Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population.

BACKGROUND: Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity. OBJECTIVE: This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area. STUDY DESIGN: This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis). RESULTS: Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant. CONCLUSION: Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.

Temporal Association Between Interracial Couples and Odds of Low Birth Weight Infants: Trends in National Vital Statistics Data from 1971 to 2016.

Our study explores the temporal association between low birth weight (LBW) infants and the increasing population prevalence of interracial relationships. Our hypothesis was that the odds of LBW would decrease as the population prevalence of interracial relationships increased. National Center for Health Statistics Natality data for 1971-2016 was analyzed. LBW was defined as birth weight less than 2500 gm. We restricted our analyses to singleton births by White and Black mothers with reported White or Black partners of the neonate. Logistic regression was used to calculate the odds ratios of LBW, both unadjusted and adjusted for maternal education and parental ages. The proportion of couples coded as interracial increased annually from 0.36% in 1971 to 3.86% in 2016 for White mothers and 0.59% to 8.63% for Black mothers during the same period. In each year the odds ratio of LBW was significant. As the proportion of White mothers with Black partners increased, their odds of LBW declined (OR1.75 to 1.30, p < 0.001). The odds ratio of LBW among Black mothers with White partners did not change and remained stable between 0.70 and 0.80 (p = 0.22) over the same time period. As the annual proportion of White mothers with Black partners increased, their odds of LBW decreased when compared to White couples. Black mothers with White partners did not exhibit a similar change when compared to Black couples, with the odds ratio of LBW remaining stable.

Second trimester cerebroplacental ratio versus umbilicocerebral ratio for the prediction of adverse perinatal outcomes.

INTRODUCTION: An abnormal third trimester cerebroplacental ratio has been previously associated with adverse perinatal outcome. The less studied inverse of the cerebroplacental ratio, the umbilicocerebral ratio, has been proposed as a better predictor of adverse perinatal outcome. However, little is known about the implication of either an abnormal cerebroplacental ratio or umbilicocerebral ratio in the second trimester. The objective of this study was to evaluate the relationship between an abnormal second trimester cerebroplacental ratio and adverse perinatal outcome and provide comparison to an abnormal second trimester umbilicocerebral ratio. MATERIALS AND METHODS: This retrospective cohort study in a single tertiary referral center utilized data from all non-anomalous singleton pregnancies that underwent Doppler assessment of the cerebroplacental ratio between 20 and 28 weeks gestation. The study period was 1 January 2015 to 31 July 2018. Abnormal cerebroplacental ratio was defined as less than the 5th percentile for gestational age. If patients had more than one ultrasound during the study period (i.e. for serial assessment of fetal growth), the lowest value of the cerebroplacental ratio was recorded. The primary outcome was a composite of clinically relevant adverse perinatal outcomes including preterm delivery, small for gestational age, and neonatal intensive care unit admission. Secondary outcomes included urgent delivery for fetal distress (operative vaginal delivery or cesarean section) and hypertensive disorders of pregnancy. An abnormal umbilicocerebral ratio was defined as greater than 95th percentile for gestational age. Areas under the curve were calculated and compared for cerebroplacental ratio and umbilicocerebral ratio. RESULTS: 2326 pregnancies met inclusion criteria. Of these, 91 (3.9%) had an abnormal second trimester cerebroplacental ratio. Fetuses with an abnormal second trimester cerebroplacental ratio had a 2.3-fold (95% CI 1.5-3.6, p < .05) increased risk of adverse perinatal outcome after adjusting for potential confounders such as chronic hypertension, pregestational diabetes, and smoking during pregnancy. Significantly increased risks of preterm delivery (OR 2.0, 95% CI 1.1-38, p < .05) and neonatal intensive care unit admission (OR 2.1, 95% CI 1.2-3.6, p < .05) were also seen in a subgroup analysis of abnormal cerebroplacental ratio in appropriate for gestational age infants. 132 (5.7%) fetuses had an abnormal second trimester umbilicocerebral ratio, and these fetuses had a 2.0-fold (95% CI 1.4-3.0, p < .05) increased risk of adverse perinatal outcome. The area under the curve for CPR and UCR for prediction of the primary outcome was 0.6 for both (95% CI 0.57-0.61 and 0.57-0.62, respectively, both p < .05). CONCLUSION: An abnormal second trimester cerebroplacental ratio or umbilicocerebral ratio is associated with adverse perinatal outcome. However, the predictive ability of either ratio remains suboptimal.

Interprofessional, learner-driven collaboration for innovative solutions to healthcare delivery in student-run clinics.

Student-run clinics are settings in which learners are empowered to design service delivery. Despite shared challenges faced by these clinics in improving clinical and educational programming, information exchange and collaboration between clinics of different institutions and professions are inefficiently facilitated by existing platforms. An abridged, one-hour hackathon event was piloted at the Society of Student-Run Free Clinics' 2018 Annual Conference. During the event, interprofessional teams were guided through defining a problem, ideating and prototyping possible solutions, and sharing them with the larger group. There were 23 participants representing 16 institutions and 5 professions; most had never discussed their clinic's problems with members of other institutions before. Teams generated novel ideas that culminated from a combination of existing local best practices or focused on developing infrastructure between clinics. Feedback of the event was positive; participants felt confident to design and implement solutions and collaborate with other clinics after the event. The abridged hackathon shows promise to facilitate communication and innovation among diverse groups across institutions.