Preconceptional and maternal obesity: epidemiology and health consequences.

Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age.

Importance Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. Objectives To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery. Design, Setting, and Participants Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among these hospitals. The statistical analysis was performed in 2016-2017. Exposure Race/ethnicity. Main Outcomes and Measures Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater). Results Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailedP  Conclusions and Relevance Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants.

/pdf/differences-in-morbidity-and-mortality-rates-in-black-white-daabdg5d5a.pdf

Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals.

Importance Severe morbidity in very preterm infants is associated with profound clinical implications on development and life-course health However, studies of racial/ethnic disparities in severe neonatal morbidities are scant and suggest that these disparities are modest or null, which may be an underestimation resulting from the analytic approach used Objective To estimate racial/ethnic differences in severe morbidities among very preterm infants Design, Setting, and Participants This population-based retrospective cohort study was conducted in New York City, New York, using linked birth certificate, mortality data, and hospital discharge data from January 1, 2010, through December 31, 2014 Infants born before 24 weeks’ gestation, with congenital anomalies, and with missing data were excluded Racial/ethnic disparities in very preterm birth morbidities were estimated through 2 approaches, conventional analysis and fetuses-at-risk analysis The conventional analysis used log-binomial regression to estimate the relative risk of 4 severe neonatal morbidities for the racial/ethnic groups For the fetuses-at-risk analysis, Cox proportional hazards regression with death as competing risk was used to estimate subhazard ratios associating race/ethnicity with each outcome Estimates were adjusted for sociodemographic factors and maternal morbidities Data were analyzed from September 5, 2017, to May 21, 2018 Main Outcomes and Measures Four morbidity outcomes were defined usingInternational Classification of Diseases, Ninth Revision,diagnosis and procedure codes: necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity Results In total, 582 297 infants were included in this study Of these infants, 285 006 were female (489%) and 297 291 were male (510%) Using the conventional approach in the very preterm birth subcohort, black compared with white infants had an increased risk of only bronchopulmonary dysplasia (adjusted risk ratio [aRR], 134; 95% CI, 109-164) and a borderline increased risk of necrotizing enterocolitis (aRR, 139; 95% CI, 100-193) Hispanic infants had a borderline increased risk of necrotizing enterocolitis (aRR, 139; 95% CI, 098-196), and Asian infants had an increased risk of retinopathy of prematurity (aRR, 185; 95% CI, 115-297) In the fetuses-at-risk analysis, black infants had a 440 times higher rate of necrotizing enterocolitis (95% CI, 298-651), a 273 times higher rate of intraventricular hemorrhage (95% CI, 163-457), a 443 times higher rate of bronchopulmonary dysplasia (95% CI, 288-681), and a 298 times higher rate of retinopathy of prematurity (95% CI, 201-440) Hispanic infants had an approximately 2 times higher rate for all outcomes, and Asian infants had increased risk only for retinopathy of prematurity (adjusted hazard ratio, 243; 95% CI, 143-411) Conclusions and Relevance In this study, racial/ethnic disparities in neonatal morbidities among very preterm infants appear to be sizable, but may have been underestimated in previous studies, and may have implications for the future Understanding these racial/ethnic disparities is important, as they may contribute to inequalities in health and development later in the child’s life

/pdf/association-of-race-ethnicity-with-very-preterm-neonatal-nbmtigyal6.pdf

Association of Race/Ethnicity With Very Preterm Neonatal Morbidities.

Obesity and reproduction: a committee opinion

Obstetric and Neonatal Risks Among Obese Women Without Chronic Disease.

Racial/ethnic differences in preterm perinatal outcomes

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Obstetric and Neonatal Risks Among Obese Women Without Chronic Disease.

Racial/ethnic differences in preterm perinatal outcomes