Publications by authors named "Korede K Yusuf"

26 Publications

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Essential newborn care practices in Benin: Are there differences by birth location?

Birth 2021 Sep 29. Epub 2021 Sep 29.

College of Nursing and Public Health, Adelphi University, Garden City, New York, USA.

Background: Annually, about 60 infant deaths occur per 1000 live births in Benin; nearly one-half of these deaths occur during the neonatal period. Home- and health facility-based newborn care practices are essential for reducing neonatal death. The aim of this study was to explore relationships between location of childbirth and essential newborn care practices in the Republic of Benin, West Africa.

Methods: We used cross-sectional data from the 2017 Benin Demographic and Health Survey. The study included 6831 women who had a recent live birth. We used multivariable logistic regression to examine associations between location of birth and early initiation of breastfeeding, breastfeeding support, and cord examination while adjusting for potential confounding factors.

Results: There was no significant difference in early initiation of breastfeeding by birth location. Compared to women with home births, those who gave birth in public hospitals, public health centers/clinics, and private health facilities had significantly higher odds of receiving breastfeeding support (public hospitals: OR: 1.71, 95% CI: 1.23-2.59; public health centers/clinics: OR: 2.06, 95% CI: 1.46-2.91; private clinics: OR: 1.97, 95% CI: 1.35-2.88). Compared with women who gave birth at home, those who gave birth in public health centers/clinics and private health facilities were twice as likely to report newborn cord examination (OR: 1.99, 95% CI: 1.41-2.79; OR: 1.97, 95% CI: 1.36-2.83, respectively).

Discussion: Despite the high prevalence of health facility births in Benin, the coverage of early newborn care is suboptimal, especially in public hospitals. Policies and public health interventions will be required, more so in public hospitals, to ensure that all mothers and newborns receive these potentially life-saving services.
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http://dx.doi.org/10.1111/birt.12596DOI Listing
September 2021

Association of urinary arsenic and sleep disorder in the US population: NHANES 2015-2016.

Environ Sci Pollut Res Int 2021 Aug 22. Epub 2021 Aug 22.

College of Nursing and Public Health, Adelphi University, One South Avenue, Garden City, NY, 11530, USA.

Arsenic is a known carcinogen and neurotoxin and is found in the natural earth crust. Arsenic exposure can develop depression, memory dysfunction, and neurodegenerative disorder. The mechanism of arsenic toxicity on the nervous system is not known. There is a lack of research on the association between arsenic exposure and sleep disturbance in humans. This study aims to investigate the relationship between six types of urinary speciated arsenic exposure and sleep disturbance in adults from the general population using the National Health and Nutrition Examination Survey (NHANES) 2015-2016 dataset. Sleep disturbance was measured using self-reported questionnaires, asking participants if they had ever told a doctor they had trouble sleeping. We utilized multivariate logistic regression analysis using complex survey procedures to examine the association between six types of urinary arsenic concentration and trouble sleeping. The total sample included 1,611 adults who were 20 years and older. Of the study participants, 30.0% had trouble sleeping. Compared to individuals with urinary arsenous acid below the lower level of detection (LLOD), those with urinary arsenous acid at or above the detection limit had lower odds of trouble sleeping [odds ratio: 0.72 (95% confidence interval 0.51-1.00, p-value: 0.05)]. The other five types of urinary speciated arsenic studied (arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid) were not associated with a sleep disorder. More studies are required to confirm or refute these findings.
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http://dx.doi.org/10.1007/s11356-021-16085-6DOI Listing
August 2021

Temporal trends and risk of small for gestational age (SGA) infants among Asian American mothers by ethnicity.

Ann Epidemiol 2021 11 24;63:79-85. Epub 2021 Jul 24.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX; Family and Community Medicine, Baylor College of Medicine, Houston, TX.

Purpose: To examine the temporal trends and risk of small for gestational age (SGA) phenotypes across Asian American ethnic groups.

Methods: We conducted a population-based retrospective study using the 1992-2018 natality data files obtained from the National Vital Statistics System. Joinpoint regression modeling was employed to calculate the average annual percentage change in SGA birth rates among Asian American sub-groups and NH-White women. Logistic regression was utilized to compute the adjusted odds ratio and 95% confidence interval for the association between maternal race (Asian American sub-groups vs. NH-White) and SGA birth and its phenotypes.

Results: We analyzed data on 2,821,798 Asian Americans and 62,174,875 NH-White US live-born infants. Overall, NH-Whites had the lowest SGA rates, while all the Asian ethnic groups had almost consistently higher rates during the 27-year period. Disparity in SGA births in the Asian subgroups was observed. Compared to NH-Whites, stratified analyses showed varying and significantly higher odds of any SGA in all Asian ethnic groups. Asian Indians had the highest odds [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 2.22-2.23] of any SGA compared to NH-Whites.

Conclusions: Our findings support the evidence that Asian Americans are not a homogenous group and highlight the need to disentangle these differences when conducting population health research and interventions among Asian Americans.
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http://dx.doi.org/10.1016/j.annepidem.2021.07.004DOI Listing
November 2021

Trends in childhood viable pregnancy and risk of stillbirth in the United States.

Eur J Pediatr 2021 Aug 17;180(8):2645-2653. Epub 2021 Jun 17.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA.

There is limited data on the trends of childhood viable pregnancy and the risk of stillbirth in the United States. Our study assessed the trends in childhood viable pregnancy and associated stillbirth rates over the previous three decades, as well as the risk of stillbirth in these highly vulnerable child mothers aged 10-14 compared with teen mothers aged 15-19. We conducted a population-based retrospective cohort study that used birth datasets, fetal death datasets, and the US population census data: 1982-2017. To assess the association between various sociodemographic and maternal comorbidities and stillbirth, we generated adjusted hazard ratios (AHR) from Cox proportional hazards regression models. From 1982 to 2017, viable pregnancy rates declined among children (from 0.3/1000 to 0.06/1000 population) and teens (from 40.5/1000 in 1982 to 18.1/1000). Overall, there were declines in the stillbirth rates in both teens (15-19 years old) and child mothers aged 10-14 years, but the rate remained consistently higher among child mothers vs. teen mothers (14 per 1000 vs. 8 per 1000 viable pregnancies). Compared to teen mothers, childhood pregnancy was modestly associated with an elevated risk for stillbirth (AHR = 1.09; 95% CI = 1.05-1.12). Other factors significantly associated with increased risk of stillbirth included maternal race, preterm birth, arterial hypertension, diabetes, and eclampsia (P<0.0001).Conclusion: Childhood pregnancy may be a risk factor for stillbirth. This is the first study to assess the trends in childhood viable pregnancy and the associated stillbirth rates in the United States. These findings further underscore the need for sustained efforts and policies to prevent pregnancies in the early years of reproductive development. What is Known: • Childhood pregnancy, defined as pregnancy among 10-14 year-old females, may be associated with a number of pregnancy complications and adverse pregnancy outcomes, including preterm delivery, low birth weight, and infant mortality. • Structural disparities in socioeconomic status and access to healthcare place some teenagers at high risk of teen pregnancy. What is New: • Our study shows the trends in childhood pregnancy over the previous three decades; overall, there were declines in the stillbirth rates in both child mothers aged 10-14 years and teen (15-19 years old) mothers, but the rate remained consistently higher among child mothers. • Child mothers aged 10-14 were more likely to experience stillbirth than teenagers, and Black mothers had an increased risk of stillbirth than White mothers-all of which underscores the effects of structural health disparities.
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http://dx.doi.org/10.1007/s00431-021-04156-2DOI Listing
August 2021

Incidence and risk of stillbirth among various Asian-American subgroups.

J Matern Fetal Neonatal Med 2021 May 23:1-6. Epub 2021 May 23.

Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.

Background: Striking racial/ethnic disparities exist in pregnancy outcomes among various racial/ethnic.

Objective: To determine the incidence and risk factors associated with stillbirth in Asian-American women.

Study Design: We conducted this retrospective cohort study using the United States Birth and Fetal Death data files 2014-2017. We used the fetuses-at-risk approach to generate stillbirth trends by gestational age among Non-Hispanic (NH)-White and Asian-American births during the study period. We calculated the adjusted risk of stillbirth for Asian-Americans, overall, and for each Asian-American subgroup: Asian Indians, Koreans, Chinese, Vietnamese, Japanese and Filipinos, with NH-Whites as the referent category.

Results: Of the 715,297 births that occurred among Asian-Americans during the study period, stillbirth incidence rate was 3.86 per 1000 births. From the gestational age of 20 weeks through 41 weeks, the stillbirth rates were consistently lower among Asian-Americans compared to NH-Whites. Stillbirth incidence ranged from a low rate of 2.6 per 1000 births in Koreans to as high as 5.3 per 1000 births in Filipinos. After adjusting for potentially confounding characteristics, Asian-Americans were about half as likely to experience stillbirth compared to NH-White mothers [adjusted hazards ratio (AHR) = 0.57, 95% confidence interval (CI) = 0.51-0.64]. This intrauterine survival advantage was evident in all Asian-American subgroups.

Conclusion: The risk of stillbirth is twofold lower in Asian-Americans than in NH-Whites. It will be an important research agenda to determine reasons for the improved intrauterine survival among Asian-Americans in order to uncover clues for reducing the burden of stillbirth among other racial/ethnic minority women in the United States.
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http://dx.doi.org/10.1080/14767058.2021.1918669DOI Listing
May 2021

Diabetes in pregnancy and risk of near-miss, maternal mortality and foetal outcomes in the USA: a retrospective cross-sectional analysis.

J Public Health (Oxf) 2021 Apr 19. Epub 2021 Apr 19.

College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.

Background: The prevalence of diabetes in pregnant women has increased in the USA over recent decades. The primary aim of this study was to assess the association between diabetes in pregnancy and maternal near-miss incident, maternal mortality and selected adverse foetal outcomes.

Methods: We conducted a retrospective, cross-sectional analysis among pregnancy-related hospitalizations in USA between 2002 and 2014. We examined the association between DM and GDM as exposures and maternal in-hospital mortality, maternal cardiac arrest, early onset of delivery, poor foetal growth and stillbirth as the outcome variables.

Results: Among the 57.3 million pregnant women in the study population, the prevalence of GDM and DM was 5.4 and 1.3%, respectively. We found that pregnant women with DM were three times more likely to experience cardiac arrest (OR = 3.21; 95% CI = 2.57-4.01) and in-hospital maternal death (OR = 3.05; 95% CI = 2.45-3.79), as compared to those without DM. Among pregnant women with GDM and DM, the risk for early onset of delivery was higher, compared to women without GDM or DM.

Conclusion: A diagnosis of diabetes prior to pregnancy contributes significantly to the risk of maternal cardiac arrest, maternal mortality and adverse foetal outcomes.
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http://dx.doi.org/10.1093/pubmed/fdab117DOI Listing
April 2021

Risk of Stillbirth Among Foreign-Born Mothers in the United States.

J Immigr Minor Health 2021 Mar 12. Epub 2021 Mar 12.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA.

The objective of this study is to assess the impact of maternal nativity on stillbirth in the US. We utilized the US Birth Data and Fetal Death Data for the years 2014-2017. Our analysis was restricted to live and stillbirths (N= of 14,867,880) that occurred within the gestational age of 20-42 weeks. The fetuses-at risk approach was used to generate stillbirth trends by gestational age. Adjusted Cox proportional hazards regression model was utilized to estimate the association between maternal nativity and stillbirth. Overall, the gestational week-specific prospective risk of stillbirth was consistently higher for native-born than their foreign-born mothers. Foreign-born mothers were 20% less likely to experience stillbirth than their native-born counterparts (AHR = 0.80; 95% CI = 0.78-0.81). Delineating the factors influencing the observed effect of maternal nativity on birth outcomes should be a research priority to inform strategies to address adverse birth outcomes in the US.
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http://dx.doi.org/10.1007/s10903-021-01164-0DOI Listing
March 2021

Impact of Maternal Age on the Foreign-Born Paradox.

J Immigr Minor Health 2021 Feb 11. Epub 2021 Feb 11.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA.

To examine the effect of maternal age on the risk of preterm birth and its phenotypes in foreign-born compared to native-born mothers. The 2014-2017 US Birth and Fetal Death data were analyzed (N = 14,867,880). Log-binomial regression models were used to estimate adjusted prevalence ratios (APR), quantifying the association between mother's nativity and preterm birth and its phenotypes, stratified by maternal age. Foreign-born mothers had a 13% lower probability of preterm birth compared to their native-born counterparts (APR, 0.87 [95% CI 0.86-0.87]). This protective effect persisted across all preterm phenotypes. Stratification by maternal age showed a slightly elevated risk in preterm and moderate-to-late preterm for adolescent mothers. Our study supports the existence of the "foreign-born paradox" whereby foreign-born mothers experienced lower levels of preterm birth despite the disadvantages of living in an alien socio-cultural environment. This favorable birth outcome was present primarily in foreign-born mothers aged ≥ 20 years.
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http://dx.doi.org/10.1007/s10903-021-01157-zDOI Listing
February 2021

Association of Domestic Physical Violence With Feto-Infant Outcomes in Afghanistan.

Asia Pac J Public Health 2021 Mar-Apr;33(2-3):273-279. Epub 2020 Nov 30.

Baylor College of Medicine, Houston, TX, USA.

Our study aimed to investigate the association between domestic physical violence in pregnancy and feto-infant outcomes among Afghan women. Our study design was a cross-sectional study that utilized secondary data from the 2015 Afghanistan Demographic and Health Survey conducted in 33 provinces of Afghanistan (n = 19 676). We used multiple logistic regression models to evaluate the relationship between domestic violence and early-pregnancy loss, perinatal, and neonatal mortality, with adjustments for confounders. Our results indicate that approximately 16.66% (n = 3278) of Afghan women experienced domestic violence while pregnant. In the adjusted models, we found that domestic physical violence in pregnancy was significantly associated with early-pregnancy loss (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI] = 1.32-1.88), but not with perinatal mortality (AOR = 1.12, 95% CI = 0.96-1.32) and neonatal mortality (AOR = 1.10, 95% CI = 0.95-1.28). The higher odds of adverse birth outcomes among victims of domestic violence underlines the necessity for interventions to address violence against women in Afghanistan.
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http://dx.doi.org/10.1177/1010539520977333DOI Listing
September 2021

Using Nominal Group Technique to Elucidate a COVID-19 Research Agenda for Maternal and Child Health (MCH) Populations.

Int J MCH AIDS 2020 15;9(3):394-396. Epub 2020 Sep 15.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA.

As the global impact of the COVID-19 pandemic continues to evolve, robust data describing its effect on maternal and child health (MCH) remains limited. The aim of this study was to elucidate an agenda for COVID-19 research with particular focus on its impact within MCH populations. This was achieved using the Nominal Group Technique through which researchers identified and ranked 12 research topics across various disciplines relating to MCH in the setting of COVID-19. Proposed research topics included vaccine development, genomics, and artificial intelligence among others. The proposed research priorities could serve as a template for a vigorous COVID-19 research agenda by the NIH and other national funding agencies in the US.
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http://dx.doi.org/10.21106/ijma.410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520884PMC
September 2020

COVID-19 Devastation of African American Families: Impact on Mental Health and the Consequence of Systemic Racism.

Int J MCH AIDS 2020 16;9(3):390-393. Epub 2020 Sep 16.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA.

African Americans are bearing a disproportionate burden of morbidity and mortality due to COVID-19 pandemic. To our knowledge, no previous study has delineated inequities potentially incentivized by systemic racism, and whether synergistic effects impose an abnormally high burden of social determinants of mental health on African American families in the era of COVID-19 pandemic. We applied the social ecological model (SEM) to portray inequities induced by systemic racism that impact the mental health of African American families. In our model, we identified systemic racism to be the primary operator of mental health disparity, which disproportionately affects African American families at all levels of the SEM. Programs tailored towards reducing the disproportionate detrimental effects of COVID-19 on the mental health of African Americans need to be culturally appropriate and consider the nuances of systemic racism, discrimination, and other institutionalized biases.
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http://dx.doi.org/10.21106/ijma.408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520885PMC
September 2020

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic.

Int J MCH AIDS 2020 16;9(3):386-389. Epub 2020 Sep 16.

Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.
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http://dx.doi.org/10.21106/ijma.405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520882PMC
September 2020

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap.

Int J MCH AIDS 2020 15;9(3):381-385. Epub 2020 Sep 15.

Department of Family and Community Medicine; and Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.

The COVID-19 pandemic threatens to set back major successes that have been achieved in global vaccine initiatives. We conducted a rapid review and synthesis of the literature on immunization provision and Utilization since the onset of the COVID-19 pandemic. A total of 11 papers comprising peer-reviewed articles and key policies and guidelines, published between January 1 and June 15, 2020, were analyzed. Widespread disruptions of routine immunization and vaccination campaigns were reported leaving millions of children worldwide at risk of measles outbreaks. We present an expanded model of the World Health Organization's Global Routine Immunization Strategic Plan (GRISP) action areas as a tool to help countries quickly adapt to immunization challenges in the presence of COVID-19 and close the emerging immunization coverage gaps.
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http://dx.doi.org/10.21106/ijma.401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520883PMC
September 2020

Covid-19 and Neuro-Behavioral Economics: A Conceptual Framework to Improve Physical and Mental Health among Remote Workers.

Int J MCH AIDS 2020 15;9(3):360-363. Epub 2020 Sep 15.

Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.

Long-term home confinement during the ongoing COVID-19 can have negative mental and physical health consequences, which in turn can reduce productivity among those working remotely. We sought to delineate factors related to neuro-behavioral economics that employers should consider for their employees who are teleworking during the current Covid-19 pandemic. Physical and mental well-being are intertwined and are strongly correlated to high productivity at workplace. By integrating the factors of neuro-behavioral economics into the work culture, companies will alleviate work-related stress leading to improved mental and physical functioning; thus leading to increased productivity.
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http://dx.doi.org/10.21106/ijma.399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520886PMC
September 2020

Association between birth attendant and early newborn care in Senegal.

Midwifery 2020 Nov 20;90:102804. Epub 2020 Jul 20.

College of Nursing and Public Health, Adelphi University, 1 South Ave, Garden City, NY 11530, United States. Electronic address:

Objective: To examine the association between type of birth attendant and early newborn care in Senegal.

Design: This was a secondary analysis of cross-sectional data from the 2017 Continuous Demographic and Health Survey.

Participants: The study included data on 6328 women with live births in the three years preceding the survey.

Measurements: The main exposure was the type of birth attendant (doctor, nurse/midwife, auxiliary midwife/matrone, traditional birth attendant, or "others (friend, relative, or no one)). We assessed three outcomes: 1) early initiation of breastfeeding, 2) breastfeeding support, and 3) cord examination. We used multivariable logistic regression to estimate the odds ratios and 95% confidence intervals of early newborn care after adjusting for potential confounders.

Findings: The coverage of all three newborn care indicators of interest was low. In the adjusted regression models, women whose births were assisted by a nurse/midwife were nearly twice as likely to initiate breastfeeding early compared to those assisted by doctors (odds ratio: 1.87, 95% confidence interval: 1.00-3.45). Women assisted at birth by doctors were significantly more likely to report breastfeeding support and newborn cord examination than those assisted by other types of birth attendants.

Conclusions And Implications For Practice: Although most recent births were facility-based and assisted by skilled birth attendants, the prevalence of early newborn care was suboptimal. This presents a missed opportunity to improve neonatal outcomes. Training and supporting skilled birth attendants may bridge the gap between opportunity and practice, and lead to improved coverage and quality of newborn care in Senegal.
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http://dx.doi.org/10.1016/j.midw.2020.102804DOI Listing
November 2020

Pre-pregnancy maternal obesity, macrosomia, and risk of stillbirth: A population-based study.

Eur J Obstet Gynecol Reprod Biol 2020 Sep 9;252:1-6. Epub 2020 Jun 9.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic address:

Objective: An examination of the synergistic effects of maternal obesity and macrosomia on the risk of stillbirth is lacking. The purpose of this study was to determine the association between fetal macrosomia, maternal obesity, and the risk of stillbirth.

Methods: This retrospective cross-sectional study used the CDC's Birth Data and Fetal Death Data files for 2014-2017 [n = 10,043,398‬ total births; including 48,799 stillbirths]. The exposure was fetal macrosomia stratified by obesity subtypes (I-III). The outcome was the risk of stillbirth. We also controlled for potential and known confounding factors in adjusted models. Adjusted Relative Risks (ARR) were estimated with log-binomial regression models.

Results: The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without (6.55 vs. 0.54 per 1000 total births). After controlling for confounding, women with obesity types II and III were at increased risk for stillbirth [Obesity II ARR = 2.37 (2.07-2.72); Obesity III ARR = 9.06 (7.61-10.78)].

Conclusions For Practice: Obesity-related fetal overgrowth is a significant risk factor for stillbirth, especially among women with type II and type III obesity. This finding highlights the need for more effective clinical and public health strategies to address pre-pregnancy obesity and to optimize gestational weight gain.
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http://dx.doi.org/10.1016/j.ejogrb.2020.06.004DOI Listing
September 2020

Urinary speciated arsenic and depression among US adults.

Environ Sci Pollut Res Int 2020 Jun 24;27(18):23048-23053. Epub 2020 Apr 24.

Independent University, Dhaka, 1219, Bangladesh.

Arsenic is a naturally occurring chemical in the environment. The International Agency for Research on Cancer (IARC) declared arsenic a class 1 human carcinogen. The inorganic form of arsenic is considered toxic to the human population; arsenic is a neurotoxin and can cause memory dysfunction. Very few studies have investigated the association between exposure to arsenic and depression in humans. The purpose of this study was to assess the association between urinary speciated arsenic and depression among adults in the USA using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) III dataset. Depression was measured using the nine-item Patient Health Questionnaire (PHQ-9). We computed a total depression score from the PHQ-9 and categorized individuals with a score ≥ 10 as depressed. The exposure included six different speciated arsenic concentrations dichotomized as at or above the limit of detection and below the limit of detection. We conducted a crude and multivariate logistic regression analysis using complex survey procedures to assess the association between speciated arsenic concentrations and depression. The sample included 1619 adults, of whom approximately half were females (51.69%) and married (53.29%). Seven percent of the sample had depression. Urinary arsenous acid was significantly associated with depression. In the adjusted model, arsenous acid was associated with depression with an odds ratio of 1.76 (95% CI 1.05-2.96, p = 0.035). No other forms of arsenic were significantly associated with depression. In this study, urinary arsenous acid was significantly associated with depression. Future research in humans is required to confirm or refute this finding.
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http://dx.doi.org/10.1007/s11356-020-08858-2DOI Listing
June 2020

Maternal Cotinine Levels and Red Blood Cell Folate Concentrations in the Periconceptual Period.

South Med J 2020 04;113(4):156-163

From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.

Objectives: Studies have examined the association between tobacco use and folate levels in pregnancy, yet few have assessed this relation using objective and accurate measures of both smoking and folate. In this study, we evaluated the association between maternal cotinine levels and periconceptional red blood cell (RBC) folic acid reserves in a cohort of low-income pregnant mothers.

Methods: Smoking information, based on salivary cotinine, a highly sensitive and specific tobacco smoke exposure biomarker, was used. Furthermore, folate was assessed using RBC folate, an indicator of long-term folate storage. Participants were early to mid-trimester pregnant women who received antenatal care between 2011 and 2015 at the Genesis Clinic of Tampa (Florida). A total of 496 women were enrolled in the study. Associations between smoking status/maternal salivary cotinine concentrations, sociodemographic factors, and folate concentrations were investigated using Tobit regression analyses.

Results: The mean folate level of the participants was 718.3 ± 183.2 ng/mL, and only 2 (0.4%) participants were deficient in folate. We observed no significant difference in folate levels by smoking status. In contrast, salivary cotinine levels were significantly associated with decreased RBC folate concentrations (β -11.43, standard error 5.45, = 0.032). Prepregnancy maternal body mass index, gestational age, stress, and depression also were associated with folate levels.

Conclusions: Low RBC folate is associated with perinatal factors, including high maternal cotinine levels, body mass index, stress, and depression. The effect of low folate levels among smokers cannot be overemphasized, considering that tobacco products not only reduce folate levels but also decrease the bioutilization of folate.
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http://dx.doi.org/10.14423/SMJ.0000000000001083DOI Listing
April 2020

Characteristics of Early Newborn Care: A Descriptive Analysis of Recent Births in Nigeria.

Int J MCH AIDS 2020 12;9(1):93-102. Epub 2020 Jan 12.

College of Nursing and Public Health, Adelphi University, Garden City, NY, USA.

Background Or Objectives: The neonatal period, the first 28 days of life, is the most critical period for child survival. In 2017, 214,000 children in Nigeria died during the neonatal period. Newborn care practices play a key role in preventing these deaths. The aim of this study was to examine the association between delivery location and early newborn care in Nigeria.

Methods: Data from the 2013 Nigeria Demographic and Health Survey were analyzed. The main exposure variable was delivery location (home, public hospital, public health center/clinic and private hospital/clinic). The outcomes were early initiation of breastfeeding, breastfeeding support, and cord examination. We used multivariate logistic regression to estimate the odds of newborn care.

Results: We observed that the prevalence of all three outcome indicators was low. After adjusting for confounders, birth in public health facilities, compared to home birth, was associated with early initiation of breastfeeding (public hospitals: OR 1.62, 95% CI: 1.29-2.03; public health centers/clinics OR: 1.28, 95% CI: 1.02-1.61). Breastfeeding support and cord examination were each associated with birth in public hospitals only compared to home birth (OR 1.41, 95% CI: 1.09-1.81 and OR 1.41, 95% CI: 1.11-1.79, respectively).

Conclusion And Global Health Implications: Early newborn care in Nigeria was suboptimal and the quality of this care varied across delivery locations and birth attendants. Public hospitals had the most favorable newborn care outcomes. Policies and programs to enhance the quality of facility-based early newborn care and promote community-based newborn care could improve neonatal outcomes and reduce overall child mortality in resource-challenged settings.
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http://dx.doi.org/10.21106/ijma.324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031874PMC
January 2020

Racism, Psycho-Social Stress, and Health-related Quality of Life.

Int J MCH AIDS 2020 30;9(1):73-76. Epub 2019 Dec 30.

REACHUP, Inc. Tampa, Florida.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress.
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http://dx.doi.org/10.21106/ijma.339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031886PMC
December 2019

Maternal Caffeine Consumption and Racial Disparities in Fetal Telomere Length.

Int J MCH AIDS 2020 30;9(1):14-21. Epub 2019 Dec 30.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, One Baylor Plaza, MS:411 Houston, TX 77030, USA.

Background And Objectives: The identification of risk factors for shorter telomere length, especially during fetal development, would be important towards caffeine consumption recommendations for pregnant women on a global scale. The purpose of this study was to evaluate the association between caffeine intake and fetal telomere length as well as racial/ethnic differences in telomere length regardless of maternal caffeine consumption status.

Methods: Caffeine intake was measured using a food frequency questionnaire (FFQ). Three generalized linear models (GLM) were compared based on binary categorical variables of caffeine levels using data mean value of 117.3 mg as cut-off; the World Health Organization (WHO) recommendations of 300 mg; and the American College of Obstetricians and Gynecologists (ACOG) recommendations of 200 mg. The association between caffeine consumption and telomere length (telomere to single-copy [T/S] ratio) was then assessed.

Results: Among 57 maternal-fetal dyads, 77.2% reported less than 200 mg of caffeine (ACOG) and 89.5% less than 300 mg (WHO). Both WHO and ACOG models found that caffeine intake was significantly and positively associated with longer telomere length (p<0.05); and sodium (p<0.05). Other" race (p<0.001) and "white" race (p<0.001) were also significantly and positively associated with longer telomere length in the same models. Increasing maternal age shortened telomere length significantly in all models (p<0.001).

Conclusion And Global Health Implications: Caffeine intake, maternal age, and race may be associated with alterations in fetal telomere length. This indicates that caffeine consumption during pregnancy may have long-term implications for fetal development. The racial/ethnic differences in telomere length found in this study warrant larger studies to further confirm these associations.
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http://dx.doi.org/10.21106/ijma.290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031881PMC
December 2019

Phenotypes of fetal macrosomia and risk of stillbirth among term deliveries over the previous four decades.

Birth 2020 06 10;47(2):202-210. Epub 2020 Jan 10.

Center of Excellence in Maternal and Child Health Education, Science, and Practice, College of Public Health, University of South Florida, Tampa, FL, USA.

Objectives: To evaluate the association between macrosomia and stillbirth over the previous four decades and to determine the consistency of the relationship.

Methods: This was a population-based retrospective cohort study using United States Natality and Fetal Death Data from 1982 to 2017 and restricted to the gestational age range of 37-41 weeks inclusive. Macrosomia was defined as birthweight ≥4000 g and subdivided into its grades as previously recommended: grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g). We calculated temporal trends of stillbirth among fetuses with macrosomia over the years using joinpoint regression. We generated odds ratios from adjusted binomial logistic regression models to examine the association between macrosomia and risk of stillbirth stratified by grades using normal-weight infants (2500-3999 g) as referent.

Results: Within the fetal macrosomia group, the rate of stillbirth declined from 2.04/1000 in 1982 to 1.05/1000 by the end of the study period (2017), representing a drop of about 48.5%. For the normal-weight fetuses, stillbirth rate declined from 1.95/1000 to 0.83/1000, equivalent to a decline of 57.4%. Macrosomia was significantly associated with elevated risk for stillbirth: grade 2 (OR = 1.27; 95% CI = 1.22-1.32) and grade 3 (OR = 5.97; 95% CI = 5.69-6.22).

Conclusions: Fetal macrosomia is a significant risk factor for fetal demise with the worst intrauterine survival observed among those classified as grade 3. Fetal macrosomia is a heterogeneous rather than a homogeneous entity in terms of risk profiles, and this needs to be considered in future policy guidelines.
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http://dx.doi.org/10.1111/birt.12479DOI Listing
June 2020

Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971-2017.

Arch Gynecol Obstet 2020 02 6;301(2):415-426. Epub 2019 Dec 6.

Center of Excellence in Maternal and Child Health Education, Science, and Practice, College of Public Health, University of South Florida, Tampa, FL, USA.

Purpose: Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28-42 weeks inclusive.

Methods: This was a retrospective cohort study covering the period 1971-2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000-4499 g), Grade 2 (4500-4999 g) and Grade 3 (≥ 5000 g).

Results: A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain.

Conclusion: This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.
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http://dx.doi.org/10.1007/s00404-019-05400-9DOI Listing
February 2020

The effect of maternal vitamin C intake on fetal telomere length.

J Matern Fetal Neonatal Med 2021 Apr 15;34(7):1143-1148. Epub 2019 Jul 15.

Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Background: A telomere is a nucleoprotein structure that is located at the end of a chromosome. Reduced telomere length manifests as physical ailments such as the increased risk of age-related illnesses. These age-related illnesses include heart disease and failure. Telomere length has been studied extensively in adults; however, limited information exists regarding maternal dietary influences on fetal telomere length.

Objectives: The objective of this study is to investigate the relationship between maternal vitamin C intake and fetal telomere length.

Methods: Data for this analysis were collected as part of a prospective cohort study that recruited pregnant women upon admission into labor and delivery. Umbilical cord serum was collected for 96 maternal-fetal dyads, and DNA analysis was performed using a quantitative polymerase chain reaction. The telomere to single copy gene ratio method was used to determine telomere length, and maternal vitamin C intake was measured using the Dietary History Questionnaire (DHQ). Statistical analysis was conducted using generalized linear modeling-based analyses.

Results: The linear model indicates that maternal vitamin C intake (OR = 1.0032, 95%CI: 1.0014-1.0052,  ≤ .05) was positively associated with fetal telomere length. BMI (OR = 1.1096, 95%CI: 1.0619-1.1660,  ≤ .05) had a significant positive association with fetal telomere length while sodium intake was negatively associated with this outcome (OR = 0.9997, 95%CI: 0.9995-0.9998,  ≤ .05). Black ethnicity had a significant negative association with fetal telomere length (OR = 0.0186, 95%CI: 0.0031-0.0824,  ≤ .05).

Conclusions: Our study shows a positive association between maternal vitamin C intake and fetal telomere length. These findings may provide a method of understanding and preventing adult-onset disease and mortality through intrauterine reprograming.
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http://dx.doi.org/10.1080/14767058.2019.1628940DOI Listing
April 2021

Folic Acid Intake, Fetal Brain Growth, and Maternal Smoking in Pregnancy: A Randomized Controlled Trial.

Curr Dev Nutr 2019 Jun 4;3(6):nzz025. Epub 2019 Apr 4.

Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN.

Background: Folic acid supplementation during pregnancy plays an important role in fetal growth and development. To our knowledge, no experimental study has examined the effect of folic acid on fetal brain growth in women who smoke cigarettes during pregnancy.

Objectives: The aim of this study was to investigate the efficacy of higher-dose compared with standard-dose folic acid supplementation on prenatal fetal brain growth, measured by head circumference, brain weight, and brain-body weight ratio (BBR).

Design: In this randomly assigned, double-blind, controlled clinical trial, we recruited 345 smoking pregnant women attending a community health center in Tampa, FL between 2010 and 2014. Participants were randomly assigned in a 1:1 ratio to receive either 0.8 mg folic acid/d (standard of care at the study center) or 4 mg folic acid/d (higher strength). Participants were also enrolled in a smoking cessation program. A 2-level linear growth model was used to assess treatment effect and factors that predict intrauterine growth in head circumference over time. Multiple linear regression analyses were conducted to estimate the effect of higher-strength folic acid on head circumference at birth, fetal brain weight, and fetal BBRs.

Results: Mothers who received the higher dose of folic acid had infants with a 1.18 mm larger mean head circumference compared with infants born to mothers who received the standard dose, but this difference was not statistically significant (= 0.2762). Higher-dose folic acid also had no significant effect on brain weight. The BBR of infants of mothers who received higher-dose folic acid was, however, 0.33 percentage points lower than that for infants of mothers who received the standard dose of folic acid (= 0.044).

Conclusions: Infants of smokers in pregnancy may benefit from higher-strength maternal folic acid supplementation. We noted a decrease in the proportion of infants with impaired BBR among those on higher-dose folic acid. This trial was registered at clinicaltrials.gov as NCT01248260.
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http://dx.doi.org/10.1093/cdn/nzz025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529553PMC
June 2019
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