Population Changes, Racial/Ethnic Disparities, and Birth Outcomes in Louisiana After Hurricane Katrina

2010 ◽  
Vol 4 (S1) ◽  
pp. S39-S45 ◽  
Author(s):  
Emily W. Harville ◽  
Tri Tran ◽  
Xu Xiong ◽  
Pierre Buekens
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Cesarean Section ◽  
Racial Disparities ◽  
New Orleans ◽  
Birth Outcomes ◽  
The State ◽  
Obstetric Outcomes ◽  
Population Changes ◽  
Inadequate Prenatal Care

ABSTRACTObjective: To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes.Methods: Vital statistics data were used to compare the incidence of low birth weight (LBW) (<2500 g), preterm birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates.Results: After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced.Conclusions: Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.(Disaster Med Public Health Preparedness. 2010;4:S39-S45)

scholarly journals Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Dyer ◽  
Rachel Hardeman ◽  
Dovile Vilda ◽  
Katherine Theall ◽  
Maeve Wallace
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Black Women ◽  
Low Birth Weight ◽  
Racial Disparities ◽  
Population Health ◽  
Birth Outcomes ◽  
Mass Incarceration ◽  
Interquartile Range ◽  
Adverse Birth Outcomes

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.

Does increasing access to prenatal care reduce racial disparities in birth outcomes?

2021 ◽  
Vol 59 ◽  
pp. 96-102
Author(s):  
Holly Thurston ◽  
Bronwyn E. Fields ◽  
Jamie White
Keyword(s):  
Prenatal Care ◽  
Racial Disparities ◽  
Birth Outcomes

scholarly journals Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Sheryl L. Coley ◽  
Tracy R. Nichols ◽  
Kelly L. Rulison ◽  
Robert E. Aronson ◽  
Shelly L. Brown-Jeffy ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
African American ◽  
Preterm Birth ◽  
Socioeconomic Factors ◽  
Racial Disparities ◽  
Birth Outcomes ◽  
Maternal Age ◽  
Birth Outcome ◽  
Teen Mothers ◽  
Neighborhood Socioeconomic Status

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17–19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.

scholarly journals Factors associated with the route of birth delivery in a city in the Northeast region in the State of Rio Grande do Sul, Brazil

2019 ◽  
Vol 19 (4) ◽  
pp. 797-805
Author(s):  
Silvane Rasador ◽  
Claides Abegg
Keyword(s):  
Prenatal Care ◽  
Cesarean Section ◽  
Rio Grande ◽  
The State ◽  
Public Health Care ◽  
Rio Grande Do Sul ◽  
Cross Sectional ◽  
Northeast Region ◽  
Factors Associated ◽  
Private Healthcare

Abstract Objectives: to investigate factors associated with the route of birth delivery in a hospital extending public and private healthcare services, in the Northeast region in the State of Rio Grande do Sul. Methods: a cross-sectional study with 676 postpartum women, conducted from January to May 2017. The data were collected from the hospital records and women were interviewed shortly after childbirth in the maternity. Data analysis was performed by associating the Pearson’s chi-square and the Poisson regression tests with robust variance. Results: the prevalence of cesarean sections was 58.7%, that is, 41.7% in public health-care and 83.9% in private healthcare. The main reason for having a cesarean section was having had a previous one (PR=5.69; CI95%=3.64 - 8.90; p<0.001), followed by having source of childbirth financing (PR=1.54; CI95%=1.27 - 1.87; p<0.001), having source of prenatal care financing (PR=1.48; CI95%=1.22 - 1.79; p<0.001), the childbirth and prenatal care professional (PR=1.46; CI95%=1.28 - 1.66; p<0.001) and the prenatal care professional (PR=1.43; CI95%=1.07 - 1.90; p=0.016). Conclusions: the high cesarean section rates identified in this study were mainly associated with previous cesarean section. The findings suggest a change in the current childbirth care model in the city, characterized as highly medicalized, focused on the physician and on hospital care.

scholarly journals Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Rong Yang ◽  
Hui Mei ◽  
Tongzhang Zheng ◽  
Qiang Fu ◽  
Yiming Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Population Based ◽  
Adverse Birth Outcomes ◽  
Cesarean Section Delivery ◽  
Increased Risk

Abstract Background The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. Method We conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes. Results Out of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60–7.00) and cesarean section (OR 3.63, 95% CI 1.95–6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever. Conclusions This population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.

Exposure to Interpersonal Violence During Pregnancy and Its Association With Women’s Prenatal Care Utilization: A Meta-Analytic Review

2018 ◽  
Vol 21 (5) ◽  
pp. 904-921 ◽  
Author(s):  
Brittany Jamieson
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Interpersonal Violence ◽  
Care Utilization ◽  
Obstetric Outcomes ◽  
Prenatal Care Utilization ◽  
Analytic Review ◽  
Study Results ◽  
Violence During Pregnancy ◽  
Inadequate Prenatal Care

Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation ( k = 9) and (2) delayed entry into prenatal care ( k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [ OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care ( OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.

Birth outcomes for medically high-risk pregnancies: comparing group to individual prenatal care

2021 ◽  
Author(s):  
Emily Heberlein ◽  
Jessica C. Smith ◽  
Ana LaBoy ◽  
Jessica Britt ◽  
Amy Crockett
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Prenatal Care ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Outcome Data ◽  
Exposure Level ◽  
Group Prenatal Care ◽  
Minimum Threshold ◽  
Individual Care

Objective(s): Group prenatal care models were initially designed for women with medically low risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birthweight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group vs. individual prenatal care. Study Design: This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI >45). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (1 or more groups) or minimum threshold (≥ 5 groups). Results: Participation in group prenatal care at either treatment exposure level was associated with a lower risk of NICU admissions (10.2% group vs 13.8% individual care, OR 0.708, p<0.001). Participating in the minimum threshold of groups (≥5 sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR 0.569, p<0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR 0.483, p<0.001). No differences in birthweight were observed. Conclusion: This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birthweight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.

scholarly journals Maternal health care utilization and the obstetric outcomes of undocumented women in Finland – a retrospective register-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Janita Tasa ◽  
Ville Holmberg ◽  
Susanna Sainio ◽  
Päivi Kankkunen ◽  
Katri Vehviläinen-Julkunen
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Prenatal Care ◽  
Infectious Diseases ◽  
Pregnant Women ◽  
Maternal Health Care ◽  
Obstetric Outcomes ◽  
Increased Risk ◽  
Study Population ◽  
Inadequate Prenatal Care

Abstract Background Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, capital city of Finland, in addition to comparing the results with all pregnant women in Finland. Methods The study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N = 47,274 women) and with prenatal screening tests for infectious diseases (N = 51,447 [HIV, HBV], N = 51,446 [syphilis]). Results The majority (91%) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71%) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5% (3/59) tested positive for HIV, 3% (2/59) for HBV, and 2% (1/57) for syphilis. The prevalence of HIV (p-value < 0.001) and HBV (p-value = 0.007) was significantly higher amongst undocumented women compared with all pregnant women. Conclusions Undocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was significantly higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.

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