Stress, Discrimination And Repeat Pregnancy In Adolescent Parents

Objective Adolescent mothers are at high risk of repeat pregnancy and repeat birth with short birth intervals. Perceived stress is known to affect young women\u27s use of contraception, and therefore risk of unintended pregnancy. The primary aim of the study was to examine how stress, stressful life events, discrimination and economic hardship affect adolescent mothers\u27 risk for repeat pregnancy. Secondary aims included examining if the association between stress and repeat pregnancy was mediated by contraception use, if the stress experienced by the mother\u27s partner was associated with risk of pregnancy and if the association between stress and repeat pregnancy was mediated by social support and family functioning. Methods Data was obtained from a subset of participants from a longitudinal study of pregnant adolescent females and their partners. Couples completed individual structured interviews via audio computer-assisted self-interview (ACASI) during pregnancy and at six and twelve months postpartum. The association between the predictors and repeat pregnancy was examined using logistic regression. Results Stressful life events (OR: 1.52, 95% CI: 1.13, 2.03) and discrimination (OR: 2.35, 95% CI: 1.16, 4.76) were associated with greater risk of repeat pregnancy. Contraception use did not mediate the association between the predictors and repeat pregnancy. Conclusions The results of this study suggest that adolescent mothers that experience mental distress, and specifically stressful life events and discrimination, are at a greater risk of repeat pregnancy. The results support the need for postpartum services that address the physical health as well as the mental health of adolescent mothers to help them avoid a repeat pregnancy

Examining the Effectiveness of Medicaid Family Planning Expansion in Connecticut

Abstract Introduction Medicaid family planning expansion programs have been shown to improve reproductive health outcomes and reduce unintended pregnancies. Connecticut implemented Medicaid Family Planning Expansion in March of 2012 with the intention of expanding access to family planning services and improving reproductive health outcomes. The aims of this study are to evaluate the effectiveness of the Medicaid Family Planning Expansion in reducing unintended pregnancies, estimate the funds saved to the state of Connecticut due to the expansion and to demonstrate that women will choose highly effective methods of contraception when cost is not a barrier. Methods Mathematical models developed by the Guttmacher Institute were adapted to estimate the number of pregnancies averted in the state based on patterns of contraceptive use in participants after enrolling in the program and contraceptive failure rates. The number of pregnancies averted was used to determine the state funds saved by reducing pregnancies that would have resulted in births covered by Medicaid. Multivariate logistic regression was used to examine predictors of using a highly effective method of contraception. Results Complete data were available for 1,153 women enrolled in the Medicaid Family Planning Expansion program. Our calculations indicated that an estimated 84 unintended pregnancies were averted in this group between 2011 and 2013, with an estimated 31.2 unintended births averted and $324,379 saved to the state of Connecticut. Women enrolled in the expansion program were more likely to choose a highly effective method of contraception than women not enrolled (OR: 7.16, 95% CI: 5.76, 8.90). Discussion Our results support the conclusion that when the barrier of cost is removed, women are more likely to choose highly effective methods of contraception, helping them to avoid unintended pregnancies. Our results suggest the need for continued funding of Medicaid Family Planning Expansion in Connecticut, and further research on barriers to enrollment in the program.https://elischolar.library.yale.edu/ysph_pbchrr/1005/thumbnail.jp

Determinants of Severe Maternal Morbidity and Its Racial/Ethnic Disparities in New York City, 2008–2012

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. The study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008–2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences

Abstract 05: Race and Hospitalization for Cardiovascular Disease in Patients With Systemic Lupus Erythematosus

Background: Patients diagnosed with systemic lupus erythematosus (SLE) are at greater risk of cardiovascular disease (CVD) and death at earlier ages than the general population, with African Americans (AA) at risk at earlier ages than non-AAs. However, the association between race and recurrent hospitalizations for CVD, which are associated with mortality, has not been explored. Methods: The Georgia Lupus Registry (GLR) is a population-based registry of individuals with SLE in 2002-2004 in Atlanta, Georgia. Both incident and prevalent cases were enrolled, and we included all cases diagnosed beginning in 2000. The GLR was matched to Georgia inpatient hospital discharge records from 2000-2013. Using ICD-9-CM codes, we identified hospitalizations classified as having coronary heart disease, peripheral artery disease, cerebrovascular disease or heart failure. The Prentice-Williams-Peterson Model with a total time scale measured from diagnosis was used to examine recurrent time to event data. We truncated the number of hospitalizations at 3 to maintain stable modeling estimates. Patients were censored at the time of death or at the end of 2013. Models were adjusted for sex and age at diagnosis. Results: A total of 556 participants in the GLR (87% female, 73% AA) had a median age at SLE diagnosis of 38 years and 27% experienced at least 1 CVD hospitalization, while 17% experienced ≥ 2. Overall, AA race was associated with recurrent hospitalizations (adjusted hazard ratio [aHR]: 1.7, 95% confidence interval [CI]: 1.2, 2.3). In an event-specific stratified analysis, the association between AA race and the hazard of recurrence became even more pronounced in later events (Event 1 aHR: 1.2, 95% CI: 1.0, 1.5; Event 2 aHR: 1.5, 95% CI: 1.2, 2.2; Event 3 aHR: 1.9, 95% CI: 1.1, 3.2). Conclusions: African-Americans with SLE were more likely to experience recurrent hospitalizations for CVD than their non-AA counterparts, suggesting that AA individuals with SLE may be more vulnerable to CV complications of SLE. Figure 1. Survival curve for 1st event </jats:p

Anti-Müllerian hormone in African-American women with systemic lupus erythematosus

ObjectiveWomen with SLE may experience ovarian insufficiency or dysfunction due to treatment or disease effects. Anti-Müllerian hormone (AMH), a marker of ovarian reserve, has been examined in small populations of women with SLE with conflicting results. To date, these studies have included very few African-American women, the racial/ethnic group at greatest risk of SLE.MethodsWe enrolled African-American women aged 22–40 years diagnosed with SLE after age 17 from the Atlanta Metropolitan area. Women without SLE from the same area were recruited from a marketing list for comparison. AMH was measured in serum using the Ansh Labs assay (Webster, Texas, USA). We considered AMH levels &lt;1.0 ng/mL and AMH &lt;25th percentile of comparison women as separate dichotomous outcomes. Log-binomial regression models estimating prevalence ratios were adjusted for age, body mass index and hormonal contraception use in the previous year.ResultsOur sample included 83 comparison women without SLE, 68 women with SLE and no history of cyclophosphamide (SLE/CYC−) and 11 women with SLE and a history of cyclophosphamide treatment (SLE/CYC+). SLE/CYC+ women had a greater prevalence of AMH &lt;1.0 ng/mL compared with women without SLE (prevalence ratio (PR): 2.90, 95% CI: 1.29 to 6.51). SLE/CYC− women were also slightly more likely to have AMH &lt;1.0 ng/mL (PR: 1.62, 95% CI: 0.93 to 2.82) than comparison women. Results were similar when considering AMH &lt;25th percentile by age of comparison women.ConclusionsTreatment with CYC is associated with low AMH in African-American women with SLE. SLE itself may also be associated with reduced AMH, but to a lesser extent.</jats:sec

Association of Urinary Cadmium Concentration With Cognitive Impairment in US Adults: A Longitudinal Cohort Study

Background and objectives: Studies have indicated that cadmium (Cd) exposure is associated with neurotoxicity. However, data linking Cd exposure to cognitive impairment are sparse. We aimed to investigate the association between urinary Cd concentration and cognitive impairment in US adults. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is an ongoing population-based prospective cohort study that enrolled 30,239 Black and White US adults aged 45 years or older at baseline (2003-2007). In a randomly selected subcohort of REGARDS participants who were free of cognitive impairment or stroke at baseline, certain trace element concentrations, including urinary creatinine-corrected Cd, were measured using biospecimens collected and stored at baseline. During an average of 10 years of follow-up, global cognitive impairment was assessed annually using the Six-Item Screener, and domain-based cognitive impairment, including verbal learning, memory, and executive function, was evaluated every other year using the Enhanced Cognitive Battery. Multivariable-adjusted logistic regression models were used to examine the association between urinary Cd concentration and the odds of global or domain-based cognitive impairment. Results: A total of 2,172 participants (mean age: 64.1 ± 9.0 years; female: 54.8%; Black participants: 38.7%) with available data on urinary Cd concentration, including 195 cases of global cognitive impairment and 53 cases of domain-based cognitive impairment, were included in the analyses. While there was no association between Cd and cognitive impairment in the full sample, there was a significant positive association of urinary Cd concentration with global cognitive impairment among White but not Black participants. The odds of cognitive impairment for White participants in the high urinary Cd concentration group (≥median) were doubled compared with those in the low urinary Cd group (odds ratio 2.07, 95% CI 1.18-3.64). Sex, age, region, smoking pack-years, alcohol consumption, and other related metals did not materially modify the associations of interest. Discussion: Findings from this prospective cohort study suggest that urinary Cd concentrations are associated with global cognitive impairment among White but not Black individuals. Further studies with repeatedly measured Cd exposure, larger sample sizes, and longer duration are needed to confirm our findings and explore the potential explanations for the observed racial discrepancy, such as the impact of smoking

Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics

Abstract Background Participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been associated with lower risk of stillbirth. We hypothesized that such an association would differ by race/ethnicity because of factors associated with WIC participation that confound the association. Methods We conducted a secondary analysis of the Stillbirth Collaborative Research Network’s population-based case-control study of stillbirths and live-born controls, enrolled at delivery between March 2006 and September 2008. Weighting accounted for study design and differential consent. Five nested models using multivariable logistic regression examined whether the WIC participation/stillbirth associations were attenuated after sequential adjustment for sociodemographic, health, healthcare, socioeconomic, and behavioral factors. Models also included an interaction term for race/ethnicity x WIC. Results In the final model, WIC participation was associated with lower adjusted odds (aOR) of stillbirth among non-Hispanic Black women (aOR: 0.34; 95% CI 0.16, 0.72) but not among non-Hispanic White (aOR: 1.69; 95% CI: 0.89, 3.20) or Hispanic women (aOR: 0.91; 95% CI 0.52, 1.52). Conclusions Contrary to our hypotheses, control for potential confounding factors did not explain disparate findings by race/ethnicity. Rather, WIC may be most beneficial to women with the greatest risk factors for stillbirth. WIC-eligible, higher-risk women who do not participate may be missing the potential health associated benefits afforded by WIC