The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes.
The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes.
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DOI：
10.1016/j.ajogmf.2022.100649
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发表时间：
2022-07
影响因子：
6.3
通讯作者：
中科院分区：
文献类型：
--
作者：
Structural racism and pandemic-related stress from the COVID-19 pandemic may increase the risk of adverse birth outcomes. Our objective was to examine associations between neighborhood measures of structural racism and pandemic stress with 3 outcomes: SARS-CoV-2 infection, preterm birth, and delivering small-for-gestational-age newborns. Our secondary objective was to investigate the joint association of SARS-CoV-2 infection during pregnancy and neighborhood measures with preterm birth and delivering small-for-gestational-age newborns. We analyzed data of 967 patients from a prospective cohort of pregnant persons in New York City, comprising 367 White (38%), 169 Black (17%), 293 Latina (30%), and 87 Asian persons (9%), 41 persons of other race or ethnicity (4%), and 10 of unknown race or ethnicity (1%). We evaluated structural racism (social/built structural disadvantage, racial-economic segregation) and pandemic-related stress (community COVID-19 mortality, community unemployment rate increase) in quartiles by zone improvement plan code. SARS-CoV-2 serologic enzyme-linked immunosorbent assay was performed on blood samples from pregnant persons. We obtained data on preterm birth and small-for-gestational-age newborns from an electronic medical record database. We used log-binomial regression with robust standard error for clustering by zone improvement plan code to estimate associations of each neighborhood measure separately with 3 outcomes: SARS-CoV-2 infection, preterm birth, and small-for-gestational-age newborns. Covariates included maternal age, parity, insurance status, and body mass index. Models with preterm birth and small-for-gestational-age newborns as the dependent variables additionally adjusted for SARS-CoV-2 infection. A total of 193 (20%) persons were SARS-CoV-2–seropositive, and the overall risks of preterm birth and small-for-gestational-age newborns were 8.4% and 9.8%, respectively. Among birthing persons in neighborhoods in the highest quartile of structural disadvantage (n=190), 94% were non-White, 50% had public insurance, 41% were obese, 32% were seropositive, 11% delivered preterm, and 12% delivered a small-for-gestational-age infant. Among birthing persons in neighborhoods in the lowest quartile of structural disadvantage (n=360), 39% were non-White, 17% had public insurance, 15% were obese, 9% were seropositive, 6% delivered preterm, and 10% delivered a small-for-gestational-age infant. In adjusted analyses, structural racism measures and community unemployment were associated with both SARS-CoV-2 infection and preterm birth, but not small-for-gestational-age infants. High vs low structural disadvantage was associated with an adjusted relative risk of 2.6 for infection (95% confidence interval, 1.7–3.9) and 1.7 for preterm birth (95% confidence interval, 1.0–2.9); high vs low racial-economic segregation was associated with adjusted relative risk of 1.9 (95% confidence interval, 1.3–2.8) for infection and 2.0 (95% confidence interval, 1.3–3.2) for preterm birth; high vs low community unemployment increase was associated with adjusted relative risk of 1.7 (95% confidence interval, 1.2–1.5) for infection and 1.6 (95% confidence interval, 1.0–2.8) for preterm birth. COVID-19 mortality rate was associated with SARS-CoV-2 infection but not preterm birth or small-for-gestational-age infants. SARS-CoV-2 infection was not independently associated with birth outcomes. We found no interaction between SARS-CoV-2 infection and neighborhood measures on preterm birth or small-for-gestational-age infants. Neighborhood measures of structural racism were associated with both SARS-CoV-2 infection and preterm birth, but these associations were independent and did not have a synergistic effect. Community unemployment rate increases were also associated with an increased risk of preterm birth independently of SARS-CoV-2 infection. Mitigating these factors might reduce the impact of the pandemic on pregnant people.
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影响因子：
9.8
作者：
Lokken EM;Taylor GG;Huebner EM;Vanderhoeven J;Hendrickson S;Coler B;Sheng JS;Walker CL;McCartney SA;Kretzer NM;Resnick R;Kachikis A;Barnhart N;Schulte V;Bergam B;Ma KK;Albright C;Larios V;Kelley L;Larios V;Emhoff S;Rah J;Retzlaff K;Thomas C;Paek BW;Hsu RJ;Erickson A;Chang A;Mitchell T;Hwang JK;Gourley R;Erickson S;Delaney S;Kline CR;Archabald K;Blain M;LaCourse SM;Adams Waldorf KM;Washington COVID-19 in Pregnancy Collaborative
通讯作者：
Washington COVID-19 in Pregnancy Collaborative
影响因子：
9.7
作者：
Janevic, Teresa;Zeitlin, Jennifer;Egorova, Natalia;Hebert, Paul L.;Balbierz, Amy;Howell, Elizabeth A.
通讯作者：
Howell, Elizabeth A.
影响因子：
9.8
作者：
Research Committee;Society for Maternal-Fetal Medicine (SMFM);Boelig RC;Aagaard KM;Debbink MP;Shamshirsaz AA;SMFM Research Committee. Electronic address: smfm@smfm.org
通讯作者：
SMFM Research Committee. Electronic address: smfm@smfm.org
影响因子：
3.4
作者：
Huynh, M.;Spasojevic, J.;Krieger, N.
通讯作者：
Krieger, N.
影响因子：
2.3
作者：
Janevic T;Maru S;Nowlin S;McCarthy K;Bergink V;Stone J;Dias J;Wu S;Howell EA
通讯作者：
Howell EA