Search Results (52)

Background: During pregnancy, mothers and their infants are at increased risk for complications due to COVID-19 infection, influenza, and pertussis. At the time of writing, the previous advisory committee on immunization practices (ACIP) recommended that pregnant women receive the COVID-19 vaccine, influenza, tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, as well as respiratory syncytial virus vaccinations during pregnancy. The COVID-19 pandemic greatly impacted routine vaccinations especially among medically underserved women in the South. The barriers to recommended vaccinations during pregnancy for medically underserved women in the South are unclear and require further investigation. The purpose of this study is to examine the attitudes, opinions, and beliefs of a multiracial pregnant cohort from diverse backgrounds in Central Tennessee about their experiences with the vaccines that are recommended during pregnancy. The vaccines included in the study are COVID-19, flu, and Tdap because RSV was not yet FDA-approved for pregnant women at the launch of this study. Methods: In this study, we focus on medically underserved women in Nashville, Tennessee, and the surrounding rural counties regarding vaccine acceptance and initiation of the COVID-19, influenza, and the Tdap vaccines. This study involved 208 pregnant people (100%) aged 18–49 years. All respondents were pregnant at the time of the study. The study consisted of a 26 question Redcap survey about participants’ beliefs, attitudes, opinions, and experiences with the COVID-19, flu, and Tdap vaccines during their pregnancy. Results: The randomly selected participants in the cohort were 40.4% White, 31.7% Black, 21.6% Hispanic, and 6.3% other race/ethnicity. The mothers in the cohort were young, with an average age of 27 years, most were married, and 52.8% had an annual household income before taxes of less than USD 35,000. Only 19.2% of the mothers in this study were very confident of the safety of the COVID-19 vaccine, compared to 32.7% for both the flu and Tdap vaccines. Overall, primary care providers were identified as the most trusted messengers for both disease and vaccine information for COVID-19, flu, and Tdap. However, only 11 participants out of 208 received all three of the ACIP recommended vaccines during their pregnancies in the study, barring the time-dependent vaccination for Tdap. The most common reasons for not receiving these vaccines involved concerns for the safety of themselves and their babies and a fear of needles. Conclusions: Education and awareness of ACIP-recommended vaccines during pregnancy needs improvement, and the support of primary care providers as the main driver of pregnancy vaccine initiation is essential. Full article

Background: Prenatal depression, affecting up to a quarter of all pregnancies in the United States, contributes to morbidity and mortality and is associated with increased risk of adverse birth and long-term mental health outcomes. Adverse childhood experiences (ACEs, or experiences of abuse, neglect, or family dysfunction experienced prior to age 18) are a strong predictor of adult depression and adverse health outcomes. The present study investigated whether epigenetic modification in the form of DNA methylation (DNAm) of four stress-related, glucocorticoid pathway genes (CRH, CRHR1, FKBP5, NR3C1) mediates associations between ACEs and depressive symptoms among Black pregnant women. Methods: Using a cross-sectional design, we examined the mediating role of DNAm on the relationship between depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D)) and ACEs (Centers for Disease Control and Prevention 10-item questionnaire), in a subsample (n = 61) of Black pregnant women who were participants of the Biosocial Impacts of Black Births (BIBB) study. Results: A significant association was found between ACEs and depressive symptoms scores (TE α_X = 2.29 with p_TE = 6.60 × 10⁵). DNAm on five CpG sites within two genes significantly mediated the relationship between ACEs and depressive symptoms (cg03238273 on CRHR1, and cg08845721, cg16594263, cg19820298, and cg23430507 on NR3C1). Conclusions: This study provides evidence that DNAm partially mediated the association of ACEs and depressive symptoms during pregnancy among Black pregnant women. Understanding the molecular pathways underlying the mediating effect of ACEs on depressive symptoms among Black pregnant women can illuminate biological markers that help identify and treat pregnant women who are at an increased risk for depression following childhood trauma. Full article

Chronic exposure to structural violence and environmental hazards may disrupt stress regulation, trigger inflammation, and impair iron metabolism in women. Iron deficiency has been associated with depression, but the combined impact of environmental stressors and anemia on maternal mental health remains understudied. We analyzed associations between 28 neighborhood-level environmental stressors, hemoglobin levels, and depressive symptoms (measured by the Patient Health Questionnaire-9) during early pregnancy, using retrospective data from 1964 pregnant patients (2015–2019) at an urban health center in Chicago. Demographic and residential data were linked to environmental indicators from the Chicago Health Atlas. Factor analysis reduced the environmental variables, and multivariable regression models examined associations with PHQ-9 scores at first pregnancy encounter. Participants were predominantly non-Hispanic Black (56%) and Hispanic (27%), with 13% anemic and 16% screening positive for depressive symptoms. Poverty, non-Hispanic Black race, single status, public or no insurance, and unemployment were associated with higher depressive symptoms. Among anemic individuals, neighborhood crime was significantly associated with depressive symptoms, while hemoglobin levels and gestational age were not. These findings highlight how environmental and social inequities contribute to maternal mental health disparities and support the need for integrated, equity-focused prenatal care interventions. Full article

Background/Objectives: Stress during pregnancy critically impacts maternal and fetal health. While prior research has linked sociodemographic and biological factors to stress levels, the role of specific biomarkers, such as vitamin D (VD), remains unexplored. This study examined the relationships among sociodemographic factors, VD status (as measured by serum 25-hydroxyvitamin D [25(OH)D] concentration), and perceived stress in pregnant women. We hypothesized that 25(OH)D concentration would be associated with perceived stress levels during pregnancy. Methods: A post hoc analysis of the Kellogg Pregnancy VD study was conducted on a cohort of 232 pregnant women with Perceived Stress Scale (PSS-10) scores at months 2, 5, and 7 with corresponding 25(OH)D concentrations. PSS-10 scores were classified into two groups: patients with scores of 0–13 were considered to have low stress, while those with scores of 14–40 were considered to have moderate-to-high stress. Logistic regression models identified factors associated with moderate-to-high stress. Results: At month 2, univariate analyses showed that being married (p = 0.002), having a college education (p = 0.0013), and lower BMI (p = 0.018) were associated with lower perceived stress, whereas Black race was associated with higher perceived stress (p = 0.027). By month 7, higher serum 25(OH)D concentration was the only significant predictor of perceived stress in univariate analysis (p = 0.002). In multivariate models at month 7, 25(OH)D approached significance (p = 0.053). Conclusions: Early in pregnancy, race, marital status, college education, and BMI were significantly associated with PSS-10 score. By month 7, 25(OH)D concentration over time emerged as a factor that was significantly associated in univariate analysis and showed a trend toward significance in multivariate models. VD status, as measured by 25(OH)D concentration, may act as a biomarker of stress during pregnancy. Results warrant further study in prospective intervention trials. Full article

Intimate partner violence (IPV) and life stressors, such as housing instability, unsafe neighborhoods, and lack of support, significantly impact maternal and fetal health, potentially leading to perinatal loss. This qualitative study explored the lived experiences of 22 Black women in the United States who identified IPV and other stressors as contributing factors to their perinatal loss. Semi-structured interviews were carried out with women who had experienced perinatal loss and were either pregnant or had given birth after a loss. Descriptive coding and thematic analysis were used in analyzing the data, revealing three main themes: pregnancy in the context of IPV, unsafe and unstable living environments, and challenges in finding support. Women perceived IPV and life stressors as direct causes of their loss, complicating their ability to heal and increasing their anxiety about future pregnancies. This study underscores the importance of addressing IPV and related stressors within maternity care. Maternity care providers should recognize signs of IPV and significant life stressors, provide trauma-informed, culturally responsive care, and facilitate access to supportive services. These insights inform perinatal public health strategies, including surveillance, prevention, and responsive policy. Full article

Antenatal depression significantly contributes to maternal and neonatal morbidity worldwide; however, the rate of screening, particularly in low- and middle-income countries (LMICs), remains very low. This cross-sectional survey study was aimed at determining the prevalence of depressive symptoms among women aged 18 to 34 years attending antenatal clinics at a quaternary hospital in Johannesburg, South Africa, utilizing a Biographical Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). The study is based on a total of 151 questionnaires. The mean age of the study population was 27.6 years (range: 18–34). Majority of participants identified themselves as Black (138, 91.4%), had previously been pregnant (111, 73.5%), were in the third trimester of pregnancy (89, 58.9%), were unemployed or seeking employment (108, 71.5%), and had no pre-existing medical (107, 70.9%) or mental illnesses (143, 94.7%). The prevalence of antenatal depressive symptoms among the study population was 43.7% (66/151), and 18 (27.3%) of the women who screened positive had suicidal ideation. The prevalence of antenatal depressive symptoms in this study exceeds that reported in other regions, underscoring the urgent need for universal screening throughout pregnancy and provision of perinatal mental healthcare services for pregnant and postpartum women. Full article

Cytomegalovirus (CMV) is the leading infectious cause of birth defects and has been linked to increased risk of preterm birth (PTB). CMV establishes lifelong latency and is more prevalent among Black and Hispanic/Latina women, populations already at higher risk for adverse pregnancy outcomes. Vitamin D deficiency, also common in these groups, has been linked to impaired immune function and increased susceptibility to infections, including CMV. In this cross–sectional study of 63 pregnant minority women (50 CMV+, 13 CMV−), we evaluated associations among serum 25(OH)D levels, CMV serostatus, and cmvIL–10, the CMV–encoded interleukin–10 homolog that modulates host immune responses. While vitamin D insufficiency and CMV seropositivity were both highly prevalent, we found no statistically significant associations between 25(OH)D levels and CMV serostatus or cmvIL–10 levels. These findings highlight the need for further investigation into how vitamin D deficiency and CMV infection may independently or synergistically contribute to maternal and neonatal health disparities. Full article

Preterm birth (PTB; <37 weeks’ gestation) is a persistent problem in the United States that affects non-Hispanic Black women at much higher rates than White women. Several biomarkers have been associated with PTB, including vitamin D deficiency (VDD) and low levels of vitamin D-binding protein (VDBP). However, no biomarker has been found to predict PTB. To identify a predictive biomarker of PTB, gene expression differences were determined in Black women with PTB and full-term births and between women with high and low levels of plasma vitamin D and high and low VDBP levels. In this pilot study of 19 pregnant women from the Biosocial Impact on Black Births (BIBB) study, we found that 47 genes were upregulated and 16 genes were downregulated in women with PTB as compared with women who had a full-term birth, 361 genes were downregulated and 61 genes were upregulated in women with VDD as compared with those that had vitamin D sufficiency, and 44 genes were upregulated and 295 were downregulated in women with low VDBP. Several genes expressed by neutrophils were downregulated in the PTB, VDD, and low VDBP groups. These findings support the idea that vitamin D and VDBP status may be important clinical markers influencing the gene expression of genes associated with PTB. Full article

Previous cross-sectional studies have investigated social determinants of health (SDOH) among pregnant women with COVID-19. However, there are scant data on the impact of these determinants on maternal outcomes from cohorts of pregnant women with COVID-19. We evaluated the association between social determinants of health and both COVID-19 severity and adverse pregnancy outcomes (APOs) in a cohort of pregnant women in Los Angeles (L.A.) County, California. The APOs considered were fetal loss, gestational hypertensive disorders, prolonged rupture of membranes, and maternal death. We recruited pregnant women with confirmed SARS-CoV-2 and collected data on maternal COVID-19 severity, trimester at diagnosis, comorbidities, mode of delivery, COVID-19 vaccination, APOs, maternal age, medical insurance type, race/ethnicity, and neighborhood income. Participants who were obese were more likely to experience severe COVID-19 (OR: 3.61, 95% CI: 1.44–9.46), while even one vaccine dose before COVID-19 infection was associated with reduced odds of severe disease (OR:0.14, 95% CI: 0.02–0.52). Pregnant participants living in low-income areas were more likely to experience APOs (p = 0.01) and severe COVID-19 (p = 0.009). This suggests that economic inequities could negatively impact maternal outcomes among pregnant women with COVID-19. We also found that SDOH moderated severity effects on APOs in Black women vs. non-Black women. These findings underscore the importance of considering social determinants of health to improve maternal health. Full article

Background/Objectives: We examined the association between bean consumption and the risk of gestational diabetes mellitus (GDM). Methods: We analyzed data from 1397 U.S. pregnant women from Infant Feeding Practices Study II. By using a Diet History Questionnaire, pregnant women were asked about the frequency of consumption and portion size of dried beans, chili, and bean soup over the previous month. They also reported the status of GDM. We used multivariable logistic regression models to examine associations between maternal bean consumption and the risk of GDM, adjusting for socio-demographic and pregnancy-related confounders. Results: Mean bean consumption was low among pregnant women: 0.31 cups/week of dried beans, 0.16 cups/week of chili, and 0.10 cups/week of bean soup. Dried bean consumption was relatively high in Hispanic mothers (mean, 0.65 cups/week) and mothers from the East South Central region (0.44). Chili consumption was relatively high in mothers who were Black (0.33), who did not attend college (0.18), who had a household size of 4+ (0.19), whose household income was <USD 25,000/year (0.20), who were WIC recipients (0.18), or who lived in the East South Central region (0.26). Pregnant women who consumed chili one time per month had a lower risk of GDM, compared with never consumers (3.5% vs. 7.4%; confounder-adjusted odds ratio or OR, 0.37 [95% confidence interval or CI, 0.17–0.79]; p = 0.011). However, there was no significant association between dried bean (6.6% for one time per week or more vs. 7.0% for never; confounder-adjusted OR, 0.82 [95% CI, 0.41–1.62]; p-value = 0.569) or bean soup (4.9% for two–three times per month or more vs. 6.6% for never; confounder-adjusted OR, 0.40 [95% CI, 0.05–3.08]; p-value = 0.382) consumption and GDM. Conclusions: Bean consumption during pregnancy is low and varies by socio-demographics in the U.S. A moderate frequency of chili consumption may offer some protection against GDM. Replication is needed in larger cohorts with more diverse populations, detailed measures of bean consumption, gold standards of GDM diagnosis, and experimental design. Research in this field can potentially inform dietary approaches to addressing GDM and related morbidities. Full article

In the past, it has been reported that the black South African population may have a cardio-protective lipid profile; however, this may no longer be the case with urbanization, industrialization, and the nutritional transition that occurred in South Africa. Although these transitions may be low in rural areas, one would expect this influence to be lower in the rural populations; however, they are not immune to these changes. Hence, the present study aimed to determine the association of serum lipid profiles and lipid ratios with kidney dysfunction. This cross-sectional retrospective study used the AWI-Gen 1 dataset. This study consisted of 1399 participants who took part in the AWI-Gen phase 1. Participants aged below 40 years, pregnant women, mentally disturbed and participants with incomplete information to answer the aims and objectives of this study were excluded in the analysis of this study. The data were analyzed using SPSS. In the present study, the prevalence of kidney dysfunction was 11.7%, with women having a significantly higher prevalence as compared to men. Women with kidney dysfunction had significantly higher TC, TG, TG/HDL-C, and TC/HDL-C compared to those without kidney dysfunction. However, in men, there was no association between the two groups. TC, and LDL/HDL-C were associated with kidney dysfunction in women only. TG/HDL-C was associated with kidney dysfunction in both women and men. Elevated TC, LDL/HDL-C, TC/HDL-C, and TG/HDL-C were the risk factors for kidney dysfunction, particularly in women. This suggests that TC, TC/HDL-C, and TG/HDL-C levels may be useful for risk stratification and a potential target to reduce the risk of developing kidney dysfunction, particularly in women. Upcoming longitudinal studies examining the causal connection between serum lipids, and lipid ratios with the risk of kidney dysfunction are necessary to fully understand the potential relationship between TG/HDL-C, TC, and TC/HDL-C levels and kidney dysfunction. Full article

Background: Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women. Methods: From 1985–2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White participants; 98% using Medicaid in pregnancy). Study visits, including questionnaires, dietary assessments, and biospecimen collection, occurred in early and late pregnancy as well as at delivery. Medical records were abstracted, and a subset of mothers and infants participated in a six-week postpartum visit. Results: Findings from the Camden Study have added to the understanding of adolescent and young adult maternal health and perinatal outcomes. These include associations of adolescent linear growth while pregnant with smaller neonatal birth size, low dietary zinc intake in early pregnancy with increased risk of delivery <33 gestational weeks, and higher circulating fatty acid levels with greater insulin resistance. More recent analyses have begun to unpack the biochemical pathways in pregnancy that may be shaped by race as an indicator of systemic racism. Conclusions: The Camden Study data and biorepositories are well-positioned to support future research aimed at better understanding perinatal health in under-represented women and infants. Linkages to subsequent health and administrative records and the potential for recontacting participants over 18–39 years after initial participation may provide key insights into the trajectories of maternal and child health across the life course. Full article

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons. Full article

Objective: Emerging evidence suggests that essential trace elements, including iodine, play a vital role in depressive disorders. This study investigated whether prenatal dietary iodine intake alone and in combination with supplemental iodine intake during pregnancy were associated with antepartum and postpartum depressive and anhedonia symptoms. Methods: The study population included 837 mothers in the PRogramming of Intergenerational Stress Mechanisms (PRISM) study. The modified BLOCK food frequency questionnaire was used to estimate prenatal dietary and supplemental iodine intake, while the 10-item Edinburg Postpartum Depression Scale (EPDS) ascertained depressive symptoms. Analyses considered the global EPDS score and the anhedonia and depressive symptom subscale scores using dichotomized cutoffs. Logistic regression estimating odds ratios and 95% confidence intervals (CIs) assessed associations of iodine intake in the second trimester of pregnancy and 6-month postpartum depressive and anhedonia symptoms considering dietary intake alone and combined dietary and supplementary intake in separate models. Results: Most women were Black/Hispanic Black (43%) and non-Black Hispanics (35%), with 39% reporting a high school education or less. The median (interquartile range, IQR) dietary and supplemental iodine intake among Black/Hispanic Black (198 (115, 337) µg/day) and non-Black Hispanic women (195 (126, 323) µg/day) was higher than the overall median intake level of 187 (116, 315) µg/day. Relative to the Institute of Medicine recommended iodine intake level of 160–220 µg/day, women with intake levels < 100 µg/day, 100–<160 µg/day, >220–<400 µg/day and ≥400 µg/day had increased adjusted odds of 6-month postpartum anhedonia symptoms (aOR = 1.74 (95% CI: 1.08, 2.79), 1.25 (95% CI: 0.80, 1.99), 1.31 (95% CI: 0.82, 2.10), and 1.47 (95% CI: 0.86, 2.51), respectively). The corresponding estimates for postpartum global depressive symptoms were similar but of smaller magnitude. Conclusions: Prenatal iodine intake, whether below or above the recommended levels for pregnant women, was most strongly associated with greater anhedonia symptoms, particularly in the 6-month postpartum period. Further studies are warranted to corroborate these findings, as dietary and supplemental iodine intake are amenable to intervention. Full article

Background/Objectives: Lipid metabolism plays an important role in maternal health and fetal development. There is a gap in the knowledge of how lipid metabolism changes during pregnancy for Black women who are at a higher risk of adverse outcomes. We hypothesized that the comprehensive lipidome profiles would show variation across pregnancy indicative of requirements during gestation and fetal development. Methods: Black women were recruited at prenatal clinics. Plasma samples were collected at 8–18 weeks (T₁), 22–29 weeks (T₂), and 30–36 weeks (T₃) of pregnancy. Samples from 64 women who had term births (≥37 weeks gestation) were subjected to “shotgun” Orbitrap mass spectrometry. Mixed-effects models were used to quantify systematic changes and dimensionality reduction models were used to visualize patterns and identify reliable lipid signatures. Results: Total lipids and major lipid classes showed significant increases with the progression of pregnancy. Phospholipids and glycerolipids exhibited a gradual increase from T₁ to T₂ to T₃, while sphingolipids and total sterol lipids displayed a more pronounced increase from T₂ to T₃. Acylcarnitines, hydroxy acylcarnitines, and Lyso phospholipid levels significantly decreased from T₁ to T₃. A deviation was that non-esterified fatty acids decreased from T₁ to T₂ and increased again from T₂ to T₃, suggestive of a potential role for these lipids during the later stages of pregnancy. The fatty acids showing this trend included key fatty acids—non-esterified Linoleic acid, Arachidonic acid, Alpha-linolenic acid, Eicosapentaenoic acid, Docosapentaenoic acid, and Docosahexaenoic acid. Conclusions: Mapping lipid patterns and identifying lipid signatures would help develop intervention strategies to reduce perinatal health disparities among pregnant Black women. Full article