“If I knew what was going on with me, then I probably wouldn’t feel so sad or scared”: A CBPR Study Addressing Health Disparities for Black Pregnant Women

Objectives: Breastfeeding reduces the risk of breast cancer, particularly triple negative breast cancer. Yet black women, who are at greater risk of developing triple negative breast cancer, are the least likely racial group to breastfeed. Little is known about black women's knowledge of the link between breast cancer and breastfeeding. Given the link between BC and breastfeeding, among other benefits to breastfeeding, it is critical to understand why black women are the least likely racial group to breastfeed. The current study was designed to describe pregnant women's knowledge of the breastfeeding and breast cancer link and other psychosocial variables among three racial/ethnic groups (black, white and Hispanic). It is hypothesized that pregnant black women will have lower knowledge about the benefits of breastfeeding, including knowledge about the link between breastfeeding and breast cancer than either white or Hispanic women. It is further hypothesized that, compared to other racial groups, black women will have lower intentions to breastfeed, poorer attitudes toward breastfeeding, lower self-efficacy, and lower levels of social influence/support to breastfeed. Methods: This research study was Institutional Review Board-approved and conducted in accordance with prevailing ethical principles. Pregnant women 18 years or older (N=93; 48.4% black; 28.0% Hispanic) were recruited during a prenatal visit at the OB/GYN practice of an urban hospital. The practice primarily serves underinsured women. The one-time, anonymous self-report survey was comprised of questions that captured each participant's socio-demographic information such as age, race/ethnicity, education level and income as well as their breastfeeding knowledge, intentions, attitudes, and social influences (i.e., baby's father, maternal/paternal grandmother opinion and preference for infant feeding). Results: Less than 40% of both black and white women were aware of the relationship between breastfeeding and breast cancer risk reduction, in comparison to 64.7% of Hispanic women. The opinions of the baby's father and their doctor about breastfeeding were regarded the most important to black women. Contrary to our hypotheses, all women reported high intentions to breastfeed but most women indicated that they intended to breastfeed for less than 12 months. Black women also had the highest levels of positive breastfeeding attitudes and self-efficacy. Conclusions: The benefits of breastfeeding for long-term maternal health such as reduced risk of BC, including triple negative breast cancer in black women, have been documented in the literature; yet black women are least likely to breastfeed. The current study demonstrates that women have low knowledge about the link between BC and breastfeeding, particularly black and white women. These findings support the need for targeted interventions educating black women about the protective benefits of breastfeeding, particularly breast health, as a strategy to reduce their incidence and mortality of breast cancer. Despite our hypotheses, black women had higher rates of self-efficacy, breastfeeding attitudes, breastfeed intent, and medical mistrust. Future research efforts need to further explore why black women have the lowest breastfeeding rates, yet high rates of intentions, self-efficacy and attitudes about breastfeeding. Citation Format: Jamilia Sly, Sarah Miller, Rhoda Sperling, Fahimeh Sasan, Holly Loudon, Elizabeth Howell, Lina Jandorf. Racial/ethnic differences in pregnant women's knowledge of the relationship between breast cancer risk and breastfeeding. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B60.

Background: Significant advancement has been made in breast cancer care, resulting in improved outcomes, largely due to enhanced screening and targeted management. However, these benefits are not equally distributed across all population subgroups. Factors such as genetics, access to healthcare, racial identity, social determinants of health, education, and clinical trial enrollment opportunities all contribute to persistent disparities in breast health. This study aims to compare female breast cancer incidence, mortality, and 5-year survival rates based on age, race, and stage at diagnosis. Method: Data were extracted from the SEER 22 registries database, focusing on age, stage at diagnosis, and race. Rates are per 100,000 and age-adjusted to the 2000 US Standard Population (19 age groups - Census P25-1130). Mortality data was sourced from U.S. Mortality Data (1969-2022), National Center for Health Statistics, CDC. We compared incidence, mortality, and 5-year survival rates across different racial groups and age categories. Results: The incidence rate in Hispanic women was 101.2 (100.5-101.9), in Black women was 129 (128.3-130.3), and in White women was 139.0 (138.5-139.4). The rate for localized breast cancer was 60.7 (60.2-61.2), 74.1 (73.3-74.8), and 93.7 (93.3-94.1) in Hispanic, Black, and White women, respectively. The rate for distant breast cancer was 6.4 (6.2-6.5), 11.5 (11.2-11.8), and 7.5 (7.4-7.6) in Hispanic, Black, and White women, respectively. The incidence rate in women aged 15-39 years was 19.8 (19.4-20.3), 27.2 (26.4-28.0), and 24.3 (23.9-24.7), and for ages 40-64 years was 175 (174.2-177.3), 218.4 (216.1-220.7), and 234.5 (233.3-235.7) for Hispanic, Black, and White women respectively. For women aged more than 75 years, the incidence was 291.6 (286.0-297.4), 408.8 (401.0-416.7), and 454.8 (451.8-457.8) for Hispanic, Black, and White women, respectively. The mortality rate was 13.7 (13.5-13.9), 26.8 (26.5-27.1), and 19.4 (19.3-19.5) in Hispanic, Black, and White women respectively. For ages 15-39 years, the mortality rate was 1.8 (1.7-1.9), 3.8 (3.6-4.0), and 2.0 (1.9-2.1). For ages 40-64 years, the mortality rate was 17.8 (17.4-18.2), 37.1 (36.4-37.7), and 22.7 (22.5-22.9). For ages 65-74 years, the mortality rate was 43.4 (42.0-44.9), 85.0 (83.2-87.0), and 63.3 (62.6-63.9) in Hispanic, Black, and White women, respectively. The 5-year survival rates (%) for Hispanic, Black, and White women were 88.4 (88.1-88.7), 83.8 (83.4-84.3), and 93.0 (92.8-93.1) respectively. Age- and race-adjusted 5-year survival rates were as follows: for ages 15-39, 84.6% (83.5-85.6) for Hispanic, 79.7% (78.3-81.0) for Black, and 89.1% (88.5-89.7) for White women. For ages 40-64, 89.4% (89.1-89.8) for Hispanic, 84.6% (84.1-85.1) for Black, and 93.4% (93.2-93.6) for White women. For ages 65-74, 91.2% (90.4-91.9) for Hispanic, 86.3% (85.3-87.2) for Black, and 94.4% (94.1-94.7) for White women. For ages 75 and over, 79.7% (78.0-81.3) for Hispanic, 78.7% (76.7-80.5) for Black, and 90.6% (90.0-91.2) for White women. Conclusion: White women had the highest incidence rate of breast cancer, followed by black and Hispanic women. Localized breast cancer incidence was highest in white women, while distant breast cancer incidence was highest in black women. Young black women (ages 15-39) had the highest incidence rates for their group. Mortality rates were highest among black women across all age groups. Overall and age-adjusted 5-year survival rates were lowest for black women, followed by Hispanic and white women. Citation Format: Navneet Kaur. Comparative Analysis of Female Breast Cancer: Incidence, Mortality, and 5-Year Survival Rates Across Races and Diagnosis Stages in Different Age Groups [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-04-12.

Objective: This study examined the extent to which stigma-related concerns about mental health care account for the underuse of mental health services among low-income immigrant and U.S.-born black and Latina women. Methods: Participants included 15,383 low-income women screened for depression in county entitlement services who were asked about barriers to care, stigma-related concerns, and whether they wanted or were getting mental health care. Results: Among those who were depressed, compared with U.S.-born white women, each of the black groups were more likely to report stigma concerns (African immigrants, odds ratio [OR]=3.28, p=.004; Caribbean immigrants, OR=6.17, p=.005; U.S.-born blacks, OR=6.17, p=.06). Compared with U.S.-born white women, immigrant African women (OR=.18, p

921 How do birth outcomes in black hispanic women compare to other racial/ethnic groups?

Black women suffer from a persistent disparity in breast cancer mortality after controlling for prognostic and sociodemographic factors, suggesting that differential receipt or efficacy of treatment may contribute to their poorer outcomes. Black women are more likely to experience delays in diagnostic workup and initiation of treatment, but it is not known whether i) timeliness of subsequent care is also impacted, and ii) racial disparities in time to treatment initiation and completion persist among black and white women with comparable clinical and sociodemographic characteristics. The Carolina Breast Cancer Study Phase III is a large population-based cohort of North Carolina women newly diagnosed with breast cancer. This study was restricted to black and white women undergoing surgery for the treatment of nonmetastatic disease. We investigated mean differences in the distribution of time from diagnosis to earliest surgery, chemotherapy, or radiation treatment (treatment initiation) and once started, time to treatment completion (treatment duration) by race. Only treatment-oriented surgeries excluding biopsies were included in this analysis, and last or definitive surgery was defined as the final treatment-oriented surgery occurring prior to recurrence and within 18 months of diagnosis. Cumulative incidence curves were used to graphically examine the distributions of time to treatment initiation and treatment duration, and general linear models were used to estimate crude and adjusted mean differences in time to treatment initiation and duration between black and white women. We also conducted stratified analyses to examine racial disparities by age and stage at diagnosis, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) positivity, treatment pathway (surgery only, surgery plus chemotherapy, surgery plus radiation, or all three modalities), marital status, education level, income, and insurance type. A total of 1,328 black and 1,331 white women met study inclusion criteria. Overall, black women had an average of 3.68 additional days to treatment initiation and 34.26 days longer treatment duration than white women, for 37.94 days longer total treatment time (95% confidence interval (CI): 34.21-41.67). Adjustment for clinical and sociodemographic factors resulted in a greater estimated mean difference in time to initiate treatment (4.04 days, 95% CI: 3.08-5.00), while it attenuated the mean difference in treatment duration towards the null (9.07 days, 95% CI: 6.82-11.32). Black women experienced significantly longer time to initiate treatment and treatment duration in nearly every stratum of clinical or sociodemographic factor examined. Black women with stage II or III tumors had significantly longer time to initiate treatment than white women (4.50 and 7.84 days, respectively), and after starting treatment, treatment duration was approximately 25 days longer for black women with stage I and II disease. Black women undergoing radiation and/or chemotherapy had longer time to initiate treatment and significantly longer treatment durations. Having a college education or higher or being insured through Medicaid were associated with the greatest mean differences in time to treatment initiation comparing black and white women. Younger age at diagnosis, HR+ or HER2- disease, being unmarried, having less than a high school education, and being uninsured were associated with the greatest mean differences in treatment duration by race. Overall, black women experienced longer intervals between diagnosis and treatment initiation and greater treatment durations after controlling for clinical and sociodemographic factors. Racial disparities were more pronounced in examination of treatment duration, suggesting that interventions to improve care coordination and timeliness should be targeted at high-risk groups. Citation Format: Sophie E. Mayer, Melissa Troester, Stephanie B. Wheeler, Andrew Olshan, Lisa A. Carey, Jessica Tse, Katherine E. Reeder-Hayes. Temporal patterns of breast cancer treatment initiation and completion among black and white women in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr PR11.

Black women have higher morbidity and mortality in pregnancy and postpartum, as compared with women of other races/ethnicities, including white and Hispanic women. Pregnancy-associated deaths are rising in the USA and are higher than in other developed nations. Pregnancy-associated mortality rates are disproportionately higher among non-Hispanic black women. The purpose of this paper is to (1) review the current literature regarding pregnancy-associated cardiovascular disease prevalence in black women compared with women of other races/ethnicities, (2) review proposed factors contributing to these health disparities, and (3) discuss potential avenues to address these disparities in the name of reproductive justice. There is a paucity of data regarding factors contributing to disparities in health among black pregnant women, but it is clear that these cannot be fully explained by differences in socioeconomic backgrounds, access to health insurance, or healthcare literacy. Additionally, although some cardiovascular-related pregnancy mortality etiologies such as hemorrhage, pulmonary embolism, and hypertensive disorders of pregnancy are decreasing in incidence, other pregnancy-associated cardiovascular diseases and cardiomyopathy rates are increasing. Although the pathophysiology behind peripartum cardiomyopathy is still unclear, its prevalence is high among black women. Studies are lacking probing the influence of psychosocial factors on patient-provider relationships and patient-centered decision-making among black women during pregnancy and postpartum. Black women disproportionately experience higher pregnancy-related cardiovascular morbidity and mortality compared with white women. More studies are needed to fill the gap in the literature data regarding the causes of this significant health disparity. A better understanding of the various factors driving these maternal health disparities could inform the development of holistic, multifaceted approaches to caring for black women in pregnancy and postpartum. Continued dialog—among healthcare professionals, patients, and their allies—is important to promote advocacy and to improve patient-provider relationships.

Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black, and Hispanic women

Eliminating disparities in endometrial cancer: adherence to high-quality care is not enough

Background: Non-Latina Black (black) women, despite their lower BC incidence, are more likely to die from breast cancer compared to their nL White (white) counterparts. While differential access to care, comorbidities and BC aggressiveness are potential contributors to this difference, the potential impact of HMD on this disparity has rarely been explored. For example, nL black women are disproportionately diagnosed with more aggressive tumors that lack estrogen and progesterone receptors (ER and PR) and that are high grade. Therefore, if the association of HMD with breast cancer incidence varied by tumor subtype this could have implications for disparities in breast cancer aggressiveness and subsequent outcomes. Most of the conclusions establishing high mammographic breast density (HMD) as a risk factor for increased breast cancer incidence are derived from studies conducted primarily in whites, which jeopardizes generalizability. We sought to estimate the association between HMD and breast cancer incidence separately for white and black women and by tumor subtype, using data from a single, large healthcare organization. Methods: We used data from screening mammograms performed in women ages 18-100, between 2001 and 2010, probabilistically linked to incident BC cases recorded in the Illinois State Cancer Registry (ISCR) during 2001-2011. Each screening mammogram received a breast density score from the interpreting radiologist using the American College of Radiology Breast Imaging Reporting and Data System (BIRADS 1-4), defined as fatty (BIRADS 1), scattered fibroglandular (BIRADS 2), heterogeneously dense (BIRADS 3) or extremely dense (BIRADS 4). A mean BIRADS breast density score was calculated using available scores from both breasts at each exam. The mean was dichotomized as high (mean BIRADS score > 2.5) versus low (mean BIRADS score ≤2.5) and the dichotomous variable was modeled in logistic regression with generalized estimating equations (to account for multiple screens per woman) to estimate the association between breast density and the probability of a breast cancer diagnosis within 12 months of the screen. Models included age, race, family history, parity and exam year as covariates, and separate models were estimated for black and white women. Odds ratios were interpreted as rate ratios (RR) due to the rarity of the outcome (<1%). Model-based standardization (predictive margins) was use to estimate adjusted rate differences from the logistic regression models. Results: Included in this analysis were 616,466 screens on 201,348 white or black women during 2001-2010, and 4,104 BC in 3,706 women during 2001-2011 (overall rate of 6.7 per 1000 screens, 6.7 for whites and 6.5 for blacks, p=0.21). There were disparities in the distribution of tumor subtypes: breast cancers diagnosed in black women were more likely to be ER negative (23% vs. 15%, p<0.0001) and high grade (38% vs. 30%, p<0.0001) when compared to white women. Upon adjustment for age, family history, parity and exam year, HMD was associated with increased breast cancer incidence overall (RR=1.24, 95% CI: 1.16, 1.32, equivalent to an adjusted Rate Difference of 1.4 per 1000 screens). The association between HMD and breast cancer incidence was similar for whites (RR=1.26, 95% CI: 1.16, 1.36) and blacks (RR=1.19, 95% CI: 1.05, 1.34) and similar for ER positive (RR=1.23, 95% CI: 1.15, 1.31) and ER negative breast cancer (RR=1.29, 95% CI: 1.16, 1.45). HMD was modestly associated with incidence of low grade (RR=1.26, 95% CI: 1.12, 1.41), and moderate grade (RR=1.18, 95% CI: 1.08, 1.29) tumors, but more strongly associated with incidence of high grade tumors (RR=1.45, 95% CI: 1.30, 1.61). These RRs translated into adjusted Rate Differences of 0.4, 0.4 and 0.8 breast cancers per 1000 screens, respectively. Discussion: Our findings reiterate high breast density as a risk factor for breast cancer incidence. In addition, we found that the association was of roughly equal magnitude among white and black women, and of roughly equal magnitude for ER negative and ER positive tumors. The stronger association of HMD with high grade tumors, however, implies that HMD may be a more detrimental risk factor for black women who are more likely to experience higher grade tumors than white women. Citation Format: Katherine Y. Tossas-Milligan, Firas Dabbous, Garth Rauscher. Is the influence of high mammographic breast density on breast cancer incidence the same for non-Latina black and white women? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C43.

The objective of this was to determine whether the change in hemoglobin A1c (HbA1c) from early to late pregnancy differs between non-Hispanic Black and White women with prepregnancy diabetes. A retrospective analysis was performed from an integrated prenatal and diabetes care program from 2012 to 2016. We compared HbA1c as a continuous measure and secondarily, HbA1c <6.5%, cross-sectionally, and longitudinally in early (approximately 10 weeks) and late (approximately 31 weeks) pregnancies. Linear and logistic regression were used and adjusted for age, body mass index, White diabetes class, medication use, diabetes type, gestational age at baseline HbA1c measurement, and baseline hemoglobin. Among 296 non-Hispanic Black (35%) and White pregnant women (65%) with prepregnancy diabetes (39% type 1 and 61% type 2), Black women were more likely to experience increased community-level social determinants of health as measured by the Social Vulnerability Index (SVI) and were less likely to have type 1 diabetes and have more severe diabetes versus White women (p < 0.05). Black women had higher mean HbA1c (7.8 vs. 7.4%; beta: 0.75; 95% confidence interval [CI]: 0.30-1.19) and were less likely to have HbA1c < 6.5% at 10 weeks compared with White women (24 vs. 35%; adjusted odds ratio: 0.45; 95% CI: 0.24-0.81) but not after adjusting for SVI. At 31 weeks, both groups had similar mean HbA1c (both 6.5%) and were equally as likely to have HbA1c < 6.5% (57 vs. 54%). From early to late pregnancy, Black women had a higher percentage decrease in HbA1c (1.3 vs. 0.9%; beta = 0.63; 95% CI: 0.27-0.99) and were equally as likely to have an improvement or stable HbA1C < 6.5% from 10 to 31 weeks, with both groups having a similar mean HbA1c (6.5%) at 31 weeks. Despite experiencing greater community-level social determinants of health, Black women with pregestational diabetes had a larger reduction in HbA1c and were able to equally achieve the target of HbA1c < 6.5% by late pregnancy compared with White women as part of an integrated diabetes and prenatal care program. · An integrated diabetes and pregnancy care program may decrease racial and ethnic disparities in glycemic control.. · Black women had a larger reduction in HbA1c versus White women.. · Black women were able to equally achieve the target of HbA1c < 6.5% by late pregnancy versus White women..

In the United States, the rate of cervical cancer is disproportionally higher in Hispanic and Black women compared with White women. In the current study, the authors compared human papillomavirus (HPV) testing and cytology results among Black and White women over a 24-month period. They then assessed the rates in young women in 2011 compared with 2017 according to race. The authors searched the gynecologic cytology case files for Black and White women treated at Johns Hopkins Hospital across all ages for a period of 24 months (2017-2019) and compared HPV results and cytologic interpretations. They then compared results among Black and White cohorts of young women (aged 21-29 years) in 2011 versus 2017. A total of 26,302 specimens from January 2017 to January 2019, including 11,676 Black women and 14,626 White women, were reviewed. The most common HPV genotype(s) detected were non-HPV-16 and/or HPV-18 (non-16/18) high-risk HPV (hrHPV) (84% of positive results). Non-16/18 hrHPV was more common in Black women (1309 women; 15%) compared with White women (1075 women; 9%). Non-16/18 hrHPV was more commonly observed in association with atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion and/or high-grade squamous intraepithelial lesion (ASC-H/HSIL) in HPV-positive Black women compared with White women (P=.007). Black women were found to have higher rates of HPV-positive Papanicolaou results and high-grade lesions, including carcinoma (P<.01). In the 2011 cohort, young Black women were found to have a higher rate of ASC-H/HSIL (P=.003) compared with White women. However, the difference was not noted in the 2017 cohort. There was a decrease in ASC-H/HSIL in 2017 compared with 2011, with a lower incidence of ASC-H/HSIL noted among Black women in 2017. Black women appear to have a higher incidence of higher grade lesions, but the difference between Black and White cohorts was not found to be significant in young women in more recent years.

Obesity is defined as a body mass index (BMI) ≥30 kg/m2. Forty-three percent of women of childbearing age are obese, with a greater prevalence noted in Black women. Obesity increases the risk of diabetes (Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM)). Obesity and diabetes are chronic states of overnutrition and metabolic dysregulation, each associated with an increased risk of macrosomia (large weight for gestational age in offspring). Macrosomia not only increases pregnancy complications but also increases the risk of metabolic disorders throughout the lifespan of the offspring. Fetal growth in utero is mediated by the nutritional environment and nutritional transport across the placenta. Maternal-fetal nutrient transport is primarily mediated by placental transporters for glucose, amino acids, free fatty acids, and cholesterol in the syncytiotrophoblast of the placenta. Yet, the mechanistic pathway driving fetal overgrowth in environments of overnutrition are not well defined. Therefore, we will test the hypothesis that diabetes (T2DM or GDM) exacerbates placental nutrient transport and fetal overgrowth in Black pregnant women with obesity. To evaluate the combined influence of obesity and diabetes (T2DM or GDM) on fetal growth, we evaluated n=100 electronic medical records of Black obese women with and without diabetes (T2DM or GDM) from 2012-2022 at the University of Mississippi Medical Center (UMMC). These women were singleton pregnancies with no additional underlying conditions. Gestational age of offspring and maternal age were similar among all groups. This study was approved by the Institutional Review Board at UMMC (IRB-UMMC-2021-0455). We found that Black obese women with diabetes (n=43) had higher BMIs compared to Black women with obesity alone (n=57) (43.50 ± 4.76 kg/m2 vs. 39.19 ± 3.48 kg/m2) (p&lt;0.05), indicating that obesity increases risk of diabetes in Black pregnant women. Additionally, offspring from Black obese women with diabetes had elevated birthweight compared to offspring from women with obesity alone (3345 ± 614.6 g vs. 3099 ± 465.4 g; p&lt;0.05). Male offspring from Black obese women with diabetes had elevated birthweight (3460 ± 695.8 g) compared to female offspring from Black obese women without diabetes (3068 ± 439.8 g) (p&lt;0.05), suggesting the maternal nutritional environment influences males more than females. Yet, the type of diabetes, T2DM or GDM, did not influence birthweight in offspring from Black obese women (T2DM: 3412 ± 743.5 g vs GDM: 3271 ± 439.7 g). To evaluate the influence of obesity plus diabetes on placental nutrient transport, we measured placental protein expression of glucose transporter-1 (Glut-1), a primary glucose transporter in the placenta, in a separate subset of placental tissue from Black obese women with and without diabetes (IRB-UMMC-2019-0058). Protein expression of Glut-1 was increased in placental tissue from Black women with obesity and diabetes (n=4) compared to Black women with obesity alone (n=4) (20.38 ± 5.87 A.U. vs. 9.41 ± 1.46 A.U.; p&lt;0.05). However, BMI was elevated in the group of women with obesity and diabetes compared to obesity alone (49.565 ± 1.39 kg/m2 vs. 43.44 ± 2.44 kg/m2; p&lt;0.05), again indicating that obesity increases risks of diabetes in Black pregnant women. This study indicates that combined obesity with diabetes during pregnancy is associated with increased birthweight and placental protein expression of Glut-1. Additional studies are warranted to decipher the separate influences of elevated BMI and diabetes on fetal growth, along with the associated placental mechanisms that influence nutrient transport and fetal growth in pregnancies complicated by obesity and diabetes. UMMC Department of OBGYN. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

PURPOSE: Women with endometriosis have a 2 to 3-fold greater risk of endometrioid and clear cell ovarian cancer than other women, based on estimates from studies predominantly of White women. Fibroids have not been consistently associated with ovarian cancer risk but are the most common indication for hysterectomies in the U.S. Hysterectomy has been associated with lower ovarian cancer risk in subgroups of women including those with fibroids; thus fibroids may indirectly impact ovarian cancer risk. We evaluated the association of endometriosis and fibroids with ovarian cancer risk among Black and White women, taking into consideration the impact of hysterectomy. METHODS: We used data from six studies in the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium. Participants included 2,995 Black women and 5,281 White women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between endometriosis and fibroids with ovarian cancer risk, overall, by race, and stratified by histotype. We also assessed effect modification by hysterectomy. RESULTS: Overall the prevalences of endometriosis and fibroids were 6.4% and 43.2% among Black women and 7.0% and 21.5% among White women, respectively. Endometriosis was associated with an increased risk of endometrioid and clear cell ovarian cancer in Black and White women. Among Black women the association was strongest for endometrioid tumors (OR=7.06; 95% CI=3.86-12.91) compared to White women (OR=2.17; 95% CI=1.36-3.45) with a significant difference by race (phetereogeneity=0.003). When stratified by hysterectomy the association between endometriosis and ovarian cancer risk in White women was stronger in those who did not report a hysterectomy. However, in Black women, the elevated risk of ovarian cancer among women with endometriosis was present among those with and without hysterectomy. Fibroids were associated with a slightly elevated risk of ovarian cancer in Black (OR=1.34; 95% CI=1.11-1.62) and White women (OR=1.22; 95% CI=1.05-1.41). For both groups, the association was present only in those who did not report a hysterectomy. Black women who had a history of fibroids and no hysterectomy had a 53% greater odds of ovarian cancer (95% CI=1.23-1.89) compared to those without fibroids, while there was no association with fibroids in the hysterectomy group (OR=0.92, 95% CI=0.62-1.36) (pinteraction=0.05). A similar pattern was observed among White women, but the interaction was not significant (pinteraction=0.21). CONCLUSION: Both Black and White women with endometriosis had a higher risk of ovarian cancer, and hysterectomy modified this association only among White women. Fibroids were associated with modestly increased risk of ovarian cancer among Black and White women, with hysterectomy modifying the risk in both groups. Further research is needed to understanding how racial differences in diagnoses of these conditions, and differential access to care and treatment options, impact or modify ovarian cancer risk. Citation Format: Holly Harris, Lauren Peres, Courtney Johnson, Kristin Guertin, Alicia Beeghly-Fadiel, Elisa Bandera, Traci Bethea, Charlotte Joslin, Anna Wu, Patricia Moorman, Heather Ochs-Balcom, Jessica Petrick, Veronica Setiawan, Lynn Rosenberg, Joellen Schildkraut, Evan Myers. Racial differences in the association of endometriosis and fibroids with risk of ovarian cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C105.

BackgroundVitamin D deficiency is a growing public health problem, with pregnant women being particularly vulnerable due to its influences on maternal and neonatal outcomes. However, there are limited data published about mediators of vitamin D status in Louisiana women. We aimed to assess the vitamin D status and its determinants among low-income pregnant and non-pregnant reproductive-aged women from southeast Louisiana.MethodsThis study was conducted using data from the Gulf Resilience on Women’s Health (GROWH) research consortium cohort of pregnant and non-pregnant women which contained sociodemographic and dietary variables as well as blood and salivary element concentrations. Serum 25-hydroxy vitamin D was measured using an enzyme-linked immunosorbent assay in 86 pregnant and 98 non-pregnant women with an even distribution of race in both groups.ResultsThe prevalence of deficient vitamin D levels in the total cohort (184 women) was 67% and the mean 25(OH) vitamin D3 was 24.1 ng/mL (SD 10.7). Self-identifying as White, being pregnant, autumn season, young age and high exposure to tobacco smoke measured by cotinine were significantly associated with higher serum levels of vitamin D. Visiting Women and Infant clinics (WIC) was an important determinant in improving 25(OH) vitamin D3 levels for Black women but not for White women and concentrations varied more among Black women across seasons compared to White women.ConclusionsSerum vitamin D levels are inadequate among a high proportion of Black and White low-income pregnant and reproductive-aged women living in Southeast Louisiana who were enrolled in the GROWH study. Black women who are over 35 years old and non-WIC participants constitute the subpopulation most at risk for vitamin D deficiency, especially during the winter. As an overall higher level of deficiency exists in Black women, if even small behavioral and dietary modifications are produced by WIC, this can lead to a comparatively greater improvement in vitamin D status in women from Southeast Louisiana who self-identify as Black.

Pregnancy-related maternal morbidity and mortality disproportionately affect Black women more than their White counterparts. Black pregnant women are more likely to omit or engage in prenatal care late than White women. Social media is an essential source of pregnancy-related information and shows it effectively improves pregnancy knowledge. Greater than 80% of Black women own a mobile device, and some data demonstrate that Black women use social media for pregnancy-related information. However, little is known about social media use during pregnancy for this population. Several gaps exist about what maternal health content is available on social media, how Black women use social media during pregnancy, and what factors influence their social media use behaviors. It is vital to explore how this tool can be utilized to address knowledge gaps and promote equitable maternal health among Black women. This dissertation sought to fill these gaps by conducting a content analysis of maternal health Instagram posts from three popular parenting accounts (Aim 1) and doing a cross-sectional survey of Black women who were pregnant or gave birth within a year to (1) assess whether health literacy or eHealth literacy influenced their social media to use patterns (Aim 2) and (2) examine whether prenatal care quality (precisely the quality of guidance and support and respect) impacted how they use social media (Aim 3). Aim 1 results suggest that maternal health and Black maternal health topics are rarely posted on popular parenting Instagram accounts. Aim 2 analyses indicate that Black women use social media and share pregnancy information and obtain support. Black birthing women with low health literacy used social media more and obtained support from social media. Women with higher health literacy reported sharing information found online with others more. Those with higher eHealth literacy were more likely to use social media, share pregnancy information found on social media with others, and use social media for support. Aim 3 found that the quality of guidance and the quality of support and respect delivered during prenatal care were scored as good. Black women who reported getting more prenatal care guidance from their provider reported more social media use and more use of social media for giving and getting support. Also, Black women who reported getting more prenatal care support and respect from their provider reported more social media use and more use of social media for giving and getting support. Findings across all three aims