Evaluating the Effect of San Francisco’s Paid Parental Leave Ordinance on Birth Outcomesf

Since 2017, San Francisco’s Paid Parental Leave Ordinance (PPLO) has allowed parents who work for private-sector employers to take 6 weeks of fully paid postnatal parental leave. Previous studies have linked paid parental leave with health improvements for birthing people and babies, although evidence for birth outcomes is limited. We hypothesized that the PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of increased financial security and postnatal leave. We used linked California birth certificate and hospital discharge records from January 2013 to December 2018 (n = 1,420,781). We used quasi-experimental difference-in-difference (DD) models to compare outcomes among SF births before and after PPLO to outcomes among births in control counties. Births from January 2017 through December 2018 among working San Francisco (SF) people were considered “exposed” to PPLO; births during this time among working people outside of SF, as well as all births before 2017, served as controls. We conducted subgroup analyses by race/ethnicity, education and Medicaid coverage at delivery. Overall analyses adjusting for covariates and indicators for time and seasonality indicated no association between PPLO and birth outcomes. Our results indicate that PPLO may not have affected the birth outcomes we examined among marginalized groups who, due to structural racism, are at heightened risk of poor outcomes. We speculate that this result is due to the PPLO’s design and focus on postnatal leave. Future work should examine the policy’s effects on other outcomes

Retirements of Coal and Oil Power Plants in California: Association With Reduced Preterm Birth Among Populations Nearby.

Coal and oil power plant retirements reduce air pollution nearby, but few studies have leveraged these natural experiments for public health research. We used California Department of Public Health birth records and US Energy Information Administration data from 2001-2011 to evaluate the relationship between the retirements of 8 coal and oil power plants and nearby preterm (gestational age of <37 weeks) birth. We conducted a difference-in-differences analysis using adjusted linear mixed models that included 57,005 births-6.3% of which were preterm-to compare the probability of preterm birth before and after power plant retirement among mothers residing within 0-5 km and 5-10 km of the 8 power plants. We found that power plant retirements were associated with a decrease in the proportion of preterm birth within 5 km (-0.019, 95% CI: -0.031, -0.008) and 5-10 km (-0.015, 95% CI: -0.024, -0.007), controlling for secular trends with mothers living 10-20 km away. For the 0-5-km area, this corresponds to a reduction in preterm birth from 7.0% to 5.1%. Subgroup analyses indicated a potentially larger association among non-Hispanic black and Asian mothers than among non-Hispanic white and Hispanic mothers and no differences in educational attainment. Future coal and oil power plant retirements may reduce preterm birth among nearby populations

Work-Family Conflict and Work Exit in Later Career Stage.

This study investigated relationships between work–family conflict and routes of later-life work exit

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

<p>Abstract</p> <p>Background</p> <p>Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.</p> <p>Methods</p> <p>From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.</p> <p>Results</p> <p>We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.</p> <p>Conclusions</p> <p>The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.</p

Reproductive decision-making under uncertainty: exploring the relationship of economic preferences and reproductive health

Little research has examined how economic uncertainty and preferences affect decision-making surrounding fertility intention, contraceptive behavior and pregnancy outcomes –an area where intention-behavior inconsistencies are widely acknowledged. Risk preference are defined as a person’s willingness to assume risk, and time preference as a person’s degree of present bias. Measures of risk and time preferences that underlie decision-making have been linked to health behaviors, especially substance use. There is a long history in social science of examining how these preferences correlate with financial decision-making and behavior, and measures have therefore been included in population surveys to examine economic behavior. Far less frequent are analyses that examine how economic preferences may extend beyond financial behavior to explain behavior in other domains, such as health behavior. Sexual and contraceptive behaviors are influenced by uncertainty surrounding pregnancy risk, pregnancy intention, access to methods, sexual and reproductive control, as well as perception of STI risk. Decision-making theory may therefore be especially helpful to shed light on disparities in unintended pregnancy and contraceptive use.Drawing on behavioral economics, this dissertation expands understanding of uncertainty and reproductive health decision-making in several steps. My three papers examine if there are general decision-making constructs, including risk-taking propensity and degree of present bias that may extend beyond financial decisions to health behavior and ultimately reproductive health outcomes. In the first paper, I review the state of the literature on temporal and risk preferences and sexual and reproductive health. Next, I examine how risk preferences are related to sexual behavior and contraceptive use in the National Longitudinal of Youth (NLSY97). Finally, I examine the relationship between national economic uncertainty and pregnancy intentions and outcomes in the National Survey of Family Growth (NSFG). This work draws on economics, psychology, and social epidemiology.The goal of this research is to contribute to understanding the context of reproductive decision-making and behavior. This work deepens our understanding of the mechanisms underlying choices that drive health behavior. This is an important step towards predicting who will be at highest risk of adverse outcomes and develop models for intervention

Racial Differences in the Association between the U.S. Earned Income Tax Credit and Birthweight

ObjectiveWe examined whether the largest U.S. poverty alleviation program for families, the Earned Income Tax Credit (EITC), has different associations with birthweight among women of different racial backgrounds.DesignWe analyzed data from the 1985-2015 waves of the Panel Study of Income Dynamics, a longitudinal cohort study of U.S. families (N&nbsp;=&nbsp;5,230 infants born to 3,672 women). The primary outcome was a continuous measure of birthweight, with secondary outcomes including low birthweight (LBW) and very LBW. Using rich sociodemographic data available in the Panel Study of Income Dynamics, we calculated the amount of EITC benefit for which women were eligible. We then examined the association of EITC benefit size with each outcome using multivariable regressions, examining the sample overall as well as racial subgroups (White, Black, or other).ResultsWe found that larger EITC benefits were not associated with increased infant birthweight for the overall sample (18.37&nbsp;g per $1,000 of EITC; 95% confidence interval [CI], -2.62 to 33.36). There was an increase in birthweight for Black women (40.17&nbsp;g; 95% CI: 7.32 to 73.02), but not for White women (-1.86&nbsp;g; 95% CI, -33.33 to 29.60) or women of other races (-13.26&nbsp;g; 95% CI, -75.90 to 49.38). There was no association between EITC benefit size and the probability of LBW or very LBW. Results were robust to alternative model specifications.ConclusionsSocial policies to address poverty may be effective at decreasing racial disparities in birthweight. Future work should examine potential mechanisms and the benefits of improved health outcomes for children later in life

Sun smoke in Sweden

BackgroundThe Icelandic volcano Laki erupted from June 1783 through January 1784. It produced 122 megatons of sulfur dioxide, particulate matter, and acid rain and contributed to one of the coldest winters on record in Western Europe. Although uncontrollable volcanic eruptions continue, few studies have investigated their perinatal health implications.MethodsUsing the Human Mortality Database, we assessed the association between the Laki event and the secondary sex ratio, infant mortality rates, and the number of births from 1751 to 1800 with time-series models that controlled for temporal trends.ResultsThe secondary sex ratio decreased 3% below expected levels in 1784 (95% CI = -4%, -1%). Both female and male infant mortality rates exceeded expectation in 1785, by 54% (95% CI = 25%, 83%) and 37% (-1%, 74%), respectively. We observed little change in female live births but a reduction in male live births in 1784.ConclusionsOur findings are consistent with the hypothesis that the large-scale Laki volcanic eruptions of 1783-1784 resulted in adverse perinatal health outcomes in Sweden

Reproductive suppression, birth defects, and periviable birth.

We argue that reproductive suppression has clinical implications beyond its contribution to the burden of spontaneous abortion. We theorize that the incidence of births before the 28th week of gestation, which contribute disproportionately to infant morbidity and mortality, varies over time in part due to reproductive suppression in the form of selection in utero. We further theorize that the prevalence of structural birth defects among survivors to birth from conception cohorts gauges selection in utero. We based these theories on literature positing that natural selection conserved mechanisms that spontaneously abort "risky" pregnancies including those otherwise likely to yield infants with structural birth defects or small-for-gestational age males. We test our theory using high-quality birth defect surveillance data. We identify 479,885 male infants exposed to strong selection defined as membership in conception cohorts ranked in the lowest quartile of odds of a birth defect among live-born females. We estimate the risk of periviable birth among these infants as a function of selective pressure as well as of mother's race/ethnicity and age. We find that male infants from exposed conception cohorts exhibited 10% lower odds of periviable birth than males from other conception cohorts. Our findings support the argument that selection in utero has implications beyond its contribution to the burden of spontaneous abortion