First name
Nancy
Last name
Yang

Title

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

Year of Publication

2022

Date Published

08/2022

ISSN Number

1476-5543

Abstract

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.

DOI

10.1038/s41372-022-01488-1

Alternate Title

J Perinatol

PMID

35974082

Title

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

Year of Publication

2022

Date Published

08/2022

ISSN Number

1660-4601

Abstract

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.

DOI

10.3390/ijerph191610365

Alternate Title

Int J Environ Res Public Health

PMID

36012001

Title

Second trimester short cervix is associated with decreased abundance of cervicovaginal lipid metabolites.

Year of Publication

2022

Date Published

2022 Apr 22

ISSN Number

1097-6868

Abstract

<p><strong>BACKGROUND: </strong>Short cervix is a risk factor for preterm birth. Molecular drivers of short cervix remain elusive. Metabolites may function as mediators of pathologic processes.</p>

<p><strong>OBJECTIVES: </strong>We sought to determine if a distinct cervicovaginal metabolomic profile is associated with short cervix (&lt;25 mm) to unveil potential mechanisms by which premature cervical remodeling leads to short cervix.</p>

<p><strong>STUDY DESIGN: </strong>This was a secondary analysis of a completed prospective pregnancy cohort. Cervicovaginal fluid was obtained between 20-24 weeks' gestation. Participants selected for metabolomic profiling were frequency matched by birth outcome and cervicovaginal microbiota profile. This analysis included the 222 participants with cervical length measured. Short cervix was defined as &lt;25 mm as measured by transvaginal ultrasound. Unpaired t-tests were performed with a Bonferroni correction for multiple comparisons.</p>

<p><strong>RESULTS: </strong>There were 27 participants with short cervix and 195 with normal cervical length. Of the 637 metabolites detected, 26 differed between those with short cervix and normal cervical lengths; 22 were decreased, of which 21 belonged to the lipid metabolism pathway (all P&lt;7.85E-5). Diethanolamine, erythritol, progesterone and mannitol/sorbitol were increased in cases of short cervix. Among participants with a Lactobacillus-deficient microbiota, only diethanolamine and mannitol/sorbitol differed between short cervix (n=17) and normal cervical length (n=75), both increased.</p>

<p><strong>CONCLUSIONS: </strong>Short cervix is associated with decreased cervicovaginal lipid metabolites, particularly sphingolipids. This class of lipids stabilizes cell membranes and protects against environmental exposures. Increased diethanolamine, an immunostimulatory xenobiotic, is associated with short cervix. These observations begin to identify potential mechanisms by which modifiable environmental factors may invoke cell damage in the setting of biologic vulnerability, thus promoting premature cervical remodeling in spontaneous preterm birth.</p>

DOI

10.1016/j.ajog.2022.04.031

Alternate Title

Am J Obstet Gynecol

PMID

35469813

Title

States with more killings of unarmed Black people have larger Black-White preterm birth disparities.

Year of Publication

2021

Date Published

2021 Jan 15

ISSN Number

1476-5543

DOI

10.1038/s41372-020-00914-6

Alternate Title

J Perinatol

PMID

33452418

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