The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes

Janević, Teresa; Lieb, Whitney; Ibroci, Erona; Lynch, Jezelle; Lieber, Molly; Molenaar, Nina M.; Rommel, Anna‐Sophie; Witte, Lotje D. De; Ohrn, Sophie; Carreño, Juan Manuel; Krammer, Florian; Zapata, Lauren B.; Snead, Margaret C.; Brody, Rachel; Jessel, Rebecca H.; Sestito, Stephanie; Adler, Alan D.; Afzal, Omara; Gigase, Frederieke; Missall, Roy; Carrión, Daniel; Stone, Joanne; Dolan, Siobhan M.; Howell, Elizabeth A.

doi:10.1016/j.ajogmf.2022.100649

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Our results suggest that the stress associated with these health determinants is a significant culprit in elevating risk for shorter gestation, in addition to the SDoH themselves. The findings corroborate recent reports of increased risk for preterm birth in communities faced with structural disadvantage, more severe COVID‐19 related impacts, and distress (Janevic et al., 2021, 2022; Khoury et al., 2022). Social determinants of health appear to matter not only because of their inherent disadvantages (e.g., lower access to quality care) but also because they heighten prenatal stress, which can wear down or weather the body, especially when stress is chronic and compounded by a lifetime of stress exposure (Forde et al., 2019; Holzman et al., 2009; Love et al., 2010).…”

Section: Discussionsupporting

confidence: 90%

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID‐19 pandemic

Preis

Wang

Zhu

et al. 2023

Social & Personality Psych

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During the COVID‐19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID‐19 pandemic. To examine these processes, we used a longitudinal cohort of 2473 women pregnant during the COVID‐19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID‐19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under‐resourced and marginalized communities.

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Section: Discussionsupporting

confidence: 90%

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID‐19 pandemic

Preis

Wang

Zhu

et al. 2023

Social & Personality Psych

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“…Recent publications have attempted to understand how existing structures of socioeconomic inequality, as well as pandemic-related social and economic stressors, in uence SARS-CoV-2 infection during pregnancy and adverse birth outcomes. [13] In this New York City study, structural racism and community unemployment were associated with SARS-CoV-2 infection and preterm birth. In Brazil, socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the pandemic, with disproportionately adverse in states and municipalities with greater vulnerability socioeconomic.…”

Section: Discussionmentioning

confidence: 75%

Maternal and perinatal outcomes associated with COVID-19 among pregnant and postpartum women in public and private hospitals in Brazil

Arlindo

Souza

Costa

et al. 2022

Preprint

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Introduction Brazil is a country of continental dimensions with a great challenge to ascertain adequate healthcare throughout regions. The country registered increased numbers of maternal deaths and adverse perinatal outcomes in pregnant and postpartum women with COVID-19 infection, rising great concern. There is scarce data on findings among public versus private settings. Objective to compare maternal and perinatal outcomes in pregnant and postpartum women with SARS-CoV-2 infection, among admissions in public and private maternity hospitals during a period before vaccination. Study Design Secondary analysis of the REBRACO initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed COVID-19 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. In addition, clinical, laboratory findings and maternal and perinatal outcomes were compared in both groups. The prevalence ratio (PR) and its 95%CI for each predictor and outcome were calculated. Results Of 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) women in public hospitals and 76 (27.3%) women in private hospitals. SARS-CoV-2 infection frequency was not significantly different among groups. Women treated at public hospitals had lower schooling (p < 0.001), and half of them declared that their pregnancy was not planned. There were 13 maternal deaths among women treated at public services and no maternal deaths among pregnant women treated at private hospitals (p-value – 0,024). Pregnant women in public hospitals had higher rates of fever (p-value – 0,041), tachypnea (p-value – 0,003), abnormal laboratory findings in liver enzymes (p-value – 0,005), severe acute respiratory syndrome SARS (p-value 0.014) and their neonates presented more neonatal respiratory distress (p-value – 0,020). Conclusion Adverse maternal and perinatal outcomes were worse in the public hospital group with increased rates of severe acute respiratory syndrome and neonatal respiratory distress. The alarming difference between the number of deaths in patients treated in the public and private sector calls attention to the need to better understand the differences in access to health and other delays experienced by patients of different social levels.

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“…The Generation C cohort represents a large diverse prospective cohort of pregnant persons recruited in one of the pandemic epicenters: New York City (NYC). Interim analyses on the effect of SARS-CoV-2 infection on various pregnancy outcomes in this cohort failed to reveal any associations ( Janevic et al, 2022 ; Molenaar et al, 2022 ). In the current study, we (1) investigated the effect of antenatal SARS-CoV-2 infection on gestational age at delivery and birthweight in the entire cohort of more than 2000 patients.…”

Section: Introductionmentioning

confidence: 72%

SARS-CoV-2 infection, inflammation and birth outcomes in a prospective NYC pregnancy cohort

Gigase,

Jessel,

Kaplowitz

et al. 2024

Journal of Reproductive Immunology

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The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes

Cited by 9 publications

References 37 publications

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID‐19 pandemic

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID‐19 pandemic

Maternal and perinatal outcomes associated with COVID-19 among pregnant and postpartum women in public and private hospitals in Brazil

SARS-CoV-2 infection, inflammation and birth outcomes in a prospective NYC pregnancy cohort

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