Racial discrepancies in the association between paternal vs. maternal educational level and risk of low birthweight in Washington State

BACKGROUND: The role of paternal factors in determining the risk of adverse pregnancy outcomes has received less attention than maternal factors. Similarly, the interaction between the effects of race and socioeconomic status (SES) on pregnancy outcomes is not well known. Our objective was to assess the relative importance of paternal vs. maternal education in relation to risk of low birth weight (LBW) across different racial groups. METHODS: We conducted a retrospective population-based cohort study using Washington state birth certificate data from 1992 to 1996 (n = 264,789). We assessed the associations between maternal or paternal education and LBW, adjusting for demographic variables, health services factors, and maternal behavioral and obstetrical factors. RESULTS: Paternal educational level was independently associated with LBW after adjustment for race, maternal education, demographic characteristics, health services factors; and other maternal factors. We found an interaction between the race and maternal education on risk of LBW. In whites, maternal education was independently associated with LBW. However, in the remainder of the sample, maternal education had a minimal effect on LBW. CONCLUSIONS: The degree of association between maternal education and LBW delivery was different in whites than in members of other racial groups. Paternal education was associated with LBW in both whites and non-whites. Further studies are needed to understand why maternal education may impact pregnancy outcomes differently depending on race and why paternal education may play a more important role than maternal education in some racial categories

Sex Transm Dis

BackgroundNeisseria gonorrhoeae (gonorrhea) remains an important cause of reproductive and obstetric complications. There has been limited population-based research to evaluate the association between maternal gonorrhea and adverse birth outcomes.MethodsA population-based retrospective cohort study was conducted of women with singleton pregnancies in Washington State from 2003\u20132014 using linked birth certificate and birth hospitalization discharge data. The exposed cohort consisted of women with gonorrhea diagnosed during pregnancy. The unexposed group, defined as pregnant women without gonorrhea, was selected by frequency-matching by birth year in a 4:1 ratio. Logistic regression was used to determine crude and adjusted odds ratios (OR) for the association of maternal gonorrhea and adverse birth outcomes.ResultsWomen with gonorrhea during pregnancy (N=819) were more likely to be younger, Black, single, less educated, multiparous, and smokers compared to women without gonorrhea (N=3276). Maternal gonorrhea was significantly associated with a 40% increased odds (adjusted OR 1.4, 95% confidence interval (CI) 1.0\u20131.8) of low birth weight (LBW) infants compared to women without gonorrhea when adjusted for marital and smoking status. Maternal gonorrhea was associated with a 60% increased odds (OR 1.6, 95% CI 1.3\u20132.0) of small for gestational age (SGA) infants compared to women without gonorrhea.ConclusionsThis analysis showed that pregnant women with gonorrhea were more likely to have LBW infants, consistent with prior literature, and provided new evidence that maternal gonorrhea is associated with SGA infants. These findings support increased public health efforts to prevent, identify, and treat gonorrhea infection during pregnancy.T32 AI007044/AI/NIAID NIH HHS/United StatesT32 AI007140/AI/NIAID NIH HHS/United StatesU62 PS004584/PS/NCHHSTP CDC HHS/United States2018-05-01T00:00:00Z28407641PMC5407319vault:2344

Cesarean Delivery in Women With Genital Herpes in Washington State, 1989–1991

Objective: The purpose of this study was to determine whether the proportion of cesarean deliveries in pregnant women with a history of genital herpes and no active lesions at birth is higher than that in women with no history of genital herpes, and to determine whether this risk was modified by birth facilities' underlying prevalence of cesarean delivery

Small-for-Gestational Age Prevalence Risk Factors in Central Appalachian States with Mountain-top Mining.

OBJECTIVES: To identify risk factors for small-for-gestational age (SGA) for counties in central Appalachian states (Kentucky (KY), Tennessee (TN), Virginia (VA), and West Virginia (WV)) with varied coal mining activities. MATERIAL AND METHODS: Live birth certificate files (1990-2002) were used for obtaining SGA prevalence rates for mothers based on the coal mining activities of their counties of residence, mountain-top mining (MTM) activities, underground mining activities but no mountain-top mining activity (non-MTM), or having no mining activities (non-mining). Co-variable information, including maternal tobacco use, was also obtained from the live birth certificate. Adjusted odds ratios were obtained using multivariable logistic regression comparing SGA prevalence rates for counties with coal mining activities to those without coal mining activities and comparing SGA prevalence rates for counties with coal mining activities for those with and without mountain-top mining activities. Comparisons were also made among those who had reported tobacco use and those who had not. RESULTS: Both tobacco use prevalence and SGA prevalence were significantly greater for mining counties than for non-mining counties and for MTM counties than for non-MTM counties. Adjustment for tobacco use alone explained 50% of the increased SGA risk for mining counties and 75% of the risk for MTM counties, including demographic pre-natal care co-variables that explained 75% of the increased SGA risk for mining counties and 100% of the risk for MTM. The increased risk of SGA was limited to the third trimester births among tobacco users and independent of the mining activities of their counties of residence. CONCLUSIONS: This study demonstrates that the increased prevalence of SGA among residents of counties with mining activity was primarily explained by the differences in maternal tobacco use prevalence, an effect that itself was gestational-age dependent. Self-reported tobacco use marked the population at the increased risk for SGA in central Appalachian states. Int J Occup Med Environ Health 2018;31(1):11-23

Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses

Background: More women are choosing to birth at home in well-resourced countries. Concerns persist that out-of-hospital birth contributes to higher perinatal and neonatal mortality. This systematic review and meta-analyses determines if risk of fetal or neonatal loss differs among low-risk women who begin labour intending to give birth at home compared to low-risk women intending to give birth in hospital. Methods: In April 2018 we searched five databases from 1990 onward and used R to obtain pooled estimates of effect. We stratified by study design, study settings and parity. The primary outcome is any perinatal or neonatal death after the onset of labour. The study protocol is peer-reviewed, published and registered (PROSPERO No.CRD42013004046). Findings: We identified 14 studies eligible for meta-analysis including ~ 500,000 intended home births. Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03). Interpretation: The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. Funding: Partial funding: Association of Ontario Midwives open peer reviewed grant. Research in Context: Evidence before this study Although there is increasing acceptance for intended home birth as a choice for birthing women, controversy about its safety persists. The varying responses of obstetrical societies to intended home birth provide evidence of contrasting views. A Cochrane review of randomised controlled trials addressing this topic included one small trial and noted that in the absence of adequately sized randomised controlled trials on the topic of intended home compared to intended hospital birth, a peer reviewed protocol be published to guide a systematic review and meta-analysis including observational studies. Reviews to date have been limited by design or methodological issues and none has used a protocol published a priori.Added value of this study Individual studies are underpowered to detect small but potentially important differences in rare outcomes. This study uses a published peer-reviewed protocol and is the largest and most comprehensive meta-analysis comparing outcomes of intended home and hospital birth. We take study design, parity and jurisdictional support for home birth into account. Our study provides much needed information to policy makers, care providers and women and families when planning for birth.Implications of all the available evidence Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital

Population Assessment to Determine the Eligibility for Birth Center Care at University of Kentucky Midwife Clinic

Background: The COVID-19 crisis prompted patients to inquire about their options to avoid going to the hospital for birth. Outside of the hospital, birth center care has been identified as an evidence-based model for healthy women during pregnancy and birth, but it is not available in Kentucky. Purpose The purpose of this study was to determine if there are women eligible for birth center care who have been part of a nurse midwifery service and given birth in a large, academic, tertiary care setting. Methods: A retrospective chart review was used for this study. It involved a collection of data from the records of 700 patients who have given birth with the University of Kentucky Healthcare Midwife Clinic (referred to throughout as UK Midwife Clinic) for the three fiscal years beginning July 1, 2017 and ending June 30, 2020. Results: The results indicated that 33.2% of the patients who gave birth during the specified time frame would have been eligible for birth center care. This group had the lowest risk going into labor and had a vaginal birth rate of 96.54% and the cesarean birth rate was 3.03%. Discussion: Although it is a hospital-based service, care provided by the midwives showed a higher vaginal birth rate and a lower cesarean section rate than what is discussed in the literature and is consistent with the model of care provided in birth centers. Conclusion. Birth center program development may be a feasible endeavor for the patients at UK Midwife Clinic. Further research is recommended to determine consumer demand, acceptance by other medical providers and administration, and financial feasibility

The Trail, 1972-05-05

https://soundideas.pugetsound.edu/thetrail_all/2071/thumbnail.jp

Maternal Smoking and the Timing of WIC Enrollment

We investigate the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and smoking among prenatal WIC participants. We use WIC data from eight states participating in the Pregnancy Nutrition Surveillance System (PNSS). Women who enroll in WIC in the first trimester of pregnancy are 2.7 percentage points more likely to be smoking at intake than women who enroll in the third trimester. Among participants who smoked before pregnancy and at prenatal WIC enrollment, those who enrolled in the first trimester are 4.5 percentage points more likely to quit smoking 3 months before delivery and 3.4 percentage points more likely to quit by postpartum registration, compared with women who do not enroll in WIC until the third trimester. Overall, early WIC enrollment is associated with higher quit rates, although changes are modest when compared to the results from smoking cessation interventions for pregnant women.

ENVIRONMENTAL EXPOSURE TO ATRAZINE AND BIRTH DEFECTS: AN ECOLOGICAL STUDY IN KENTUCKY, 2005-2014

Atrazine is one of the most widely used pesticides in the United States. Studies have shown that pesticides, in particular herbicides such as atrazine, may be associated with birth defects. The purpose of this study is to evaluate the association between potential environmental exposures to atrazine in water systems and prevalence rates of birth defects for the state of Kentucky. An ecological study using the Kentucky Birth Defects Registry Surveillance and the Kentucky Geological Survey databases from 2005 to 2014 was conducted. Poisson regression was used to estimate crude and adjusted rate ratios of the association between agricultural exposure metrics and birth defects. Overall, the results of this study support the majority of previous research reporting some or mixed association between atrazine and birth defects. Counties with high mean atrazine exposure had higher rates of all birth defects and genital birth defects than counties with low mean atrazine exposure. This study examining the association of atrazine and birth defects reported mostly statistically insignificant results. There was no evidence of increasing strength of association when the atrazine exposure was categorized into increasing exposure levels for mean concentration level, samples above the maximum containment level, and acres of corn planted. This research provides important information on how atrazine herbicide concentration in water systems affects birth defects prevalence. These results contribute to the existing literature and expand the understanding of endocrine disruptors 4 in agrichemical exposures and the role they have on birth defects. Based on the findings from this study, future, more in-depth studies can be designed to examine individual measures of risk and exposures for birth defects