Disparities In Neonatal Outcomes Research Articles

Sexual Orientation-Related Disparities in Neonatal Outcomes.

To evaluate whether disparities exist in adverse neonatal outcomes among the offspring of lesbian, gay, bisexual, and other sexually minoritized (LGB+) birthing people. We used longitudinal data from 1995 to 2017 from the Nurses' Health Study II, a cohort of nurses across the United States. We restricted analyses to those who reported live births (N=70,642) in the 2001 or 2009 lifetime pregnancy questionnaires. Participants were asked about sexual orientation identity (current and past) and same-sex attractions and partners. We examined preterm birth, low birth weight, and macrosomia among 1) completely heterosexual; 2) heterosexual with past same-sex attractions, partners, or identity; 3) mostly heterosexual; 4) bisexual; and 5) lesbian or gay participants. We used log-binomial models to estimate risk ratios for each outcome and weighted generalized estimating equations to account for multiple pregnancies per person over time and informative cluster sizes. Compared with completely heterosexual participants, offspring born to parents in all LGB+ groups combined (groups 2-5) had higher estimated risks of preterm birth (risk ratio 1.22, 95% CI, 1.15-1.30) and low birth weight (1.27, 95% CI, 1.15-1.40) but not macrosomia (0.98, 95% CI, 0.94-1.02). In the subgroup analysis, risk ratios were statistically significant for heterosexual participants with past same-sex attractions, partners, or identity (preterm birth 1.25, 95% CI, 1.13-1.37; low birth weight 1.32, 95% CI, 1.18-1.47). Risk ratios were elevated but not statistically significant for lesbian or gay participants (preterm birth 1.37, 95% CI, 0.98-1.93; low birth weight 1.46, 95% CI, 0.96-2.21) and bisexual participants (preterm birth 1.29, 95% CI, 0.85-1.93; low birth weight 1.24, 95% CI, 0.74-2.08). The offspring of LGB+ birthing people experience adverse neonatal outcomes, specifically preterm birth and low birth weight. These findings highlight the need to better understand health risks, social inequities, and health care experiences that drive these adverse outcomes.

Association of Reproductive Autonomy and Rates of State-Level Racialized Disparities in Preterm Birth and Low Birthweight.

Reproductive policies' impact on disparities in neonatal outcomes is understudied. Thus, we aimed to assess whether an index of reproductive autonomy is associated with black-white disparities in preterm birth (PTB) and low birthweight (LBW). We used publicly available state-level PTB and LBW data for all live-births among persons aged 15-44 from January 1, 2016, to December 31, 2018. The independent measure was an index of state laws characterizing each state's reproductive autonomy, ranging from 5 (most restrictive) to 43 (most enabling), used continuously and as quartiles. Linear regression was performed to evaluate the association between both the index score (continuous, primary analysis; quartiles, secondary analysis) and state-level aggregated black-white disparity rates in PTB and LBW per 100 live births. Among 10,297,437 black (n=1,829,051 [17.8%]) and white (n=8,468,386 [82.2%]) births, rates of PTB and LBW were 6.46 and 8.24 per 100, respectively. Regression models found that every 1-U increase in the index was associated with a -0.06 (confidence interval [CI]: -0.10 to -0.01) and -0.05 (CI: -0.08, to -0.01) per 100 lower black-white disparity in PTB and LBW rates (p<0.05, p<0.01), respectively. The most enabling quartiles were associated with -1.21 (CI: -2.38 to -0.05) and -1.62 (CI: -2.89 to -0.35) per 100 lower rates of the black-white disparity in LBW, compared with the most restrictive quartile (both p<0.05). Greater reproductive autonomy is associated with lower rates of state-level disparities in PTB and LBW. More research is needed to better understand the importance of state laws in shaping racialized disparities, reproductive autonomy, and birth outcomes.

Disparities in Neonatal Outcomes: Past, Present, and Our Future?

Neonatal outcomes and infant mortality rates have improved significantly in the past century. However, the disparities in outcomes linked to racial and ethnic variations have persisted and actually increased. Those differences in outcomes have been acknowledged for years as care providers strive to improve care for all of our most vulnerable and youngest individuals. Trends in neonatal outcomes are summarized.

Race and Ethnicity and Disparities in Neonatal Outcomes in Twin Pregnancies [ID: 1375610

INTRODUCTION: Twin pregnancies are associated with adverse neonatal outcomes. We aimed to investigate disparities in neonatal outcomes by maternal race and ethnicity. METHODS: This was an IRB-approved, retrospective cohort of twin deliveries at a single institution between 2001 and 2018. Pregnancies delivered less than 23 weeks’ gestational age (GA), fetal demise, or major anomaly were excluded. The primary exposure, race and ethnicity, was self-reported as follows: non-Hispanic White, Hispanic, non-Hispanic Black, Asian/Pacific Islander, and other/mixed race. The primary outcome was neonatal intensive care unit (NICU) admission of at least one twin. Secondary outcomes included 5-minute Apgar less than 7 for either twin, GA at delivery, small for GA (SGA) neonate (&lt;10th percentile for GA), and NICU length of stay. Chi-square, ANOVA, and Student’s t test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences. RESULTS: Eight hundred four twin pregnancies were identified; 48% of patients identified as non-Hispanic White, 30% as Hispanic, 10% as Asian/Pacific Islander, 5.6% as non-Hispanic Black, and 6.6% as other/mixed race. Age, parity, chorionicity, and body mass index differed between groups. The overall rate of NICU admission was 77.5% and did not differ by race and ethnicity (P=.05). Pregnancies with at least one SGA neonate varied significantly by race and ethnicity (P=.02). Gestational age at delivery, Apgar of less than 7, and ICU length of stay did not differ. CONCLUSION: The risk of having an SGA neonate varies by race and ethnicity in twin gestations, with highest rates among non-Hispanic Black women. Additional racial and ethnic disparities in neonatal morbidity were not found. Disparities in rate of preterm birth were not seen in this cohort.

Adolescent Pregnancy Outcomes and Risk Factors.

One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20-34 years (n = 2140) who gave birth in 2019-2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3-21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5-24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8-6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent mothers than in those born to adult mothers (p < 0.001). Our findings showed that infants of teenage mothers often had lower birth weights (-332.6 g, p < 0.001). Adolescent mothers were associated with lower Apgar scores at the first minute (p = 0.003). As compared with the control group, pregnant teenage girls had a greater prevalence of preterm deliveries in our research (p = 0.004). This study finds significant age-related disparities in neonatal outcomes between mothers. These results might be used to identify vulnerable groups who need special assistance and actions to reduce the probability of negative outcomes for such groups.

Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities

In the past two years, we have witnessed social unrest, the unequal effects of a pandemic across our society, and a focus on how systems in the United States produce unequal outcomes along racial and cultural divides. With increased national awareness, there has also been a call for change in healthcare, specifically racial inequities in Neonatal Intensive Care Unit (NICU) outcomes (1). While race may be a data point used to classify outcomes, it has no basis in biology, and merely identifying it does not make it simple to address. To address these inequities we need to look past the social construct of race and to the social aspects of our care in the NICU. Focusing on small and large changes that we can make as individuals, units, and as a specialty that can improve the care and outcomes of this at-risk patient population. This perspective focuses on culturally congruent care, trauma-informed care, and other approaches to reduce disparities in neonatal outcomes.

Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial/ethnic groups and rural–urban populations

Variations in infant and neonatal mortality continue to persist in the United States and in other countries based on both socio-demographic characteristics, such as race and ethnicity, and geographic location. One potential driver of these differences is variations in access to risk-appropriate delivery care. The purpose of this article is to present the importance of delivery hospitals on neonatal outcomes, discuss variation in access to these hospitals for high-risk infants and their mothers, and to provide insight into drivers for differences in access to high-quality perinatal care using the available literature. This review also illustrates the lack of information on a number of topics that are crucial to the development of evidence-based interventions to improve access to appropriate delivery hospital services and thus optimize the outcomes of high-risk mothers and their newborns.

902 Racial and ethnic disparities in neonatal outcomes of mothers with chronic hypertension

To compare outcomes of neonates born to mothers with chronic hypertension based on maternal race and ethnicity. A retrospective cohort study from the Consortium on Safe Labor of unique persons with chronic hypertension and available self-reported maternal race and ethnicity (2002-2008). Maternal race and ethnicity were analyzed as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic. The following neonatal outcomes were compared between the three groups: preterm birth, low birth weight, small for gestational age (SGA), 5-minute Apgar <7, respiratory distress syndrome, hypoxic-ischemic encephalopathy (HIE), intraventricular hemorrhage, admission to neonatal intensive care unit (NICU), neonatal sepsis, and neonatal death were compared between persons with singleton gestations. Univariable and multivariable analyses were performed to examine the association between maternal race and ethnicity and neonatal outcomes in mothers with chronic hypertension, while controlling for maternal sociodemographic and clinical factors. A total of 4,612 persons were eligible for analysis. Most of maternal sociodemographic and clinical characteristics differed between the groups (Table 1). All neonatal outcomes except HIE differed between the three groups with all of the rates being significantly higher in NHB mothers compared with NHW mothers (Table 1). The outcomes of low birth weight, neonatal sepsis, and neonatal death were also higher in Hispanic compared to NHW group. In multivariable logistic regression, neonates of NHB mothers had higher odds of preterm birth, SGA, low birth weight, 5-min Apgar<7, NICU admission and neonatal sepsis compared with NHW mothers (Table 2). Similarly, neonates of Hispanic mothers had higher odds of preterm birth, low birth weight, NICU admission, neonatal sepsis and also neonatal death compared with NHW mothers. Significant racial disparities were seen in neonatal outcomes of mothers with chronic hypertension, with neonates born to NHB and Hispanic mothers having higher rates of complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Recent progress in global newborn health: thinking beyond acute to strategic care?

Advancements in neonatal care globally highlight ongoing disparities in neonatal outcomes between low-income countries (LICs) and high-income countries (HICs). Drivers of this gap are primarily prematurity, infection, and intrapartum-related events. Significant success is being achieved; however, for neonatal outcomes in LIC to approximate those of HICs within a generation, acceleration of the current trajectory of progress is needed. This requires a renewed focus on newborn-specific and newborn-sensitive strategies. Newborn-specific strategies are those directly affecting the well-being of the neonate. Newborn-sensitive strategies address the broader macro-environmental drivers that affect underlying neonatal outcomes such as decreased poverty, improved sanitation, and increased maternal empowerment and health. To create such an enabling macro-environment requires significant political will, financing, advocacy, and policy generation. This manuscript highlights recent advances in newborn research, programming, policy, and funding, and highlights key opportunities to bend the curve on advancing neonatal health globally.

703: Racial disparities in neonatal outcomes among pregnant women with major depressive disorder

703: Racial disparities in neonatal outcomes among pregnant women with major depressive disorder

Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals

Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery. Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among these hospitals. The statistical analysis was performed in 2016-2017. Race/ethnicity. Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater). Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailed P < .001). The risk-standardized morbidity and mortality rate was twice as great for VPTB infants born in hospitals in the highest morbidity and mortality tertile (0.40; 95% CI, 0.38-0.41) as for those born in the lowest morbidity and mortality tertile (0.16; 95% CI, 0.14-0.18). Black (1204 of 2775 [43.4%]) and Hispanic (746 of 2168 [34.4%]) VPTB infants were more likely than white (325 of 1418 [22.9%]) VPTB infants to be born in hospitals in the highest morbidity and mortality tertile (2-tailed P < .001; black-white difference, 20%; 95% CI, 18%-23% and Hispanic-white difference, 11%; 95% CI, 9%-14%). The largest proportion of the explained disparities can be attributed to differences in infant health risks among black, Hispanic, and white VPTB infants. However, 40% (95% CI, 30%-50%) of the black-white disparity and 30% (95% CI, 10%-49%) of the Hispanic-white disparity was explained by birth hospital. Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants.

The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women.

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.