Connie L. Bish

Gestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesity

OBJECTIVE Current pregnancy weight gain guidelines are based on prepregnancy body mass indices (BMI), but gestational weight gains by BMI class among US women are unknown. STUDY DESIGN We assessed the amount of gestational weight gain among 52,988 underweight, normal-weight, overweight, and obese US women who delivered a singleton, full-term infant in 2004-2005. Excessive weight gain during pregnancy was defined as gaining 35 or more pounds for normal-weight and 25 or more pounds for overweight women. RESULTS Approximately 40% of normal-weight and 60% of overweight women gained excessive weight during pregnancy. Obese women gained the least, although one-fourth of these women gained 35 or more pounds. Excessive weight gain levels were highest among women aged 19-years-old or younger and those having their first birth. CONCLUSION Excessive gestational weight gains were common, especially among the youngest and those who were nulliparous. These results predict higher obesity levels from pregnancy weight gains among US women.

Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women.

OBJECTIVE: To examine 2009 H1N1 influenza illness severity and the effect of antiviral treatment on the severity of illness among pregnant women. METHODS: We abstracted medical records from hospitalized pregnant (n=62) and nonpregnant (n=74) women with laboratory-confirmed 2009 H1N1 influenza in New York City, May through June 2009. We compared characteristics of pregnant and nonpregnant women and of severe and moderate influenza illness among pregnant women, with severe defined as illness resulting in intensive care admission or death. RESULTS: The 2009 H1N1 hospitalization rate was significantly higher among pregnant than nonpregnant women (55.3 compared with 7.7 per 100,000 population). Eight pregnant (including two deaths) and 16 nonpregnant (including four deaths) cases were severe. Pregnant women represented 6.4% of hospitalized cases and 4.3% of deaths caused by 2009 H1N1 influenza. Only 1 in 30 (3.3%) pregnant women who received oseltamivir treatment within 2 days of symptom onset had severe illness compared with 3 of 14 (21.4%) and four of nine (44.4%) pregnant women who started treatment 3–4 days and 5 days or more after symptom onset, respectively (P=.002 for trend). Severe and moderate 2009 H1N1 influenza illness occurred in all pregnancy trimesters, but most women (54.8%) were in the third trimester. Twenty-two women delivered during their influenza hospitalization, and severe neonatal outcomes (neonatal intensive care unit admission or death) occurred among five of six (83.3%) women with severe illness compared with 2 of 16 (12.5%) women with moderate illness (P=.004). CONCLUSION: Our findings highlight the potential for severe illness and adverse neonatal outcomes among pregnant 2009 H1N1 influenza-infected women and suggest the benefit of early oseltamivir treatment. LEVEL OF EVIDENCE: II

Percentage of gestational diabetes mellitus attributable to overweight and obesity.

OBJECTIVES We calculated the percentage of gestational diabetes mellitus (GDM) attributable to overweight and obesity. METHODS We analyzed 2004 through 2006 data from 7 states using the Pregnancy Risk Assessment Monitoring System linked to revised 2003 birth certificate information. We used logistic regression to estimate the magnitude of the association between prepregnancy body mass index (BMI) and GDM and calculated the percentage of GDM attributable to overweight and obesity. RESULTS GDM prevalence rates by BMI category were as follows: underweight (13-18.4 kg/m(2)), 0.7%; normal weight (18.5-24.9 kg/m(2)), 2.3%; overweight (25-29.9 kg/m(2)), 4.8%; obese (30-34.9 kg/m(2)), 5.5%; and extremely obese (35-64.9 kg/m(2)), 11.5%. Percentages of GDM attributable to overweight, obesity, and extreme obesity were 15.4% (95% confidence interval [CI] = 8.6, 22.2), 9.7% (95% CI = 5.2, 14.3), and 21.1% (CI = 15.2, 26.9), respectively. The overall population-attributable fraction was 46.2% (95% CI = 36.1, 56.3). CONCLUSIONS If all overweight and obese women (BMI of 25 kg/m(2) or above) had a GDM risk equal to that of normal-weight women, nearly half of GDM cases could be prevented. Public health efforts to reduce prepregnancy BMI by promoting physical activity and healthy eating among women of reproductive age should be intensified.

Trends in Ectopic Pregnancy Mortality in the United States: 1980-2007

OBJECTIVE: To estimate trends in ectopic pregnancy mortality and examine characteristics of recently hospitalized women who died as a result of ectopic pregnancy in the United States. METHODS: We used 1980–2007 national birth and death certificate data to calculate ectopic pregnancy mortality ratios (deaths per 100,000 live births) overall and stratified by maternal age and race. We performed nonparametric tests for trend to assess changes in ectopic pregnancy mortality over time and calculated projected mortality ratios for 2013–2017. Ectopic pregnancy deaths among hospitalized women were identified from 1998–2007 Nationwide Inpatient Sample data. RESULTS: Between 1980 and 2007, 876 deaths were attributed to ectopic pregnancy. The ectopic pregnancy mortality ratio declined by 56.6%, from 1.15 to 0.50 deaths per 100,000 live births between 1980–1984 and 2003–2007; at the current average annual rate of decline, this ratio will further decrease by 28.5% to 0.36 ectopic pregnancy deaths per 100,000 live births by 2013–2017. The ectopic pregnancy mortality ratio was 6.8 times higher for African Americans than whites and 3.5 times higher for women older than 35 years than those younger than 25 years during 2003–2007. Of the 76 deaths among women hospitalized between 1998 and 2007, 70.5% were tubal pregnancies; salpingectomy was performed in 80.6% of cases. Excessive hemorrhage, shock, or renal failure accompanied 67.4% of ectopic pregnancy deaths among hospitalized women. CONCLUSION: Despite a significant decline in ectopic pregnancy mortality since the 1980s, age disparities, and especially racial disparities, persist. Strategies to ensure timely diagnosis and management of ectopic pregnancies can further reduce related mortality and age and race mortality gaps.

Health‐Related Quality of Life and Weight Loss among Overweight and Obese U.S. Adults, 2001 to 2002

Objective: To examine the prevalence and association of health‐related quality of life (HRQOL) with trying to lose weight and with weight loss practices (eating fewer calories, physical activity, and both) among overweight and obese U.S. adults ≥ 20 years of age.

Racial/ethnic differences in the prevalence of gestational diabetes mellitus and maternal overweight and obesity, by Nativity, Florida, 2004-2007

We examined the risk of gestational diabetes mellitus (GDM) among foreign‐born and U.S.‐born mothers by race/ethnicity and BMI category.

Preconception health among women with frequent mental distress: a population-based study.

PURPOSE We examined the extent to which mental distress may be associated with a womans preconception health. METHODS We analyzed population-based, self-reported data from the 2005, 2007, and 2009 Behavioral Risk Factor Surveillance System (BRFSS) and limited analyses to 213,137 women aged 18-44 years. Women whose mental health was not good for ≥14 days during the past month were categorized as having frequent mental distress. For 15 preconception health indicators, we used chi-square tests to measure differences in prevalence by mental distress and the average marginal predictions approach to logistic regression to assess associations between mental distress and each preconception health indicator in separate models, adjusted for demographic characteristics. We conducted analyses using SUDAAN software to account for the complex sampling design and used weights to produce unbiased estimates. RESULTS The prevalence of good preconception health for each indicator was higher for women reporting infrequent mental distress (chi-square p value<0.001 for all). The greatest disparities in preconception health between women with infrequent and frequent mental distress, respectively, were adequate social and emotional support (adjusted prevalence ratio [aPR]=1.4, prevalence=83.7% and 54.8%), not smoking (aPR=1.2, 82.3% and 62.4%), adequate fruit and vegetable consumption (aPR=1.2, 26.1% and 21.5%), normal weight (aPR=1.2, 50.4% and 39.0%), and good general health (aPR=1.2, 91.7% and 71.5%). CONCLUSIONS Interventions tailored for women with poor mental health may be needed to target specific preconception health indicators, such as social support, smoking, weight, and nutrition.

Economic Evaluation Enhances Public Health Decision Making.

Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking “how do investments in public health strategies influence or offset the need for downstream spending on medical care and/or social services?” is important when making decisions about resource allocation and scaling of interventions.

A Cost Analysis of the 1-2-3 Pap Intervention

BACKGROUND Cervical cancer places a substantial economic burden on our healthcare system. The three-dose human papillomavirus (HPV) vaccine series is a cost-effective intervention to prevent HPV infection and resultant cervical cancer. Despite its efficacy, completion rates are low in young women aged 18 through 26 years. 1-2-3 Pap is a video intervention tested and proven to increase HPV vaccination completion rates. PURPOSE To provide the full scope of available evidence for 1-2-3 Pap, this study adds economic evidence to the interventions efficacy. This study tested the economies of scale hypothesis that the cost of 1-2-3 Pap intervention per number of completed HPV vaccine series would decrease when offered to more women in the target population. METHODS Using cost and efficacy data from the Rural Cancer Prevention Center, a cost analysis was done through a hypothetical adaptation scenario in rural Kentucky. RESULTS Assuming the same success rate as in the efficacy study, the 1-2-3 Pap adaptation scenario would cover 1000 additional women aged 18 through 26 years (344 in efficacy study; 1346 in adaptation scenario), and almost three times as many completed series (130 in efficacy study; 412 in adaptation scenario) as in the original 1-2-3 Pap efficacy study. IMPLICATIONS Determination of the costs of implementing 1-2-3 Pap is vital for program expansion. This study provides practitioners and decision makers with objective measures for scalability.

The Economic Value of Informal Caregiving for Persons With Dementia: Results From 38 States, the District of Columbia, and Puerto Rico, 2015 and 2016 BRFSS

Objectives To estimate the economic value from a societal perspective of informal caregiving of persons with dementia in 38 states, the District of Columbia, and Puerto Rico. Methods Using a cost replacement method and data from the 2015 and 2016 Behavioral Risk Factor Surveillance System caregiver module, the US Bureau of Labor Statistics May 2016 Occupation Profiles, and the US Department of Labor, we estimated the number and economic direct cost of caregiving hours. Results An estimated 3.2 million dementia caregivers provided more than 4.1 billion hours of care, with an average of 1278 hours per caregiver. The median hourly value of dementia caregiving was