Implications of Social Determinants of Health Characteristics on Fetal Growth Restriction Among Various Racial/Ethnic Groups.

OBJECTIVES: Current knowledge regarding the relationship between social determinants of health (SDOH) characteristics of hospitalized American pregnant women and fetal growth restriction (FGR) reveals a dearth in the literature. Therefore, we examined the impact of SDOH on FGR among hospitalized American women in this study. METHODS: Using the Nationwide Inpatient Sample (NIS) dataset for the years 2016-2018, we conducted this cross-sectional study. We conducted survey logistic regression to examine the association between SDOH factors and FGR, after adjusting for various hospitalization characteristics. RESULTS: Non-Hispanic (NH)-Black people had the highest prevalence of SDOH issues (0.7%), followed by Hispanics who had a prevalence of 0.4%. We observed that pregnant women with SDOH issues were 1.16 times as likely to experience FGR as those without SDOH (95% CI 1.0-1.34). When compared to their respective racial counterparts without SDOH, Hispanics with SDOH had increased odds, NH-White and NH-others with SDOH had the same likelihood, and NH-Black women with SDOH had lower odds of FGR. CONCLUSIONS FOR PRACTICE: Overall, our study illustrated an association between maternal SDOH issues and FGR, and the impact of SDOH issues on the outcome of FGR across various racial/ethnic groups. While our study provides useful insight into the topic, further research is needed to explain the observed varied influence of SDOH on FGR across racial/ethnic groups.

What is already known on this subject? Children with fetal growth restriction (FGR) present with a greater risk of long-term health effects including impaired neurological, cardiovascular and endocrine diseases in adulthood. FGR affects 5-10% of pregnancies and is the second leading cause of perinatal mortality.What this study adds? An association between maternal social determinants of health (SDOH) issues and FGR, and the impact of SDOH issues on the outcome of FGR across various racial/ethnic groups is present. When compared to their respective racial counterparts without SDOH, Hispanics with SDOH had increased odds of FGR.

Hispanic Ethnicity, Nativity and the Risk of Stillbirth.

The objective of this study was to examine stillbirth risk by nativity and Hispanic ethnicity. We analyzed births and fetal deaths among women of Hispanic origin within gestational ages of 20-42 weeks from the 2014-2019 Birth and Fetal Death. Foreign-born Hispanic mothers were 8% less likely (HR 0.92, 95% CI 0.90-0.95) to experience stillbirth than their counterparts. Stratified by ethnicity, foreign-born Mexican and Central/South American women had a lower risk of stillbirth (HR 0.85, 95% CI 0.81-0.88 and HR 0.68, 95% CI 0.63-0.75, respectively) while foreign-born Puerto Rican women were more likely to experience stillbirth (HR 1.37, 95% CI 1.24-1.51) than their native-born counterparts. While overall foreign-born Hispanic mothers were less likely to experience stillbirth than native-born Hispanic mothers, this differed depending on ethnicity. Counseling regarding risk of stillbirth among Hispanic women should take into consideration nativity and country of origin as influential factors.

Assessment of hospitalization rates, factors associated with hospitalization and in-patient mortality in pediatric patients with cystic fibrosis.

INTRODUCTION: Cystic fibrosis (CF), an inherited autosomal recessive disease that results in the accumulation of mucus and damage primarily to the respiratory and digestive tracts is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In the United States, it has been estimated that CF occurs in 1 out of 3500 infants. The objective of this study was to explore the patient and hospital characteristics associated with CF hospitalizations and inpatient mortality in pediatric CF patients. METHODS: Utilizing the National Inpatient Sample database from 2008 to 2017, a retrospective cohort study was conducted to analyze the hospitalization rates, associated factors, and the inpatient mortality of CF patients 0-17 years of age. Hospitalizations with a diagnosis of CF were identified with ICD-9-CM and ICD-10-CM codes. Adjusted survey logistic regression models were utilized to determine factors associated with CF hospitalizations and in-hospital deaths in CF patients. RESULTS: There were a total of 98,660 (about 0.2%) CF hospitalizations in patients 17 years of age or younger during the study period. Non-Hispanic (NH) White CF patients had the highest prevalence of CF (26.30 per 10,000 hospitalizations). The prevalence of inpatient deaths were highest among those identified as NH-Others and NH-Blacks (71.35 and 68.83 per 10,000 CF hospitalizations, respectively. When compared with NH-White category, those belonging to NH-Black, Hispanic and Other racial/ethnic sub-group had reduced odds of being hospitalized with CF. DISCUSSION: Despite our finding of an increased likelihood of being hospitalized for CF among NH-White and male pediatric patients, no association between race or sex and CF inpatient death was observed when adjusted for covariates. More research is needed to determine the impact of sex and race on CF mortality rates.

Maternal pre-pregnancy underweight and the risk of small-for-gestational-age in Asian-American ethnic groups.

OBJECTIVE: This study aimed to examine the association between maternal pre-pregnancy underweight and the risk of small-forgestational-age (SGA) birth among Asian Americans compared with non-Hispanic (NH) whites. METHODS: Using 2014-2018 birth data, we categorized maternal underweight and SGA according to severity. Bivariate analyses were performed to examine the demographics and maternal body mass index (BMI). Adjusted logistic regression models were used to analyze the association between maternal BMI and SGA among Asian Americans compared with NH-Whites. RESULTS: In Asian Americans, the likelihood of SGA birth was higher among underweight mothers than among mothers with a normal BMI (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.30-1.46). We observed that as the severity of maternal underweight increased, the adjusted odds of SGA increased. Underweight Asian American mothers were more likely to give birth to SGA infants than underweight NH-White mothers (OR, 1.36; 95% CI, 1.28-1.44). CONCLUSION: This study shows the association between maternal underweight and SGA birth among Asian Americans, supporting the development of culture-sensitive interventions addressing the impact of weight on pregnancy.