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To evaluate the association between prenatal stress and gestational weight gain (GWG). This was an analysis of women recruited between 2013–2015 from four sites in the US. We tested associations between responses at 32–35 weeks to the Life Experiences Survey (LES), a 37-item measure of events and perceived stress, and GWG categories. Bivariable comparisons and logistic regression were used to estimate the association between the total LES score and the odds of achieving adequate GWG. Among the 725 women, those with adequate GWG had lower median LES scores (5) compared to women with inadequate (7) and excessive (7) GWG, p?=?0.02. After adjusting for age, initial BMI, income, education, marital status and gestational diabetes, lower LES scores (multiples of the median) were associated with adequate GWG (aOR 0.81, 95% CI 0.67–0.98). Lower reported stress, as measured by the LES, was associated with a greater chance of women achieving adequate GWG. This relationship highlights the potential for interventions directed toward psychosocial support to have salutary effects upon GWG.

Pregnancy outcomes in the United States and other developed countries are considerably better than those in many developing countries. However, adverse pregnancy outcomes are generally more common in the United States than in other developed countries. Low-birth-weight infants, born after a preterm birth or secondary to intrauterine growth restriction, account for much of the increased morbidity, mortality, and cost. Wide disparities exist in both preterm birth and growth restriction among different population groups. Poor and black women, for example, have twice the preterm birth rate and higher rates of growth restriction than do most other women. Low birth weight in general is thought to place the infant at greater risk of later adult chronic medical conditions, such as diabetes, hypertension, and heart disease. Of interest, maternal thinness is a strong predictor of both preterm birth and fetal growth restriction. However, in the United States, several nutritional interventions, including high-protein diets, caloric supplementation, calcium and iron supplementation, and various other vitamin and mineral supplementations, have not generally reduced preterm birth or growth restriction. Bacterial intrauterine infections play an important role in the etiology of the earliest preterm births, but, at least to date, antibiotic treatment either before labor for risk factors such as bacterial vaginosis or during preterm labor have not consistently reduced the preterm birth rate. Most interventions have failed to reduce preterm birth or growth restriction. The substantial improvement in newborn survival in the United States over the past several decades is mostly due to better access to improved neonatal care for low-birth-weight infants. KEY WORDS Low birth weight, preterm birth, fetal growth restriction, cerebral palsy, neonatal mortality, stillbirth

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.02.036 Byline: Jennifer F. Culhane (a), Paul Nyirjesy (a), Kelly McCollum (a), Robert L. Goldenberg (b), Shari E. Gelber (a), Sabina Cauci (c) Abstract: This study was undertaken to assess if levels of interleukin-1[beta] (IL-1[beta]), IL-8, sialidase, prolidase and immunoglobulin A against Gardenerella vaginalis hemolysin (anti-Gvh IgA) in vaginal secretions differ between BV+ women with (M+) and without (M-) Mobiluncus spp. Author Affiliation: (a) Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA (b) Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (c) Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Udine, Italy Article History: Received 22 September 2005; Revised 30 January 2006; Accepted 26 February 2006 Article Note: (footnote) Supported by Centers for Disease Control and Prevention/ATPM TS-0626 and TS-0561. Reprints not available from the authors. Address correspondence to Jennifer Culhane, PhD, MPH, Drexel University College of Medicine, Department of Obstetrics and Gynecology and Drexel School of Public Health, Department of Epidemiology and Biostatistics, Mail Stop 495, 245 N 15th St, 17th floor, Philadelphia, PA 19102.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.10.193 Byline: Ian M. Bennett (a), Jennifer F. Culhane (b), Kelly F. McCollum (b), Irma T. Elo (c) Abstract: The purpose of this study was to assess the contribution of depressive symptoms and poor contraceptive use early in the first postpartum year to the risk of unintended repeat pregnancy at the end of that year among adults with low educational status ( Author Affiliation: (a) Departments of Family Practice and Community Medicine (c) Sociology, University of Pennsylvania (b) Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, PA Article History: Received 31 May 2005; Accepted 5 October 2005 Article Note: (footnote) Supported in part by funding from National Institute of Child Health and Human Development (1ROl D36462-01A I; I.T.E., J.F.C.), and the Centers for Disease Control (TS 312-15/15; J.F.C.).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.01.069 Byline: Leonardo Pereira (a), Jennifer Culhane (b), Kelly McCollum (b), Kathy Agnew (c), Paul Nyirjesy (b) Abstract: The purpose of this study was to determine if clinical findings and sociodemographic variables among bacterial vaginosis (BV)-positive pregnant women are associated with different microbiologic profiles. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Oregon Health and Science University, Portland, OR (b) Departments of Obstetrics and Gynecology, Drexel University, Philadelphia, PA (c) University of Washington, Seattle, WA Article History: Received 27 September 2004; Revised 26 January 2005; Accepted 26 January 2005 Article Note: (footnote) Supported by Center for Disease Control and Prevention/ATPM, grant nos. TS-0561/TS-0626.

The empiric data that examines the association between the neighborhood conditions and reproductive health are reviewed. The major challenges that researchers face when trying to incorporate neighborhood-level variables into studies of health outcomes and by considering social, economic, and biologic determinants of reproductive health are discussed.

Greater amounts of stress may explain why African-American women are more likely to have bacterial vaginosis during pregnancy than white women. In a study of 2,304 pregnant women, 64% of the African-American women had bacterial vaginosis compared to 35% of the white women. However, one-third of the black women experienced threats to their personal safety and 63% lived in a rough neighborhood. Among the white women, these percentages were 13% and 25%, respectively.

Objective. To assess the effect of maternal length of stay (LOS) legislation on LOS and hospital charges associated with Philadelphia resident live births from 1994 through 1997. Data Source/Study Setting. This was a descriptive epidemiological study involving secondary data analyses of linked birth record and hospital discharge data pertaining to all Philadelphia resident live births occurring between January 1, 1994 and December 31, 1997. Study Design. Using these linked data, trends in median and mean maternal and infant LOS and hospital charges were described for three distinct time periods: (1) a "prelegislative" period (January 1, 1994 through June 30, 1995); (2) a one-year period during which LOS legislation was introduced, debated, modified, and eventually passed by Pennsylvania lawmakers (July 1, 1995 through June 30, 1996); and (3) a "post-LOS law" period immediately following enactment of Act 85 mandating minimum LOS for mothers and their newborns (July 1, 1996 through December 31, 1997). LOS variables for both mothers and infants were calculated based on the actual number of hours elapsing between birth and discharge; hospital charges were obtained directly from information available in the Hospital Discharge Survey data. Principal Findings. Maternal median charges and LOS per delivery for vaginal births rose from $5,270 to $6,333 and from 35 to 47 hours following the enactment of Pennsylvania maternal minimum LOS legislation. Median infant cost and LOS per delivery mirrored these trends. Conclusion. Pennsylvania LOS legislation had a profound effect on maternal and infant discharge practices in Philadelphia. As much as $20 million may have been added to annual health care costs associated with Philadelphia resident births. Key Words. Early discharge, length of stay, maternity, The average maternity length of stay (LOS) in the hospital in the United States increased from 2.1 days in 1995 to 2.4 days in 1997 following dramatic decreases during the [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.06.061 Byline: Thaddeus P. Waters (a), Jeff M. Denney (b), Leny Mathew (b), Robert L. Goldenberg (b), Jennifer F. Culhane (b) Keywords: bacterial vaginosis; longitudinal studies; pregnancy Abstract: This study was undertaken to characterize the course of bacterial vaginosis in pregnancy and to discern the bacterial morphotypes responsible for infection. Author Affiliation: (a) Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH (b) Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA Article History: Received 29 February 2008; Revised 2 May 2008; Accepted 21 June 2008 Article Note: (footnote) Cite this article as: Waters TP, Denney JM, Mathew L, et al. Longitudinal trajectory of bacterial vaginosis during pregnancy. Am J Obstet Gynecol 2008;199:431.e1-431.e5. , Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.05.035 Byline: Sabina Cauci (a), Jennifer Flatow Culhane (b), Manuela Di Santolo (a), Kelly McCollum (b) Keywords: bacterial vaginosis; clue cells; interleukin-1[beta]; interleukin-8; neutrophils; pregnancy; prolidase; sialidase; vaginal innate immunity Abstract: The objective of the study was to explore the mechanisms of local innate immunity induction and modulation in pregnant women with bacterial vaginosis (BV). Author Affiliation: (a) Department of Biomedical Sciences and Technologies, University of Udine School of Medicine, Udine, Italy (b) Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA. Article History: Received 24 October 2006; Revised 9 March 2007; Accepted 22 May 2007 Article Note: (footnote) Cite this article as: Cauci S, Flatow Culhane J, Di Santolo M, et al. Among pregnant women with bacterial vaginosis, the hydrolytic enzymes sialidase and prolidase are positively associated with interleukin-1[beta]. Am J Obstet Gynecol 2008;198:132.e1-132.e7. , Supported in part by the Centers for Disease Control and Prevention/Association of Teachers of Preventive Medicine TS-0626 and TS-0561. The authors do not have a commercial or other association that might pose a conflict of interest.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.08.033 Byline: Sabina Cauci (1), Jennifer Flatow Culhane (2) Keywords: adverse pregnancy outcome; bacterial vaginosis; interleukin-1[beta]; interleukin-8; prolidase; sialidase; Trichomonas vaginalis; vaginal neutrophils Abstract: This study was undertaken to examine the influence of coinfections on vaginal innate and adaptive immunity, and microbial enzyme activities of pregnant women with bacterial vaginosis (BV). Author Affiliation: (1) Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Italy (2) Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA. Article Note: (footnote) This study was supported by Centers for Disease Control and Prevention/ATPM TS-0626 and TS-0561. Cite this article as: Cauci S, Flatow Culhane J. Modulation of vaginal immune response among pregnant women with bacterial vaginosis by Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and yeast. Am J Obstet Gynecol 2007;196;133.e1-133.e7.

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The placenta is the principal regulator of the in uteroenvironment, and disruptions to this environment can result in adverse offspring health outcomes. To better characterize the impact of in uteroperturbations, we assessed the influence of known environmental pollutants on the expression of microRNA (miRNA) in placental samples collected from the National Children's Study (NCS) Vanguard birth cohort. This study analyzed the expression of 654 miRNAs in 110 term placentas. Environmental pollutants measured in these placentas included dichlorodiphenyldichloroethylene (DDE), bisphenol A (BPA), polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd). A moderated t-test was used to identify a panel of differentially expressed miRNAs, which were further analyzed using generalized linear models. We observed 112 miRNAs consistently expressed in >70% of the samples. Consistent with the literature, miRNAs located within the imprinted placenta-specific C19MC cluster, specifically mir-517a, mir-517c, mir-522, and mir-23a, are among the top expressed miRNA in our study. We observed a positive association between PBDE 209 and miR-188–5p and an inverse association between PBDE 99 and let-7c. Both PCBs and Cd were positively associated with miR-1537 expression level. In addition, multiple let-7 family members were downregulated with increasing levels of Hg and Pb. We did not observe DDE or BPA levels to be associated with placental miRNA expression. This is the first birth cohort study linking environmental pollutants and placental expression of miRNAs. Our results suggest that placental miRNA profiles may signal in uteroexposures to environmental chemicals.

Purpose. To understand how social and structural contexts shape individual risk, vulnerability, and interconception health-related behaviors of African-American women.Approach or Design. A longitudinal ethnographic study was conducted.Setting. The study was conducted in Philadelphia, Pennsylvania.Participants. The sample included 19 African-American women who were participants in the intervention group of a randomized clinical trial of interconceptional care.Method. Data were collected through interaction with participants over a period of 6 to 12 months. Participant observation, structured and unstructured interviews, and Photovoice were used to obtain data; grounded theory was used for analysis. The analysis was guided by intersectional theory.Results. Social disadvantage influenced health and health care–seeking behaviors of African-American women, and the disadvantage centered on the experience of racism. The authors identify seven experiences grounded in the interactions among the forces of racism, class, gender, and history that may influence women's participation in and the effectiveness of preconception and interconception health care.Conclusion. African-American women's health and wellness behaviors are influenced by an experience of racism structurally embedded and made more virulent by its intersection with class, gender, and history. These intersecting forces create what may be a unique exposure that contributes significantly to the proximal determinants of health inequities for African-American women. Health promotion approaches that focus on the individual as the locus of intervention must concomitantly unravel and address the intertwining structural forces that shape individual circumstance in order to improve women's interconceptional health and to reduce disparities.

Objectives. We used Home Mortgage Disclosure Act (HMDA) data to demonstrate a method for constructing a residential redlining index to measure institutional racism at the community level. We examined the application of the index to understand the social context of health inequities by applying the residential redlining index among a cohort of pregnant women in Philadelphia.Methods. We used HMDA data from 1999–2004 to create residential redlining indices for each census tract in Philadelphia County, Pennsylvania. We linked the redlining indices to data from a pregnancy cohort study and the 2000 Census. We spatially mapped the levels of redlining for each census tract for this pregnancy cohort and tested the association between residential redlining and other community-level measures of segregation and individual health.Results. From 1999–2004, loan applicants in Philadelphia County, Pennsylvania, of black race/ethnicity were almost two times as likely to be denied a mortgage loan compared with applicants who were white (e.g., 1999 odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.63, 2.28; and 2004 OR=2.26, 95% CI 1.98, 2.58). The majority (77.5%) of the pregnancy cohort resided in redlined neighborhoods, and there were significant differences in residence in redlined areas by race/ethnicity (p<0.001). Among the pregnancy cohort, redlining was associated with residential segregation as measured by the percentage of black population (r=0.155), dissimilarity (r=0.250), exposure (r=–0.115), and isolation (r=0.174) indices.Conclusions. The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities.

Objectives. We determined the prevalence of first lifetime use of cigarettes during pregnancy or in the early postpartum period (incident smoking) and identified sociodemographic and health-related characteristics of incident smokers.Methods. We used statistics based on data from a longitudinal study of a large cohort of pregnant, low-income, urban women (n= 1,676) to describe the timing of first-time use and to compare incident smokers with those who had never smoked and those who had already smoked prior to pregnancy.Results. About one in 10 (10.2%) women who had not previously smoked initiated cigarette smoking during pregnancy or in the early postpartum period. Compared with those who had never smoked, incident smokers were more likely to report high levels of stress and to have elevated levels of depressive symptomatology, which may be rooted in relatively poor social and economic conditions.Conclusion. A significant number of women may be initiating smoking during pregnancy or in the early postpartum period. These women have characteristics that are consistent with the risk factors associated with smoking. Further research is warranted to determine prevalence in other populations, identify the risk factors for incident smoking, and assess the potential for primary prevention efforts designed to help women who had previously avoided cigarette use to remain smoke-free throughout pregnancy and in the postpartum period.

Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors.

Objective: Severe Retinopathy of Prematurity (ROP) is a primary cause of visual morbidity for very low birth weight infants. Known risk factors include short gestational age, low birth weight and supplemental oxygen exposure. Some studies have shown that Black infants are less at risk for severe ROP than White infants, however this finding has not been confirmed in studies designed to look at the risk of ROP and race/ethnicity specifically. The purpose of this study is to assess the relationship between the race/ethnicity of infants and the risk of severe ROP for a sample of 1,604 infants in 1,189 hospitals located in 39 states. Patients and methods: ParadigmHealth database records for surviving infants born between 1/1/2001 and 12/31/2004 with a birth weight less than or equal to 1250 g were included in this analysis (n=1,604). Multivariate logistic regression was used to assess the association between race/ethnicity and risk for severe ROP. Models were adjusted for birth weight, gestational age, Apgar score, race and measures of illness severity including days on oxygen and mechanical ventilation, sepsis, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis and pneumothorax. Results: In the analytic data set, the distribution of maternal race was 47.2% White, 35.3% Black, 14.9% Hispanic and 3.2% Asian. Of these infants, 9.4% developed severe ROP; 6.6% for Blacks, 9.6% for Whites, 13.8% for Hispanics and 15.7% Asians. Compared to Black neonates, the unadjusted odds ratio for ROP among White infants was 1.5 (95% CI: 1.0, 2.3), for Hispanics 2.2 (95% CI: 1.4, 3.7) and for Asians 2.6 (95% CI: 1.2, 5.9). After adjustment for gestational age, birth weight and 1 minute Apgar score, the odds ratios increased to 2.0 (CI: 1.2, 3.2) for Whites, 2.7 (CI: 1.5, 4.8) for Hispanics and 5.3 (CI 1.9, 15.1) for Asians compared to Black neonates. Adjusting for additional markers of illness severity did not alter these results. Conclusions: Results revealed lower rates of ROP among Black confirming findings from earlier studies. Interestingly, relatively high rates of ROP were also found among Hispanic and Asian neonates compared to Black infants. Controlling for possibly confounding morbidities and measures of illness severity did not alter these results. Further research in this area is warranted.

Abstract: Census data are widely used for assessing neighborhood socioeconomic context. Research using census data has been inconsistent in variable choice and usually limited to single geographic areas. This paper seeks to a) outline a process for developing a neighborhood deprivation index using principal components analysis and b) demonstrate an example of its utility for identifying contextual variables that are associated with perinatal health outcomes across diverse geographic areas. Year 2000 U.S. Census and vital records birth data (1998–2001) were merged at the census tract level for 19 cities (located in three states) and five suburban counties (located in three states), which were used to create eight study areas within four states. Census variables representing five socio-demographic domains previously associated with health outcomes, including income/poverty, education, employment, housing, and occupation, were empirically summarized using principal components analysis. The resulting first principal component, hereafter referred to as neighborhood deprivation, accounted for 51 to 73% of the total variability across eight study areas. Component loadings were consistent both within and across study areas (0.2–0.4), suggesting that each variable contributes approximately equally to “deprivation” across diverse geographies. The deprivation index was associated with the unadjusted prevalence of preterm birth and low birth weight for white non-Hispanic and to a lesser extent for black non-Hispanic women across the eight sites. The high correlations between census variables, the inherent multidimensionality of constructs like neighborhood deprivation, and the observed associations with birth outcomes suggest the utility of using a deprivation, index for research into neighborhood effects on adverse birth outcomes.

In April 1992, the American Academy of Pediatrics (AAP) recommended that healthy infants be positioned for sleep on their side or back to reduce the risk of Sudden Infant Death Syndrome (SIDS). The authors hypothesized three different forms of the intervention to examine the impact of the recommendation according to theory such as technology diffusion. Seasonality was included in the models to control its effect when testing.

IMPORTANCE: The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. OBJECTIVE: To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31?211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. EXPOSURES: State-level NAS incidence and county-level uninsured rates and rurality. MAIN OUTCOMES AND MEASURES: Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. RESULTS: Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P?=?.04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of =20?000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P?=?.002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P?&lt;?.001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P?=?.007). CONCLUSIONS AND RELEVANCE: Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients’ access to buprenorphine, especially during pregnancy.