Social determinants of health and coronavirus disease 2019 in pregnancy

Prasannan, Lakha; Rochelson, Burton; Shan, Weiwei; Nicholson, Kaitlin; Solmonovich, Rachel; Kulkarni, Aparna; Lewis, Dawnette; Greenberg, Meir; Nimaroff, Michael; Blitz, Matthew J.

doi:10.1016/j.ajogmf.2021.100349

Cited by 29 publications

(49 citation statements)

References 41 publications

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“…The Northwell Health Institutional Review Board approved this study as minimal‐risk research using data collected for routine clinical practice and waived the requirement for informed consent (IRB # 20‐0890; initial approval October 22, 2020). Some patients in this study were included in previous publications characterizing SARS‐CoV‐2 in pregnancy 9,18–20 …”

Section: Methodsmentioning

confidence: 99%

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Preterm birth among women with and without severe acute respiratory syndrome coronavirus 2 infection

Blitz

Gerber

Gulersen

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Studies directly comparing preterm birth rates in women with and without severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are limited. Our objective was to determine whether preterm birth was affected by SARS‐CoV‐2 infection within a large integrated health system in New York with a universal testing protocol. Material and methods This retrospective cohort study evaluated data from seven hospitals in New York City and Long Island between March 2020 and June 2021, incorporating both the first and second waves of the coronavirus disease 2019 (COVID‐19) pandemic in the USA. All patients with live singleton gestations who had SARS‐CoV‐2 polymerase chain reaction (PCR) testing at delivery were included. Deliveries before 20 weeks of gestation were excluded. The rate of preterm birth (before 37 weeks) was compared between patients with positive and negative SARS‐CoV‐2 test results. This analysis was performed separately for resolved prenatal infections and infections at delivery, with the latter group subdivided by symptom status. Multiple logistic regression analysis was used to examine the association between SARS‐CoV‐2 infection and preterm birth, adjusting for maternal age, race‐ethnicity, parity, history of preterm birth, body mass index, marital status, insurance type, medical co‐morbidities, month of delivery, and wave of pandemic. Results A total of 31 550 patients were included and 2473 (7.8%) had laboratory‐confirmed infection. Patients with symptomatic COVID‐19 at delivery were more likely to deliver preterm (19.0%; adjusted odds ratio 2.76, 95% CI 1.92–3.88) compared with women with asymptomatic infection (8.8%) or without infection (7.1%). Among preterm births associated with symptomatic infection, 72.5% were medically indicated compared with 44.1% among women without infection (p < 0.001). Risk of preterm birth in patients with resolved prenatal infection was unchanged when compared with women without infection. Among women with infection at delivery, preterm birth occurred more frequently during the second wave compared with the first wave (13.6% vs. 8.7%, respectively; p < 0.006). However, this was not significant on multiple regression analysis after adjusting for other explanatory variables. Conclusions Pregnant women with symptomatic COVID‐19 are more than twice as likely to have a preterm delivery than patients without infection. Asymptomatic infection and resolved prenatal infection are not associated with increased risk.

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Section: Methodsmentioning

confidence: 99%

“…Some patients in this study were included in previous publications characterizing SARS‐CoV‐2 in pregnancy. 9 , 18 , 19 , 20 …”

Section: Methodsmentioning

confidence: 99%

Preterm birth among women with and without severe acute respiratory syndrome coronavirus 2 infection

Blitz

Gerber

Gulersen

et al. 2021

Acta Obstet Gynecol Scand

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“…Several studies have described the clinical characteristics related to deaths among pregnant and postpartum women due to COVID-19; [ 10 , [24] , [25] , [26] , [27] , [28] , [29] ] but few have explored how social, economic and demographic features are associated with the maternal mortality risk. [13] In this study, we describe the spatial distribution of COVID-19 cases and deaths in an obstetric population and their association with socioeconomic vulnerability. In Brazil, COVID-19 cases and deaths among pregnant and postpartum women had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside.…”

Section: Discussionmentioning

confidence: 99%

“… [8] Further, a higher risk of maternal death among SARS-CoV-2 infected pregnant women with some comorbidity [11] and certain socio-demographic characteristics, such as black ethnicity, living in a peri-urban area and also distant from the referral hospital. [ 8 , 11 , 12 ] Notwithstanding, information on how COVID-19 maternal deaths are related to social determinants of health (SDH) is still scarce, [13] particularly from low- and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study

Siqueira

Souza

Leite

et al. 2021

The Lancet Regional Health - Americas

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Background Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health. Methods This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities’ risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19. Findings A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19. Interpretation In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators. Funding None

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“…Though Hispanic women represent a disproportionate amount of the SARS-CoV-2-infected population across the country, much of the literature demonstrates disease severity similar to that of non-Hispanic white women. 3 , 10 , 12 , 18 Of the studies examining racial and ethnic disparities in SARS-CoV-2 infection in the pregnant population, the largest, a cross-sectional study of 4873 delivered pregnant patients exploring the associations with social determinants of health at large, found race and ethnicity to be associated with SARS-CoV-2 prevalence but did not find any association between race and ethnicity and disease severity. 12 Emeruwa et al, 10 in their retrospective cohort study of 100 delivered patients, similarly did not find any association.…”

Section: Racial and Ethnic Identitymentioning

confidence: 99%

Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics

Emeruwa

Gyamfi-Bannerman

Miller

2021

Clinical Obstetrics &Amp; Gynecology

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The influence of social determinants of health on disease dynamics and outcomes has become increasingly clear, making them a prime target of investigation and mitigation efforts. The obstetric population is uniquely positioned to provide insight into the health inequities exacerbated by the coronavirus disease 2019 pandemic given their susceptibility to infectious disease morbidity and frequent interactions with the health care system, which provide opportunities for ascertainment of disease incidence and severity. This review summarizes the data on disparities identified in the US obstetric population during the coronavirus disease 2019 pandemic as they relate to race and ethnicity, built environment, insurance status, language, and immigration status.

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Social determinants of health and coronavirus disease 2019 in pregnancy

Cited by 29 publications

References 41 publications

Preterm birth among women with and without severe acute respiratory syndrome coronavirus 2 infection

Preterm birth among women with and without severe acute respiratory syndrome coronavirus 2 infection

Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study

Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics

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