Pregnant Women In California Research Articles

A Micro-Level Analysis of Physiological Responses to COVID-19: Continuous Monitoring of Pregnant Women in California.

Continuous monitoring of perinatal women in a descriptive case study allowed us the opportunity to examine the time during which the COVID-19 infection led to physiological changes in two low-income pregnant women. An important component of this study was the use of a wearable sensor device, the Oura ring, to monitor and record vital physiological parameters during sleep. Two women in their second and third trimesters, respectively, were selected based on a positive COVID-19 diagnosis. Both women were tested using the polymerase chain reaction method to confirm the presence of the virus during which time we were able to collect these physiological data. In both cases, we observed 3–6 days of peak physiological changes in resting heart rate (HR), heart rate variability (HRV), and respiratory rate (RR), as well as sleep surrounding the onset of COVID-19 symptoms. The pregnant woman in her third trimester showed a significant increase in resting HR (p = 0.006) and RR (p = 0.048), and a significant decrease in HRV (p = 0.027) and deep sleep duration (p = 0.029). She reported experiencing moderate COVID-19 symptoms and did not require hospitalization. At 38 weeks of gestation, she had a normal delivery and gave birth to a healthy infant. The participant in her second trimester showed similar physiological changes during the 3-day peak period. Importantly, these changes appeared to return to the pre-peak levels. Common symptoms reported by both cases included loss of smell and nasal congestion, with one losing her sense of taste. Results suggest the potential to use the changes in cardiorespiratory responses and sleep for real-time monitoring of health and well-being during pregnancy.

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

Severe maternal hardships are associated with food insecurity among low-income/lower-income women during pregnancy: results from the 2012\u20132014 California maternal infant health assessment

BackgroundAssess the associations between ten severe maternal hardships and food insecurity experienced during pregnancy.MethodsData on 14,274 low-income/lower-income women (below 400% of the income to federal poverty guideline ratio) from the statewide-representative 2010–2012 California Maternal and Infant Health Assessment were used to estimate food security status prevalence. Prevalence of severe maternal hardships by food security status was estimated. Multinomial logistic regression was used to assess the associations between severe maternal hardship and food security status, adjusting for sociodemographic characteristics.ResultsFood insecurity was common among low- and lower-income pregnant women in California; 23.4% food insecure and an additional 11.5% marginally secure. In adjusted analysis, nine of ten hardships were associated with food security status. Only the respondent or someone close to the respondent having a problem with alcohol or drugs was not associated with food security status after adjusting for socioeconomic factors. Husband/partner losing a job, depressive symptoms, not having practical support and intimate partner violence were consistently associated with marginal, low and very low food security status. Each additional severe maternal hardship a woman experienced during pregnancy was associated with a 36% greater risk of reporting marginal food security (Relative Risk Ratio 1.36, 95% CI: 1.27, 1.47), 54% for low food security (Relative Risk Ratio 1.54, 95% CI: 1.44, 1.64), and 99% for very low food security (Relative Risk Ratio 1.99, 95% CI: 1.83, 2.15).ConclusionsFood security status was strongly linked with several maternal hardships that could jeopardize maternal and/or infant health.Services—including prenatal care and nutritional assistance—for a large proportion of pregnant women should address a wide range of serious unmet social needs including food insecurity.

Tdap Vaccine Knowledge and Acceptance Rates during Pregnancy in a Los Angeles Public Teaching-Hospital Clinic [7P

INTRODUCTION: Though the prevalence of pertussis is on the rise, only 35% of pregnant women in California with public insurance reported receiving the tetanus, diphtheria and pertussis vaccine (Tdap). The Tdap vaccine has been shown to reduce the risk of neonatal pertussis by 78% if mothers received it in the third trimester. This study evaluates pregnant women’s knowledge about the Tdap and its acceptance rate during pregnancy. METHODS: After IRB approval was obtained, pregnant women receiving prenatal care at a public teaching-hospital clinic were individually interviewed from June to August 2017 about their knowledge of vaccines during pregnancy. Interviews were conducted in English or Spanish. Women who already received the Tdap were excluded. The clinic’s Tdap acceptance rate was obtained through chart review. RESULTS: Among 152 pregnant women who had not yet received the Tdap during the current pregnancy, 80(53%) had never heard of the vaccine. An additional 53(35%) had heard of the vaccine but could not identify why the vaccine was recommended in pregnancy. Forty-eight percent of these women were either undecided at the time of their interview or did not plan to get the Tdap. In contrast, the Tdap acceptance rate in the third trimester in this clinic was 84%. CONCLUSION: The majority of pregnant women in a low-income clinic have limited understanding of the importance of the Tdap during pregnancy. Interestingly, most pregnant women in this population nonetheless received the vaccine. Educational initiatives about the Tdap may improve patients' knowledge and help them become more informed in their pregnancy-related decisions.

Polybrominated Diphenyl Ethers, Hydroxylated Polybrominated Diphenyl Ethers, and Measures of Thyroid Function in Second Trimester Pregnant Women in California

Prenatal exposure to polybrominated diphenyl ethers (PBDEs) may disrupt thyroid function and contribute to adverse neurodevelopmental outcomes. We conducted a pilot study to explore the relationship between serum concentrations of lower-brominated PBDEs (BDE-17 to -154), higher-brominated PBDEs (BDE-183 to -209), and hydroxylated PBDE metabolites (OH-PBDEs) with measures of thyroid function in pregnant women. Concentrations of PBDEs, OH-PBDEs, thyroid-stimulating hormone (TSH), total thyroxine (T(4)), and free T(4) were measured in serum samples collected between 2008 and 2009 from 25 second trimester pregnant women in California. Median concentrations of lower-brominated PBDEs and OH-PBDEs were the highest reported to date in pregnant women. Median concentrations of BDE-47 and the sum of lower-brominated PBDEs (ΣPBDE(5)) were 43.1 ng/g lipid and 85.8 ng/g lipid, respectively, and the sum of OH-PBDEs (ΣOH-PBDE(4)) was 0.084 ng/mL. We observed a positive association between the weighted sum of chemicals known to bind to transthyretin (ΣTTR binders) and TSH levels. We also found positive associations between TSH and ΣPBDE(5), ΣOH-PBDE(4), BDE-47, BDE-85, 5-OH-BDE47, and 4'-OH-BDE49, and an inverse association with BDE-207. Relationships with free and total T(4) were weak and inconsistent. Our results indicate that PBDE exposures are elevated in pregnant women in California and suggest a relationship with thyroid function. Further investigation is warranted to characterize the risks of PBDE exposures during pregnancy.

Most pregnant women in California do not receive dental care: findings from a population-based study.

We examined the prevalence of dental care during pregnancy and reasons for lack of care. Using a population-based survey of 21,732 postpartum women in California during 2002-2007, we calculated prevalence of dental problems, receipt of care, and reasons for non-receipt of care. We used logistic regression to estimate odds of non-receipt of care by maternal characteristics. Overall, 65% of women had no dental visit during pregnancy; 52% reported a dental problem prenatally, with 62% of those women not receiving care. After adjustment, factors associated with non-receipt of care included non-European American race/ethnicity, lack of a college degree, lack of private prenatal insurance, no first-trimester prenatal insurance coverage, lower income, language other than English spoken at home, and no usual source of pre-pregnancy medical care. The primary reason stated for non-receipt of dental care was lack of perceived need, followed by financial barriers. Most pregnant women in this study received insufficient dental care. Odds were elevated not only among the poorest, least educated mothers, but also among those with moderate incomes or some college education. The need for dental care during pregnancy must be promoted widely among both the public and providers, and financial barriers to dental care should be addressed.

Choline and Risk of Neural Tube Defects in a Folate-fortified Population

Folic acid is known to reduce risk of neural tube defects (NTDs). Even so, NTDs continue to occur despite individual supplementation or population fortification with folic acid. We investigated other nutrients related to one-carbon metabolism that may affect NTD risk. This prospective study included data from more than 180,000 pregnant women in California from 2003 through 2005. Midpregnancy serum specimens were linked with delivery information regarding the presence of a NTD, another structural malformation, or no malformation in the fetus. We identified 80 NTD-affected pregnancies (cases) and we randomly selected 409 pregnancy controls. Serum specimens were tested for methylmalonic acid, homocysteine, cysteine, methionine, total choline, betaine, cystathionine, vitamin B6, folate, vitamin B12, riboflavin, and creatinine. We observed elevated NTD risks associated with lower levels of total choline, and reduced risks with higher levels of choline. Specifically, we observed an odds ratio of 2.4 (95% confidence interval = 1.3-4.7) associated with the lowest decile and an odds ratio of 0.14 (0.02-1.0) associated with the highest decile, both relative to the 25th-74th percentiles of the control distribution. These data did not show meaningful differences between cases and controls for any other analytes. This is the first study to investigate total choline in NTD-affected pregnancies. Our findings for choline, for which low levels were a risk factor and higher levels were a protective factor for NTDs, may offer a useful clue toward understanding the complex etiologies of NTDs in an era of folic acid fortification of the food supply.

Pregnancy-associated colon and rectal cancer: perinatal and cancer outcomes

Objective. Assess the impact of colorectal cancer on maternal and neonatal outcomes.Methods. Cases were identified using several computer-generated linkage analyses. Maternal and newborn hospital discharges in California were linked to birth and if applicable infant death certificate records. This database was then linked to the California Cancer Registry, to create a cohort of women with pregnancy-associated colon and rectal cancer. This cohort was compared to pregnant women in California without colorectal cancer. Our secondary comparison was to non-pregnant, Californian women with colorectal cancer who could be aged-matched.Results. Women with pregnancy-associated colorectal cancer were more likely to undergo cesarean section (OR: 1.9) and to develop puerperal infections (OR: 2.8). In addition, higher rates of preterm delivery were found both secondary to scheduled deliveries and preterm labor (OR for preterm labor, 2.8). Neonatal outcomes were fairly similar between the two groups. Pregnancy was not found to have a significant effect on survival (HR: 0.73).Conclusions. We found that women with pregnancy-associated colorectal cancer had excellent maternal and neonatal outcomes. This is likely secondary to the fact that most women are diagnosed after delivery. In addition, survival is similar between pregnancy-associated and non-pregnancy associated cases.

Response to: DEA in consumer products is safe

We thank Dr. Bailey for providing the perspective of the Cosmetic, Toiletry, and Fragrance Association. In our paper we reported that the developing mouse hippocampus was sensitive to dermally administered diethanolamine (DEA) during pregnancy. We used 80 mg/kg/d DEA in these experiments, and we estimated that this exposure was approximately 10-fold higher than likely human exposure. The message of our paper was that, for the first time, DEA was observed to have effects on brain development, and until we know more about this effect it would be prudent for pregnant women to minimize their exposure. Dr. Bailey disputes this, arguing that human skin is less permeable, that the DEA now commonly used in cosmetics is conjugated to a fatty acid, and that humans are not very susceptible to choline deficiency. Dr. Bailey is mistaken when he states that we reported a no-effect level of 20 mg/kg/day for the DEA effect on brain development. The only dose we tested was 80 mg/kg/day and we do not know what the no-effect dose will be; these studies are underway. We agree that estimating the dose exposure to DEA in humans is difficult. We agree with Dr. Bailey that penetration of DEA through human skin is likely to be less than through mouse skin. We administered DEA for only 11 days during pregnancy, many women use DEA-containing products long before they are pregnant and daily throughout pregnancy. The biological half-life of DEA is about 1 week, with steady state for bioaccumulation reached at approximately 4 weeks of dosing (1). Thus, it is likely that our 11 day-dosing procedure underestimated potential exposure. Finally, though shampoos are washed off and do not stay in contact with skin, DEA compounds are also used in sunscreen and skin lotions (2) that are applied to large areas of skin surface and left on the skin. We applied DEA to a small area of skin in our experiments. Note that the lowest dose tested by the National Toxicology Program when they assessed DEA-related carcinogenicity was 10 mg/kg/day (2). In addition, Dr. Bailey does not address occupational exposure. Occupational exposure to DEA is most likely through the use of lubricating liquids in various processes in machine building; DEA is a component of bulk cutting fluids (3). The National Institute for Occupational Safety and Health estimates that the number of workers potentially exposed to DEA is approximately 800,000/year (3). Dr. Bailey points out that many manufacturers have begun using fatty acid conjugates of DEA. We do not know whether such amides have equivalent effects to DEA. The National Toxicology Program has tested DEA-lauryl and reported that it was absorbed across the skin, and that 14 week treatment dermally resulted in modest pathology in the liver of mice (4). The dose with this effect was the molar equivalent of half the dose of DEA we used in our study. Until we know more, we think it is prudent to be cautious. Finally, Dr. Bailey cites an old reference suggesting that humans are less dependent on choline than are rodents. Recent studies clearly demonstrate that humans are susceptible to choline deficiency (5-12). We estimate that normal choline intake is 750 mg/day in adults. However, Shaw and colleagues, studying pregnant women in California observed intakes that were less than half this amount in 25% of the women studied (13). Women in this lowest quartile for dietary choline had 4 the risk of having a baby with a neural tube defect, and 1.6 the risk of having a baby with a cleft palate (13, 14). Thus, there is a real possibility that dietary choline intake during pregnancy is marginal and that exposure to DEA might compromise choline availability further.

Utilization of Pay-in Antenatal Leave Among Working Women in Southern California

Examine antenatal leave arrangements among pregnant workers in California, and the occupational, demographic and well-being characteristics associated with leave taking. Unlike most states, California provides paid pregnancy leave up to 4 weeks antenatally and 6-8 weeks postnatally. Weighted data from postpartum telephone interviews conducted between July 2002 and November 2003 were analyzed for 1214 women participating in a case-control study of birth outcomes in Southern California. Eligible women worked at least 20 h/week during the first two trimesters of pregnancy or through the date of prenatal screening. The overall response rate was 73%. Fifty-two percent of women took no leave, 32% took antenatal leave expecting to return to their job or employer sometime after giving birth, and 9% quit their jobs during pregnancy. For leave-takers with paid leave (69%), the state was the main source of pay (74%). Medical problems (52%) rather than maternity leave benefits (25%) were the most common stated reasons for taking leave. The strongest predictors of leave taking versus working through pregnancy were feeling stressed and tired (adjusted OR = 4.3, 95% CI [2.2-8.2]) and having young children (adjusted OR = 2.1, 95% CI [1.2-3.7]), followed by occupational factors (night shift, unfulfilling and inflexible work, short work tenure). Lack of employer-offered maternity leave benefits was associated with increased quitting relative to both leave taking and working through pregnancy. Maternity benefits influence quitting, but alone do not determine antenatal leave taking. Working pregnant women in California utilize leave cautiously and predominantly to cope with health problems, work dissatisfaction and fatigue.

Malignant melanoma in pregnancy

For many years, there has been controversy in the medical community regarding the correlation of female hormonal factors with the outcome of women with malignant melanoma. There have been multiple reports that women with high hormone states, such as pregnancy, had thicker tumors and/or a worse prognosis compared with a group of control women. The authors used a database that contained maternal and neonatal discharge records from the entire state of California from 1991 to 1999 and linked those records to the California Cancer Registry, which maintains legally mandated records of all cancers reported in California during the same time period. Four hundred twelve women with malignant melanoma diagnosed during or within 1 year after pregnancy were identified (145 antepartum, 4 at delivery, and 263 postpartum) and were compared with a group of age-matched, nonpregnant women with melanoma (controls). The database captured only pregnancies at > or = 20 weeks of gestation. When comparing women who had pregnancy-associated melanoma with the control group, the authors found no difference in the distribution of disease stage (82.0% of pregnant and postpartum women had localized melanoma vs. 81.9% of control women) or the tumor thickness (mean: 0.77 mm for pregnant women, 0.90 mm for postpartum women, and 0.81 mm for the control group). In a multiple regression model that controlled for age, race, stage, and tumor thickness, pregnancy had no impact on survival in women with melanoma. Lymph node assessment and positivity of lymph nodes also were equivalent between the two groups. Maternal and neonatal outcomes did not differ between pregnant women with melanoma and control women who were pregnant and had no history of malignancy. Small numbers of women with advanced melanoma and the inability to capture melanoma that occurred in pregnancies that were lost or were terminated prior to 20 weeks limited the conclusions primarily to women with localized melanoma. In this large, population-based study of pregnant women in California from 1991 to 1999 with malignant melanoma, there were no data found to support a more advanced stage, thicker tumors, increased metastases to lymph nodes, or a worsened survival. The outcome for women with localized melanoma associated with pregnancy was excellent. Maternal and neonatal outcomes also were equivalent to those of pregnant women without melanoma.

Maternal and neonatal outcomes of assaults and intentional injuries in pregnancy

TIONAL INJURIES IN PREGNANCY DINA EL KADY, LLOYD SMITH, WILLIAM M. GILBERT, University of California, Davis, OB/GYN, Sacramento, CA OBJECTIVE: To determine the occurrence rates and maternal and fetal/ neonatal outcomes secondary to assaults in pregnant women. STUDY DESIGN: This is a population-based retrospective cohort study of maternal and fetal/neonatal outcomes of assaults and intentional injuries in pregnant women in California from 1991-1999. External causation codes (E codes) for assaults and intentional injuries were identified from hospital discharge records. Maternal and fetal/neonatal outcomes including PTL, PROM, abruption, uterine rupture, blood transfusions, fetal distress, birth asphyxia, low birth weight, prematurity, maternal death, and fetal death were analyzed using odds ratios and 95% confidence intervals. RESULTS: Of 4,824,926 deliveries, a total of 14,110 women were hospitalized for injuries in pregnancy. Of this group, 29% (4122 women) sustained intentional injuries and assaults. Women sustaining injuries secondary to assaults severe enough for delivery had a 4.9-fold increased risk of placental abruption (CI 2.9, 8.7), a 41-fold increased risk of uterine rupture prior to the onset of labor (CI 5.7, 295), a 7-fold increase in blood transfusions (CI 3.5, 14.6), an 18-fold increased risk of maternal death (CI 2.5, 134), and a 7-fold increased risk of fetal death (CI 4.1, 12.7). Women sustaining assaults who were discharged undelivered had an increased risk of PTL (OR 2.6 [CI 2.4, 2.8]), preterm delivery (OR 1.3 [1.2, 1.4]), low birth weight infants (OR 1.7 [1.5, 1.9]), PROM (OR 1.6 [1.3, 2.0]), placental abruption (OR 1.6 [1.2, 2.0]), and the need for blood transfusions (OR 2.2 [1.6, 3.3]). CONCLUSION: Assaults and intentional injuries during pregnancy result in significantmaternal and fetal morbidity andmortality. Maternal and neonatal morbidity persisted, even for women who were discharged undelivered, suggesting possible long-term consequences of the assaults. Finally, uterine rupture prior to the onset of labor should alert the physician to the possibility of assault.

The working-class context of pregnancy smoking

The risk of smoking during pregnancy in the US is strongly associated with women's individual socioeconomic status (SES) but little is known about the influence of local area context. The aim of this study was to examine whether local-area characteristics increase the risk of smoking during pregnancy above and beyond individual SES. In a hospital-based cohort of 878 pregnant women in California, who delivered between 1980 and 1990, we compared risk of smoking during pregnancy based on individual and local-area factors. Adjusting for individual SES, neighborhood social class was related to smoking in early pregnancy. Living in a predominantly working-class area significantly increased the risk of pregnancy smoking for both working-class and non-working-class women. However, local-area economic and demographic indicators were not related to smoking early in pregnancy. Individual and family characteristics alone may be insufficient to explain smoking during pregnancy; the social class context of the places in which pregnant women live may also influence this behavior.

Contextual Effects of Perinatal Substance Exposure among Black and White Women in California

This secondary analysis assessed the impact of neighborhood characteristics on individual substance exposures among pregnant women in California. Zip code-level census data were attached to data from the 1992 California Perinatal Substance Exposure Study to serve as a proxy for neighborhood characteristics. The central hypothesis of this study suggests that there are differences in substance exposure rates among women living in neighborhoods with differing socioeconomic statuses. The second hypothesis for this study suggests that there are no differences among black and white prevalence rates after controlling for neighborhood characteristics. Logistic regression analyses indicated that the proportion of a neighborhood receiving public assistance was a significant predictor for use of amphetamines, opiates, marijuana, tobacco, and any illegal drug but not alcohol or cocaine. Results also indicated that blacks had higher predicted prevalence risks for alcohol and cocaine while whites had higher predicted risks for tobacco, marijuana, and amphetamines.

Individual and Community Level Correlates of Prenatal Care in California

This event history analysis of the Perinatal Substance Exposure Study investigates individual and community level correlates of the timing of first prenatal care among pregnant women in California. Data were collected anonymously at the time of delivery and include demographic information from hospital records and urine samples which were tested for a battery of substances. Zip-code level data from the 1990 census were appended to each record to assess absolute community effects. A discrete-time hazard rate was estimated for each trimester in six nested models using logistic regression. Results suggest that: poor, non-White, younger, native born, Spanish-speaking, substance-using women in poorer neighborhoods were least likely to receive prenatal care. While a positive urine test for alcohol was not associated with prenatal care initiation; overall drug positives and tobacco positives (self-report) were. The optimal model, with interactions, estimates that women in poorer communities were less likely to receive prenatal care in the first trimester, but more likely to receive care in the third trimester. This pattern is similar for most of the time-varying covariates in that non-Whites, English speakers and younger women were less likely to receive first trimester care, but more likely to receive second and third trimester care.