Poor metabolic health during pregnancy is associated with health concerns for pregnant individuals and their offspring. Lower socioeconomic status (SES) is one risk factor for poor metabolic health, and may be related to limited access to healthful and affordable foods (e.g., living in a food desert). This study evaluates the respective contributions of SES and food desert severity on metabolic health during pregnancy. The food desert severity of 302 pregnant individuals was determined using the United States Department of Agriculture Food Access Research Atlas. SES was measured using total household income adjusted for household size, years of education, and amount of reserve savings. Information about participants’ glucose concentrations one hour following an oral glucose tolerance test during the second trimester was extracted from medical records and percent adiposity during the second trimester was assessed using air displacement plethysmography. Information about participants’ nutritional intake during the second trimester was obtained by trained nutritionists via three unannounced 24-h dietary recalls. Structural equation models showed that lower SES predicted higher food desert severity (β = − 0.20, p = 0.008) and higher adiposity (β = − 0.27, p = 0.016) and consumption of a more pro-inflammatory diet (β = − 0.25, p = 0.003) during the second trimester of pregnancy. Higher food desert severity also predicted higher percent adiposity during the second trimester (β = 0.17, p = 0.013). Food desert severity significantly mediated the relationship between lower SES and higher percent adiposity during the second trimester (βindirect = − 0.03, 95% CI [− 0.079, − 0.004]). These findings indicate that access to healthful and affordable foods is a mechanism by which SES contributes to adiposity during pregnancy and may inform interventions intended to improve metabolic health during pregnancy.
OBJECTIVE: To examine the association between acetaminophen use in pregnancy and fetal brain development using a prospective study design. STUDY DESIGN: PEEPs is a prospective study that began in 2018 in a single maternal-fetal medicine practice of pregnant women < 13 weeks gestation designed to examine the relationship between common environmental exposures and fetal/child development. Participants completed questionnaires every trimester, frequent exposure diaries, underwent serial ultrasounds, and had serial urine samples stored. This analysis examines the relationship between reported acetaminophen (APAP) use and fetal head size, as measured by ultrasound head circumference (HC) percentiles and Z-scores (as defined by Intergrowth-2) at 16-and 32-weeks' gestation. Sonographers and data collectors were blinded to acetaminophen use data. We included all women who completed at least one diary, one questionnaire, and had one ultrasound >16 weeks. Student's t-test and linear regression were used. RESULTS: 94 women were included, 53 (56%) of whom reported APAP use. APAP users reported APAP exposure in 29% of their diaries, with an average of 3.5 weeks with exposure. Indications for acetaminophen use were pain (85.0%), fever (2.0%), and other (13.0%). There were no differences between the groups in maternal age, BMI, parity, GA at ultrasound, marital status, education, income, or ethnicity. Using linear regression controlling for maternal age, BMI, parity, and gestational age, HC indices were significantly smaller in the APAP group at 16 weeks, and across the pregnancy (Table). CONCLUSION: Prospectively reported acetaminophen use in pregnancy may be associated with a smaller fetal HC, but this requires confirmation in a larger study. Planned neonatal and childhood evaluation could help determine if this effect is clinically significant. Perinatal deviances in HC have been associated with neurodevelopmental disorders in children later in life. Because of the widespread use of acetaminophen by pregnant women, even small effects on offspring development could potentially have a large impact on public health.
ObjectiveThe objective is to evaluate whether the implementation of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) postpartum discharge educational initiative is associated with improved patient knowledge of warning signs of severe maternal morbidity (SMM) and if the initiative is self-sustaining.DesignA pre–post design was used to evaluate patient knowledge of warning signs of SMM (Plan–Do–Study–Act, PDSA cycle 1) and if the quality improvement initiative was self-sustaining (PDSA cycle 2). Patient understanding of warning signs of SMM prior to initiation of the AWHONN education (Usual Discharge) was compared with understanding of those who were discharged after implementation (POST-BIRTH discharge). The initiative was designed to be self-sustaining. The POST-BIRTH flyer describes nine warning signs of SMM. Eligible participants were English-speaking patients discharged with a live newborn who were able to be contacted within 2 weeks. Participants completed a telephone administered nine-item survey to assess knowledge of SMM. The primary outcome was the percentage of correct answers. To evaluate sustainability, whether the POST-BIRTH fliers and discharge checklist were still being used at 19 months postinitiative was planned.ResultsFor PDSA cycle 1, in the Usual Discharge group, 347 patients were discharged, 164 (44.7%) were eligible and 151 (92.1%) completed the survey. In the POST-BIRTH discharge group, 268 patients were discharged, 199 (74.3%) were eligible and 183 (92.0%) completed the survey. Compared with the Usual Discharge group, the POST-BIRTH group had significantly more correct responses (30% vs 60%, p<0.001). In PDSA cycle 2, POST-BIRTH flyers were still being used universally on one of the two floors from which postpartum patients are discharged, but not the other.ConclusionThe implementation of an educational initiative for postpartum patients is associated with improved knowledge of warning signs of SMM. The use of the education was self-sustaining on one discharge floor but not the other.
OBJECTIVE: Antenatal corticosteroid (ANCS) administration between 22 0/7 e 22 6/7 wks is not recommended by SMFM and ACOG given current existing evidence. We sought to evaluate whether ANCS exposure was associated with improved survival among resuscitated newborns delivered at 22 and 23 wks. STUDY DESIGN: We conducted a population-based cohort study of all resuscitated livebirths delivered between 22 0/7 and 23 6/7 wks in the United States from 2009-2014. The primary outcome was difference in rate of survival to 1 year of life (YOL) based on ANCS exposure. Secondary outcomes included neonatal survival (< 28 days of life), cesarean delivery, and composite adverse maternal outcome (CAMO) associated with ANCS utilization. Multivariable logistic regression provided confounder adjusted effect estimates. RESULTS: In the United States between 2009-2014, there were 2,635 and 7,992 infants who received postnatal resuscitation after delivery between 22 0/7 e 22 6/7 and 23 0/7 e 23 6/7 wks, respectively. Few infants who were resuscitated after birth between 22 0/7 e 22 6/7 (15.9%) and 23 0/7-23 6/7 (26.0%) wks received ANCS. Infant survival to 1 YOL was 45.2 vs 27.8% (aRR 1.6, 95% CI 1.2-2.1) among infants exposed to ANCS compared to those who did not receive ANCS at 22 wks. Survival to 1 YOL was 57.9 vs 47.7% (aRR 1.3, 95% CI 1.1-1.5) among infants exposed to ANCS compared to those who did not receive ANCS at 23 wks. When stratified by 100g birthweight category (400-499g, 500-599g, 600-699g, and 700-799g), ANCS was associated with increased survival among neonates weighing 500-599g (aRR 1.9, 95% CI 1.3-2.9) and 600-699g (aRR 1.7, 95% CI 1.1-2.6) at 22 wks. ANCS exposure had a positive association with cesarean delivery (aRR 2.1, 95% CI 1.4-3.0) and composite adverse maternal outcome (aRR 2.3, 95% CI 1.2-4.3) among infants born at 22 wks. CONCLUSION: Exposure to ANCS was associated with increased survival to 1 YOL among infants born at 22 and 23 wks. Counseling regarding the utilization of ANCS at the limits of viability should be investigated further given emerging evidence of benefit.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.