Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With Multiple Sclerosis: A Diverse Multicenter Cohort

BACKGROUND AND OBJECTIVES: Racial disparities exist in both neurologic and obstetric populations, underscoring the importance of evaluating pregnancy outcomes in diverse women with multiple sclerosis (MS). The objective of this multicenter retrospective study was to compare pregnancy care and outcomes between Black and Hispanic (underrepresented) and White women with MS. METHODS: Demographic and clinical data were extracted from medical records of 9 US MS centers for women with MS/clinically isolated syndrome who delivered live births between 2010 and 2021. Sites identified at last 15 consecutive Black/Hispanic women and a matching number of White women. Socioeconomic factors, pregnancy, and MS care/outcomes were compared between groups (underrepresented and White and then Black and Hispanic) using Wilcoxon rank sum (U statistic and effect size r reported), χ2, t tests and logistic regressions as appropriate to data type. Multiple imputation by chained equation was used to account for missing data. RESULTS: Overall, 294 pregnancies resulting in live births were analyzed ( 81 Black, 67 Hispanic, and 146 White mothers). Relative to underrepresented women, White women lived in areas of higher median (interquartile range [IQR]) Child Opportunity Index (79 [45.8] vs 22 [45.8], U = 3,824, r = 0.56, p < 0.0001) and were more often employed (84.9% vs 75%, odds ratio [OR] 2.57, CI 1.46-4.50, p = 0.0008) and privately insured (93.8% vs 56.8%, OR 11.6, CI 5.5-24.5, p < 0.0001) and more received a 14-week ultrasound (98.6% vs 93.9%, OR 4.66, CI 0.99-21.96, p = 0.027). Mode of delivery was significantly different between the three groups (X2(10,294) = 20.38, p = 0.03); notably, Black women had the highest rates of emergency cesarean deliveries, and Hispanic women highest rates of uncomplicated vaginal deliveries. Babies born to underrepresented women had lower median (IQR) birthweights than babies born to White women (3,198 g [435.3 g] vs 3,275 g [412.5 g], U = 9,255, r = 0.12, p = 0.04) and shorter median (IQR) breastfeeding duration (4.5 [3.3] vs 6.0 [4.2] months, U = 8,184, r = 0.21, p = 0.003). While underrepresented women were younger than White women (mean [SD] 30.9 [4.8] vs 33.8 [4.0], t = 1.97, CI 1.96-3.98, p < 0.0001), their median (Q1-Q3, IQR) Expanded Disability Status Scale was higher (1.5 [1-2.5, 1.5] vs 1 [0-1.5, 1.5], U = 7,260, r = 0.29, p < 0.0001) before pregnancy. Finally, medical records were missing more key data for Black women (19.7% missing vs 8.9% missing, OR 2.54, CI 1.25-5.06, p = 0.008). DISCUSSION: In this geographically diverse multicenter cohort, underrepresented women entered pregnancy with higher disability and fewer health care resources. Pregnancy represents a pivotal window where structural factors affect maternal and fetal health and neurologic trajectories; it is a critical period to optimize care and health outcomes.

Removal of As3+, As5+, Sb3+, and Hg2+ ions from aqueous solutions by pure and co-precipitated akaganeite nanoparticles: adsorption kinetics studies.

Adsorption kinetics models have been used to evaluate the adsorption behaviour of pollutants on different materials but there are no reports for the adsorption of As5+, As3+, Sb3+ and Hg2+ on co-precipitated akaganeite nanoparticles which were previously formed in the presence of these ions. In this research, the performance of pure and co-precipitated akaganeite nanoparticles as adsorbents of As3+, As5+, Sb3+ and Hg2+ in aqueous solutions was evaluated using the nonlinear kinetics models of Langmuir, Lagergren, Ho-McKay, Bangham, Elovich and simplified Elovich. In addition, transmission 57Fe Mössbauer spectrometry was used for the first time to compare the physico-chemical properties of akaganeite before and after the adsorption processes. The results showed that co-precipitated akaganeites had much better adsorption capacities than pure akaganeites. On the other hand, the Sb3+ and Hg2+ were the fastest and slowest pollutants respectively adsorbed on all akaganeites. The kinetics models that best described the experimental data for As3+, As5+ and Sb3+ were those of Elovich and simplified Elovich. For Hg2+, the kinetic model that best described the experimental data was that of Bangham. The 300 K and 77 K Mössbauer spectrometry showed only slight variations in some of the hyperfine parameters for the akaganeites after adsorption.