Neighborhood Characteristics and Racial Disparities in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seropositivity in Pregnancy.

2022

1018-1026

06/2022

1873-233X

OBJECTIVE: To quantify the extent to which neighborhood characteristics contribute to racial and ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity in pregnancy.

METHODS: This cohort study included pregnant patients who presented for childbirth at two hospitals in Philadelphia, Pennsylvania from April 13 to December 31, 2020. Seropositivity for SARS-CoV-2 was determined by measuring immunoglobulin G and immunoglobulin M antibodies by enzyme-linked immunosorbent assay in discarded maternal serum samples obtained for clinical purposes. Race and ethnicity were self-reported and abstracted from medical records. Patients' residential addresses were geocoded to obtain three Census tract variables: community deprivation, racial segregation (Index of Concentration at the Extremes), and crowding. Multivariable mixed effects logistic regression models and causal mediation analyses were used to quantify the extent to which neighborhood variables may explain racial and ethnic disparities in seropositivity.

RESULTS: Among 5,991 pregnant patients, 562 (9.4%) were seropositive for SARS-CoV-2. Higher seropositivity rates were observed among Hispanic (19.3%, 104/538) and Black (14.0%, 373/2,658) patients, compared with Asian (3.2%, 13/406) patients, White (2.7%, 57/2,133) patients, and patients of another race or ethnicity (5.9%, 15/256) (P<.001). In adjusted models, per SD increase, deprivation (adjusted odds ratio [aOR] 1.16, 95% CI 1.02-1.32) and crowding (aOR 1.15, 95% CI 1.05-1.26) were associated with seropositivity, but segregation was not (aOR 0.90, 95% CI 0.78-1.04). Mediation analyses revealed that crowded housing may explain 6.7% (95% CI 2.0-14.7%) of the Hispanic-White disparity and that neighborhood deprivation may explain 10.2% (95% CI 0.5-21.1%) of the Black-White disparity.

CONCLUSION: Neighborhood deprivation and crowding were associated with SARS-CoV-2 seropositivity in pregnancy in the prevaccination era and may partially explain high rates of SARS-CoV-2 seropositivity among Black and Hispanic patients. Investing in structural neighborhood improvements may reduce inequities in viral transmission.

10.1097/AOG.0000000000004791

Obstet Gynecol

35675599

Addressing bias and knowledge gaps regarding race and ethnicity in neonatology manuscript review.

2022

06/2022

1476-5543

A recent shift in public attention to racism, racial disparities, and health equity have resulted in an abundance of calls for relevant papers and publications in academic journals. Peer-review for such articles may be susceptible to bias, as subject matter expertise in the evaluation of social constructs, like race, is variable. From the perspective of researchers focused on neonatal health equity, we share our positive and negative experiences in peer-review, provide relevant publicly available data regarding addressing bias in peer-review from 12 neonatology-focused journals, and give recommendations to address bias and knowledge gaps in the peer review process of health equity research.

10.1038/s41372-022-01420-7

J Perinatol

35668123

Avoiding loss of native individuals in birth certificate data.

2022

07/2022

1476-5543

10.1038/s41372-022-01469-4

J Perinatol

35871190

Hypereosinophilia in NICU patients with a neonatal lymphatic flow disorder.

2022

07/2022

1476-5543

10.1038/s41372-022-01460-z

J Perinatol

35859185

Changes in preterm birth during the COVID-19 pandemic by duration of exposure and race and ethnicity.

2022

08/2022

1476-5543

OBJECTIVE: We aimed to determine whether coronavirus-disease-2019 (COVID-19) pandemic exposure duration was associated with PTB and if the pandemic modified racial disparities.

STUDY DESIGN: We analyzed Philadelphia births and replicated in New Haven. Compared to matched months in two prior years, we analyzed overall PTB, specific PTB phenotypes, and stillbirth.

RESULTS: Overall, PTB was similar between periods with the following exceptions. Compared to pre-pandemic, early pregnancy (<14 weeks') pandemic exposure was associated with lower risk of PTB < 28 weeks' (aRR 0.60 [0.30-1.10]) and later exposure with higher risk (aRR 1.77 [0.78-3.97]) (interaction p = 0.04). PTB < 32 weeks' among White patients decreased during the pandemic, resulting in non-significant widening of the Black-White disparity from aRR 2.51 (95%CI: 1.53-4.16) to aRR 4.07 (95%CI: 1.56-12.01) (interaction P = 0.41). No findings replicated in New Haven.

CONCLUSION: We detected no overall pandemic effects on PTB, but potential indirect benefits for some patients which could widen disparities remains possible.

10.1038/s41372-022-01488-1

J Perinatol

35974082

Benzene and NO Exposure during Pregnancy and Preterm Birth in Two Philadelphia Hospitals, 2013-2017.

2022

08/2022

1660-4601

Infants born preterm are at risk of neonatal morbidity and mortality. Preterm birth (PTB) can be categorized as either spontaneous (sPTB) or medically indicated (mPTB), resulting from distinct pathophysiologic processes such as preterm labor or preeclampsia, respectively. A growing body of literature has demonstrated the impacts of nitrogen dioxide (NO) and benzene exposure on PTB, though few studies have investigated how these associations may differ by PTB subtype. We investigated the associations of NO and benzene exposure with sPTB and mPTB among 18,616 singleton live births at two Philadelphia hospitals between 2013 and 2017. Residential NO exposure was estimated using a land use regression model and averaged over the patient's full pregnancy. Benzene exposure was estimated at the census tract level using National Air Toxics Assessment (NATA) exposure data from 2014. We used logistic mixed-effects models to calculate odds ratios for overall PTB, sPTB, and mPTB separately, adjusting for patient- and tract-level confounders. Given the known racial segregation and PTB disparities in Philadelphia, we also examined race-stratified models. Counter to the hypothesis, neither NO nor benzene exposure differed by race, and neither were significantly associated with PTB or PTB subtypes. As such, these pollutants do not appear to explain the racial disparities in PTB in this setting.

10.3390/ijerph191610365

Int J Environ Res Public Health

36012001

Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression.

2022

985-993

10/2022

1435-1102

Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort (n=1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development.

10.1007/s00737-022-01263-3

Arch Womens Ment Health

36030417

The Uptake of Telemedicine in Obstetric Care During the Early Acute Phase of the Coronavirus 2019 Pandemic.

2022

09/2022

1556-3669

The early acute phase of the coronavirus disease 2019 pandemic created rapid adaptation in health care delivery. Using electronic medical record data from two different institutions located in two different states, we examined how telemedicine was integrated into obstetric care. With no telemedicine use prior, both institutions rapidly incorporated telemedicine into prenatal care (PNC). There were significant patient-level and institutional-level differences in telemedicine use. Telemedicine users initiated PNC earlier and had more total visits, earlier timing of ultrasounds, and earlier diabetes screening during pregnancy compared with nonusers. There were no significant differences in delivery mode or stillbirth associated with telemedicine use at either institution. Rapid adoption of obstetric telemedicine maintained adequate prenatal care provision during the early pandemic, but implementation varied across institutions.

10.1089/tmj.2022.0291

Telemed J E Health

36067146

Preterm birth in historically redlined neighborhoods-spatial analysis with individual and community level factors.

2022

09/2022

1476-5543

10.1038/s41372-022-01509-z

J Perinatol

36097286

Neighborhood deprivation increases the risk of Post-induction cesarean delivery.

2021

2021 Dec 17

1527-974X

OBJECTIVE: The purpose of this study was to measure the association between neighborhood deprivation and cesarean delivery following labor induction among people delivering at term (≥37 weeks of gestation).

MATERIALS AND METHODS: We conducted a retrospective cohort study of people ≥37 weeks of gestation, with a live, singleton gestation, who underwent labor induction from 2010 to 2017 at Penn Medicine. We excluded people with a prior cesarean delivery and those with missing geocoding information. Our primary exposure was a nationally validated Area Deprivation Index with scores ranging from 1 to 100 (least to most deprived). We used a generalized linear mixed model to calculate the odds of postinduction cesarean delivery among people in 4 equally-spaced levels of neighborhood deprivation. We also conducted a sensitivity analysis with residential mobility.

RESULTS: Our cohort contained 8672 people receiving an induction at Penn Medicine. After adjustment for confounders, we found that people living in the most deprived neighborhoods were at a 29% increased risk of post-induction cesarean delivery (adjusted odds ratio = 1.29, 95% confidence interval, 1.05-1.57) compared to the least deprived. In a sensitivity analysis, including residential mobility seemed to magnify the effect sizes of the association between neighborhood deprivation and postinduction cesarean delivery, but this information was only available for a subset of people.

CONCLUSIONS: People living in neighborhoods with higher deprivation had higher odds of postinduction cesarean delivery compared to people living in less deprived neighborhoods. This work represents an important first step in understanding the impact of disadvantaged neighborhoods on adverse delivery outcomes.

10.1093/jamia/ocab258

J Am Med Inform Assoc

34921313