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Objective Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB. Study Design This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5–7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth. Results Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios = [aOR 6.21], 95% confidence interval [CI]: 5.84–6.60; aOR = 3.57, 95% CI: 3.36–3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018. Conclusion Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits. Key Points PNC utilization is associated with the risk of PTB. Despite an increase in PNC utilization, PTB rates have increased. There is an even stronger association between PNC utilization and PTB over time. [ABSTRACT FROM AUTHOR]

Objective  Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm. Study Design  Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals. Results  Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p  = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28–4.07). Conclusion  Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision. Key Points Tobacco exposure is not associated with impaired neurodevelopment in this preterm population. Prenatal tobacco exposure is associated with increased need for corrective lenses. Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children. [ABSTRACT FROM AUTHOR]

Across the globe, states are enacting increasingly anti-migrant policies in the face of growing refugee crises. Indonesia is a prominent example of a country that denies permanent settlement to refugees within its territory. Nonetheless, when Rohingya refugees who fled violence and religious persecution were stranded in the Adaman Sea, fishermen from Indonesia's Aceh province intervened to rescue the refugees when nearby governments, including Indonesia, refused to act. Local Acehnese villagers and NGOs then acted to provide critical emergency shelter and aid to the refugees. This analysis will examine the reasons that motivated the Acehnese to welcome the Rohingya despite the anti-refugee policies of the Indonesian government, and whether these motivations could have been extended in the long term. It will also analyze how Indonesia can use the example set by the Acehnese to expand its own refugee policies and become a more welcoming and open country for the long-term resettlement of refugees. [ABSTRACT FROM AUTHOR]

In the current American political climate, immigration is a highly contentious issue. As immigration from Central America's Northern Triangle (El Salvador, Guatemala, and Honduras) increases, the Trump Administration has enacted harsher immigration laws and revamped border security in an attempt to discourage migrants from journeying to the U.S. Historically, U.S. military and economic interventions helped create environments in the region that foster violence and encourage migration. Moreover, the policies adopted by the U.S. following its involvement in Central America have done little to decrease the number of immigrants arriving at the border. Based on historical precedent, increased border security and harsher immigration policies will not successfully decrease the number of immigrants attempting to cross into the U.S. today. Utilizing various case studies concerning U.S.-Latin American relations, this analysis will illustrate the influence that the U.S. had in creating unstable environments in Central America, as well as highlight how socio-economic factors play a much larger role in influencing one's decision to migrate rather than the threat of apprehension at the border. The U.S., therefore, must invest in sustainable development programs that expand human capital if it hopes to reduce the number of immigrants arriving at the southern border. [ABSTRACT FROM AUTHOR]

Objective: Black patients have disproportionately more cases of peripartum cardiomyopathy (PPCM) and more severe disease. To better understand these disparities, we examined the geographic distribution of patients with PPCM by race and evaluated associations between race and social vulnerability. We hypothesized that Black patients with PPCM are more likely than White patients to live in socially vulnerable communities., Study Design: A retrospective cohort study of patients with PPCM defined by the National Institutes of Health, National Heart, Lung, and Blood Institute was conducted at a single center from January 2000 to November 2017. The US census tract for each patient was identified, and social vulnerability was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Higher SVI values represent a more vulnerable community. SVI and select subcomponents were compared by self-reported race., Results: Among 90 patients with PPCM (47 White, 43 Black), the ejection fraction at diagnosis was similar between groups, although Black patients were more likely to have an ejection fraction of ≤40% at 6 to 12 months postpartum. Black race was associated with living in areas of greater social vulnerability; mean SVI was significantly higher among Black individuals than among White individuals (.56 versus .33, P=.0003). Black patients lived in areas with more people living in poverty, higher unemployment, and more single-parent households., Conclusion: Black patients with PPCM were more likely to have persistent left ventricular dysfunction and live in areas of greater social vulnerability. Strategies to achieve equitable social determinants of health are needed to improve health outcomes in Black patients with PPCM.