Search

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 n = 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 (n = 368) also performed one prenatal and one postnatal personal fine particulate matter (P[M.sub.2.5]) measurement. Systolic and diastolic BP (SBP and DBP) were measured in n = 667 4-y-old children along with their P[M.sub.2.5] exposure (n = 692). We examined the effect of the intervention on resting BP z-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 z-scores. Among those with P[M.sub.2.5] measures, we examined associations between P[M.sub.2.5] and resting BP z-scores. Sexspecific effects were considered. RESULTS: Intention-to-treat analyses identified that DBP z-score at 4 years of age was lower among children born in the LPG arm (LPG [beta] = -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 z-score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP z-score. In the subset with P[M.sub.2.5] measurements, higher maternal postnatal P[M.sub.2.5] exposure was associated with higher SBP z-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. https://doi.org/10.1289/EHP13225, Introduction Blood pressure (BP), a critical component of cardiovascular health (CVH), may be programmed early in life. (1) Evidence from longitudinal cohort studies suggests that children with higher BP are [...]

Background/Objectives The purpose of this study was to explore the postpartum experiences of publicly-insured women of color, and identify how postpartum care can be improved to reduce hospital emergency department usage after delivery. Methods We conducted four focus groups with 18 publicly-insured women who primarily self-identified as Black and/or Latina and gave birth between June 1, 2019 and May 1, 2020. We used inductive qualitative analysis to identify prominent themes from focus group discussions. Results We identified four domains: (1) lack of access to and communication with a medical team; (2) lack of preparation; (3) value of social support; and (4) participant-identified opportunities for improvement. Conclusions for Practice This study describes the postpartum experiences of publicly-insured women of color with the objective of identifying areas for intervention to reduce postpartum emergency department usage. Our findings suggest that focused efforts on enhancing continuity of care to increase healthcare access, strengthening patient-provider communication by training providers to recognize unconscious bias, increasing postpartum preparation by adapting teaching materials to an online format, and engaging women's caregivers throughout the pregnancy course to bolster social support, may be beneficial., Author(s): Taylor Harrell [sup.1] , Elizabeth A. Howell [sup.2] , Amy Balbierz [sup.3] [sup.4] [sup.5] , Luz Guel [sup.6] , Juan Pena [sup.7] , Teresa Janevic [sup.3] [sup.4] [sup.7] , [...]

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., Author(s): Teresa Janevic [sup.1] [sup.2] [sup.3] , Sheela Maru [sup.1] [sup.4] [sup.5] , Sarah Nowlin [sup.2] [sup.6] , Katharine McCarthy [sup.2] [sup.3] , Veerle Bergink [sup.1] [sup.3] [sup.7] , Joanne [...]

The authors comment on the article "Navigating the Labyrinth of Pregnancy-Related Coverage for Undocumented Immigrants: An Assessment of Current State and Federal Policies, " by DiMeo and colleagues, published in the issue. Topics include barriers to obtaining insurance coverage by pregnant immigrants, consequence of the lack of online access to eligibility and information of pregnant immigrants on state agency websites, and policy solutions to increase health insurance coverage.

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., Author(s): Elizabeth A. Howell [sup.1] [sup.2] [sup.3] , Teresa Janevic [sup.1] [sup.2] [sup.3] , James Blum [sup.3] [sup.4] , Jennifer Zeitlin [sup.5] , Natalia N. Egorova [sup.2] [sup.3] , Amy [...]