Partner support in a cohort of African American families and its influence on pregnancy outcomes and prenatal health behaviors

Abstract Background We examined how two indicators of partner involvement, relationship type and paternal support, influenced the risk of pregnancy outcomes (preterm birth, low birth weight) and health behaviors (prenatal care, drug use, and smoking) among African American women. Methods Interview and medical record data were obtained from a study of 713 adult African American women delivering singletons between March 2001 and July 2004. Women were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution (JHMI) prenatal clinics or post-partum if they delivered at JHMI with late, no or intermittent prenatal care. Relationship type was classified as married, unmarried/cohabitating, or unmarried/non-cohabitating. Partner support was assessed using an 8-item scale and was dichotomized at the median. Differences in partner support by pregnancy outcome and health behaviors were assessed using linear regression. To assess measures of partner support as predictors of adverse pregnancy outcomes and health behaviors, Poisson regression was used to generate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). Results There were no statistically significant differences in pregnancy outcomes or health behaviors by relationship type or when partner support was examined as a continuous or categorical variable. Modeled as a dichotomous variable, partner support was not associated with the risk of preterm birth (PR = 0.81, 95% CI = 0.56, 1.56), low birth weight (PR = 0.77, 96% CI = 0.48, 1.26), or health behaviors. Conclusions Paternal involvement was not associated with pregnancy outcomes or maternal health behaviors. Attention to measurement issues and other factors relevant for African American women are discussed.http://deepblue.lib.umich.edu/bitstream/2027.42/112953/1/12884_2013_Article_844.pd

Partner support in a cohort of African American families and its influence on pregnancy outcomes and prenatal health behaviors

Abstract Background We examined how two indicators of partner involvement, relationship type and paternal support, influenced the risk of pregnancy outcomes (preterm birth, low birth weight) and health behaviors (prenatal care, drug use, and smoking) among African American women. Methods Interview and medical record data were obtained from a study of 713 adult African American women delivering singletons between March 2001 and July 2004. Women were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution (JHMI) prenatal clinics or post-partum if they delivered at JHMI with late, no or intermittent prenatal care. Relationship type was classified as married, unmarried/cohabitating, or unmarried/non-cohabitating. Partner support was assessed using an 8-item scale and was dichotomized at the median. Differences in partner support by pregnancy outcome and health behaviors were assessed using linear regression. To assess measures of partner support as predictors of adverse pregnancy outcomes and health behaviors, Poisson regression was used to generate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). Results There were no statistically significant differences in pregnancy outcomes or health behaviors by relationship type or when partner support was examined as a continuous or categorical variable. Modeled as a dichotomous variable, partner support was not associated with the risk of preterm birth (PR = 0.81, 95% CI = 0.56, 1.56), low birth weight (PR = 0.77, 96% CI = 0.48, 1.26), or health behaviors. Conclusions Paternal involvement was not associated with pregnancy outcomes or maternal health behaviors. Attention to measurement issues and other factors relevant for African American women are discussed

Direct and Proxy Recall of Childhood Socio‐Economic Position and Health

Background The utility of proxy reporting within the life course framework has not been adequately assessed; therefore we sought to assess the magnitude and type of agreement that exists between index and proxy reports for bodyweight, health, and socio‐economic position ( SEP ) in childhood. Methods Participants were enrolled as part of an ongoing study of preterm birth in African American women in M etro D etroit. Post‐partum women and their mothers ( n  = 333 pairs) provided retrospective reports about the woman's childhood bodyweight, health, and SEP . Agreement was assessed using kappa, weighted kappa (κ), and intraclass correlation coefficients ( ICC ). Log‐linear models were used to describe the pattern of agreement for ordinal data. Results Birthweight and weight at age 18 was reported with a high level of agreement ( ICC  = 0.86 and 0.71, respectively). Kappa indicated moderate agreement for early and late childhood/adolescent weight. Log‐linear models suggested that there was diagonal agreement plus linear by linear association for early childhood weight and linear by linear association in late childhood/adolescence. Reports of childhood medical problems and hospitalisations had only moderate agreement. Agreement for SEP in both early (κ = 0.14) and late childhood/adolescence (κ = 0.20) was poor. Log‐linear models suggest a linear by linear association, indicating a positive association between the responses. Conclusions Results suggest that proxy reports may be utilised in conjunction with an index report to provide an estimate of the accuracy of report or to more fully capture experiences over the life course. This may be particularly useful when multiple developmental periods are examined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97462/1/ppe12045.pd

Community health workers as change agents in improving equity in birth outcomes in Detroit

We examined whether pairing pregnant women with community health workers improved pregnancy outcomes among 254 Black women with singleton pregnancies participating in the Women-Inspired Neighborhood (WIN) Network: Detroit using a case-control design. A subset (N = 63) of women were recontacted and asked about program satisfaction, opportunities, and health behaviors. Michigan Vital Statistics records were used to ascertain controls (N = 12,030) and pregnancy and infant health outcomes. Logistic and linear regression were used to examine the association between WIN Network participation and pregnancy and infant health outcomes. The WIN Network participants were less likely than controls to be admitted to the neonatal intensive care unit (odds ratio = 0.55, 95% CI 0.33-0.93) and had a longer gestational length (mean difference = 0.42, 95% CI 0.02-0.81). Community health workers also shaped participants\u27 view of opportunities to thrive. This study demonstrates that community health workers can improve pregnancy outcomes for Black women

Association between prenatal antimicrobial use and offspring attention deficit hyperactivity disorder

BACKGROUND: Gut-brain cross-talk may play an important role in modulating neurodevelopment. Few studies have examined the association between antimicrobials that influence infant gut microbiota assemblage and attention deficit hyperactivity disorder (ADHD). OBJECTIVE: To examine the association between maternal prenatal antimicrobial use and ADHD in offspring at 10 years of age. METHODS: Data are from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study, a racially and socioeconomically diverse birth cohort in metropolitan Detroit, Michigan. Maternal antimicrobial use was extracted from the medical record. ADHD diagnoses were based on parental report at the 10-year study visit. Poisson regression models with robust error variance were used to calculate risk ratios (RR). Cumulative frequency of exposure to antibiotics, and effect modification were also evaluated. RESULTS: Among the 555 children included in the analysis, 108 were diagnosed with ADHD. During pregnancy, 54.1% of mothers used antibiotics while 18.7% used antifungals. Overall, there was no evidence of an association between prenatal antibiotic exposure and ADHD (RR [95% CI] = 0.98 [0.75, 1.29]), but there was an increased risk of ADHD among those with mothers using 3+ courses of antibiotics (RR [95%CI] = 1.58 [1.10, 2.29]). Prenatal exposure to antifungals was associated with a 1.6 times higher risk of ADHD (RR [95% CI] = 1.60 [1.19, 2.15]). In examining effect modification by child sex for antifungal use, there was no evidence of an association among females (RR [95% CI] = 0.97 [0.42, 2.23]), but among males, prenatal antifungal use was associated with 1.82 times higher risk of ADHD (RR [95% CI] = 1.82 [1.29, 2.56]). CONCLUSIONS: Maternal prenatal antifungal use and frequent prenatal antibiotic use are associated with an increased risk of ADHD in offspring at age 10. These findings highlight the importance of the prenatal environment and the need for careful use of antimicrobials

Prenatal pet keeping and caregiver-reported attention deficit hyperactivity disorder through preadolescence in a United States birth cohort

BACKGROUND: While the keeping of pets has been shown to protect against childhood allergic disease and obesity, less is known regarding potential associations of prenatal pet keeping and attention deficit hyperactivity disorder (ADHD). We sought to examine the associations between prenatal dog or cat keeping with caregiver-reported ADHD in preadolescents in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort (N = 1258). METHODS: At an interview with the caregiver at child age 10-12 years, caregivers reported if the WHEALS child had ever been diagnosed with ADHD. Similarly, during an interview with the mother prenatally, pet keeping (defined as dog or cat kept inside ≥1 h/day) was ascertained. Logistic regression models were fit to examine the association of prenatal pet keeping (dog keeping and cat keeping, separately) with ADHD. RESULTS: A subset of 627 children were included in the analyses: 93 who had ADHD and 534 with neurotypical development. After accounting for confounders and loss to follow-up, maternal prenatal dog exposure was associated with 2.23 times (95% CI: 1.15, 4.31; p = 0.017) greater odds of ADHD among boys. Prenatal dog keeping was not statistically significantly associated with ADHD in girls (odds ratio = 0.27, 95% CI: 0.06, 1.12; p = 0.070). Prenatal cat keeping was not associated with ADHD. CONCLUSIONS: In boys, but not girls, maternal prenatal dog keeping was positively associated with ADHD. Further study to confirm these findings and to identify potential mechanisms of this association (e.g., modification of the gut microbiome, exposure to environmental toxicants or pet-related medications) is needed

Progression of C-reactive protein from birth through preadolescence varies by mode of delivery

INTRODUCTION: Delivery via caesarean section (C-section) has been associated with an increased risk of childhood chronic diseases such as obesity and asthma, which may be due to underlying systemic inflammation. However, the impact of specific C-section types may be differential, as emergency C-sections typically involve partial labor and/or membrane rupture. Our objectives were to determine if mode of delivery associates with longitudinal profiles of high sensitivity CRP (hs-CRP) -a marker of systemic inflammation-from birth through preadolescence, and to examine if CRP mediates the association between mode of delivery and preadolescent body mass index (BMI). METHODS: Data from the WHEALS birth cohort (N = 1,258) were analyzed; 564 of the 1,258 children in the cohort had data available for analysis. Longitudinal plasma samples (birth through 10-years of age) from 564 children from were assayed for hs-CRP levels. Maternal medical records were abstracted to obtain mode of delivery. Growth mixture models (GMMs) were used to determine classes of hs-CRP trajectories. Poisson regression with robust error variance was used to calculate risk ratios (RRs). RESULTS: Two hs-CRP trajectory classes were identified: class 1 (76% of children) was characterized by low hs-CRP, while class 2 (24% of children) was characterized by high and steadily increasing hs-CRP. In multivariable models, children delivered via planned C-section had 1.15 times higher risk of being in hs-CRP class 2, compared to vaginal deliveries (p = 0.028), while no association was found for unplanned C-section deliveries [RR (95% CI) = 0.96 (0.84, 1.09); p = 0.49]. Further, the effect of planned C-section on BMI z-score at age 10 was significantly mediated by hs-CRP class (percent mediated = 43.4%). CONCLUSIONS: These findings suggest potentially beneficial effects of experiencing partial or full labor, leading to a lower trajectory of systemic inflammation throughout childhood and decreased BMI during preadolescence. These findings may have implications for chronic disease development later in life

Ambient BTEX exposure and mid-pregnancy inflammatory biomarkers in pregnant African American women

Air pollution is associated with preterm birth (PTB), potentially via inflammation. We recently showed the mixture benzene, toluene, ethylbenzene, and xylene (BTEX) is associated with PTB. We examined if ambient BTEX exposure is associated with mid-pregnancy inflammation in a sample of 140 African-American women residing in Detroit, Michigan. The Geospatial Determinants of Health Outcomes Consortium study collected outdoor air pollution measurements in Detroit; these data were coupled with Michigan Air Sampling Network measurements to develop monthly BTEX concentration estimates at a spatial density of 300 m(2). First trimester and mid-pregnancy BTEX exposure estimates were assigned to maternal address. Mid-pregnancy (mean 21.3 ± 3.7 weeks gestation) inflammatory biomarkers (high-sensitivity C-reactive protein, interleukin [IL]-6, IL-10, IL-1β, and tumor necrosis factor-α) were measured with enzyme immunoassays. After covariate adjustment, for every 1-unit increase in first trimester BTEX, there was an expected mean increase in log-transformed IL-1β of 0.05 ± 0.02 units (P = 0.014) and an expected mean increase in log-transformed tumor necrosis factor-α of 0.07 ± 0.02 units (P = 0.006). Similarly, for every 1-unit increase in mid-pregnancy BTEX, there was a mean increase in log IL-1β of 0.06 ± 0.03 units (P = 0.027). There was no association of either first trimester or mid-pregnancy BTEX with high-sensitivity C-reactive protein, IL-10, or IL-6 (all P \u3e 0.05). Ambient BTEX exposure is associated with inflammation in mid-pregnancy in African-American women. Future studies examining if inflammation mediates associations between BTEX exposure and PTB are needed