Background: Preterm birth rates are higher among individuals of lower socioeconomic status and non-White race, which is possibly related to life-course stressors. It is important to understand the underlying mechanisms of these health disparities, and inflammation is a possible pathway to explain the disparities in birth outcomes.Objective: In this study, we aimed to determine whether patterns of inflammation differed by maternal race and socioeconomic status.Study design: Seven hundred and forty-four participants in a multi-site, prospective study of pregnancy and birth outcomes provided biological and psychological data between 12′0-20′6 weeks gestation. Participants with recent infection, fever, antibiotics or steroid treatment were excluded. Cytokines including INFɣ, IL-10, IL-13, IL-6, IL-8, and TNFα, and the acute phase protein CRP were measured in serum and values and were log-transformed for normality when appropriate, and a non-orthogonal rotation (Oblimid) was performed to allow the extracted factor to inter-correlate. IFNγ, IL-8, IL-10, IL-6, TNF-a, and IL-13 loaded onto Inflammatory Factor 1 (IF-1), while CRP and IL-6 loaded onto Inflammatory Factor 2 (IF-2). Race and education were
BackgroundHousing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.MethodsWe used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.ResultsIndividuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.ConclusionOur results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.
There are substantial, unexplained racial disparities in women’s health. Some of the most pronounced involve elevated rates of preterm delivery (PTD) and cardiovascular disease (CVD) among Black women. We hypothesized that stress associated with excessive use of force by police may contribute to these disparities. In two prospective cohorts derived from electronic health records (pregnancy cohort, N = 67,976; CVD cohort, N = 6773), we linked formal complaints of excessive police force in patients’ neighborhoods with health outcomes. Exposed Black women were 1.19 times as likely to experience PTD [95% confidence interval (CI): 1.04 to 1.35] and 1.42 times as likely to develop CVD (95% CI: 1.12 to 1.79), even after adjustment for neighborhood disadvantage and homicide. The excess risks of PTD were also observed in maternal fixed-effects analyses comparing births to the same woman. These findings suggest police violence may be an unrecognized contributor to health inequity for Black women.
OBJECTIVE: Elective induction of labor aids in managing timing of delivery and reducing risks associated with late-term pregnancy. Results of a recent randomized controlled trial showed that rates of cesarean section and hypertensive disorders were lower with elective induction compared to expectant management. The primary objective of this study was to determine the safety of elective induction at or beyond 39 weeks gestation by comparing incidence of maternal and neonatal outcomes among women who did and did not opt for elective induction. STUDY DESIGN: This was a prospective cohort study of low-risk pregnant women delivering at a regional tertiary obstetric care center. The study group was composed of low-risk pregnant women who opted for elective induction at or beyond 39 weeks gestation between May 1, 2019 and November 30, 2019 and between February 15, 2020 and August 15 2020. The comparison group included low-risk pregnant women who opted for expectant management and delivered during the same timeframes. Outcomes were compared between groups. For categorical variables, relative risks with confidence intervals were determined. For continuous variables, differences between means were determined. Significance levels of 0.05 (two-sided) were used. RESULTS: There were 228 participants with 112 (49.1%) in the elective induction group and 116 (50.9%) in the comparison group. Patient characteristics are described in Table 1. There was no significant difference in maternal and neonatal outcomes (Table 2). The use of ripening agents was significantly greater in the elective induction group (p < 0.0001). Length of stay on antepartum and labor and delivery units were significantly greater among the elective induction group (p < 0.0001 and p ¼ 0.0015, respectively). Length of stay on postpartum was significantly greater in the comparison group (p ¼ 0.0368). CONCLUSION: Elective induction does not have increased maternal or neonatal risks compared to expectant management. It can be offered to patients, although they should be counseled on the increased time and amount of cervical ripening needed for elective induction.
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