Maternal and Child Health Commons^™

Risk Factors For Community-Acquired Bacterial Infection Among Young Infants In South Asia: A Longitudinal Cohort Study With Nested Case-Control Analysis, Nicholas E Connor, Mohammad Shahidul Islam, Luke C Mullany, Nong Shang, Zulfiqar A Bhutta, Sajid Soofi, Pinaki Panigrahi, Kalpana Panigrahi, Radhanath Satpathy, Anuradha Bose, Rita Isaac, Abdullah H Baqui, Dipak K Mitra, Qazi Sadeq-Ur Rahman, Tanvir Hossain, Stephanie J Schrag, Jonas M Winchell, Melissa L Arvay, Maureen H Diaz, Jessica L Waller, Martin W Weber, Davidson H Hamer, Patricia Hibberd, A S M Nawshad Uddin Ahmed, Maksuda Islam, Mohammad Belal Hossain, Shamim A Qazi, Shams El Arifeen, Gary L Darmstadt, Samir K Saha

Faculty, Staff and Student Publications

OBJECTIVE: Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.

METHODS: Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build …

Outcome Prediction In Newborn Infants: Past, Present, And Future, Edward F Bell

Faculty, Staff and Student Publications

The perinatal and neonatal periods are the periods of considerable organ development and maturation. Perinatal and neonatal illnesses can result in mortality and morbidities that burden families and the healthcare system. Outcome prediction is essential for informing perinatal and intensive care management, prognosis, and post-discharge interventions. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) research databases include hospital and neurodevelopment follow-up outcomes of infants with various underlying diseases and conditions receiving intensive care, providing a unique opportunity to assess outcome risk prediction. The NRN has developed outcome risk prediction tools for use …

Speech-Language Disorder Severity, Academic Success, And Socioemotional Functioning Among Multilingual And English Children In The United States: The National Survey Of Children’S Health, Claudia Pedroza

Faculty, Staff and Student Publications

Randomized controlled trials (RCTs) are challenging, but are the studies most likely to change practice and benefit patients. RCTs investigating neonatal surgical therapies are rare. The Necrotizing Enterocolitis Surgery Trial (NEST) was the first surgical RCT conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN), and multiple lessons were learned. NEST was conducted over a 7.25-year enrollment period and the primary outcome was death or neurodevelopmental impairment (NDI) at 18-22 months corrected age. Surgical investigators designing clinical trials involving neonatal surgical treatments have many considerations to include, including how to …

Dexterity Of The Less Affected Hand In Children With Hemiplegic Cerebral Palsy

Faculty, Staff and Student Publications

BACKGROUND: To determine if the "unaffected" hand in children with hemiplegic cerebral palsy (CP) is truly unaffected.

METHODS: We performed a retrospective review of manual dexterity as measured by the Functional Dexterity Test (FDT) in 66 children (39 boys, 27 girls, mean age: 11 years 4 months) with hemiplegic CP. Data were stratified by Manual Ability Classification System (MACS) level, birth weight, and gestational age at birth, and compared with previously published normative values.

RESULTS: The FDT speed of the less affected hand is significantly lower than typically developing (TD) children (

CONCLUSIONS: Both dexterity and rate of fine motor …

The Reading Profiles Of Late Elementary English Learners With And Without Dyslexia, Gaël Abou-Ghannam

Faculty, Staff and Student Publications

This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a "mother", with the developing attachment relationship to the unborn child considered as a milestone in the future parent's developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic …

The Risks Of Birth Defects And Childhood Cancer With Conception By Assisted Reproductive Technology, Barbara Luke, Morton B Brown, Ethan Wantman, Maria J Schymura, Marilyn L Browne, Sarah C Fisher, Nina E Forestieri, Chandrika Rao, Hazel B Nichols, Mahsa M Yazdy, Susan T Gershman, Caitlin R Sacha, Melanie Williams, Mary K Ethen, Mark A Canfield, Kevin J Doody, Michael L Eisenberg, Valerie L Baker, Carrie Williams, Alastair G Sutcliffe, Melissa A Richard, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Study question: Is there an association between fertility status, method of conception and the risks of birth defects and childhood cancer?

Summary answer: The risk of childhood cancer had two independent components: (i) method of conception and (ii) presence, type and number of birth defects.

What is known already: The rarity of the co-occurrence of birth defects, cancer and ART makes studying their association challenging. Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects or cancer but have been limited by small sample size and inadequate statistical power, failure to adjust for …

Neurodevelopment Assessment Of Small For Gestational Age Children In A Community-Based Cohort From Pakistan, Sabahat Naz, Zahra Hoodbhoy, Ali Jaffar, Sidra Kaleem Jafri, Babar Hasan, Devyani Chowdhury, Melissa Gladstone

Department of Paediatrics and Child Health

Background: Children born small for gestational age (SGA) may experience more long-term neurodevelopmental issues than those born appropriate for gestational age (AGA). This study aimed to assess differences in the neurodevelopment of children born SGA or AGA within a periurban community in Pakistan.
Methods: This was a prospective cohort study in which study participants were followed from the pilot Doppler cohort study conducted in 2018. This pilot study aimed to develop a pregnancy risk stratification model using machine learning on fetal Dopplers. This project identified 119 newborns who were born SGA (2.4±0.4 kg) based on International Fetal and Newborn Growth …

Maternal Prenatal Cortisol Trajectories Predict Accelerated Growth In Infancy, Jennifer Hahn-Holbrook, Elysia Poggi Davis, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Higher maternal cortisol in pregnancy has been linked to childhood obesity. Much of the previous research has been limited in that cortisol in pregnancy is only measured at one time-point, precluding the ability to examine critical timing effects of prenatal maternal cortisol. To fill this gap, this longitudinal study measured maternal plasma cortisol at 15, 19, 25, and 31 weeks of pregnancy, and assessed infant body mass index percentile (BMIP)1 at birth, 3, 6, 12, and 24 months in 189 mother-infant pairs. Three distinct patterns of maternal cortisol in pregnancy (typical, steep, and flat trajectories) were identified using general growth …

Maternal And Fetal Attachment Before Birth: Trends In Pregnant Women Of Urban Karachi, Shelina Bhamani, Anita Attaullah, Hajra Malik, Faiqa Binte Aamir, Areeba Syed, Amir Raza, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Background: Maternal-fetal attachment is a multidimensional phenomenon and product of diverse physiological, psychological, and socio-emotional factors. The prenatal period is crucial in forming this bond and further predicts postnatal attachment.
Methodology: The present research was conducted using a cross-sectional survey design. Sixty-six participants filled out the survey regarding practices, perceptions, and attitudes toward maternal-fetal attachment after attending an online session on "Talking to the Baby in the Womb."
Results: Analysis revealed that participants talk to their baby in their tummy. Wondering when the baby starts thinking, feeling, and hearing within also aids in forming a maternal-fetal relationship. A statistically significant …

Poliovirus Immunity Among Children Aged 6-11 And 36-48 Months In 14 Polio High-Risk Provinces Of Afghanistan: A Health-Facility-Based Study, Sajid Bashir Soofi, Maureen Martinez, Noha H. Farag, William S. Hendley, Derek Ehrhardt, Imran Ahmed, Imtiaz Hussain, William Weldon, Ahmed M. Kassem

Department of Paediatrics and Child Health

Afghanistan is one of two countries where wild poliovirus (WPV) type 1 remains endemic. We conducted a facility-based cross-sectional survey of antipoliovirus antibodies in children in 14 provinces of Afghanistan. The provinces were selected based on programmatic priorities for polio eradication. Children aged 6-11 and 36-48 months attending outpatient clinics were enrolled in the study. We collected venous blood, isolated serum, and conducted neutralization assays to detect poliovirus neutralizing antibodies. A total of 2086 children from the 14 provinces were enrolled. Among the enrolled children, 44.3% were girls; the median age in the 6-11-month group was 9.4 months, and in …

Demographic And Socioeconomic Factors Predict Maternal Postpartum Rehospitalization: A Retrospective Numom2b Dataset Study, Colin Wakefield

Tower Health Research Day

No abstract provided.

Respiratory Virus Surveillance Among Children With Acute Respiratory Illnesses - New Vaccine Surveillance Network, United States, 2016-2021, Natasha B Halasa, Monica M Mcneal, Benjamin Clopper, Yingtao Zhou, Brett L Whitaker, Elizabeth Lemasters, Elizabeth Harker, Janet A Englund, Eileen J Klein, Rangaraj Selvarangan, Christopher J Harrison, Julie A Boom, Leila C Sahni, Marian G Michaels, John V Williams, Gayle E Langley, Susan I Gerber, Angela Campbell, Aron J Hall, Brian Rha, Meredith Mcmorrow

Faculty, Staff and Student Publications

The New Vaccine Surveillance Network (NVSN) is a prospective, active, population-based surveillance platform that enrolls children with acute respiratory illnesses (ARIs) at seven pediatric medical centers. ARIs are caused by respiratory viruses including influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and most recently SARS-CoV-2 (the virus that causes COVID-19), which result in morbidity among infants and young children (1-6). NVSN estimates the incidence of pathogen-specific pediatric ARIs and collects clinical data (e.g., underlying medical conditions and vaccination status) to assess risk factors for severe disease and calculate influenza and COVID-19 vaccine effectiveness. Current NVSN …

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Shama Munim

Department of Obstetrics & Gynaecology

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.
Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, …

Antenatal Dexamethasone For Improving Preterm Newborn Outcomes In Low-Resource Countries: A Cost-Effectiveness Analysis Of The Who Action-I Trial, Who Action Trial Collaborators, Katherine E. Eddy, Joshua P. Vogel, Nick Scott, Dagnachew Fetene, Shabina Ariff, Sajid Bashir Soofi, Lumaan Sheikh, Farrukh Raza, Almas Aamir

Department of Paediatrics and Child Health

Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries.
Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk …

Frequency Of Bystander Exposure To Antibiotics For Enteropathogenic Bacteria Among Young Children In Low-Resource Settings, Elizabeth T. Rogawski Mcquade, Stephanie A. Brennhofer, Sarah E. Elwood, Timothy L. Mcmurry, Joseph A. Lewnard, Estomih R. Mduma, Sanjaya Shrestha, Najeeha Talat Iqbal, Pascal O. Bessong, Gagandeep Kang

Department of Paediatrics and Child Health

Children in low-resource settings carry enteric pathogens asymptomatically and are frequently treated with antibiotics, resulting in opportunities for pathogens to be exposed to antibiotics when not the target of treatment (i.e., bystander exposure). We quantified the frequency of bystander antibiotic exposures for enteric pathogens and estimated associations with resistance among children in eight low-resource settings. We analyzed 15,697 antibiotic courses from 1,715 children aged 0 to 2 y from the MAL-ED birth cohort. We calculated the incidence of bystander exposures and attributed exposures to respiratory and diarrheal illnesses. We associated bystander exposure with phenotypic susceptibility of E. coli isolates in …

Association Of Antenatal Steroid Exposure At 21 To 22 Weeks Of Gestation With Neonatal Survival And Survival Without Morbidities, Dhuly Chowdhury, Edward F Bell, Seetha Shankaran, Krisa P Van Meurs, Namasivayam Ambalavanan, Rachel G Greenberg, Noelle Younge, Erika F Werner, Abhik Das, Waldemar A Carlo, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Neonatal Research Network

Faculty, Staff and Student Publications

IMPORTANCE: The provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials.

OBJECTIVE: To compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks' gestation or less vs no exposure to antenatal steroids.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of …

Biophysical And Biochemical Characterization Of The Receptor Binding Domain Of Sars-Cov-2 Variants, Sneha Raj, Shubbir Ahmed

Faculty, Staff and Student Publications

The newly emerging SARS-CoV-2 variants are potential threat and posing new challenges for medical intervention due to high transmissibility and escaping neutralizing antibody (NAb) responses. Many of these variants have mutations in the receptor binding domain (RBD) of SARS-CoV-2 spike protein that interacts with the host cell receptor. Rapid mutation in the RBD through natural selection to improve affinity for host receptor and antibody pressure from vaccinated or infected individual will greatly impact the presently adopted strategies for developing interventions. Understanding the nature of mutations and how they impact the biophysical, biochemical and immunological properties of the RBD will help …

Reproductive Health Perspectives Of Young Women With Perinatally And Behaviourally Acquired Hiv: A Qualitative Study, Jacob Abadi

Faculty, Staff and Student Publications

INTRODUCTION: The aim of this study was to describe the sexual and reproductive goals of female adolescents with human immunodeficiency virus (HIV) in an urban cohort and decipher if they vary depending on the mode of HIV acquisition.

METHODS: We conducted in-depth qualitative interviews with 25 Black and/or Hispanic/Latinx female adolescents living with HIV (14 perinatally, 11 behaviourally acquired) aged 17-25 years who have access to care and antiretroviral therapy at an urban public hospitals (NYC, NY). Interviews were transcribed, coded and analysed using thematic analysis.

RESULTS: Interviews demonstrated that access to antiretroviral therapy and HIV disclosure to a sexual …

Practical Approaches To Improve Vancomycin-Related Patient Outcomes In Pediatrics- An Alternative Strategy When Auc/Mic Is Not Feasible, Kashif Hussain, Muhammad Sohail Salat, Shahzad Rauf, Manoj Rathi, Midhat Khan, Fizzah Naz, Wasif Ahmed Khan, Rahila Ikram, Gul Ambreen

Department of Biological & Biomedical Sciences

Background: Anecdotal experience and studies have shown that most pediatric patients fail to reach target therapeutic vancomycin trough levels (VTLs) and required higher total daily doses (TDD). This retrospective study aims to evaluate the frequency of hospitalized children who achieved target VTLs with a vancomycin (VNCO) dosing regimen of 40-60 mg/kg/d q6h and to assess the VNCO-TDD required to attain the target and their effects on clinical outcomes in pediatric patients.
Methods: After ethical approval, patients of 3 month-12 years were evaluated in this chart review study who received ≥ 3 intravenous-VNCO doses and appropriately drawn blood samples of VTLs …

Cmv And Ebv Co-Infection In Hiv-Infected Children: Infection Rates And Analysis Of Differential Expression Of Cytokines In Hiv Mono- And Hiv-Cmv-Ebv Co-Infected Groups, Fizza Nazim, Hammad Afzal Kayani, Aspara Ali Nathwani, Fatima Mir, Syed Hani Abidi

Department of Biological & Biomedical Sciences

Background: CMV and EBV co-infections can affect the HIV disease progression by modulating the immune system. The disease dynamics can differ in HIV-positive adults and children. In Pakistan, HIV is rapidly expanding, especially in children; however, the prevalence of CMV and EBV co-infection and the effect on immune modulation in HIV-positive children are not known. This study aimed to bridge this gap by estimating the rate of active CMV and EBV co-infection in HIV-positive children, followed by the analysis of differential expression of cytokines in HIV mono- and HIV/CMV/EBV co-infected children.
Methods: DNA samples from 319 HIV-positive children, previously recruited …

Barriers And Facilitators To Exclusive Breastfeeding In Rural Pakistan: A Qualitative Exploratory Study, Atif Riaz, Shelina Bhamani, Sheraz Ahmed, Fayyaz Umrani, Sadaf Jakhro, Abdul Khaliq Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Exclusive breastfeeding (EBF) of children until six months of age is considered one of the most critical interventions in tackling childhood undernutrition. EBF rates are suboptimal in Pakistan, particularly in rural areas where child undernutrition is most prevalent. This study aimed to explore barriers to EBF in a rural context of Pakistan.
Methods: The study was conducted in the rural district Matiari of Sindh, Pakistan, during Jan-March 2020. We used a qualitative exploratory study design and conducted 36 focus group discussions (FGDs). Participants were purposively selected mothers who had not practiced EBF during their previous childbirth, their spouses and …

Standardizing Perinatal Mental Health Interventions: A Guide For The U.S., Maile Lauren Robles

Master's Projects and Capstones

The term perinatal individual refers to women and other individuals who are pregnant or who have been pregnant within the last 12 months. Every year, in the United States there are 700 pregnancy-related deaths and 10% are due to mental health causes including death by suicide. Mental health conditions including but not limited to anxiety, depression, substance use disorders, and post-traumatic stress disorder affect one in five perinatal individuals throughout the United States. This increases perinatal morbidity, hospitalization costs, and economic burden nationwide.

After 43 days postpartum, mental health conditions are the second leading cause of death. The United States …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Hellp Syndrome: Hemolysis, Elevated Liver Enzymes, Low Platelets, Kimberly Roman

Nursing Student Class Projects (Formerly MSN)

The research provided was to understand a rare, life-threatening condition that occurs in pregnant women or recently postpartum women. The topic searched was HELLP Syndrome, an acronym for Hemolysis, Elevated Liver Enzymes, and Low Platelets. This syndrome is named this due to the underlying conditions in women who experience this disorder. Women can recover from HELLP Syndrome if detected early and treated appropriately, but symptoms are vague and difficult to diagnose. The best way to understand and detect this disorder is by promoting awareness and understanding the mechanisms and treatment involved. A search was conducted about the topic through research …

Longitudinal Reduction In Diversity Of Maternal Gut Microbiota During Pregnancy Is Observed In Multiple Low-Resource Settings: Results From The Women First Trial, Minghua Tang, Nicholas E. Weaver, Daniel N. Frank, Diana Ir, Charles E. Robertson, Jennifer F. Kemp, Jamie Westcott, Kartik Shankar, Sumera Aziz Ali, Sarah Saleem

Community Health Sciences

Objective: To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala).
Methods: Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm …

Mechanism Of Neonatal Hypoglycemia After Late Preterm Steroids: Are Fetal Metabolic Effects Responsible?, Alan T N Tita

Faculty, Staff and Student Publications

OBJECTIVE:

Betamethasone administration in the late preterm period(340/7–365/7 weeks’ gestation) not only reduces neonatal respiratory morbidity but also increases neonatal hypoglycemia through an uncertain mechanism.¹ Based on data from pregnant individuals with diabetes, excessive amounts of maternal glucose can cross the placenta and cause fetal hyperinsulinemia, which can cause neonatal hypoglycemia at birth.² Given that betamethasone can also increase maternal glucose levels,³ our objective was to explore the potential mechanisms for late preterm steroid-induced neonatal hypoglycemia by measuring the fetal metabolic effects of antenatal late preterm betamethasone and assessing the relationship of the fetal metabolic effects with …

Placental Pathology In Spontaneous And Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features, Pawel T Schubert

Faculty, Staff and Student Publications

INTRODUCTION: Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The aim of this study was to investigate these relationships.

METHODS: Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13.

RESULTS: In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) …

Maternal Iron Deficiency Programs Rat Offspring Hypertension In Relation To Renin-Angiotensin System And Oxidative Stress, You-Lin Tain

Faculty, Staff and Student Publications

Hypertension is an important public health challenge, affecting up to 30-50% of adults worldwide. Several epidemiological studies indicate that high blood pressure originates in fetal life-the so-called programming effect or developmental origin of hypertension. Iron-deficiency anemia has become one of the most prevalent nutritional problems globally. Previous animal experiments have shown that prenatal iron-deficiency anemia adversely affects offspring hypertension. However, the underlying mechanism remains unclear. We used a maternal low-iron diet Sprague Dawley rat model to study changes in blood pressure, the renal renin-angiotensin system, oxidative stress, inflammation, and sodium transporters in adult male offspring. Our study revealed that 16-week-old …

A Comparison Of American Women's Experiences With Both Gestational Surrogate Pregnancies And Spontaneous Pregnancies, Jennifer Lahl, Kallie Fell, Kate Bassett, Frances H. Broghammer, William M. Briggs

Dignity: A Journal of Analysis of Exploitation and Violence

This article evaluates the pregnancy experiences of American women by comparing their spontaneous or non-surrogate pregnancies with their gestational surrogate pregnancies. Data were collected through structured interviews using an online video platform. In total, 96 interviews were conducted. Data revealed that a woman was more likely to have a pregnancy that was high-risk during a surrogate pregnancy than during a non-surrogate pregnancy, independent of maternal age or gravidity (OR 11.4, 3.5-36.6; p<.0001). A surrogate pregnancy had three times higher odds of resulting in a cesarean section (p<.0001) and was five times more likely to deliver at an earlier gestational age (p<.0001). Women in this study were significantly more likely to experience postpartum depression following the delivery of surrogate children than after delivering their non-surrogate children (p=.01), and overall, they were more likely to have adverse outcomes during a surrogate pregnancy. The rate of new post-surrogacy chronic health issues for women of color was significantly higher than for women identified as white (p<.0001). We found that women’s economic disadvantage was a major contributor to the decision to proceed with surrogacy. This study confirms that health disparities exist for women with surrogate pregnancies compared to non-surrogate pregnancies, which can lead to long-term complications after a surrogate pregnancy. In terms of biomedical ethics, it raises important social, economic, and political issues related to surrogacy, all requiring further exploration. Future research will build on the present work in further helping us to understand the circumstances and consequences involved for women in surrogacy.

Hypertension In Pregnancy And Adverse Outcomes Among Low-Risk Nulliparous People Expectantly Managed At Or After 39 Weeks: A Secondary Analysis Of A Randomized Controlled Trial, Alan T N Tita, Dwight J Rouse, George R Saade, John M Thorp, Maged M Costantine, Edward K Chien, Brian M Casey, Sindhu K Srinivas, Geeta K Swamy, Hyagriv N Simhan, Eunice Kennedy Shriver National Institute Of Child Health And Human Development (Nichd) Maternal-Fetal Medicine Units (Mfmu) Network

Faculty, Staff and Student Publications

OBJECTIVE: To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous women expectantly managed at or after 39 weeks of gestation are associated with adverse outcomes.

DESIGN: Secondary analysis of a randomised trial.

SETTING: Multicentre, USA.

POPULATION: Individuals in the expectantly managed group who delivered on or after 39 weeks.

METHODS: Multivariable analysis to estimate adjusted relative risks (aRR) for binomial outcomes, adjusted odds ratios (aOR) for multinomial outcomes and 95% CI.

MAIN OUTCOME MEASURES: Composite adverse maternal outcome including placental abruption, pulmonary oedema, postpartum haemorrhage, postpartum infection, venous thromboembolism or intensive care unit admission. Secondary outcomes included a …