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Neonatal mortality and morbidity are often caused by preterm birth and lower birth weight. Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are the most prevalent maternal medical complications during pregnancy. However, evidence on effects of air pollution on adverse birth outcomes and pregnancy complications is mixed. Singleton live births conceived between January 1st, 2000, and December 31st, 2015, and reached at least 27 weeks of pregnancy in Kansas were included in the study. Trimester-specific and total pregnancy exposures to nitrogen dioxide (NO 2 ), particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ), and ozone (O 3 ) were estimated using spatiotemporal ensemble models and assigned to maternal residential census tracts. Logistic regression, discrete-time survival, and linear models were applied to assess the associations. After adjustment for demographics and socio-economic status (SES) factors, we found increases in the second and third trimesters and total pregnancy O 3 exposures were significantly linked to preterm birth. Exposure to the second and third trimesters O 3 was significantly associated with lower birth weight, and exposure to NO 2 during the first trimester was linked to an increased risk of GDM. O 3 exposures in the first trimester were connected to an elevated risk of GH. We didn’t observe consistent associations between adverse pregnancy and birth outcomes with PM 2.5 exposure. Our findings indicate there is a positive link between increased O 3 exposure during pregnancy and a higher risk of preterm birth, GH, and decreased birth weight. Our work supports limiting population exposure to air pollution, which may lower the likelihood of adverse birth and pregnancy outcomes.

There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews. We explored how participants positioned obesity-in-pregnancy clinical encounters within their broader narratives. Employing narrative analysis, we identified five narrative tensions contributing to communication challenges: 1) obesity as a detriment to health versus an acceptable biologic variation; 2) obesity as the result of personal choice versus the result of uncontrollable circumstances; 3) a regular pregnancy versus a high-risk diagnosis; 4) a typical and problem-free clinical encounter versus a tremendously difficult clinical encounter; and 5) talking openly about Body Mass Index (BMI) and related co-morbidities versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity in general influenced these tensions. These narrative tensions revealed specific areas where communication is vulnerable to breaking down during the obesity-in-pregnancy clinical encounter. Participants' (both HCPs and patients) past experiences of clinical encounters-and the meanings they ascribe to them-shape subsequent encounters, and our analysis illuminates the complexities of this interactive space. This research has implications for improving clinical practice and education.

Previous studies of short-term ambient air pollution exposure and asthma morbidity in the United States have been limited to a small number of cities and/or pollutants and with limited consideration of effects across ages. To estimate acute age group-specific effects of fine and coarse particulate matter (PM), major PM components, and gaseous pollutants on emergency department (ED) visits for asthma during 2005-2014 across the United States. We acquired ED visit and air quality data in regions surrounding 53 speciation sites in 10 states. We used quasi-Poisson log-linear time-series models with unconstrained distributed exposure lags to estimate site-specific acute effects of air pollution on asthma ED visits overall and by age group (1-4, 5-17, 18-49, 50-64, and y), controlling for meteorology, time trends, and influenza activity. We then used a Bayesian hierarchical model to estimate pooled associations from site-specific associations. Our analysis included asthma ED visits. We observed positive associations for multiday cumulative exposure to all air pollutants examined [e.g., 8-d exposure to : rate ratio of 1.016 with 95% credible interval (CI) of (1.008, 1.025) per increase, : 1.014 (95% CI: 1.007, 1.020) per increase, organic carbon: 1.016 (95% CI: 1.009, 1.024) per increase, and ozone: 1.008 (95% CI: 0.995, 1.022) per increase]. and ozone showed stronger effects at shorter lags, whereas associations of traffic-related pollutants (e.g., elemental carbon and oxides of nitrogen) were generally stronger at longer lags. Most pollutants had more pronounced effects on children ( y old) than adults; had strong effects on both children and the elderly ( y old); and ozone had stronger effects on adults than children. We reported positive associations between short-term air pollution exposure and increased rates of asthma ED visits. We found that air pollution exposure posed a higher risk for children and older populations. https://doi.org/10.1289/EHP11661.

Abstract Objective: The objectives of this study were to identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice and policy. Methodology: A systematic review was conducted and the databases Embase and Medline were searched from December 2019 to February 8, 2023, using terms related to social media, pregnancy, COVID-19 vaccines and misinformation. The inclusion criteria were original research studies that discussed misinformation about COVID-19 vaccination during pregnancy on social media. The exclusion criteria were review articles, no full text, and not published in English. Two independent reviewers conducted screening, extraction, and quality assessment. Results: Our search identified 76 articles, of which 3 fulfilled eligibility criteria. Included studies were of moderate and high quality. The social media platforms investigated included Facebook, Google Searches, Instagram, Reddit, TikTok, and Twitter. Misinformation was related to concerns regarding vaccine safety, and its association with infertility. Misinformation was increased due to lack of content monitoring on social media, exclusion of pregnant women from early vaccine trials, lack of information from reputable health sources on social media, and others. Suggested solutions were directed at pregnancy care providers (PCPs) and public health/government. Suggestions included: (i) integrating COVID-19 vaccination information into antenatal care, (ii) PCPs and public health should increase their social media presence to disseminate information, (iii) address population-specific vaccine concerns in a culturally relevant manner, and others. Conclusion: Increased availability of information from reputable health sources through multiple channels could increase COVID-19 vaccine uptake in the pregnant population and help combat misinformation. Highlights of the StudyExamples of misinformation on social media include safety of the COVID-19 vaccine, infertility, and harmful side-effects.Misinformation disseminated rapidly due to lack of social media monitoring, increased anti-vaccination messages, and lack of accurate information.Suggested solutions directed at care providers include integrating COVID-19 vaccination discussions into antenatal care.Public health and physicians should increase their presence on social media to disseminate vaccine-promoting information.

BackgroundPopulation-based short-term air pollution health studies often have limited spatiotemporally representative exposure data, leading to concerns of exposure measurement error.ObjectiveTo compare the use of monitoring and modeled exposure metrics in time-series analyses of air pollution and cardiorespiratory emergency department (ED) visits.MethodsWe obtained daily counts of ED visits for Atlanta, GA during 2009–2013. We leveraged daily ZIP code level concentration estimates for eight pollutants from nine exposure metrics. Metrics included central monitor (CM), monitor-based (inverse distance weighting, kriging), model-based [community multiscale air quality (CMAQ), land use regression (LUR)], and satellite-based measures. We used Poisson models to estimate air pollution health associations using the different exposure metrics. The approach involved: (1) assessing CM-based associations, (2) determining if non-CM metrics can reproduce CM-based associations, and (3) identifying potential value added of incorporating full spatiotemporal information provided by non-CM metrics.ResultsUsing CM exposures, we observed associations between cardiovascular ED visits and carbon monoxide, nitrogen dioxide, fine particulate matter, elemental and organic carbon, and between respiratory ED visits and ozone. Non-CM metrics were largely able to reproduce CM-based associations, although some unexpected results using CMAQ- and LUR-based metrics reduced confidence in these data for some spatiotemporally-variable pollutants. Associations with nitrogen dioxide and sulfur dioxide were only detected, or were stronger, when using metrics that incorporate all available monitoring data (i.e., inverse distance weighting and kriging).SignificanceThe use of routinely-collected ambient monitoring data for exposure assignment in time-series studies of large metropolitan areas is a sound approach, particularly when data from multiple monitors are available. More sophisticated approaches derived from CMAQ, LUR, or satellites may add value when monitoring data are inadequate and if paired with thorough data characterization. These results are useful for interpretation of existing literature and for improving exposure assessment in future studies.Impact statementThis study compared and interpreted the use of monitoring and modeled exposure metrics in a daily time-series analysis of air pollution and cardiorespiratory emergency department visits. The results suggest that the use of routinely-collected ambient monitoring data in population-based short-term air pollution and health studies is a sound approach for exposure assignment in large metropolitan regions. CMAQ-, LUR-, and satellite-based metrics may allow for health effects estimation when monitoring data are sparse, if paired with thorough data characterization. These results are useful for interpretation of existing health effects literature and for improving exposure assessment in future air pollution epidemiology studies.

This systematic review aimed to evaluate the effects of digital health counseling or behavioral weight management interventions for preventing excessive gestational weight gain (GWG) among pregnant individuals of all body mass index (BMI) categories, compared to routine care. We searched MEDLINE, Embase, CINAHL, ProQuest Dissertations/Theses, PsycINFO, and the Cochrane Central Register of Controlled Trials, up to February 2024. We included randomized controlled trials (RCTs) wherein pregnant women received counseling or behavioral interventions through digital health compared to routine care. Pairs of reviewers independently screened titles and abstracts and extracted data from eligible RCTs. Data were pooled using inverse-variance random-effects meta-analyses. We applied the Cochrane Risk of Bias 2.0 tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the magnitude and certainty of the effects. We included 18 trials. Moderate certainty evidence showed 0.78 kg lower GWG in the weight management digital health intervention group, compared with routine care (95% CI: -1.40 to -0.16 kg). This reduction was higher in individuals with BMI ≥ 25 kg/m2. Digital health interventions likely reduce the risk of excessive GWG (RR = 0.80; 95% CI: 0.68 to 0.95) and may result in little to no difference in the rate of cesarean birth (CB) (RR = 1.09; 95% CI: 0.81 to 1.48). Low-certainty evidence suggested that digital health weight management interventions may reduce the risk of gestational diabetes mellitus (GDM) (RR = 0.80; 95% CI: 0.57 to 1.12), pre-eclampsia (RR = 0.82; 95% CI: 0.51 to 1.33), and preterm birth (RR = 0.83; 95% CI: 0.53 to 1.28). High-certainty evidence showed that digital health weight management interventions have little to no effect on birthweight (MD = 0.00; 95% CI: -0.08 to 0.08). Digital health interventions are effective in reducing GWG and excessive GWG based on BMI. Additionally, evidence suggests that these interventions may lower the risk of GDM, pre-eclampsia, and preterm birth. However, their impact on birthweight, GWG across all BMI categories, and the risk of CB is trivial.

Introduction Stellate ganglion block (SGB) is performed to relieve head, face, neck, or upper limb pain, and several non-pain indications for performing this block have emerged over the years. To date, there has been no attempt to synthesize evidence on SGB for treating non-pain indications. This scoping review presents a summary of the efficacy and adverse effects of SGB when performed for 6 non-pain indications. Methods This scoping review was accomplished through the use of Arksey and O’Malley framework. A literature search was conducted for relevant articles in medical databases to identify publications on SGB and specified study types. Two reviewers independently assessed the risk of bias for randomized controlled trials, nonrandomized comparative studies, and case series. Results were summarized and recommendations were made on the basis of the strength of the available evidence according to the US Preventative Services Task Force grading system. Results Twenty-four studies (19 randomized controlled trials and 5 nonrandomized studies) were included in this review. On the basis of the evidence, SGB is recommended for obtunding cardiovascular sympathetic stimulation, improving perfusion in limbs, and alleviating menopausal symptoms with a Grade B or C recommendation and a moderate-to-low level of certainty. There was insufficient evidence to recommend SGB for the other indications. Conclusions SGB can be considered for obtunding cardiovascular sympathetic stimulation and stress response, reducing vascular tone to improve vascular insufficiency in the limbs and perioperative hemodynamic stability, and alleviating hot flashes in menopause, in conditions refractory to conventional medical management.

Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals. We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools. The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations.

ObjectiveTo perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native valvular heart disease (VHD) from medium/higher Human Development Index (HDI) countries.MethodsOvidSP platform databases were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% confidence intervals (CI) of maternal/fetal outcomes could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS).ResultsTwelve studies on 646 pregnancies were included. Pregnant women with severe MS had mortality rates of 3% (95% CI, 0% to 6%), pulmonary oedema 37% (23%–51%) and new/recurrent arrhythmias 16% (1%–25%). Their stillbirth, neonatal death and preterm birth rates were 4% (1%–7%), 2% (0%–4%), and 18% (7%–29%), respectively. Women with moderate MS had mortality rates of 1%(0%–2%), pulmonary oedema 18% (2%–33%), new/recurrent arrhythmias 5% (1%–9%), stillbirth 2% (1%–4%) and preterm birth 10%(2%–17%).Pregnant women with severe AS had a risk of mortality of 2% (0%–5%), pulmonary oedema 9% (2%–15%), and new/recurrent arrhythmias 4% (0%–7%). Their stillbirth, neonatal death and preterm birth rates were 2% (0%–5%), 3% (0%–6%) and 14%(4%–24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary oedema (8%; 0%–20%), new/recurrent arrhythmias (2%; 0%–5%), and preterm birth (13%; 6%–20%).ConclusionsWomen with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience.

AbstractObjectiveTo estimate the effectiveness of maternal mRNA covid-19 vaccination during pregnancy against delta and omicron severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and hospital admission in infants.DesignTest negative design study.SettingCommunity and hospital testing in Ontario, Canada.ParticipantsInfants younger than six months of age, born between 7 May 2021 and 31 March 2022, who were tested for SARS-CoV-2 between 7 May 2021 and 5 September 2022.InterventionMaternal mRNA covid-19 vaccination during pregnancy.Main outcome measuresLaboratory confirmed delta or omicron infection or hospital admission of the infant. Multivariable logistic regression estimated vaccine effectiveness, with adjustments for clinical and sociodemographic characteristics associated with vaccination and infection.Results8809 infants met eligibility criteria, including 99 delta cases (4365 controls) and 1501 omicron cases (4847 controls). Infant vaccine effectiveness from two maternal doses was 95% (95% confidence interval 88% to 98%) against delta infection and 97% (73% to 100%) against infant hospital admission due to delta and 45% (37% to 53%) against omicron infection and 53% (39% to 64%) against hospital admission due to omicron. Vaccine effectiveness for three doses was 73% (61% to 80%) against omicron infection and 80% (64% to 89%) against hospital admission due to omicron. Vaccine effectiveness for two doses against infant omicron infection was highest with the second dose in the third trimester (53% (42% to 62%)) compared with the first (47% (31% to 59%)) or second (37% (24% to 47%)) trimesters. Vaccine effectiveness for two doses against infant omicron infection decreased from 57% (44% to 66%) between birth and eight weeks to 40% (21% to 54%) after 16 weeks of age.ConclusionsMaternal covid-19 vaccination with a second dose during pregnancy was highly effective against delta and moderately effective against omicron infection and hospital admission in infants during the first six months of life. A third vaccine dose bolstered protection against omicron. Effectiveness for two doses was highest with maternal vaccination in the third trimester, and effectiveness decreased in infants beyond eight weeks of age.