Unequal Spatial Consequences of Abortion Restrictions in Texas, 2021-2023.

Objectives. To demonstrate the spatially uneven effects of abortion restriction laws in Texas. Methods. We used network analysis to determine the change in distance to the nearest surgical abortion provider for 5253 Texas neighborhoods after the passing of Texas Senate Bill 8 (SB8; 2021) and the US Supreme Court's Dobbs v Jackson Women's Health Organization (2022) decision. We identified associations between key measures of neighborhood socioeconomic context and change in distance to providers using multivariable linear regression models. Results. After the Dobbs decision, Texas residents experienced an average change in distance to the nearest provider of 457 miles (SD = 179). Neighborhoods of concentrated disadvantage experienced the greatest increase in distance to abortion providers after SB8's passing, and neighborhoods with high levels of income inequality experienced the greatest increase in distance after the Dobbs decision. Conclusions. We document the rapidly changing abortion landscape in a highly restrictive state and show that women living in more disadvantaged and unequal areas are most affected by the increasing distance to providers. Public Health Implications. Our methods and findings will continue to be relevant in understanding the burden placed on women in areas where medical abortion has been restricted because of the Dobbs decision. (Am J Public Health. Published online ahead of print May 23, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307652).

Health care use and health consequences of geographic lack of access to abortion and maternity care.

BACKGROUND: Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. METHODS: We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. RESULTS: In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). CONCLUSIONS: Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.

Trends in Pregnancy-Associated Homicide, United States, 2020.

Objectives. To estimate the national pregnancy-associated homicide rate in 2020 and to characterize patterns of victimization. Methods. Using a retrospective analysis of the 2020 US national mortality file, I identified all homicides of women who were pregnant or within 1 year of the end of pregnancy. Descriptive statistics characterized these victims, and I calculated annual pregnancy-associated homicide rates (deaths per 100 000 live births) for comparisons with 2018 and 2019. I estimated the added risk conferred by pregnancy in 2020 by comparing the pregnancy-associated homicide rate to homicide in the nonpregnant, nonpostpartum population of females aged 10 to 44 years. Results. There were 5.23 pregnancy-associated homicides per 100 000 live births in 2020, a notable increase from previous years. Rates were highest among adolescents and non-Hispanic Black women. Eighty percent of incidents involved firearms. The risk of homicide was 35% greater for pregnant and postpartum women than for their nonpregnant, nonpostpartum counterparts, who did not experience as large an increase from previous years. Conclusions. Pregnancy-associated homicide substantially increased in 2020. Public Health Implications. Policies to address domestic and community violence against women are urgently needed. (Am J Public Health. 2022;112(9):1333-1336. https://doi.org/10.2105/AJPH.2022.306937).

State Abortion Policies and Maternal Death in the United States, 2015‒2018.

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.

Association of the Neighborhood Built Environment With Incident and Prevalent Depression in the Rural South.

INTRODUCTION: A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS: We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS: Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION: The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study.

BACKGROUND: Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies. METHODS: Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations. RESULTS: Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics. CONCLUSIONS: Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

HIV Stigma, Mental Health, and Alcohol Use Disorders among People Living with HIV/AIDS in New Orleans.

Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use disorders among PLWH. Furthermore, no studies have examined this relationship within the larger context of urban life stressors. The purpose of this study was to examine associations of an overall HIV-related stigma measure and four HIV stigma subscales on depression, anxiety, and hazardous drinking among a sample of 380 PLWH in New Orleans. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by urban life stressors. Overall, higher levels of HIV-stigma were associated with depressive symptoms (RR 1.67, 95% CI 1.25, 2.23), anxiety symptoms (RR 1.91, 95% CI 1.17, 3.12), and hazardous drinking (RR 1.45, 95% CI 1.02, 2.05). Internalized HIV-stigma (measured using the negative self-image subscale) was associated with all three outcomes and had the highest magnitude point estimates across the four stigma subscales. Urban life stressors, measured by the Urban Life Stressors Scale (ULSS), modified the association between HIV-related stigma and mental health and alcohol use disorders (P < 0.2), highlighting the importance for examining the larger urban environmental context. Findings from this study may inform interventions to reduce HIV-related stigma operating at the individual and structural level.

Pre-pregnancy cardiovascular risk factors and racial disparities in birth outcomes: the Bogalusa Heart Study.

BACKGROUND: Racial disparities in birth outcomes are mirrored in cardiovascular health. Recently there have been calls for more attention to preconception and interconceptional health in order to improve birth outcomes, including as a strategy to reduce black-white disparities. METHODS: As part of a larger study of cardiovascular and reproductive health ("Bogalusa Babies"), female participants were linked to their children's birth certificates for Louisiana, Mississippi, and Texas births from 1982 to 2009. Three thousand and ninety-five women were linked to birth certificate data. Birth outcomes were defined as low birthweight (LBW) birthweight < 2500 g; preterm birth (PTB), > 3 weeks early; small for gestational age (SGA), <10th percentile for gestational age (percentiles based on study population); large for gestational age (LGA) >90th percentile for gestational age]. Cardiovascular measures (blood pressure, lipids, glucose, insulin) at the visit closest in time but prior to the pregnancy was examined as predictors of birth outcomes using logistic models adjusted for covariates. RESULTS: Only a few cardiovascular risk factors were associated with birth outcomes. Triglycerides were associated with higher risk of LBW among whites (aOR 1.05, 95% 1.01-1.10). Higher glucose was associated with a reduction in risk of SGA for black women (aOR 0.85, 95% CI 0.76-0.95), but not whites (p for interaction = 0.02). Clear racial disparities were found, but they were reduced modestly (LBW/SGA) or not at all (PTB/LGA) after CVD risk factors were adjusted for. CONCLUSIONS: This analysis does not provide evidence for preconception cardiovascular risk being a strong contributor to racial disparities.

Fasting glucose concentrations and associations with reproductive history over 40 years of follow-up.

Gestational diabetes mellitus (GDM) is the onset or first recognition of diabetes that occurs during pregnancy. We aimed to assess for trends in fasting blood glucose levels across the life-course among a cohort of women by reproductive history: nulligravid women, gravid women with and without a history of GDM. Women who had participated in the Bogalusa Heart Study as children were interviewed about their reproductive history, including GDM (n = 358). We compared fasting blood glucose (mg/dL) measured after last pregnancy (or after age 40 among nulligravid women) across reproductive history groups in linear models adjusted for prepregnancy fasting blood glucose, body mass index, race, parity, and age at outcome measure. We fit a log-Poisson model to estimate the associations with prediabetes risk after age 40. After adjustments, mean fasting glucose after age 40 was not different between gravid women without GDM history and nulligravid women. However, women with a history of GDM had mean fasting glucose 27 mg/dL greater than nulligravid women (95% CI = 12.35, 41.64). Heterogeneity by race indicated Black women with a history of GDM had disproportionately elevated mean fasting glucose after age 40. Fasting blood glucose trends over the life-course differ among women by reproductive history and race.

Racial/ethnic differences in preterm perinatal outcomes.

BACKGROUND: Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation. OBJECTIVE: The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race. STUDY DESIGN: A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined. RESULTS: Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms. CONCLUSION: Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities.

Exposure to Ambient Air Pollution and Premature Rupture of Membranes.

Premature rupture of membranes (PROM) is a major factor that predisposes women to preterm delivery. Results from previous studies have suggested that there are associations between exposure to air pollution and preterm birth, but evidence of a relationship with PROM is sparse. Modified Community Multiscale Air Quality models were used to estimate mean exposures to particulate matter less than 10 µm or less than 2.5 µm in aerodynamic diameter, nitrogen oxides, carbon monoxide, sulfur dioxide, and ozone among 223,375 singleton deliveries in the Air Quality and Reproductive Health Study (2002-2008). We used log-linear models with generalized estimating equations to estimate adjusted relative risks and 95% confidence intervals for PROM per each interquartile-range increase in pollutants across the whole pregnancy, on the day of delivery, and 5 hours before delivery. Whole-pregnancy exposures to carbon monoxide and sulfur dioxide were associated with an increased risk of PROM (for carbon monoxide, relative risk (RR) = 1.09, 95% confidence interval (CI): 1.04, 1.14; for sulfur dioxide, RR = 1.15, 95% CI: 1.06, 1.25) but not preterm PROM. Ozone exposure increased the risk of PROM on the day of delivery (RR = 1.06, 95% CI: 1.02, 1.09) and 1 day prior (RR = 1.04, 95% CI: 1.01, 1.07). In the 5 hours preceding delivery, there were 3%-7% increases in risk associated with exposure to ozone and particulate matter less than 2.5 µm in aerodynamic diameter and inverse associations with exposure to carbon monoxide and nitrogen oxides. Acute and long-term air pollutant exposures merit further study in relation to PROM.

Sexual and physical abuse and gynecologic disorders.

STUDY QUESTION: Is sexual and/or physical abuse history associated with incident endometriosis diagnosis or other gynecologic disorders among premenopausal women undergoing diagnostic and/or therapeutic laparoscopy or laparotomy regardless of clinical indication? SUMMARY ANSWER: No association was observed between either a history of sexual or physical abuse and risk of endometriosis, ovarian cysts or fibroids; however, a history of physical abuse was associated with a higher likelihood of adhesions after taking into account important confounding and mediating factors. WHAT IS KNOWN ALREADY: Sexual and physical abuse may alter neuroendocrine-immune processes leading to a higher risk for endometriosis and other noninfectious gynecologic disorders, but few studies have assessed abuse history prior to diagnosis. STUDY DESIGN, SIZE, DURATION: The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of the 14 surgical centers located in Salt Lake City, UT, USA or San Francisco, CA, USA. Women with a history of surgically confirmed endometriosis were excluded. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Prior to surgery, women completed standardized abuse questionnaires. Relative risk (RR) of incident endometriosis, uterine fibroids, adhesions or ovarian cysts by abuse history were estimated, adjusting for age, race/ethnicity, education, marital status, smoking, gravidity and recruitment site. We assessed whether a history of chronic pelvic pain, depression, or STIs explained any relationships via mediation analyses. MAIN RESULTS AND ROLE OF CHANCE: 43 and 39% of women reported experiencing sexual and physical abuse. No association was observed between either a history of sexual or physical abuse, versus no history, and risk of endometriosis (aRR: 1.00 [95% confidence interval (CI): 0.80-1.25]); aRR: 0.83 [95% CI: 0.65-1.06]), ovarian cysts (aRR: 0.67 [95% CI: 0.39-1.15]); aRR: 0.60 [95% CI: 0.34-1.09]) or fibroids (aRR: 1.25 [95% CI: 0.85-1.83]); aRR: 1.36 [95% CI: 0.92-2.01]). Conversely, a history of physical abuse, versus no history, was associated with higher risk of adhesions (aRR: 2.39 [95% CI: 1.18-4.85]). We found no indication that the effect of abuse on women's adhesion risk could be explained by a history of chronic pelvic pain, depression or STIs. LIMITATIONS, REASONS FOR CAUTION: Limitations to our study include inquiries on childhood physical but not sexual abuse. Additionally, we did not inquire about childhood or adulthood emotional support systems, found to buffer the negative impact of stress on gynecologic health. WIDER IMPLICATIONS OF THE FINDINGS: Abuse may be associated with some but not all gynecologic disorders with neuroendocrine-inflammatory origin. High prevalence of abuse reporting supports the need for care providers to screen for abuse and initiate appropriate follow-up. STUDY FUNDING/COMPETING INTERESTS: Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts NO1-DK-6-3428, NO1-DK-6-3427, and 10001406-02). The authors have no potential competing interests.

Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance.

BACKGROUND: Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to nonpregnant women, but US national data have not been reported since the implementation of enhanced mortality surveillance. OBJECTIVE: The objective of the study was to estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death with nonpregnant/nonpostpartum women. STUDY DESIGN: Death certificates (n = 465,097) from US states with enhanced pregnancy mortality surveillance from 2005 through 2010 were used to compare mortality among 4 groups of women aged 10-54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death), and nonpregnant/nonpostpartum. We estimated pregnancy-associated mortality ratios and compared with nonpregnant/nonpostpartum mortality ratios to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature. RESULTS: Pregnancy-associated homicide victims were most frequently young, black, and undereducated, whereas pregnancy-associated suicide occurred most frequently among older white women. After adjustments, pregnancy-associated homicide risk ranged from 2.2 to 6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared with 2.5-2.6 per 100,000 nonpregnant/nonpostpartum women aged 10-54 years. Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared with 5.3-5.5 per 100,000 women aged 10-54 years among nonpregnant/nonpostpartum women. Assuming the most conservative published estimate of misclassification, the risk of homicide among pregnant/postpartum women was 1.84 times that of nonpregnant/nonpostpartum women (95% confidence interval, 1.71-1.98), whereas risk of suicide was decreased (relative risk, 0.62, 95% confidence interval, 0.57-0.68). CONCLUSION: Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the United States.

Preterm Birth in the Context of Increasing Income Inequality.

OBJECTIVE: Preterm birth is a leading cause of infant morbidity and mortality. Little is known about the contextual effect of U.S. income inequality on preterm birth, an issue of increasing concern given that the current economic divide is the largest since 1928. METHODS: We examined changes in inequality over time in relation to preterm birth among singleton deliveries from an electronic medical record-based cohort (n = 223,512) conducted in 11 U.S. states and the District of Columbia from 2002 to 2008. Increasing income inequality was defined as a positive change in state-level Gini coefficient from the year prior to birth. Multi-level models estimated the independent effect of increasing inequality on preterm birth (>22 and <37 weeks) controlling for maternal demographics, health behaviors, insurance status, chronic medical conditions, and state-level poverty and unemployment during the year of birth. RESULTS: The preterm birth rate was 12.3% where inequality increased and 10.9% where it did not. After adjustment, increasing inequality remained significantly associated with preterm birth (adjusted odds ratio 1.07, 95% confidence interval 1.04, 1.11). We observed no significant interaction by insurance status or race, suggesting that increasing inequality had a broad effect across the population. CONCLUSIONS: The contextual effect of increasing income inequality on preterm birth risk merits further study.

Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth.

OBJECTIVES: We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth. METHODS: Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor's or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. RESULTS: Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. CONCLUSIONS: High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur.

States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20.

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.

Adverse Obstetric and Perinatal Outcomes Among Birthing People in Same-Sex and Different-Sex Relationships in Louisiana.

Purpose: We investigated sexual orientation disparities in several obstetric and perinatal outcomes in Louisiana and examined whether these disparities differed among Black, Latine, and White populations. Methods: We analyzed cross-sectional vital records data on singleton live births in Louisiana (2016-2022). Same-sex relationships (SSR) vs. different-sex relationships (DSR) were classified based on the sex of the parents listed on the birth certificate. Using modified Poisson regression, we estimated adjusted risk ratios and 95% confidence intervals among birthing persons in SSR vs. DSR for preterm birth (PTB), low birthweight (LBW), spontaneous labor, Cesarean delivery, gestational hypertension, and gestational diabetes. We examined within and across group disparities in models stratified by sexual orientation and race/ethnicity. Results: In the total birthing population, those in SSR experienced higher risk of gestational hypertension and gestational diabetes and were less likely to have spontaneous labor compared with persons in DSR. The risk of PTB and LBW was two-fold higher among Black birthing people in SSR compared with White birthing people in SSR and DSR. Latine birthing people in SSR experienced higher risk of gestational hypertension and gestational diabetes compared with their peers in DSR and White people in DSR. Some of these disparities were partially explained by including socioeconomic and health risk factors. Conclusion: Sexual orientation-related disparities exist across and within racial/ethnic groups among birthing people in Louisiana. Adopting an intersectional approach that considers the mutually constituted nature of heterosexism and racism is critical to addressing sexual orientation-related inequities in reproductive and perinatal health.

Allostatic load and birth outcomes among white and black women in New Orleans.

As a marker of chronic stress, allostatic load has been theoretically recognized as a potential contributor to racial disparities in birth outcomes. The purpose of this investigation was to identify associations between allostatic load and birth outcomes and to assess differences in allostatic load and its relation to birth outcomes between white and black women. Blood samples from 123 women at 26-28 weeks gestation were assayed for cholesterol, glycosylated hemoglobin, dehydroepiandrosterone-sulfate, and cortisol, with 42 women having complete data on all biomarkers and birth outcomes. Together with systolic blood pressure, these biomarkers were combined to create an allostatic load index. Multiple linear regression models were used to evaluate associations between allostatic load index and gestational age, birth weight, birth weight ratio, birth length, and head circumference. Black women had a significantly lower allostatic load index than white women (P < 0.05). Gestational age was the only outcome significantly associated with allostatic load in both unadjusted and adjusted models (P < 0.05). Gestational age decreased significantly with increasing allostatic load (adjusted ß -0.18, 95 % CI -0.35, 0.00). A significant interaction with age indicated that the effect was less strong at higher maternal ages (adjusted interaction ß 0.04, 95 % CI 0.00, 0.08). There was no racial difference in the effect of allostatic load on birth outcomes. These findings represent possible evidence of the effect of stress age on gestational age. As a measure of cumulative disadvantage, allostatic load may prove to be a contributor to the racial disparities in birth outcomes.

Associations Between State and Local Government Spending and Pregnancy-Related Mortality in the U.S.

INTRODUCTION: There is limited evidence on how government spending is associated with maternal death. This study investigates the associations between state and local government spending on social and healthcare services and pregnancy-related mortality among the total, non-Hispanic Black, Hispanic, and non-Hispanic White populations. METHODS: State-specific total population and race/ethnicity-specific 5-year (2015-2019) pregnancy-related mortality ratios were estimated from annual natality and mortality files provided by the National Center for Health Statistics. Data on state and local government spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized linear Poisson regression models with robust SEs were fitted to estimate adjusted rate ratios and 95% CIs associated with proportions of total spending allocated to social services and healthcare domains, adjusting for state-level covariates. All analyses were completed in 2021-2022. RESULTS: State and local government spending on transportation was associated with 11% lower overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96) and 9%-12% lower pregnancy-related mortality among the racial/ethnic groups. Among spending subdomains, expenditures on higher education, highways and roads, and parks and recreation were associated with lower pregnancy-related mortality rates in the total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87, 95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively). These results were consistent among the racial/ethnic groups, but patterns of associations with pregnancy-related mortality and other spending subdomains differed notably between racial/ethnic groups. CONCLUSIONS: Investing more in local- and state-targeted spending in social services may decrease the risk for pregnancy-related mortality, particularly among Black women.

Diet Quality and Sleep Characteristics in Midlife: The Bogalusa Heart Study.

BACKGROUND: Sleep and diet contribute to cardiometabolic disease, but evidence is sparse for the association between these behaviors. This study analyzed the cross-sectional relationship between diet quality and multiple sleep outcomes in the Bogalusa Heart Study (BHS). METHODS: Diet and sleep characteristics, including insomnia and sleep apnea symptoms, were measured with validated questionnaires. Poisson regression using generalized estimating equations with a log link estimated prevalence rate ratios (PRR) of sleep outcomes by dietary pattern scores (quintile (Q) and per SD). Models were adjusted for body mass index (BMI), multi-level socioeconomic factors, physical activity, depressive symptoms, and other potential confounders. RESULTS: In 824 participants, higher diet quality, measured by the Alternate Healthy Eating Index-2010, was associated with lower sleep apnea risk score after adjustment (PRR [95% confidence interval (CI)] Q5 vs. Q1: 0.59 [0.44, 0.79], per SD increase: 0.88 [0.81, 0.95], p-trend < 0.0001). There were no statistically significant associations with the Healthy Eating Index 2015 or the Alternate Mediterranean dietary patterns, or for insomnia symptoms or a healthy sleep score. CONCLUSIONS: Higher diet quality, after adjustment for BMI, was associated with a lower sleep apnea risk score in a cohort with substantial minority representation from a semi-rural, lower-income community.