Obesity and postpartum hospital use among individuals without additional medical comorbidities.

Objective: The objective of this study was to examine whether obesity without preexisting or gestational comorbidities is associated with postpartum hospital use (PHU).

Methods: We studied 2016 to 2018 birth certificate and discharge data on 178,729 New York City births without International Classification of Diseases, Tenth Revision (ICD-10) codes at delivery for diabetes; hypertension; placental disease; anemia; thyrotoxicosis; bariatric surgery; and pulmonary, cardiac, renal, bleeding, autoimmune, digestive, neuromuscular, mental, or substance-use disorders. We defined PHU as ≥1 readmission or emergency department visit within 30 days of delivery discharge.

Prospective transitions in hemoglobin A1c following gestational diabetes using Multistate Markov Models.

Objective: We characterized the state-to-state transitions in postpartum A1c levels after gestational diabetes, including remaining in a state of normoglycemia or transitions between prediabetes or diabetes states of varying severity.

Methods: We used data from the APPLE Cohort, a postpartum population-based cohort of individuals with gestational diabetes between 2009-2011and linked HbA1c data with up to 9 years follow-up (N=34,171). We examined maternal sociodemographic and perinatal characteristics as predictors of transitions in A1c progression using Markov multistate models.

Disparities in perinatal COVID-19 infection and vaccination.

The COVID-19 pandemic exposed and exacerbated persistent health inequities in perinatal populations, resulting in disparities of maternal and fetal complications. In this narrative review, we present an adapted conceptual framework of perinatal social determinants of health in the setting of the COVID-19 pandemic and use this framework to contextualize the literature regarding disparities in COVID-19 vaccination and infection. We synthesize how elements of the structural context, individual socioeconomic position, and concrete intermediary determinants influence each other and perinatal COVID-19 vaccination and infection, arguing that systemic inequities at each level contribute to observed disparities in perinatal health outcomes.

Maternal Characteristics and Rates of Unexpected Complications in Term Newborns by Hospital.

Importance: The Joint Commission Unexpected Complications in Term Newborns measure characterizes newborn morbidity potentially associated with quality of labor and delivery care. Infant exclusions isolate relatively low-risk births, but unexpected newborn complications (UNCs) are not adjusted for maternal factors that may be associated with outcomes independently of hospital quality.

Objective: To investigate the association between maternal characteristics and hospital UNC rates.

Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality.

Objective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM).

Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants.

Development of a prediction model of postpartum hospital use using an equity-focused approach.

Background: Racial inequities in maternal morbidity and mortality persist into the postpartum period, leading to a higher rate of postpartum hospital use among Black and Hispanic people. Delivery hospitalizations provide an opportunity to screen and identify people at high risk to prevent adverse postpartum outcomes. Current models do not adequately incorporate social and structural determinants of health, and some include race, which may result in biased risk stratification.

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity: A Focus on Quality and Equity.

Objective: To investigate which organizational factors, policies, and practices distinguish hospitals with high compared with low risk-adjusted rates of severe maternal morbidity (SMM).

Methods: Using a positive deviance approach, this qualitative study included 50 semistructured interviews with health care professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, and chief medical officers) in four low-performing and four high-performing hospitals in New York City. Hospital performance was based on risk-adjusted morbidity metrics from previous research.

Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers.

Objective: The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic.

COVID-19 pandemic-related change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery hospitalization: a differences-in-differences analysis.

Objective: Exclusive breastmilk feeding during the delivery hospitalization, a Joint Commission indicator of perinatal care quality, is associated with longer-term breastfeeding success. Marked racial and ethnic disparities in breastfeeding exclusivity and duration existed prior to COVID-19. The pandemic, accompanied by uncertainty regarding intrapartum and postpartum safety practices, may have influenced disparities in infant feeding practices.

The validity of self-reported SARS-CoV-2 results among postpartum respondents.

Background: Rapid and reliable health data on SARS-CoV-2 infection among pregnant individuals are needed to understand the influence of the virus on maternal health and child development, yet the validity of self-reported COVID-19 testing and diagnosis remains unknown.

Objectives: We assessed the validity of self-reported COVID-19 polymerase chain reaction (PCR) testing and diagnosis during delivery among postpartum respondents as well as how diagnostic accuracy varied by respondent characteristics.

Methods: We validated receipt of a COVID-19 PCR test and test results by comparing self-reported results obtained through an electronic survey to electronic medical record data (gold standard) among a cross-sectional sample of postpartum respondents who delivered at four New York City hospitals between March 2020 and January 2021.

Postpartum Hospital Readmissions and Emergency Department Visits Among High-Risk, Medicaid-Insured Women in New York City.

To describe the incidence of and characteristics associated with postpartum emergency department (ED) visits and hospital readmissions among high-risk, low-income, predominantly Black and Latina women in New York City (NYC). We conducted a secondary analysis of detailed survey and medical chart data from an intervention to improve timely postpartum visits among Medicaid-insured, high-risk women in NYC from 2015 to 2016. Among 380 women who completed surveys at baseline (bedside postpartum) and 3 weeks after delivery, we examined the incidence of having an ED visit or readmission within 3 weeks postpartum.

Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications.

Objectives: To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities.

Methods: We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups.

A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health.

Our objective was to review the role of maternal health disparities and mental health in the maternal mortality crisis in the USA, and discuss how perinatal care quality improvement in these areas is a critical lever for reducing maternal death. This paper summarizes content from a plenary talk delivered at the 2020 Biennial Meeting of the International Marcé Society for Perinatal Mental Health, in commemoration of the Society's 40th anniversary. The talk synthesized literature on two characteristics of the maternal mortality crisis in the US: (1) wide racial and ethnic disparities in maternal mortality and severe morbidity and (2) the impact of mental health and substance use disorders on maternal death, and introduced a framework for how health care quality gaps contribute to both of these issues.

The Course of Weight/Shape Concerns and Disordered Eating Symptoms Among Adolescent and Young Adult Males.

Purpose: Male weight concerns tend to focus on shape and muscularity as opposed to a desire for thinness and remain underdetected by conventional eating disorder assessments. We aimed to describe the longitudinal course of weight concerns and disordered eating behaviors among males across adolescence and young adulthood.

Methods: We used prospective assessments of 4,489 U S.

Intertwined disparities: Applying the maternal-infant dyad lens to advance perinatal health equity.

Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society.

Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic.

Importance: The coronavirus disease 2019 (COVID-19) pandemic may exacerbate existing racial/ethnic inequities in preterm birth.

Objective: To assess whether racial/ethnic disparities in very preterm birth (VPTB) and preterm birth (PTB) increased during the first wave of the COVID-19 pandemic in New York City.

Design, Setting, And Participants: This cross-sectional study included 8026 Black, Latina, and White women who gave birth during the study period.

Racial and Ethnic Disparities in Severe Maternal Morbidity: A Qualitative Study of Women's Experiences of Peripartum Care.

Introduction: Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity.

Methods: We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20).

Term Labor Induction and Cesarean Delivery Risk among Obese Women with and without Comorbidities.

Objective: Findings of the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, showing reduced cesarean risk with elective labor induction among low-risk nulliparous women at 39 weeks' gestation, have the potential to change interventional delivery practices but require examination in wider populations. The aim of this study was to identify whether term induction of labor was associated with reduced cesarean delivery risk among women with obesity, evaluating several maternal characteristics associated with obesity, induction, and cesarean risk.

Study Design: We studied administrative records for 66,280 singleton, term births to women with a body mass index ≥30, without a prior cesarean delivery, in New York City from 2008 to 2013.

Perinatal care experiences among racially and ethnically diverse mothers whose infants required a NICU stay.

Objective: To learn how diverse mothers whose babies required a neonatal intensive care unit (NICU) stay evaluate their obstetric and neonatal care.

Study Design: We conducted three focus groups stratified by race/ethnicity (Black, Latina, White, and Asian women, n = 20) who delivered infants at <32 weeks gestation or <1500 g with a NICU stay. We asked women to assess perinatal care and applied classic qualitative analysis techniques to identify themes and make comparisons across groups.

Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review.

Objective: To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research.

Data Sources: We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States.

Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.

Purpose: We aimed to quantify the extent to which overweight and obesity explain cesarean delivery risk among women of different racial and ethnic backgrounds.

Methods: Using administrative records for 216,481 singleton, nulliparous births in New York City from 2008 to 2013, we calculated risk ratios, risk differences, and population attributable fractions for associations between body mass index (BMI) and cesarean, stratified by race and ethnicity.

Results: The population attributable fraction (95% confidence interval) for BMI was 6.

The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence, Stability, and Transitions.

Purpose: To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States.

Methods: Using 11 prospective assessments from 9,031 U.S.

Air pollution, land use, and complications of pregnancy.

Background: Mounting evidence suggests that the natural and built environment can affect human health, but relatively few studies have considered links between features of the residential natural and built environment other than air pollution and complications of pregnancy.

Objectives: To quantify the impact of features of the maternal residential natural and built environments on risk of gestational diabetes mellitus (GDM), gestational hypertension and preeclampsia among 61,640 women who delivered at a single hospital in Rhode Island between 2002 and 2012.

Methods: We estimated residential levels of ambient fine particulate matter (PM) and black carbon (BC) using spatiotemporal models, neighborhood green space using remote sensing and proximity to recreational facilities, and neighborhood blue space using distance to coastal and fresh water.