Poor Birth Outcomes Research Articles

Prenatal exposure to parabens affects birth outcomes through maternal Glutathione S-Transferase (GST) Polymorphisms

TPS 743: Health effects in pregnancy, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background/Aim: Human exposure to parabens is very common in daily life by using personal care products. These chemicals are associated with poor birth outcomes. However, modifying effects of polymorphism in glutathione S-transferases (GST) gene remain unexplored. Therefore, the aim of this study was to investigate the effect of genetic polymorphisms on the association of prenatal exposure to parabens with birth outcomes. Methods: We plan to recruit more than 300 women during 3rd stage pregnancy between 2017 and 2019 in Korean pregnant women, called The Mother And Kids Environmental health (MAKE) Study. We measured parabens (Methyl-paraben (MeP), Ethyl-paraben (EtP), Propyl-paraben (PrP)) concentrations in maternal urine samples, also collected information on birth outcome, socio-economic status, and consumption habits of consumer products. Multivariate linear regression was used to examine whether the association between prenatal exposure to parabens and birth outcomes (gestational age, birth weight, body length, head circumference and abdominal circumference) varied by maternal GST genes. Results: The adjusted geometric means for urinary concentrations of MeP, EtP, and PrP were 13.96, 9.45, and 1.70 ng/mL, respectively. Parabens were positively associated with weight and abdominal circumference at birth. In particular, MeP and PrP showed significant association with an increase in abdominal circumference (MeP, ß=0.355, p=0.02; PrP, ß=0.376, p=0.02) adjusting for potential confounders. Prenatal exposure to parabens showed significantly positive association with abdominal circumference in mother of GST null genotype (MeP, ß=0.634, p=0.02; EtP, ß=0.546, p=0.05; PrP, ß=0.618, p=0.04). Conclusions: This study reported the association between prenatal parabens exposure and birth outcomes. We also found that GST polymorphism might affect the association between prenatal parabens exposure and abdominal circumference, suggesting the effect of genetic susceptibility on the relation between prenatal parabens exposure and abdominal circumference.

Abstract # 3234 The role of neutrophil granulocytes in immune-to-brain communication during LPS-induced systemic versus lung inflammation

Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r = −0.73, p < 0.0001), IL6/IL10 (r = −0.38, p = 0.01), IL1β/IL10 (r = −0.44, p = 0.004) and TNFα/IL10 (r = −0.41; p = 0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r = −0.25, p = 0.43; IL6/IL10: r = 0.12, p = 0.70; IL1 β/IL10: r = 0.05, p = 0.87; TNFα/IL10: r = 0.10; p = 0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p < 0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.

High DNA stainability in the SCSA® is associated with poor embryo development and lower implantation rate

Objective To determine if the high DNA stainability index (HDS), as measured by the sperm chromatin structure assay (SCSA®), is associated with in vitro embryo development and concurrent assisted reproductive technology (ART) outcomes. Design A retrospective IRB approved, chart review of patients who completed at least one ART cycle (in vitro fertilization or intracytoplasmic sperm injection) and had a male partner in a DNA fragmentation index (DFI) of 25%. Materials and Methods Semen samples for ART patients were analyzed at SCSA® Diagnostics Inc. A list of male partners with a DFI less than 25% and an HDS greater than 25% was compared to those who completed ART cycle(s) with their female partner. We collected data on the number of patients, the number of cycles, quality of Day 3 and Days5/6 embryos, positive serum human chorionic gonadotropin (hCG) results, fetal cardiac activity (FCA) and live births (LB). We stratified the data into four groups by mean HDS. Results 75 IVF cycles had confirmed DFI levels below 25% and HDS levels above 25%. The number of top quality Day 3 and Day 5 embryos decreased when the HDS was above 31% (25%-30%, n=344; 31-35%, n=132; 36-40%, n=79%; 41+%, n=65), however the total percentage of cycles with successful blastocyst formation was similar (25-30% = 33%, 31-35% = 25%; 36-40% = 39%; 41+% = 42%). The total number as well as percentage of positive hCG results after fresh embryo transfer diminished as HDS climbed (25-30%, n = 18 (42%); 31-35% n = 6 (46%); 36-40% n = 4 (44%); 41+% n = 1 (10%). The same trend occurred with FCA (25-30%, n = 18 (42%); 31-35% n = 6 (46%); 36-40% n = 2 (22%); 41+% n = 0 (0%), and LB outcomes (25-30%, n = 14 (33%); 31-35% n = 3 (23%); 36-40% n = 2 (22%); 41+% n = 0 (0%). The implantation rate declined when the HDS was above 36% (25-30% = 30%, 31-35% = 30%; 36-40% = 16%; 41+% = 15%). Conclusions These data suggest that while a sperm with an HDS above 25% can fertilize oocytes, as HDS rises, it may be associated with delayed and/or impaired embryo development in vitro as well as poor live birth outcomes. Disclosures Co-author D. Evenson is the owner and CEO of SCSA® Diagnostics Inc. Funding None

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

The Impact of Infection in Pregnancy on Placental Vascular Development and Adverse Birth Outcomes.

Healthy fetal development is dependent on nutrient and oxygen transfer via the placenta. Optimal growth and function of placental vasculature is therefore essential to support in utero development. Vasculogenesis, the de novo formation of blood vessels, and angiogenesis, the branching and remodeling of existing vasculature, mediate the development and maturation of placental villi, which form the materno-fetal interface. Several lines of evidence indicate that systemic maternal infection and consequent inflammation can disrupt placental vasculogenesis and angiogenesis. The resulting alterations in placental hemodynamics impact fetal growth and contribute to poor birth outcomes including preterm delivery, small-for-gestational age (SGA), stillbirth, and low birth weight (LBW). Furthermore, pathways involved in maternal immune activation and placental vascularization parallel those involved in normal fetal development, notably neurovascular development. Therefore, immune-mediated disruption of angiogenic pathways at the materno-fetal interface may also have long-term neurological consequences for offspring. Here, we review current literature evaluating the influence of maternal infection and immune activation at the materno-fetal interface and the subsequent impact on placental vascular function and birth outcome. Immunomodulatory pathways, including chemokines and cytokines released in response to maternal infection, interact closely with the principal pathways regulating placental vascular development, including the angiopoietin-Tie-2, vascular endothelial growth factor (VEGF), and placental growth factor (PlGF) pathways. A detailed mechanistic understanding of how maternal infections impact placental and fetal development is critical to the design of effective interventions to promote placental growth and function and thereby reduce adverse birth outcomes.

Reducing sexual health risks and substance use in the prenatal setting: A study protocol for a randomized controlled trial

Sexually transmitted infections (STIs) are at a record high in the United States, and STI risk is a critical and costly public health concern for childbearing women. STIs can lead to a number of serious health risks including premature birth, low birth weight, ectopic pregnancy, and fetal death. Similarly, there has been a dramatic increase in substance use during pregnancy, leading to complications during pregnancy and poorer birth outcomes. Women who misuse substances are disproportionately more likely to engage in risky sexual behaviors that can result in STIs. The proposed study will test whether the Health Check-Up for Expectant Moms (HCEM), a computer-delivered brief intervention that simultaneously targets STI risk and alcohol/illicit drug use during pregnancy, reduces antenatal and postpartum risk more than an attention, time, and information matched control condition among pregnant women seeking prenatal care. The study is a two-group, randomized controlled trial in which a diverse sample of 250 pregnant women will be recruited from prenatal care clinics and assigned to either (a) a computer-delivered, single-session brief intervention plus two booster sessions); or (b) a computer-delivered control condition. Follow-up assessments will occur at 2 and 6 months from baseline, and at 6 weeks postpartum. Our objective measures include STI incidence and birth outcomes. The results of this trial will fill a critical gap and provide much-needed data on the efficacy, costs, and resource utilization of a practical computer-delivered, brief motivational intervention tailored to reach high-risk women during pregnancy and extending impact to postpartum.

Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth

RationalePreterm birth and other poor birth outcomes disproportionately affect women of color. Emerging evidence suggests that socially-driven issues such as disrespect, abuse, and discrimination within the health care system influence how people of color experience care during pregnancy, birth, and postpartum, which contributes to poorer outcomes for the mother and baby. ObjectiveAs recommended by community partners, we explored how interactions with providers were perceived and understood in the context of seeking care for pregnancy and birth. MethodFor this constructivist grounded theory study, we recruited 22 self-identified women of color 18 years of age or older and who were between six weeks and one year postpartum. Women participated in interviews exploring their experiences, which were audiorecorded and transcribed. Data were analyzed using dimensional analysis and situational analysis methods. ResultsThe concepts of information and power surfaced in analysis, in which providers have control over the information they share and “package” information to exert power over women's ability to participate in decision-making. An established relationship with providers and acknowledged levels of privilege or marginalization influenced how information was shared. Contextual factors included provider bias and judgment towards their patients, health care system structural issues, and the overall power dynamic between patient and provider. ConclusionsWomen of color's experiences during pregnancy and birth were influenced by how they were treated by providers, particularly in how information was shared and withheld. The providers' control over information led to a power dynamic that diminished women's ability to maintain autonomy and make health care decisions for themselves and their children. This study provides insight and impetus for change in how providers share information, utilize informed consent, and provide respectful care to women of color during pregnancy and birth care.

Are preterm birth and intra-uterine growth restriction more common in Western Australian children of immigrant backgrounds? A population based data linkage study

BackgroundTo compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australian-born non-Indigenous and Indigenous counterparts.MethodsA population-based linked data study, involving 767,623 singleton births in Western Australia between 1980 and 2010 was undertaken. Neonatal outcomes included preterm birth, post term births, intra-uterine growth restriction (assessed using the proportion of optimal birth weight) and low Apgar scores. These were compared amongst foreign-born women from low, lower-middle, upper middle and high income countries and Australian-born non-Indigenous and Indigenous women over two different time periods using multinomial logistic regression adjusted for covariates.ResultsCompared with Australian born non-Indigenous women, foreign-born women from low income countries were at some increased risk of extreme preterm (aRRR 1.59, 95% CI 0.87, 2.89) and very early preterm (aRRR 1.63, 95% CI 0.92, 2.89) births during the period from 1980 to 1996. During the period from 1997 to 2010 they were also at some risk of extreme preterm (aRRR 1.42, 95% CI 0.98, 2.04) very early preterm (aRRR 1.34, 95% CI 1.11, 1.62) and post term birth (aRRR 1.93, 95% CI 0.99, 3.78). During this second time period, other adverse outcomes for children of foreign-born women from low income and middle income countries included increases in severe (aRRR 1.69, 95% CI 1.30, 2.20; aRRR 1.72, 95% CI 1.53, 1.93), moderate (aRRR 1.54, 95% CI 1.32, 1.81; aRRR 1.59, 95% CI 1.48, 1.70) and mild (aRRR 1.28, 95% CI 1.14, 1.43; aRRR 1.31, 95% CI 1.25, 1.38) IUGR compared to children of Australian-born non-Indigenous mothers. Uniformly higher risks of adverse outcomes were also demonstrated for infants of Indigenous mothers.ConclusionsOur findings illustrate the vulnerabilities of children born to foreign women from low and middle-income countries. The need for exploratory research examining mechanisms contributing to poorer birth outcomes following resettlement in a developed nation is highlighted. There is also a need to develop targeted interventions to improve outcomes for these women and their families.

Sleep and female reproduction.

Sleep disturbances are increasing in prevalence in North America. There is growing evidence that poor sleep quality and short sleep duration may adversely affect circadian rhythms, which in turn may affect female reproduction. The objective of this review is to evaluate recent literature on the association between sleep disturbances and female reproduction. There is accumulating evidence that sleep quality and duration are important for female reproduction, but epidemiologic research is limited. Recent studies provide suggestive evidence that sleep disorders are associated with increased menstrual irregularity, subfertility/infertility, and poor pregnancy and birth outcomes. Mechanisms underlying these associations are likely to be multifactorial and complex. In addition to genetics, circadian disruption may impact reproductive outcomes through dysregulation of the hypothalamic-pituitary-adrenal axis, insulin resistance, oxidative stress, and systemic inflammation. Recommendations for future studies include: use of prospective study designs; assessment of populations not already experiencing reproductive disorders; more detailed and accurate assessments of sleep such as validated self-reported measures or objective sleep measures (e.g. actigraphy); comprehensive assessment of potential confounders and mediators; and elucidation of biologic mechanisms. There is a growing body of literature showing evidence that sleep disturbances influence female reproduction, although further epidemiologic research is needed.

Emergency department utilization during the first year of life among infants born to women at risk of disability

BackgroundWomen with disabilities are at risk for poor birth outcomes. Little is known about longer-term health and healthcare utilization of infants of women with disabilities. ObjectivesWe identified women at risk for disability and evaluated their infants’ emergency department (ED) utilization during the first year of life. Study designThis population-based cohort study used Massachusetts 2007–2009 birth certificates linked to 2007–2010 hospital discharge data. Access Risk Classification System categorized ICD-9 CM/CPT codes into disability risk categories. Infant ED visits were evaluated overall and by severity (emergent/intermediate vs. non-emergent). Cox proportional hazards models provided adjusted estimates. Results were stratified by gestational age (preterm, < 37 weeks, term, 37 + weeks). ResultsOf 218,599 women, 6.7% were at risk of disability. Infants born to women at risk had a higher rate of ED visits in their first year than infants born to women not at risk: 0.85 visits/person-year (95% CI 0.84–0.87) vs. 0.55 (0.55–0.55) for term, 0.74 (0.70–0.77) vs. 0.55 (0.54–0.56) for preterm. Utilization varied by maternal diagnosis. Emergent/intermediate and non-emergent visits were both elevated among infants born to women at risk for disability. In adjusted analyses, term infants of women with musculoskeletal diagnoses (HR = 1.3, 95% CI 1.2–1.4) and preterm infants of women with circulatory diagnoses (HR = 1.2, 1.0–1.3) had the highest hazards of ED visit vs. infants of women not at risk of disability. ConclusionMaternal disability risk is associated with postnatal infant ED utilization; utilization varies by maternal diagnosis. Interventions to improve health of infants born to women with disabilities are warranted.

Stressor landscapes, birth weight, and prematurity at the intersection of race and income: Elucidating birth contexts through patterned life events.

Women of color and women in poverty experience disproportionately high rates of adverse birth outcomes in the United States (US). We use an intersectionality-based approach to examine how maternal life events (LE's) preceding childbirth are patterned and shape birth outcomes at the intersection of race and income. Using population data from the Pregnancy Risk Assessment Monitoring System we uncover common maternal LE clusters preceding births in 2011–2015, offering a description and measurement of what we call “stressor landscapes” that go beyond standard measures by frequency or type alone. Three landscapes emerge: (1) Protected, characterized by very few LE's; (2) Illness/Isolated, with very few LE's and most commonly involving an illness or death of someone close; and (3) Toxic/Cumulative, comprising more frequent and acute LE's. Mothers in the toxic landscape experience on average 107-g lighter birth weights and a 27%, 49%, and 57% greater risk of PTB, LBW, and VLBW, respectively, compared to in the protected landscape. Low-income and non-Hispanic black (NHB), Hispanic, American Indian (AI), and Alaska Native (AN) mothers are among the groups disproportionately exposed to toxic stressor landscapes. The association between landscape and birth outcomes additionally varies by race and income. Among non-Hispanic white mothers, toxic landscapes are linked to poor birth outcomes at lower incomes. Among NHB mothers, illness-related stressors are additionally linked to worse outcomes and stressor landscapes disproportionately harm middle-income mothers. Toxic stressors may contribute to worse outcomes among middle- and high-income Hispanic and AI/AN mothers, but these patterns are less clear. Our study offers a new approach to measuring LE's that match common conceptions of exposure clustering and applies it to US population data to reveal LE patterns underlying persistent social disparities in maternal and child health.

Smoking Cessation and Pregnancy: Timing of Cessation Reduces or Eliminates the Effect on Low Birth Weight.

Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500g) which increases risks of infant mortality and morbidity, including chronic conditions later in life. Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smokingcessation has on the reduction of poorbirth outcomes in term pregnancies is unknown. This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status. Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure. Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies.

Maternal Hemoglobin Concentrations Across Pregnancy and Maternal and Child Health: A Systematic Review and Meta-analysis (P11-033-19)

ObjectivesMaternal anemia is a well-recognized global health problem; however, there remain questions on specific hemoglobin thresholds that predict health risk or protection for mother and child. Our objective was to conduct a systematic review and meta-analysis to examine the associations of maternal hemoglobin concentrations with a range of maternal and infant health outcomes, accounting for timing of measurement (preconception, first, second and third trimesters), etiology of anemia and cut-off category. MethodsOur search strategy identified 7,677 articles. Screening and article selection was conducted using Covidence systematic review software to organize search results from PubMed and Cochrane Review. The systematic review included 272 studies and the meta-analysis included 102 studies. ResultsLow maternal hemoglobin (< 110 g/L) was associated with poor birth outcomes (low birth weight, OR (95%CI): 1.43 (1.31-1.55); preterm birth, 1.35 (1.25-1.46); small-for-gestational age, 1.08 (1.00-1.18); stillbirth, 1.43 (1.05-1.95); perinatal mortality, 1.73 (1.32-2.26); and neonatal mortality, 1.49 (1.19-1.87); and adverse maternal outcomes (post-partum hemorrhage, 2.17 (1.51-3.10); preeclampsia, 1.84 (1.31-2.59); and blood-transfusion, 6.57 (3.59-12.00). High maternal hemoglobin (> 130 g/L) was associated with increased odds of small-for-gestational age, 1.22 (1.08-1.37); stillbirth, 1.88 (1.21-2.91); preeclampsia, 1.48 (1.10-2.01); and gestational diabetes, 2.02 (1.63-2.50). Relationships varied by timing of measurement and cut-off category; limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long-term child health outcomes. ConclusionsCurrent data are insufficient for determining if revisions to current hemoglobin cut-offs are required. Pooled high-quality individual-level data analyses as well as prospective cohort studies that measure hemoglobin throughout pregnancy would be valuable to inform the re-evaluation of hemoglobin cut-offs. Funding SourcesThis work was commissioned and financially supported by the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development of the World Health Organization (WHO), Geneva, Switzerland.

Grassroots Maternal Child Health Leadership Curriculum

In the United States, Indiana ranks 43rdfor its infant mortality rate. Twenty-nine (of the 988) Indiana zip codes account for 27% of infant deaths. There is a need to train and mentor community members to lead local maternal and child health (MCH) efforts that address the priorities of community members as related to poor birth outcomes and facilitate the community’s solution strategies to this important public health problem. This community-centered approach coupled with local healthcare delivery helps thoroughly address local adverse birth outcomes. A comprehensive grassroots MCH leadership curriculum is needed for this training process. To meet this need we developed and solicited feedback on a curriculum designed to train community members situated in Indiana’s high-risk zip codes to be grassroots maternal child health leader (GMCHLs). The curriculum teaches GMCHLs the knowledge and skills to become self-reflective leaders who understand the causes and effects of adverse and inequitable birth outcomes, the negative health effects of chronic stress, and the protective power of the community. These GMCHLs will become skilled in the use of storytelling, Photovoice, policy development/advocacy and EvaluLead to build the capacity of their local community to support positive maternal and child health (MCH) outcomes.

Ask them all: Self-report universal prenatal substance use screening in the United States

ABSTRACTBackground: Increasing rates of opioid use in the United States have created a national public health crisis. Substance use in pregnancy increases risk for poor birth outcomes. National advisory groups recommend screening all women for prenatal substance use. However, there is no single approach or tool recommended for universal prenatal substance use screening.Objective: This study seeks to evaluate the effectiveness of universal screening using a direct approach self-report of substance use in pregnancy.Method: A retrospective review of de-identified data to evaluate women’s willingness to self-report substance use through direct screening. Data obtained from 24 months of maternal self-report were analyzed to assess the overall effectiveness of a direct screening method during the prenatal period.Results: Findings revealed maternal substance use disclosure rates of 9.7%, higher than the 5.4% United States national average.Conclusion: Increasing awareness of maternal prenatal substance use offers opportunity for education and support early in pregnancy. Findings suggest the direct method may support maternal self-report of substance use in universal prenatal screening. Additional study with diverse populations and clinical settings is needed.

Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics.

Background and objectiveAs of 2016, 43 US states have policies regarding alcohol use during pregnancy. A recent study found that out of eight state-level alcohol/pregnancy policies, six are significantly associated with poorer birth outcomes, and two are not associated with any outcomes. Here we estimate the excess numbers of low birthweight (LBW) and preterm births (PTB) related to these policies and their associated additional costs in the first year of life.MethodsCost study using birth certificate data for 155,446,714 singleton live births in the United States between 1972–2015. Exposures were state- and month/year-specific indicators of having each of eight alcohol/pregnancy policies in place. Outcomes were excess numbers of LBW and PTB and associated costs in the first year of life. Fixed effects regressions with state-specific time trends were used for statistical analyses in 2018.ResultsIn 2015, policies mandating warning signs were associated with an excess of 7,375 LBW; policies defining alcohol use during pregnancy as child abuse/neglect were associated with an excess of 12,372 PTB; these excess adverse outcomes are associated with additional costs of $151,928,002 and $582,698,853 in the first year of life, respectively.ConclusionsMultiple state-level alcohol pregnancy policies lead to increased prevalence of LBW and PTB, which cost hundreds of millions of dollars annually. Policymakers should consider adverse public health impacts of alcohol/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states.

Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six.

Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.

Obstetric Outcomes in Nepali Immigrant Patients: A Retrospective Study Within the Rochester Regional Health System [26Q

INTRODUCTION: Ethnic minorities particularly immigrants, tend to be at increased risk for poor birth outcomes. Rochester New York is home to many Nepali immigrants with a 56% increase in 2014. These immigrants face many barriers which includes communication, health literacy and accessibility to health services. The purpose of this study was to evaluate the obstetric outcomes of Nepali patients within the Rochester Regional Health System. METHODS: Nepali women who delivered between January 1, 2011 and December 31, 2016 were matched with Non-Nepali women who delivered during the same time period. Demographic and obstetric information was extracted from the electronic medical records. Obstetric outcomes between the 2 study groups were then analyzed. Data analysis was done using the SPSS, version 24. RESULTS: The final analysis was performed on 194 patients (86 Nepali and 108 Non-Nepali). Nepali patients had prolonged second stage of labor (P&lt;.05) and a higher cesarean section rate (33.7% vs 26.9%) compared to Non-Nepali patients. Nepali patients also had significantly higher rates of chorioamnionitis/endometritis (P&lt;.05) as well as third degree vaginal lacerations (P&lt;.05). More postpartum hemorrhage was seen in the Nepali group of patients, 17.4% vs 12.0%. Babies born to Nepali mothers were more likely to be admitted to the Neonatal Intensive Care unit (P&lt;.05). CONCLUSION: Nepali mothers had higher obstetric complications than Non-Nepali mothers. Further ongoing analysis of health outcomes within this particular migrant population is warranted. This will certainly help to inform better reproductive health care practices for these patients, and ultimately minimize disparities in their obstetric care and outcomes.

Associations Between Maternal Body Mass Index, Gestational Weight Gain, Maternal Complications, and Birth Outcome in Singleton, Term Births in a Largely Non-Hispanic White, Rural Population.

Background: In 2009, the Institute of Medicine (IOM) published guidance on gestational weight gain (GWG) modified by body mass index (BMI). GWG outside of IOM recommendations negatively affects birth outcomes and child health. This study examined the relationship between BMI, GWG, birth complications, and birth outcomes in a rural, non-Hispanic white population over 10 years. Materials and Methods: We examined maternal BMI, GWG, birth weight, birth complications, and Apgar score in 18,217 term singleton births from medical records at Geisinger, PA from 2006 to 2015. Primary outcomes were GWG, delivery mode, Apgar score, and infant birth weight. Results: A majority of women (74.2%) had GWG outside of recommendations. Prevalence of cesarean delivery was highest for women with GWG above recommendations regardless of BMI. One in five neonates of obese women with GWG above recommendations had Apgar scores below eight. Although most births were normal for gestational age (88%), underweight women who gained below recommendations had the highest percentage of small for gestational age (SGA) births (10.4%) and obese women who gained above recommendations had the highest percentage of large for gestational age (LGA) births (22.2%). Among women with BMIs above 35 kg/m2 and GWG within recommendations, 18.9% of births were LGA. Conclusions: Most pregnant women are not gaining weight within recommendations. GWG outside of IOM recommendations resulted in poorer birth outcomes, particularly in underweight and obese women. Underweight women with GWG below recommendations are at increased risk for SGA neonates. We suggest reducing GWG recommendations for women above 35 kg/m2 to decrease LGA births and pregnancy complications.

A Survey of Women and Their Providers Regarding Gestational Weight Gain.

Background: Inappropriate gestational weight gain (GWG) is prevalent in the United States. About 20% of women gain below Institute of Medicine (IOM) recommendations; more than 50% gain above. GWG outside of recommendations is linked to poor birth outcomes and health issues for mother and baby. Counseling by health care providers is important to encourage appropriate GWG. Methods: Assess patient recall of counseling regarding GWG, provider knowledge, and opinions about IOM GWG guidance, and GWG outcomes in a subset of women. Cross-sectional, with questionnaires distributed by 8 medical centers across the United States to patients. Questionnaires were distributed to providers and data on maternal body mass index (BMI) and GWG collected at seven sites. Results: A total of 1,157 women returned questionnaires (1,820 maximum possible). A majority at all sites reported a provider discussed their expected GWG with them. Close to half reported that a provider had discussed potential harms from inappropriate GWG. Most of the women (71.2%) considered their obstetrician to be a helpful resource for GWG advice. Most providers (87.5%) reported they were aware of IOM guidelines. As many providers disagreed (18.8%) as agreed (20.8%) that they were successful helping their patients attain appropriate GWG (58.3% were neutral). Physician self-reported confidence was associated with whether they believed they could help their patients avoid excessive GWG. The most common outcome was GWG above recommendations (51.4%). Overweight and obese women were more likely to gain above recommendations. Providers underestimated the proportion of their patients that gained below IOM recommendations (8.5% vs. 18.6%). Conclusions: Providers are aware of the dangers of excessive GWG and a majority of patients report receiving counseling. Providers appear more cognizant of excessive GWG and underestimate inadequate GWG. Most women are not achieving an appropriate GWG, with overweight and obese women especially likely to gain above recommendations.