Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States

Lu, Michael C.; Noursi, Samia

doi:10.1089/jwh.2020.8877

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…While increasing the number of doulas and/or access to doula care could help many individual women, the systemic problems in health care would remain unaddressed. Social, structural, and environmental disparities breed inequalities in maternal health care (Lu and Noursi 2021). Individual doulas cannot fix the larger problems of racism, classism, and gender inequality that pervade health care systems.…”

Section: Discussionmentioning

confidence: 99%

“…The United States has an alarmingly high maternal mortality rate for an industrialized nation, and rates are highest among racial minorities (Peterson et al 2019). In addition, racial disparities in maternal morbidity persist, increasing pressure on hospitals and obstetricians to adopt more standardized methods of care (Debbink et al 2022; Lu and Noursi 2021). This leads to frequent debates about best practices.…”

Section: Literature Reviewmentioning

confidence: 99%

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Walking That Fine Line: Doulas as Overseers of Evidence-based Practice

Henley

2022

Sociological Perspectives

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Doulas provide individualized support during labor and childbirth. Research has consistently shown that having doulas support increases positive physical and psychological outcomes. Professional medical organizations have begun to recognize the evidence showing the positive effects of doula support. Even though professional organizations recommend doulas to reduce non-medically indicated treatments such as overuse of cesarean delivery, many practitioners uphold their authority to intervene as they see necessary. I utilize interviews with 25 doulas to explore how doulas use scientific evidence to ensure that women receive appropriate care. Results indicate that doulas do not think that many obstetricians follow evidence-based practices; doulas feel compelled to serve as overseers who remind medical staff about the clinical guidelines. In addition, doulas use evidence to prepare mothers to confront providers. I argue that while doulas can help close gaps, obstetric medicine needs to implement evidence-based strategies more systemically to improve care for all women.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Walking That Fine Line: Doulas as Overseers of Evidence-based Practice

Henley

2022

Sociological Perspectives

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“…As studies, shows the occurrence of those complications is more likely frequent in areas with difficult socio-economic conditions. Furthermore, controlling the risk factors remains a challenging subject, in addition to every maternal death, 20 or 30 women's suffer from acute or chronic morbidity pregnancy-related (2) and the main cause remains the lack of primary prevention strategies for most pregnancy complications (5).…”

Section: Introductionmentioning

confidence: 99%

Pregnancy morbidity: Situation and determinants in the province of Essaouira - Morocco-

et al. 2021

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Pregnancy-related morbidity is a public health problem. The main aim of this study is to assess the prevalence of maternal morbidity among childbearing women in Essaouira province (Morocco) and to determine the associated factors. A cross-sectional descriptive and analytical study conducted by questionnaire, surveyed 1184 married women aged between 18 to 49 years. The prevalence of pregnancies morbidity is 55.9% (662/1184). The mains determinants identified is sexually transmitted infections (STIs) with 50.1% and anaemia with 45.8%. Also, based on the multinomial logistic regression model, the socio-economic level, antenatal care regularity and precocity, pregnancies risks knowledge, distance from health care facilities and place of residence determine the pregnancies morbidity independently. In conclusion, Morocco must address family living conditions, health education, literacy, and other social determinants of health.

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“…[1][2][3][4][5][6][7] Taken together, these adverse pregnancy outcomes are the leading causes of pregnancy morbidity and mortality. [8][9][10][11] The pathophysiology leading to these adverse pregnancy outcomes remains uncertain. One contributing factor may be cumulative stress.…”

mentioning

confidence: 99%

“…1–7 Taken together, these adverse pregnancy outcomes are the leading causes of pregnancy morbidity and mortality. 8–11…”

mentioning

confidence: 99%

Allostatic Load and Adverse Pregnancy Outcomes

Lueth

Allshouse²,

Blue³

et al. 2022

Obstetrics &Amp; Gynecology

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OBJECTIVE:To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. METHODS:This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes.RESULTS: Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA.CONCLUSION: High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.

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Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States

Cited by 13 publications

References 26 publications

Walking That Fine Line: Doulas as Overseers of Evidence-based Practice

Walking That Fine Line: Doulas as Overseers of Evidence-based Practice

Pregnancy morbidity: Situation and determinants in the province of Essaouira - Morocco-

Allostatic Load and Adverse Pregnancy Outcomes

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