Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data.

BACKGROUND: Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. OBJECTIVE: This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. METHODS: Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. RESULTS: In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. CONCLUSIONS: This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.

Hispanic Women's Perceptions of Neural Tube Defects and Folic Acid Supplementation: A Qualitative Study.

INTRODUCTION: In the United States, the prevalence of neural tube defects (NTDs) is higher among infants born to Hispanic women compared with those born to non-Hispanic women. The purpose of this study is to investigate perceptions of NTDs and the use of folic acid and folate as a preventive measure among Hispanic women. METHODS: Purposive sampling was used to recruit Hispanic women from a prenatal clinic in a Northeastern metropolitan city. In-depth interviews were conducted by native Spanish-speaking researchers using a semistructured interview guide. Thematic analysis was used to develop themes related to a priori domains. FINDINGS: The study sample consisted of 26 Hispanic women representing nine countries of origin. Four themes were revealed: dietary sources of folic acid, awareness of folic acid supplementation and fortification, preferences for receiving health information, and factors in decision-making concerning an NTD diagnosis. CONCLUSIONS: This study highlights the importance of early and targeted educational interventions sensitive to the cultural needs of this population. Results suggest that current NTD health education efforts may not be sufficient to increase our participants' knowledge of NTD. Additionally, the disparity may be multimodal, potentially influenced by insufficient understanding of prenatal folic acid use and the role of religiosity in decision-making during pregnancy. If Hispanic women are more likely to continue pregnancies affected by NTDs, this factor could be a part of NTD disparities. Exploring factors beyond supplementation and fortification that might influence rates of NTDs at birth in the U.S. Hispanic population can help to inform prevention efforts.

Laundromats: Community-Based Partnerships to Increase Reproductive Health Literacy Outreach.

Laundromats are a regularly visited, highly localized community venue, especially in underserved communities. Few health literacy and health-promotion programs have taken place in laundromats, and there have been no efforts to apply community-based participatory research approaches in this setting. Literacy programs and cancer-prevention initiatives have been held in laundromats, but little data exist on the empirical outcomes of such initiatives or whether the programs have been fashioned as a collaboration between community and researchers. In this paper, we present a brief overview of literacy and cancer-prevention initiatives that have taken place in laundromats and introduce our Wash and Spin Toward Health/Washington Avanzando la Salud Hispana (W.A.S.H.) project. We describe how we applied community-based participatory research principles to launch this effort and identify both benefits and challenges of this approach. We hope this project will stimulate greater interest in laundromat settings for outreach and education efforts, especially those addressing disparities in health literacy and access.

Women's perceptions of provider communication on birth options after cesarean: A qualitative study.

In the United States, Hispanic and non-Hispanic Black women are more likely to have a repeat cesarean birth (RCB) than non-Hispanic White women. The underrepresentation of Hispanic women and women with previous cesarean births in prior studies has resulted in a limited understanding of the reasons for this disparity. This study used in-depth interviews to investigate the perceptions of 27 Hispanic and non-Hispanic Black and White women about the communication that took place with their providers about their birth options after a previous cesarean. The roles of cultural norms and trust in providers in communication about RCBs were also explored. Results suggest that patient-provider communication and trust of providers for Hispanic and non-Hispanic Black and White women may influence their perception of choice, uptake of information, and ability to make an informed choice regarding birth options. Findings have implications for providers and healthcare management systems who need to account for and attempt to address these differences as they directly affect women's birth outcomes.

A Checklist to Assess Childbearing Intentions and Promote Referral to Preconception Care or Contraception: A Multi-Site Study.

INTRODUCTION: This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. METHODS: Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. RESULTS: Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. DISCUSSION: Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.

Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution.

BACKGROUND: Despite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payer source, provider gender) factors accounted for any observed differences by ethnicity/race. METHODS: Our retrospective cohort study used logistic regression to evaluate the relationship between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital. RESULTS: Statistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03-6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67-4.81) had higher odds of RCD than White women. CONCLUSIONS: Adjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers.

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

"The Program Affects Me 'Cause it Gives Away Stress": Urban Students' Qualitative Perspectives on Stress and a School-Based Mindful Yoga Intervention.

CONTEXT: School-based mindfulness and yoga studies generally measure stress-related outcomes using quantitative measures. OBJECTIVE: This study answers the following research questions: How do youth define stress and in what ways, if any, was a mindful yoga intervention helpful to youth during stress experiences? DESIGN AND SUBJECTS: To explore youths' own perspectives on stress, stressors in youths' lives, and perceived changes in responses to stress post-intervention, we conducted focus group discussions with 22 middle school students from low-income urban communities following a 16-week mindful yoga intervention. RESULTS: Using thematic analysis, the following three themes emerged: (1) youth conflated stress with negative emotions; (2) peer and family conflicts were common stressors; and (3) youth reported improved impulse control and emotional regulation following the intervention. Study findings have implications for refining intervention content (e.g., discussions of stress), as well as informing the selection and development of quantitative measures for future research on stress and stress responses in urban youth.

A Qualitative Evaluation of Student Learning and Skills Use in a School-Based Mindfulness and Yoga Program.

Previous studies on school-based mindfulness and yoga programs have focused primarily on quantitative measurement of program outcomes. This study used qualitative data to investigate program content and skills that students remembered and applied in their daily lives. Data were gathered following a 16-week mindfulness and yoga intervention delivered at three urban schools by a community non-profit organization. We conducted focus groups and interviews with nine classroom teachers who did not participate in the program and held six focus groups with 22 fifth and sixth grade program participants. This study addresses two primary research questions: (1) What skills did students learn, retain, and utilize outside the program? and (2) What changes did classroom teachers expect and observe among program recipients? Four major themes related to skill learning and application emerged as follows: (1) youths retained and utilized program skills involving breath work and poses; (2) knowledge about health benefits of these techniques promoted self-utilization and sharing of skills; (3) youths developed keener emotional appraisal that, coupled with new and improved emotional regulation skills, helped de-escalate negative emotions, promote calm, and reduce stress; and (4) youths and teachers reported realistic and optimistic expectations for future impact of acquired program skills. We discuss implications of these findings for guiding future research and practice.