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BACKGROUND: The association between prenatal household air pollution (HAP) exposure and childhood blood pressure (BP) is unknown. OBJECTIVE: Within the Ghana Randomized Air Pollution and Health Study (GRAPHS) we examined time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure with BP at 4 years of age and, separately, whether a stove intervention delivered prenatally and continued through the first year of life could improve BP at 4 years of age. METHODS: GRAPHS was a cluster-randomized cookstove intervention trial wherein 푛=1,414 pregnant women were randomized to one of two stove interventions: a) a liquefied petroleum gas (LPG) stove or improved biomass stove, or b) control (open fire cooking). Maternal HAP exposure over pregnancy and child HAP exposure over the first year of life was quantified by repeated carbon monoxide (CO) measurements; a subset of women (푛=368) also performed one prenatal and one postnatal personal fine particulate matter (PM2.5) measurement. Systolic and diastolic BP (SBP and DBP) were measured in 푛=667 4-y-old children along with their PM2.5 exposure (푛=692). We examined the effect of the intervention on resting BP 푧-scores. We also employed reverse distributed lag models to examine time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure and resting BP 푧-scores. Among those with PM2.5 measures, we examined associations between PM2.5 and resting BP 푧-scores. Sex-specific effects were considered. RESULTS: Intention-to-treat analyses identified that DBP 푧-score at 4 years of age was lower among children born in the LPG arm (LPG β= -0.20; 95% CI: -0.36, -0.03) as compared with those in the control arm, and females were most susceptible to the intervention. Higher CO exposure in late gestation was associated with higher SBP and DBP 푧-score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP 푧-score. In the subset with PM2.5 measurements, higher maternal postnatal PM2.5 exposure was associated with higher SBP 푧-scores. DISCUSSION: These findings suggest that prenatal and first-year-of-life HAP exposure are associated with child BP and support the need for reductions in exposure to HAP, with interventions such as cleaner cooking beginning in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health. Study Design: We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery. Results: Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD. Conclusion: Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color. [ABSTRACT FROM AUTHOR]

Objective: To determine whether delivery hospitals that perform poorly for women also perform poorly for high-risk infants and to what extent Black and Hispanic women receive care at hospitals that perform poorly for both women and infants. Methods: We examined the correlation between hospital rankings for severe maternal morbidity and very preterm morbidity and mortality in New York City Hospitals using linked birth certificate and state discharge data for 2010–2014. We used mixed-effects logistic regression with a random hospital-specific intercept to generate risk standardized severe maternal morbidity rates and very preterm birth neonatal morbidity and mortality rates for each hospital. We ranked hospitals separately by these risk-standardized rates. We used k-means cluster analysis to categorize hospitals based on their performance on both metrics and risk-adjusted multinomial logistic regression to estimate adjusted probabilities of delivering in each hospital-quality cluster by race/ethnicity. Results: Hospital rankings for severe maternal morbidity and very preterm neonatal morbidity-mortality were moderately correlated (r =.32; p =.05). A 5-cluster solution best fit the data and yielded the categories for hospital performance for women and infants: excellent, good, fair, fair to poor, poor. Black and Hispanic versus White women were less likely to deliver in an excellent quality cluster (adjusted percent of 11%, 18% vs 28%, respectively, p <.001) and more likely to deliver in a poor quality cluster (adjusted percent of 28%, 20%, vs. 4%, respectively, p <.001). Conclusions for Practise: Hospital performance for maternal and high-risk infant outcomes is only moderately correlated but Black and Hispanic women deliver at hospitals with worse outcomes for both women and very preterm infants. [ABSTRACT FROM AUTHOR]

Recent national and state legislation has called attention to stark racial/ethnic disparities in maternal mortality and severe maternal morbidity (SMM), the latter of which is defined as having a lifethreatening condition or life-saving procedure during childbirth. Using linked New York City birth and hospitalization data for 2012-14, we examined whether racial and economic spatial polarization is associated with SMM rates, and whether the delivery hospital partially explains the association. Women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of SMM per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration (risk difference = 2.4 cases per 100). Thirty-five percent of this difference was attributable to the delivery hospital. Women in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods. Housing policy that targets racial and economic spatial polarization may address a root cause of SMM, while hospital quality improvement may mitigate the impact of such polarization. [ABSTRACT FROM AUTHOR]

Objectives: The Arabic-speaking population is increasing in Europe and North America. Evidence suggests that Arab migrants have a greater risk of adverse birth outcomes than nonmigrants, but the risk of stillbirth is largely understudied. We examined inequality in stillbirth rates between Arab women and the French and English majority of women in Quebec, Canada. Methods: We conducted a retrospective study of all births in Quebec from 1981 through 2015. We computed stillbirth rates by period and cause of death, and we used log binomial regression to estimate the association between Arabic mother tongue and stillbirth, adjusted for maternal characteristics. Results: Stillbirth rates per 1000 births overall were lower among women with Arabic mother tongue (3.89) than among women with French or English mother tongue (4.52), and rates changed little over time. However, Arabic-speaking women from Arab countries had a higher adjusted risk of stillbirth than French- or English-speaking women (risk ratio = 1.23; 95% confidence interval, 1.07-1.42). Congenital anomalies, termination of pregnancy, and undetermined causes contributed to a disproportionate number of stillbirths among women with Arabic mother tongue compared with the French- and English-speaking majority. Conclusions: Arabic-speaking women from Arab countries have higher risks of stillbirth compared with the French and English majority in Quebec. Strategies to reduce stillbirth risk among Arabic speakers should focus on improving identification of causes of death. [ABSTRACT FROM AUTHOR]

Little is known about pregnancy outcomes of black immigrant women to the US. We surveyed 447 black women post-partum in two hospitals in Newark, NJ. Length of gestation was obtained from medical records. Covariates and information on immigration were collected by in-person interview. Risks ratios for preterm birth (< 37 weeks) comparing immigrant to US-born women were calculated using log-binomial regression. Associations with gestational age at delivery were estimated using linear regression. Multivariable models adjusted for socioeconomic and social/behavioral variables. Immigrant women relative to US-born women had a 60% lower risk of preterm birth (adjusted risk ratio = 0.4; 95% confidence interval (CI) 0.2, 0.8) and longer gestation (adjusted difference = 1.4 weeks, 95%CI 0.6, 2.1). Gestation was 1.9 weeks longer for recent immigrants compared to US-born women (95%CI 0.2, 3.6), whereas for those who lived in the US for at least 10 years there was no difference. The healthy immigrant effect found among black immigrants may erode with time in the US. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of a multilevel intervention, Healthy Babies are Worth the Wait (HBWW), in reducing preterm birth (PTB) and very preterm birth (VPTB) among black women in Newark, NJ. Methods HBWW is a program linking the local March of Dimes office, providers, community-based organizations, and public health institutions to increase uptake of evidence based preterm birth interventions. We used birth certificate data before (2009-2011) and after (2012-2015) the introduction of HBWW in Newark. We estimated differences in PTB and VPTB between these periods among black women in Newark and compared them to rate differences among black women in the rest of NJ (difference-in-differences). We used interrupted time series analysis (ITSA) to examine declines in PTB and VPTB following the introduction of HBWW controlling for secular trends. All models adjusted for maternal age, education and parity. Results PTB declined in Newark 1.1 case per 100 (95% confidence interval (CI) − 2.3, 0) and in the rest of NJ 0.5 case per 100 (− 1.4, 0.4) (difference-in-differences = 0.6 fewer cases per 100 in Newark, 95% CI − 1.6, 0.3). VPTB declined in both Newark (− 0.6 cases per 100, 95% CI − 1.0, 0) and the rest of NJ (− 0.2 cases per 100, 95% CI − 0, 0.3) (difference-in-differences = 0.4 fewer cases per 100 in Newark, 95% CI − 0.9, 0). However, using ITSA the downward VPTB trend in Newark was not different from the rest of NJ or pre-intervention trends. Conclusions for Practice Our study supports the importance of critically evaluating and advancing complex interventions to reduce PTB among black women. [ABSTRACT FROM AUTHOR]

The conflict in Kosovo created mass displacement and a fractured health system. Roma, Ashkali, and Balkan Egyptian communities are particularly vulnerable to discrimination and exclusion from institutions. We aimed to examine Roma, Ashkali, and Balkan Egyptian disparities in quantity and quality of antenatal care received. We conducted a cross-sectional study in August 2012 with 603 women aged 15 or older who had given birth in the previous two years. We measured quantity of antenatal care using number of visits and quality of care using antenatal checklists. We used linear regression with interaction terms of displacement and type of health institution (for example, Serbian or Kosovar) to assess ethnic disparities in antenatal care. Women from Roma, Ashkali, and Balkan Egyptian communities received poorer quantity and quality of antenatal care compared to Kosovar Albanian and Serbian women. In adjusted models, Roma, Ashkali, and Balkan Egyptian women scored 3.5 points lower [95% CI (-5.2, -1.8)] on the checklists. Roma, Ashkali, and Balkan Egyptian women who were displaced received even poorer quality of care. Ethnic disparities exist in quality of antenatal care. Women from Roma, Ashkali, and Balkan Egyptian communities receive the poorest quality of services. As Kosovo strives to build a multiethnic health care system, a focus on equity is important to ensure the right to health for Roma, Ashkali, and Balkan Egyptian women. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to examine predictors of prenatal smoking, and attempted smoking cessation during pregnancy among Romani women. Methods A community-based, cross-sectional study (November 2012 to February 2013) of 410 Romani women in Roma settlements in Serbia and Macedonia was conducted. Logistic regression was used to identify predictors of prenatal smoking and attempted smoking cessation during pregnancy. Results Romani women older than 30 years and those who were living with a man were over twice as likely (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.12-5.46; aOR 2.09, 95% CI 1.27-3.43) to smoke during pregnancy, compared to women <20 and married women, respectively. An inverse relationship between education and prenatal smoking was observed (for primary education versus no education, aOR 0.56, 95% CI 0.32-0.98; for secondary or higher education versus no education, aOR 0.38, 95% CI 0.16-0.90). Having a husband/partner who smokes was associated with significantly increased likelihood of prenatal smoking (aOR 3.71, 95% CI 2.20-6.25) and decreased likelihood of attempting to quit (aOR 0.51, 95% CI 0.24-1.06). Conclusions Culturally sensitive and comprehensive prevention strategies and intervention programs are needed to reduce smoking during pregnancy among Romani women, including interventions targeting male partners. [ABSTRACT FROM AUTHOR]

The study determined the incidence of low birth weight (LBW), small for gestational age (SGA), preterm birth, and perinatal morbidity among Asian Indians (AI) in New Jersey (NJ), as well as identified predictors of SGA. We analyzed birth records for singletons born to mothers identified as AI and non-Hispanic white from 2008 to 2011, obtained from the NJ Department of Health. For AI, rates of LBW and SGA were elevated, rates of preterm birth were similar, and neonatal intensive care unit admission was lower, compared to whites. Factors associated with SGA in AI included nulliparity, anemia, hypertension, placental abruption, and lack of prenatal care. Maternal education, marital status, substance abuse, and timing of prenatal care were associated with SGA in whites, but not in AI. SGA incidence was higher among AI despite preterm rates similar to whites. Anemia was associated with SGA uniquely among AI. [ABSTRACT FROM AUTHOR]

Introduction: Little is known regarding the association between socioeconomic factors and contraceptive use in the Newly Independent States (NIS), countries that have experienced profound changes in reproductive health services during the transition from socialism to a market economy. Methods: Using 2005-2006 data from Demographic Health Surveys (Armenia, Azerbaijan, and Moldova) and Multiple Indicator Cluster Surveys (Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine, and Uzbekistan), we examined associations between individual and community socioeconomic status with current modern contraceptive use (MCU) among N = 55,204 women aged 15-49 married or in a union. Individual socioeconomic status was measured using quintiles of wealth index and education level (higher than secondary school, secondary school or less). Community socioeconomic status was measured as the percentage of households in the poorest quintile of the nationals household wealth index (0%, 0-25%, or greater than 25%). We used multilevel logistic regression to estimate associations adjusted for age, number of children, urban/rural, and socioeconomic variables. Results: MCU varied by country from 14% (in Azerbaijan) to 62% (in Belarus). Overall, women living in the poorest communities were less likely than those in the richest to use modern contraceptives (adjusted odds ratio (aOR) = 0.82, 95% Confidence Interval = 0.76, 0.89). Similarly, there was an increasing odds of MCU with increasing individual-level wealth. Women with a lower level of education also had lower odds of MCU than those with a higher level of education (aOR = .75, 95%CI = 0.71, 0.79). In country-specific analyses, community-level socioeconomic inequalities were apparent in 4 of 10 countries; in contrast, inequalities by individual-level wealth were apparent in 7 countries and by education in 8 countries. All countries in which community-level socioeconomic status was associated with MCU were in Central Asia, whereas at the individual-level inequalities of the largest magnitude were found in the Caucasus. There were no distinct patterns found in Eastern European countries. Conclusions: Community-level socioeconomic inequalities in MCU were most pronounced in Central Asian countries, whereas individual-level socioeconomic inequalities in MCU were most pronounced in the Caucasus. It is important to consider multilevel contextual determinants of modern contraceptive use in the development of reproductive health and family planning programs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. METHODS: We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483834 low-risk (term, singleton, birth weight $2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. RESULTS: The unexpected complications rate was 48.0 per 1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3-1.9]; odds ratio: 1.2 [95% confidence interval 1.1-1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from 25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with 10% of white and Asian American women (P<.001). CONCLUSIONS: Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes. [ABSTRACT FROM AUTHOR]