Pregnant African American Women Research Articles

The Impact of Environmental Benzene, Toluene, Ethylbenzene, and Xylene Exposure on Blood-Based DNA Methylation Profiles in Pregnant African American Women from Detroit.

African American women in the United States have a high risk of adverse pregnancy outcomes. DNA methylation is a potential mechanism by which exposure to BTEX (benzene, toluene, ethylbenzene, and xylenes) may cause adverse pregnancy outcomes. Data are from the Maternal Stress Study, which recruited African American women in the second trimester of pregnancy from February 2009 to June 2010. DNA methylation was measured in archived DNA from venous blood collected in the second trimester. Trimester-specific exposure to airshed BTEX was estimated using maternal self-reported addresses and geospatial models of ambient air pollution developed as part of the Geospatial Determinants of Health Outcomes Consortium. Among the 64 women with exposure and outcome data available, 46 differentially methylated regions (DMRs) were associated with BTEX exposure (FDR adjusted p-value < 0.05) using a DMR-based epigenome-wide association study approach. Overall, 89% of DMRs consistently exhibited hypomethylation with increasing BTEX exposure. Biological pathway analysis identified 11 enriched pathways, with the top 3 involving gamma-aminobutyric acid receptor signaling, oxytocin in brain signaling, and the gustation pathway. These findings highlight the potential impact of BTEX on DNA methylation in pregnant women.

It’s the Small Things: An Intersectional Approach to African American Women on Medicaid Receiving Prenatal Care

Background: When examining prenatal care utilization rates, African American women were more likely to receive inadequate prenatal care. Yet, research about African American women’s prenatal care experiences fails to account for how their experiences may vary by socioeconomic status and insurance type. Therefore, the purpose of this study was to provide African American women on Medicaid with the opportunity to speak to what they found to be meaningful during their interactions with their prenatal care provider using an intersectionality framework.Methods: Individual interviews were conducted with pregnant African American women (n = 20) receiving Medicaid who were in their second or third trimester of pregnancy. Participants aged 18 to 45 years were recruited from various health care systems located in Ohio. Researchers applied a thematic analysis approach during data collection and data analysis.Results: Two overarching themes emerged about what these African American women considered meaningful when they talked to their prenatal care provider during pregnancy: (1) conversations around my prenatal care and (2) equipping me with knowledge.Conclusion: The results obtained through the application of intersectionality theory allow researchers the opportunity to create effective solutions, interventions, and policies that can be implemented to improve infant health outcomes and reduce the risk of infant mortality among pregnant African American women receiving Medicaid. Implications also suggested that public health practitioners in Ohio should increase their awareness of what is important to this population to build patient's trust in provider recommendations and patient’s confidence in shared decision-making.

Maternal Group B Streptococcus Infection Correlates Inversely With Preeclampsia in Pregnant African American Women

Abstract Objective To determine whether an association exists between group B Streptococcus (GBS) colonization and preeclampsia among pregnant Black women. Methods This retrospective cross-sectional study involved Black women who gave birth at State University of New York Downstate Hospital between January 2010 and December 2017. Data were collected from the Obstetric Department, including delivery date, time, mode of delivery, age of the mother, weeks of gestation at delivery, and antepartum complications. The GBS test results were originally determined using the eSwab transport system. Preeclampsia was defined based on the American College of Obstetricians and Gynecologists criteria for the periods 2010–2012 and 2013–2017. The primary outcome was whether GBS was associated with the outcome of preeclampsia in the population of Black women. Covariates, including smoking status, gestational age, parity, body mass index, maternal age, and presence of herpes simplex virus (HSV) and human immunodeficiency virus (HIV) were examined as potential confounders. Chi-squared test and logistic regression model were used, presenting odds ratios with 95% confidence intervals (P &lt; 0.050), analyzed with SAS on Demand for Academics (SAS Institute, Inc., NY). Results Among the 8,019 Black women included in this study, GBS-positive women (n = 977) had a 53% reduction in the likelihood of being diagnosed with preeclampsia compared to GBS-negative women (adjusted odds ratio, 0.47; 95% confidence interval, 0.32–0.70). We did not find evidence of differences in the distribution of smoking habits (P = 0.783) or maternal age (P = 0.107) between GBS-positive and GBS-negative women. However, the GBS-positive women tended to be less likely to have a preterm delivery (9.62% (94/977) vs. 24.24% (1707/7042), P &lt; 0.001), less likely to be nulliparous (33.37% (326/977) vs. 37.87% (2667/7042), P = 0.006), and less likely to be obese (51.38% (502/977) vs. 55.30% (3894/7042), P &lt; 0.001) compared with GBS-negative women. In contrast, GBS-positive women were more likely to have a comorbid infection than their counterparts: HSV (5.94% (58/977) vs. 2.63% (185/7042), P &lt; 0.001) and HIV (1.54% (15/977) vs. 0.82% (58/7042), P = 0.028). Conclusion We found a reduced likelihood of preeclampsia among women who were positive for GBS at delivery. Given the cross-sectional nature of our study, more research is needed to further explore this association.

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study.

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

African American mothers' perceptions of infant body size are prospectively associated with infant growth and BMI.

The effect of mothers' perceptions of infant body size on infant growth and later BMI is poorly understood. We aimed to assess whether maternal perceptions were associated with infant BMI and weight gain and to identify factors that may influence maternal perceptions. We analyzed data from a prospective, longitudinal study of pregnant African American women living with healthy weight (BMI < 25 kg/m2 ) or obesity (BMI ≥ 30 kg/m2 ). We collected sociodemographic, feeding mode, perceived stress, depression, and food insecurity information. The African American Infant Body Habitus Scale assessed maternal perceptions of infant body size at age 6months. A "maternal satisfaction with infant body size" score was derived. Infant BMI z-scores (BMIZ) were calculated at 6 and 24 months. Maternal perception and satisfaction scores did not differ between obese (n=148) and healthy weight (n=132) groups. Perception of infant size at 6months was positively associated with infant BMIZ at 6 and 24 months. A positive association of maternal satisfaction scores with change in infant BMIZ from 6 to 24 months indicated that BMIZ changed less for infants whose mothers preferred them to be smaller at 6months. Perception and satisfaction scores were not associated with feeding variables, maternal stress, depression, socioeconomic status, or food security status. Mothers' perceptions of and satisfaction with infant size correlated with current and later infant BMI. However, mother's perceptions were not associated with maternal weight status or other factors explored for their potential to impact maternal perceptions. Further work is needed to elucidate factors linking maternal perception/satisfaction and infant growth.

Selected Lifestyle Practices in Urban African American Women—Relationships to Pregnancy Outcome, Dietary Intakes and Anthropometric Measurements

The relationships of selected lifestyle factors (cigarette smoking, consumption of alcoholic beverages, recreational drug use, and exercise during pregnancy), all self-reported, to pregnancy outcomes, dietary intake during pregnancy, and maternal anthropometric measurements, were investigated in a group of urban African American pregnant women. The 234 subjects were aged 16-35 years and were free of diabetes and abnormal hemoglobins. The lifestyle data were collected by trained interviewers during the subjects' prenatal clinic visits, and the dietary data by monthly, quantitative 24-hour food recalls conducted during these same visits. Maternal anthropometric measurements were obtained from the subjects' hospital records, and pregnancy outcome data during physical examinations of the newborn infants. Both cigarette smoking and drug use were associated with significantly lower mean birth weight, length, and head circumference, while exercise was associated with a significantly higher mean birth weight, and head circumference (P < 0.05). Drug use during pregnancy was associated with a significantly higher intake of vitamin C, and a significantly lower intake of iron; while women reporting drug use before pregnancy had significantly higher mean intakes of food energy, protein, total and saturated fat, and zinc. Prepregnancy weight, percent ideal prepregnancy body weight, prepregnancy body mass index, and delivery weight were significantly lower among those reporting drug use before pregnancy. Multiple regression analyses indicated that smoking explained a relatively small proportion of the variance in infant birth weight compared with delivery weight and percent of ideal prepregnancy body weight.

Joint effects of individual socioeconomic status and residential neighborhood context on vaginal microbiome composition.

The vaginal microbiome is a dynamic ecosystem that is important for women's health. Its composition has been associated with risk for menopausal symptoms, sexually transmitted infections, gynecologic cancer, and preterm birth. Conventional risk factors for a vaginal microbiome linked with these adverse health outcomes include sexual behaviors, hygiene practices, individual social factors, and stress levels. However, there has been limited research on socio-contextual determinants, and whether neighborhood context modifies the association with individual socioeconomic factors. Socioeconomically diverse pregnant African American women in Atlanta, Georgia (n = 439) provided residential addresses and first trimester vaginal swab samples, which underwent sequencing, taxonomic classification, and assignment into mutually exclusive CST (community state types) via hierarchical clustering. Linear probability models were used to estimate prevalence differences (PD) for the associations of neighborhood factors with vaginal microbiome CST and to evaluate for additive interaction with maternal level of education, health insurance type, and recruitment hospital. Factors such as higher (vs. lower) maternal education, private (vs. public) insurance, and private (vs. public) hospital were associated with higher prevalence of Lactobacillus-dominant vaginal microbiome CSTs typically associated with better health outcomes. When considering the joint effects of these individual socioeconomic status and residential neighborhood factors on vaginal microbiome CST, most combinations showed a greater than additive effect among the doubly exposed; however, in the case of local income homogeneity and local racial homogeneity, there was evidence of a crossover effect between those with less-advantaged individual socioeconomic status and those with more-advantaged individual socioeconomic status. Compared to women at the public hospital who lived in economically diverse neighborhoods, women at the private hospital who lived in economically diverse neighborhoods had a 21.9% higher prevalence of Lactobacillus-dominant CSTs, while women at the private hospital who lived in less economically diverse neighborhoods (the doubly exposed) had only an 11.7% higher prevalence of Lactobacillus-dominant CSTs, showing a crossover effect (interaction term p-value = 0.004). In this study, aspects of residential neighborhood context were experienced differently by women on the basis of their individual resources, and the joint effects of these exposures on vaginal microbiome CST showed a departure from simple additivity for some factors.

The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial

BackgroundPregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women.Methods/designIn this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is a culturally relevant, manualized, psychosocial, group intervention integrating two cognitive behavioral therapies for both pregnant Latinas and Black/African American women (total n = 221). Study inclusion criteria are: women with current pregnancy at 14–20 weeks gestation, ability to read and speak English or Spanish, self-identify as Latina of Mexican heritage or Black/African American, 18–45 years old, born in the US or Mexico, and currently living in the US. Participants must receive Medicaid or other government-supported insurance, and meet screening criteria for anxiety, depressive symptoms, or stress. Participants are randomly assigned to either the intervention (MLI) or usual care group (UCG) in groups of 6–8 participants that occur over 6 consecutive weeks. Data are collected at 3 time points: enrollment (14–20 weeks gestation), following treatment (20–26 weeks), and 6 weeks after treatment (32–36 weeks gestation). Additional outcome, mediating, and moderating data are collected from the electronic health record during pregnancy and at birth. Analyses will primarily use generalized linear mixed modeling (GLMM) to evaluate the relationships between predictors and outcomes.DiscussionThis RCT will test the efficacy of two combined third generation cognitive behavioral therapies (the MLI), given in a group format over 6 sessions, as compared to a usual prenatal care group, for both Latina and African American pregnant women. If efficacious, it may be provided as an adjunct to routine prenatal care and improve mental health, as well as babies being born too small and too soon.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov. Bethesda (MD): National Library of Medicine. Identifier NCT05012072, Reducing Pregnancy Risks: The Mastery Lifestyle Intervention (MLI); August 19, 2021. The trial is currently recruiting participants.

Racial Disparities in Screening and Management of Anemia Among Pregnant Women

Background: Iron deficiency anemia (IDA) in pregnancy is common in the United States, with an overall prevalence of 18%. ACOG and CDC guidelines recommend screening for anemia be done at the first prenatal visit with a CBC. IDA in pregnancy is associated with several adverse fetal and maternal health outcomes, including pre-term birth and low birth weight. Studies are just beginning to emerge describing racial disparities associated with assessment and management of IDA in pregnancy. Our primary objective in this study is to investigate the screening practices for anemia in pregnant women at our institution. Further objectives include investigating potential racial disparities in screening practices and management for anemia in pregnant women. Methods: We performed a retrospective cohort study of all pregnant women, aged 13-50 years old, who delivered at the University of Michigan (UM) between July 2015 and January 2022, and who received prenatal care at UM beginning the first trimester of pregnancy. After IRB approval, data were collected from the UM electronic medical record, MiChart. Inclusion in the cohort was based on CPT codes for delivery; first trimester visit was defined based on calculation from last menstrual period to 13 weeks of gestation. We used a t-test to compare mean hemoglobin (Hgb) and mean corpuscular volume (MCV) in Caucasian and African American women. We defined anemia as Hgb <10.5 g/dL during any point in pregnancy. We used Chi-square analysis to compare the proportion of Caucasian and African American women screened for anemia with Hgb and screened for iron deficiency with ferritin and transferrin saturation. Chi-square analysis was also used to compare the proportion of women prescribed iron supplementation. Results: A total of 16,073 pregnant women were included in the study, with 1,781 (11.08%) self-reported African Americans, 11,590 (72.11%) Caucasians, 1,472 (9.16%) Asians, and 1,230 (7.65%) women of other races/unknown. While screening for anemia was very common in our cohort, Caucasian women were slightly more likely to be screened for anemia than African American women (98.88% vs. 97.47%, p <0.001); see Table 1 below. Overall, 23.87% of women in our cohort were anemic at some point during pregnancy. Anemia was more common among African American women compared to Caucasian women (39.79% vs 21.41%, p <0.001). The mean Hgb was significantly higher in Caucasians versus African Americans (11.63 g/dL, SD 1.58 vs. 10.84 g/dL, SD 1.62, p <0.001). Mean MCV was lower in African Americans than Caucasians (85.94 fL, SD 6.63 vs. 89.04 fL, SD 5.12, p <0.001). African American women were more likely to be tested for iron deficiency compared to Caucasian women using ferritin (1.12% vs. 0.53%, p <0.001), and transferrin saturation (1.12% vs 0.44%, p <0.001). In terms of anemia management, 31.05% of patients overall were prescribed iron supplementation (oral or IV forms). African American women were more likely to be prescribed supplemental iron compared to Caucasian women (45.65% vs. 28.81%, p <0.001). Conclusion: Overall screening for anemia among pregnant women is very common among patients in our cohort, in congruence with guideline recommendations. Even though only a small proportion of patients did not have a Hgb checked during pregnancy, African American women were less likely to be screened for anemia during pregnancy compared to Caucasian women. In our cohort, pregnant African American women were more likely to be anemic, with a lower mean Hgb level and MCV compared to Caucasian women. Interestingly, although approximately one in four women were found to be anemic overall, less than 1% of women in our cohort had laboratory testing with ferritin or transferrin saturation to further work up iron deficiency. Despite this, nearly one third of patients received a prescription for iron supplementation. This suggests a frequent practice at our institution of empirically prescribing iron supplementation in the absence of laboratory work up for iron deficiency, especially among African Americans. Next steps include further evaluation as to whether this is an effective approach to treating anemia in pregnancy, or whether additional anemia work up is warranted in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Adapting an organ-on-chip device to study the effect of fetal sex and maternal race/ethnicity on preterm birth related intraamniotic inflammation leading to fetal neuroinflammation.

Fetal neuroinflammation has been linked to preterm birth-related intraamniotic infection and inflammation; However, the contribution of fetal sex and maternal race/ethnicity is unknown. To determine if fetal sex and maternal race/ethnicity influence neuroinflammation, an organ-on-chip (OOC) model were established under normal or pathologic conditions utilizing amniotic fluid. OOC is composed of two-cell culture chambers connected by Type IV collagen-coated microchannels. Human fetal astroglia (SVGp12) and microglia (HMC3) were co-cultured at an 80:20 ratio in the inner chamber. The outer chamber contained amniotic fluid (AF) from male and female fetuses of White Hispanic (WH) and African-American (AA) pregnant women with or without lipopolysaccharide (LPS-100ng/ml) and incubated for 48h. Glial migration (brightfield microscopy), activation (Immunocytochemistry), and cytokine production (Luminex assays) were quantified and compared (N=4 for each category of sex and race/ethnicity). In a pooled analysis, AF+LPS did not induce glial activation or inflammatory changes compared to AF alone. When stratified by sex, male AF+LPS promoted significant glial activation (high CD11b:p<0.05; low Iba1:p<0.01) compared to male AF without LPS; however, this was not associated with changes in pro-inflammatory cytokines. When stratified by race/ethnicity, AF+LPS induced glial activation in both groups, but a differential increase in pro-inflammatory cytokines was seen between WH and AA AF (WH-interleukin-1β: p<0.05; AA-interleukin-8: p<0.01). This OOC model of fetal neuroinflammation has determined that race/ethnicity differences do exist for perinatal brain injury. The fetal sex of neonates was not a determining factor of susceptibility to intraamniotic inflammation leading to neuroinflammation.

Neighborhood racial composition: associations with macrophage migration inhibitory factor (MIF) and interferon-gamma among pregnant african american women

Neighborhood racial composition: associations with macrophage migration inhibitory factor (MIF) and interferon-gamma among pregnant african american women

Use of high-resolution metabolomics to assess the biological perturbations associated with maternal exposure to Bisphenol A and Bisphenol F among pregnant African American women

Use of high-resolution metabolomics to assess the biological perturbations associated with maternal exposure to Bisphenol A and Bisphenol F among pregnant African American women

Variability of per- and polyfluoroalkyl substances concentrations among pregnant African American women and newborns

Variability of per- and polyfluoroalkyl substances concentrations among pregnant African American women and newborns

Use of high-resolution metabolomics to assess the biological perturbations associated with maternal exposure to Bisphenol A and Bisphenol F among pregnant African American women

BackgroundHuman and animal exposure to bisphenol A (BPA) has been associated with adverse developmental and reproductive effects. The molecular mechanisms by which BPA exposure exerts its effects are not well-understood, even less known about its analogues bisphenol F (BPF). To address these knowledge gaps, we conducted an untargeted metabolome-wide association study (MWAS) to identify metabolic perturbations associated with BPA/BPF exposures in a pregnant African American cohort. MethodsFrom a subset of study participants enrolled in the Atlanta African American Maternal-Child cohort, we collected both urine samples, for targeted exposure assessment of BPA (N = 230) and BPF (N = 48), and serum samples, for high-resolution metabolomics (HRM) profiling (N = 230), during early pregnancy (8–14 weeks’ gestation). Using an established untargeted HRM workflow consisting of MWAS modeling, pathway enrichment analysis, and chemical annotation and confirmation, we investigated the potential metabolic pathways and features associated with BPA/BPF exposures. ResultsThe geometric mean creatinine-adjusted concentrations of urinary BPA and BPF were 0.85 ± 2.58 and 0.70 ± 4.71 µg/g creatinine, respectively. After false positive discovery rate correction at 20 % level, 264 and 733 unique metabolic features were significantly associated with urinary BPA and BPF concentrations, representing 10 and 12 metabolic pathways, respectively. Three metabolic pathways, including steroid hormones biosynthesis, lysine and lipoate metabolism, were significantly associated with both BPA and BPF exposure. Using chemical standards, we have confirmed the chemical identity of 16 metabolites significantly associated with BPA or BPF exposure. ConclusionsOur findings support that exposure to BPA and BPF in pregnant women is associated with the perturbation of aromatic amino acid metabolism, xenobiotics metabolism, steroid biosynthesis, and other amino acid metabolism closely linked to stress responses, inflammation, neural development, reproduction, and weight regulation.

P017 Project DINE: Improving Diet Quality in Pregnant Women Through the University of Georgia EFNEP

<h3>Background</h3> Georgia's maternal mortality rates are 60% higher for African American women compared to all racial/ethnic groups. There is also evidence that father involvement in prenatal maternal health initiatives may positively influence health outcomes. Nutrition education during pregnancy may also promote positive nutrition outcomes. <h3>Objective</h3> A primary goal of Project DINE (Dads in Nutrition Education) is to improve maternal nutritional outcomes and to increase father involvement through family participation in UGA (the University of Georgia) EFNEP (Expanded Food and Nutrition Education Program), an evidence-based community nutrition program. <h3>Study Design, Setting, Participants</h3> Participants were recruited by Morehouse School of Medicine and community partners, and were divided into two groups: single moms and expectant couples with father/male involvement. Inclusion criteria were African American pregnant women or men expecting a baby and Healthy Start program participants. UGA EFNEP provided an eight-week virtual nutrition education program in both metro and rural counties. <h3>Measurable Outcome/Analysis</h3> Data analyses were completed via WebNEERs, the centralized database for NIFA EFNEP at the federal level. Overall diet quality indicators (i.e., fruit/vegetable intake, sweet beverage intake, dinner at home) were measured pre/post analysis of the validated and federally mandated survey. <h3>Results</h3> Twenty single moms (SM) and 6 couples (C) (n = 32) graduated from Project DINE EFNEP (FY21). Overall diet quality improved in 97% of all graduates. When comparing groups, overall diet quality improved in 100% graduate couples vs. 95% (SM), including increased vegetable intake (54% couples vs. 40% SM) <h3>Conclusions</h3> Preliminary data indicate that UGA EFNEP as a nutrition intervention for pregnant women improves overall diet quality, including fruit and vegetable intake. Father involvement in nutrition education may provide an additional benefit to improving overall diet quality for their pregnant partners. <h3>Funding</h3> Expanded Food and Nutrition Education Program

Congenital cardiac masses: a case report

BackgroundCardiac tumors in infants and children are rare. The most common cardiac tumor is rhabdomyoma, which may be associated with tuberous sclerosis. However, not all cardiac rhabdomyomas are pathognomonic for tuberous sclerosis, and not all congenital cardiac tumors are rhabdomyomas. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care.Case presentationWe report a 36-year-old African American pregnant women. At 32 weeks 5 days gestational age, the male fetus had a fetal echocardiogram due to fetal arrhythmia. The fetal echocardiogram showed two small echogenic, RV apex and septal masses, suspicious of rhabdomyomas. After a routine pregnancy and a normal spontaneous vaginal delivery (39 weeks 1 day), the male baby was admitted to the neonatal intensive care unit for further monitoring and postnatal evaluation.ConclusionsRhabdomyomas are extremely rare and unique tumors. These tumors are very dangerous, but they usually regress after birth. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care. We present this case to share our findings with our pediatric colleagues. Although a rarely reported case, we hope this cardiac rhabdomyoma case report and literature review can increase cardiac tumor awareness.

Psychosocial and behavioral factors affecting inflammation among pregnant African American women

African American women are reported to have greater inflammation compared with women from other racial groups. Higher inflammation during pregnancy has been associated with increased risk of adverse perinatal outcomes. We hypothesized that maternal inflammation is related to depressive symptoms and social and behavioral risk factors among pregnant African American women. Pregnant African American women (n ​= ​187) were recruited at prenatal clinics in the Midwest. Women completed questionnaires and had blood drawn at a prenatal visit. Plasma levels of cytokines (interferon gamma [IFN]-γ, interleukin [IL]-6, IL-8, IL-10, tumor necrosis factor [TNF]-α) and C-reactive protein (CRP) were measured by multiplex assays. Women had a mean age of 26.58±5.42 years and a mean gestational age at data collection of 16.35±5.95 weeks. Twenty-six percent of women had Center for Epidemiological Studies-Depression (CES-D) scores ≥23 (scores that have been correlated with clinical diagnosis of depression), 15.5% smoked cigarettes, 16.6% used marijuana, and 5.3% reported experiencing intimate partner violence (IPV). Higher CES-D scores were correlated with higher plasma CRP levels (r ​= ​0.16, p ​= ​0.046). Women who reported any experiences of IPV during pregnancy had higher levels of IL-8 (p ​= ​0.018) and lower levels of IFN-γ (p ​= ​0.012) compared with women who did not report IPV. Cigarette smoking during pregnancy was associated with lower levels of the anti-inflammatory cytokine IL-10 (p ​= ​0.003). These findings suggest that depressive symptoms, IPV, and cigarette smoking during pregnancy relate to select inflammatory markers in pregnant African American women. The relationships of inflammation with these factors should be further investigated to better understand the mechanisms which influence maternal and fetal health outcomes.

Initial Psychometric Testing of a Brief Maternal Oral Symptom Survey

IntroductionOral health is an important component of maternal health. Pregnant women face unique oral health challenges. Although there is abundant evidence of the strong association between poor oral health and adverse pregnancy outcomes, oral health assessment is frequently overlooked by prenatal care providers. The purpose of this study was to test the reliability and validity of a brief maternal oral symptom survey for potential use by prenatal care providers to screen pregnant women for oral health concerns.MethodsThis study provides results of preliminary psychometric testing of a brief maternal oral symptom survey. The survey was administered to 455 pregnant African American women at 2 time points: early pregnancy (8‐14 weeks) and late pregnancy (24‐30 weeks). Saliva samples were collected on a small subset of the larger sample (n = 34). Cronbach's alpha was used to measure the internal consistency of the survey. Content validity was assessed using an expert panel (n = 32), and criterion validity was assessed by testing the association of survey items with salivary biomarkers.ResultsThe oral health survey showed moderate overall content validity. Scores on the content validity index identified that 5 out of 10 survey items were relevant, clear, and important. Log‐transformed C‐reactive protein levels were associated with reported “dry mouth” and education. Cronbach's alpha value was 0.502.DiscussionSuggested revisions of the oral symptom survey include removing items that performed poorly on the content validity index and additional inclusion of sociodemographic variables. With further testing and validation, this survey has the potential to be an effective screening tool to assess for prenatal oral health concerns that increase risk for poor birth outcomes.

Per- and polyfluoroalkyl substance (PFAS) exposure, maternal metabolomic perturbation, and fetal growth in African American women: A meet-in-the-middle approach.

Prenatal exposures to per- and polyfluoroalkyl substances (PFAS) have been linked to reduced fetal growth. However, the detailed molecular mechanisms remain largely unknown. This study aims to investigate biological pathways and intermediate biomarkers underlying the association between serum PFAS and fetal growth using high-resolution metabolomics in a cohort of pregnant African American women in the Atlanta area, Georgia. Serum perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) measurements and untargeted serum metabolomics profiling were conducted in 313 pregnant African American women at 8-14weeks gestation. Multiple linear regression models were applied to assess the associations of PFAS with birth weight and small-for-gestational age (SGA) birth. A high-resolution metabolomics workflow including metabolome-wide association study, pathway enrichment analysis, and chemical annotation and confirmation with a meet-in-the-middle approach was performed to characterize the biological pathways and intermediate biomarkers of the PFAS-fetal growth relationship. Each log2-unit increase in serum PFNA concentration was significantly associated with higher odds of SGA birth (OR=1.32, 95% CI 1.07, 1.63); similar but borderline significant associations were found in PFOA (OR=1.20, 95% CI 0.94, 1.49) with SGA. Among 25,516 metabolic features extracted from the serum samples, we successfully annotated and confirmed 10 overlapping metabolites associated with both PFAS and fetal growth endpoints, including glycine, taurine, uric acid, ferulic acid, 2-hexyl-3-phenyl-2-propenal, unsaturated fatty acid C18:1, androgenic hormone conjugate, parent bile acid, and bile acid-glycine conjugate. Also, we identified 21 overlapping metabolic pathways from pathway enrichment analyses. These overlapping metabolites and pathways were closely related to amino acid, lipid and fatty acid, bile acid, and androgenic hormone metabolism perturbations. In this cohort of pregnant African American women, higher serum concentrations of PFOA and PFNA were associated with reduced fetal growth. Perturbations of biological pathways involved in amino acid, lipid and fatty acid, bile acid, and androgenic hormone metabolism were associated with PFAS exposures and reduced fetal growth, and uric acid was shown to be a potential intermediate biomarker. Our results provide opportunities for future studies to develop early detection and intervention for PFAS-induced fetal growth restriction.

Assessment of metabolic perturbations associated with exposure to phthalates among pregnant African American women

BackgroundPhthalates have been linked with numerous harmful health effects. Limited data are available on the molecular mechanism underlying phthalate toxicity on human health. In this study, we measured urinary phthalate metabolites and used high-resolution metabolomics (HRM) to identify biological perturbations associated with phthalate exposures among pregnant African American (AA) women, who are disproportionately exposed to high phthalates levels. MethodsWe used untargeted HRM profiling to characterize serum samples collected during early (8–14 weeks gestation) and late (24–30 weeks gestation) pregnancy from 73 participants from the Atlanta AA Maternal-Child cohort. We measured eight urinary phthalate metabolites in early and late pregnancy, including Monoethyl phthalate (MEP), Mono(2-ethlyhexyl) phthalate (MEHP), and Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), to assess maternal exposures to phthalates. Metabolite and metabolic pathway perturbation were evaluated using an untargeted HRM workflow. ResultsGeometric mean creatinine-adjusted levels of urinary MEP, MEHP, and MEHHP were 67.3, 1.4, and 4.1 μg/g creatinine, respectively, with MEP and MEHP higher than the mean levels of non-Hispanic blacks in the general US population (2015–2016). There were 73 and 1435 metabolic features significantly associated with at least one phthalate metabolite during early and late pregnancy (p < 0.005), respectively. Pathway enrichment analysis revealed perturbations in four inflammation- and oxidative-stress-related pathways associated with phthalate metabolite levels during both early and late pregnancy, including glycerophospholipid, urea cycle, arginine, and tyrosine metabolism. We confirmed 10 metabolites with level-1 evidence, which are associated with urinary phthalates, including thyroxine and thiamine, which were negatively associated with MEP, as well as tyramine and phenethylamine, which were positively associated with MEHP and MEHHP. ConclusionOur results demonstrated that urinary phthalate levels were associated with perturbations in biological pathways connected with inflammation, oxidative stress, and endocrine disruption. The findings support future targeted investigations on molecular mechanisms underlying the impact of maternal phthalates exposure on adverse health outcomes.