I'M DR. SHANNON ZENK, DIRECTOR
OF THE NATIONAL INSTITUTE OF
NURSING RESEARCH.
ALSO A CO-CHAIR OF THE IMPROVE
INITIATIVE, ALONG WITH MY
COLLEAGUE, DR. DIANA BIANCHI AND
DR. JANINE CLAYTON.
IT REALLY IS MY PLEASURE TO
WELCOME YOU TO TODAY'S IMPROVE
AWARDEE WORKSHOP WHERE YOU AND
YOUR COLLEAGUES CAN SHARE
LESSONS LEARNED, EXPLORE
COMMONALITIES ACROSS YOUR
PROGRAMS OF RESEARCH, AND THINK
ABOUT NEW LINES OF INQUIRY.
ALLOW ME TO LOOK BACK AT HOW
IMPROVE CAME TO BE.
NEXT SLIDE PLEASE.
IT IS WELL DOCUMENTED THAT THE
MATERNAL MORTALITY RATE IN THE
UNITED STATES CONTINUES TO
EXCEED THAT OF MANY OTHER
INDUSTRIALIZED NATIONS.
THE RATE OF MATERNAL MORTALITY
INCREASE BUYING 29% FROM 2009 TO
2020.
A RECENT CDC REPORT FOUND THAT
AN ALARMING 84% OF
PREGNANCY-RELATED DEATHS THAT
OCCURRED IN THE UNITED STATES
BETWEEN 2017 AND 2019 WERE
DETERMINED TO BE PREVENTIBLE.
EVEN MORE CONCERNING WILL THE
STARK DISPARITIES IN MATERNITY
HEALTH OUTCOMES WHEN VIEWED
THROUGH THE LENS OF RACIAL AND
ETHNIC GAT -- CATEGORIES, BLAC,
AMERICAN INDIAN AND NATIVE
AMERICAN ARE MORE LIKELY TO DIE
FROM PREGNANCY RELATED CAUSES
THAT WHITE WOMEN, DISPARITIES
INCREASE BY AGE, FOUR TO FIVE
TIMES OF THE WHITE COUNTER
PARENTS AND MORALITY RATE FOR
WOMEN WITH AT LEAST A COLLEGE
DEGREE WAS FIVE TIMES AS HIGH AS
WHITE WOMEN WITH SIMILAR
EDUCATION.
IN THE SAME CDC REPORT,
RESEARCHERS SHOWED VAST
VARIATION IN THE MOST FREQUENT
UNDERLYING CAUSES OF DEATH FOR
BIRTHING PEOPLE WHEN COMPARED
ACROSS RACIAL AND ETHNIC GROUPS.
CARDIAC AND CORONARY CONDITIONS
WERE THE MOST FREQUENT
UNDERLYING CAUSE OF DEATH AMONG
NON-HISPANIC BLACK PERSONS.
MENTAL HEALTH CONDITIONS WERE
THE MOST FREQUENT UNDERLYING
CAUSE OF DEATH AMONG HISPANIC
PERSONS, AND HEMORRHAGE WAS THE
MOST FREQUENT UNDERLYING CAUSE
OF DEATH AMONG ASIAN PERSONS.
ONE OF THE MOST DISTURBING
FINDINGS WAS THE DETERMINATION
93% OF PREGNANCY-RELATED DEATHS
IN THE AMERICAN INDIAN AND
ALASKA POPULATIONS WERE
PREVENTIBLE.
IT IS CRUCIAL TO NOTE THE RISING
RATE DOES NOT HAVE TO BE
INEVITABLE.
WE MUST CONTINUE TO ACT TO
REVERSE THIS DEADLY TREND AND
SAVE LIVES OF PREGNANT AND
BIRTHING PEOPLE.
NEXT SLIDE PLEASE.
AS A COUNTERMEASURE TO THE
RISING RATES OF MATERNAL
MORTALITY IN THIS COUNTRY, IN
2019 NIH RESPONDED BY LAUNCHING
IMROFT INITIATIVE TO SUPPORT
RESEARCH TO REDUCE PREVENTABLE
CAUSES OF MATERNAL DEATH AND
IMPROVE HEALTH BEFORE, DURING,
AFTER DELIVERY.
SINCE ITS INCEPTION, THE
"IMPROVE" INITIATIVE HAS RALLIED
THE DISTINCT INSTITUTES, CENTERS
AND OFFICES OF NIH TO SUPPORT
RESEARCH AND IMPROVE'S MISSION
TO REDUCE PREVENTABLE MORTALITY
AND PROMOTE HEALTH EQUITY.
THROUGH THIS CROSS-NIH
INITIATIVE WE PLACE A SPECIAL
EMPHASIS ON HEALTH DISPARITIES.
THE POPULATIONS THAT ARE ARE
DISPROPORTIONATELY AFFECTED BY
HIGH RATES OF PREGNANCY-RELATED
COMPLICATIONS AND DEATH
INCLUDING RACIAL AND ETHNIC
MINORITY POPULATIONS, VERY YOUNG
WOMEN, WOMEN OF ADVANTAGESSED
MATERNAL -- ADVANCED MATERNAL
AGE AND PEOPLE WITH
DISABILITIES.
THE INITIATIVE HAS BEEN DESIGNED
TO RECOGNIZE AND ADDRESS THE
REALITY THAT PREGNANCY-RELATED
COMPLICATION AND DEATHS NOT ONLY
OCCUR DURING BIRTH BUT ALSO
PRENATAL AND POSTPARTUM PERIODS.
NEXT SLIDE PLEASE.
ADDITIONALLY, THE "IMPROVE"
INITIATIVE RECOGNIZES THE
REALITY THAT PREGNANCY-RELATED
COMPLICATION AND DEATH OCCUR NOT
ONLY DURING BIRTH BUT ALSO AGAIN
AS I SAID DURING THE PRENATAL
AND POSTNATAL PERIODS.
NEXT SLIDE PLEASE.
IN FISCAL YEAR 2020, NIH AWARDED
OVER $7 MILLION TO SUPPORT 36
PROJECTS THROUGH IMPROVE, TO
RAPIDLY ENHANCE OUR
UNDERSTANDING OF AND MITIGATION
STRATEGIES FOR LEADING CAUSES OF
PREGNANCY-RELATED MORBIDITY
THROUGH ONE YEAR POSTPARTUM.
THESE PROJECTS FOCUS ON MAJOR
DRIVERS OF MORTALITY, INCLUDING
THOSE RELATED TO CARDIOVASCULAR
AND MENTAL HEALTH CONDITIONS.
THE NEXT YEAR NIH CONTINUED TO
SUPPORT RESEARCHERS AND
CLINICIANS THROUGH IMPROVE BY
AWARDING OVER $13 MILLION, TO
SUPPORT 22 PROJECTS THAT
EXAMINED LEADING CAUSES OF
MATERNAL MORBIDITY AND MORTALITY
INCLUDING IMPACT OF COVID-19 AS
WELL AS IMPACT OF STRUCTURAL
RACISM AND DISCRIMINATION, ON
MATERNAL HEALTH OUTCOME IN
CONTEXT OF COVID-19.
SO DURING TODAY'S WORKSHOP WE'LL
HEAR SOME OF THE KEY FINDINGS
FROM A NUMBER OF THESE PROJECTS,
AS RESEARCHERS REVIEW MAJOR
RESULTS AND LESSONS LEARNED FROM
THEIR IMPROVE-FUNDED PROJECTS.
AND WITH THE RECENT
CONGRESSIONAL APPROPRIATION OF
$30 MILLION IN FISCAL YEAR 22,
TO SUPPORT THE "IMPROVE"
INITIATIVE, WE LOOK FORWARD TO
SHOWCASING SEVERAL MORE STUDIES
AND FUTURE WORKSHOPS.
NEXT SLIDE PLEASE.
SO WHILE SUPPORTING RESEARCH
STUDIES IN THE AREAS OF MATERNAL
MORBIDITY AND MORTALITY IS A
LARGE COMPONENT OF IMPROVE THE
INITIATIVE IS IN FACT DIVIDED
INTO SIX COMPONENTS.
THE DISSEMINATION AND
IMPLEMENTATION RESEARCH NOTICE
OF SPECIAL INTEREST IS THE
PRIMARY FUNDING MECHANISM FOR
THE PROJECT THAT YOU WILL HEAR
ABOUT TODAY.
THE CONNECT-A-THON ENGAGES
STAKEHOLDER COMMUNITIES TO
DEVELOP ELECTRONIC HEALTH RECORD
STANDARDS, ESTABLISH
LONGITUDINAL MATERNAL HEALTH
RECORDS AND ENABLE AUTOMATED TO
LINK MATERNAL-CHILD HEALTH
RECORDS.
RAPID ACCELERATION OF
DIAGNOSTICS AIMS TO ACCELERATE
DEVELOPMENT OF MATERNAL HEALTH
DIAGNOSTIC AND REMOTE SENSING
TECHNOLOGIES TO REDUCE
DISPARITIES AND CARE DESERTS.
THE PROGRAM AIMS TO STUDY USE OF
STRATEGIES TO ADOPT AND
INTEGRATE INTERVENTIONS OF KNOWN
EFFICACY AND EFFECTIVENESS INTO
COMMUNITY SETTINGS, TO IMPROVE
MATERNAL HEALTH OUTCOMES.
THE CONNECTING THE COMMUNITY FOR
MATERNAL HEALTH CHALLENGE
FOCUSES ON BUILDING RESEARCH
INFRASTRUCTURE AND CAPACITY FOR
NON-PROFIT ORGANIZATIONS SEEKING
TO ADVANCE MATERNAL HEALTH
RESEARCH.
AND FINALLY, THE MATERNAL HEALTH
RESEARCH CENTERS OF EXCELLENCE
WILL ULTIMATELY UNIFY EACH OF
THE "IMPROVE" INITIATIVE WORK
STREAMS TO INTEGRATE BIOLOGICAL
AND BIOPSYCHOSOCIAL RESEARCH
WITH PROJECTS THAT INCORPORATE
LOCAL COMMUNITY NEEDS AND
PERSPECTIVES.
NEXT SLIDE PLEASE.
NOW I'D LIKE TO SHARE A LITTLE
BIT ABOUT NIMR AND OUR
ENGAGEMENT.
FOR THOSE WHO MAY NOT BE
FAMILIAR WITH U.S., NINR'S
MISSION TO TO LEAD RESEARCH TO
SOLVE CHALLENGES AND INFORM
PRACTICE AND POLICY, OPTIMIZING
HEALTH AND ADVANCING HEALTH
EQUITY INTO THE FUTURE.
WE SUPPORT NURSING SCIENCE THAT
VIEWS HEALTH AND HEALTH CARE
THROUGH FIVE RESEARCH LENSES,
INCLUDING HEALTH EQUITY, SOCIAL
DETERMINANTS OF HEALTH,
POPULATION AND COMMUNITY HEALTH,
PREVENTION AND HEALTH PROMOTION,
AND SYSTEMS AND MODELS OF CARE.
AND WE ARE VERY PROUD TO BE
HELPING TO LEAD IMPROVE WHICH IS
SUCH AN IMPORTANT INITIATIVE.
NEXT SLIDE PLEASE.
MATERNAL HEALTH AND MORBIDITY
ARE ISSUES THAT CUT ACROSS THE
NINR RESEARCH LENSES AND WE
SUPPORT STUDIES UNDER IMPROVE.
ONE OF THEM WILL FOR THE FIRST
TIME EVALUATE THE IMPLEMENTATION
OF A REMOTE ACCESS ON DEMAND
PERINATAL DEPRESSION PREVENTION
PROGRAM EMBEDDED IN THE PATIENT
PORTAL OF A LARGE SYSTEM.
ANOTHER STUDY EXAMINES HOW
PERSISTENT CARE SHORTAGES IMPACT
MATERNAL MORTALITY AND
MORBIDITY.
MORE SPECIFICALLY INVESTIGATORS
ARE LOOKING AT WHETHER RECENT
INTERVENTIONS AND EXPANSION OF
THE NATIONAL HEALTH SERVICE
CORPS IS HELPING REDUCE
DISPARITIES IN MATERNAL CARE AND
OUTCOMES BETWEEN SHORTAGE AREAS
AND OTHER AREAS.
NEXT SLIDE PLEASE.
A THIRD STUDY BEING SUPPORTED
UNDER IMPROVE IS USING
INNOVATIVE APPROACH TO
UNDERSTAND BIOLOGICAL
SPECIFICALLY IMMUNOLOGICAL AND
SOCIOCULTURAL FACTORS THAT
CONTRIBUTE TO OVERALL MORTALITY
AND SEVERE MATERNAL MORBIDITY.
INVESTIGATORS WILL DETERMINE HOW
MATERNAL STRESS AFFECTED IMMUNE
FUNCTION.
A FOURTH STUDY IS EXAMINING
IMPACT OF THE COVID-19 PANDEMIC
ON PREGNANT AND POSTPARTUM
WOMEN, WITH LOW INCOME MOTHERS
IN LOUISIANA, INVESTIGATORS ARE
LOOKING AT HOW THE PANDEMIC
AFFECTED WEIGHT GAIN, ADVERSE
OUTCOMES, PERINATAL MENTAL
HEALTH.
THE GOAL IS TO USE THE FINDINGS
TO DEVICE STRATEGIES AND
SOLUTIONS THAT IMPROVE PERINATAL
OUTCOMES DURING THIS PANDEMIC
AND FUTURE DISASTERS.
NEXT SLIDE PLEASE.
ANOTHER NINR INITIATIVE I'M
EXCITED TO TELL YOU ABOUT IS ONE
IN WHICH WE SUPPORT MATERNAL
HEALTH, AND CALLED ADVANCING
INTEGRATED MODELS OF CARE TO
IMPROVE MATERNAL HEALTH OUTCOMES
AMONG WOMEN WHO EXPERIENCE
PERSISTENT DISPARITIES, OR AIM.
FOCUS ON IDENTIFYING SOLUTIONS,
THIS INITIATIVE SUPPORTS
INTERVENTION RESEARCH TO
DEVELOP, IMPLEMENT, AND EVALUATE
INTEGRATED MODELS OF SUPPORTIVE
CARE THAT ADDRESS STRUCTURAL AND
SOCIAL INEQUITIES, TO PREVENT
ADVERSE MATERNAL HEALTH OUTCOMES
AND DISPARITIES.
TO DATE WE FUNDED SEVEN PROJECTS
ACROSS THE COUNTRY THROUGH THIS
INITIATIVE AND I'M HAPPY TO
REPORT THAT THIS FUNDING
OPPORTUNITY WAS JUST REISSUED.
WE LOOK FORWARD TO SUPPORTING
EVEN MORE CUTTING-EDGE RESEARCH
THAT WILL HELP ELIMINATE HEALTH
DISPARITIES.
I KNOW THAT EVERYONE HERE TODAY
JOINS NINR IN OUR DEDICATION TO
SOLVING PREGNANCY-RELATED HEALTH
CHALLENGES AND ENDING
DISPARITIES.
I WANT TO THANK YOU FOR YOUR
COMMITMENT TO YOUR RESEARCH AND
TO THE PEOPLE WHO MAY BENEFIT.
I'LL HAND OVER TO THE FIRST
MODERATOR TO BEGIN OUR FIRST
SESSION OF THE DAY.
NAHITA?
>>THANK YOU, DR. ZENK.
I'M AT NICHD, PREGNANCY AND
PERINATOLOGY Y BRANCH.
I'LL INTRODUCE SPEAKERS AND TURN
IT TO THE FIRST SPEAKER FOR HER
PRESENTATION.
FIRST PRESENTER IS DR. THERESA
GENOVIK, A PROFESSOR AT THE
ICAHN SCHOOL OF MEDICINE AT
MOUNT SINAI.
SHE WILL BE FOLLOWED BY DR.
ANDREA ADLOW, SOCIAL PROFESSOR
OF OBSTETRICS AT HARVARD.
DR. HEIDI PRICE, ASSISTANT
PROFESSOR OF RESEARCH DEPARTMENT
OF OBSTETRICS AND REPRODUCTIVE
MEDICINE, RENAISSANCE SCHOOL AT
STONY BROOK AND DR. NATASHA
DEJINA, ASSOCIATE PROFESSOR OF
PSYCHIATRY, EPIDEMIOLOGY,
UNIVERSITY OF PITTSBURGH.
I WILL TURN IT NOW TO DR. TERESA
JANEVIC FOR HER PRESENTATION.
>>THANK YOU FOR THE
INTRODUCTION.
I APPRECIATE THE OPPORTUNITY TO
BE PART OF THIS IMPORTANT
CONVERSATION TODAY.
I'M GOING TO TALK ABOUT OUR
RESEARCH ON GENDERED RACIAL
MICROAGGRESSION IN THE CONTEXT
OF THE PANDEMIC, AND POSTPARTUM
BLOOD PRESSURE.
NEXT SLIDE PLEASE.
THE CORONAVIRUS IMPACT ON BIRTH
EQUITY, THE VIBE STUDY, CAME
ABOUT AT THE ONSET OF THE
PANDEMIC, MOST OF YOU ARE AWARE
THAT HERE IN NEW YORK CITY WE
WERE ONE OF THE FIRST EPICENTERS
IN THE UNITED STATES OF THE
PANDEMIC.
AT ICAHN SCHOOL OF MEDICINE WE
LAUNCHED A POSTPARTUM SURVEY TO
UNDERSTAND BECAUSE WE WERE
GRAVELY CONCERNED ABOUT BIRTHING
PEOPLE'S EXPERIENCES DURING THE
PANDEMIC.
AND WE FOUND THAT WOMEN OF COLOR
WERE MORE LIKELY TO REPORT
EVERYDAY EXPERIENCES OF
DISCRIMINATION DURING THE
PANDEMIC THAN WHITE PATIENTS,
AND IMPORTANTLY HIGHER INCIDENCE
OF RACIAL HEALTH CARE
DISCRIMINATION DURING DELIVERY
AS WELL AS GREATER SYMPTOMS OF
ANXIETY AND DEPRESSION.
NEXT SLIDE PLEASE.
THIS LED US TO APPLY TO THE
"IMPROVE" INITIATIVE TO DIG OF
DEEPER.
SO THE OVERALL GOAL OF THE VIBE
STUDY IS TO EXAMINE INFLUENCE OF
STRUCTURAL INTERPERSONAL AND
INTERNALIZED RACISM AS WELL AS
COVID-19 EXPOSURES ON POSTPARTUM
MATERNAL HEALTH, DRAWING FROM
DR. JONES'S SUPER INFLUENTIAL
FRAMEWORK OF LEVELS OF RACISM.
TODAY'S FOCUS IS GOING TO BE ON
A VERY IMPORTANT OUTCOME FOR
MATERNAL MORTALITY, WHICH IS
POSTPARTUM BLOOD PRESSURE.
AND I'M GOING TO SHOW SOME
FINDINGS REGARDING THE QUESTION
ARE GENDERED RACIAL MICRO
AGGRESSION ASSOCIATED WITH
DIFFERENCE IN POSTPARTUM BLOOD
PRESSURE IN NON-WHITE WOMEN, AND
DOES EXPERIENCING
COVID-19-RELATED ECONOMIC STRESS
MAGNIFY THESE ASSOCIATIONS.
NEXT SLIDE PLEASE.
THE STUDY TOOK PLACE IN
PHILADELPHIA AND NEW YORK CITY,
FOUR HOSPITALS, AND WE ENROLLED
WOMEN IN POSTPARTUM UNITS AT
DELIVERY FROM APRIL TO OCTOBER
IN 2022 AND FOLLOWED THEM FOR
THREE MONTHS POSTPARTUM.
ELIGIBLE PEOPLE IDENTIFIED AS
BLACK HISPANIC OR ASIAN SPOKE
ENGLISH OR SPANISH, HAD A
WORKING CELL PHONE.
YOU CAN SEE OUR STUDY KIT ON THE
RIGHT.
NEXT SLIDE PLEASE.
THE LEFT YOU'LL SEE THE
DEMOGRAPHIC RACIAL/ETHNIC
BACKGROUND FOR THE NEW YORK CITY
HOSPITALS.
THEY WERE TWO PUBLIC HOSPITALS
IN NEW YORK CITY THAT ARE
AFFILIATES OF MOUNT SINAI AS
WELL AS TWO OF THE UNIVERSITY OF
PENNSYLVANIA HOSPITALS.
HERE IN OUR NEW YORK HOSPITALS,
THE POPULATION WAS MAJORITY
REPRESENTED BY HISPANIC AND IN
PENNSYLVANIA MAJORITY BLACK.
NEXT SLIDE PLEASE.
AT BASELINE IN THE HOSPITAL WE
HAD PEOPLE CREATE AN ONLINE --
EXCUSE ME COMPLETE AND ONLINE
SURVEY AND PARTICIPATED IN A
HOME TEXT-BASED BLOOD PRESSURE
MONITORING SYSTEM, CALLED WAY TO
HEALTH, AND THIS TEXT MESSAGING
SYSTEM PROMPTED THEM TO TAKE
THEIR BLOOD PRESSURE IN THE
FIRST WEEK DAILY TWO TIMES, AND
UP THROUGH THREE MONTHS, TWICE
WEEKLY AND EXIT SURVEY AT THREE
MONTHS.
NEXT SLIDE PLEASE.
THIS TO OUR KNOWLEDGE IS THE
FIRST STUDY TO USE THE GENDERED
RACIAL MICRO AGGRESSION SCALE IN
THIS CONTEXT WORKING WITH A
COMMUNITY EXPERT PANEL TO THINK
ABOUT WHICH QUESTIONS WERE
RELEVANT FOR THIS CONTEXT, AND
WHAT WOULD BE RELEVANT FOR
OBSTETRIC CARE.
SO IN SHORT, THE SCALE ASKED
PARTICIPANTS HOW FREQUENTLY THEY
EXPERIENCED MICRO AGGRESSION
SUCH AS FEELING UNHEARD, BEING
IGNORED, BEING PUT IN THEIR
PLACE, ET CETERA.
AND WE DID CONDUCT PSYCHOMETRIC
ANALYSES WHICH I WON'T PRESENT
TODAY BUT WE FOUND THAT THE
SCALE PERFORMED SIMILARLY IN OUR
BLACK AND HISPANIC SUBGROUPS.
NEXT SLIDE PLEASE.
FOR COVID-19 ECONOMIC STRESS WE
DREW FROM THREE QUESTIONS, TWO
ASKED ABOUT HOUSING AND FOOD
INSECURITY, AND THE THIRD ASKED
ABOUT OVERALL DISTRESS DUE TO
FINANCIAL EMPLOYMENT IMPACTS OF
COVID-19.
GROUPS TOGETHER HIGHLY EXPOSED
THOSE WHO ANSWERED IN THE HIGH
END ANY OF THESE QUESTIONS.
NEXT SLIDE PLEASE.
WE FOLLOWED CONCEPTUAL FRAMEWORK
IN WHICH WE PLACED BOTH GENDERED
RACIAL MICROAGGRESSION DURING
OBSTETRIC CARE AND CONTEXT OF
ECONOMIC STRESS AS PART OF THE
FRAMEWORK OF STRUCTURAL RACISM
DURING THE PANDEMIC, OVERLAID ON
EXISTING STRUCTURES OF RACIAL,
GENDER, ECONOMIC INEQUALITY, AND
THEN WE PROPOSED THAT THROUGH
EMBODIMENT AND DIFFERENT
DISRUPTION OF PHYSIOLOGIC
SYSTEMS THIS WOULD AFFECT
POSTPARTUM SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE.
NEXT SLIDE PLEASE.
LINEAR MIXED MODELS USED
REPEATED MEASURES OF BLOOD
PRESSURE, TO LOOK AT
ASSOCIATIONS BETWEEN GENDERED
RACIAL MICROAGGRESSION AND THE
COVID ECONOMIC STRESS WITH
POSTPARTUM BLOOD PRESSURE.
AND THEN IMPORTANTLY WE LOOKED
AT IF THE ASSOCIATION BETWEEN
THE MICROAGGRESSIONS AND BLOOD
PRESSURE WAS INTENSIFIED BY
COVID-19 STRESS.
ALSO IF IT WAS WORSE IN WOMEN
WHO WERE HIGH RISK DUE TO
HYPERTENSIVE DISORDERS OF
PREGNANCY.
NEXT SLIDE PLEASE.
ABOUT A THIRD OF PARTICIPANTS
OVERALL REPORTED EXPERIENCING AT
LEAST ONE GENDERED RACIAL
MICROAGGRESSION DURING PREGNANCY
OR DELIVERY CARE, THE MOST
COMMON ITEM ALTHOUGH ALL HAD
SOME FREQUENCY WERE FEELING
UNHEARD, COMMENTING IGNORED,
TOLD TO CALM DOWN.
OVER A QUARTER OF SAMPLE
REPORTED HIGH ECONOMIC STRESS,
AND ABOUT A QUARTER FELL INTO
THAT HIGH RISK CATEGORY OF
HAVING EITHER PRE-PREGNANCY
GESTATIONAL HYPERTENSION OR
PREECLAMPSIA.
NEXT SLIDE PLEASE.
IN BOLD YOU'LL SEE THE RESULTS
SO WOMEN WHO DID EXPERIENCE
GENDERED RACIAL MICROAGGRESSION
ADJUSTED FOR FACTORS TWO
MILLIMETERS OF MERCURY HIGHER
BLOOD PRESSURE THAN THOSE WHO
DIDN'T.
THIS WAS SIGNIFICANT FOR BOTH
SYSTOLIC AND DIASTOLIC BLOOD
PRESSURE.
COVID ECONOMIC STRESS HOWEVER
WAS NOT ASSOCIATED WITH BLOOD
PRESSURE AND WE DID NOT FIND
THAT INTENSIFIED GENDERED RACIAL
MICROAGGRESSIONS.
NEXT SLIDE PLEASE.
THIS SHOWED WE DID FIND
INTERACTION SUCH THAT YOU CAN
SEE ON THE RIGHT WOMEN WHO HAD
HYPERTENSIVE DISORDERS HAD A
BIGGER EFFECT OF THE
MICROAGGRESSIONS THAN THOSE WHO
DID NOT.
THERE WAS AN EFFECT, A SMALL
EFFECT PRESENT EVEN IN LOW RISK
WOMEN, HIGH RISK IT WAS
INTENSIFIED.
NEXT SLIDE PLEASE.
CONCLUSION, GENDERED RACIAL
MICROAGGRESSION DURING OBSTETRIC
CARE IS COMMON AMONG NON-WHITE
WOMEN AND IS ASSOCIATED WITH
HIGHER POSTPARTUM SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE THROUGH
90 DAYS, THIS ASSOCIATION WAS
STRONGEST IN HIGH RISK PATIENTS.
COVID ECONOMIC STRESS WASN'T
ASSOCIATED WITH BLOOD PRESSURE
MEASURES BUT DEFINITELY MIGHT BE
RELEVANT TO OTHER POSTPARTUM
HEALTH OUTCOMES TO BE EXPLORED.
NEXT SLIDE PLEASE.
IMPLICATIONS ARE INTERVENTIONS
ARE NEEDED TO ELIMINATE
MICROAAGGRESSION, THESE INCREASS
WE SEE POSTPARTUM IN BLOOD
PRESSURE EVEN THOUGH SOME MAY BE
IN THE NORMAL RANGE, COULD
POTENTIALLY INCREASE RISK OF
CARDIOVASCULAR DISEASE ACROSS
THE LIFE COURSE.
NEXT SLIDE PLEASE.
I'D LIKE TO ACKNOWLEDGE THE
PRINCIPLE INVESTIGATOR ELIZABETH
HOWELL AS WELL AS OUR WONDERFUL
STUDY TEAM.
>>THANK YOU.
IT'S MY PLEASURE TO BE HERE TO
SPEAK WITH YOU ABOUT A NOVEL
COMMUNITY INITIATIVE TO IMPROVE
PERINATAL MENTAL HEALTH IN HIGH
RISK POPULATION.
THESE ARE THE MEMBERS OF OUR
STUDY TEAM.
TO GIVE BACKGROUND, HUGS/ABRAZOS
WAS CREATED TO ADDRESS
SIGNIFICANT SOCIAL AND
BEHAVIORAL HEALTH NEEDS
EXACERBATED BY THE COVID-19
PANDEMIC AMONG PREGNANT
INDIVIDUALS AND FAMILIES WITH
CHILDREN UNDER 6 LIVING IN THESE
COMMUNITIES SERVED BY
MASSACHUSETTS GENERAL HOSPITAL.
THE MAP OF LOCATIONS AT THE
UPPER LEFT SHOWS COMMUNITIES IN
MASSACHUSETTS DIAGNOSING MORE
THAN 25 CASES OF COVID-19 DAILY,
JUST THE PERIOD FROM OCTOBER
2020 TO FEBRUARY OF 2021, BUT
THE MAP WAS RED FOR THESE
COMMUNITIES FOR MORE THAN A YEAR
OF THE COVID PANDEMIC.
SO THIS SHOWS THESE LOCATIONS
SERVED BY YOUR HEALTH CENTERS
WERE HARD HIT BY COVID-19.
THE HEAT MAP ON THE BOTTOM LEFT
SHOWS PATIENTS FROM THESE
COMMUNITIES COMPRISED MAJORITY
OF PREGNANT INDIVIDUALS
DIAGNOSED WITH SARS-COV-2 IN
PREGNANCY AT MASSACHUSETTS
GENERAL HOSPITAL.
AND WE HAD A PUBLICATION
ADDRESSING THESE DISPARITIES NOT
ONLY IN DIAGNOSIS OF SARS-COV-2
BUT ALSO IN DISEASE SEVERITY IN
THE GREEN JOURNAL AND REAL
EPICENTER OF THE PANDEMIC FOR
LONG PERIOD OF TIME WITH THE
CHELSEA COMMUNITY HERE SHOWN IN
RED ON THE BOTTOM LEFT.
THE BAR GRAPH ON THE RIGHT FROM
THE GREATER BOSTON FOOD BANK
SHOWS SIGNIFICANT INCREASE IN
FOOD INSECURITY THAT OCCURRED IN
GREATER BOSTON AREA DURING THE
COVID-19 PANDEMIC, AND THESE
EFFECTS WERE AMPLIFIED IN
CHELSEA, REVERE, EVERETT.
CHELSEA, NEARLY 16% OF FAMILIES
LIVED BELOW THE FEDERAL POVERTY
LEVEL, MORE THAN TWICE THE RATE
IN MASSACHUSETTS AS A WHOLE.
67% OF HOUSEHOLDS IN CHELSEA
SELF-IDENTIFY AS LATINX OR
HISPANIC.
PARTICIPANTS FROM THESE
COMMUNITIES ARE AT HIGH RISK FOR
ADVERSE LIFE EXPERIENCES
INCLUDING TOXIC LEVELS OF
STRESS, DEPRESSION, ANXIETY AND
HAVE A HIGH BURDEN OF SOCIAL
RISK FACTORS.
WE SOUGHT TO EVALUATE IMPACT OF
NOVEL COMMUNITY-BASED
INTERVENTION HELPING US GROW
STRONGER, HUGS, OR ABRAZOS IN
SPANISH, IN A DIVERSE POPULATION
IN THE COVID-19 PANDEMIC.
AND HUGS/ABRAZOS WAS DEVELOPED
BY, ASSESSING HOW POSTPARTUM
INDIVIDUALS EXPERIENCED THE
PROGRAM BY MOLLY SIEGLE.
THIS IS A STUDY OF INDIVIDUALS
REFERRED TO HUGS, INDIVIDUALS
WERE OFFERED UP TO FOUR VIRTUAL
BEHAVIORAL HEALTH SESSIONS FROM
A COGNITIVE BEHAVIORAL THERAPY
TRAINED AND TRAUMA INFORMED CARE
TRAINED SOCIAL WORKER AND UP TO
FOUR RESOURCE NAVIGATION VISITS
WITH A COMMUNITY HEALTH WORKER
TO SERVE NEEDS SUCH AS REFERRAL
TO SNAP, WIC, FOOD BANK, NEED
FOR DIAPERS, CLOTHING, LEGAL
ASSISTANCE, HOUSING NEEDS.
INDIVIDUALS ALSO RECEIVED A CARE
PACKAGE WHICH I'LL SHOW ON THE
NEXT PAGE.
THIS IS THE SCHEMATIC OF THE
PROGRAM, PATIENTS WHO WERE
ELIGIBLE ARE IN THE TOP BAR,
UNMET SOCIAL DETERMINANT OF
HEALTH NEEDS, ESTABLISHED CARE
IN OUR SYSTEM.
IF THEY HAD PATIENT NAVIGATION
NEEDS THERE WAS A NOVEL RESOURCE
TOOL USED TO OPTIMIZE PATIENT
NAVIGATION AND PATIENTS HAD A
DEDICATED COMMUNITY HEALTH
WORKER.
THOSE PATIENTS IDENTIFIED AS
HAVING BEHAVIORAL HEALTH SUPPORT
NEEDS MET WITH SOCIAL WORKER AS
DESCRIBED AND THEN INDIVIDUALS
RECEIVED SOME DIRECT RELIEF FROM
CARE PACKAGES THAT INCLUDED $50
GROCERY GIFT CARD, MASKS, HAND
SANITIZER, LANGUAGE CONCORDANT
BOOKS AND ACTIVITIES FOR
CHILDREN AS INFORMATION ABOUT
HEALTHY EATING.
PARTICIPANTS COMPLETED THE
VALIDATED SURVEY INSTRUMENTS, WE
SELECTED INSTRUMENTS THAT
ASSESSED MOOD, ANXIETY, STRESS,
FOOD INSECURITY, EXPERIENCES OF
DISCRIMINATION, AND ALSO HAD
NON-VALIDATED QUESTIONS ABOUT
PROGRAM SATISFACTION.
SO HERE IS A SCHEMATIC
DEMONSTRATING HOW MANY PATIENTS
WERE APPROACHED FOR THE PROGRAM,
OF THESE 45 INDIVIDUALS HAD
ALREADY BEGUN THE PROGRAM AND SO
WE WERE ABLE TO CONSENT THEM AND
ADMINISTERED VALIDATED SURVEY
INSTRUMENTS AFTER THEY COMPLETED
THE PROGRAM OF THE OF THE
REMAINING 188 ELIGIBLE
PARTICIPANTS, 45 DECLINED
ALTOGETHER.
OF THOSE THAT COMPLETED, 10
DECLINED PARTICIPATION IN THE
SURVEY STUDY, REMAINING 133
COMPLETED SURVEY PRE AND POST
HUGS PROGRAM AND SUBSET WERE
ALSO ENROLLED IN OUR COVID-19
PREGNANCY BIOREPOSITORY AND WE
HAD CYTOKINES FROM THEIR BLOOD
DRAWS TAKEN DURING ACUTE COVID
INFECTION BECAUSE WE ALSO WANTED
TO INVESTIGATE HOW THE DEGREE OF
INFLAMMATION MIGHT IMPACT HOW
THE PATIENTS RECEIVED THE STUDY
AND BASELINE STRESS ANXIETY
SCORES HOW THOSE MIGHT CORRELATE
WITH INFLATION.
TURNING TO RESULTS, THESE ARE
DEMOGRAPHICS, OVERALL
PARTICIPANTS WERE RELATIVELY
YOUNG, MAJORITY IDENTIFIED AS
HISPANIC OR LATINX, OVER 30%
WERE SPANISH SPEAKING, OVER 80%
PUBLICLY INSURED, AND WE FOUND
VERY HIGH RATES OF INDIVIDUALS
IN THE STUDY WHO WERE DIAGNOSED
WITH SARS-COV-2 INFECTION IN
PREGNANCY, WHO REPORTED
EXPERIENCING DISCRIMINATION OR
FOOD INSECURITY IN THE LATTER
MONTHS.
HIGH RATES OF FOOD INSECURITY
WERE PARTICULARLY SURPRISING AND
NOTABLE TO US PARTICULARLY GIVEN
THAT PRIOR TO THE PANDEMIC FOOD
INSECURITY REPORTED IN A
DIFFERENT PATIENT POPULATION AT
MASS GENERAL HOSPITAL WITH 5%,
SO AMONG THIS COMMUNITY HEALTH
CLINIC POPULATION DURING THE
PANDEMIC, 63% OF PATIENTS ARE
REPORTING FOOD INSECURITY, 68%
REPORTED EXPERIENCES OF
DISCRIMINATION, AND 62% WERE
INFECTED WITH SARS-COV-2 IN THE
LAST YEAR.
OUR PATIENTS ALSO REPORTED HIGH
PROGRAM SATISFACTION, SO THE
VAST MAJORITY WERE VERY OR
EXTREMELY LIKELY TO RECOMMEND
THE PROGRAM TO A FRIEND OR
FAMILY MEMBER.
THEY FELT THE PROGRAM MET THEIR
NEEDS WELL OR EXTREMELY WELL AND
FELT THE PROGRAM WAS HELPFUL OR
VERY HELPFUL IN CONNECTING THEM
TO SERVICES.
SCORES ON THE VALIDATED
INSTRUMENTS, WHEN WE TOOK THE
PARTICIPANTS ALL TOGETHER WE
FOUND THAT COMPLETING THE
HUGS/ABRAZOS PROGRAM WAS
ASSOCIATED WITH IMPROVED
IMPROVEMENT IN SCORES AND SCREEN
POSITIVE THRESHOLD FOR THIS IS
8, SO WE SAW SIGNIFICANT
REDUCTION THERE.
WE SAW SIGNIFICANT DIFFERENCES
PRE AND POST PROGRAM COMPLETION
IN PERCEIVED STRESS SCALE SCORES
AS WELL AS SIGNIFICANT
IMPROVEMENT IN PREGNANCY ANXIETY
SCALE SCORES.
WE DID NOT SEE SIGNIFICANT
DIFFERENCES PRE AND POST PROGRAM
COMPLETION IN THE PROMISE SCALE,
HOWEVER.
WE WERE INTERESTED IN
UNDERSTANDING MORE ABOUT HOW
THOSE INDIVIDUALS AT HIGHEST
RISK, WHETHER DUE TO FOOD
INSECURITY, HAVING COVID-19 IN
PREGNANCY OR EXPERIENCES OF
DISCRIMINATION MIGHT RECEIVE THE
PROGRAM AND HOW THE PROGRAM
MIGHT MODIFY THEIR SCORES ON
THESE VALIDATED INSTRUMENTS.
WE DID A STRATIFIED ANALYSIS AND
THE PATTERN THROUGHOUT WAS THAT
THOSE INDIVIDUALS AT HIGHEST
RISK DUE TO FOOD INSECURITY,
COVID INFECTION IN
PREGNANCY-RELATED FREQUENCY HAD
THE GREATEST REDUCTION IN
DEPRESSION, STRESS, ANXIETY
SCORES BETWEEN STARTING AND
COMPLETING THE PROGRAM SO THE
PROGRAM BENEFITED THOSE
INDIVIDUALS AT HIGHEST RISK
POTENTIALLY MORE.
WHAT CONCLUSIONS CAN WE DRAW
FROM THIS WORK?
IN THIS URBAN HEALTH CENTER
OBSTETRIC POPULATION NOTED HIGH
RATES OF FOOD INSECURITY,
EXPERIENCES OF DISCRIMINATION,
AND COVID-19 INFECTION, AND THIS
INTERVENTION LED TO IMPROVEMENT
IN DEPRESSION, PERCEIVED STRESS
AND ANXIETY WITH GREATEST IMPACT
IN THOSE WITH FOOD SECURED AND
COVID-19 INFECTION, A PIPELINE
CAN ENSURE TIMELY ACCESS TO
BEHAVIORAL HEALTH SERVICES AS
WELL AS COMMUNITY HEALTH WORKER
NAVIGATION CAN INFLUENCE HEALTH
OF THE MOTHER-INFANT DYADS WITH
POTENTIAL TO HAVE LONG LASTING
ON MATERNAL AND ALSO CHILD
HEALTH.
WITH THAT, I WANT TO THANK ALL
OF OUR COLLABORATORS IN THIS
WORK AND OTHER WORK AROUND
COVID-19, ESPECIALLY THANKS TO
IMPROVE INITIATIVE FOR FUNDING
THIS PROJECT AND ANOTHER PROJECT
THAT WE DID IN THE LAB AND
EVERYONE IN MY LAB WHO HAS DONE
SO MUCH WORK ON THIS AND OTHER
PROJECTS, ESPECIALLY
HIGHLIGHTING MOLLY SEGAL WHO
SPEARHEADED THIS PROJECT.
>>THANK YOU SO MUCH, ANDREA.
NOW WE TURN TO DR. HEIDI PRICE.
>>GOOD AFTERNOON.
VERY EXCITED TO BE HERE.
CAN YOU SEE MY SLIDES?
>>YES.
>>GREAT.
>>THE SLIDES OR WORD DOCUMENT,
WHICH ARE YOU SEEING?
>>WORD DOCUMENT.
>>I'M SHARING THE WRONG SCREEN.
THIS SHOULD BE IT.
>>YES.
>>ALL RIGHT.
SORRY ABOUT THAT.
I'M GOING TO TALK ABOUT
PERINATAL ANXIETY, DURING THE
COVID-19 PANDEMIC AND GROWTH
TRAJECTORIES AND THEIR
CONTRIBUTORS IN THE FIRST YEAR
POSTPARTUM.
SMALL DISCLOSURE I'M GOING TO BE
USING THE TERM WOMEN AND
MATERNAL, I RECOGNIZE NOT ALL
INDIVIDUALS THAT ARE CAPABLE OF
PREGNANCY AND BIRTH IDENTIFY
WITH THOSE TERMS.
AND ANOTHER DISCLOSURE, THIS
WORK WAS FUNDED BY STONY BROOK
UNIVERSITY, OF COURSE BY THE
"IMPROVE" INITIATIVE.
SO, SOME BACKGROUND ABOUT
ANXIETY IN THE PERIPARTUM PERIOD
AND PERINATAL PERIOD.
IT IS ONE OF THE MOST COMMON
MORBIDITIES WITH UP TO 1 IN 5
WOMEN AFFECTED BY ANXIETY, AS WE
ALSO HEARD THIS IS ALSO
POTENTIALLY RELATED TO MORBIDITY
AND MORTALITY IN THE FIRST YEAR
POSTPARTUM.
IT IS ASSOCIATED WITH INCREASED
RISK FOR MATERNAL AND CHILD
HEALTH, IN TERMS OF THE
PREGNANCY RELATED TO HIGHER
RATES OF ADVERSE OUTCOMES LIKE
GESTATIONAL DIABETES OR PRE-TERM
BIRTH.
IT'S RELATED TO POSTPARTUM
ANXIETY AND DEPRESSION.
AND ALSO HAS NEGATIVE POTENTIAL
EFFECT ON INFANTS.
THE RISK FACTORS INCLUDE ADVERSE
CHILDHOOD EXPERIENCES, DIFFERENT
SOCIOECONOMIC DEPRIVATIONS, AND
ALSO STRESS AND HISTORY OF
MENTAL HEALTH DISORDERS.
NOW, WHAT HAPPENED WITH
PERIPARTUM ANXIETY DURING THE
PANDEMIC?
AS EXPECTED, YOU KNOW, DURING
THE PANDEMIC WE SAW ELEVATED
LEVELS OF ANXIETY REPORTED
WORLDWIDE, PARTICULARLY AMONG
WOMEN.
AND WOMEN THAT WERE PREGNANT
FACED ADDITIONAL UNIQUE
STRESSORS DURING THE PANDEMIC
LIKE UNCERTAINTY ABOUT EFFECT OF
THE INFECTION ON PREGNANCY OR
FETUS, IMPACT TO PRENATAL CARE,
TO SUPPORT, AND THESE INCREASED
THEIR ANXIETY LEVELS, AND WE --
THIS RESULTED IN SIGNIFICANT
INCREASES IN PERINATAL ANXIETY
THAT WERE REPORTED IN MULTIPLE
STUDIES.
HOWEVER, LITTLE IS KNOWN ABOUT
THE TRAJECTORIES OF ANXIETY
THROUGHOUT PREGNANCY AND INTO
THE FIRST YEAR POSTPARTUM, AS
THE PANDEMIC CONDITIONS CHANGED.
WHICH BRINGS US TO THE AIMS OF
THE CURRENT PROJECT THAT I'M
PRESENTING TODAY, WHICH WAS TO
IDENTIFY LONGITUDINAL ANXIETY
TRAJECTORIES FROM THE PRENATAL
CARE INTO THE FIRST YEAR
POSTPARTUM.
ANOTHER WAS NOT JUST TO IDENTIFY
TRAJECTORIES BUT ALSO IDENTIFY
THE INDIVIDUAL AND COMMUNAL RISK
AND RESILIENCE FACTORS RELATED
TO THESE TRAJECTORIES OF ANXIETY
SYMPTOMS.
SO, THE REPORT TODAY IS PART OF
THE SB-COPE STUDY, STONY BROOK
COVID PREGNANCY EXPERIENCES
STUDY.
AND IN THIS STUDY WE HAD TWO
RECRUITMENT PHASES, WAVE 1
RECRUITED OVER 4,000 WOMEN AT
THE PANDEMIC ONSET, PREGNANT
DURING RECRUITMENT.
AND THE WAVE 2 PARTICIPANTS,
CLOSE TO 3,000 PARTICIPANTS THAT
WERE RECRUITED DURING THE SECOND
U.S. COVID SURGE IN DECEMBER
2020.
BASELINE DATA THAT WE COLLECTED
INCLUDES SOCIAL DETERMINANTS OF
HEALTH, MEDICAL FACTORS,
DIFFERENT TYPES OF PERCEIVED
STRESS MEASURES, PANDEMIC AND
NON-PANDEMIC RELATED.
STRESSFUL EVENTS,
PANDEMIC-RELATED CONDITIONS,
MENTAL HEALTH MEASURES,
PARTICULARLY RELEVANT TO WHAT
I'M PRESENTING TODAY IS THE USE
OF THE GENERALIZED ANXIETY
DISORDER 7, OR THE GAD7 SCALE.
WE ALSO HAD INFORMATION ABOUT
COUNTY LEVEL OR COMMUNITY LEVEL
FACTORS LIKE COVID INFECTION
RATES, COVID DEATH RATES, AND
ALSO DEPRIVATION INDICES THAT WE
GOT INFORMATION ON.
PARTICIPANTS IN THE STUDY HAVE
BEEN FOLLOWED UP EVERY FOUR TO
SIX MONTHS INCLUDING REPEATED
MEASURES OF MENTAL HEALTH AND
THE CURRENT REPORT FOCUSES ON
ANXIETY SYMPTOMS OF WAVE 2
PARTICIPANTS THAT COMPLETED ALL
FOUR TIME POINTS THAT WE HAVE
FULL DATA ON THEIR MENTAL
HEALTH.
OUR STATISTICAL APPROACH
INCLUDED IDENTIFYING BEST
FITTING NUMBER OF LATENT GROWTH
CLASSES.
AND THEN WE VISUALIZED AND
CHARACTERIZED THE BEST-FITTING
CLASSES.
WE THEN CONDUCTED UNIVARIATE
ANALYSIS TO EXAMINE ASSOCIATION
BETWEEN 36 PREDICTORS AND CLASS
MEMBERSHIP.
AND THEN FOR THOSE FACTORS THAT
WERE SIGNIFICANT IN THE
UNIVARIATE ANALYSIS, WHEN THE
P-VALUE OF LESS THAN 0.001
INCLUDED THOSE IN AS PREDICTORS
IN THE STEP-WISE LOGISTIC
REGRESSION TO REALLY NARROW DOWN
AND IDENTIFY UNIQUE PREDICTORS
OF CLASS MEMBERSHIP.
WE IDENTIFIED THREE TRAJECTORIES
OF ANXIETY.
I DON'T KNOW WHY I WROTE STRESS
UP THERE.
THE FIRST CLASS INCLUDED 68 --
CLOSE TO 68% OF PARTICIPANTS,
CHARACTERIZED BY LOW LEVELS OF
ANXIETY, MILD, THAT DECREASED TO
MINIMAL THROUGHOUT THE FIRST
YEAR POSTPARTUM.
THE SECOND CLASS INCLUDED A
QUARTER OF THE PARTICIPANTS THAT
HAD INITIAL MODERATE LEVELS OF
ANXIETY, WHICH REMAINED STABLE
THROUGHOUT THE POSTPARTUM YEAR.
THE THIRD CLASS THAT HAD CLOSE
TO 7% OF THE PARTICIPANTS
STARTED OFF WITH MODERATE LEVELS
OF ANXIETY THAT DECREASED,
EXCUSE ME, THAT INCREASED OVER
THE FIRST YEAR POSTPARTUM TO
SEVERE LEVELS, AND ON AVERAGE WE
SAW AN INCREASE OF 5 POINTS IN
THE GA D SCALE WHICH SIGNIFIES
CLINICALLY SIGNIFICANT WORSENING
OF SYMPTOMS.
NEXT WAS TO IDENTIFY
CONTRIBUTORS TO CLASS
MEMBERSHIPS.
AND 23 OF THE 36 PREDICTORS WERE
RELATED SIGNIFICANTLY LESS THAN
0.001 TO THE CLASS MEMBERSHIP.
HOWEVER, NONE OF THE COMMUNITY
LEVEL FACTORS WERE SIGNIFICANTLY
RELATED, SO THEY WERE NOT
INCLUDED IN FURTHER ANALYSIS.
WE TOOK THESE ARE 23 PREDICTORS,
AND CONDUCTED STEP-WISE LOGISTIC
REGRESSION WHICH IDENTIFIED 11
UNIQUE PREDICTORS THAT ARE
RELATED TO BELONGING TO CLASS 2
OR CLASS 3 AS COMPARED TO CLASS
1.
AND THESE INCLUDED VARIETY OF
INDIVIDUAL LEVEL STRESSORS, SOME
SOCIAL DETERMINANTS OF HEALTH,
AND SOME HAVE TO DO WITH STRESS
PANDEMIC AND NON-PANDEMIC
RELATED.
AND WHAT WAS INTERESTING IS THAT
SOME OF THESE CONTRIBUTORS WERE
RELATED TO HIGHER RISK OF
BELONGING TO BOTH CLASS 2 AND
CLASS 3, AND SOME CONTRIBUTORS
WERE RELATED TO ONE OF THESE
RISK GROUPS.
SO THINGS LIKE MAJOR STRESSFUL
LIFE EVENTS THAT OCCURRED PRIOR
TO THE THIRD TIME POINT, HISTORY
OF MENTAL HEALTH DIAGNOSIS, HIGH
LEVELS OF NON-PANDEMIC RELATED
STRESS WERE RELATED TO HIGHER
RISK OF BELONGING TO CLASS 2 OR
CLASS 3, AND PARTNER SUPPORT
THROUGHOUT, CONTINUED SUPPORT
THROUGHOUT THE PERINATAL PERIOD
WAS A PROTECTIVE FACTOR.
OF SEVERAL FACTORS RELATED, ONLY
TO INCREASED RISK OF BEING IN
CLASS 2 THAT MODERATE AND STABLE
ANXIETY, SO THINGS LIKE LOWER
EDUCATION, HISTORY OF
INTERPERSONAL VIOLENCE, AND
PANDEMIC-RELATED PREGNANCY
STRESS WERE RELATED TO CLASS 2
MEMBERSHIP.
FOR CLASS 3 MEMBERSHIP THAT
MODERATE TO SEVERE CLASS THERE
WAS ONLY ONE FACTOR THAT WAS
UNIQUELY RELATED JUST TO THAT,
THAT WAS FINANCIAL INSECURITY.
IN CONCLUSION WE FOUND THREE
GROUPS THAT DIFFERED IN THEIR
INITIAL ANXIETY LEVELS IN
TRAJECTORIES OF CHANGE OVER
TIME, AND IN THEIR PSYCHOSOCIAL
CHARACTERISTICS.
AND THE CONTRIBUTORS WE FOUND
REALLY CORROBORATE KNOWN
LITERATURE ON ELEVATED ANXIETY.
HOWEVER WE SAW CLASS 2, WHICH IS
THAT STABLE MODERATE ANXIETY,
THEY WERE CHARACTERIZED BY
SOCIODEMOGRAPHIC RISK FACTORINGS
THAT COULD EXPLAIN WHY ANXIETY
REMAINED STABLE THROUGHOUT THE
POSTPARTUM PERIOD, BUT CLASS 3
SEEMED TO HAVE SITUATIONAL
FINANCIAL INSECURITY THAT COULD
HAVE MADE THEM VULNERABLE TO
DETERIORATING MENTAL HEALTH IN
THE POSTPARTUM PERIOD, AND THERE
IS SOME -- THERE ARE SOME
REPORTS THAT TALK ABOUT HOW
DURING THE PANDEMIC THOSE THAT
HAD LESS MATERIAL RESOURCES
EXPERIENCED WORSENING MENTAL
HEALTH.
WE ALSO SAW THAT CLASS 2 AND
CLASS 3 WOMEN WERE TWICE AS
LIKELY TO HAVE HAD PRE-TERM
BIRTH AND POSSIBLE RECIPROCAL
EFFECT WHERE HIGH ANXIETY LIKELY
INCREASED RISK OF PRE-TERM BIRTH
AND THEN IN TURN PRE-TERM BIRTH
LIKELY MAINTAINED OR INCREASED
THEIR ELEVATED ANXIETY LEVELS.
AND THERE ARE SEVERAL PRACTICE
AND POLICY IMPLICATIONS TO THESE
FINDINGS.
ONE IS THAT SCREENING FOR THESE
RISK FACTORS FOR PSYCHOSOCIAL
CONTRIBUTORS BOTH SOCIAL
DETERMINANTS OF HEALTH AND ALSO
STRESSORS, IS IMPERATIVE TO
ENABLE PREVENTION AND
INTERVENTIONS WHICH WILL REDUCE
MORBIDITY IN TERMS OF ANXIETY
AND ALSO ITS SEQUEL.
AND SPECIAL ATTENTION SHOULD BE
GIVEN TO THOSE WITH LESS
FINANCIAL OR SOCIAL CAPITAL,
WHICH ARE AT GREATEST RISK FOR
WORSENING ANXIETY SYMPTOMS.
THANK YOU.
>>THANK YOU.
AS WE LOAD THE SLIDES, I'D LIKE
TO REMIND EVERYBODY THAT YOU CAN
SUBMIT YOUR QUESTIONS TO THE
PRESENTERS THROUGH THE VIDEOCAST
LIVE FEEDBACK SO WE CAN ANSWER
YOUR QUESTIONS DURING THE Q&A
DISCUSSION.
THANK YOU.
>>THANK YOU, I'M AT THE
UNIVERSITY OF PITTSBURGH, AND
I'M JUST AMAZED BY THE
TREMENDOUS WORK THAT'S BEEN DONE
IN THE PAST COUPLE YEARS AROUND
THIS SUBJECT.
AND THE TITLE OF MY TALK IS
YOUNG BLACK WOMEN'S DESIRED
PREGNANCY AND BIRTHING SUPPORT
DURING THE COVID-19 PANDEMIC.
AND ALTHOUGH IT FITS WELL WITH
THE GROUP OF TALKS TODAY IT
DIFFERS IN A COUPLE IMPORTANT
WAYS.
THIS FOCUSES ON VERY YOUNG
PEOPLE, THE PEOPLE IN THIS STUDY
WERE 23 YEARS AND YOUNGER, AND
IT'S INTERESTING BECAUSE PEOPLE
THINK THAT BECAUSE YOU'RE
YOUNGER YOU'RE GOING TO
NATURALLY HAVE A HEALTHIER
PREGNANCY THAN GIVING BIRTH AT
NORMATIVE OR OLDER AGE.
THAT'S NOT THE CASE.
A PAPER JUST CAME OUT LAST YEAR
THAT SHOWED PEOPLE UNDER THE AGE
OF 20 ARE NOT ONLY MORE LIKELY
TO DIE DURING CHILD BIRTH AND
EXPERIENCE MATERNAL MORBIDITY
BUT IN THE PAST DECADE, THEY
ACTUALLY HAD INCREASED RISK FOR
SEVERE MATERNAL MORBIDITY.
SO IT'S WITHIN THE CONTEXT OF
THAT THAT WE FOCUS ON YOUNGER
PEOPLE.
THE SECOND BIG DIFFERENCE
BETWEEN TALKS IS WITH THIS
STUDY, IT BRINGS EQUAL IT
THAT -- QUALITATIVE DATA IN
TERMS OF DISCRIMINATION SOME
PEOPLE EXPERIENCED DURING THE
PANDEMIC.
SO, BEFORE WE MOVE TO THE NEXT
SLIDE I'D LIKE TO ACKNOWLEDGE
FUNDING BY NIDA AND OFFICE OF
WOMEN'S HEALTH AND THE IMPROPER
INITIATIVE.
I WANT TO THANK MY MENTEE AND
JUNIOR COLLEAGUE ASHLEY HILL,
DR. HILL WAS INSTRUMENTAL IN
ENCOURAGING ME TO SEEK OUT EXTRA
FUNDING BECAUSE SHE EVEN THOUGH
WE WERE DOING QUALITATIVE WORK
IN THE PROJECT SHE KNEW THERE
WAS MORE THAT PEOPLE HAD TO SAY
ABOUT THEIR EXPERIENCES
PARTICULARLY DURING THE PANDEMIC
WHEN THOSE HEALTH DISPARITIES
BECAME EVEN MORE PRONOUNCED.
NEXT SLIDE.
THE PARENT STUDY IS YOUNGMOMS
PROJECT, FUNDED BY NIDA TO LOOK
AT PRENATAL TOBACCO AND CANNABIS
USE, IN THE YOUNGEST PREGNANT
AND BIRTHING PEOPLE.
AND SO ALTHOUGH WE'RE FUNDED AND
INTERESTED IN LOOKING AT
CORRELATES OF TOBACCO AND
CANNABIS DUES ACROSS PREGNANCY
AND POSTPARTUM WE TOOK ALL
COMEERS UNDER 22 WHO CAN READ
AND WRITE ENGLISH TO PROVIDE
INFORMED CONSENT AND COMPLETE
MEASURES AND WHO ARE NOT
CURRENTLY IN TREATMENT FOR
OPIOID USE DISORDER.
REALLY NO OTHER EXCLUSIONS.
NEXT SLIDE PLEASE.
THE PROJECT I'M GOING TO TALK
BEER IS QUALITATIVE INTERVIEWS
WITH PEOPLE FROM THE TALK ABOUT
IS QUALITATIVE INTERVIEWS,
SELECTED BECAUSE THEY WERE NOT
RECRUITED INTO THE LONGITUDINAL
STUDIES, DID NOT HAVE REPEATED
ASSESSMENTS, THEY WERE INVITED
TO JUST PARTICIPATE IN ONE ON
ONE INTERVIEWS, WITH OUR STAFF
TOUCHES ON A THESE THREE THEMES.
TODAY I'M GOING TO TALK ABOUT
THE TEAMS THAT EMERGED AROUND
STRUCTURAL RACISM GIVEN THE TIME
LIMIT.
WE THOUGHT THESE WOULD BE
IMPORTANT WITH OUR YOUNGER BLACK
AND BIRACIAL PARTICIPANTS GIVEN
RESEARCH THAT HAS SHOWN THEY
EXPERIENCE AT LEAST IN ADULT
POPULATIONS, EXPERIENCE GREATER
STRUCTURAL RACISM AND
DISCRIMINATION, AS THESE YOUNG
PEOPLE IN THE STUDY ARE
EXPERIENCING MULTIPLE
MARGINALIZED IDENTITIES AND
EXPERIENCES AS A RESULT OF THOSE
INTERACTING AND INTERSECTING
IDENTITIES WE THOUGHT IT MIGHT
BE VERY IMPORTANT TO TALK TO
THEM SPECIFICALLY ABOUT THESE
ISSUES.
IN OUR INTERVIEWS, WE FOUND FOUR
THEMES AROUND STRUCTURAL RACISM
AND DISCRIMINATION I'D LIKE TO
SHARE USING IN QUOTES THINGS
THAT ILLUSTRATE SOME THEMES.
ONE WAS AWARENESS OF HISTORICAL
RACISM AND DISCRIMINATION IN
HEALTH CARE AND HOW THAT
INFLUENCES PRENATAL CARE TODAY.
THIS PERSON SAID I WAS READING
AN ARTICLE THAT WOMEN OF COLOR,
A LOT DIE.
DON'T MEDICAL PROVIDERS DON'T
TAKE THEIR PROBLEMS SERIOUS.
THIS IS A VERY YOUNG PERSON,
THIS PERSON IS AWARE OF THE
HEALTH DISPARITIES BETWEEN WOMEN
OF COLOR AND OTHER WOMEN DURING
PREGNANCY AND BIRTHING
EXPERIENCES, AND FELT THAT
WASN'T TAKEN SERIOUSLY BY THEIR
HEALTH CARE PROVIDERS.
IN THE OTHER QUOTE THIS PERSON
SAID THERE WAS AN IDEA FOR LONG
TIME THAT BLACK PEOPLE COULD
TOLERATE PAIN BETTER THAN WHITE
PEOPLE, AND THIS LEADS INTO THE
HEALTH CARE SITUATION SITUATION
NOW, PEOPLE NOT LISTENING WHEN
THEY SAY THEY ARE IN PAIN.
ONE MORE QUOTE THAT WAS
POWERFUL, I WISH THEY WOULD
REALLY, THEY MEANING HEALTH CARE
PROVIDERS, WOULD SIT DOWN AND GO
BACK INTO HISTORY AND LOOK AT
WHERE BLACK WOMEN CAME FROM.
WE CAME FROM BEING SLAVES AT ONE
POINT AND BEING RAPED BY SLAVE
MASTERS.
STUFF DID GET BETTER.
STILL THE SEPARATION BETWEEN, OH
BECAUSE MY SKIN IS TOO DARK, I'M
NOT PRETTY ENOUGH OR MY BABY IS
NOT GOING TO BE TAKEN CARE OF IN
THE HOSPITAL AS A WHITE WOMAN'S
WOULD.
THESE ARE YOUNGER PEOPLE, THEY
ARE AWARE OF THE HISTORICAL
CONTEXT OF RACISM AND LEGACY
THAT HAS CONTRIBUTED TO MORE
DIFFICULT AND DISTRUST IN
OBSTETRIC PATIENT/PROVIDER
COMMUNICATION.
MY COLLEAGUES IN OBSTETRICS AND
GYNECOLOGY WITH WONDERFUL PEOPLE
DEDICATED TO PROVIDING THE BEST
CARE POSSIBLE SO THIS IS NOT
INTENTIONAL BUT THIS IS WHAT THE
EXPERIENCES OF YOUNG BLACK AND
BIRACIAL PEOPLE IN HOSPITAL
SYSTEM TODAY IS.
NEXT.
ANOTHER THEME THAT PEOPLE VOICED
THERE WAS A CLINICIAN BIAS IN
THEIR ASSUMPTIONS ABOUT THEM,
USING SUBSTANCES, AND ALSO THERE
WAS CONTRACEPTIVE COERCION FROM
THEIR PROVIDERS.
NEXT.
THIS OCCURRED BEFORE THE
INTERVIEW WAS CONDUCTED.
WHEN I WAS 18 I WENT TO GET AN
IUD BECAUSE I HAD CRAMPS AND
DIDN'T WANT TO HAVE A BABY AT
THAT TIME AND ACCIDENTS DO
HAPPEN.
THE DOCTOR WAS UNHAPPY THAT I
WAS 18, EXPRESSING HOW SHE FEELS
I SHOULD FOCUS ON SCHOOL AND SEX
SHOULD BE THE LAST THING ON MY
MIND AND I'M TOO YOUNG AND DID
NOT DO THE IMPLANT, A YOUNG
PERSON VOICING NEEDS FOR
REPRODUCTIVE HEALTH CARE, BEING
DENIED AND DIMINISHED, EXAMPLE
OF CONTRACEPTIVE COERCION, AND
HER NEEDS NOT BEING MET.
NEXT.
THE DOCTORS MADE IT SEEM LIKE I
WAS DOING SUBSTANCE, AND I
WASN'T.
THE PATIENT SWITCHED PROVIDERS
AND HOSPITALS BECAUSE THEY
DIDN'T FEEL LIKE THEIR VOICE WAS
BEING HEARD IN THIS HEALTH CARE
SITUATION.
SO I THOUGHT THAT WAS A GOOD
EXAMPLE OF A BIAS REGARDING
SUBSTANCE USE DURING THE
PATIENT-PROVIDER INTERACTION.
NEXT.
THEY FELT BECAUSE THEY WERE
BLACK THAT THEIR COMPLAINTS AND
THEIR CONCERNS WEREN'T BEING
TAKEN AS SERIOUSLY.
AGAIN, WE SAW THIS IN DR.
JANOVIC'S TALK AND FROM
HUGS/ABRAZOS THESE ARE AN EFFECT
ON HEALTH.
I WAS SCARED THROUGH THE
EXPERIENCE, THIS ONE SAID, AGAIN
THIS IS IN THE CONTEXT OF GIVING
BIRTH AND HAVING PRENATAL CARE
DURING COVID, THEY KNEW I WAS
SECURED, THEY WERE DOING A LOT
OF THINGS, TALKING TO
THEMSELVES, NOT LETTING ME KNOW
WHAT THEY WERE DOING.
THIS PARTICIPANTS FELT LIKE AN
OBJECT, THEY WEREN'T BEING
CONSULTED ON PROCEDURES AND
THINGS WERE OCCURRING WITHOUT
THEIR CONSENT AND AROUND THEM.
THIS WAS VOICED BY SEVERAL
PARTICIPANTS, EXPERIENCES LIKE
THIS.
AND MAY BE A FUNCTION OF ALSO
AGE, RACE, GENDER, SO THERE'S
LIKE MULTIPLE INTERSECTING
IDENTITIES THAT ARE CONTRIBUTING
TO THESE EXPERIENCES.
NEXT.
AND PEOPLE WITH DARKER SKIN
COLOR HAVE A HARDER TIME
EXPRESSING BECAUSE WE COME OFF
AS GREEDY, WE CAN'T SAY IT
OUTRIGHT.
I'VE NEVER BEEN ABLE TO SAY,
HEY, THIS IS HOW I FEEL, WHAT I
THINK IS GOING ON.
NO, I'M QUIET WHEN I GO, I
QUESTION THEM AND MYSELF.
THIS PERSON IS ACTUALLY
SELF-SILENCING THEMSELVES AND
CHANGING SO THEY FEEL LIKE THIS
HAS AN IMPACTS NOT ONLY ON THE
PATIENT-PROVIDER COMMUNICATION
FROM PROVIDER SIDE BUT
THEMSELVES AS THE PATIENT.
NEXT.
AND THEN ANOTHER EXAMPLE WHERE
THEY FELT THAT BECAUSE OF
THEIR -- I'M RUSHING A BIT NOW
WITH THE POWERFUL QUOTES BUT I
ONLY HAVE A MINUTE.
I WANTED TO GIVE ANOTHER EXAMPLE
HOW THEY FELT IF I WAS A WHITE
WOMAN THEY WOULD HAVE HEARD ME.
AGAIN, THE SENSE THEIR VOICES
ARE NOT BEING HEARD.
NEXT.
AND WHEN WE ASKED WHAT THEY
WOULD LIKE TO SEE, ONE THING
THAT CAME THROUGH FROM A LOT OF
PARTICIPANTS I'D LIKE TO SEE
SOMEONE THAT LOOKS LIKE ME, EVEN
JUST A PERSON OF COLOR.
NEXT.
TO CONCLUDE, WHAT YOUNG PEOPLE
KNOW IS THAT HISTORICAL RACISM
AND DISCRIMINATION CONTINUES TO
IMPACT THEIR OB INTERACTIONS
TODAY AND THEY ARE VERY AWARE
AND CLINICIAN BIAS INFLUENCES
THEIR CARE AND DECISION MAKING,
AND WE FOUND EXAMPLES FROM
SUBSTANCE USE AND REPRODUCTIVE
AUTONOMY, THEY ARE VERY GOOD AND
ARTICULATE AND CLEAR ABOUT
SAYING WHAT THEY WANT AND NEED
TO SEE IN PRENATAL CARE BUT FEEL
THEY ARE NOT BEING HEARD.
NEXT.
I'LL CONCLUDE WITH THIS SLIDE OF
MY AMAZING COLLABORATORS AND
STAFF WHO WERE I FEEL ABLE TO --
THE THE STAFF ESPECIALLY ABLE TO
CREATE TRUST WITH THESE VERY
YOUNG PEOPLE AND SO THEY FELT
COMFORTABLE SHARING PREGNANCY
AND BIRTHING STORIES WITH US,
AND MOST GRATEFUL TO THE YOUNG
MOMS PARTICIPANTS WHO
PARTICIPATED AND SHARED
EXPERIENCES WITH US.
THANK YOU.
>>I'LL ASK THE PRESENTERS TO GO
ON CAMERA FOR THE Q&A PERIOD
UNTIL 1:10 FOR QUESTIONS ANYBODY
FROM THE PANEL OR AUDIENCE HAS.
I CAN START WITH DR. JANEVIC.
QUICK QUESTION RELATED TO YOUR
PATIENT POPULATION.
SO I DIDN'T SEE AND I DIDN'T
LOOK TO SEE IF YOUR PATIENT
POPULATION HAD ANY COMORBID
CONDITIONS OR PRE-DIAGNOSIS SORT
OF PRE-PREGNANCY THAT THEY HAD
THE INCREASED RISK OF POSTPARTUM
ELEVATION IN THEIR BLOOD
PRESSURES IN ADDITION TO
INSECURITIES AND COVID.
>>WE DID CONTROL FOR THAT.
27% HAD EITHER PREEXISTING OR
HYPERTENSION IN PREGNANCY.
>>THE FOOD INSECURITY AND
FINANCIAL INSECURITY, AMAZING
THAT PLAYED A PART IN THE
MAJORITY OF YOUR STUDIES THAT
YOU IDENTIFIED.
I'M WONDERING FOR THE FOOD
INSECURITY, DID THEY NOT HAVE
ACCESS TO WIC PROGRAMS SO THE
PARTICIPANTS IN YOUR STUDIES,
DID NOT HAVE ACCESS TO WIC OR
WERE SERVICES LIMITED DURING
COVID?
>>I THINK IT WAS A COMBINATION
OF, YOU KNOW, THE PARTICIPANTS
WEREN'T RECEIVING WIC IN A
TIMELY FASHION, IT WASN'T REALLY
NECESSARILY SUFFICIENT TO MEET
THE NEEDS.
THE QUESTIONS WERE ABOUT ANYTIME
IN THE PRIOR 12 MONTHS, SO EVEN
IF PARTICIPANTS WERE ABLE TO
ACCESS SUFFICIENT FOOD FOR
THEMSELVES DURING THE ACTUAL
PREGNANCY, THEY WERE EVEN IN THE
12 MONTHS PRIOR TO PREGNANCY
WHEN THEY DIDN'T HAVE ACCESS TO
WIC THEY WERE EXPERIENCING FOOD
INSECURITIES SO OH QUESTIONS
WERE UNABLE TO TEASE APART WAS
IT ONLY DURING THE PREGNANCY OR
JUST IN THE LAST 12 MONTHS, WE
WERE SHOCKED BY THE HIGH RATES
OF FOOD INSECURITY AND THAT SORT
OF SPURRED US TO APPLY FOR OTHER
FUNDING INCLUDING ONE OF OUR
PEDIATRICS COLLEAGUES LEADING A
PCORI APPLICATION, TO DELIVER
GROCERIES TO PREGNANT AND
POSTPARTUM INDIVIDUALS IN THOSE
COMMUNITIES BECAUSE THERE ARE
NEEDS AROUND PREGNANCY AND LATER
NOT BEING MET.
>>ABSOLUTELY.
THANK YOU.
ANYONE ELSE FROM THE PANEL?
I'M LOOKING FOR HANDS RAISED OR
ANY OTHER QUESTIONS.
THERE ARE NO QUESTIONS FROM THE
AUDIENCE SO FAR.
I WAS ALSO VERY IMPRESSED, DR.
DE GENNA, ABOUT THE KNOWLEDGE OF
HISTORICAL RACISM AND HOW THAT
INFLUENCED YOUNGER AGE WOMEN IN
THEIR -- YOU KNOW, AROUND 25
YEARS OF AGE.
DID ANY OF YOUR 25 EXPERIENCE
ANY ADVERSE EVENTS THAT YOU
SAMPLED?
DO YOU KNOW IF THEY HAD ANY
PREGNANCY-RELATED ADVERSE EVENTS
THAT PLAYED ALONG WITH THEIR
IMPRESSIONS?
>>NO, OUR INTERVIEW GUIDE
DIDN'T ASK ABOUT THAT
SPECIFICALLY.
MAYBE THAT'S WHY WE DIDN'T
ELICIT THOSE STORIES.
I WILL SAY WE'RE ABSTRACTING THE
MEDICAL CHARTS FROM EVERYBODY
WHO COMPLETES THE FIRST BASELINE
SURVEY SO WE'LL BE ABLE TO.
I KNOW ANECDOTALLY WE'VE SEE
PREECLAMPSIA, PREGNANCY LOSS,
PRE-TERM BIRTHS EVEN IN THE
YOUNG AND SUPPOSEDLY HEALTHY
SAMPLE.
BUT WE WILL TRY TO FIND OUT AND
WE'LL HAVE ABOUT 500 OF THOSE WE
CAN LOOK AT TO SEE AND IN SOME
SURVEY DATA WE'RE ASKING ABOUT
EXPERIENCES OF DISCRIMINATION
AND THINGS LIKE THAT SO WE'LL BE
ABLE TO SEE IF WE CAN TIE THOSE
TO ADVERSE EVENTS.
>>ANDREA HAS A QUESTION FOR YOU
AS WELL.
I'LL TURN IT TO ANDREA.
>>OH, THANKS.
I WAS SAYING I THINK THAT THIS
WORK IS SO POWERFUL AND SOME OF
THE BEST WAYS WE CAN GET A SENSE
OF PEOPLE THROUGH STAKEHOLDERS,
SO WHAT DID YOU VIEW AS YOUR
STEPS?
AS HIGH RISK OBSTETRICIAN WE
KNOW ABOUT THIS BUT WHAT DO YOU
THINK SHOULD BE DONE TO FOLLOW
UP ON THIS?
>>WELL, ONE OF THE FIRST THING
IS MEET WITH OBSTETRIC PROVIDER
PARTNERS AND SHARE RESULTS, AND
ONE OF EXPERTS TRIES TO SEE WHAT
WE CAN DO TO CHANGE WHAT'S
HAPPENING, AT LEAST FROM THE
PROVIDER END OF THINGS.
I THINK SOME IS JUST STRUCTURAL
THINGS SO WE CAN'T HAVE
INDIVIDUAL INTERVENTIONS WORKING
WITH INDIVIDUAL PATIENTS.
THAT'S NOT GOING TO CHANGE.
IT HAS TO HAPPEN ON A BIGGER
LEVEL.
ON AN INDIVIDUAL SIDE I'M
WORKING WITH ANOTHER PERSON WHO
DOES INTERVENTION WORK TO TRY TO
DEVELOP A COLLABORATIVE OF BLACK
PEOPLE WITH EXPERIENCES OF
PRENATAL SMOKING TO UNDERSTAND
HOW HOW EXPERIENCES MIGHT RELATE
TO SMOKING, AND ANOTHER THING WE
DO IS WE HAVE A SURVEY WE
DEVELOP WE'RE USING QUALITATIVE
INTERVIEW DATA TO REVISE AND
REFINE AND THEN LEARN MORE ABOUT
FOR EXAMPLE FOOD INSECURITY IS
NOT IN THE PARENT STUDY AND WE
WANT TO LEARN BECAUSE WE DIDN'T
ASK ABOUT THAT.
A LOT OF NEXT STEPS TO TRY TO
FIGURE OUT WHAT CAN WE DO TO
HELP AND IMPROVE THE SITUATION
NOW THAT THESE VOICES ARE BEING
HEARD.
>>I'M THANKFUL YOU'RE HEARING
THE VOICES.
THERE'S A QUESTION IN THE CHAT.
I'LL READ IT.
IT'S FOR EVERYONE SPEAKING.
SOME OF IT YOU'VE ALREADY
ADDRESSED, BUT WERE YOU
SURPRISED BY THE HIGH RATES OF
STRESS ACROSS STUDIES, WHETHER
RACISM, FOOD INSECURITY AND LOW
SCORES OF STRESS AND DEPRESSION,
TWO QUESTIONS, IN THE STUDY THAT
EXAMINED PRE-TERM BIRTH, SMOKING
MEASURED, WOULD HAVE -- SORRY,
ONE OF THE WAYS THAT
PARTICIPANTS COPED WITH STRESS.
DOES ANYONE WANT TO TAKE THE
FIRST QUESTION ABOUT SORT OF THE
ADVERSE EVENTS AND LOW SCORE OF
STRESS AND DEPRESSION AND
ANXIETY?
>>I MEAN, I CAN TRY TO ANSWER
BUT I'M NOT SURE THIS IS REALLY
GEARED TOWARDS ME BECAUSE IN MY
STUDY WE DID HAVE HIGH STRESS
AND ALSO HIGH ANXIETY.
SO I WAS NOT SURPRISED BY THE
HIGH RATES OF ANXIETY.
AND I'M NOT SURE THAT THE
QUESTION ABOUT PRE-TERM BIRTH,
IS THAT ABOUT MY FINDINGS?
OKAY.
>>I BELIEVE SO, RIGHT?
YOU'RE THE ONLY ONE TWO
MENTIONED PRE-TERM BIRTH.
IF YOU WANT TO UNMUTE AND ASK
YOUR QUESTION.
>>SURE.
I FOUND IT SURPRISING, I THINK
YOU USED A SCORE OF GREATER THAN
8 SO I KNOW YOU GOT THERE, BUT
FOR SUCH HIGH PREVALENCE OF
THESE REALLY KIND OF ENORMOUS
STRESSORS OF RACISM AND
FINANCIAL INSECURITY AND, YOU
KNOW, THE METRICS THAT YOU
SHOWED OF COVID IN
MASSACHUSETTS, THAT THE SCORES
WERE, I THINK, RELATIVELY LOW
COMPARED TO WHAT I'VE SEEN SO I
WONDERED IF YOU HAD THOUGHTS
ABOUT THE STUDIES THAT MEASURED
IT AND, YES, MY QUESTION WAS FOR
HEIDI AROUND PRE-TERM BIRTH AS
DR. DE GENNA MENTIONED ABOUT
SMOKING AS A WAY TO COPE WITH
RACISM AND OTHER STRESSORS
DURING PREGNANCY.
>>IN TERMS OF PRE-TERM BIRTH,
WHAT I PRESENTED NOW, WE DID NOT
LOOK AT PRE-TERM BIRTH AS
PREDICTORS OF PRE-TERM BIRTH AND
HOW STRESS IS A PREDICTOR.
SO CONTROLLING FOR TOBACCO USE
IS NOT REALLY RELEVANT TO THAT
QUESTION BECAUSE THE OUTCOME WAS
NOT PRE-TERM BIRTH.
RATHER, THE ANXIETY WAS THE
OUTCOME.
WE HAVE A DIFFERENT PUBLICATION
FROM THE WAVE 1 PARTICIPANTS
THAT WE LOOKED AT PERINATAL
ADVERSE OUTCOMES, AS OUR OUTCOME
MEASURES, AND THERE WE DO HAVE
ANALYSES THAT INCLUDED TOBACCO
USE AND OTHER THINGS THAT I'M
JUST GOING TO POP THAT IN THE
CHAT.
IF YOU'RE INTERESTED IN LOOKING
AT THAT PUBLICATION.
>>AS FAR AS THE SCREENING
SCORES, I AGREE WITH YOU, MAYBE
WE WOULD HAVE EXPECTED OUR MEAN
SCORES TO BE HIGHER, BUT IN THE
STRATIFIED ANALYSES LOOKING AT
INDIVIDUALS WITH FOOD INSTITUTER
AS - FOOD INSECURITY AND
DISCRIMINATION, 10 TO 12, MORE
MODERATE RISK OF DEPRESSION ON
THE SCREENER, EVEN TAKEN
ALTOGETHER IF THE MEAN STARTING
SCORE WAS JUST SLIGHTLY ABOVE 8,
WHICH IS SCREEN POSITIVE BUT NOT
HIGHEST RISK GROUP FOR HAVING
DEPRESSION, ARE INDIVIDUALS WHO
HAD THE GREATER LIFE STRESSORS
WERE MORE SQUARELY IN THAT
MODERATE CHANGE AND ANOTHER
GROUP AT MASS GENERAL WHO
EXAMINED DEPRESSION SCORES AND
CHANGES IN COVID PANDEMIC AMONG
HIGH RISK CLINIC POPULATIONS,
PATIENTS WITH SUBSTANCE USE
DISORDER FOUND THE PANDEMIC HAD
NO IMPACT ON THEIR DEPRESSION
SCORES AND PART OF THAT THEY
POSTULATED WAS BECAUSE AN
INDIVIDUAL WHO HAS SO MANY LIFE
STRESSORS AND SO MANY THINGS
GOING ON AT ALL TIMES, THEY
EITHER MIGHT HAVE DEVELOPED
DIFFERENT RESILIENCY METRICS
THAT WOULD BE MEASURED BY EPDS,
BASELINE SCORES OF HOW THEY
EXPERIENCE LIFE MIGHT NOT HAVE
DEPRESSION FIGURING AS
PROMINENTLY AND HAVING ANXIETY
AND STRESS AS MORE PROMINENT, SO
THAT'S THE ONLY OTHER INSIGHT I
HAVE TO OFFER THERE.
>>WE DID ASK ABOUT SMOKING AND
DRINKING SPECIFICALLY AND HAD
THAT CHANGED DURING COVID.
SOME PEOPLE SHARED THEY SMOKED
BUT DIDN'T COME THROUGH AS A NEW
WAY OF COPING WITH THE STRESSORS
OF COVID AND THEN THE UNREST AND
EVERYTHING GOING ON AROUND THE
COUNTRY AT THE TIME OF
INTERVIEWS BUT THERE'S A LOT OF
PRENATAL SMOKING IN THE PARENT
STUDY SO I FEEL LIKE THAT WAS
ALREADY THERE FOR A LOT OF
REASONS INCLUDING THE FACT THAT
STRUCTURAL RACISM AND
DISCRIMINATION HAS BEEN A
STRESSOR FOR A LONG TIME AND
ADDING COVID PLAY NOT HAVE
AMPLIFIED BUT I HAVEN'T LOOKED
AT -- AND I DON'T HAVE THE
SAMPLE TO LOOK AT THE INCREASES
IN LEVELS OF SMOKING OR ANYTHING
OVER THE COURSE OF THE BEFORE,
DURING, AFTER THE PANDEMIC.
>>THANK YOU FOR THAT.
WE HAVE A QUESTION FROM THE
AUDIENCE FOR DR. DEGENNA.
WHAT ARE SOME EXAMPLES OF THE
TYPES OF QUESTIONS YOU ASKED IN
YOUR INTERVIEW GUIDE THAT
ELICITED RESPONSES ABOUT
EXPERIENCES WITH RACISM, WERE
THE INTERVIEWERS WOMEN WHO WERE
BLACK AS WELL?
>>ONE MAJOR LIMITATION OF THE
STUDY IS THAT OUR INTERVIEWERS
WERE NOT BLACK.
TWO WOMEN OF COLOR WERE NOT
BLACK, THAT'S SOMETHING THAT
COULD INFLUENCE OBVIOUSLY THE
RESPONSES.
THANK YOU FOR THAT EXCELLENT
QUESTION.
CERTAINLY A LIMITATION OF THE
STUDY.
AND THE KINDS OF QUESTIONS, WE
KNOW FROM PREVIOUS STUDIES THAT
THIS EXISTS FROM STUDIES WITH
OLDER WOMEN.
WE WERE INTERESTED -- THE
QUESTIONS WE'RE INTERESTED IN,
DO YOU FEEL YOU WERE TREATED
DIFFERENTLY BY YOUR PROVIDERS,
BECAUSE OF ANYTHING ABOUT YOUR
IDENTITY, AND THOSE WERE THE
KINDS OF QUESTIONS WE ASKED, HOW
WAS IT LIKE GIVING BIRTH DURING
COVID IS ANOTHER FOCUS, WAS THE
PANDEMIC -- WERE THINGS
DIFFERENT?
AND WE HAVE A SEPARATE PAPER
WITH DIFFERENT THEMES AROUND
SPECIFICALLY THE PANDEMIC, A LOT
OF QUESTIONS ABOUT WHAT WAS THAT
LIKE FOR YOU AND YOUR FAMILY,
AND MANY OF THEM HAD BEEN
PREGNANT PREVIOUSLY, EVEN THOUGH
VERY YOUNG, WERE ABLE TO
CONTRAST THE EXPERIENCE WITH NOT
HAVING THE SUPPORT PERSON WITH
THEM, AND ALSO A BIG THING WAS
LACK OF CHILD CARE AND NOT BEING
ABLE TO BRING YOUR CHILDREN IN
WITH THEM TO THEIR VISITS AND I
THINK WE SEE THAT IN OTHER
STUDIES IN OLDER PEOPLE AS WELL,
A BARRIER TO PRENATAL CARE AT
THE HEIGHT OF THE PANDEMIC,
ESPECIALLY THE CASE FOR YOUNG
PEOPLE ARE LESS SOCIAL SUPPORT
AND ACCESS THAN OLDER PATIENTS.
I'M NOT SURE IF I ANSWERED
APPROPRIATELY BUT LET ME
KNOWMENT
>>THANK YOU VERY MUCH.
WE'RE AT TIME.
I WANT TO THANK ALL OUR
PRESENTERS AND FOR JOINING US,
AND HOPEFULLY YOU'LL STAY FOR
THE REST OF THE SESSION AS WELL.
WE HAVE A 15-MINUTE BREAK.
WE WILL RECONVENE AT 1:25.
>>WELCOME TO THIS SESSION,
CONSIDERING MENTAL HEALTH AND
BEHAVIORAL HEALTH IN ADDRESSING
DISPARITIES.
I'M DR. QUATTARA MODERATING THIS
SESSION.
FOR OUR FIRST PRESENTATION IN
THIS SESSION, WE WOULD LIKE TO
WELCOME DR. JENNIFER HERN,
PROFESSOR OF EPIDEMIOLOGY AT
UNIVERSITY OF CALIFORNIA
BERKELEY SCHOOL OF PUBLIC
HEALTH, PRESENTING ON COMMUNITY
VIOLENCE AND DISPARITIES IN
MATERNAL AND INFANT HEALTH
EFFECT AND MECHANISM.
DR. AHERN, YOU HAVE THE FLOOR.
>>THANK YOU SO MUCH.
THANK YOU FOR THE INVITATION TO
PRESENT.
I'M JUST GOING TO PUT MY SLIDES
UP HERE.
ALL RIGHT.
HOPEFULLY THAT LOOKS GOOD.
ALL RIGHT.
LET'S GET STARTED.
AS THE INTRODUCTION JUST SAID MY
PROJECT IS LOOKING AT COMMUNITY
VIOLENCE AND DISPARITIES IN
MATERNAL AND INFANT HEALTH, AND
WE HAVE A SUPPLEMENT TO THAT
AWARD THROUGH THE IMPROVE
FUNDING.
THE AIMS WERE FIRST TO LOOK AT
EFFECTS OF COVID-19 PANDEMIC ON
HEALTH AND HEALTH DISPARITIES
AMONG MOTHERS AND BIRTH PARENTS
AND TO BUILD ON THAT, LOOKING AT
COMMUNITY COVID-19 AS A MODIFIER
OF EFFECT OF COMMUNITY VIOLENCE
ON HEALTH.
TODAY I'LL FOCUS ON THE FIRST
AIM, OVERALL COVID-19 PANDEMIC
IMPACTS.
THERE'S SUBSTANTIAL NEGATIVE
EFFECTS OF SARS-COV-2 ON
PERINATAL HEALTH, THESE INCLUDE
MATERNAL CONDITIONS AS WELL AS
INFANT OUTCOMES.
HOWEVER, THERE HAVE BEEN FEWER
STUDIES LOOKING AT EFFECTS OF
PANDEMIC PERIOD, IN PARTICULAR
THAT TRY TO DISENTANGLE FROM
EFFECTS OF THE PERIOD OF THE
PANDEMIC.
IN ADDITION VERY LITTLE WORK HAS
CONSIDERED RACIAL/ETHNIC
DISPARITIES IN THE INFECTION OR
PANDEMIC.
SO TO FILL IN GAPS WE WANTED TO
LOOK AT EFFECTS OF INFECTION AS
DISTINCT FROM THE PANDEMIC
PERIOD, AND LOOK AT BOTH OF
THESE IN CONNECTION MATERNAL AND
BIRTH PARENT AND INFANT HEALTH
OUTCOMES AND TO LOOK AT RACIAL
AND ETHNIC DISPARITIES PATTERNS.
TO DO THIS WE DID LINKAGE OF
STATEWIDE CALIFORNIA DATA
INCLUDING INDIVIDUALLY LINKING
VITAL STATISTICS BIRTH DATA WITH
THE MATERNAL AND BIRTH PARENTS
AS WELL AS INFANT HOSPITAL
DISCHARGE RECORDS, AND WHAT I'LL
PRESENT IS FOCUSED ON 2019 AND
2020, DURING THE PERIOD OF 2020
WHEN THERE WERE ICD CODES
AVAILABLE TO CODE COVID-19.
WE'RE LOOKING AT THREE DIFFERENT
EXPOSURES, ONE IS THE DELIVERIES
WITH INFECTION DUE TO SARS-COV-2
AT THE TIME OF DELIVERY.
NEXT GROUP IS DELIVERY IN 2020
WITHOUT ANY RECORDED INFECTION.
AND COMPARISON GROUP IS OUR
DELIVERIES FROM 2019.
WE LOOKED AT A RANGE OF MATERNAL
AND INFANT HEALTH OUTCOMES.
FOR ANALYSIS WE USED A MATCHING
APPROACH, SPECIFICALLY FULL
MATCHING.
AND TO JUST GIVE A SENSE FOR HOW
TO THINK ABOUT THIS, THE WAY
MATCHING APPROACH WORKS, IT
TAKES EXPOSURE GROUP OF
INTEREST, LET'S SAY DELIVERIES
THAT ARE POSITIVE FOR
SARS-COV-2, AT THE TIME OF
DELIVERY, AND THEN FOR THAT
GROUP COLLECTS A GROUP OF
COMPARISON DELIVERIES THAT HAVE
IN ALL POSSIBLE WAYS THE SAME
COVARIATE DISTRIBUTION AS THAT
EXPOSED GROUP.
WE MIGHT DRAW A MATCHED GROUP
FROM AMONG THE 2020 BIRTHS, BUT
THOSE THAT DID NOT HAVE A
COVID-19 INFECTION.
AND THEN ONCE WE DO THIS
MATCHING WE BALANCE THE
COVARIATES BETWEEN THE TWO
GROUPS, MAKING THEM COMPARABLE
WITH RESPECT TO WHAT THE
COVARIATES WE'VE MEASURED, AND
CAN COMPARE THE OUTCOMES BETWEEN
THESE TWO GROUPS.
WE DID THESE ANALYSES FOR
CALIFORNIA OVERALL, AND THEN
ALSO STRATIFIED BY RACIAL/ETHNIC
GROUPS, CONTROLLED FOR
COVARIATES AVAILABLE,
ADMINISTRATIVE DATA, AS WELL AS
LARGE SET OF NEIGHBORHOOD OR
COMMUNITY LEVEL COVARIATES.
SO HERE ARE SOME FINDINGS,
YOU'LL SEE LONG THE Y-AXIS
BURDEN OR PREVALENCE OF EACH OF
THESE OUTCOMES, ALONG THE X-AXIS
YOU CAN SEE DIFFERENT OUTCOMES
THAT WE EXAMINED.
AND SO THE WAY TO INTERPRET THIS
PLOT IS THE COLORED-IN CIRCLES
ARE THE BURDEN OF EACH OUTCOME
IN THE GROUP THAT WAS SARS-COV-2
POSITIVE AT DELIVERY, AND OPEN
CIRCLES ARE MATCHED COMPARISON
GROUP THAT CORRESPOND TO THAT
INFECTION GROUP, SO THAT'S AMONG
DELIVERIES THAT TOOK PLACE IN
2020 BUT WERE NOT INFECTED.
DIFFERENCE BETWEEN THESE TWO
GIVES AN ESTIMATE OF THE EFFECT
OF SARS-COV-2 INFECTION ON EACH
OF THESE OUTCOMES.
FOR EXAMPLE, IF WE PULL OUT THE
SMM OUTCOME AMONG SARS-COV-2
POSITIVE MOTHERS OR BIRTH
PARENTS THERE'S A 5% BURDEN OF
SMM, MATCHED COMPARISON GROUPED
WITH NO INFECTION THERE'S ONLY
2.3% BURDEN OF SMM, THEY GIVES A
SENSE OF A VERY LARGE DIFFERENCE
CONNECTED TO INDIVIDUAL
INFECTION AND WE TAKE THE
DIFFERENCE TO GET OUR ESTIMATES
FOR THE EFFECT OF SARS-COV-2 ON
OUTCOMES.
YOU CAN SEE THERE'S SUBSTANTIAL
ASSOCIATIONS BETWEEN SARS-COV-2
INFECTION AND A RANGE OF BOTH
MATERNAL AND INFANT OUTCOMES
THAT ARE CERTAINLY OF CONCERN.
RACIAL ETHNIC DISPARITIES I'LL
FOCUS ON SMM, ON THE OUTCOME,
NOW THE Y-AXIS IS JUST THE
BURDEN OF PREVALENCE, AND THE
X-AXIS IS EACH OF RACIAL/ETHNIC
GROUPS AS BEFORE THE COLORED-IN
CIRCLES ARE BURDEN AMONG THOSE
WITH INFECTION AT DELIVERY, OPEN
CIRCLES ARE THE ESTIMATE IT'S
BURDEN OF OUTCOME IN ABSENCE OF
INFECTION, AS COMING FROM
MATCHED GROUP OF MOTHERS AND
BIRTH PARENTS WHO DID NOT HAVE
INFECTION AT DELIVERY BUT WERE
DELIVERING IN 2020.
YOU CAN SEE DRAMATICALLY LARGE
DIFFERENCE HERE BETWEEN MOTHERS
AND BIRTH PARENTS, SO WE TAKE
THE DIFFERENCE TO GET OUR
ESTIMATES, AND CONSISTENT WITH
THE LAST PLOT YOU CAN SEE
SUBSTANTIALLY HIGHER ASSOCIATION
BETWEEN SARS-COV-2 INFECTION AND
SMM AMONG OUR BLACK MOTHERS AND
BIRTH PARENTS.
WE SHIFT TO JUST LOOKING AT
PANDEMIC PERIOD SEPARATE FROM
INFECTION.
THESE ARE DELIVERIES IN 2020 WHO
DID NOT HAVE A SARS-COV-2
INFECTION RECORDED AS COMPARED
TO DELIVERIES IN 2019, THAT TWO
TYPES OF DOTS DEPICTS THE SAME
THING.
YOU CAN SEE ACROSS THE BOARD
MOST OF THESE ARE VERY CLOSE TO
EACH OTHER INDICATING NOT MUCH
DIFFERENCE AT THE PANDEMIC
PERIOD IN CONNECTION WITH
OUTCOMES WITH EXCEPTION OF
GESTATIONAL DIABETES WHERE WE DO
IN FACT SEE AN ELEVATION IN
GESTATIONAL DIABETES FOR THE
DELIVERIES THAT ARE IN 2020, AS
COMPARED TO SIMILAR MATCHED
COMPARISON DELIVERIES IN 2019.
SO TO WRAP UP, WE FOUND
SUBSTANTIAL NEGATIVE EFFECTS OF
SARS-COV-2 INFECTION AT DELIVERY
ACROSS WIDE RANGE OF OUTCOMES.
THESE ARE LARGE ASSOCIATIONS AND
THEY ARE SUBSTANTIALLY DIFFERENT
EFFECTS BY RACE/ETHNICITY.
THE PANDEMIC PERIOD SEEMS TO BE
ASSOCIATE BE ASSOCIATE WITH
GESTATIONAL DIABETES.
WE JUST STARTED LIPPING DATA TO
ALLOW US TO LOOK O LOOK AT SHIFG
PANDEMIC CONDITIONS.
THANKS FOR YOUR ATTENTION.
>>THANK YOU FOR THE
PRESENTATION.
NEXT PRESENTATION WE WOULD LIKE
TO WELCOME JEANNE ALHUSEN,
PSYCHOSOCIAL STRESS AND ITS
RELATION TO MATERNAL AND INFANT
OUTCOMES AMONG PERSONS WITH
DISABILITIES.
YOU HAVE THE FLOOR.
>>GOOD AFTERNOON.
I'M DELIGHTED TO BE HERE AND
HAVE ENJOYED LEARNING FROM MY
COLLEAGUES.
THE FOCUS OF MY TALK WILL BE ON
PSYCHOSOCIAL STRESS AND ITS
RELATION TO MATERNAL AND INFANT
OUTCOMES AMONG PERSONS WITH
DISABILITIES.
I HAVE NO CONFLICTS TO DISCLOSE,
I'M GRATEFUL FOR FUNDING FROM
NIH SPECIFICALLY NICHD,
THROUGHOUT THIS PRESENTATION I
DO USE PERSON FIRST AND IDENTITY
FIRST LANGUAGE RECOGNIZING THAT
THERE ARE VARIED PREFERENCES IN
DISABILITY COMMUNITY, AND
MAJORITY OF RESEARCH IN THIS
AREA FOCUSES ON PREGNANT WOMEN
YET WE DO ACKNOWLEDGE THAT NOT
ALL PREGNANT PERSONS ARE WOMEN.
I'D LIKE TO ACKNOWLEDGE THE
SUPPORT OF COLLEAGUES AND
COMMUNITY ADVISORY BOARD
MEMBERS.
SO IN THE UNITED STATES, NEARLY
12 TO 13% OF PERSONS OF CHILD
BEARING AGE HAVE SOME TYPE OF
DISABILITY.
YET WE KNOW THAT PERSONS WITH
DISABILITIES OFTEN ENCOUNTER
SIGNIFICANT BARRIERS WHEN
ACCESSING SEXUAL AND
REPRODUCTIVE HEALTH SERVICES.
OFTEN VIEWED AS ASEXUAL WITH A
LONG HISTORY OF STERILIZATION,
UNDER THE NOTION OF PROTECTING
THEM FROM PREGNANCY OR SEXUAL
ABUSE.
WHILE RELATIVELY LIMITED,
RESEARCH DOES SUGGEST THAT
PREGNANT AND BIRTHING PERSONS
ARE AT AN INCREASED RISK FOR
MORBIDITY AND MORTALITY, FOR A
NUMBER OF REASONS, INCLUDING
INEQUITIES AND EDUCATIONAL AND
SUBSEQUENTLY EMPLOYMENT
OPPORTUNITIES, ACROSS BOTH
HEALTH CARE PROVIDER AND SYSTEM
LEVELS, THEY FACE BARRIERS TO
CARE, AND FINALLY FOR THE
AFOREMENTIONED REASONS ARE AT
ELEVATED RISK OF PSYCHOSOCIAL
STRESS COMPARED TO THOSE WITHOUT
DISABILITIES.
AND PSYCHOSOCIAL STRESS FOR THE
PURPOSE OF THIS PRESENTATION IS
FOCUSED ON INTIMATE PARTNER
VIOLENCE, IPV, AND DEPRESSION.
BRIEFLY, THIS ONGOING STUDY IS A
MIXED METHOD EXAMINATION OF
PSYCHOSOCIAL STRESS AND BIRTH
OUTCOMES AMONG RESPONDENTS WITH
A DISABILITY.
FOR QUANTITATIVE AIMS WE'RE
USING PRAMS DATA, A
POPULATION-BASED SURVEILLANCE
SYSTEM THAT COLLECTS DATA FROM
THE TIME BOTH BEFORE, DURING,
AND SHORTLY AFTER PREGNANCY,
AMONG PERSONS WHO HAD A RECENT
LIVE BIRTH.
PRAMS COLLECTS INFORMATION ON
ACCESS TO TO HEALTH CARE, VARIS
BEHAVIORS.
IN 2018 THROUGH COLLABORATION
WITH NIH AND CDC, QUESTIONS
SPECIFIC TO DISABILITY WERE
ADDED AS AN OPTIONAL
QUESTIONNAIRE THAT STATES COULD
OPT INTO.
THERE WAS A RECOGNITION THAT A
BETTER UNDERSTANDING OF
PREGNANCY, DELIVERY, AND
POSTPARTUM EXPERIENCES OF
DISABLED WOMEN WAS NEEDED, AS
WELL AS INFORMATION ON HOW THESE
EXPERIENCES COMPARE TO THOSE OF
NON-DISABLED WOMEN.
DISABILITY QUESTIONNAIRE
SUPPLEMENT CONSISTS OF
WASHINGTON GROUP SHORT SET OF
QUESTIONS ON DISABILITY, AND
THAT'S BEEN USED IN OTHER
FEDERAL AND FRANKLY GLOBAL
SURVEYS.
THESE QUESTIONS ARE BASED ON
W.H.O.'S INTERNATIONAL
CLASSIFICATION OF FUNCTIONING
DISABILITY AND HEALTH.
AND PROVIDE US WITH STANDARDIZED
LANGUAGE AS WELL AS A FRAMEWORK
FOR HOW WE OPERATIONALIZE
DISABILITY.
SO THESE QUESTIONS AND THERE'S
SIX, WERE ASKED IN 24 STATES,
DURING THIS TIME FRAME OF
ANALYSIS, SOME STATES ACTUALLY
DISCONTINUED USING THEM, WHILE A
FEW OTHER STATES BEGAN USING
THEM.
THE MAJORITY OF PARTICIPATING
STATES DO ASK QUESTIONS SPECIFIC
TO PHYSICAL VIOLENCE, WITH FAR
FEWER STATES ASKING ABOUT
REPRODUCTIVE COERCION.
AND THE EQUAL INDICATIVE AIM
INCLUDES INTERVIEWS WITH PERSONS
WITH DISABILITY EITHER PREGNANT
OR HAVE GIVEN BIRTH IN THE LAST
TWO YEARS AND HAVE EXPERIENCED
VIOLENCE OR MENTAL HEALTH
CONCERNS.
SO WE'VE RECENTLY PUBLISHED
THREE PAPERS STEMMING FROM THIS
ANALYSIS AROUND ASPECTS OF
REPRODUCTIVE COERCION, IPV, AND
DEPRESSION.
I'LL BRIEFLY WALK THROUGH THOSE
WITH REGARDS TO VIOLENCE BEFORE
PREGNANCY, IN THE 12 MONTHS
BEFORE PREGNANCY OR DURING
PREGNANCY, WE ANALYZED DATA FROM
JUST SHY OF 75,000 RESPONDENTS.
THE QUESTIONS WILL DIFFICULTY IN
VISION, HEARING, AMBULATION,
COGNITION, COMMUNICATION,
SELF-CARE.
WITH THE OUTCOME BEING PERINATAL
IPV, DEFINED AS EXPERIENCING
ABUSE BY A CURRENT OR EX-PARTNER
IN THE YEAR BEFORE OR DURING
PREGNANCY.
SO IN ADJUSTED ADJUSTED MODELS
RESPONDENTS HAD 2.6 TIMES THE
ODDS BEFORE PREGNANCY, 2.5 TIMES
ODDS OF EXPERIENCING IPV DURING
PREGNANCY AS COMPARED TO THOSE
WITHOUT DISABILITIES.
SPECIFIC TO DEPRESSIVE SYMPTOMS
WE FOUND DEPRESSIVE SYMPTOMS
WERE SIGNIFICANTLY HIGHER IN
RESPONDENTS WITH DISABILITY
COMPARED TO THOSE WITHOUT, WITH
43% OF RESPONDENTS WITH
DISABILITY REPORTING SYMPTOMS
DURING PREGNANCY, AND A THIRD
REPORTING SYMPTOMS IN THE
POSTPARTUM PERIOD.
FULLY ADJUSTED MODELS THOSE
RESPONDENTS WITH DISABILITY WITH
NEARLY 2 1/2 TIMES AS LIKELY AS
THOSE WITHOUT TO REPORT
DEPRESSIVE SYMPTOMS.
WE WANTED TO LOOK CLOSER AT
REPRODUCTIVE COERCION AS OUR
PREVIOUS WORK SUGGESTS, PREVIOUS
WORK AND CERTAINLY WORK OF
OTHERS, SUGGESTS THAT PERSONS
WITH DISABILITIES EXPERIENCE
UNIQUE FORMS OF ABUSE IN
ADDITION TO THE KIND OF MORE
TRADITIONAL MEASURES IN
POPULATION-BASED SURVEYS.
UNFORTUNATELY IN PRAMS ONLY THE
STATE OF MASSACHUSETTS COLLECT,
DATA ON BOTH DISABILITY AND
REPRODUCTIVE COERCION.
WE REALLY COULDN'T DO FULLY
ADJUSTED MODELS DUE TO LIMITS IN
BOTH SAMPLE SIZE AND THUS MODEL
STABILITY.
PRELIMINARY LOOKS SUGGEST THAT
RESPONDENTS WITH DISABILITIES
ARE FOUR TIMES MORE LIKELY TO
EXPERIENCE REPRODUCTIVE COERCION
THAN WITHOUT, SOMETHING WE'RE
EXPLORING AND CONFIRMING WHAT
WE'RE SEEING HERE.
PART OF THE CURRENT SUPPLEMENT
DELVING DEEPER INTO HOW COVID-19
MAY BE AFFECTING THE MENTAL
HEALTH OF PERSONS WITH
DISABILITIES, AND THUS FAR HAVE
CONDUCTED 16 IN-DEPTH INTERVIEWS
WITH ANALYSES CENTERED ON THREE
THEMES, NAMELY ISOLATION DUE TO
COVID-19, ANXIETY DUE TO
COVID-RELATED CHAOS, DIMINISHED
ACCESS TO CARE DUE TO COVID-19.
SO WITH REGARDS TO ISOLATION,
RESPONDENTS TALKED ABOUT HOW
ISOLATION WAS MAGNIFIED DUE TO
THE PANDEMIC.
REALLY IN WAYS THAT WERE UNIQUE
FOR PERSONS WITH DISABILITIES.
THAT MANY HAD HEALTH CONCERNS
THAT PRECLUDED THEM OR THEIR
INFANTS FROM BEING IN SOCIAL
SITUATIONS, EVEN IF ADHERING TO
THE RECOMMENDED PRECAUTIONS.
ANXIETY WAS HEIGHTENED OBVIOUSLY
DURING THIS TIME FOR A NUMBER OF
REASONS.
FOR SOME, COVID PRECAUTIONS
INTERFERED WITH BASIC
ACCOMMODATION NEEDS SUCH AS
LIPREADING, HAVING AN
INTERPRETER IN THE ROOM, NOT
HAVING A SUPPORT PERSON WITH
THEM WHICH WE HEARD IN A PRIOR
PRESENTATION.
AND FOR THESE, YOU KNOW,
PREGNANT AND BIRTHING PERSONS IT
WAS MOST OFTEN A PARTNER OR
SPOUSE WHO THEY NEEDED THERE.
ONE RESPONDENT TALKED ABOUT
GIVING BIRTH WITH A NURSE AND
SHE PASSING A CLIPBOARD TO
COMMUNICATE DURING THE LABOR
PROCESS BECAUSE THEY DIDN'T
ALLOW AN INTERPRETER IN THE
ROOM.
IT'S NOT HARD FOR ANY ONE OF US
TO IMAGINE HOW STRESSFUL THAT
COULD BE.
AND RESPONDENTS DISCUSSED
DIMINISHED ACCESS TO CARE DUE TO
COVID, INCLUDING LACK OF
CRITICAL SUPPORTS, WHETHER IT BE
PHYSICAL THERAPY OR LACTATION
CONSULTANT OR EVEN REGULAR
PRENATAL CARE WHERE VIRTUAL
APPOINTMENTS WERE EITHER NOT
ACCESSIBLE OR LACKING.
AND ALL OF THESE BARRIERS
CONTRIBUTING TO INCREASED MENTAL
HEALTH CONCERNS AS WELL AS
DIMINISHED OPPORTUNITIES TO BOTH
SCREEN AND INTERVENE ON THESE
RISKS AND THE SECOND EXEMPLAR
FROM A QUADRIPLEGIC MEMBER
OFFERED VIRTUAL LACTATION
SUPPORT, NOT HELPFUL BECAUSE AS
A QUADRIPLEGIC SHE NEEDED
SOMEONE WHO COULD BE HANDS-ON
AND SO DESPITE HER GREAT DESIRE
TO BREASTFEED THAT WAS NOT
SOMETHING SHE COULD CONSIDER.
TAKEN TOGETHER WE KNOW
PSYCHOSOCIAL STRESS INCREASES
MATERNAL, FETAL, INFANT RISKS
FOR ADVERSE OUTCOMES.
AND WE'VE SHOWN RESPONDENTS WITH
DISABILITIES ARE AT INCREASED
RISK, WHILE SCREENING FOR THESE
RISKS IS AN IMPORTANT FIRST STEP
WE REALLY NEED TO BETTER
UNDERSTAND THE UNIQUE RISKS AND
BARRIERS THAT EXIST FOR OUR
DISABLED RESPONDENTS AT
INDIVIDUAL LEVEL, SYSTEM LEVEL,
HEALTH CARE AND EVEN SOCIETAL
LEVEL IF WE'RE TRULY COMMITTED
TO REDUCING INEQUITIES AMONG
PERSONS WITH DISABILITIES.
SO THE REFERENCES ARE SHOWN
HERE, AND I THANK YOU FOR YOUR
TIME AND THE OPPORTUNITY TO
SHARE OUR TEAM'S WORK.
>>THANK YOU FOR YOUR
PRESENTATION.
WE WANT TO REMIND THE AUDIENCE
TO SUBMIT QUESTIONS THROUGH THE
"SEND LIVE FEEDBACK" ON THE
VIDEOCAST AND QUESTION WILL BE
DISCUSSED DURING THE Q&A
SECTION.
NOW I WOULD LIKE TO MOVE TO OUR
LAST PRESENTATION OF THIS
SESSION, AND WOULD LIKE TO
WELCOME DR. MICHELLE LEVINE, A
CLINICAL LICENSED PSYCHOLOGY AND
PROFESSOR OF PSYCHIATRY AT
UNIVERSITY OF PITTSBURGH.
YOU HAVE THE FLOOR.
>>THANK YOU.
I'M EXCITED TO JOIN YOU ALL
TODAY AND GRATEFUL FOR THE
OPPORTUNITY TO TALK ABOUT OUR
WORK WHICH IS HOPEFULLY SHOWING
ON YOUR SCREEN RIGHT NOW.
I'M GOING TO TALK A BIT ABOUT
RELATIONSHIP BETWEEN EATING
BEHAVIORS, PSYCHOLOGICAL
DISTRESS, FOOD INSECURITY,
EXPERIENCES OF DISCRIMINATION
AMONG PREGNANT PEOPLE AT HIGH
RISK FOR CARDIOVASCULAR DISEASE
AND ONGOING WORK.
TO START I WANTED TO START WITH
A DEFINITION OF EATING BEHAVIOR
WE FOCUSED ON, LOSS OF CONTROL
EATING, MOST BASIC SENSE LOSS OF
CONTROL EATING CAN BE LIKENED TO
BINGE EATING LIKE BULIMIA, THE
SENSE OF BEING UNABLE TO CONTROL
AMOUNT OR QUANTITY OR QUALITY OF
FOOD EATEN ASSOCIATED WITH
HIGHER CALORIE INTAKE AND MORE
FREQUENT EPISODES OF OVEREATING,
ALSO DEPRESSIVE SYMPTOMS AND
EXPERIENCE OF PSYCHOLOGICAL
DISTRESS.
ONE OF THE REASONS WE'VE BEEN
INTERESTED IN IT IN PREGNANCY IS
BECAUSE IT'S THE MOST COMMON
EATING DISORDERED BEHAVIOR
OBSERVED IN PREGNANT PEOPLE AND
DOES NOT IMPROVE OVER THE COURSE
OF PREGNANCY UNLIKE OTHER EATING
DISORDERED BEHAVIORS.
MOST IMPORTANTLY, DURING
PREGNANCY WE'VE SHOWN THAT THIS
EATING BEHAVIOR LOSS OF CONTROL
PREDICTING POOR CARDIOVASCULAR
HEALTH AND POOR PSYCHOLOGICAL
HEALTH.
ANOTHER CONSTRUCT THAT'S
IMPORTANT TO THIS TOPIC
MENTIONED OTHER TIMES TODAY IS
THE CONSTRUCT OF FOOD
INSECURITY, WHICH YOU KNOW IS
HAVING LIMITED OR UNCERTAIN
ACCESS TO SUFFICIENT FOODS FOR A
HEALTHY AND ACTIVE LIFESTYLE.
I PUT THE RUBRIC IN THE TOP
RIGHT CORNER TO REMIND MYSELF
AND ALL OF US THAT FOOD
INSECURITY REFLECTS NOT JUST THE
PROBLEMS WITH ACCESS TO FOODS OF
HIGH QUALITY OR ENOUGH QUANTITY
BUT THAT IT ALSO HAS
PSYCHOLOGICAL AND PSYCHOSOCIAL
IMPLICATIONS AS WELL.
RATES OF FOOD SECURITY ARE
HIGHER IN PREGNANT POPULATIONS
THAN GENERAL POPULATION, RANGING
BETWEEN 15 AND AS HIGH AS 37%.
IN PREGNANT POPULATIONS
AND ON AVERAGE 12%.
FOOD INSECURITY IS ASSOCIATED
WITH NUMEROUS ADVERSE PRENATAL
LET OUTCOMES INCLUDING
PSYCHOLOGICAL YOU OUTCOMES AS
WELL AS SIMILAR MEDICAL
OUTCOMES.
WE'VE BEEN INTERESTED IN TRYING
TO PUT THESE THINGS TOGETHER,
LOSS OF CONTROL OVER EATING,
FOOD INSECURITY, CONSTRUCT OF
STRUCTURAL RACISM AND
DISCRIMINATION FOR OBVIOUS
REASONS DURING THE PANDEMIC, WE
WERE INTERESTED IN UNDERSTANDING
THESE EXPERIENCES BECAUSE AS WE
KNOW THE PANDEMIC AFFECTED
WELL-BEING IN PERINATAL
POPULATIONS AND PARTICULARLY
THOSE FROM HISTORICALLY
MARGINALIZED GROUPS.
WE ALSO IS A THE PANDEMIC
AFFECTED EATING BEHAVIOR SO
THERE'S GOOD EVIDENCE THAT RATES
OF FRANK EATING DISORDERS
INCREASED DURING THE PANDEMIC,
LARGELY EVIDENCE COMES FROM
STUDIES OF YOUNGER PEOPLE
DIAGNOSED WITH EATING DISORDERS
AND WE CAN REMEMBER THE PANDEMIC
WAS ASSOCIATED WITH LOTS OF
PROBLEMS WITH FOOD ACCESS.
FOOD INSECURITY ITSELF AND
EXPERIENCES OF DISCRIMINATION
HAVE BEEN WELL LINKED TO
PSYCHOLOGICAL DISTRESS OUTSIDE
OF PREGNANCY SO WITH THE HELP OF
THE IMPROVE INITIATIVE WE SOUGHT
TO ANSWER TWO QUESTIONS.
ONE WAS DID THE PANDEMIC AFFECT
PRENATAL LOSS OF CONTROL EATING,
EATING DISORDER BEHAVIOR RELATED
TO HEALTH AND PSYCHOLOGICAL
HEALTH, AND YOU WHO DID IT
AFFECT PSYCHOLOGICAL HEALTH IN
GENERAL.
TWO, HOW WAS FOOD INSECURITY AND
EXPERIENCES OF DISCRIMINATION
RELATED TO PRENATAL LOSS OF
CONTROL AND PSYCHOLOGICAL
DISTRESS.
WE DID THAT BY ADDING MEASURES
TO A RANDOMIZED TRIAL, A RUBRIC
SHOWN HERE.
TODAY I'LL TALK ABOUT DATA
COLLECTED PRIOR TO FIRST
RANDOMIZATION.
SO WE'RE IN THE MIDDLE OF
STUDYING A GROUP OF PREGNANT
INDIVIDUALS WITH PRE-PREGNANCY
BMIs ABOVE 25, HIGHER
LONG-TERM CARDIOVASCULAR HEALTH
RISK, AND FOCUSING ON PERIOD
PRIOR TO THE FIRST
RANDOMIZATION, YOU CAN IGNORE
THE COMPLICATED MULTIPLE
RANDOMIZATION SCHEME THAT
HAPPENED.
WE ADDED THE TWO MEASURES IN THE
BOTTOM, USDA HOUSEHOLD FOOD
INSTITUTER MEASURES AS WELL AS
MAJOR EXPERIENCES OF
DISCRIMINATION MEASURE, TO THIS
ONGOING FILE ALREADY ASSESSING
LOSS OF CONTROL OF EATING USING
A QUESTIONNAIRE BASED MEASURE
AND PERCEIVED STRESS SCALES.
WE COMPARED PREGNANT PEOPLE
ASSESS THE BEFORE AND AFTER THE
PANDEMIC, YOU'LL NOTE WE JUST
USED THE TIME IN MARCH 2020 AS
THE ONSET OF THE PANDEMIC FOR
THESE COMPARISONS AND OBVIOUSLY
HAD A LARGER SAMPLE PRIOR TO THE
PANDEMIC THAN AFTER.
WE EVALUATED THE RELATIONSHIPS
BETWEEN LOSS OF CONTROL AND OUR
TWO MEASURES OF PSYCHOLOGICAL
DISSUPPRESS -- DISTRESS.
IN THE WHOLE SAMPLE OF 312 YOU
CAN SEE WE HAD PREGNANT PEOPLE
AROUND 31 YEARS OF AGE,
ASSESSING THEM EARLY IN
PREGNANCY JUST AFTER THE END OF
THE FIRST TRIMESTER AT 13 1/2
WEEKS, YOU CAN SEE THE REST OF
PRENATAL CHARACTERISTICS HERE
INCLUDING THE FACT IN MOST CASES
THE PREGNANCY WAS INTENTIONAL,
THEY HAD MODERATE LEVEL OF
HOUSEHOLD INCOME ON AVERAGE, AND
HERE YOU CAN SEE RACIAL AND
ETHNIC BREAK DOWN OF THE SAMPLE.
68.5 IDENTIFIED AS WHITE, ABOUT
A QUARTER AS BLACK OR AFRICAN
AMERICAN, AND JUST UNDER 5% AS
HISPANIC OR LATINA.
WHAT DID WE FIND?
IN TERMS OF PRE AND POST
PANDEMIC WE DID SEE A
RELATIONSHIP BETWEEN THE
PANDEMIC AND EXPERIENCE OF LOSS
OF CONTROL OVER EATING, PRIOR TO
THE PANDEMIC ON THE LEFT PART
30% OF THE SAMPLE ENDORSED LOSS
OF CONTROL OVER EATING, AFTER
THE PANDEMIC IT WAS ABOUT 42.5%
REPORTED AT LEAST ONE EPISODE OF
LOSS OF CONTROL OVER EATING IN
THE PAST MONTH.
HOWEVER WE DIDN'T SEE WHAT WE
EXPECTED, WHICH WAS A CHANGE IN
THE PSYCHOSOCIAL CORRELATES OF
THE PANDEMIC, RATES OF STRESS
AND PERCEIVED STRESS AND
DEPRESSIVE SYMPTOMS DID NOT
INCREASE PRE-TO POST-PANDEMIC.
WE FOUND THAT 25% OF OUR
PARTICIPANTS REPORTED SOME LEVEL
OF FOOD INSECURITY.
WE MADE THE DECISION TO CONSIDER
EVEN A MARGINAL LEVEL OF FOOD
INSECURITY AS FOOD INSECURITY
AND COMPARE THEM TO THE 75%
IDENTIFIED AS FOOD SECURE BASED
ON SOME DATA THAT SHOW EVEN
MARGINAL LEVEL OF FOOD
INSECURITY ASSOCIATED WITH
SIMILAR OUTCOMES AS THOSE OF
VERY LOW FOOD INSECURITY
INDIVIDUALS.
AND ABOUT HALF OF OUR GROUP
REPORTED AT LEAST ONE MAJOR
EXPERIENCE OF DISCRIMINATION IN
THEIR LIFETIME.
YOU CAN SEE ON THE RIGHT THE
HISTOGRAM OF THOSE AND THE
EXPERIENCES OF DISCRIMINATION
THAT WERE SPECIFICALLY RELATED
TO RACIAL REASONS HIGHLIGHTED IN
BLUE COLOR.
WE DID NOT AS EXPECTED FIND A
RELATIONSHIP BETWEEN FOOD
INSECURITY AND LOSS OF CONTROL.
AS YOU CAN SEE THOSE WHO
EXPERIENCED A LOSS OF CONTROL
AND THOSE WHO DID NOT REPORTED
SIMILAR LEVELS OF FOOD
INSECURITY, ABOUT 20% OF THOSE
WITH LOSS OF CONTROL REPORTED
FOOD INSECURITY PRENATALLY, AND
29% WHO DID NOT EXPERIENCE LOSS
OF CONTROL REPORTED FOOD
INSECURITY.
BUT WE DID FIND FOOD INSECURITY
RELATED TO PSYCHOLOGICAL
DISTRESS, MOST STRONGLY IN TERMS
OF DEPRESSIVE SYMPTOMS HIGHER IN
THE FOOD INSECURITY GROUP THAN
FOOD SECURE.
RATES OF PERCEIVED STRESS HIGHER
IN FOOD INSECURE GROUP,
DIFFERENCE WAS NOT SIGNIFICANT.
AND FINALLY WE FOUND
SURPRISINGLY AND HAPPY TO TALK
ABOUT IT BECAUSE I DON'T KNOW
WHAT IT MEANS THE EXPERIENCE OF
DISCRIMINATION WAS RELATED TO
LOSS OF CONTROL BUT NOT IN THE
DIRECTION WE MIGHT HAVE
HYPOTHESIZED.
WE FOUND THOSE WHO REPORTED A
LOSS OF CONTROL EXPERIENCE IN
THE LAST MONTH HAD FEWER
LIFETIME EXPERIENCES OF
DISCRIMINATION THAN DID THOSE
WHO DID NOT REPORT LOSS OF
CONTROL.
WE DID NOT, HOWEVER, SEE
ASSOCIATION BETWEEN EXPERIENCES
OF DISCRIMINATION AND OUR TWO
MEASURES OF PSYCHOLOGICAL
DISTRESS.
IN TRYING TO PUT IT TOGETHER WE
FIRST WANTED TO SEE IF THE
PANDEMIC AFFECTED LOSS OF
CONTROL, THIS EATING DISORDER
BEHAVIOR, AND PSYCHOLOGICAL
DISTRESS.
RATES OF LOSS OF CONTROL AMONG
AMONG
PREGNANT PEOPLE WERE INCREASED
AFTER THE ONSET OF THE PANDEMIC,
BUT RATES OF PSYCHOLOGICAL
DISTRESS DID NOT INCREASE.
ONE IDEA ABOUT THAT IS THAT WE
JUST OPERATIONALIZE THE ONSET OF
THE PANDEMIC BY THE DATE AND CAN
ALL REMEMBER THAT THE ACUTE
MOMENTS OF THE PANDEMIC WERE
DIFFERENT THAN THE SORT OF
LINGERING MOMENTS AND SO IT
MIGHT BE OUR MEASURES OF
PSYCHOLOGICAL DISTRESS WERE
DIFFERENT AMONG THE GROUP
SAMPLED EARLIER ON THAN LATER ON
IN THE PANDEMIC.
WE ALSO FOUND CONSISTENT WITH
PRIOR RESEARCH THAT PREGNANT
PEOPLE WHO HAD SOME LEVEL OF
FOOD INSECURITY ENDORSED MORE
SYMPTOMS IN HIGHER LEVELS OF
PERCEIVED ALTHOUGH NO
RELATIONSHIP BETWEEN FOOD
INSECURITY AND LOSS OF CONTROL
AND RELATIONSHIP BETWEEN FOOD
INSECURITY AND PERCEIVED STRESS
WAS NOT STATISTICALLY
SIGNIFICANT.
THERE ARE INTERESTING
MEASUREMENT ISSUES WITH FOOD
INSECURITY AND EATING BEHAVIORS
IN PREGNANCY.
CHRISTINE CALL IN OUR LAB IS
PURSUING THESE QUESTIONS.
LOOK OUT FOR WORK FROM HER IN
THE FUTURE, TRYING TO UNDERSTAND
PROXIMAL RELATIONSHIPS BETWEEN
FOOD INSECURITY AND EATING
PREGNANCY SINCE WE MEASURE USING
USDA MEASURE ON THE GROWTH
LEVEL.
WE ALSO THINK THERE MIGHT BE
OTHER EATING BEHAVIORS LIKE A
MORE RESTRICTIVE STYLE WHERE
CALORIES ARE FEWER THAT MIGHT BE
RELATED TO FOOD INSECURITY AND
PREGNANCY AND DIDN'T LOOK AT
THAT IN THIS SAMPLE.
IT'S POSSIBLE SCREENING FOR
IMPROVING DURING PREGNANCY MAY
HAVE A RELATIONSHIP TO THE
EXPERIENCE OF PRENATAL
DEPRESSION.
FINALLY EXPERIENCES OF
DISCRIMINATION WERE RELATED TO
LOSS OF CONTROL IN THE OPPOSITE
DIRECTION THAN WE HYPOTHESIZED.
IT'S POSSIBLE MEASURING
DISCRIMINATION IN A PROXIMAL
LEVEL, MORE PROXIMAL EXPERIENCE
AS OTHER TALKED ABOUT MIGHT HAVE
A GREATER IMPACT ON PRENATAL
MENTAL HEALTH.
I WANTED TO END WITH THANKING
THE MEMBERS OF OUR LAB AND
PARTICULARLY CHRISTINE CALL,
WHOSE WORK I MENTIONED, DR.
RACHEL CONLON AND CLAUDIA.
>>THANK YOU FOR YOUR WONDERFUL
PRESENTATIONS.
NOW WE'LL START ENTERING THE Q&A
DISCUSSION
QUESTIONS.
ANY QUESTIONS FROM THE AUDIENCE?
I HAVE A GENERAL QUESTION I
WANTED TO ASK EVERYBODY ON THE
PANEL.
SO RESEARCH INDICATES COVID-19
PANDEMIC HAS DETRIMENTAL TO
PERINATAL HEALTH ESPECIALLY FOR
HISTORICAL DISADVANTAGED GROUPS.
ARE THERE ANY LESSONS LEARNED
FROM THE PANDEMIC THAT WE CAN
USE TO IMPROVE MATERNAL AND
INFANT OUTCOMES?
>>I'M HAPPY TO START.
I DIDN'T PRESENT THE DATA
SPECIFIC TO DISABLED WOMEN OF
COLOR, THIS NOTION OF
INTERSECTIONALITY, AND HOW
MAGNIFIED THEIR RISK FOR ADVERSE
OUTCOMES IS.
A TERM I CONTINUED TO HEAR IN
INTERVIEWS FOR PREGNANT OR
BIRTHING MOTHERS OF COLOR
DISABLED IS DOUBLE JEOPARDY, AT
LEAST SIX OR SEVEN PARTICIPANTS
HAVE TALKED ABOUT THIS, AND WHAT
THEY ARE TALKING ABOUT IS FOR
INSTANCE JUST LAST WEEK, A WOMAN
WHO HAD GIVEN BIRTH TAIL END OF
2020 TALKED ABOUT NOT WANTING TO
LIFT THE BABY OUT OF THE
BASSINET IN THE HOSPITAL ROOM
FOR FEAR OF DROPPING IT.
THIS IS A WOMAN WITH A PHYSICAL
DISABILITY AND HAS DIMINISHED
STRENGTH IN UPPER EXTREMITIES.
I ASKED MORE ABOUT THAT.
SHE SAID FIRST YOU'RE JUDGED FOR
BEING BLACK AND PREGNANT.
AND I SHOULD SAY THIS WOMAN GAVE
BIRTH AT A FACILITY NOT FAR FROM
WHERE I AM IN VIRGINIA.
SHE SAID THEN YOU ADD THE
DISABILITY PIECE ON IT, AND
THAT'S DOUBLE JEOPARDY FOR CPS
COMING TO TAKE MY CHILD AWAY.
I THINK INTERVENTION AS I
BRIEFLY ALLUDED TO NEED TO
HAPPEN ACROSS ALL LEVELS.
IT CAN'T JUST BE ONE OTHER
SPEAKER TALKED ABOUT AT THE
PROVIDER LEVEL.
I MEAN IT NEEDS TO BE SYSTEMS,
NEEDS TO BE POLICIES, NEEDS TO
BE ACCESS TO QUALITY AND NOT
JUST QUANTITY FOOD.
I THINK THERE ARE SO MANY THINGS
WE NEED TO DO IF WE TRULY ARE
COMMITTED TO REDUCING INEQUITIES
AMONG OUR MOST MARGINALIZED
GROUPS.
>>THANK YOU.
ANY OTHER INTERVENTION?
>>I CAN SPEAK TO, YOU KNOW, OUR
SORT OF BIG DATA APPROACH
DOESN'T ALLOW US TO DIG INTO THE
NUANCES SO GREAT TO SEE IN THE
OTHER PRESENTATIONS, BUT I DO
THINK WE KNOW SOME AT LEAST
ABOUT WHAT CAN BE DONE TO HELP
PREVENT RACIAL/ETHNIC
DISPARITIES IN THINGS LIKE SMM
WHERE HAVING SUPPORT, FOR
EXAMPLE, FROM A DOULA WHO CAN BE
THERE TO HELP SUPPORT THE MOTHER
AND COMMUNICATE WITH THE
PROVIDER AND MAKE SURE THE
MOTHER IS BEING HEARD ARE VERY
EFFECTIVE AND OBVIOUSLY I DIDN'T
LOOK AT THIS DIRECTLY IN MY WORK
BUT WE KNOW DURING THE PANDEMIC
PEOPLE WERE GIVING BIRTH ALONE
AND SO IT'S NOT PERHAPS
SURPRISING TO SEE THE
DISPARITIES AND DIFFERENTIAL
IMPACT ON BLACK MOTHERS, BUT TO
ME IT HIGHLIGHTS THE IMPORTANCE
OF -- INFECTION WAS ONE ASPECT
OF RISK BUT THERE ARE OTHER
ASPECTS, MAYBE GOING FORWARD HOW
TO BALANCE THAT IN A WAY THAT
DOESN'T LEAVE PEOPLE DELIVERING
ON THEIR OWN.
>>I WAS JUST GOING TO ADD, YOU
KNOW, SORT OF DATA THE
IMPORTANCE OF LINING ELEVATING
PEOPLE'S VOICES, ONE OF THE
THINGS WE'VE ALL LEARNED IN THIS
PANDEMIC OR I'VE LEARNED IN THE
PANDEMIC IS THAT THE WAY WE
MEASURE THINGS, CONCEPTUALIZE
THINGS, BASED HISTORICALLY ALSO
TOO AND THAT HISTORICALLY
MARGINALIZED GROUPS HAVE BEEN
UNDERREPRESENTED HISTORICALLY
AND SO WE NEED SOME SORT OF NEW
MEASURES AND I FEEL LIKE MY
UNDERSTANDING OF HOW DEPRESSION
OR THIS EATING BEHAVIOR THAT
WE'RE INTERESTED IN MIGHT BE
BASED ON SAMPLES OR MEASURES
DEVELOPED ON LARGELY WHITE
IDENTIFYING SAMPLES, SO THE NEED
TO TRANSLATE INTO BOTH OUR
RESEARCH AND OUR INTERVENTIONS.
>>WONDERFUL.
THANK YOU ALL.
WE HAVE A QUESTION FROM THE
AUDIENCE, ADDRESSING TO DR.
ALHUSEN, COULD THE MARRIAGE BE A
PROTECTIVE FACTOR?
>>I WANT TO MAKE SURE I
UNDERSTAND THE QUESTION.
HOW DID SOME MOTHERS WHO ARE
EXPERIENCING IPV NOT REPORT IT?
>>YES, DESPITE EXPERIENCE OF
DISABILITY.
YES.
HOW SOME MOTHERS DID NOT REPORT
IPV DESPITE EXPERIENCE OF
DISABILITY IN PANDEMIC.
AND THE QUESTION CONTINUES,
COULD THE MARRIAGE BE A
PROTECTIVE FACTOR?
>>SURE, I DON'T THINK THAT'S
UNIQUE FOR PERSONS WITH
DISABILITIES.
THERE ARE PLENTY OF HEALTHY
RELATIONSHIPS WITH PARTNERS OR
SPOUSES.
WE DO KNOW THAT PERSONS WITH
DISABILITY MAY BE LESS LIKELY,
WELL, THE PAPER IS FORTHCOMING,
BUT TO BE SCREENED FOR VIOLENCE.
WE'VE JUST FINISHED ANALYZING
THAT DATA BY HEALTH CARE
PROVIDERS AND I HEAR TO DR.
LEVINE'S POINT I HEAR FROM WOMEN
PROVIDERS WILL SAY THINGS LIKE
LOOK HOW GREAT HE IS FOR
STICKING NEXT TO YOU AFTER YOUR
SPINAL CORD INJURY, THEY JUST
DON'T EVEN ASK ABOUT VIOLENCE
BECAUSE IT'S VERY PATERNALISTIC
VIEW OF DISABILITY.
BUT JUST SO I'M CLEAR, THE
DISABILITY IN MY ANALYSES
PRECEDED VIOLENCE.
WE CERTAINLY KNOW VIOLENCE CAN
CAUSE DISABILITY BUT FOR
ELIGIBILITY THE DISABILITY
PRECEDED VIOLENCE, SO DISABILITY
IN AND OF ITSELF IS A RISK
FACTOR FOR VIOLENCE BUT THAT
DOESN'T MEAN EVERY DISABLED
PERSON EXPERIENCES VIOLENCE AND
I HOPE I ANSWERED THAT QUESTION.
>>THANK YOU FOR YOUR ANSWER.
I THINK THIS QUESTION WILL GO TO
DR. LEVINE.
IN THE LARGER TRIAL ARE YOU
EXAMINING LOSS OF CONTROL TO
FETAL OR INFANT OUTCOMES?
WHAT TYPE OF INTERVENTION
ADDRESS LOC IN PREGNANT PERSONS?
CAN I ANSWER THE SECOND FIRST?
IT'S MOST EXCITING TO ME AND
THANK YOU FOR THE QUESTION.
IT'S MOST EXCITING SINCE THERE
ARE LOTS OF INTERVENTIONS TO
ADDRESS LOSS OF CONTROL EATING,
MOIST COME FROM INDIVIDUALS WITH
FRANK EATING DISORDERS, WE'RE
FINDING THIS HIGH RATE IN
PRENATAL AND PERINATAL
POPULATIONS THAT AREN'T
NECESSARILY DIAGNOSED WITH AN
EATING DISORDER AND SO ONE OF
THE THINGS WE'RE REALLY HOPING
TO DO IF YOU COULD SEND GOOD
JUJU TO ANYBODY ON THE REVIEW
PANEL IS TO TRY TO DEVELOP
INTERVENTIONS SPECIFICALLY FOR
LOSS OF CONTROL OVER EATING IN
PREGNANCY BECAUSE THE FACT OF
PREGNANCY CHANGES THE
RELATIONSHIP TO FOOD, IT'S A
TIME OF UNEXPECTED WEIGHT GAIN,
ALSO MAY AFFECT NAUSEA, WHAT YOU
CAN AND CAN'T EAT.
WE'RE HOPING TO DO THAT BECAUSE
NONE EXISTS NOW.
FETAL AND INFANT OUTCOMES SADLY
NOT.
THE HEALTH OF THE MOM OR
POSTPARTUM PERSON AS THE
OUTCOME, BUT IT'S A REALLY
IMPORTANT POINT SO WE SHOULD DO
THAT.
>>THANK YOU SO MUCH.
NEXT QUESTION IS GOING TO DR.
AHERN.
YOUR RESULTS ARE DRAMATIC, I
ASSUME ANALYSIS WAS
POPULATION-WIDE, APPLYING CAUSAL
INFERENCE TECHNIQUES, CAN YOU
ASSIGN A CAUSAL INTERPRETATION
TO YOUR FINDINGS?
ARE THERE LIMITATIONS OR
ASSUMPTIONS NOT SATISFIED AND
WHICH PROHIBIT CAUSAL
INTERPRETATION?
I CAN READ SOME PORTION IF YOU
WANT TO.
>>GREAT.
THANK YOU FOR THAT QUESTION.
SO IN THIS ANALYSIS WE APPLIED A
MATCHING METHOD, IT WAS NOT G
COMPUTATION BUT MATCHING IS
OFTEN ALSO CONSIDERED, I GUESS A
CAUSAL INFERENCE TECHNIQUE.
I DON'T LOVE THAT PHRASE BECAUSE
IT CONFLATES STATISTICAL METHODS
WITH INTERPRETATION BEING CAUSAL
WHICH YOU DON'T GET TO SAY IS A
CAUSAL EFFECT JUST BECAUSE YOU
USED A CERTAINLY STATISTICAL
METHOD.
AND SO SIMILARLY IN OUR
SITUATION WE USED THIS METHOD
BECAUSE IT CREATES A SORT OF
VERY SUITABLE COMPARISON GROUP
FOR EACH EXPOSURE GROUP, AND
MAKES SURE, FOR EXAMPLE, WHEN
COMPARING MOTHERS AND BIRTH
PARENTS WHO HAVE A COVID
INFECTION THAT WE'RE COMPARING
THEM TO OTHER MOTHERS AND BIRTH
PARENTS WHO HAVE SIMILAR
COVARIATES AMONG THOSE WE
MEASURED, AND THAT WE'RE NOT
EXTRAPOLATING INTO DIFFERENT
TINES OF MOTHERS THAT MIGHT NOT
HAVE HAD AS MUCH INFECTION
DURING THE EARLY PANDEMIC PERIOD
BUT OF COURSE WITH ANY ANALYSIS
WHETHER YOU USE G COMPUTATION
AND REGRESSION, WHATEVER YOU
USE, WE WORRY ABOUT POSSIBLE
BIAS THAT WOULD MEAN WHAT WE
FIND IS DIFFERENT FROM TRUE
CAUSAL EFFECT.
THINGS OF CONCERN MIGHT BE
CONFOUNDERS WE'RE ABLE TO
CONTROL ARE LIMITED BY DATA
SOURCES, WE INCLUDED EVERYTHING
THAT WE CAN REASONABLY MEASURE
AND CAPTURE FROM ADMINISTRATIVE
DATA SOURCES, WE TRIED TO
ENHANCE THAT BY BRINGING IN A
LARGE SET OF I THINK 10
DIFFERENT COMMUNITY
CHARACTERISTICS, BUT OF COURSE
THERE COULD BE OTHER DIFFERENCES
BETWEEN THE MOTHERS FOR EXAMPLE
WITH INFECTION AND THOSE WITHOUT
INFECTION BUT DELIVERING IN 2020
THAT WE'RE NOT ABLE TO CAPTURE.
USING THESE IS USEFUL, PROVIDES
NICE INTERPRETABLE RESULTS.
POPULATION BURDEN TYPE
ESTIMATES.
SO, YEAH, I DON'T KNOW IF THAT
ADDRESSED ALL THE PIECES OF THE
QUESTION.
>>THANK YOU SO MUCH, DR. AHERN.
I WANT TO THANK AGAIN ALL OUR
PRESENTERS.
WE'RE AT THE END OF THE Q&A
DISCUSSION.
AND WE WILL HAVE 15 MINUTES
BREAK, WE'LL RECONVENE AT 2:25.
THANK YOU ALL FOR ATTENDING.
WE WILL SEE YOU AT THE NEXT
SESSION.
>>WELCOME BACK.
I'M A PROGRAM DIRECTOR IN THE
OFFICE OF RESEARCH ON WOMEN'S
HEALTH.
IT IS MY PLEASURE TO MODERATE
THIS NEXT SESSION CONSIDERING
MENTAL HEALTH AND BEHAVIORAL
HEALTH IN ADDRESSING
DISPARITIES.
OUR FIRST PANELIST IS ASSISTANT
PROFESSOR OF PEDIATRICS AND
PSYCHIATRY AND ATTENDING
PHYSICIAN IN THE WELL BABY
NURSERY, PRESENTATION IS
STRUCTURAL AND SOCIAL
DETERMINANTS.
AFTER THAT ASSOCIATE PROFESSOR
OF EPIDEMIOLOGY AT TULANE
UNIVERSITY SCHOOL OF PUBLIC
HEALTH IN TROPICAL MEDICINE,
GESTATIONAL WEIGHT GAIN IN
LOUISIANA DURING THE COVID
PANDEMIC AND LAST WILL BE DR.
PATRICIA KISNEH, DEAN OF
RESEARCH AT VIRGINIA
COMMONWEALTH UNIVERSITY SCHOOL
OF NURSING, IMPACT OF RISK AND
RESILIENCE FACTORS INCLUDING
STRUCTURAL RACISM AND
DISCRIMINATION ON MATERNAL
HEALTH OUTCOMES DURING THE
COVID-19 PANDEMIC.
THANK YOU FOR JOINING US TODAY.
>>THANK YOU FOR HAVING ME.
IT'S A REAL HONOR TO BE PART OF
THE GROUP.
TODAY I'M GOING TO SHARE WITH
YOU A LITTLE BIT ABOUT OUR
ONGOING WORK SO UNLIKE MOST OF
THE PRESENTERS I WON'T REALLY
HAVE RESULTS BUT RATHER TELL YOU
ABOUT WHAT WE'RE DOING IN THE
COMBO INITIATIVE STUDY.
THIS IS A VERY LARGE STUDY THAT
WE WERE ABLE TO RAPIDLY MOBILIZE
AT THE HEIGHT OF THE PANDEMIC,
IN NEW YORK CITY, SPRING OF
2020.
AS YOU KNOW THAT WAS ONE OF THE
EARLIEST EPICENTERS.
WE PUT THE STUDY TOGETHER
INITIALLY WITH THE BACKBONE OF
SURVEYS, KEPT ADDING SURVEYS AS
FUNDING WAS AVAILABLE, INFANTS
MATURED.
WE'RE ABOUT TO ROLL OUT OUR
THREE-YEAR SURVEY NOW.
BUT AS FUNDING BECAME AVAILABLE
WE WERE ABLE TO ADD ADDITIONAL
COMPONENTS SUCH AS BIOSPECIMENS,
VIDEO VISITS, BRAIN MRIs, AND
OLFACTION TESTING.
I REALLY WANT TO EMPHASIZE THAT
THIS IS THE WORK OF A VERY LARGE
GROUP OF INDIVIDUALS, WE RUN THE
STUDY AS A CONSORTIUM AND HAVE
BEEN ABLE TO RAISE SIGNIFICANT
FUNDS OVER THE PAST FEW YEARS,
AMONG THE 150 OR SO INDIVIDUALS
THAT HAVE CONTRIBUTED TO THIS
WORK AND WE HAVE BEEN ABLE TO
ENROLL OVER 1300 DYADS EXPANDING
THROUGH A CDC COLLABORATION.
THIS STUDY WORKS AS BOTH
LONGITUDINAL AND CROSS-SECTIONAL
STUDY, WE HAVE ABOUT FOUR TO
FIVE HUNDRED ACTIVE PARTICIPANTS
WHO CONTINUE TO CONTRIBUTE
LONGITUDINALLY BUT WE ALSO HAVE
ALLOWED ENTRY INTO THE STUDY AT
ANY POINT TO BE ABLE TO CAPTURE
AS MUCH OF THE RICHNESS OF WHAT
HAS HAPPENED OVER THE LAST FEW
YEARS, DURING THE PANDEMIC, SO
YOU SEE SOME OF THE SAMPLE SIZES
FOR A VARIETY OF SURVEYS, EACH
IS APPROXIMATELY 45 MINUTES TO
AN HOUR.
I WANT TO FOCUS ON LIVED
EXPERIENCES INTERVIEWS.
WE HAVE A LARGES NUMBER OF
OUTCOMES CONTRIBUTING
INVESTIGATOR FOCUSES ON THE
PARTICULAR TOPIC, MINE IS
MOTHER-BABY HEALTH BUT WE COVER
THE MATERNAL-CHILD SPACE BROADLY
AS WELL AS FOCUS ON SOCIAL
DETERMINANTS OF HEALTH.
THIS SHOWS AN ASSOCIATION WITH
LOWER NEURODEVELOPMENTAL SCORES
FOR INFANTS BORN IN THE PANDEMIC
BUT NOT DUE TO COVID.
ONE OF THE OTHER THINGS TO
HIGHLIGHT FOR THIS TOPIC HERE IS
THE UNIQUE MATCHING STRATEGY
THAT WE CHOSE IN THE BEGINNING
WHICH REALLY ENDED UP
HIGHLIGHTING HEALTH DISPARITIES.
I'M A PEDIATRICIAN, I'M BABY
FOCUSED, SO WHEN WE STARTED THIS
STUDY WE BEGAN CASE MATCHING
BASED ON INFANT CHARACTERISTICS,
YOU CAN SEE ^5 00 PARTICIPANTS
THERE'S NICE MATCHING IN TERMS
OF CHARACTERISTICS BUT WE BEGAN
TO SEE EARLY IN THE PANDEMIC WAS
A DISPARITY IN REAL TIME, SOME
DATA COME FROM THE SUMMER OF
2020 WHEN THIS WAS NOVEL, AND
YOU CAN SEE HERE HOW OUR COVID
POSITIVE GROUP IS
OVERREPRESENTED IN TERMS OF
HISPANICS, SPANISH SPEAKING AND
LOW SOCIODEMOGRAPHIC GROUPS WHO
RECEIVED MEDICAID.
TODAY I'M HERE BECAUSE WE WERE
FORTUNATE TO RECEIVE FUNDING TO
STUDY STRUCTURAL AND SOCIAL
DETERMINANTS OF MATERNAL MENTAL
HEALTH IN OUR COMBO INITIATIVE
THROUGH 2021 NOSI AWARD, A
SUPPLEMENT TO AN ONGOING R01,
MOTHER-BABY BRAIN AND BEHAVIOR,
AIMS ARE TO LOOK AT EFFECTS OF
STRUCTURAL RACISM AND
DISCRIMINATION ON MATERNAL BRAIN
AND BEHAVIOR, TO LOOK AT
TEMPORAL TRENDS IN MATERNAL
MENTAL HEALTH, USING ELECTRONIC
HEALTH RECORDS, AND TO LOOK AT
LIVED EXPERIENCES THROUGH 60
IN-DEPTH INTERVIEWS, THAT'S WHAT
I WILL FOCUS ON TODAY.
WE WERE ACTUALLY ABLE TO
OVERSHOOT AND HAVE CAPTURED 63
INTERVIEWS WITH WOMEN, TRYING TO
CAPTURE AS WIDE OF A RANGE
WITHIN COMBO AS POSSIBLE, SO YOU
CAN SEE NICE REPRESENTATION IN
TERMS OF COVID STATUS, AGE,
INFANT SEX, AGE AND ETHNICITY
AND OTHER SOCIODEMOGRAPHIC
FACTORS.
THE TOPICS WE COVER IN
APPROXIMATELY 60 MINUTES AND
THESE ARE ZOOM INTERVIEWS THAT
WE ARE CONDUCTING, GROSSLY SPAN
FOUR DOMAINS, PERINATAL
EXPERIENCES, PANDEMIC RELATED
EXPERIENCES, EXPERIENCES OF
RACISM AND DISCRIMINATION, AND
PROTECTIVE FACTORS AND STRESS
BUFFERS AND SOLUTIONS.
THIS IS ONGOING BUT TODAY I WANT
TO GIVE YOU A FLAVOR OF WHAT
WE'RE HEARING FROM OUR NEW YORK
CITY MOTHERS.
FOR EXAMPLE NEGATIVE
INTERACTIONS WITH THE MEDICAL
COMMUNITY.
I WENT FOR EARLY SCAN, BOUTIQUE
PRIVATE PRACTICE IN MANHATTAN.
I WENT IN AND DID THE SCAN AND
IT WAS FINE BUT THEN WE SAT DOWN
AND I HAD QUESTIONS PREPARED.
I ASKED ABOUT AN UNMEDICATED
BIRTH, HOW DOES HE FELL ABOUT
THEM?
DOES HE SUPPORT THEM?
JUST TO SEE IF THIS MIGHT BE A
GOOD FIT.
HE LAUGHED AN AUDIBLE LAUGH.
I DID NOT KNOW HOW TO PROCESS.
IT TOOK ME A MOMENT TO SEE HE
WAS SERIOUS.
HE WAS.
THEN I ASKED A FEW OTHER
QUESTIONS.
HE CONTINUED TO BE VERY
DISMISSIVE OF THE IDEA THAT I
WOULD ESSENTIALLY HAVE ANY IDEA
OR CONTROL OR AUTONOMY OR VOICE
IN THE PROCESS OF HOW I GAVE
BIRTH.
THAT WAS PROBABLY MY FIRST TIME
FEELING REALLY MARGINALIZED BY
THE MEDICAL COMMUNITY.
WE ALSO HEAR A LOT ABOUT
CONCERNS ABOUT THE VIRUS.
HERE IS AN EXAMPLE.
I WAS CONCERNED I WAS GOING TO
CATCH THE VIRUS AND IT WAS GOING
TO AFFECT THE BABY.
I WAS CONCERNED ABOUT -- SO I
THAT THIS OTHER THING I WAS
MONITORING FOR AND THAT
SOMETHING WOULD GO WRONG WITH
HER, THE BILIRUBIN THAT THEY
WERE MONITORING FOR IN UTERO AND
WE WOULDN'T CATCH IT IN TIME.
I WAS CONCERNED SOMEBODY ELSE IN
MY FAMILY WOULD CATCH IT AND I
DIDN'T KNOW HOW WE WOULD HANDLE
ALL OF THAT.
IF MY HUSBAND GOT SICK, I
REMEMBER EVEN TALKING TO HIM, I
GUESS I WOULD CALL AN AMBULANC,
NOT GOING TO DRIVE YOU TO THE
HOSPITAL.
THE REALITY OF THINKING THROUGH
THAT, THAT I WOULD HAVE TO STAY
WITH THE KIDS, THAT WAS
STRESSFUL.
YEAH, A LOT OF WORRIES.
WE'RE ALSO HEARING OF INCREASED
EXPERIENCES WITH DISCRIMINATION.
I REMEMBER ACTIVELY AVOIDING
GOING INTO THE CITY WHEN THERE
WAS A SPIKE IN ASIAN HATE
CRIMES, ON ELDERLY ESPECIALLY.
I WAS CONSCIOUS OF NOT HAVING MY
FAMILY AROUND DURING THAT TIME.
WE ARE HEARING ABOUT INCREASED
NEIGHBORHOOD VIOLENCE.
WE MOVED OUT OF THE CITY LAST
YEAR TO JERSEY, WHICH I DON'T
KNOW MY NEIGHBORHOOD CHANGED
AFTER THE PANDEMIC.
WE LOVED OUR NEIGHBORHOOD AND
THE PANDEMIC HAPPENED.
I STILL LOVE THE NEIGHBORHOOD
AND ONCE THINGS STARTED EASING,
THE NEIGHBORHOOD ITSELF CHANGED
AND IT DIDN'T FEEL LIKE THE SAME
PLACE.
YOU COULD SEE, I MEAN I LIVED IN
HARLEM, IT WAS ROUGH AROUND THE
EDGES BUT I NEVER FELT UNSAFE.
THERE WAS A WAY MORE DRUG USE
THAT WAS SORT OF OBVIOUS.
THERE WAS AN INCREASE IN GUN
VIOLENCE.
I KNOW IT HAPPENS AND THERE'S
SOME BLOCKS HOTTER THAN OTHERS
BUT I NEVER EXPERIENCED HEARING
GUNSHOTS LIKE THAT.
THE WHOLE COMMUNITY.
I DIDN'T WANT TO BRING MY KID ON
THE SUBWAY.
I DON'T WANT TO BE STUCK TO MY
NEIGHBORHOOD.
IF I DON'T REALLY FEEL
COMFORTABLE GETTING ON THE
SUBWAY WITH PEOPLE THAT ARE
SUPPOSED TO BE MASKING BUT
AREN'T MASKING.
WE'RE HEARING ABOUT INCREASED
HOUSEHOLD VIOLENCE, PROBABLY THE
SADDEST QUOTE AND ALSO ONE OF MY
FAVORITES.
I MADE A PHOTO JOURNAL AS THE AM
OF IMAGERY OF COVID BECAME MORE
PRESENT IN MY LIFE.
I TOOK PHOTOS.
THE FIRST TIME I WALKED DOWN THE
STREET I SAW SOMEONE WEARING A
MASK, I TOOK A PICTURE BECAUSE I
HAD NEVER SEEN THAT BEFORE.
THE WEIRD THING IS THAT BECAUSE
BEING ISOLATED WITH MY ABUSER,
BECAUSE OF THE PANDEMIC, MADE
THE ABUSE SO BAD, I HAVE THIS
DARK JOKE THAT I SAY THAT MY
ABUSE REALLY RUINED MY PANDEMIC
FOR ME.
BECAUSE I COULD BARELY EVEN FEEL
THE PANDEMIC BECAUSE MY
EXISTENTIAL CRISIS WAS LIKE AM I
GOING TO LIVE TO SEE TOMORROW?
I FELT THE PANDEMIC BECAUSE I
WAS CAGED WITH MY ABUSER BECAUSE
OF THE PANDEMIC, AND I HAD TO
LEAVE THE HOUSE, AND I FELT THE
OPPRESSION OF THE VIRUS AROUND
ME WHEN I LEFT THE HOUSE.
I WAS MORE AFRAID OF WHAT MY
HUSBAND WAS GOING TO DO TO ME
THAN WHAT THE VIRUS WAS GOING TO
DO TO ME, ON THE
MOMENT-TO-MOMENT BASIS EVEN
THOUGH I WAS ALSO TERRIFIED OF
THE VIRUS.
THE VIRUS DIDN'T LIVE IN MY
HOUSE, AND HAVE A MOUSTACHE, AND
SIX FEET TALL NEXT TO ME, YOU
KNOW?
AND FINALLY I WILL END WITH ONE
OF THE POSITIVE EXPERIENCES THAT
WE'VE SEEN.
THIS IS RELATED TO COMING TO A
NEW CULTURE.
I'M NOT SURE WHETHER I'M
PROBABLY NOT THAT BIG A
DIFFERENCE, BECAUSE ACTUALLY --
OOPS, IN TRADITIONAL CHINA WE
HAVE A LOT OF RULES FOR THE
PREGNANCY AND THE BABY
DELIVERIES, THAT'S A LOT OF
RULES BUT LUCKY I'M HERE, I
DON'T LIKE THOSE RULES.
I THINK THAT WAS PROBABLY NOT
THAT SCIENTIFIC BECAUSE TOO MUCH
BECAUSE IN CHINA YOU JUST SAY,
OH, IF YOU'RE PREGNANT YOU
CANNOT DO A LOT OF THINGS.
YOU CANNOT DO SPORTS.
YOU NEED TO WORK SLOWLY,
CAREFULLY, AND I REALLY DON'T
LIKE THOSE RULES.
ACTUALLY DURING THE SECOND
PERIOD OF THE PREGNANCY I STILL
GO SWIMMING AND EVERYTHING.
I THINK THE CHINESE WAY IS NOT
AS SCIENTIFIC.
AFTER BABY DELIVERY, THEY WOULD
SAY ESPECIALLY FOR THE FIRST
MONTH AFTER THE BABY DELIVERY,
THAT'S VERY IMPORTANT, YOU NEED
TO STAY AT HOME, YOU CANNOT GO
ANYWHERE, YOU CAN ONLY STAY HOME
TO LIE ON BED OR SOMETHING LIKE
THAT.
YOU CANNOT WASH YOUR HAIR.
THAT'S NOT SCIENTIFIC SO I'M
GOOD, I'M HERE, AND I DON'T NEED
TO FOLLOW THOSE RULES.
AND WITH THAT I WANT TO AGAIN
THANK MY VERY LARGE TEAM AND THE
INCREDIBLE FUNDING WE'VE
RECEIVED FOR THIS WORK.
THANK YOU.
>>THANK YOU.
WE'RE LOOKING FORWARD TO DIVING
INTO THE RESEARCH DURING THE Q&A
SESSION.
NEXT WE'LL HAVE OUR PRESENTATION
FROM DR. HARVILLE, THE PODIUM IS
YOURS.
>>CAN YOU SEE THE SLIDES?
>>YES, WE CAN.
>>GREAT.
I'D LIKE TO THANK THE ORGANIZERS
FOR INVITING US TO PRESENT.
I AM PRESENTING ON BEHALF OF A
TEAM FROM TULANE PENNINGTON
RESEARCH AND WOMEN'S HOSPITAL
AND LEE ANN REDMOND IS THE
PRINCIPAL INVESTIGATOR ON THIS
PROJECT.
SO AS YOU KNOW GESTATIONAL
WEIGHT GAIN IS ASSOCIATED WITH
COMPLICATIONS IN PREGNANCY.
AND SOCIAL DISTANCING AND
LOCKDOWN LED TO TIME BEING SPENT
SEDENTARY, LESS HEALTHY EATING,
WORSE ANXIETY AND DEPRESSION.
AL THOSE HAVE BEEN ASSOCIATED
WITH CHANGES IN WEIGHT GAIN.
THERE'S BEEN STUDIES FROM CHINA
AND THE UNITED STATES THAT HAVE
SUGGESTED THAT THERE WAS HIGHER
GESTATIONAL WEIGHT GAIN IN THE
FIRST YEAR OF THE PANDEMIC
COMPARED TO DELIVERY IN THE
PREVIOUS YEARS.
SO IN THIS ANALYSIS WE WERE
LOOKING TO EXTEND THAT FURTHER,
INTO THE SECOND YEAR, INTO MARCH
OF 2022, AND ALSO TO EXAMINE A
BIT BY CONSIDERING BOTH
CROSS-SECTIONAL AND COHORT MODEL
OF DATA.
SO WE'RE USING ELECTRONIC HEALTH
RECORDS FROM WOMEN'S HOSPITAL IN
BATON ROUGE, ONE OF THE LARGEST
SPECIALTY HOSPITALS IN THE
COUNTRY.
THEY DO ABOUT 8,000 DELIVERIES
PER YEAR.
OUR INITIAL DATABASE WAS ALL
DELIVERIES BETWEEN JANUARY OF
2017 AND JULY OF 2022, YOU'LL
SEE WE NARROWED DOWN A LITTLE
BIT.
WE COMPILED DATA BASED ON ICD
CODES, ADMITTING AND DISCHARGE
DATA, AS WELL AS NURSE TO
PHYSICIAN CHARTING WHERE
NECESSARY, LINKED TO STATE LEVEL
BIRTH CERTIFICATE DATA USING
SEVERAL IDENTIFIERS TO LINK.
WHEN WE'RE LOOKING AT TIME
PERIODS FOR COMPARISON, AND
THERE'S FAIRLY ROBUST DISCUSSION
OF THIS IN THE PERINATAL
EPIDEMIOLOGY LITERATURE BUT THIS
IS WHAT WE LANDED ON.
FIRST WE USED CROSS-SECTIONAL
DATA, DELIVERY DATES.
THERE WE JUST USED THE YEAR
BEFORE THE PANDEMIC, THE YEAR,
FIRST YEAR POST-PANDEMIC, SECOND
YEAR POST-PANDEMIC, AND MARCH
13, 2020 IS WHEN THERE STARTED
TO BE RESTRICTIONS AT WOMEN'S
HOSPITAL AROUND VISITORS AND SO
FORTH, SO WE USED THAT AS A
CUTOFF.
WE ALSO USED CONCEPTION DATE TO
LINE UP COHORTS, AND THAT ALLOWS
FOR A LITTLE EASIER COMPARISON
OF TIMING OF EXPOSURE.
AND THAT WAS BASED ON
GESTATIONAL AGE, AND SO THERE WE
HAVE A COHORT THAT AGAIN IS
COMPLETELY PRE-PANDEMIC, ONE
THAT WAS EXPOSED DURING PART OF
THE PREGNANCY, ONE WHERE THE
ENTIRE PREGNANCY OCCURRED
POST-PANDEMIC OR DURING THAT
FIRST YEAR PANDEMIC, SO AFTER
MARCH 2020, AND THEN LAST GROUP
THAT WAS CONCEIVED AFTER THE
MAJORITY OF THE RESTRICTIONS
WERE LIFTED, WHICH OCCURRED IN
MARCH 2021, IN LOUISIANA.
AND WE ALSO LOOKED AT THE
OUTCOMES MONTH TO MONTH, FOR A
LITTLE MORE NUANCE.
OUR MAJOR OUTCOME WAS TOTAL
GESTATIONAL WEIGHT GAIN WHICH WE
DID WEIGHT AT DELIVERY MINUS
PRE-PREGNANCY, HAD OTHER
ANALYSES WHERE WE CONTROLLED FOR
LENGTH OF GESTATION, IT DIDN'T
MAKE A DIFFERENCE SO WE'RE DOING
TOTAL HERE.
AND WE ALSO CATEGORIZED
GESTATIONAL WEIGHT GAIN BASED ON
INSTITUTE OF MEDICINE
CATEGORIES, WHICH VARY BASED ON
THE PRE-PREGNANCY BMI AS WELL AS
WHETHER THE PREGNANCY IS
MULTIPLE OR SINGLETON BIRTH.
AND WOMEN WERE CATEGORIZED AS
EXCEEDING RECOMMENDATIONS,
MEETING THEM OR BELOW.
SEEMED LIKE THE MAJOR
DIFFERENCES WERE AMONG THAT
COMPETEDDED GROUP SO THE --
EXCEEDED GROUP SO WE HAD
DICHOTOMY THERE.
MODELS LOOKING AT ADJUSTED IT
CONTROLLED FOR SOME COVARIATES
THAT SEEMED TO SHIFT IN
DISTRIBUTION OVER THE PANDEMIC,
SO MATERNAL AGE, PARITY,
RACE/ETHNICITY, MARITAL STATUS
AND EDUCATION, USED LINEAR
REGRESSION, GENERALIZED
ESTIMATING EQUATIONS TO CONTROL
FOR SITUATIONS WHERE THERE WERE
MULTIPLE BIRTHS PER WOMAN DUE TO
TWINS OR DUE TO MULTIPLE
PREGNANCIES WITHIN THAT THREE OR
FOUR YEAR TIME SPAN, AND WE ALSO
DID A SIBLING ANALYSIS WHERE WE
COMPARED GROUP WITH ONE BIRTH
PRIOR TO THE PANDEMIC TO ONE
BIRTH AFTER THAT.
THERE WERE 1300 WOMEN IN THE
CATEGORY.
THEN WE ALSO LOOKED AT --
GESTATIONAL WEIGHT GAIN VARIES
SO WE LOOKED AT INTERACTION WITH
THAT PRE-PREGNANCY BMI TO SEE IF
THERE WERE CHANGES THERE.
IF WE LOOK AT THE POPULATION AS
A WHOLE, YOU CAN SEE THAT
OVERALL ABOUT HALF OF THE
POPULATION GIVING BIRTH AT
WOMEN'S IS WHITE, ANOTHER 40% OR
SO IS BLACK.
WITH THE NEXT GROUP BEING
HISPANIC.
WERE THERE WERE SHIFTS OR TRENDS
IN SOME OF THE COVARIATES IF WE
COMPARE ACROSS THE PANDEMIC, YOU
CAN SEE THESE ARE QUITE SMALL,
JUST A PERCENTAGE POINT OR TWO.
BUT WE CAN PICK THEM UP
STATISTICALLY.
SO IF WE LOOK AT GESTATIONALLY
WEIGHT GAIN WE DO SEE
STATISTICAL DIFFERENCES ACROSS
THE PANDEMIC.
THE MAGNITUDE IS QUITE SMALL,
WE'RE LOOKING AT HALF A
KILOGRAM, SO MAYBE A POUND OR
TWO ON AVERAGE.
AND THE PATTERN SEEMED TO BE
THAT THE GESTATIONAL WEIGHT GAIN
ON AVERAGE ROSE A BIT FOR THAT
FIRST YEAR, AFTER MARCH 2020,
AND THEN FELL DOWN A BIT.
WE SEE THAT REGARDLESS OF
WHETHER WE LOOKED AT DATE OF
DELIVERY OR TIME OF CONCEPTION
WITH A RISE EARLIER AND THEN
PERHAPS A FALLBACK.
FOR PRE-PREGNANCY WEIGHT WE SEE
THERE WAS AN INCREASE IN
PRE-PREGNANCY WEIGHT, AGAIN
SMALL BUT SEEMED TO BE A
CONSISTENT RISE.
AND IF WE LOOK AT THE
CATEGORIZED OUTCOME AGAIN WE SEE
A RISE IN THOSE ABOVE THE
RECOMMENDED WEIGHT GAIN AND
FALLBACK AND SIMILAR PATTERN
HERE.
IF WE LOOK AT ADJUSTED MODELS WE
GET THE SAME IDEA.
WE HAVE THE SMALL INCREASE IN
GESTATIONAL WEIGHT GAIN IN THE
PEAK AND SHORTLY AFTER, AND
PERHAPS A FALLBACK AGAIN
REGARDLESS OF HOW THE TIMING IS
SPLIT UP HERE.
WE DO SEE A SIGNIFICANT
INTERACTION WITH PRE-PREGNANCY
BMI FOR THE UNDERWEIGHT GROUP
WHICH IS THE SMALLEST, WE DIDN'T
SEE ANY CHANGE FOR THE NORMAL
WEIGHT GROUP HERE AT LEAST IF WE
DEFINE BY DELIVERY WE DON'T SEE
A CHANGE THOUGH WE SEE PATTERN
OF RISE AND FALL.
IF WE LOOK BY CONCEPTION COHORT
WE SEE RISE FOR EARLY OR FIRST
YEAR AND PERHAPS FALLBACK.
IN THE NORMAL WEIGHT GROUP WE
SEE CONSISTENT RISE ACROSS THE
TIME FRAME, AND IN THE OBESE
GROUP IT'S A LITTLE
INCONSISTENT, WE SEE A RISE AND
FALL HERE BUT HERE WE SEE A RISE
AND FALL AND THEN A RISE AGAIN.
SO STILL WORKING ON FIGURING OUT
TO SEE HOW THE TRENDS CONTINUE
TO PLAY OUT.
HERE ARE SOME DATA MONTH BY
MONTH, AS YOU CAN SEE THIS DATA
LOOKS MORE EXCITING IF WE
PRESENT IT LIKE THIS THAN IF
LIKE THIS.
THIS GIVES AN IDEA HOW SMALL
THESE CHANGES ARE.
BUT THE ONE THING WE DID NOTICE
MONTH BY MONTH THAT WE FOUND
INTERESTING WAS THERE WAS THIS
DIP IN MARCH 2020, AND WE SEE
THAT SHORT-TERM THERE MIGHT HAVE
BEEN FOOD SHORTAGES, IN THE
SHORT TERM.
THE OTHER POSSIBILITY IS THAT
WHILE DATA ARE COMING OUT OF
MEDICAL RECORDS AND VITAL
STATISTICS A LOT OF THOSE DATA
ACTUALLY DO COME FROM THE
SELF-REPORT OF THE WOMAN, SO
IT'S POSSIBLE THAT IF SHE DIDN'T
HAVE HER LAST IN-PERSON PRENATAL
VISIT SHE MIGHT NOT HAVE BEEN
AWARE OF HOW MUCH WEIGHT SHE
GAINED AND PERHAPS UNDERREPORTED
DUE TO THAT.
BUT THOSE ARE SPECULATION.
AND THEN FINALLY WHEN WE LOOKED
AT COMPARE THOSE WHO GAINED OR
HAD THE TWO PREGNANCIES, WE SAW
SIMILAR PROPORTION TO
DISCREPANCY EARLY AND LATER, IN
IN THE EARLY AND LATER
PREGNANCIES, AND ONCE WE HAD
CONTROLLED FOR AGE AND PARITY WE
DIDN'T SEE ANY DIFFERENCE
REGARDLESS OF HOW WE SPLIT UP
THE TIME.
STRENGTHS AND LIMITATIONS, LARGE
ELECTRONIC HEALTH RECORD,
DIVERSE POPULATION, ABLE TO TAKE
THE DATA OUT TO MARCH 2022 FOR
MORE TIME CONSIDERING HORIZON
BUT AS I MENTIONED MUCH WEIGHT
GAIN DATA IN THE MEDICAL RECORDS
AND BIRTH CERTIFICATES IS
SELF-REPORTED AND THAT'S A
DEFINITE LIMITATION FOR
UNDERSTANDING THINGS.
TO CONCLUDE WE FOUND GESTATIONAL
WEIGHT GAIN ON AVERAGE ROSE A
SMALL AMOUNT DURING THE
PANDEMIC, THESE CHANGES DIFFERED
BY PRE-PREGNANCY BMI, AND SEEMS
LIKE SOME INCREASES MAY HAVE
PLATEAUED OR EVEN STARTED TO
SINK BACK A LITTLE BIT.
THANK YOU.
>>DR. KISNER, THE FLOOR IS
OURS I WANT TO REMIND MEMBERS WE
WELCOME YOU JOINING THE
DIALOGUE, FEEL FREE TO SUBMIT
QUESTIONS FOR ANY PRESENTERS
USING THE "SEND LIVE FEEDBACK"
BUTTON ON THE INDIVIDUAL
VIDEOCAST.
DR. KINSER?
>>THANK YOU.
HAPPY TO BE HERE.
THE FOCUS TODAY IS TO DISCUSS
IMPACT OF RISK AND RESILIENCE
FACTORS ON MATERNAL HEALTH
OUTCOMES DURING THE COVID
PANDEMIC, REPRESENTING A LARGER
TEAM BUT I'M THE P.I. OF THE
STUDY.
NEXT SLIDE PLEASE.
I'D LIKE TO ACKNOWLEDGE NICHD
AND THE NIMH FOR FUNDING FOR
THIS WORK.
I DON'T NEED TO SPEND TIME ON
BACKGROUND BECAUSE THE WONDERFUL
PRESENTERS BEFORE ME HAVE DONE
SUCH A GREAT JOB.
CLEARLY THE COVID-19 PANDEMIC IS
A COLLECTIVE STRESSOR THAT HAS
HAD WIDESPREAD EFFECTS ACROSS
THE GLOBE, AS WE'VE HEARD FROM
OTHER PRESENTERS EFFECTS HAVE
BEEN DIRECT, SAY ON RELATING TO
INFECTION AND MORTALITY OR
INDIRECT WITH STRESS, ISOLATION,
CHANGES IN SUPPORT, HEALTH CARE
DELIVERY HAS BEEN DISRUPTED.
MINORITY POPULATIONS HAVE BEEN
DISPROPORTIONATELY AFFECTED AT
HIGHER RISK FOR EXPERIENCING
ADVERSE EFFECTS RELATED TO
STRUCTURAL RACISM AND
DISCRIMINATION.
THERE HAVE BEEN SEVERAL STUDIES
THAT CAME OUT, THAT LOOK AT
MENTAL HEALTH IMPACT, 62 STUDIES
FINDING PREVALENCE TO BE 28%,
ANXIETY 33%, BOTH ARE HIGHER
THAN GENERAL POPULATION
ESTIMATES OUTSIDE OF THE
PANDEMIC AND ARE HIGHER AMONG
THOSE WITH PREEXISTING
CONDITIONS.
MORE CONTEXT FROM THE COVID
SURVEY, SHOWING MANY AMERICANS
REPORTED SUBSTANTIAL ECONOMIC
HARDSHIP THAT LATINX AND BLACK
EXPERIENCE AT HIGHER RATES THAN
WHITE PEOPLE AND LATINX AND
BLACK PEOPLE AS WELL AS WOMEN
AND THOSE WITH LOWER INCOMES ARE
AT MOST RISK FOR MENTAL HEALTH
CONCERNS BECAUSE OF COVID.
INTERSECTIONALITY OF THESE
FACTORS IS IMPORTANT TO CONSIDER
AND IS OF PARTICULAR INTEREST TO
OUR RESEARCH TEAM.
OUR TEAM HAS BEEN RUNNING A
TRIAL TO EVALUATE A
NON-PHARMACOLOGIC AND SCALABLE
INTERNET BASED INTERVENTION
DESIGNED TO PREVENT PERINATAL
DEPRESSIVE SYMPTOMS.
NEARLY 20% OF PREGNANT
INDIVIDUALS IN THE U.S.
EXPERIENCE CLINICALLY
SIGNIFICANT DEPRESSIVE SYMPTOMS
IN THE PREGNANCY OR INTO THE
POSTPARTUM PERIOD AND THE
PANDEMIC AND OTHER STRESSORS
SUCH AS RACISM AND
DISCRIMINATION MIGHT BE RISK
FACTORS FOR ONGOING SYMPTOMS.
THE FUNDING HAS SUPPORTED OUR
INVESTIGATION INTO
PANDEMIC-RELATED DISCRIMINATION
BASED STRESSORS AS WELL AS
POSSIBLE PRODUCTIVE FACTORS INTO
DEPRESSIVE SYMPTOM OUTCOMES IN
LARGE ONGOING RANDOMIZED
CONTROLLED TRIAL.
THE PURPOSE IS TO EXAMINE IMPACT
OF STRESSORS AND POSSIBLE
PROTECTIVE FACTORS ON THE COURSE
OF DEPRESSIVE SYMPTOMS.
THIS IS A THREE ARM RANDOMIZED
CONTROLLED TRIAL DESIGNED TO
EVALUATE EFFICACY AND MECHANISMS
OF EFFECT OF THE MAMMA MIA
INTERVENTION TO BE USED IN
PREGNANCY AND POSTPARTUM PERIOD
AND PROVIDES ACCESS TO RESOURCES
SUCH AS MINDFULNESS TECHNIQUES,
RELATIONSHIP TIPS, PLANNING FOR
BREASTFEEDING AND INFANT CARE
AND MORE.
MORE CAN BE LEARNED HERE ON THE
WEBSITE.
NEXT SLIDE.
AND MORE DETAILS ON THE STUDY
PROTOCOL ARE AVAILABLE IN THE
PUBLICATION INDICATED IN THE TOP
RIGHT CORNER OF THE SLIDE,
BRIEFLY WE'RE ENROLLING CLOSE TO
2,000 PREGNANT INDIVIDUALS TO
PARTICIPATE IN THE LONGITUDINAL
THREE ARM RCT, RECRUITMENT IS
ONGOING AT THIS TIME.
WE HAVE RECRUITED APPROXIMATELY
1500 OF THE CLOSE TO 2,000
PARTICIPANTS THAT WE INTEND TO
ENROLL IN THIS STUDY.
NEXT SLIDE.
SO WITH THE SUPPLEMENT WHAT I'M
REPORTING ON TODAY THE PURPOSES
TO EVALUATE HOW THE SARS-COV-2
INFECTION CAN AFFECT THE
POPULATION, AND TO EVALUATE
FACTORS THAT MIGHT IMPACT HEALTH
OUTCOMES FOR THESE PARTICIPANTS
SUCH AS PERCEIVED IMPACT OF THE
COVID-19 PANDEMIC, STRUCTURAL
RACISM AND DISCRIMINATION, AND
RESILIENCE AND RISK FACTORS FROM
COPING TO ECONOMIC STRESS AND
FOOD AND HOUSING INSECURITY.
YOU'LL SEE MEASURES INCLUDED IN
THE FOCUS OF THE SUPPLEMENT, AND
ANALYTIC PLAN.
WHAT I'M REPORTING TODAY IS THAT
PRELIMINARY ANALYSIS SO THIS IS
THE DATASET THAT WAS AVAILABLE
IN TIME TO PREPARE FOR THIS
MEETING.
SO THERE ARE A COLUMN OF
EXCLUDED CATEGORY, PEOPLE WHO
HAVE MISSING DATA FOR COVARIATES
BECAUSE OF TIMING.
THE SUPPLEMENT WAS FUNDED AFTER
THE STUDY WAS RUNNING SO NOT ALL
DATA WAS COLLECTED AND THOSE
RECRUITED INITIALLY.
AND THEN ALSO DOES NOT INCLUDE
THOSE MORE RECENTLY ENROLLED AND
HAVE NOT YET MOVED THROUGH THE
LONGITUDINAL ASSESSMENTS YET.
WE SEE THE ANALYSIS CONTAINS A
HIGHER PERCENTAGE OF NON-WHITE
RESPONDENTS, THAN THOSE IN THE
EXCLUDED DATASET.
SIGNIFICANTLY LOWER PERCENTAGE
OF THOSE WITH LESS THAN THE
COLLEGE EDUCATION, AND
SIGNIFICANTLY HIGHER PERCENTAGE
OF RESPONDENTS WITH AN ANNUAL
INCOME LESS THAN $50,000.
SOME DIFFERENCE IS DUE TO FOCUS
EFFORTS OF OUR STUDY TEAM THANKS
TO THE ADMINISTRATIVE SUPPLEMENT
TO TARGET RECRUITMENT STRATEGIES
FOCUSED ON MARGINALIZED
POPULATIONS SUCH AS THOSE WHO
ARE HISTORICALLY MINORITIZED AND
HAVE A LOWER ANNUAL INCOME.
NEXT SLIDE PLEASE.
SO OUR ANALYTIC PLAN WE USE
PURPOSEFUL SELECTION TO BUILD
MULTIVARIATE MODEL AT 37 WEEKS
GESTATION.
I'LL PAUSE FOR A MOMENT AND
ACKNOWLEDGE THAT WE'RE TRACKING
DEPRESSIVE SYMPTOMS INTO THE
POSTPARTUM SO THIS IS JUST A
MOMENT IN TIME WE'RE LOOKING AT
THAT LATE PREGNANCY POINT.
AND AS WE FIT OUR COVARIATES AT
THE UNIVARIATE LEVEL BASELINE
DEPRESSION TREATMENT GROUP
EDUCATION INCOME DISCRIMINATION
PERCEIVED PANDEMIC IMPACT
RESILIENCE AND CONTEXTUALIZED
STRESS WERE RELATED TO OUTCOME.
BUT IN OUR FINAL MULTIVARIATE
MODEL WE FOUND THAT ONLY
BASELINE SYMPTOMS, TREATMENT
GROUP, INCOME, EXPERIENCES OF
DISCRIMINATION AND RESILIENCE
WERE RELATED TO THE OUTCOME.
ADJUSTED R SQUARED INDICATES
APPROXIMATELY 38% OF VARIABILITY
IN DEPRESSION IN LATE PREGNANCY
IS PREDICTED BY THIS MODEL.
THE MODEL PREDICTED AT 37 WEEKS
COUNTING FOR 38% OF VARIANCE,
FINAL MODEL FOUND BASELINE
DEPRESSIVE SYMPTOMS,
SIGNIFICANTLY RELATED TO OUTCOME
BUT MODERATED EFFECT OF
TREATMENT CONDITION SO WHAT DOES
THIS MEAN?
NEXT SLIDE.
THE IMPLICATIONS HERE ARE THAT
AGAIN PRELIMINARY FINDINGS WE
ACKNOWLEDGE THIS IS VERY
PRELIMINARY BUT THESE
PRELIMINARY FIND EGGS DO SUGGEST
THAT MAMMA MIA, THE ONLINE
MOBILE BASED APPROACH, MIGHT BE
REASONABLE INTERVENTION FOR
PREVENTING PERINATAL DEPRESSIVE
SYMPTOMS IN PREGNANT PERSONS
ACROSS THE U.S.
THIS FINDING HELD UP WHEN
CONTROLLING FOR LOW INCOME
PERCEPTIONS OF DISCRIMINATION
AND RESILIENCE WHICH ALSO SHOWED
SIGNIFICANT ASSOCIATIONS WITH
SCORES.
THERE ARE LIMITATIONS.
THERE WERE LARGE NUMBER OF
MISSING VALUES FOR THE
CONTEXTUALIZED STRESS AND
RESILIENCE MEASURES DUE TO THE
FACT THE MEASURES WERE ONLY PART
OF THE SUPPLEMENTAL DATA
COLLECTION.
AND WE INTEND TO TAKE THIS
FURTHER, OUR PLAN FOR FUTURE
ANALYSIS INCLUDE A LATENT GROWTH
CURVE ANALYSIS ON SYMPTOMS
ACROSS THE STUDY AND CONDUCTING
MODERATION ANALYSIS AS TO HOW
RISK AND RESILIENCE FACTORS CAN
INFLUENCE DEPRESSIVE SYMPTOM
TRAJECTORIES ACROSS TIME
EXAMINING COVID-RELATED CHANGES,
COVID INFECTION, COPING AND
DISCRIMINATION.
NEXT SLIDE.
I'D LIKE TO EXTEND GRATITUDE TO
ALL OF THE TEAM MEMBERS INVOLVED
IN THIS WORK, RANGING FROM OUR
CO-INVESTIGATORS AT VCU AND
ARIZONA STATE UNIVERSITY, STUDY
TEAM ON THE GROUND WORKING DAY
BY DAY WITH OUR PREGNANT AND
POSTPARTUM PARTICIPANTS,
RESEARCH ASSISTANTS AND
COMMUNITY CONSULTANTS.
AND NEXT SLIDE.
I'D LIKE TO THANK OUR
PARTICIPANTS ACROSS THE NATION
FOR ENGAGING AS PARTNERS WITH US
IN THIS WORK, AND I'D LIKE TO
THANK OUR MULTIPLE COMMUNITY
PARTNERS WHO HAVE SHARED ABOUT
THIS PROJECT.
I WILL FINISH WITH OFFERING
MYSELF TO ANSWER ANY QUESTIONS
AND WELCOMING ANYONE TO GO TO
OUR STUDY WEBSITE.
>>WE'RE EXCITED TO HAVE YOU
HERE TODAY AND SHARE SOME MORE
THOUGHTFUL ENGAGEMENT AROUND
YOUR SPECIFIC WORK.
SO LET'S START WITH A QUESTION
TO DR. KINSNER.
CAN YOU TALK ABOUT HOW YOUR WORK
SPECIFICALLY ADDRESSED SOME OF
THE ACUTE STRESSORS CALMING
PATHWAYS THAT INCREASED RISK?
>>SO, THAT'S A BIG QUESTION.
>>IT IS.
>>PRELIMINARY DATA ALONE I
CAN'T GUARANTEE ANY OF THAT.
CERTAINLY WE HYPOTHESIZE THAT
PROVIDING THAT THROUGH AN
INTERVENTION LIKE THIS THAT
PROVIDES COMPREHENSIVE
INFORMATION AND PRACTICES, IT'S
AN OPPORTUNITY FOR INDIVIDUALS
TO THINK ADDITIONAL SUPPORT GAIN
GAIN SOCIAL SUPPORT AS WELL EVEN
THOUGH THEY ARE NOT DIRECTLY
INTERACTING WITH OTHERS THROUGH
THE PROGRAM.
THESE INTERVENTIONS THAT WE'RE
DISCUSSING WE HAVE TO LOOK AT
CONTEXT, AND THE CONTEXT IN ONE
OTHER OTHER OUR TEAM IS
INTERESTED IN IS WHAT PORTION OF
OUR PARTICIPANTS WERE IN RURAL
AREAS VERSUS URBAN AREAS.
ARE THERE TEMPORAL DIFFERENCES
ACCORDING TO AREAS OF THE
NATION, WHAT WAS HAPPENING WHEN
THESE PERCEIVED DISCRIMINATION
AND RACISM QUESTIONS WERE ASKED.
SO, A LOT OF THOSE TEMPORAL
DIFFERENCES WILL BE CRITICAL IN
ANSWERING THAT QUESTION.
I'M NOT SURE I HAVE THE FINAL
ANSWER TO THAT REALLY IMPORTANT
QUESTION YET.
>>THANK YOU SO MUCH.
THAT WAS SUPER HELPFUL.
THIS COULD BE A QUESTION FOR OUR
WHOLE PANEL.
HOW DOES YOUR INDIVIDUAL
INTERVENTION PROGRAM FIT INTO
EFFORTS TO IMPROVE MENTAL HEALTH
COVERAGE, ACCESS TO MENTAL
HEALTH PROVIDERS AND REDUCED
STIGMA AMONG PREGNANT AND
BIRTHING PERSONS WHO NEED
TREATMENT?
ANY THOUGHTS FROM ANYONE?
>>I CAN QUICKLY SAY MINE WAS
NOT AN INTERVENTION SO I CAN'T
ANSWER THAT QUESTION.
>>OURS NEITHER.
AND WE'RE STILL GETTING INTO
INDIVIDUAL LEVEL DATA.
>>I'D BE HAPPY TO TAKE -- I
THINK THE BENEFIT OF HAVING A
UNIVERSALLY AVAILABLE PREVENTION
TOOL WILL HELP WITH ADDRESSING
STIGMA TO SOME DEGREE BECAUSE IT
DOESN'T REQUIRE THE VERY
COMPLICATED PROCESS OF SOMEBODY
IDENTIFYING I NEED HELP OR I
NEED TO HAVE SOME PREVENTION
STRATEGIES, AND THEN CONTACTING
A PROVIDER, YOU KNOW, MAKING
THOSE MULTIPLE STEPS AND THE
REALITIES THAT WE KNOW TO BE
TRUE OVER THE PAST 2 1/2 YEARS
WERE ALSO THAT ACCESS TO MENTAL
HEALTH PROVIDERS HAS BEEN
SEVERELY LIMITED AND NOT MEETING
REAL NEED MOST PREGNANT AND
POSTPARTUM INDIVIDUALS ARE
FACING IN OUR COUNTRY, SO THAT'S
WHY MANY OF US HAVE GOTTEN INTO
THE PREVENTION INTERVENTION
WORLD, BECAUSE IF WE CAN OFFER
STRATEGIES FOR PREVENTION AND/OR
EASY INTERVENTION TOOLS THAT ARE
EASILY ACCESSIBLE AND
NON-PHARMACOLOGIC LOW COST, THAT
IDEALLY WE'LL BE ABLE TO START
ADDRESSING STIGMA RELATING TO
MENTAL HEALTH.
>>THANK YOU.
THE NEXT QUESTION IS FOR DR.
HARVILLE.
WHAT ARE YOUR THOUGHTS ABOUT
FUTURE COLLABORATIONS ON
RIGOROUS STUDIES ACROSS MULTIPLE
COMMUNITIES THAT EXAMINE
RELATIONSHIP BETWEEN FEATURE
RESPECT OF THE BUILT ENVIRONMENT
AND GESTATIONAL WEIGHT GAIN IN
PREGNANT WOMEN?
>>YEAH, SO DR. REDMOND, THE
P.I. ON THIS PROJECT, THIS WAS
ALL THESE SUPPLEMENT TO EXISTING
PROJECT, RIGHT?
HER EXISTING PROJECT ACTUALLY IS
IN CONJUNCTION WITH THE WIC
CLINIC, I DON'T THINK IT'S AS
MUCH ABOUT THE BUILT ENVIRONMENT
BUT LOOKING AT SOME
INTERVENTIONS TO IMPROVE
NUTRITION AND SO FORTH DURING
PREGNANCY AND POSTPARTUM.
I'M ALL FOR INTERVENTIONS THAT
IMPROVE THE BUILT ENVIRONMENT.
I THINK TO FIND THE STRONG
EFFECT WE WILL HAVE TO BE LIKE
MULTIPLE SITES AND A WHOLE LOT
OF PEOPLE BECAUSE I THINK THE
EFFECT IS SUBTLE SO I'M ALL FOR
THAT FOR A NUMBER OF REASONS BUT
TRYING TO PICK OUT THE SIGNAL
THERE I KNOW IS GOING TO BE
DIFFICULT.
>>THANK YOU.
NEXT QUESTION IS FOR DR.
DUMITRU.
MENTAL HEALTH RELATED STIGMA IS
WIDESPREAD, INTERDISCIPLINARY
COLLABORATION IS SUCH AN
IMPORTANT PART TO WOMEN, DURING
PREGNANCY, BIRTHING PERIOD AND
POSTPARTUM.
TALK ABOUT THE FEASIBILITY AND
IMPORTANCE OF TRAINING THE WHOLE
CARE TEAM TO CONDUCT MENTAL
HEALTH SCREENINGS AND PROVIDE
THE ENTREE INTO PSYCHOSOCIAL
CARE AND SUPPORTS DURING THE
ENCOUNTER.
>>YEAH, THE MULTI-DISCIPLINARY
NATURE IS REALLY MY FAVORITE
PART OF THE WORK.
I ALSO WANT TO REITERATE I'M A
PEDIATRICIAN WHICH IS I KNOW A
BIT UNIQUE FOR THIS PARTICULAR
VENUE, BUT I CAN OFFER
PERSPECTIVE EVEN IN PEDIATRICS
WE'RE REALLY TALKING ABOUT HOW
DO WE AS PEDIATRICIANS TAKE ON
THE PARENT AS OUR PATIENT AS
WELL, AND PERHAPS DO UNIVERSAL
SCREENING, FOR EXAMPLE, IN THE
PEDIATRICIAN'S OFFICE.
IT'S INCREDIBLY IMPORTANT TO
THINK IN VERY BROAD TERMS AS I
ALSO MENTIONED MY OWN PERSONAL
MAIN FOCUS OF RESEARCH IS ON
RELATIONAL HEALTH, PARENT-CHILD
RELATIONAL HEALTH, WE'RE TRYING
TO THINK CREATIVELY OF HOW TO DO
THAT IN A PEDIATRIC OFFICE AND
HOW TO DO THAT AT SCALE.
SO I THINK IT'S INCREDIBLY
IMPORTANT.
I WANT TO SAY THAT HAVING WORKED
WITH A VERY LARGE TEAM AND
COMBO, WORKED WITH LOTS OF OB
DOCS, PSYCHOLOGISTS,
PSYCHIATRISTS, ADULT
NEUROLOGISTS, ENTs, IT'S
REALLY WHAT COMES OUT OF
SOMETHING LIKE THAT IS TRULY
UNIQUE AND DIFFERENT, AND SORT
OF EMERGENT PROPERTY OF A GROUP
SO I REALLY THINK IT'S
IMPORTANT.
>>THANK YOU.
ONE OF YOUR FELLOW PANELISTS
HAVE A QUESTION, FOR DR.
KINSNER.
DISCRIMINATION HAD A UNIQUE
EFFECT, WHAT ARE IMPLICATIONS
FOR TREATMENT?
THAT'S AROUND THE MAMMA MIA
STUDY.
>>MY UNMUTE WOULDN'T UNMUTE.
TO CLARIFY DISCRIMINATION DID
NOT HAVE A UNIQUE EFFECT
SEPARATE FROM INTERVENTION,
WHICH WAS SURPRISING TO US.
NONETHELESS I THINK THERE WOULD
BE AN OBVIOUS COMMENT THAT ANY
OF US WOULD GIVE THAT THERE ARE
OPPORTUNITIES TO ADDRESS
DISCRIMINATION ACROSS HEALTH
CARE SYSTEMS, ACROSS SOCIETY, I
THINK IMPLICATIONS FOR TREATMENT
OF WHAT WOULD BE MY QUESTION
BACK IMPLICATIONS FOR TREATMENT
OF DEPRESSION SYMPTOMS AND
DISCRIMINATION, I WONDER IF SHE
WANTS TO CLARIFY HER QUESTION.
I'LL ECHO ONE THING SAID THAT
TREATING THE PARENT-CHILD DYAD
IS SO CRITICAL BECAUSE IN
PREGNANCY THEY ARE A DYAD, IN
THE POSTPARTUM PERIOD THEY DO
CONTINUE TO BE THAT DYAD.
AND SO HAVING THAT DYAD AT THE
CENTER OR TRIAD IF WE HAVE TWO
PARENTS AND CHILD, AND PAYING
ATTENTION TO DEPRESSIVE AND
OTHER RELATED SYMPTOMS THAT ARE
ARISING IS GOING TO BE CRITICAL
FOR THE HEALTH AND WELLNESS OF
THE CHILD AS WELL AS FAMILY
FUNCTIONING SO I LOVE TO HEAR
THESE CONVERSATIONS WHERE WE'RE
ALL -- WE ALL HAVE THIS AS
COMMON GOAL AND ADDRESSING
STIGMA IN A PEDIATRIC SETTING
JUST AS MUCH AS WE ADDRESS IT IN
AN OBSTETRIC OR WOMEN'S HEALTH
SETTING IS SO CRITICAL FOR
ADVANCING PERINATAL MENTAL
HEALTH.
ANOTHER THING I'LL SAY THERE ARE
OPPORTUNITIES FOR ENHANCING HOW
WE SCREEN AND HOW WE HAVE
NORMALIZING CONVERSATIONS ABOUT
SOME OF THE QUESTIONS THAT ARE
IN SCREENINGS, IT'S AN
INCREDIBLE OPPORTUNITY FOR
IMPROVEMENT.
>>THANK YOU.
THAT BRINGS ME TO A QUESTION FOR
THE ENTIRE PANEL, WHAT ARE SOME
BARRIERS TO CLINICAL TRIALS WITH
PREGNANT WOMEN THAT ARE SEEKING
TO EXPLORE SOME MODIFIABLE RISK
FACTORS AND LEVERAGE POLICY
INTERVENTIONS TO REDUCE WHETHER
WEIGHT GAIN, MENTAL HEALTH
IMPACT ON WOMEN DURING THIS
IMPORTANT PERIOD, OTHER THINGS?
DEFINITELY SOME CLEAR
OPPORTUNITIES AND I THOUGHT IT
WOULD BE OPPORTUNITY TO DIALOGUE
ABOUT THAT.
>>I'M NOT THE OBSTETRICIAN BUT
PREGNANT WOMEN ARE CONSIDERED A
HIGH RISK GROUP IN GENERAL, IT
IS ALWAYS A LITTLE BIT TOUGHER
TO CONDUCT RCTs, MOST OF THE
STUFF WE'RE TALKING ABOUT IS LOW
RISK BUT THERE'S A LOT OF
CHALLENGES BECAUSE IT'S NOT JUST
ONE INDIVIDUAL.
THERE ARE TWO INDIVIDUALS
INVOLVED.
ALSO THERE'S A LOT OF CHALLENGES
WITHIN OUR FIELD.
WE'VE BEEN SUCCESSFUL IN FORGING
A TRUE COLLABORATION BETWEEN
OBSTETRICS AND PEDIATRICS AT
COLUMBIA BUT IT TOOK SOME TIME,
IT TAKES A LOT OF PATIENCE AND
YOU HAVE TO BE REALLY WILLING TO
LISTEN TO A VERY DIFFERENT
PERSPECTIVE AND THAT'S NOT
ALWAYS EASY.
>>I THINK WE CAN SAY THAT EVEN
BEYOND THE RESTRICTIONS OR
REGULATION TO PROTECT PREGNANT
WOMEN, FETUSES, SO FORTH, WHICH
ANY OF US WHO DO RESEARCH IN
THAT GROUP KNOW ABOUT THE EXTRA
FORMS WE HAVE TO FILL OUT.
THERE'S A LOT OF CONSERVATISM ON
THE PART OF IRBs AND
REGULATORY AGENCIES EVEN BEYOND
WHAT IS MAYBE INDICATED BY THE
STRENGTH OF THE EVIDENCE.
THE OTHER THING I THINK THAT IS
IMPORTANT IS RELEVANT TO
MATERNAL HEALTH.
A LOT IS HOW THE WOMAN ENTERS
PREGNANCY, AND A LOT ARE
UNPLANNED, AND THE TIME WE
REALLY WANT TO BE INTERVENING
MIGHT BE, YOU KNOW, A YEAR
EARLIER OR TWO YEARS EARLIER AND
THAT IS EVEN HARDER BECAUSE THE
POPULATION IS IMPOSSIBLE TO
DEFINE EVEN.
BUT I THINK THAT'S ANOTHER
CHALLENGE.
CONCENTRATING ON NOT EVEN THE
WHOLE PREGNANCY AS YOUR TIME
FRAME OF INTEREST, IT'S A TALL
ORDER TO REVERSE ANYTHING,
RIGHT? WHETHER A MEDICAL
CONDITION OR SOCIETAL
DISCRIMINATION, WITHIN THREE
MONTHS, SO I THINK THAT'S
ANOTHER CHALLENGE.
>>THANK YOU.
WE DO NEED A BROADER INVESTMENT
OVERALL, WONDERFUL INVESTIGATORS
LIKE YOU DO HELP US WORK TOWARDS
GETTING TO A PLACE WE GET TO A
POPULATION HEALTH WITH RESPECT
TO POPULATIONS OF WOMEN
THROUGHOUT THE REPRODUCTIVE
PERIOD AND THROUGHOUT THEIR LIFE
COURSE AS WELL.
THANK YOU FOR SHARING YOUR WOR.
WE'LL BREAK AND ALLOW OUR
PANELISTS AS WELL AS AUDIENCE TO
TAKE A QUICK BREAK.
THANK YOU FOR JOINING US.
WE APPRECIATE IT.
>>WELCOME BACK.
I'M DARA BLACHMAN-DEMNER, I'M
THRILLED TO BE MODERATING THE
NEXT PANEL ON SHAPING OUTCOMES
THROUGH TRANSLATIONAL RESEARCH.
FIRST WE WOULD LIKE TO WELCOME
DR. SHERYL FRANKLIN FROM
MOREHOUSE AND DR. NASIM KATEBI
FROM EMORY UNIVERSITY,
PRESENTING TODAY ON
IMPLEMENTATION AND FEASIBILITY
STUDY OF BESPOKE SMARTPHONE
BASED FOR APPLICATION MONITORING
OF PATIENT BLOOD PRESSURE AND
RELATED OUTCOME TO AVOID
PREVENTIBLE DELAYS IN HEALTH
CARE DURING THE POSTPARTUM
PERIOD.
THIS IS PART OF THE GEORGIA
IMPROVE PROGRAM ON MATERNAL
HEALTH, STRUCTURAL RACISM,
DISCRIMINATION.
>>I'M DR. CHERYL FRANKLIN,
PLEASED TO PRESENT OUR WORK TO
YOU TODAY.
WE HAVE BEEN PRIVILEGED TO HAVE
TWO GEORGIA -- TWO IMPROVE
INITIATIVE PROJECTS, THE FIRST
OF WHICH WAS GEORGIA IMPROVE,
AND THE SECOND OF WHICH WAS
GEORGIA IMPROVE ON MATERNAL
HEALTH, STRUCTURAL RACISM AND
DISCRIMINATION, AND COVID-19.
AND I'D LIKE TO PRESENT SOME
WORK FROM THE EFFORTS BUT WE'LL
FOCUS ON A TRANSLATIONAL
RESEARCH TOPIC THAT WE UNDERTOOK
WITHIN OUR GEORGIA IMPROVE ON
MATERNAL HEALTH STRUCTURAL
RACISM AND DISCRIMINATION AND
COVID-19.
I'M JOINED BY MY COLLEAGUE, DR.
NASIM KATEBI, FROM EMORY
UNIVERSITY.
WE'RE THRILLED AT RECEIVING
FUNDING FROM NIH IMPROVE
INITIATIVE, SPECIFICALLY THROUGH
THE NATIONAL CENTER FOR
ADVANCING TRANSLATIONAL
SCIENCES, THROUGH AN
ADMINISTRATIVE SUPPLEMENT TO THE
GEORGIA CTSA.
THERE'S OTHER FUNDING FOR
DEVELOPING TECHNOLOGY USED IN
OUR APPLICATION.
AS WE KNOW, MATERNAL MORTALITY
RATES IN THE UNITED STATES ARE
SOME OF THE HIGHEST IN THE
WORLD, AND WITHIN THE COUNTRY WE
LIVE IN GEORGIA, AND THE RATES
IN GEORGIA ARE SECOND HIGHEST IN
THE COUNTRY.
WE HAD -- THERE ARE ALSO
SIGNIFICANT RACIAL AND ETHNIC
DISPARITIES WITH BLACK WOMEN,
NON-HISPANIC BLACK WOMEN BEING
TWO TO THREE TIMES MORE LIKELY
TO DIE AS A RESULT OF A
PREGNANCY-RELATED ILLNESS AFTER
CHILD BIRTH.
SO WE WANT TO --
>>I'M SORRY TO INTERRUPT.
I WANT TO LET YOU KNOW WE'RE
SEEING THE SPEAKER VIEW, SO WE
CAN SEE YOUR NOTES.
I DON'T KNOW IF YOU WANT TO KEEP
GOING BUT I DID WANT TO LET YOU
KNOW.
>>OKAY.
THAT'S INTERESTING.
>>I DON'T KNOW IF OUR TECH
FOLKS ARE ON.
MAYBE THEY CAN PROVIDE SOME
GUIDANCE.
I APOLOGIZE FOR INTERRUPTING.
>>QUITE ALL RIGHT.
NOW I CAN'T SEE MY NOTES BUT
I'LL WING IT.
>>THANK YOU.
>>I DON'T KNOW WHY THAT
HAPPENED.
BUT OF COURSE WE WERE TALKING
ABOUT HEALTH DISPARITIES IN THE
ISSUES IN GEORGIA, AND SOME
GEORGIA RECOMMENDATIONS THAT
HAVE COME OUT OF OUR MATERNAL
MORTALITY REVIEW COMMITTEE
INCLUDE THAT THERE SHOULD BE
BLOOD PRESSURE CHECKS AT 72
HOURS AFTER DELIVERY IN PERSONS
WITH PREECLAMPSIA AND WE SHOULD
DO -- PROVIDERS SHOULD EDUCATE
PATIENTS AND FAMILIES ABOUT
WARNING SIGNS AND SYMPTOMS THAT
COULD INDICATE WHEN THEY NEED TO
SEEK CARE AND WHEN THEY HAVE A
POTENTIAL LIFE-THREATENING
CONDITION.
AND SO WE TOOK THESE AND USED
THE THREE DELAY RUBRICS OR
FRAMEWORK HOW TO GUIDE OUR WORK.
AND WITH THIS FIRST CRITICAL
DELAY AFTER DELIVERY, BEING OR
DURING PREGNANCY, BEING
RECOGNIZING DANGER SIGNS AND
SYMPTOMS, A LACK OF AWARENESS,
EDUCATION, PATIENT AND FAMILY
EDUCATION, AS WELL AS SOME
CULTURAL NORMS AND PERSONAL
CHOICES.
SECOND CRITICAL DELAY THAT MIGHT
DELAY A PERSON'S ABILITY TO GET
APPROPRIATE CARE WOULD BE
SOCIOECONOMIC CONSTRAINTS,
DECIDING WHEN TO SEEK CARE,
ACCESS TO CARE, ABSENCE OF
FAMILY SUPPORT, POOR REFERRALS.
THE THIRD DELAY BEING ONCE A
PERSON IS IN A SUITABLE SITE OF
CARE BEING ABLE TO RECEIVE
APPROPRIATE CARE.
OUR FIRST GEORGIA IMPROVE
PROJECT WAS REALLY AN
INFRASTRUCTURE FACILITATION TYPE
OF A PROJECT.
WE WANTED TO BE ABLE TO EXTENDS
OR WORK INTO THE COMMUNITY IN
GEORGIA.
AND SO WE SET ABOUT DEVELOPING A
PERINATAL CARE RESEARCH AND
INTERVENTION NETWORK OF
PATIENTS, PROVIDERS, HEALTH
SYSTEMS THROUGHOUT THE STATE OF
GEORGIA TO BE ABLE TO
DEMOCRATIZE RESEARCH EFFORTS AND
GET SOME OF OUR RESEARCH OUT
INTO THE COMMUNITY.
WE TRAINED PROVIDERS,
COMMUNITY-BASED PROVIDERS, IN
RESEARCH METHODS.
WE HELPED THEM TO GET CERTIFIED
TO DO RESEARCH.
AND WE GAVE -- SHARED SOME OF
THE INFRASTRUCTURE FROM
MOREHOUSE SCHOOL OF MEDICINE
WITH PROVIDERS IN ORDER TO EQUIP
THEM TO BE ABLE TO SHARE IN
RESEARCH EFFORTS.
WE ALSO DID STAKEHOLDER NEEDS
ASSESSMENTS, AND WE PARTNERED
WITH THE GEORGIA DEPARTMENT OF
PUBLIC HEALTH TO DEVELOP A PEER
LEARNING NETWORK IN MATERNAL
HEALTH.
WE EMBARKED UPON THE GEORGIA
IMPROVE ON STRUCTURAL RACISM AND
DISCRIMINATION AND COVID-19
STUDY, AND THAT STUDY IS A
LARGER STUDY WITH FOUR SPECIFIC
AIMS, THE FIRST BEING ONE WHERE
WE LOOKED, DID A MULTI-LEVEL
ASSESSMENT OF FACTORS THAT
EXACERBATE OR AMELIORATE THE
OVERALL IMPACT OF COVID-19 ON
PREGNANT AND POSTPARTUM WOMEN.
SECONDLY, WE LOOKED AT SOME OF
THE STRESSORS, BOTH ACUTE AND
CHRONIC STRESSORS, AND
MEASURED -- WANTED TO MEASURE
THE BURDEN OF THAT CHRONIC
STRESS OF DUAL PANDEMICS,
STRUCTURAL RACISM AND
DISCRIMINATION AND COVID-19 ON
PREGNANT AND POSTPARTUM WOMEN.
FOURTH TO DO ASSESSMENT TO
MEASURE ASSOCIATIONS BETWEEN
STRUCTURAL RACISM AND
DISCRIMINATION, AND HEALTH AND
RACIAL DISPARITIES IN MATERNAL
HEALTH.
TIME DOES NOT PERMIT ME TO GO
INTO DETAIL, AID LIKE TO FOCUS
ON OUR THIRD AIM WHICH WAS PILOT
FEASIBILITY STUDY TO MONITOR
BLOOD PRESSURE SYMPTOMS AND
MENTAL HEALTH IMPACTS OF
COVID-19 DURING THE PERINATAL
PERIOD, AND SRD.
THAT'S THE AIM WE DID OUR
TRANSLATIONAL RESEARCH PROJECT
THAT WE WOULD LIKE TO PRESENT TO
YOU NOW.
THIS WAS A PILOT FEASIBILITY
STUDY LOOKING AT A
SMARTPHONE-BASED APPLICATION,
MORE MONITORING PATIENT BLOOD
PRESSURE AND RELATED OUTCOMES TO
AVOID PREVENTIBLE DELAYS IN
HEALTH CARE DURING THE
POSTPARTUM PERIOD.
AND NOW I'D LIKE TO INVITE MY
COLLEAGUE, DR. NASIM KATEBI,
FROM THE BIOMEDICAL INFORMATICS
LAB AT EMORY UNIVERSITY TO SHARE
ON OUR APPLICATION.
>>THANK YOU SO MUCH.
HI, EVERYONE.
HOW WE ANALYZED DATA, IN THE
STUDY.
IT TRACKS CHANGES IN BLOOD
PRESSURE DATA.
THE DESIGN TO MEASURE POSTPARTUM
COMMUNICATION BETWEEN PATIENT
AND CLINICIANS.
AND NEXT SLIDE PLEASE.
USERS HAVE INCENTIVIZED TO
ANSWER SURVEYS, ALSO TO RECORD
SYMPTOMS AND REGULARLY MEASURE
THEIR BLOOD PRESSURE USING THE
PROVIDED BLOOD PRESSURE CUFF.
SEVERE RANGE OF BLOOD PRESSURES
AND SYMPTOMS OF HYPERTENSIVE
COMPLICATIONS WITH CLINICIANS
AND USERS, ALSO TO INSTRUCT THEM
TO SEEK EMERGENCY CARE.
YOU CAN SEE THE MOBILE APP
INTERFACE DESIGN AND THIS IS
MADE OF SUPPORT OF MECHANISMS
INCLUDING SYMPTOMS OF SEVERE
COVID-19, HYPERTENSION, MOOD,
PERSONAL EXPERIENCE RELATED TO
MENTAL HEALTH STRUCTURE RACISM
AND DISCRIMINATION.
ADDITIONAL INFORMATION RELATED
TO EACH FEATURE FOR USERS, AND
COLOR CODED.
PARTICIPANTS WERE RECRUITED AND
ELECTRONICALLY ENROLLED AT GRADY
HOSPITAL IN ATLANTA.
AFRICAN AMERICAN WOMEN MOST
UNDER 30 YEARS OLD, 34% BEYOND
HIGH SCHOOL DIPLOMA, 66%
EMPLOYED.
MOST WERE MEDICAID INSURED, MANY
DEMONSTRATED SOCIAL NEEDS
ESPECIALLY FOR FOOD AND
UTILITIES.
NEXT SLIDE.
WE COLLECTED 776 BLOOD PRESSURE
DATA FROM 48 PARTICIPANTS.
YOU CAN SEE DISTRIBUTION OF
BLOOD PRESSURE, NUMBER OF BLOOD
PRESSURE DATA, ALSO TIME OF THE
RECORDING OF THE BLOOD PRESSURE
WE HAD 21 PARTICIPANTS WITH
BLOOD PRESSURE IN THE RANGE OF
HYPERTENSION STAGE 2, RECORDED
SEVERELY HYPERTENSIVE BLOOD
PRESSURE, ALSO 47 SYMPTOMS OF
SEVERE HYPERTENSION FROM 39
PARTICIPANTS.
THIS TRANSCRIBES MEASUREMENTS
FROM DEVICES, THE AIM IS TO
ADJUST CHALLENGES ASSOCIATED
WITH TRANSMITTING BLOOD PRESSURE
READINGS IN HOME-BASED
MONITORING SYSTEMS.
THIS HAS STEPS.
FAR BELOW REQUIREMENTS, PROPOSED
MODELS SUITABLE FOR GENERAL USE.
COMPARED MANUAL TRANSCRIPTION
AND AUTOMATIC TRANSCRIPTION
METHODS AND SHOWED THERE WAS NO
STATISTICAL SIGNIFICANT
DIFFERENCE BETWEEN THESE TWO
METHODS.
>>ONE MINUTE LEFT PLEASE.
>>THE NEXT SLIDE PLEASE.
>>I HEAR YOU.
I CAN'T GET IT TO GO, FOR
WHATEVER REASON.
>>WE STUDIED POSTPARTUM
DEPRESSION AND BLOOD PRESSURE,
FOR 33 WITH EPDS AND BLOOD
PRESSURE DATA HIGHER
SELF-REPORTED SIGNIFICANTLY
ASSOCIATED WITH LOWER SYSTOLIC
BLOOD PRESSURE, YOU CAN SEE IN
THIS FIGURE SIGNIFICANT
CORRELATION BETWEEN THE TWO.
I PASS IT TO DR. FRANKLIN FOR
THE CONCLUSION.
>>OKAY.
IN CONCLUSION, WE FOUND THAT
THIS WAS AN EFFICIENT AND
RELIABLE METHOD FOR
AUTOMATICALLY TRANSCRIBING AND
TRANSMITTING DATA THAT WE SAW
FROM OUR BLOOD PRESSURE DEVICES,
IT WAS ACCURATE.
WE WERE ABLE TO SHOW THAT IT WAS
SUITABLE FOR GENERAL USE.
WE WERE ABLE TO COMMUNICATE BACK
AND FORTH BETWEEN PARTICIPANTS
AND THEIR PROVIDERS.
WE DID ENTIRE ELECTRONIC
PARTICIPANT RECRUITMENT,
ENGAGING ENGAGEMENT CONSENTING
ENROLLMENT, OUR PROVIDERS FOUND
THIS TO BE A USEFUL WAY TO
MONITOR THEIR PARTICIPANTS'
BLOOD PRESSURES, OR THEIR
PATIENTS' BLOOD PRESSURES.
WE WERE ABLE TO DO DIGITAL
EPIDEMIOLOGY, COLLECTING
SENSITIVE DATA FROM
PARTICIPANTS, IN TERMS OF
DEPRESSION, COVID IMPACT,
SOCIODEMOGRAPHIC DATA, ET
CETERA, THAT CAN BE ANALYZED
FURTHER.
AND MOST IMPORTANT OR VERY
IMPORTANT WE WERE ABLE TO ENGAGE
THE COMMUNITY IN OUR RESEARCH
AND FURTHER DEVELOPING OUR
PERINATAL CARE RESEARCH AND
INTERVENTION NETWORK TO BRING IN
COMMUNITY PRACTICES AND
PROVIDERS TRAINING THEM IN
RESEARCH METHODS AND BEING ABLE
TO EQUIP THEM TO HELP WITH OUR
RESEARCH AND TO IMPLEMENT
EVIDENCE-BASED INTERVENTIONS.
THANK YOU FOR YOUR ATTENTION.
>>THANK YOU.
AND NEXT AND FINAL SPEAKER FOR
THIS PANEL IS DR. MELISSA SIMON
FROM NORTHWESTERN UNIVERSITY
FEINBERG SCHOOL OF MEDICINE ON
THE OPTIMIZED STUDY, ROUTINE
PERINATAL CARE.
>>HELLO, EVERYONE.
I'M TRYING TO SHARE MY SCREEN
BUT IT'S NOT LETTING ME.
ALL RIGHT.
THANK YOU FOR INVITING ME.
I REALLY APPRECIATE IT.
THANK YOU FOR STAYING TO NEAR
ALMOST THE END OF THIS WONDERFUL
SYMPOSIUM.
THANK YOU TO THE "IMPROVE"
INITIATIVE.
IT'S DONE WONDERS, IT'S GOING TO
ADVANCE THE SCIENCE AND CARE OF
PREGNANT AND BIRTHING PERSONS IN
THIS COUNTRY AND HOPEFULLY
IMPROVE ON EGREGIOUS INEQUITIES
THAT EXIST.
SO, OUR OPTIMIZE STUDY WAS
FUNDED BY NIMHD R01 IMPROVE
INITIATIVE.
THE ENTIRE TEAM INCLUDING NIMHD
HELPED FUND THIS, AND ALL THE
PARTNERS ACROSS NIH THAT HAVE
REALLY HELPED PROMOTE AND CREATE
THIS WONDERFUL IMPROVE
INITIATIVE ACROSS MULTIPLE
I.C.s.
AND SPECIAL THANKS TO
COLLABORATORS AND CLEARLY OUR
COMMUNITY PARTNERS WHO HELPED
REALLY DRIVE THIS IN CHICAGO AND
THE COMMUNITY CLINICS, GRASS
ROOTS ORGANIZATIONS AND OF
COURSE BLACK PREGNANT ANT
BIRTHING PERSONS THEMSELVES.
I'M A MEMBER OF THE NIH OFFICE
OF RESEARCH OF WOMEN'S HEALTH
ADVISORY COMMITTEE.
SO YOU HEARD FROM DR. FRANKLIN
AND COLLEAGUES ABOUT THE
EGREGIOUS HEALTH INEQUITIES IN
MORTALITY AND SEVERE MORBIDITY,
AND IN THIS COUNTRY, AND REALLY
ROUTINE PERINATAL CARE WHICH THE
MAJORITY OF PEOPLE RECEIVE IN
THIS COUNTRY, ESPECIALLY THOSE
WHO IDENTIFY AS BLACK RECEIVE IN
THIS COUNTRY HAS NEVER REALLY
BEEN CHANGED OR EXAMINED TO
ACTUALLY CHANGE DIFFERENT TYPES
OF COMPONENTS OR CADENCE OR
ANYTHING LIKE THAT, CADENCE OF
VISITS, CONTENT OF VISITS, OTHER
THAN GROUP MODELS CENTERING
PREGNANCY, OTHER TYPES OF GROUP
PRENATAL CARE.
REALLY REENGINEERING THIS,
UNDERSTANDING THAT THOSE
STRUCTURES, ORIGINAL PERINATAL
CARE, WAS DESIGNED UNDERPINNED
BY SYSTEMS OF OPPRESSION AND
RACISM, AND SO WE REALLY DO NEED
TO REENGINEER AND RETHINK THE
ROUTINE CARE THAT WE GIVE ON THE
GROUND TO MEET THE TRUE NEEDS OF
BLACK PREGNANT AND BIRTHING
PERSONS.
I'M AN OB/GYN AT NORTHWESTERN IN
CHICAGO, FULL DISCLOSURE.
SO WE DECIDED TO CREATE A HYBRID
TYPE 1 CLUSTER RANDOMIZED
EFFECTIVENESS TRIAL.
AND TO EVALUATE EFFECTIVENESS OF
A CHECKLIST.
WE HAVE GREAT SAFETY IN AVIATION
IN OUR COUNTRY, AROUND THE
WORLD, BECAUSE OF ALL THE
CHECKLISTS, AND CHECK LISTS HAVE
BEEN STUDIED IN POSTPARTUM
HEMORRHAGE, THERE ARE SETS OF
CARE SETS FOR HIGH BLOOD
PRESSURE IN PREGNANCY, CHECK
LISTS ARE IMPORTANT, TIMEOUTS IN
THE OPERATING ROOM, PRE AND POST
PROCEDURE, ET CETERA.
WHY NOT REALLY THINK ABOUT HOW
TO EMBED CERTAIN EQUITY MEASURES
INTO PERINATAL CARE THROUGH
THINGS LIKE CHECK LISTS BECAUSE
THE PERINATAL CARE FORM, THE
HOLLISTER FORM ORIGINALLY
CREATED BY ACOG AND THE AMERICAN
ASSOCIATION OF PEDIATRICS, YOU
KNOW, IT IS A CHECKLIST OF A
SORT.
IT'S JUST NOT REALLY DESIGNED
WITH CENTERING PATIENTS AND
ESPECIALLY BLACK PREGNANT AND
BIRTHING PERSONS IN MIND.
AND SO HOW CAN YOU ALSO THEN
IMPLEMENT -- EMBED NAVIGATION
SUPPORT IN THAT PERINATAL CARE
TRAJECTORY?
AND THEN HOW CAN YOU MODIFY THE
CADENCE AND CONTENT OF ROUTINE
PERINATAL VISITS?
FOR EXAMPLE, DOES THE FIRST
PRENATAL VISIT REALLY NEED TO
HAVE LIKE THIS DELUGE OF
INFORMATION GIVEN TO THE
PREGNANT AND BIRTHING PERSON UP
FRONT?
WHY CAN'T THERE BE TWO VISITS IN
THE FIRST TWO WEEKS APART OR SO,
WHY NOT?
WHEN WE STEP BACK AND START
ASKING QUESTIONS LIKE THAT, IT'S
NOT ACCEPTABLE TO HEAR THAT'S
THE WAY WE ALWAYS DO IT OR
THAT'S THE WAY BILLING WILL
ALLOW IT BECAUSE THAT'S WHEN WE
PERPETUATE THE SYSTEM OF
OPPRESSION AND UNDERLYING
STRUCTURAL RACISM AND DRIVE
INEQUITIES BECAUSE THAT'S HOW WE
GOT THE PHENOTYPES WE HAVE
TODAY, THAT'S HOW WE GOT TO
WHERE WE ARE IN THE EGREGIOUS
DISPARITIES, IN OUR COUNTRY.
SO WE REALLY HAVE TO ASK HARD
QUESTIONS AS WHY, SOUNDS LIKE
IT'S NOT A HARD QUESTION TO ASK
WHY.
THE OTHER THING WHAT IS
DELIVERED IN THE FIRST VISIT
THAT COULD BE BETTER IN ORDER TO
START BRIDGING TRUST?
THE REALLY IMPORTANT PART OF
THIS IS THAT WE IN THE HEALTH
CARE SYSTEM AND SCIENTISTS, I'M
BOTH, A SCIENTIST AND OB/GYN
PHYSICIAN, WE'VE EARNED THIS
TRUST.
WE'VE BEEN ABUSIVE AND OUTRIGHT
WRONG TO PREGNANT AND BIRTHING
PERSONS, PEOPLE IN GENERAL,
ESPECIALLY THOSE WHO IDENTIFY AS
RACIALIZED AND MINORITIZED, WHO
IDENTIFY AS BLACK FOR CERTAIN,
EVEN THE UNDERPINNINGS OF MARION
SIMS, THE GODFATHER OF OB/GYN,
EGREGIOUS ABUSE.
WE HAVE TO EARN THE TRUST BACK.
WHY CAN'T THE FIRST PERINATAL
CARE VISIT BE A FEW QUESTIONS
ABOUT TRUST?
WHAT ARE YOUR HOPES AND DREAMS
FOR THIS PREGNANCY?
WHAT ARE YOUR FEARS?
HOW CAN I HELP YOU?
HOW CAN WE WALK WITH YOU?
START TO GET THAT SENSE OF --
GARNER A SENSE OF BELONGING AND
CENTERING THE PATIENT AND THE
BLACK BIRTHING PERSON THEMSELF
INTO THAT CONVERSATION AND GET
THEM IN CONTROL OF THAT CARE TO
HELP GUIDE.
SO, WE ALWAYS START OUR STUDIES
CENTERED WITH THE COMMUNITIES
THAT WE'RE GOING TO WORK WITH SO
WE DID LOTS OF QUALITATIVE
RESEARCH AND THIS WAS DURING
COVID, WE HAD PATIENT INTERVIEWS
ABOUT EXPERIENCES WITH CARE,
BELIEFS, VIEWS OF MEDICINE,
HEALTH CARE BEHAVIORS, PRIOR
EXPERIENCES WITH NAVIGATORS AND
CARE, ET CETERA.
AND STAKEHOLDER INTERVIEWS OF
PEOPLE WHO CARE FOR BLACK
PREGNANT AND BIRTHING PERSONS AS
WELL.
TO GET FEEDBACK ON THE
BEGINNINGS, ITERATIVE FEEDBACK.
A LITTLE BIT ABOUT QUALITATIVE
FINDINGS, WHEN TRUST IS
ESTABLISHED PATIENTS ATTEND
APPOINTMENTS, FEEL ENGAGED, PART
OF THE TEAM, THE BELONGING IS
REALLY IMPORTANT CONCEPT.
TRUST INCREASES.
PATIENTS BELIEVE THE INFORMATION
IS IN THEIR BEST INTEREST THAT
IS GIVEN TO THEM WHEN YOU START
TO RE-TAILOR HOW YOU APPROACH A
PERSON, TREAT THEM AS HUMAN,
PART OF THE TEAM.
HEALTH LITERACY INCREASES
BECAUSE THEY CAN HEAR YOU.
PATIENTS OPEN UP AND WILL WORK
WITH YOU.
PATIENTS EXPRESSED IMPORTANCE OF
TRUST AND DESIRE FOR PROVIDERS
TO ASK PATIENTS HOW THEY ARE
FEELING AND ASK THE RIGHT
QUESTIONS.
INCLUDE QUESTIONS THAT SHOW THE
PROVIDER CARES.
PATIENTS SHOULD BE ABLE TO ASK
MORE QUESTIONS, OPEN THAT SPACE,
CREATE THAT SPACE TO ASK
QUESTIONS.
PATIENTS BE MORE COMFORTABLE
ASKING SENSITIVE QUESTIONS IF
THE PROVIDER BROUGHT IT UP FIRST
AND ANSWERING PATIENT QUESTIONS
INCREASES TRUST.
THIS WAS AN RCT WITH SAMPLE SIZE
OF 600.
THE CLINICS ARE UNITS OF
RANDOMIZATION.
EVALUATE EFFECTIVENESS OF
INTERVENTION FOR PARTICIPANTS IN
IMPROVING CARE, SOCIAL
DETERMINANTS OF HEALTH
SCREENING, REFERRAL, REDUCING
DEPRESSION, INCREASING
BREASTFEEDING, VACCINE,
CONTRACEPTION UPTAKE.
SO WE ARE FOLLOWING PATIENTS
OVER TIME SO BASELINE AND AROUND
32 WEEKS GESTATION, POSTPARTUM,
6 WEEKS, 3 MONTHS, 6 MONTHS,
MIXED METHODS.
THIS IS JUST ONE EXAMPLE OF WHAT
WE HAD TO DO WITH THE CLINICS.
PART OF IMPLEMENTATION IS
UNDERSTANDING EACH OF THE
CLINICS YOU'LL WORK IN, WHETHER
THEY ARE INTERVENTION OR CONTROL
GROUPS, AND YOU REALLY NEED TO
UNDERSTAND THE DESIGN, FLOW OF
THE WORK, WHO IS THERE, ALL THE
PLAYERS, STAKEHOLDERS, AND
THAT'S JUST AN EXAMPLE.
KEY TAKEAWAYS, TAKES TIME,
NECESSARY FOR THE INTERVENTION
TO BE MOST EFFECTIVE, PANDEMIC
HAS HAD AND WILL CONTINUE TO
HAVE IMPACT ON CARE AND
RESEARCH, AND SOME CHALLENGES WE
CONTINUE TO FACE, ENROLLMENT HAS
BEEN AN ISSUE, BUT THERE'S
COMPETING PRIORITIES FOR
CLINICS, WORKFORCE SHORTAGES,
ACROSS THESE, CHURN, TRYING TO
MAKE STRUCTURAL CHANGE IS HARD.
ANYTIME YOU TRY TO CHANGE
SOMETHING LIKE PRENATAL CARE
TEMPLATE, IMAGINE THAT, REALLY
HARD.
SO I WANT TO THANK YOU ALL AND
I'M LOOKING FORWARD TO THE
QUESTION AND ANSWER.
>>FABULOUS.
THANK YOU.
I'LL INVITE OUR OTHER PRESENTERS
TO TURN THEIR CAMERAS ON AND I
THINK WE ONLY HAVE TIME FOR ONE
OR TWO QUESTIONS FOR EACH
PRESENTER SO WE CAN GET OUR
SELVES BACK ON TIME.
I DON'T SEE ANY QUESTIONS COMING
IN SO I CAN TAKE THE PREROGATIVE
AS MODERATOR.
FOR DR. FRANKLIN AND DR. KATEBI,
YOU HAD TO GO THROUGH YOUR
SLIDES QUICKLY AT THE END BUT
DID I SEE CORRECTLY THAT IN YOUR
FINDINGS YOU WERE SEEING THAT AS
BLOOD PRESSURE WENT UP
DEPRESSION WENT DOWN?
DID I SEE THAT CORRECTLY?
WAS WONDERING IF YOU HAVE
THOUGHTS ABOUT THAT.
>>AS DEPRESSION SCORES WENT UP
WE FOUND LOWER BLOOD PRESSURE IN
THAT GROUP, SURPRISING TO US.
>>WONDERING IF HAD YOU THOUGHTS
ABOUT THAT.
>>WELL, I'LL LET DR. KATEBI
ANSWER.
WE FOUND IN THE LITERATURE THAT
AMONG NON-PREGNANT ADULTS THERE
WAS A SIMILAR TYPE OF
PHENOMENON.
>>INTERESTING.
>>IT WAS VERY INTERESTING AND
WE FOUND THAT THERE'S NOT
SIMILAR STUDIES ON POSTPARTUM OR
DURING PREGNANCY, BUT IN GENERAL
THIS RELATIONSHIP LIKE NEGATIVE
RELATIONSHIP BETWEEN THE
DEPRESSION AND THE BLOOD
PRESSURE.
>>DEFINITELY SOMETHING WE WANT
TO STUDY MORE AND TO GET MORE
INSIGHT ON.
>>GREAT.
THANK YOU VERY MUCH.
AND FOR DR. SIMON, I REALLY
APPRECIATED HOW YOU WERE FRAMING
THIS IDEA OF TRUST, AND
CONNECTION, AND SORT OF
CENTERING.
THERE'S BEEN TALK ABOUT KIND OF,
YOU KNOW, IMPORTANCE OF HAVING
OTHER PROVIDERS THAT LOOK LIKE
THE PATIENT AND WE KNOW THERE'S
A SHORTAGE OF THOSE PROVIDERS SO
I'M WONDERING IF THAT'S
SOMETHING THAT YOU WERE ABLE TO
LOOK AT OR YOU PLAN TO LOOK AT,
OR IF NOT I KNOW YOU TALKED
ABOUT SOME OF THE KINDS OF
QUESTIONS THAT PROVIDERS CAN ASK
TO START TO BUILD THAT TRUST BUT
I'M WONDERING IF YOU HAVE ANY
INSIGHT INTO THAT PARTICULAR
ASPECT OF THAT RELATIONSHIP.
>>IT IS ABSOLUTELY AN IMPORTANT
PART OF THE RELATIONSHIP BUT
IT'S NOT AN END-ALL, BE-ALL
BECAUSE AT THIS POINT, UNTIL WE
IMPROVE OUR WORKFORCE
DIVERSIFICATION AND STABILIZE WE
HAVE TO STABILIZE OUR WORKFORCE
FIRST, THERE'S BEEN A MASS
EXODUS, 20% OF NURSES ACROSS THE
COUNTRY LEFT, THE PROFESSION,
PHYSICIANS ARE LEAVING, WE NEED
TO STABILIZE THE WORKFORCE
COMING OUT OF THE PANDEMIC FIRST
AND FOREMOST.
I CAN'T REPORT ON CONCORDANCE.
WE WILL.
BUT ONE THING, THESE QUESTIONS
AND JUST PAUSING AND TAKING A
MOMENT IN THE FIRST PRENATAL
CARE VISIT INSTEAD OF DELUGE OF
ALL THOSE QUESTIONS, WE TALK
ABOUT GENETIC SCREENING AND ALL
KINDS OF STUFF.
IF YOU HAVE DIABETES AND
HYPERTENSION, ALL THIS STUFF ON
TOP OF THAT, THAT MAKES THAT IS
HAVE IT EVEN WORSE WITH HEALTH
INFORMATION.
SO IF WE TAKE A PAUSE, ASK THESE
QUESTIONS ABOUT WHAT ARE YOUR
FEARS, YOUR WORRIES ABOUT THIS
PREGNANCY, HOPES AND DREAMS,
WHAT CAN WE DO, SLOW IT DOWN, I
THINK WE HAVE A BETTER CHANCE OF
STARTING THAT BRIDGE OF BUILDING
TRUST REGARDLESS OF THE
CONCORDANCE.
>>ABSOLUTELY.
THANK YOU SO MUCH.
I THINK WITH THAT I DON'T SEE
ANY OTHER QUESTIONS COMING IN.
I WANT TO MAKE SURE WE HAVE TIME
FOR OUR FINAL SESSION OF THE
DAY.
I'M GOING TO THANK THE SPEAKERS
AND TURN IT OVER TO MY
COLLEAGUES SARAH YOON MODERATING
THE LAST SESSION.
>>THANK YOU.
I APOLOGIZE FOR MY
PRONUNCIATIONS, I'LL DO MY BEST.
I'M SARAH YOON, PROGRAM DIRECTOR
AT NINR.
I WILL MODERATE CARDIOVASCULAR
AND ENVIRONMENTAL RISKS SESSION.
AND IN THIS SESSION WE HAVE
THREE SPEAKERS, FIRST DR.
DOCTORS RICHARDSON AND TOLUHI
FROM THE UNIVERSITY OF ALABAMA
BIRMINGHAM.
SECONDS IS DR. KARAGAS AND DR.
ROMANO FROM DARTMOUTH SCHOOL OF
MEDICINE.
LAST PRESENTERS DOCTORS CHARRON
AND FULORIA FROM ALBERT EINSTEIN
COLLEGE OF MEDICINE.
WE'LL START WITH DR. RICHARDSON,
MULTI-LEVEL DETERMINANTS OF
MATERNAL MORTALITY AND SEVERE
MATERNAL MORBIDITY AND
ASSOCIATED HEALTH DISPARITIES.
PLEASE GO AHEAD FOR YOUR
PRESENTATION, DR. RICHARDSON.
>>THANK YOU, DR. YOON.
I'M EXCITED TO PRESENT THIS WORK
ON BEHALF OF A LARGE
MULTI-DISCIPLINARY COLLABORATION
ACROSS UAB SCHOOLS OF MEDICINE,
NURSING, PUBLIC HEALTH.
THIS WORK IS FUNDED AS
ADMINISTRATIVE SUPPLEMENT.
I'D LIKE TO ACKNOWLEDGE
LEADERSHIP AND SUPPORT FROM UAB
CENTER WORKING GROUP AND
DIVISIONS AND DEPARTMENTS.
NEXT SLIDE PLEASE.
ALABAMA HAS THE THIRD WORST
MATERNAL MORTALITY RATIO IN THE
U.S., THREE TIMES AS LIKELY
AMONG BLACK VERSUS WHITE WOMEN
IN THE U.S.
CONCEPTUAL MODELS ON THE RIGHT
ILLUSTRATE PATHWAYS TO RACIAL
DISPARITIES AND MATERNAL
MORTALITY, SHOWING FACTORS AT
MULTIPLE LEVELS.
OUR TEAM IDENTIFIED MULTI-LEVEL
DETERMINANTS OF MATERNAL HEALTH
DISPARITIES AND FACTORS THAT
CONTRIBUTE TO OPTIMAL OUTCOMES.
NEXT SLIDE PLEASE.
WE EXAMINED THE RELATIONSHIP
BETWEEN INDIVIDUALS, COMMUNITY,
SYSTEMS FACTORS AND COMPOSITE OF
MATERNAL MORTALITY AND SEVERE
MORBIDITY, RECEIVING OB CARE AT
ALABAMA HEALTH SYSTEM.
WE CONDUCTED RETROSPECTIVE
COHORT STUDY OF ALL OBSTETRIC
PATIENTS FROM 2010 TO 2019,
USING DATA FROM THE INFORMATICS
FRAMEWORK.
UTILIZED MULTI-LEVEL MODELING
AND SPATIAL ANALYSIS TO EXAMINE
ASSOCIATION BETWEEN PREDICTORS
AND COMBINED MORBIDITY AND
MORTALITY OUTCOME.
WE IDENTIFIED AND INCLUDED
32,000 LIVE BIRTHS, LOOKING AT A
PARTIAL TABLE.
YOU'LL NOTE ADI BROKEN DOWN INTO
QUINTILES ON THE FAR LEFT,
SIGNIFICANT ADJUSTED ODDS RATIOS
NOTED ON THE RIGHT.
FULL TABLE IN THE PAPER DETAILS
THE OTHER VARIABLES LIKE
INSURANCE, AGE, RESIDENCE IN
MEDICALLY UNDERSERVED AREAS.
WE FOUND RESIDENTS WITHIN
DISADVANTAGED NEIGHBORS MAY
CONTRIBUTE TO SEVERE MATERNAL
MORBIDITY AND MORTALITY EVEN
AFTER ADJUSTING FOR PATIENT
LEVEL FACTORS.
THIS TELLS US THAT MEASURES SUCH
AS AREA DEPRIVATION INDEX ADI
CAN HELP IDENTIFY MOST
VULNERABLE POPULATIONS AND
PROVIDE POINTS TO POTENTIALLY
INTERVENE.
NEXT SLIDE PLEASE.
NEXT WE AIM TO IDENTIFY
PROVIDER, SYSTEM,
COMMUNITY-BASED PERSPECTIVES ON
FACTORS RESPONSIBLE FOR
DISPARITIES TO INTERVENE,
CONDUCTING 20 INTERVIEWS TO
THOSE WHO PROVIDE SERVICES TO
INDIVIDUALS IN ALABAMA.
DESCRIBING FACTORS CONTRIBUTING
TO DISPARITIES, ORGANIZED BY
LEVEL.
NEXT SLIDE PLEASE.
THESE ARE ORGANIZED BY LEVELS,
VARYING WIDELY FROM RACISM TO
WORK FORCE SHORTAGES, LACK OF
DIVERSITY AT THE HEALTH SERVICES
LEVEL, LACK OF CULTURAL
COMPETENCE AT THE PROVIDER LEVEL
TO NAME JUST A FEW.
NEXT SLIDE PLEASE.
STRATEGIES TO ADDRESS THESE
DISPARITIES NOTED THAT
STRATEGIES SHOULD BE
EVIDENCE-BASED, CULTURALLY
APPROPRIATE, ADDRESS FACTORS AT
MULTIPLE LEVELS.
THEY ALSO IDENTIFIED SPECIFIC
STRATEGIES FOR PROVIDER AND
MATERNITY HEALTH SERVICE LEVELS,
LIKE TRAININGS, SPECIFIC
RESEARCH TOPICS, INCREASING
WORKFORCE DIVERSITY.
AT THE COMMUNITY AND SYSTEMS
LEVELS THEY EMPHASIZED NEED TO
INCORPORATE CARE INTO
COMMUNITIES, INCREASE SOCIAL
SUPPORT, EXPAND HEALTH COVERAGE,
ENACT POLICIES TO SUPPORT HEALTH
AND REMOVE RESTRICTIVE ONES.
NEXT SLIDE PLEASE.
YOU CAN SEE ILLUSTRATIVE QUOTES
WHICH EMPHASIZE FACTORS AROUND
SYSTEMIC RACISM CONTRIBUTING TO
INEQUITIES.
THEY ALSO NOTICED NEED FOR
OPTION FOR HOME VISITS,
NAVIGATORS, AND EVIDENCE-BASED
INTERVENTION.
DUE TO TIME CONSTRAINTS WE CAN'T
GO IN DEPTH INTO THE VOICES.
FIND MORE DETAILS IN THE
ABSTRACT.
NEXT SLIDE PLEASE.
WE TOOK A MIX THE METHODS
APPROACH TO ASK HEALTH HEALTH E
SYSTEM DISTRESS.
WE FIRST USED EVIDENCE-BASED
SURVEYS POSTPARTUM, STRATIFIED
RESPONSES BY PERCEIVED LEVELS OF
RACISM AND DISTRUST.
WE INTERVIEWED THOSE REPORTING
HIGH AND LOW LEVELS, TO BETTER
UNDERSTAND THEIR EXPERIENCES AND
LOOK FORWARD TO SHARING THESE
RESULTS ONCE AVAILABLE.
NEXT SLIDE PLEASE.
WE FOUND FACTORS CONTRIBUTING TO
DISPARITIES ACROSS LEVELS.
STRATEGIES TO OVERCOME THESE
DISPARITIES MAY USE MEASURES OF
ADI TO IDENTIFY MOST VULNERABLE
POPULATIONS AND PROVIDE POINTS
TO INTERVENE.
STRATEGIES SHOULD BE
EVIDENCE-BASED, CULTURALLY
APPROPRIATE, ADDRESS MULTIPLE
LEVELS.
OUR RESULTS WILL INFORM
INTERVENTIONS AND TOOLS TO WORK
TOWARDS EQUITY AND MATERNAL
HEALTH, SPECIFICALLY INFORMING
DISCUSSIONS WITH HEALTH SYSTEM
AND COMMUNITY PARTNERS ABOUT
ALABAMA AND OTHER DEEP SOUTH
LOCAL AND STATEWIDE INITIATIVES
TO ADDRESS RACIAL DISPARITIES
AND MATERNAL HEALTH.
WE LOOK FORWARD TO FUTURE
INTERVENTIONAL INITIATIVES TO
FURTHER THIS WORK IN ONE OF THE
MOST UNDERSERVED STATES.
WE'RE EXCITED TO CONTINUE THIS
LINE OF WORK THROUGH THE P3
EQUATE NETWORK WHICH SUPPORTS
THE DISSERTATION WORK, PART OF
THE Q&A SESSION, OTHER PROJECTS
ARE THE HRSA FUNDED ALABAMA
MATERNAL HEALTH INNOVATION AND
DATA CAPACITY PROGRAM AND POPPY
STUDY TESTING HYPOTHESIS CARE
WITH MOBILE HEALTH INTERVENTION
WILL IMPROVE OUTCOMES.
NEXT SLIDE.
THANKS FOR YOUR ATTENTION.
PLEASE FIND OUR REFERENCES HERE.
>>THANK YOU.
MAY I ASK DR. KARAGAS TO TAKE
OVER WITH YOUR PRESENTATION, PER
AND POLYFLUOROALKYL MIXTURES
DURING PREGNANCY.
>>THANK YOU.
I'M DR. ROMANO PRESENTING THE
RESEARCH.
DR. KARAGAS IS THE P.I.
I WANT TO SAY THANK YOU TO THE
ORGANIZERS FOR INVITING US TO BE
HERE TODAY.
IT'S INCREDIBLY HUM BING TO BE
PART OF THE DAY OF ALL OF THIS
IMPACTFUL RESEARCH.
SO I HOPE TO KEEP THAT GOING AS
I TELL YOU ABOUT OUR WORK IN THE
NEW HAMPSHIRE BIRTH COHORT
STUDY.
PER AND POLYFLUOROALKYL
SUBSTANCES WITH PERSISTENT
CHEMICALS USED IN A VARIETY OF
INDUSTRIAL PROCESSES, PRESENT IN
CONSUMER PRODUCTS.
A FEW LEGACY PFAS ARE DETECTED
IN BLOOD OF THE GENERAL
POPULATION, IN ADDITION TO
RESISTING DEGRADATION THEY STAY
IN OUR BODIES FOR A LONG TIME
AFTER INITIAL EXPOSURE.
THIS IS A LARGE GROUP OF
CHEMICALS, DEPENDING ON WHOSE
DEFINITION AND HOW YOU COUNT
THERE ARE MORE THAN 12,000 PFAS
WITH ABOUT A THOUSAND COMMONLY
USED IN COMMERCE CURRENTLY.
IN ADDITION TO KNOWN HEALTH
EFFECTS INCLUDING HEPATIC AND
RENAL DYSFUNCTION,
IMMUNOTOXICITY, HIGH
CHOLESTEROL, HYPERTENSIVE
DISORDERS IN PREGNANCY AND
CERTAIN CANCERS, THEY ARE
SUSPECTED TO BE METABOLIC
DISRUPTORS.
WE KNOW MORE ABOUT EXPOSURE AS
OPPOSED TO HAVING INFLUENCE
ADIPOSITY IN MOTHERS.
NEXT SLIDE PLEASE.
IN ORDER TO INVESTIGATE HOW PFAS
IN PREGNANCY INFLUENCE
POSTPARTUM WEIGHT AMONG MOTHERS
WE USED DATA AND BIOLOGICAL
SPECIMENS FROM NEW HAMPSHIRE
BIRTH COHORT STUDY, THIS COHORT
IS DIRECTED BY DR. KARAGAS.
WOMEN PROVIDE A BLOOD SAMPLE,
AND WE PREVIOUSLY MEASURED PFAS
AMONG A THOUSAND OF THE MOTHERS
ENROLLED IN THE COHORT PRIOR TO
2018, THROUGH MY PROJECT GRANT
WHICH WAS GEARED TO
INVESTIGATING ASSOCIATION OF
PFAS WITH INFANT GROWTH
TRAJECTORY MATERNAL WEIGHT GAIN.
THE CHILDREN ARE FOLLOWED INTO
ADOLESCENCE, THE IMPROVE PROGRAM
SUPPLEMENT ALLOWED US TO OBTAIN
FUNDING THAT LED US TO NEW
FOLLOW-UP WITH MOTHERS TO HELP
US BETTER UNDERSTAND THEIR
HEALTH IN THE YEARS POSTPARTUM.
NEXT SLIDE PLEASE.
THIS IS A FORM OF A ONE-TIME
SURVEY ADMINISTERED IN 2020.
ALL OF THE WOMEN WHO WERE TWO OR
MORE YEARS POSTPARTUM, ELIGIBLE
TO PARTICIPATE IN THE SURVEY.
WE DID ADMINISTER THE SURVEY
ONLINE AS WE DO WITH MANY OF OUR
SURVEYS, IN THE BIRTH COHORT.
AND PARTICIPANTS WERE ABLE TO
SELF-REPORT ADDITIONAL PREGNANCY
HISTORY AND OF COURSE SINCE
THEIR PARTICIPATION IN THE STUDY
PREGNANCY MEASURES OF GLOBAL
HEALTH, HEALTH CONDITIONS,
RELATED MEDICATIONS AFTER THE
STUDY PREGNANCY, AS WELL AS
CURRENT WEIGHT AND TO GIVE US
UPDATED INFORMATION ABOUT
LIFESTYLE FACTORS SUCH AS
SMOKING AND PHYSICAL ACTIVITY.
WE CALCULATED WEIGHT CHANGE AS
BEING SELF-REPORTED WEIGHT IN
KILOGRAMS FROM THE SURVEY, MINUS
PRE-PREGNANCY WEIGHT ABSTRACTED
FROM THE MEDICAL RECORDS.
NEXT SLIDE PLEASE.
ONE MORE.
THANK YOU.
IN TERMS OF STATISTICAL ANALYSIS
WE USED BAYESIAN KERNEL MACHINE
REGRESSION TO MODEL RELATIONSHIP
BETWEEN WEIGHT CHANGE AND
MULTIPLE PFAS AND MANNER THAT
ALLOWS FOR NON-LINEAR
RELATIONSHIPS AND INTERACTIONS
AMONG EXPOSURE VARIABLES.
UNDERLYING MECHANISM IS COMPLEX
BUT BECAME THE KERNEL FUNCTION
THAT ESTIMATES EXPOSURE RESPONSE
SURFACE, EXPLOITING ASSUMPTION
TWO INDIVIDUALS WITH SIMILAR
EXPOSURE PROFILES WILL HAVE
SIMILAR OUTCOMES.
MODEL IS SIMILAR TO TRADITIONAL
LINEAR MODEL EXCEPT WE USE THIS
KERNEL FUNCTION TO ESTIMATE
WHICH OF OUR EXPOSURE VARIABLES
ARE ASSOCIATED WITH OUTCOME.
WE ADJUSTED FOR A NUMBER OF
SOCIODEMOGRAPHIC AND PERINATAL
FACTORS AS WELL AS MEASURES OF
DIET AND PHYSICAL ACTIVITY
DURING PREGNANCY.
NEXT SLIDE PLEASE.
AMONG NINE PFAS, FIVE WERE
FREQUENTLY DETECTED IN THE
PLASMA OF OUR PARTICIPANTS.
SO THESE WERE PFAS RETAINED IN
OUR MODELS.
CONCENTRATIONS IN POPULATION
WERE GENERALLY COMPARABLE TO
THOSE OBSERVED IN NHANES, BUT
PERHAPS SLIGHTLY ON THE LOWER
END IN TERMS OF OVERALL PFAS
CONCENTRATION IN THIS RURAL
PREGNANCY COHORT.
NEXT SLIDE PLEASE.
WE HAD JUST OVER 1100 WOMEN
PARTICIPATE IN THE ONLINE
SURVEY, RANGING FROM TWO TO
ELEVEN YEARS POSTPARTUM WITH
MAJORITY BEING 7 YEARS
POSTPARTUM ON AVERAGE.
LESS THAN 15% OF THE RESPONDENTS
RANKED GLOBAL HEALTH AS
EXCELLENT.
AND OVERALL 15% RECORDED AT
LEAST ONE CARDIOMETABOLIC
OUTCOME.
FEW IRTHAN 1% REPORTED DIABETES
OR CARDIOVASCULAR DISEASE
INCLUDING STROKE OR HEART ATTACK
WHICH MAKES SENSE BECAUSE THESE
WOMEN ARE IN THEIR 40s AND
50s SO SOME OF THESE
CARDIOMETABOLIC OUTCOMES WE
WOULD ANTICIPATE TO OBSERVE WITH
ADDITIONAL YEARS OF FOLLOW-UP.
48 2 RESPONDENTS RESPONDED.
NEXT SLIDE PLEASE.
THESE ANALYSES WERE COMPLETED BY
MY Ph.D. STUDENT, ESTIMATING
DURING PREGNANCY RELATED TO
POSTPARTUM WEIGHT RETENTION,
SEVEN YEARS ON AVERAGE.
THERE WASN'T A CLEAR OVERALL
EFFECT ON WEIGHT RETENTION BUT
PFOS, PFOA AND PFNA SEEMED TO
CONTRIBUTE TO GREATER RETENTION
OF WEIGHT IN THE POSTPARTUM
PERIOD.
THANK YOU.
WE ALSO FOUND EVIDENCE OF
MODIFICATION, EFFECT OF PFOS IN
PARTICULAR WAS STRONGEST AMONG
WOMEN WHO WERE OVERWEIGHT OR
OBESE PRIOR TO PREGNANCY.
WE FOUND EACH DOUBLING OF PLASMA
CONCENTRATION WAS ASSOCIATED
WITH 1.7, 1.4, 1.1 KILOGRAMS
RESPECTIVELY AMONG PARTICIPANTS
WITH OVERWEIGHT OR OBESE BMI
PRIOR TO THE STUDY PREGNANCY.
NEXT SLIDE PLEASE.
THESE FINDINGS SUGGEST PRENATAL
PFAS EXPOSURE MAY BE ASSOCIATED
WITH INCREASED WEIGHT RETENTION
AFTER PREGNANCY, PARTICULARLY
AMONG WOMEN WITH GREATER BODY
MASS INDEX PRIOR TO THE STUDY
PREGNANCY.
WE'RE OPTIMISTIC FINDINGS CAN
HELP TO INFORM FUTURE STRATEGIES
FOR PFAS REDUCING INTERVENTIONS
GEARED AT PREVENTING LONG-TERM
ADVERSE CARDIOMETABOLIC HEALTH
OUTCOMES, WE'RE SEEKING FUNDING
TO CONTINUE FOLLOWING THE
MOTHERS IN OUR STUDY AS THEY AGE
SO WE CAN BETTER UNDERSTAND HOW
HEALTH DURING PREGNANCY
INFLUENCES LONG-TERM
CARDIOMETABOLIC HEALTH IN THIS
COHORT.
NEXT SLIDE.
I'D LIKE TO ACKNOWLEDGE MY
COLLABORATORS AS WELL AS FUNDING
SOURCE AND THANK YOU FOR YOUR
TIME AND ATTENTION TODAY.
>>THANK YOU.
BEFORE WE MOVE ON, I WOULD LIKE
TO REMIND YOU THAT THE QUESTIONS
CAN BE SUBMITTED THROUGH THE
"LIVE FEEDBACK" BUTTON ON THE
VIDEOCAST WHICH WE WILL DISCUSS
IN THE Q&A.
PLEASE SUBMIT YOUR QUESTIONS.
NOW I WOULD LIKE TO MOVE TO OUR
NEXT SPEAKER.
>>I'M PRESENTING FOR DR.
CHARRON.
WE'RE BOTH P.I.s ON THE
PROJECT.
>>OKAY, ADVERSE SOCIAL
DETERMINANTS OF HEALTH, EFFECT
ON MATERNAL AND NEONATAL HEALTH.
THANK YOU.
>>I'M GOING TO SHARE MY SCREEN
NOW.
GOOD AFTERNOON.
IT IS AN INCREDIBLE HONOR TO
HAVE THE OPPORTUNITY TO PRESENT
OUR WORK HERE TODAY.
THE DATA WAS COLLECTED FROM
PARTICIPANTS IN THE BRONX
MATERNAL MENTAL HEALTH STUDY, A
SUPPLEMENT TO ONGOING GRANT ON
UNDERSTANDING MOLECULAR
SIGNALING MECHANISMS UNDERLYING
PATHOGENESIS OF CHILDHOOD
OBESITY, EXPLORING RACISM AND
COPING SKILLS AND HOW THESE
AFFECT OUTCOMES AND MENTAL
HEALTH.
FOR THE AFTERNOON WE'VE
DISCUSSED HOW SOCIAL DISPARITIES
CONTRIBUTE TO POOR HEALTH
OUTCOMES ACROSS THE LIFE COURSE.
IT IS ALSO VERY CLEAR THAT
HEALTH BEHAVIORS AND LIFESTYLE
FACTORS ARE IMPORTANT DRIVERS,
THEY CANNOT FULLY EXPLAIN THE
POOR HEALTH OUTCOMES OF
INDIVIDUALS WHO FACE
ADVERSITIES.
BIOLOGICAL EMBEDDING MAY
CONTRIBUTE TO SUBOPTIMAL
OUTCOMES.
ADVERSITY CAN ALTER THE
HYPOTHALAMIC AXIS.
LEPTIN WAS DISCOVERED IN THE
DEVELOPMENT OF METABOLIC
SYNDROME.
HOWEVER, ALTERATIONS IN LEVELS
HAVE BEEN OBSERVED IN PRESENTS
OF PSYCHOLOGICAL STRESS AND
DEPRESSION.
OUR GOAL HERE WAS TO DETERMINE
ASSOCIATION BETWEEN ADVERSE
SOCIAL DETERMINANTS OF HEALTH
AND MEDICAL CONDITIONS DURING
PREGNANCY AND PERINATAL
OUTCOMES, ALSO TO DETERMINE
ASSOCIATION BETWEEN LEPTIN AND
PERINATAL OUTCOMES.
ENROLLING PREGNANT WOMEN WHO
DELIVER AT THE HOSPITAL OF
MONTEFIORE MEDICAL CENTER,
COLLECTING DATA ON
CHARACTERISTICS, OUTCOMES,
MEASURES OF PSYCHOSOCIAL
ADVERSITY USING QUESTIONNAIRES
FROM THE PhenX TOOL KIT,
INCLUDING LEPTIN, TELOMERE
LENGTH.
ASSOCIATIONS BETWEEN CATEGORICAL
VARIABLES WERE ASSESSED, T-TEST
AND PEARSON'S CORRELATION
ASSESSED CATEGORICAL AND
CONTINUOUS VARIABLES.
LINEAR REGRESSION ANALYSES WERE
PERFORMED TO EXAMINE ASSOCIATION
BETWEEN BIRTH WEIGHT AND RACE,
PSYCHOSOCIAL ADVERSITY, OTHER
PERINATAL OUTCOMES.
THIS TABLE SHOWS THE MATERNAL
CHARACTERISTICS OF THE COHORT,
100 SO FAR.
YOU CAN SEE 6% ARE BLACK, 58%
HISPANIC, SIGNIFICANT PROPORTION
OF PREGNANT MOTHERS WERE EITHER
OVERWEIGHT OR OBESE PRIOR TO
BECOMING PREGNANT.
17% HYPERGLYCEMIC.
THIS DESCRIBES NEONATAL
CHARACTERISTICS.
87 OF THE 100 PREGNANT WOMEN
DELIVERED SO FAR.
ALMOST 30% WERE PRE-TERM,
APPROXIMATELY 37 WEEKS WITH
RANGE BETWEEN 24 TO 39 WEEKS
GESTATION.
APPROXIMATELY ONE-FIFTH NEONATES
ADMITTED TO THE NICU.
THIS SHOWS EXPOSURE TO
PSYCHOSOCIAL STRESSORS,
INFORMATION COLLECTED INCLUDED
JOB, HOUSING, FINANCIAL
INSECURITY, PERCEIVED
DISCRIMINATION, NEED FOR PUBLIC
HEALTH INSURANCE.
AS YOU CAN SEE FROM THE TABLE,
ALMOST 75% REPORTED EXPOSURE TO
TWO PSYCHOSOCIAL STRESSORS, A
QUARTER TO THREE STRESSORS.
ONLY 13% REPORTED NO
PSYCHOSOCIAL ADVERSITY.
WE CLASSIFIED AS BEING LOW, IF
THERE WAS NO EXPOSURE OR
EXPOSURE TO ONLY ONE.
CONSIDERED MODERATE IF A
PREGNANT PERSON WAS EXPOSED,
HIGH IF THREE OR MORE.
PERFORMED TO DETERMINE
ASSOCIATION BETWEEN ADVERSE
SOCIAL DETERMINANTS OF HEALTH
AND PERINATAL OUTCOMES.
PREGNANT WOMEN WHO REPORTED
DISCRIMINATION MORE LIKELY TO
HAVE MINIMAL CHANGE IN BMI
DURING PREGNANCY.
PERCEIVED DISCRIMINATION WAS NOT
ASSOCIATED WITH BIRTH WEIGHT,
GESTATIONAL OR ADMISSION TO
NICU.
GREATER LIKELIHOOD OF HAVING
DISORDERS OF GLUCOSE METABOLISM
IN PREGNANCY WITH HIGHER EXPOSE
YOU ARE TO PSYCHOSOCIAL STRESS.
WOMEN WHO REPORTED HOUSING
INSECURITY WERE MORE LIKELY TO
GAIN EXCESSIVE WEIGHT DURING
PREGNANCY.
WOMEN WHO REPORTED USE OF
GOVERNMENT ASSISTANCE MORE
LIKELY TO HAVE A NEONATE
ADMITTED TO ICU.
WE PERFORMED TO DETERMINE
ASSOCIATION WHEN PREGNANCY
RELATED FACTORS AND PERINATAL
OUTCOMES.
DISORDERS OF GLUCOSE METABOLISM
WERE ASSOCIATED WITH INCREASED
WEIGHT GAIN DURING PREGNANCY.
HIGHER PRE-PREGNANCY BMI
ASSOCIATED WITH WITH INCREASED
LIKELIHOOD OF C C-SECTION.
THIS DEPICTS ASSOCIATION, X-AXIS
OF STRESSORS, Y-AXIS LEPTIN
LEVELS.
INTERESTINGLY PREGNANT WOMEN WHO
REPORTED FINANCIAL INSECURITY
HAD SIGNIFICANTLY LOWER LEPTIN
LEVELS, COMPARED TO THOSE WHO
DID NOT REPORT FINANCIAL
INSECURITY.
WE DO NOT OBSERVE DIFFERENCES IN
LEPTIN LEVELS WITH REGARDS TO
OTHER STRESSORS.
WE NEXT EXAMINED THE ASSOCIATION
BETWEEN MATERNAL FACTORS AND
PERINATAL OUTCOMES.
THERE WAS NO ASSOCIATION BETWEEN
RACE, ETHNICITY AND LEPTIN
LEVELS.
THERE WAS A TREND TO HAVING
HIGHER LEVELS IN PREGNANT WOMEN
WITH HYPERTENSIVE DISORDERS.
THIS TABLE SHOWS ASSOCIATIONS
BETWEEN MATERNAL FACTORS AND
PERINATAL OUTCOMES, AS EXPECTED
THERE WAS POSITIVE CORRELATION
BETWEEN PRE-PREGNANCY BMI AND AT
DELIVERY AND MATERNAL LEPTIN
LEVELS.
THERE WAS NEGATIVE CORRELATION
BETWEEN AGE AND LEVELS.
WE CONSTRUCTED LINEAR REGRESSION
MODELS.
FIRST INCLUDED RACE,
PRE-PREGNANCY BMI, EXPOSURE TO
THREE OR MORE PSYCHOSOCIAL
STRESSORS. .
THE SECOND MODEL WAS ADJUSTED
FOR WEIGHT GAIN, DISORDERS OF
GLUCOSE METABOLISM, ASSOCIATION
BETWEEN BLACK RACE AND LOWER
BIRTH WEIGHT PERSISTED.
AS EXPECTED HYPERTENSIVE
DISORDERS IN PREGNANCY WERE
ASSOCIATED WITH LOWER BIRTH
WEIGHT.
THERE WAS POSITIVE CORRELATION
BETWEEN BMI AND WEIGHT GAIN
DURING PREGNANCY AND BIRTH
WEIGHT.
KNOWING CORRELATION BETWEEN
LEPTIN LEVELS OF A BIRTH WEIGHT,
DID NOT REACH STATISTICAL
SIGNIFICANCE.
STRESSORS WERE REMOVED, THESE
BORDERLINE ASSOCIATIONS BECAME
SIGNIFICANT.
PREGNANT WOMEN IN THE BRONX HAVE
HIGH EXPOSURES TO PSYCHOSOCIAL
STRESSORS, APPROXIMATELY
THREE-FOURTH TO TWO, A QUARTER
TO THREE.
PREGNANT WOMEN EXPOSED TO SOME
FACETS WERE MORE LIKE THROW
EXPERIENCE ABNORMAL WEIGHT GAI.
REPORTING USE OF FOOD PANTRY OR
TEMPORARY GOVERNMENT ASSISTANCE
WERE MORE LIKELY TO HAVE A
NEONATE ADMITTED TO THE NICU.
FINANCIAL INSECURITY WAS
ASSOCIATED WITH LOWER LEPTIN
LEVELS.
WE CONCLUDE EXPOSURE TO
PSYCHOSOCIAL STRESSORS IS
ASSOCIATED WITH ADVERSE
PERINATAL OUTCOMES, LIMITED
ASSOCIATIONS WE OBSERVED BETWEEN
ADVERSE SOCIAL DETERMINANTS OF
HEALTH AND PERINATAL OUTCOMES
MAY BE RELATED TO VERY HIGH
PSYCHOSOCIAL STRESS EXPOSURES,
SUBSEQUENT ANALYSES DETERMINE
RELATIVE CONTRIBUTION OF
INDIVIDUAL HEALTH DETERMINANTS
ON PERINATAL OUTCOMES.
WE WILL PERFORM ADDITIONAL
ANALYSES FOR INDIVIDUAL
COMPONENTS OF SOCIAL
DETERMINANTS WEIGHTED BASED ON
ASSESSMENT OF CONTRIBUTION TO
HEALTH OUTCOMES.
HIGHER LEVELS ASSOCIATED WITH
ADVERSE OUTCOME.
THE FINDING OF LOWER LEPTIN
LEVELS IN WOMEN FACING FINANCIAL
INSECURITY IS INTERESTING,
POSSIBLY RELATED TO DEPRESSION
OR RESTRICTED FEEDING PRACTICES
IN PREGNANCY.
WE WOULD LIKE TO THANK
COLLABORATORS AND RESEARCH TEAM.
WE'RE GRATEFUL TO THE STUDY
PARTICIPANTS FOR WILLINGNESS AND
WOULD LIKE TO THANK THE NIH AND
IMPROVE INITIATIVE WITHOUT THEIR
SUPPORT THESE STUDIES COULD NOT
HAVE BEEN PERFORMED.
THANK YOU.
>>THANK YOU.
NOW I WILL OPEN THE MEETING FOR
DISCUSSION, SO TURN ON YOUR
SCREEN, THE CAMERA, FOR
SPEAKERS.
BEFORE WE START TAKING QUESTIONS
FROM THE CHAT BOX, LET ME SEE
WHETHER WE HAVE QUESTIONS.
NO.
I WILL TAKE THE OPPORTUNITY TO
HAVE QUESTIONS.
I WOULD LIKE TO START WITH DR.
RICHARDSON.
SO, IN YOUR SLIDE THAT I WAS
WONDERING YOU HAD THE PATIENT
LEVEL FACTORS IN YOUR ANALYSIS,
THE FACTOR WITHIN DISADVANTAGED
NEIGHBORHOODS MAY CONTRIBUTE,
EVEN AFTER ADJUSTING FOR PATIENT
LEVEL FACTORS, AND I'M WONDERING
HOW DID YOU DEFINE OR CATEGORIZE
THE MEDICALLY UNDERSERVED AREAS,
THIS IS ONE OF YOUR -- ONE
PATIENT LEVEL FACTORS.
>>THANKS FOR THAT QUESTION.
WE ARE REPRESENTING A LARGE
GROUP.
I CAN'T SPEAK TO THE DETAILS BUT
I DO KNOW WE LOOKED TO THE
LITERATURE , USED ESTABLISHED
DEFINITIONS.
>>IT'S A SIMILARITY WITH THE
VARIABLE, THE PATIENT LEVEL
FACTOR THAT IS MEDICALLY
UNDERSERVED AREA AND THE OTHER,
WHAT YOU'RE LOOKING AT IS
RESIDENTS WITHIN DISADVANTAGED
NEIGHBORHOODS.
IT MIGHT BE INTERESTING TO SEE
HOW YOU MAY LOOK AT INTERACTION
BETWEEN THOSE TWO VARIABLES,
THAT MIGHT SHOW VERY STRONG
INTERACTIONS BETWEEN TWO
VARIABLES, SO I'M GOING TO MOVE
TO THE NEXT OR CHECK WHETHER WE
HAVE ANY QUESTIONS.
OKAY.
I WONDER IF THE WEIGHT CHANGE IN
PREGNANCY WAS ON THE PATHWAY
BETWEEN SDOH AND BIRTH WEIGHT.
SO WOULD REMOVING WEIGHT CHANGE
FROM THE MOTHER CHANGE THE
ASSOCIATION OF SDOH WITH THE
BIRTH WEIGHT?
>>NO, IT DID NOT CHANGE.
>>DID NOT CHANGE.
>>THERE WAS NO CHANGE WHEN YOU
MOVE THAT.
THE ONLY THING WE SAW WAS WHEN
WE HAD REASON, SOCIAL
DETERMINANTS TOGETHER, WE WERE
NOT SEEING -- WE WEREN'T SEEING
ANY OTHER VARIABLES TO BE
SIGNIFICANT.
WE REMOVED SOCIAL DETERMINANTS
STARTED SEEING OTHER VARIABLES.
THAT MAY BE RELATED TO THE FACT
THAT IN THE BRONX WE HAVE A
VERY -- BRONX IS THE POOREST
CONGRESSIONAL DISTRICT IN THE
U.S., AND WE HAVE OBVIOUSLY A
LONGSTANDING HISTORY OF, YOU
KNOW, SOCIAL AND OTHER
INEQUITIES THAT HAVE BEEN, YOU
KNOW, PERSISTENT FOR DECADES.
AND SO I THINK WHAT WE'RE
SEEING, AGAIN THIS IS VERY
PRELIMINARY, IS THAT INDIVIDUAL
FACTORS, WE SEE DIFFERENCES
THERE.
FOR EXAMPLE, FOOD INSECURITY WAS
NOT SIGNIFICANT BUT WHEN WE
BROKE IT DOWN TO FOOD PANTRY
THAT WAS SIGNIFICANT.
USE OF THE TEMPORARY ASSISTANCE
WAS SIGNIFICANT.
WE MAY NEED TO BREAK DOWN THE
DATA EVEN FURTHER TO SEE WHERE
THE DIFFERENCES ARE.
WHEN YOU LOOK AT FOOD INSECURITY
WE LUMP SEVERAL GROUPS AS ONE
GROUP.
THAT INCLUDED FOOD PANTRY,
INCLUDED USE OF CHURCHES FOR
GETTING FOODS, RESOURCES, USED
OTHER AGENCIES THAT MIGHT BE
PROVIDING FOOD TO FAMILIES.
SO WE LURCH THOSE TOGETHER AND
WE -- WE LUMP THOSE TOGETHER,
HIGHLIGHTING THE FACT
INDIVIDUALS USING FOOD PANTRIES
MAY NOT HAVE SOCIAL SUPPORT
SYSTEMS.
WHEN YOU GO TO A CHURCH, THERE
IS A SUPPORT SYSTEM IN PLACE AND
THAT MAY OFFSET SOME DIFFERENCES
THAT WE'RE SEEING.
I THINK WE HAVE TO BREAK IT DOWN
AND I THINK WE REALLY HAVE TO
PROVIDE WEIGHT TO DIFFERENT
INSECURITIES AND ELEMENTS OF
DISCRIMINATION, AND INEQUITIES
TO BE ABLE TO TEASE APART SOME
DIFFERENCES.
>>THANK YOU.
I WOULD LIKE TO TAG ON THE
QUESTION.
THE ANSWER.
SO, I WAS WONDERING WHAT TIME
POINT YOUR DATA WAS COLLECTED,
IN THE METHOD THE SLIDE
PRESENTATION, YOU KNOW, THE
SHORT TIME, YOU CANNOT PUT ALL
THE INFORMATION, SO I WAS
WONDERING TIME POINT, THE PLASMA
WAS OBTAINED, AND OTHER
INFORMATION SO TIMING.
>>RIGHT.
THE MAJORITY OF THE SAMPLES WERE
OBTAINED CLOSER TO THE TIME OF
DELIVERY ALTHOUGH SOME SAMPLES
WERE OBTAINED EARLIER DURING
PREGNANCY, AND WE APPRECIATED
THE FACT THAT LEPTIN LEVELS GO
UP DURING PREGNANCY DURING THE
THREE TRIMESTERS AND DROP AFTER
DELIVERY.
WE HAVEN'T CONCLUDED FOR THE
TIMING BUT MAJORITY CLOSER TO
DELIVERY.
>>SO SINCE WE DON'T HAVE A
QUESTION I HAVE ONE MORE
QUESTION FOR YOU.
YOU DESCRIBE FOOD SECURITY OR
SOMETIMES TEMPORARY, YOU KNOW,
PEOPLE GET FOOD SUPPORT.
>>CORRECT.
>>IT IS REALLY HARD THAT WE
COLLECT INFORMATION FOR THE FOOD
SECURITY, TIME PERIOD TO
SOMETIMES PEOPLE HAVE A LITTLE
MORE MONEY THAN SOME OTHER
TIMES, SO HOW IN YOUR TIME
POINT -- LIKE WHEN YOU MEASURE
THIS MEASUREMENT CROSS-SECTIONAL
WAY IT IS HARD, HOW FAR YOU CAN
GO FOR WHETHER YOUR INFORMATION
IS FROM ONE YEAR OR --
>>IT WAS FROM MAY 2022 TO
DECEMBER 2022.
>>OKAY.
THANK YOU.
I THINK I'M GOING TO MOVE ON TO
THE NEXT SPEAKER, DR. ROMANO.
MY QUESTION IS, THIS MEASUREMENT
WAS ONE-TIME MEASUREMENT AND
COMPARED BEFORE PREGNANCY AND
THE MEASUREMENT AFTER YOU
MEASURE.
I WAS WONDERING LIKE WHAT WEIGHT
LIKE IF YOU MEASURE NOT ONLY ONE
TIME, LONGITUDINAL WAY YOU
MEASURE BODY WEIGHTS, WHETHER
THIS OUTCOME WILL CHANGE BECAUSE
THE WEIGHT CHANGES ARE NOT
REALLY MUCH, 1.69 THROUGH 1.06
KILOGRAMS, SO IT'S KILOGRAMS,
ONE MEAL CAN CHANGE THAT MUCH SO
I WAS WONDERING WHETHER ACTUALLY
THIS WILL CHANGE THE BODY WEIGHT
IF YOU MEASURE LIKE WE HAVE
REPEAT MEASUREMENT.
>>YEAH, WE WOULD LOVE TO BE
ABLE TO LOOK LONGITUDINALLY, AND
FOLLOW THE WOMEN OVER TIME.
I THINK THE THING I CAN SAY
ABOUT THE DATA THAT WE HAVE ARE
THAT WE DID A NUMBER OF
SENSITIVITY ANALYSES WHERE WE
SORT OF RESTRICTED TO WOMEN WITH
THE MORE RECENT PREGNANCIES,
LOOKED AT THREE YEARS, OR
FURTHER OUT TIME POINTS, AND THE
RESULTS WERE FAIRLY ROBUST.
THREE PFAS BEING MAJOR PLAYERS
IN EACH OF THOSE SENSITIVITY
ANALYSES THAT WE CONDUCTED.
BUT I AGREE WITH YOU, I THINK IT
WOULD BE GREAT TO BE ABLE TO
LOOK LONGITUDINALLY AND TO
REALLY UNDERSTAND WHAT THE
WEIGHT CHANGE LOOKS LOOKS LIKE
OVER TIME AND INFLUENCE OF
CHEMICALS ON THESE CHANGES.
>>I'M SURE THIS IS SMALL STUDY,
AND STILL IT'S DEVELOPING STAGE,
ACTUALLY WHAT YOU HAVE, BUT ALSO
THIS IS VERY INTERESTING CONCEPT
AT THE SAME TIME, THIS IS A
LITTLE BIT SENSITIVE TOPIC TOO.
SO, I WAS WONDERING WHAT IS YOUR
IMPLEMENTATION?
WHAT WOULD YOU LIKE TO DO?
SO YOU SHOWED POSITIVE
RELATIONSHIP WITH THE CHEMICALS
AND THE BODY REACTION, THE
WEIGHT.
SO WHAT WOULD YOU DO AS
IMPLEMENTATION, WHAT WOULD YOU
LIKE TO DO?
>>YEAH, SO PART OF THE SORT OF
BROADER KIND OF THIS RESEARCH
HAS TO DO WITH THE FACT WE HAVE
ALSO SEEN INFLUENCES OF THESE
CHEMICALS ON DURATION OF
BREASTFEEDING, AND THAT WOMEN
WHO HAVE HIGHER CONCENTRATIONS
TEND TO NOT BE ABLE TO
BREASTFEED FOR AS MANY MONTHS,
FOLLOWING PREGNANCY.
AND ONE OF THE THINGS THAT I'M
REALLY INTERESTED IN TRYING TO
UNPACK IN THE LONGER TERM IS
TRYING TO UNDERSTAND WHAT THE
CONNECTION IS OF THE EXPOSURE TO
PFAS DURING PREGNANCY, ITS
INFLUENCE ON LACTATION, AND THEN
HOW THAT ALSO SUBSEQUENTLY
INFLUENCES WEIGHT RETENTION AND
WEIGHT GAIN IN THE POSTPARTUM
PERIOD.
AND THE HOPE WOULD BE THAT WE
COULD ULTIMATELY DEVELOP
INTERVENTIONS THAT SUPPORT
LACTATION AMONG WOMEN WHO WE
WOULD IDENTIFY AS BEING HIGH
RISK DUE TO THEIR EXPOSURE
CONCENTRATIONS AS WELL AS TO THE
MANY SOCIAL AND CULTURAL FACTORS
THAT INFLUENCE THAT DECISION TO
CONTINUE OR STOP BREASTFEEDING.
AND SO THAT'S KIND OF WHERE I
HOPE WE'RE HEADED WITH THIS
RESEARCH IN BEING ABLE TO
ULTIMATELY PROVIDE SOME SORT OF
MEASURE TO HELP WOMEN REDUCE THE
IMPACT OF THESE EXPOSURES.
>>THANK YOU.
WE HAVE THREE MINUTES.
ONE QUESTION.
SO THE MESSAGE TO EACH MEMBER,
NIH ALL INTERVENTION TO PROMOTE
CARDIOVASCULAR HEALTH OF MOTHERS
AND CHILDRENS IN WHICH PROGRAMS
WOULD FUNDED FOR SEVEN SITE AND
ONE COORDINATING CENTER FROM
2022 THROUGH 2029.
HOW MIGHT EACH TALK IN THIS
SESSION BE LINKED TO THE
INITIATIVES?
>>I'M NOT SURE IF I CAN ANSWER
THAT OR ADDRESS THAT DIRECTLY,
BUT THE MOTHERS THAT WE HAVE
ENROLLED ARE ALSO BEING FOLLOWED
OVER TIME, AT LEAST THAT'S THE
PLAN, THAT WE WANT TO MONITOR
OVER TIME.
AND WE DO HAVE SOME INFORMATION
ABOUT THEIR MEDICAL HISTORY
WHICH WE HAVEN'T NECESSARILY
STEPPED INTO BUT, FOR EXAMPLE,
BLOOD PRESSURE AND
CARDIOVASCULAR HEALTH, WE DO
HAVE SOME INFORMATION THAT'S
THERE.
THAT IS POTENTIALLY USEFUL FROM
THE PERSPECTIVE OF TRYING TO
BETTER UNDERSTAND CARDIOVASCULAR
HEALTH DURING PREGNANCY AND IN
THE POSTPARTUM PERIOD.
AND HOW ALL OF THESE FACTORS
INCLUDING ESPECIALLY IN OUR
POPULATION SO SOCIAL
DETERMINANTS AND EACH OF THESE
INDIVIDUAL -- INDIVIDUAL
DETERMINANTS, HOW THEY IMPACT
OTHER CARDIOVASCULAR RISK
FACTORS AND THAT ALSO GOES ALONG
WITH OUR OTHER ONE THAT IS, YOU
KNOW, WHICH IS NOT THE FINAL
STAGES OF COMPLETION WHERE WE'RE
LOOKING AT METABOLIC HEALTH,
AGAIN GRANTED IT'S CHARGED WITH
OBESITY, REALLY TO BETTER
UNDERSTAND SOME OF THE MOLECULAR
SIGNALING FOR PROGRAMMING,
RELATED TO SOME DETERMINANTS,
ALMOST LIKE IT'S EMBEDDED IN THE
DNA.
AND SOMEHOW WE HAVE TO STOP THAT
CYCLE THAT PERPETUATES THROUGH
GENERATIONS.
A MOTHER'S PRO CONCEPTION OF
HEALTH, DIRECTLY AFFECTS THE
CHILD.
I'M A NEONATOLOGIST, I'M SORRY,
BUT WE HAVE TO -- IT'S NOT JUST
THE PREGNANCY.
IT'S THE PRE-CONCEPTION WE HAVE
TO ADDRESS.
ONCE WE ADDRESS THE
PRE-CONCEPTION OF HEALTH, OTHER
THINGS WILL SORT OF -- I WON'T
SAY AUTOMATICALLY BUT THEY WILL
FALL INTO PLACE BETTER.
AND THEN WE CAN HAVE OBVIOUSLY
INTERVENTIONS THAT TAKE PLACE
DURING PREGNANCY BUT IT REALLY
HAS TO START IN CHILDHOOD.
WE HAVE TO ADDRESS DISPARITIES,
THESE ISSUES EARLY ON.
SO THAT WE CAN ACTUALLY IMPACT
HEALTH LONGER TERM.
>>THANK YOU.
WE HAVE ONE MORE QUESTION BUT I
HAVE TO RESPECT OF THE PEOPLE'S
TIME SO OKAY.
I THINK I HAVE TO MOVE TO THE
END.
THANK YOU ALL FOR SHARING YOUR
WORK AND JOINING US TODAY.
SO I'M JUST GOING TO GO TO TURN
OVER TO DR. CLAYTON FOR CLOSING
REMARK.
THANK YOU, EVERYONE.
>>THANK YOU SO MUCH, DR. YOON.
THANK YOU TO THE SPEAKERS OF THE
LAST SESSION AND THE WHOLE DAY.
LOOKS LIKE SLIDES ARE COMING UP.
GREAT.
MOVE TO THE NEXT SLIDE, THAT
WOULD BE WONDERFUL.
I WANT TO THANK EVERY SINGLE ONE
OF OUR SPEAKERS TODAY WHO
COVERED INCREDIBLY IMPORTANT
TOPICS, FAR RANGING TOPICS,
MULTIPLE POPULATIONS, DIFFERENT
CONTEXTS, FROM CHEMICAL
EXPOSURES AND GENDERED RACIAL
MICROAGGRESSIONS, ANXIETY, BLOOD
PRESSURE ELEVATION, RELATED TO
VARIETY OF INSULTS, AND BIRTHING
SUPPORT, AS WELL AS PERSPECTIVE
OF INDIVIDUALS DURING THE
BIRTHING EXPERIENCE AND MORE
RECENTLY IN THE LAST SESSION
EVEN CHEMICAL EXPOSURES AND
REFLECTION AND CONSEQUENCES ON
PREGNANCY AND WEIGHT.
THEY ARE NEW NUMEROUS TO COUNT
BUT I HAVE TO SAY THEY WERE EACH
AND EVERY ONE OF THEM
OUTSTANDING AND OFFERED A
PERSPECTIVE THAT'S IMPORTANT FOR
US TO CONSIDER IN THE OVERALL
IMPROVEMENT OF THE HEALTH OF
WOMEN AND MORBIDITY AND
MORTALITY OUTCOMES.
NEXT SLIDE PLEASE.
I WANT TO THANK OUR WORKSHOP
COORDINATORS BEFORE I MOVE ON.
THANK YOU TO THE ENTIRE TEAM.
NEXT ONE MORE TIME.
ONE MORE TIME.
OFFICE OF RESEARCH ON WOMEN'S
HEALTH, WE CONSIDER THE HEALTH
OF WOMEN IN THIS
MULTI-DIMENSIONAL FRAMEWORK WITH
A LIFE COURSE PERSPECTIVE RIGHT
IN THE CENTER, AND CONSIDERABLE
INTERNAL AND EXTERNAL FACTORS
THAT AFFECT HEALTH OF WOMEN, HOW
THEY INTERACT WITH EACH OTHER.
WHICH IS VERY MUCH IN CONCERT
WITH THE DISCUSSIONS AND
PRESENTATIONS TODAY.
AND FROM TODAY'S PRESENTERS WE
ALSO REALIZE HOW CRITICAL IT IS
TO ADDRESS THESE EXTERNAL
FACTORS IN DEFINITIVE WAY,
COMPREHENSIVE WAY AS WELL.
NEXT.
DURING THE BEGINNING OF THE
COVID-19 PANDEMIC THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH
RECOGNIZED THE SITUATION AND
CHARACTERIZED IT AT A COLLISION
OF CRISES.
TODAY REMINDS ME OF THAT TERM,
COLLISION OF CRISES, CERTAINLY A
SITUATION THAT WE CAN'T IGNORE.
WHETHER WE'RE TALKING ABOUT THE
IMPORTANCE OF INCLUDE PREGNANT
AND LACTATING PEOPLE INTO
CLINICAL TRIAL SO WE HAVE DATA
UPON WHICH TO BASE TREATMENT
DECISIONS FOR THOSE INDIVIDUALS,
OR THE IMPORTANCE OF ADDRESSING
POSTPARTUM HEALTH AND RACISM AND
ITS CONSEQUENCES, THESE ISSUES
ARE CRITICAL TO ADDRESSING
MATERNAL HEALTH CRISIS AS WE
MOVE FORWARD.
AND THEY ALSO UNDERSCORE HOW
IMPORTANT IT IS TO INCLUDE
PREGNANT AND LACTATING PEOPLE IN
CLINICAL RESEARCH SO WE HAVE
EVIDENCE UPON WHICH TO MAKE
THEIR TREATMENT DECISIONS.
NEXT.
AS YOU HEARD EARLIER IN THIS
MORNING FROM DR. ZENK, FROM THE
NINR EFFORTS, A VARIETY OF
INSTITUTE CENTERS AND OFFICES AT
NIH ARE ADDRESSING MATERNAL
HEALTH AND IN A VARIETY OF WAYS
IN ADDITION TO THE "IMPROVE"
INITIATIVE.
I WANT TO SHARE A COUPLE OF
THESE WITH YOU FROM THE ORWH
PERSPECTIVE.
WE LEAD WOMEN OF STUNNED STUDIED
UNDERREPRESENTED AND
UNDERREPORTED POPULATIONS U3 TO
DRAW ATTENTION TO DISPARITIES IN
WOMEN'S HEALTH AND HEALTH CARE
TO SUPPORT RESEARCH AND
EVIDENCE-BASED PROGRAMS TO
ADDRESSES THAT GAP.
THIS PROGRAM HIGHLIGHTS
INTERSECTIONAL EXPERIENCES OF
WOMEN, EXPLORING THE WAYS IN
WHICH SOCIALLY DETERMINED
CATEGORIES LIKE RACE AND GENDER
OVERLAP AND INTERACT TO CREATE
DIFFERENT OUTCOMES FOR
INDIVIDUALS AND COMMUNITIES, AND
WE PARTNER WITH 16 INSTITUTES,
CENTERS AND OFFICES ON THIS
PROGRAM, FUNDED 70 AWARDS,
SEVERAL FOCUSED ON MATERNAL
HEALTH.
ORWH HAS ALSO PARTNERED WITH
NATIONAL
NATIONAL INSTITUTE MEDICAL
SCIENCES, ON A PROGRAM THAT
BUILDS RESEARCH CAPACITY IN
STATES THAT HISTORICALLY HAD LOW
LEVELS OF NIH FUNDING, RESIDENTS
INCLUDING WOMEN AND CHILDREN
ESPECIALLY IN RURAL AREAS OFTEN
SUFFER FROM POOR HEALTH OUTCOMES
THAN AVERAGE AMERICANS, SO WE'RE
PARTNERING WITH NIGMS ON A
WOMEN'S HEALTH RESEARCH PROGRAM
IN THE IDEA STATES PROGRAM, AND
SUPPORT SEVERAL GRANTS RELATED
TO MATERNAL HEALTH AND HAVE A
NEW PROGRAM CENTER OF BIOMEDICAL
RESEARCH EXCELLENCE AS WELL.
NEXT SLIDE PLEASE.
IN ADDITION TO THESE EFFORTS,
ORWH PARTNERED WITH OFFICE OF
DISEASE PREVENTION WHO LEADS THE
PATHWAYS TO PREVENTION PROGRAM,
AS WELL AS SEVERAL OTHER
INSTITUTES TO INITIATE A P2P
PATHWAYS TO PREVENTION PROGRAM
ON RISK AND INTERVENTION TO
OPTIMIZE POSTPARTUM HEALTH.
IN DECEMBER OF LAST YEAR WE HAD
FIRST WORKSHOP, ON THIS PROGRAM,
FOCUSING ON IDENTIFYING RISKS
AND INTERVENTION TO OPTIMIZE
POSTPARTUM HEALTH AND I WANT TO
HIGHLIGHT THE MULTIPLE PIECES OF
THE PROGRAM WHICH ARE DELINEATED
ON THE SLIDE HERE.
THE WORKSHOP USES INDEPENDENT
PANEL TO DEVELOP FAIR AND
OBJECTIVE REPORT ON THE MOST
SALIENT RESEARCH GAPS NEEDED TO
ADVANCE A FIELD, IN THIS CASE
PREVENTION OF POOR POSTPARTUM
OUTCOME.
AND IMPORTANT TAKEAWAYS, STRESS
TEST CONTINUES IN THE POSTPARTUM
PERIOD, WE NEED TO BRIDGE THAT
CHASM BETWEEN THE PREGNANCY
PERIOD AND THE POSTPARTUM AND
SUBSEQUENT HEALTH CARE OF A
PERSON, WE NEED TO TAKE A LIFE
COURSE PERSPECTIVE, POOR
OUTCOMES CAN PREDICT OTHER
SUBSEQUENT DISEASE RISKS AND
IMPORTANTLY LISTEN TO THE
PERSON, THE PATIENT, AND THEIR
FAMILIES.
NEXT SLIDE PLEASE.
I DON'T EXPECT YOU TO READ THIS
GRAPHIC BUT I WANT TO HIGHLIGHT
IT BECAUSE WE WERE SO DELIGHTED
TO HAVE THESE FROM THE PATHWAYS
2 PREVENTION WORKSHOP, AVAILABLE
ON THE WEBSITE FOR THE P2P
WEBSITE.
ELEVATING PATIENT CENTEREDNESS
WAS A CRITICAL ASPECT OF THE
PROGRAM, AND A CRITICAL WAY TO
AMELIORATE MATERNAL HEALTH,
IDENTIFYING RISKS AND
INTERVENTION TO OPTIMIZE
POSTPARTUM HEALTH, SYNTHESIZE
MANY STRATEGIES THAT ARE
REPRESENTED ON THIS GRAPHIC TO
IMPROVE PATIENT CENTEREDNESS AND
CARE, AND LOOKED AT HOW THEY MAY
INTERSECT FOR POSITIVE MATERNAL
HEALTH OUTCOMES, SO MANY OF
THESE STRATEGIES ARE DIRECTLY
RELATED TO DIFFERENT ASPECTS OF
SOCIAL DETERMINANTS OF HEALTH,
MANY WE HEARD ABOUT TODAY.
AND MOST OF THE PRESENTATIONS
HIGHLIGHTED THIS IS A REAL
PATHWAY FOR CHANGE AND HOW CARE
IS ADMINISTERED, INCREASING
QUALITY OF CARE, INCREASING
ACCESS TO CARE, STRATEGIES TO
REDUCE MATERNAL MORTALITY.
WE WANT TO HIGHLIGHT THE PANEL
REPORT WILL BE RELEASED AROUND
MARCH 28, FOR PUBLIC INPUT.
WE WOULD BE MOST GRATEFUL FOR
OUR IMPROVED GRANTEES AND OTHER
EXPERTS TO WEIGH IN SO PLEASE BE
ON THE LOOKOUT FOR THAT.
AND SHARE YOUR THOUGHTS.
SUMMER OF 2023 THE PROGRAM WILL
BE CONDUCTING A MEETING WITH
FEDERAL PARTNERS, THESE ARE
COLLEAGUES ACROSS THE FEDERAL
GOVERNMENT, FINDINGS WILL BE
USED TO INFORM FUTURE RESEARCH,
POLICY AND GUIDELINES RELATED TO
RISK AND INTERVENTION DURING THE
POSTPARTUM PERIOD AND TO OVERALL
MATERNAL HEALTH.
NEXT SLIDE PLEASE.
AS I END HERE, I KNOW WE'LL GO
BACK TO WHERE WE'RE STARTED,
UNITED STATES IS THE MOST
DANGEROUS PLACE IN THE DEVELOPED
WORLD TO DELIVER A BABY.
IT'S NOW BROADLY KNOWN.
WE KNOW THESE RATES DIFFER FOR
DIFFERENT POPULATIONS, HIGHEST
FOR AFRICAN AMERICAN AND
AMERICAN INDIAN AND ALASKA
NATIVE WOMEN, INCREASING.
A RECENT W.H.O. RECORD SHOWED
TRENDS CONTINUE IN THE SAME
DIRECTION.
FOR SEVERAL COUNTRIES INCLUDING
THE UNITED STATES.
THIS CRISIS FOR UNDERREPRESENTED
RACIAL AND ETHNIC MINORITY
GROUPS HAS CAUGHT THE ATTENTION
OF MANY INCLUDING THE
BIDEN-HARRIS ADMINISTRATION WHO
SET FORTH THE WHITE HOUSE
MATERNAL DAY OF ACTION, A CALL
TO ACTION TO REDUCE MATERNAL
MORBIDITY AND MORTALITY TO
ENSURE PROPER HEALTH CARE DURING
THE PERINATAL PERIOD, BIRTHING
PERSON AND CHILD.
AMONG THEIR COMMITMENTS ARE
SEVERAL KEY ACTIONS THAT WILL
HAVE A POSITIVE EFFECT ON
PREGNANT PEOPLE, SUCH AS THE
BUILD BACK BETTER HEALTH AND
RELEASE OF NEW GUIDANCE TO HELP
STATES PROVIDE 12 MONTHS OF
CONTINUOUS POSTPARTUM COVERAGE
THROUGH MEDICAID PROGRAMS.
AND AS I MOVE TO THE NEXT SLIDE
I DO WANT TO THANK YOU ALL FOR
THIS INFORMATIVE WORKSHOP AND
INNOVATIVE APPROACHES TO ENDING
THIS WIDESPREAD CHALLENGE OF
SEVERE MATERNAL MORBIDITY AND
MATERNAL MORTALITY.
FOR MORE INFORMATION ABOUT THE
"IMPROVE" INITIATIVE YOU CAN
TAKE A LOOK AT THIS WEBSITE, SO
WE CAN TRULY IMPLEMENT A
MATERNAL HEALTH AND PREGNANCY
OUTCOMES VISION FOR EVERYONE.
NEXT SLIDE PLEASE.
THANK YOU FOR JOINING US ONCE
AGAIN TO THE MEETING ORGANIZERS,
THE TEAM BEHIND THE SCENES, ALL
OF THE SPEAKERS TODAY AND
MODERATORS, THE IMPROVE TEAM,
AND ALL OF YOU JOINING US TODAY.
WE'RE ARE ADJOURNED.
THANK YOU VERY MUCH.