County-Level Maternal Vulnerability and Preterm Birth in the US

Salazar, Elizabeth; Montoya-Williams, Diana; Passarella, Molly; McGann, Carolyn; Paul, Kathryn; Murosko, Daria; Peña, Michelle-Marie; Ortiz, Robin; Burris, Heather H.; Lorch, Scott; Handley, Sara C.

doi:10.1001/jamanetworkopen.2023.15306

Cited by 14 publications

(8 citation statements)

References 57 publications

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“…Part of the differences they found might be explained by distinct proportions of these two vulnerability profiles that were not explored. Similarly, two recent studies from the US demonstrated strong associations between social vulnerability indices and PTB [25,26]. Both indices were based on geographical indicators of social vulnerability that blended several dimensions of social vulnerability together.…”

Section: Discussionmentioning

confidence: 94%

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

Créquit

Chatzistergiou

Bierry

et al. 2023

BMC Pregnancy Childbirth

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Background Evaluating social vulnerability is a challenging task. Indeed, former studies demonstrated an association between geographical social deprivation indicators, administrative indicators, and poor pregnancy outcomes. Objective To evaluate the association between social vulnerability profiles, prenatal care use (PCU) and poor pregnancy outcomes (Preterm birth (PTB: <37 gestational weeks (GW)), small for gestational age (SGA), stillbirth, medical abortion, and late miscarriage). Methods Retrospective single center study between January 2020 and December 2021. A total of 7643 women who delivered a singleton after 14 GW in a tertiary care maternity unit were included. Multiple component analysis (MCA) was used to assess the associations between the following social vulnerabilities: social isolation, poor or insecure housing conditions, not work-related household income, absence of standard health insurance, recent immigration, linguistic barrier, history of violence, severe dependency, psychologic vulnerability, addictions, and psychiatric disease. Hierarchical clustering on principal component (HCPC) from the MCA was used to classify patients into similar social vulnerability profiles. Associations between social vulnerability profiles and poor pregnancy outcomes were tested using multiple logistic regression or Poisson regression when appropriate. Results The HCPC analysis revealed 5 different social vulnerability profiles. Profile 1 included the lowest rates of vulnerability and was used as a reference. After adjustment for maternal characteristics and medical factors, profiles 2 to 5 were independently associated with inadequate PCU (highest risk for profile 5, aOR = 3.14, 95%CI[2.33–4.18]), PTB (highest risk for profile 2, aOR = 4.64, 95%CI[3.80–5.66]) and SGA status (highest risk for profile 5, aOR = 1.60, 95%CI[1.20–2.10]). Profile 2 was the only profile associated with late miscarriage (adjusted incidence rate ratio (aIRR) = 7.39, 95%CI[4.17–13.19]). Profiles 2 and 4 were independently associated with stillbirth (highest association for profile 2 (aIRR = 10.9, 95%CI[6.11–19.99]) and medical abortion (highest association for profile 2 (aIRR = 12.65, 95%CI[5.96–28.49]). Conclusions This study unveiled 5 clinically relevant social vulnerability profiles with different risk levels of inadequate PCU and poor pregnancy outcomes. A personalized patient management according to their profile could offer better pregnancy management and reduce adverse outcomes.

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Section: Discussionmentioning

confidence: 94%

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

Créquit

Chatzistergiou

Bierry

et al. 2023

BMC Pregnancy Childbirth

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“…Lower maternal education as a proxy for SES has been widely studied in this context, perceptions of neighborhood safety and the maternal vulnerability index, a composite measure that reflects physical, social, and health care needs, have also been associated with preterm birth, less use of prenatal care and poorer long-term outcomes. 219 , 220 While the mechanisms underlying these associations are not fully elucidated, these findings suggest that strategies improving social determinants of health for premature infants may have a positive effect on their long-term health and neurodevelopmental outcomes 221 and that, as such, advocacy by clinicians in this area is vital.…”

Section: Postnatal Managementmentioning

confidence: 99%

Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

Molloy,

El-Dib,

Soul

et al. 2023

Pediatr Res

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The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. Impact With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

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“…Rates of preterm birth have increased in the US in recent years, with an annual increase of 2% per year from 2014 to 2019, and considerable racial and ethnic disparities exist with the highest rate of preterm birth among non-Hispanic Black individuals . A variety of maternal factors, including socioeconomic status, access to health care, implicit bias, perceived discrimination, and environmental exposures have each been associated with risk of preterm birth . These upstream factors may partially account for the disproportionate burden of preterm birth experienced by racial and ethnic minoritized groups in the US .…”

Section: Introductionmentioning

confidence: 99%

Maternal Nativity and Preterm Birth

Huang,

Lee,

Wang

et al. 2024

JAMA Pediatr

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ImportancePreterm birth is a major contributor to neonatal morbidity and mortality, and considerable differences exist in rates of preterm birth among maternal racial and ethnic groups. Emerging evidence suggests pregnant individuals born outside the US have fewer obstetric complications than those born in the US, but the intersection of maternal nativity with race and ethnicity for preterm birth is not well studied.ObjectiveTo determine if there is an association between maternal nativity and preterm birth rates among nulliparous individuals, and whether that association differs by self-reported race and ethnicity of the pregnant individual.Design, Setting, and ParticipantsThis was a nationwide, cross-sectional study conducted using National Center for Health Statistics birth registration records for 8 590 988 nulliparous individuals aged 15 to 44 years with singleton live births in the US from 2014 to 2019. Data were analyzed from March to May 2022.ExposuresMaternal nativity (non–US-born compared with US-born individuals as the reference, wherein US-born was defined as born within 1 of the 50 US states or Washington, DC) in the overall sample and stratified by self-reported ethnicity and race, including non-Hispanic Asian and disaggregated Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Pacific Islander, Vietnamese, and other Asian), non-Hispanic Black, Hispanic and disaggregated Hispanic subgroups (Cuban, Mexican, Puerto Rican, and other Hispanic), and non-Hispanic White.Main Outcomes and MeasuresThe primary outcome was preterm birth (&lt;37 weeks of gestation) and the secondary outcome was very preterm birth (&lt;32 weeks of gestation).ResultsOf 8 590 988 pregnant individuals included (mean [SD] age at delivery, 28.3 [5.8] years in non–US-born individuals and 26.2 [5.7] years in US-born individuals; 159 497 [2.3%] US-born and 552 938 [31.2%] non–US-born individuals self-identified as Asian or Pacific Islander, 1 050 367 [15.4%] US-born and 178 898 [10.1%] non–US-born individuals were non-Hispanic Black, 1 100 337 [16.1%] US-born and 711 699 [40.2%] non–US-born individuals were of Hispanic origin, and 4 512 294 [66.1%] US-born and 328 205 [18.5%] non–US-born individuals were non-Hispanic White), age-standardized rates of preterm birth were lower among non–US-born individuals compared with US-born individuals (10.2%; 95% CI, 10.2-10.3 vs 10.9%; 95% CI, 10.9-11.0) with an adjusted odds ratio (aOR) of 0.90 (95% CI, 0.89-0.90). The greatest relative difference was observed among Japanese individuals (aOR, 0.69; 95% CI, 0.60-0.79) and non-Hispanic Black individuals (aOR, 0.74; 0.73-0.76) individuals. Non–US-born Pacific Islander individuals experienced higher preterm birth rates compared with US-born Pacific Islander individuals (aOR, 1.15; 95% CI, 1.04-1.27). Puerto Rican individuals born in Puerto Rico compared with those born in US states or Washington, DC, also had higher preterm birth rates (aOR, 1.07; 95% CI, 1.03-1.12).Conclusions and RelevanceOverall preterm birth rates were lower among non–US-born individuals compared with US-born individuals. However, there was substantial heterogeneity in preterm birth rates across maternal racial and ethnic groups, particularly among disaggregated Asian and Hispanic subgroups.

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County-Level Maternal Vulnerability and Preterm Birth in the US

Cited by 14 publications

References 57 publications

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

Maternal Nativity and Preterm Birth

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