Ronee E. Wilson

Alcohol consumption during pregnancy and the risk of early stillbirth among singletons

The purpose of this study is to investigate the association between maternal alcohol intake in pregnancy and the occurrence of early stillbirth using a retrospective cohort analysis of singleton births in Missouri that occurred in the period 1989 through 1997 (N=655,979). We used Cox proportional hazards regression to generate adjusted risk estimates for total, early, and late stillbirth associated with maternal alcohol intake and used the Robust Sandwich Estimator to adjust for intracluster correlations among sibships. Overall, a total of 3,508 counts of stillbirth were identified, yielding a stillbirth rate of 5.3 per 1,000. Among mothers who consumed alcohol during pregnancy, the stillbirth rate was 8.3 per 1,000. Mothers who consumed alcohol while pregnant were 40% more likely to experience stillbirth as compared with nondrinking mothers (adjusted hazards ratio=1.4, 95% confidence interval: 1.2-1.7). A dose-response relationship was evident; mothers who consumed five or more drinks per week during pregnancy experienced a 70% elevated risk of stillbirth compared with nondrinking mothers (adjusted hazards ratio=1.7; 95% confidence interval: 1.0-3.0). The risk of early stillbirth was 80% higher among drinking mothers compared with abstainers (adjusted hazards ratio=1.8; 95% confidence interval: 1.3-2.3). The elevated risks for both early and late stillbirth did not reach statistical significance when broken down by level of alcohol intake. In conclusion, maternal drinking during pregnancy is associated with an increased risk of early stillbirth. These findings underscore the need to reinforce current counseling strategies toward pregnant women and women who intend to conceive on the detrimental effects of alcohol use in pregnancy.

Advanced maternal age and risk of antepartum and intrapartum stillbirth

Aim:  We sought to assess the risk of antepartum and intrapartum stillbirth subtypes among women of advanced age.

Obesity and extreme obesity: new insights into the black-white disparity in neonatal mortality.

OBJECTIVE: To estimate whether the preponderance of obesity among black women could explain the black-white disparity in neonatal mortality. METHODS: This is a population-based study using longitudinally collected data among pregnant women from the state of Missouri spanning almost two decades (1978–1997). Obesity is defined in this study as body mass index (BMI) of at least 30 and further categorized into the typically reported three subclasses: class I (BMI 30.0–34.9), class II (BMI 35.0–39.9), and extreme/morbid obesity (BMI at least 40). The main outcome measures were neonatal mortality, early neonatal mortality, and late neonatal mortality. RESULTS: Overall, neonatal mortality and early neonatal mortality but not late neonatal mortality increased with higher obesity subclass, with the greatest risk registered among morbidly obese mothers (hazards ratio for neonatal mortality 1.3; 95% confidence interval [CI] 1.1–1.5; hazards ratio for early neonatal mortality 1.3; 95% CI 1.1–1.5). Among blacks, the risk for neonatal, early, and late neonatal mortality increased significantly with rising BMI (50–100% increments). However, offspring of obese white mothers had no elevated risks for any of the three indices of mortality regardless of maternal obesity subclass. CONCLUSION: Neonates of obese black mothers have an elevated risk of mortality throughout the neonatal period, whereas those of obese white mothers do not. Obesity among black mothers may contribute to the persistent black-white disparity in infant survival in the United States and could provide an avenue for narrowing the black-white gap in infant mortality. LEVEL OF EVIDENCE: II

Prenatal Smoking and Risk of Intrapartum Stillbirth

The purpose of this study was to examine the association between prenatal smoking and intrapartum stillbirth by the use of a cohort of singleton births in Missouri from 1978 through 1997. Overall, the authors identified a total of 7,325 counts of stillbirth, yielding a stillbirth rate of 4.4 per 1,000. The timing of the occurrence of the stillbirth to onset of labor was specified in 85.6% (n = 6,273). Of these, 1,070 (17.0%) occurred intrapartum. Smoking mothers were 50% more likely to experience intrapartum fetal death as compared with nonsmoking gravidas (adjusted hazard ratio = 1.5; 95% confidence interval = 1.3-1.7). Women who smoked 10 to 19 cigarettes per day were at the highest risk of experiencing intrapartum stillbirth (adjusted hazard ratio = 1.7 [95% confidence interval = 1.4-2.0]). Our findings underscore the need for increased smoking-cessation education efforts targeted toward pregnant women.

Obesity in older mothers, gestational weight gain, and risk estimates for preterm phenotypes

OBJECTIVE To assess whether advanced maternal age modifies the relationship between maternal pregravid weight status, gestational weight gain patterns, and the occurrence of spontaneous preterm birth (SPB) and medically indicated preterm birth (MIPB). METHODS Retrospective cohort analysis of vital statistics data from the state of Florida for the period 2004 through 2007 comprising 311,422 singleton pregnancies (two age groups: 20-24 years old or younger women and >or=35 years or older women). Mothers were classified into five clusters based on their pre-pregnancy body mass index (BMI) values: non-obese (less than 30), class I obese (30.0<or=BMI<or=34.9), class II obese (35.0<or=BMI<or=39.9), class III obese (40<or=BMI<or=49.9), and super-obese (BMI>or=50.0). RESULTS MIPB occurred more frequently among older than younger women [11.8% vs. 6.4%, respectively (p<0.0001)) whereas SPB occurred more frequently among younger women [11.3% vs. 10.5%, respectively (p<0.0001)). Maternal obesity increased the risk for MIPB but not for SPB. Regardless of BMI status, the risk of MIPB was elevated among older mothers, particularly among those with suboptimal (<0.23 kg/week) and supraoptimal (>0.68 kg/week) gestational weight gain. A dose-response relationship with increasing gestational weight gain was evident (p<0.01); the greatest risk for MIPB occurred among older mothers with weekly gestational weight gain in excess of 0.79 kg (OR=7.76, 95% CI=5.73-10.5). CONCLUSION The occurrence of medically indicated preterm birth is positively associated with increased maternal pregravid body weight, older maternal age and extremes of gestational weight gain. Targeted pre- and inter-conception weight management efforts should be particularly encouraged in older mothers.

Exposure to environmental tobacco smoke and risk of antenatal depression: application of latent variable modeling

This study sought to determine the impact of passive smoking on the risk for depressive symptoms during pregnancy. In this prospective study, 236 pregnant women were recruited at less than 20 weeks of gestation from a university-affiliated obstetric clinic from November 2009 through July 2011. Tobacco use/exposure was measured using questionnaire and confirmed by salivary cotinine analysis. The Edinburgh Perinatal Depression Scale (EPDS) was employed to capture perinatal depressive symptomatology. Traditionally, a cutoff of 13 is utilized to indicate depressive symptoms in the perinatal population. However, this approach is vulnerable to measurement errors that are inherent in assessing depression using cutoff points. Therefore, in this analysis, we apply a flexible approach (latent variable modeling) that accounts for measurement errors thereby reducing bias in the estimates of association. Significant differences were observed in the mean EPDS scores across non-smokers (mean ± SD = 4.8 ± 4.8), passive smokers (5.3 ± 5.5) and active smokers (7.4 ± 6.1) [p value = 0.02]. For each itemized response of the EPDS, passive smokers demonstrated an increased risk for depressive symptoms with the greatest risk exhibited by items 8 and 9 of the questionnaire (feeling sad or miserable and feeling unhappy [and]crying, respectively). In addition, for each item of the EPDS, a dose–response pattern was revealed with non-smokers having the least risk of depressive symptoms during pregnancy and active smokers having the greatest risk. Women who are exposed to secondhand smoke are at elevated risk for depressive symptoms during pregnancy.

Recurrent versus isolated pre-eclampsia and risk of feto-infant morbidity outcomes: racial/ethnic disparity

OBJECTIVE We examined the association between recurrent versus isolated pre-eclampsia and feto-infant morbidity outcomes. STUDY DESIGN This is a population-based retrospective study on Florida hospital discharge data linked to the birth cohort files from 1998 through 2007. The study population comprised women with singleton first and second births who experienced pre-eclampsia in both pregnancies, and a comparison group consisting of women who were normotensive during their first pregnancy but developed pre-eclampsia in their second pregnancy. Feto-infant morbidities (low birth weight, very low birth weight, preterm, very preterm and small for gestational age) were the outcome of interest. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between recurrent pre-eclampsia and feto-infant morbidity outcomes were obtained from logistic regression models. RESULT Women who experienced recurrent pre-eclampsia were at elevated risk for low birth weight, very low birth weight, preterm and very preterm. The risk was most pronounced for preterm infants (OR=1.58 CL=1.42-1.76). Subgroup analysis demonstrated that infants born to black mothers with recurrent pre-eclampsia experienced the most elevated risk across all the racial/ethnic subgroups and this was most pronounced for very low birth weight and very preterm with a more than three-fold increase in risk (OR=3.77, 95% CI=2.77-5.13 and OR=3.66, 95% CI=2.66-5.03, respectively) as compared to the referent category (white mothers who were normotensive in first pregnancy but developed pre-eclampsia in their second pregnancy). CONCLUSION Pre-eclampsia is very severe when it recurs and black women are affected more than white or Hispanic women.

Hospitalizations and healthcare costs associated with serious, non-lethal firearm-related violence and injuries in the United States, 1998‐2011

Objective To describe the prevalence, trends, correlates, and short-term outcomes of inpatient hospitalizations for firearm-related injuries (FRIs) in the United States between 1998 and 2011. Methods We conducted a retrospective, cross-sectional analysis of inpatient hospitalizations using data from the Nationwide Inpatient Sample. In addition to generating national prevalence estimates, we used survey logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between FRIs and patient/hospital-level characteristics. Temporal trends were estimated and characterized using joinpoint regression. Results There were 10.5 FRIs (95% CI: 9.2–11.8) per 10,000 non-maternal/neonatal inpatient hospitalizations, with assault accounting for 60.1% of FRIs, followed by unintentional/accidental (23.0%) and intentional/self-inflicted FRIs (8.2%). The highest odds of FRIs, particularly FRIs associated with an assault, was observed among patients 18–24 years of age, patients 14–17 years of age, patients with no insurance/self-pay, and non-Hispanic blacks. The mean inpatient length of stay for FRIs was 6.9 days; however, 4.7% of patients remained in the hospital over 24 days and 1 in 12 patients (8.2%) died before discharge. The mean cost of an inpatient hospitalization for a FRI was

Transformative Use of an Improved All‐Payer Hospital Discharge Data Infrastructure for Community‐Based Participatory Research: A Sustainability Pathway

22,149, which was estimated to be

Impact of maternal thyroperoxidase status on fetal body and brain size.

679 million annually; approximately two-thirds of the annual cost (64.7%) was for assault (