Euna M. August

Super-obesity and risk for early and late pre-eclampsia

Please cite this paper as: Mbah A, Kornosky J, Kristensen S, August E, Alio A, Marty P, Belogolovkin V, Bruder K, Salihu H. Super‐obesity and risk for early and late pre‐eclampsia. BJOG 2010;117:997–1004.

Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes

Background and aims: To examine the association between maternal hepatitis B and C mono‐ and co‐infections with singleton pregnancy outcomes in the state of Florida.

Psychosocial issues related to sexual functioning among African‐American prostate cancer survivors and their spouses

Objective: Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African‐American (AA) prostate cancer survivors and their spouses.

The Effect of Paternal Age on Fetal Birth Outcomes

Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA). We examined these outcomes among infants across seven paternal age-groups (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and >45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.

Implementation Evaluation of a Culturally Competent Eye Injury Prevention Program for Citrus Workers in a Florida Migrant Community

Background: The Partnership for Citrus Worker Health (PCWH) is a coalition that connects academic institutions, public health agencies, industry and community-based organizations for implementation of an eye safety pilot project with citrus workers using the Camp Health Aide (CHA) model. Objectives: This project was an implementation evaluation of an eye safety curriculum using modeling and peer-to-peer education among Mexican migrant citrus workers in a southwest Florida community to increase positive perceptions toward the use of safety eyewear and reduce occupational eye injuries. Methods: CHAs have been employed and trained in eye safety and health during harvesting seasons since 2004. Field observations, focus group interviews, and written questionnaires assessed program implementation and initial outcomes. Results: There was an increase in positive perceptions toward use of safety eyewear between 2004 and 2005. Evaluation of training suggested ways to improve the curriculum. The modest literacy level of the CHAs necessitated some redesign of the curriculum and its implementation (e.g., introduction of and more reliance on use of training posters). Conclusions: PCWH benefited by extensive documentation of the training and supervision, a pilot project that demonstrated the potential effectiveness of CHAs, and having a well-defined target population of citrus workers (n = 427). Future research can rigorously test the effectiveness of CHAs in reducing eye injuries among citrus workers.

Impact of prenatal alcohol consumption on placenta-associated syndromes

The biology of placental and fetal development suggests that alcohol may play a significant role in increasing the risk of feto-infant morbidity and mortality, but study results are inconsistent and the mechanism remains poorly defined. Previous studies have not examined the risk of placenta-associated syndromes (PASs: defined as the occurrence of either placental abruption, placenta previa, preeclampsia, small for gestational age, preterm, or stillbirth) as a unique entity. Therefore, we sought to examine the relationship between prenatal alcohol use and the risk of PAS among singleton births in the Missouri maternally linked data files covering the period 1989-2005. Logistic regression with adjustment for intracluster correlation was used to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Compared with nondrinkers, drinkers were more likely to be smokers, 35 years of age or older, black, and multiparous. Drinkers had an increased risk of PAS (OR=1.26, 95% CI=1.22,1.31) when compared with their nondrinking counterparts. The risk of PAS was progressively amplified with increasing prenatal alcohol consumption (P for trend <.01). Women who reported consuming five or more alcoholic drinks per week had more than twofold increased risk of PASs, whereas women in the lowest drinking category (one to two drinks per week) had only a slight increased risk of PAS (OR=1.09, 95% CI=1.05, 1.14). Enhanced understanding of the mechanism by which prenatal alcohol consumption leads to PAS may aid in the development of more targeted interventions designed to prevent adverse pregnancy outcomes. Screening women for alcohol use may assist providers in protecting developing fetuses from the potential dangers of prenatal alcohol use.

Effectiveness of a Federal Healthy Start Program in Reducing Primary and Repeat Teen Pregnancies: Our Experience over the Decade

STUDY OBJECTIVE To evaluate the effectiveness of a Federal Healthy Start program in reducing primary and repeat teen pregnancies in a disadvantaged community. DESIGN An ecological study that compares trends in teen pregnancy in the catchment area in which the community-based intervention was administered with two ecologic controls: the county (Hillsborough) and the state (Florida). SETTING Our catchment area is East Tampa, a socio-economically disadvantaged community in Hillsborough County, Florida. PARTICIPANTS Preconception care targeted teenagers between the ages of 10 and 19 years. Interconception care involved young mothers under the age of 20 with a previous birth. The population was comprised primarily of African Americans. INTERVENTION Preconception care services for primary teen pregnancy reduction offered sex education, family planning, drug and violence prevention education, and communication and negotiation skills acquisition. Interconception care service offered young women health education through monthly home visitation or monthly peer support group meetings addressing a range of topics using the life course perspective as framework. MAIN OUTCOME MEASURE Reduction in primary teen pregnancy and repeat teen pregnancy among adolescents. RESULTS The decline in primary teen pregnancy in the catchment area was 60% and 80% greater than the reduction experienced at the county level and at the state level respectively over the period of the study. However, efforts to prevent repeat pregnancy were not successful. CONCLUSION The Federal Healthy Start Preconception Care program, in collaboration with community partners, contributed to the prevention of first-time teen pregnancy in a community faced with significant social and economic challenges.

Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge.

OBJECTIVE To assess the current state of knowledge regarding sleep disorders and their relationship to obstetric outcomes. STUDY DESIGN A systematic literature review of the previous two decades (1991 to 2010) was conducted. The exposure was sleep disorders during pregnancy, and the outcomes of interest were feto-infant morbidity and maternal complications. RESULTS Sleep apnea, snoring, and sleep quantity/duration were identified as the most frequently examined sleep disorders among pregnant women. Although our review found that studies examining the impact of sleep disorders on feto-infant outcomes were lacking, previous research indicates that such disorders may enhance the risk of preterm birth. Additionally, the current body of evidence suggests that sleep disorders adversely impact maternal health, increasing the likelihood of preeclampsia, and gestational diabetes. CONCLUSION Existing research points to the potentially harmful effects of sleep disorders on obstetric outcomes. The limited research in this arena highlights the need for further studies regarding the nature and strength of this relationship. Given the multiple dimensions of sleep and pregnancy, multivariate research approaches that incorporate biological and psychosocial factors are warranted.

Cigarette Smoking and Fetal Morbidity Outcomes in a Large Cohort of HIV-Infected Mothers

BACKGROUND Reproductive-age women comprise approximately 25% of all persons living with HIV/AIDS in the United States. HIV infection and smoking during pregnancy are independent risk factors for adverse fetal outcomes. We examined predictors of fetal growth restriction among infants born to HIV-infected mothers who smoke cigarettes in pregnancy. METHODS We analyzed hospital discharge data linked to birth records from the state of Florida for 1998-2007 (N = 1,645,209). The outcomes of interest included: low and very low birth weight (LBW and VLBW), preterm and very preterm birth (PTB and VPTB), and small for gestational age (SGA). We calculated adjusted rate ratios (ARR) for these outcomes by HIV/AIDS status, smoking status, and sociodemographic variables. We also examined the association between the observed fetal morbidity outcomes and the interaction between HIV/AIDS and smoking status. We employed the generalized estimating equation framework to correct for intracluster correlations. RESULTS All fetal morbidity outcomes were more common in mothers who had HIV/AIDS, regardless of smoking status. Maternal HIV status and cigarette use were independent predictors of LBW, PTB, and SGA, with morbidity effects more prominent in HIV-infected mothers who smoke cigarettes. We observed a significant interaction between maternal HIV and smoking status, in which mothers who were HIV positive and smoked during pregnancy experienced the greatest risks for LBW (ARR = 2.24 [1.89-2.65]), SGA (ARR = 1.95 [1.67-2.29]), and PTB (ARR = 1.70 [1.42-2.03]). CONCLUSIONS HIV-infected mothers who smoke cigarettes during pregnancy have a heightened risk for adverse fetal morbidity outcomes. There is a need for integration of smoking cessation interventions into ongoing HIV/AIDS programs.

Understanding the psychosocial issues of African American couples surviving prostate cancer.

African Americans are disproportionately affected by prostate cancer, yet less is known about the most salient psychosocial dimensions of quality of life. The purpose of this study was to explore the perceptions of African American prostate cancer survivors and their spouses of psychosocial issues related to quality of life. Twelve African American couples were recruited from a National Cancer Institute Comprehensive Cancer Center registry and a state-based non-profit organization to participate in individual interviews. The study was theoretically based on Ferrell’s Quality of Life Conceptual Model. Common themes emerged regarding the psychosocial needs of African American couples. These themes were categorized into behavioral, social, psychological, and spiritual domains. Divergent perspectives were identified between male prostate cancer survivors and their female spouses. This study delineated unmet needs and areas for future in-depth investigations into psychosocial issues. The differing perspectives between patients and their spouses highlight the need for couple-centered interventions.