maternal and fetal outcome. The patient received blood and platelet transfusions prior to delivering a healthy liveborn infant by cesarean section. This case highlights the importance for routine third trimester CBC screening to identify potential complications and decrease maternal and fetal morbidity and mortality.
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Affiliation(s)
- Jaclyn Del Pozzo
- Department of Obstetrics and Gynecology, Northwell South Shore University Hospital, Bayshore, NY 11706, USA
| | - Insaf Kouba
- Department of Obstetrics and Gynecology, Northwell South Shore University Hospital, Bayshore, NY 11706, USA
- Division of Maternal Fetal Medicine, Northwell South Shore University Hospital, Bayshore, NY 11706, USA
| | - Theodore Goldman
- Department of Obstetrics and Gynecology, Northwell Huntington Hospital, Huntington, NY 11743, USA
| | - Jolene Muscat
- Department of Obstetrics and Gynecology, Northwell South Shore University Hospital, Bayshore, NY 11706, USA
- Division of Maternal Fetal Medicine, Northwell South Shore University Hospital, Bayshore, NY 11706, USA
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Nicol A, Singh M, Del Pozzo J, Tha Ra Wun T, Mehta P, Kobayashi T, Kobayashi S, Liang Q. Knockdowns of AMPK α Subunit Isoforms Result in Differential H9c2 Cell Responses to Doxorubicin Treatment. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Akito Nicol
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Mandeep Singh
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Jaclyn Del Pozzo
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Tint Tha Ra Wun
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | | | - Tamayo Kobayashi
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Satoru Kobayashi
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
| | - Qiangrong Liang
- Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNY
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Del Pozzo J, Mehta P, Cai F, Li C, Kobayashi S, Liang Q. Unexpected Role of Adenosine-Monophosphate Activated Protein Kinase in Doxorubicin Cardiotoxicity and Metformin-Mediated Cardioprotection. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.015] [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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