Assessing Perinatal Insurance Coverage at Time of Death: A National Survey of Maternal Mortality Review Committees.

Background: The objective of this study is to understand the proportion of Maternal Mortality Review Committees (MMRCs) that investigate insurance status at the time of maternal deaths occurring during three time periods: pregnancy, childbirth, and up to 12 months postpartum. Materials and Methods: We conducted a national survey of MMRCs between July and September of 2020. Jurisdictions were e-mailed a 17-item questionnaire that addressed whether the MMRCs document insurance status for each of the three time periods as well as facilitators and barriers to doing so. Descriptive statistics were performed. Follow-up interviews were conducted with five MMRCs between November and December of 2020 to assess unique strategies and challenges discovered in their survey responses. Results: Among 46 eligible jurisdictions, 37 completed the survey (80.4%). The vast majority of MMRCs reported documenting insurance status during pregnancy (97.3%, 36/37) and childbirth (88.4%, 30/34). Fewer MMRCs reported documenting insurance status at the time of death for deaths that occur postpartum (59.4%, 19/32). Barriers to doing so included limited access to postpartum insurance data and a historic focus on deaths occurring during pregnancy and in association with childbirth. Conclusions: MMRCs primarily focus on identifying insurance status during pregnancy and at childbirth. Information on insurance status in the postpartum period is more difficult to ascertain and less often determined. The findings from this work should inform efforts for MMRCs to improve data collection on insurance status and ultimately improve the capacity of MMRCs to identify targeted insurance policy reforms that could help reduce maternal mortality.

Lipoprotein Profiles in Class III Obese Caucasian and African American Women with Nonalcoholic Fatty Liver Disease.

Triglyceride content in the liver is regulated by the uptake, production and elimination of lipoproteins, and derangements in these processes contribute to nonalcoholic fatty liver disease (NAFLD). Previous studies show a direct relationship between intrahepatic fat and production of apolipoprotein B100 (apoB100) containing particles, VLDL and LDL, but little consensus exists regarding changes in lipoprotein production in the development of simple steatosis (SS) versus nonalcoholic steatohepatitis (NASH). Further, ethnic variations in lipoproteins among SS and NASH are unknown as is how such variations might contribute to the differential prevalence of disease among Caucasians versus African Americans. In this study, we assessed plasma lipoprotein profiles by nuclear magnetic resonance (NMR) spectroscopy in 70 non-diabetic class III obese females recruited from the surgical weight loss clinic. Of these, 51 females were stratified by biopsy-staged NAFLD severity (histologically normal, SS, or NASH). NASH females displayed increased circulating triglycerides and increased VLDL particle number and size relative to those with histologically normal livers, while total and large LDL concentration decreased in SS versus NASH and correlated with increased insulin resistance (via HOMA2-IR). When Caucasian women were examined alone (n = 41), VLDL and triglycerides increased between normal and SS, while total LDL and apoB100 decreased between SS and NASH along with increased insulin resistance. Compared to Caucasians with SS, African American women with SS displayed reduced triglycerides, VLDL, and small LDL and a more favorable small to large HDL ratio despite having increased BMI and HOMA2-IR. These findings suggest that ApoB100 and lipoprotein subclass particle number and size can delineate steatosis from NASH in obese Caucasian females, but should be interpreted with caution in other ethnicities as African Americans with SS display relatively improved lipoprotein profiles. This may reflect variation in the relationship between dyslipidemia and NAFLD progression across gender and ethnicity.