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Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparas
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Abstracts / Annals of Epidemiology 25 (2015) 702e719
Results: Geometric means for serum cotinine level and FeNO were 0.29ng/ml
and 13.04 ppb, respectively. There was a statistically significant inverse relationship between serum cotinine levels and FeNO (r2 ¼0.172, b¼.061, p-value<0.001). The inverse relationship was strongest among current smokers (b¼0.101, p-value <0.001), followed by ex/non-smokers (b¼.025, pvalue< 0.001), adjusted for potential confounders. Conclusion: The results of the study show that serum cotinine suppresses FeNO levels regardless of the smoking status. However, the inverse relationship between serum cotinine and FeNO levels among ex/non-smokers suggest that secondhand smoke may predispose susceptible individuals to adverse health outcomes.
P66. Maternal Socioeconomic Status and the Odds of Failing to Receive Preconception Counseling: An Epidemiologic Study Using 2009-2011 PRAMS Data Katherine Nystrom MPH. Emory University Rollins School of Public Health Purpose: While scientific evidence is growing to support the improvement of women’s preconception health as an effective way to reduce poor pregnancy and infant outcomes, maternal socioeconomic status has not been explored as an exposure in the preconception health paradigm. The purpose of this study was to determine the degree to which maternal characteristics, psychosocial factors, and health behaviors explain or mediate the influence of socioeconomic factors on the receipt of preconception counseling. Methods: This study was a secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 6 states that included the following question in their PRAMS questionnaire: “Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to prepare for a healthy pregnancy and baby?” The sample is a population-based sample of 27,458 women who gave birth to a live infant during the years 2009-2011. Results: Only 32.7% of respondents reported receiving preconception counseling. By using multivariable logistic regression, we found modest evidence for income and education variation, although not in a clear dose-response gradient. We observed a protective, albeit non-significant, effect of extreme poverty (annual income <$10,000) against the failure to receive preconception counseling. Women earning between $10,000 and $49,999 annually or having less than 16 years of education were less likely to receive preconception counseling. Conclusions: Based on our findings, it appears that the provision of preconception care, or women’s recognition of the receipt of preconception care, remains substandard.
P67. Estimation of the Burden of CIN Lesions Preventable by Vaccination with Bivalent, Quadrivalent or 9-Valent HPV Vaccines Chandrika Piyathilake PhD, Michelle Chambers MS, Suguna Badiga PhD, Walter Bell MD, Ronald Alvarez MD, Edward Partridge MD, Maurizio Macaluso MD, DrPH. UAB Purpose: To estimate and compare the potential impact of currently available prophylactic HPV vaccines on preventing varying grades of histologically confirmed cervical intraepithelial neoplasia (CIN2+). Methods: 2296 women with histological diagnoses were tested for 37 HPV genotypes. To estimate the proportion of CIN 2 and 3 lesions that could have been prevented by immunization with bivalent (16/18), quadrivalent (6/11/ 16/18) or 9-valent (6/11/16/18/31/35/45/52/58) vaccines, we used the histology profile of women in the same race and age category who were negative for the HPV vaccine genotypes to compute the expected number of CIN 2 and 3 lesions in the absence of infection with the vaccine genotypes, and subtracted the expected numbers from the observed. We estimated alternative expected and preventable numbers using more specific patterns of infection as the reference, and a regression model including terms for genotype groups and relevant interactions. Results: The proportion of preventable CIN 2+ lesions, especially CIN 2 lesions, among African American (AA) women increased with the 9-valent vaccine compared to bivalent or quadrivalent vaccines (from 4% to 42%). However, 20-30% of CIN 3 lesions are not preventable by the 9-valent vaccine. Alternative estimation methods yielded similar results.
Conclusions: Widespread use of the 9-valent HPV vaccine would considerably reduce the prevalence of CIN 3 in our population, but the prevalence of CIN 2+ associated with HPVs not included in the 9-valent vaccine would be sufficiently high to warrant follow-up. It is unclear whether these CIN 2 + lesions would progress to more advanced lesions over time.
Reproductive Health P68. Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparas Alison Cammack MPH, Carol Hogue, Carolyn Drews-Botsch, Michael Kramer, Brad Pearce, D. Jeffrey Newport. Emory University Purpose: Determinants of preterm birth are largely unexplained, particularly in nulliparous women. Stressors over the life course, including exposure to child abuse, are proposed determinants of preterm birth (PTB); however, population-based studies of this association are limited. The goal of this study was to ascertain if maternal exposure to child abuse increases risk of preterm birth and very preterm birth (vPTB) in nulliparas. Methods: Self-reported survey data come from the National Longitudinal Survey of Adolescent Health. Participants were initially recruited in grades 712 and have been followed through ages 24-32. Abuse was measured as sexual, physical, and emotional abuse before age 18. Preterm birth was defined as a live birth before 37 weeks of gestation and very preterm birth was defined as a live birth before 32 weeks of gestation. Analytic methods include univariate and multivariate logistic regression, accounting for complex survey design. Results: There were 4222 singleton live births to nulliparous girls and women. 19.68%, 8.79%, and 53.39% of these subjects reported any physical, sexual, or emotional abuse, respectively. Overall, abuse was not associated with PTB or vPTB. However, after adjusting for demographic factors, there was an increased risk of vPTB among 19-22.99 year old women exposed to chronic (>¼5 times versus <5 times) sexual abuse (OR¼ 6.93, 95% CI: (1.2039.99)). Conclusions: The association between maternal exposure to child abuse and vPTB varies according to type and chronicity of abuse, demographic factors, and maternal age. Future studies should explore underlying biological and behavioral risk factors that may explain these findings.
P69. The Association of Gestational Weight Gain with Stillbirth: Findings from the Stillbirth Collaborative Research Network (SCRN) Case-Control Study Cassandra M. Gibbs Pickens MPH. Stillbirth Collaborative Research Network and Emory University Rollins School of Public Health, Department of Epidemiology Purpose: We examined the association between stillbirth (fetal death 20 weeks’ gestation) and weekly rate of gestational weight gain (GWG) in the second and third trimesters. Existing studies suffer from low power, poor data quality, or uncontrolled confounding. Hypotheses: GWG below Institute of Medicine (IOM) guidelines will increase the odds of stillbirth in underweight, normal weight, or overweight women (pre-pregnancy body mass index [BMI] 18.5, 18-24.99, or 25-29.99 kg/m2, respectively) but decrease the odds among the obese (BMI 30 kg/m2). GWG above IOM guidelines will increase the odds of stillbirth among overweight and obese women. Methods: SCRN was a multi-site, population-based case-control study of stillbirth conducted 2006-2008. Data were obtained via medical record abstraction and maternal interview. We restricted to singletons (N1¼620 stillbirths and N0¼1,871 live births). The exposure, average weekly GWG in the second and third trimesters, was calculated as: (total GWGdestimated first-trimester GWG)/(gestational aged14 weeks), and categorized using IOM guidelines. We used multivariable logistic regression, weighting for study design and non-participation. Results: Excluding 12.4% of individuals with missing exposure information, mothers of stillbirths were more likely than mothers of live births to gain weight below IOM guidelines (32.6% versus 18.2%, respectively; OR for below versus within guidelines: 2.17 [95% CI 1.50-3.14]). The association remained significant upon adjustment for maternal demographic characteristics, pregnancy history, substance use, preexisting disease, and BMI (aOR: 2.06 [95% CI 1.38-3.08]).
Abstracts / Annals of Epidemiology 25 (2015) 702e719
Results: Geometric means for serum cotinine level and FeNO were 0.29ng/ml
and 13.04 ppb, respectively. There was a statistically significant inverse relationship between serum cotinine levels and FeNO (r2 ¼0.172, b¼.061, p-value<0.001). The inverse relationship was strongest among current smokers (b¼0.101, p-value <0.001), followed by ex/non-smokers (b¼.025, pvalue< 0.001), adjusted for potential confounders. Conclusion: The results of the study show that serum cotinine suppresses FeNO levels regardless of the smoking status. However, the inverse relationship between serum cotinine and FeNO levels among ex/non-smokers suggest that secondhand smoke may predispose susceptible individuals to adverse health outcomes.
P66. Maternal Socioeconomic Status and the Odds of Failing to Receive Preconception Counseling: An Epidemiologic Study Using 2009-2011 PRAMS Data Katherine Nystrom MPH. Emory University Rollins School of Public Health Purpose: While scientific evidence is growing to support the improvement of women’s preconception health as an effective way to reduce poor pregnancy and infant outcomes, maternal socioeconomic status has not been explored as an exposure in the preconception health paradigm. The purpose of this study was to determine the degree to which maternal characteristics, psychosocial factors, and health behaviors explain or mediate the influence of socioeconomic factors on the receipt of preconception counseling. Methods: This study was a secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 6 states that included the following question in their PRAMS questionnaire: “Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to prepare for a healthy pregnancy and baby?” The sample is a population-based sample of 27,458 women who gave birth to a live infant during the years 2009-2011. Results: Only 32.7% of respondents reported receiving preconception counseling. By using multivariable logistic regression, we found modest evidence for income and education variation, although not in a clear dose-response gradient. We observed a protective, albeit non-significant, effect of extreme poverty (annual income <$10,000) against the failure to receive preconception counseling. Women earning between $10,000 and $49,999 annually or having less than 16 years of education were less likely to receive preconception counseling. Conclusions: Based on our findings, it appears that the provision of preconception care, or women’s recognition of the receipt of preconception care, remains substandard.
P67. Estimation of the Burden of CIN Lesions Preventable by Vaccination with Bivalent, Quadrivalent or 9-Valent HPV Vaccines Chandrika Piyathilake PhD, Michelle Chambers MS, Suguna Badiga PhD, Walter Bell MD, Ronald Alvarez MD, Edward Partridge MD, Maurizio Macaluso MD, DrPH. UAB Purpose: To estimate and compare the potential impact of currently available prophylactic HPV vaccines on preventing varying grades of histologically confirmed cervical intraepithelial neoplasia (CIN2+). Methods: 2296 women with histological diagnoses were tested for 37 HPV genotypes. To estimate the proportion of CIN 2 and 3 lesions that could have been prevented by immunization with bivalent (16/18), quadrivalent (6/11/ 16/18) or 9-valent (6/11/16/18/31/35/45/52/58) vaccines, we used the histology profile of women in the same race and age category who were negative for the HPV vaccine genotypes to compute the expected number of CIN 2 and 3 lesions in the absence of infection with the vaccine genotypes, and subtracted the expected numbers from the observed. We estimated alternative expected and preventable numbers using more specific patterns of infection as the reference, and a regression model including terms for genotype groups and relevant interactions. Results: The proportion of preventable CIN 2+ lesions, especially CIN 2 lesions, among African American (AA) women increased with the 9-valent vaccine compared to bivalent or quadrivalent vaccines (from 4% to 42%). However, 20-30% of CIN 3 lesions are not preventable by the 9-valent vaccine. Alternative estimation methods yielded similar results.
Conclusions: Widespread use of the 9-valent HPV vaccine would considerably reduce the prevalence of CIN 3 in our population, but the prevalence of CIN 2+ associated with HPVs not included in the 9-valent vaccine would be sufficiently high to warrant follow-up. It is unclear whether these CIN 2 + lesions would progress to more advanced lesions over time.
Reproductive Health P68. Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparas Alison Cammack MPH, Carol Hogue, Carolyn Drews-Botsch, Michael Kramer, Brad Pearce, D. Jeffrey Newport. Emory University Purpose: Determinants of preterm birth are largely unexplained, particularly in nulliparous women. Stressors over the life course, including exposure to child abuse, are proposed determinants of preterm birth (PTB); however, population-based studies of this association are limited. The goal of this study was to ascertain if maternal exposure to child abuse increases risk of preterm birth and very preterm birth (vPTB) in nulliparas. Methods: Self-reported survey data come from the National Longitudinal Survey of Adolescent Health. Participants were initially recruited in grades 712 and have been followed through ages 24-32. Abuse was measured as sexual, physical, and emotional abuse before age 18. Preterm birth was defined as a live birth before 37 weeks of gestation and very preterm birth was defined as a live birth before 32 weeks of gestation. Analytic methods include univariate and multivariate logistic regression, accounting for complex survey design. Results: There were 4222 singleton live births to nulliparous girls and women. 19.68%, 8.79%, and 53.39% of these subjects reported any physical, sexual, or emotional abuse, respectively. Overall, abuse was not associated with PTB or vPTB. However, after adjusting for demographic factors, there was an increased risk of vPTB among 19-22.99 year old women exposed to chronic (>¼5 times versus <5 times) sexual abuse (OR¼ 6.93, 95% CI: (1.2039.99)). Conclusions: The association between maternal exposure to child abuse and vPTB varies according to type and chronicity of abuse, demographic factors, and maternal age. Future studies should explore underlying biological and behavioral risk factors that may explain these findings.
P69. The Association of Gestational Weight Gain with Stillbirth: Findings from the Stillbirth Collaborative Research Network (SCRN) Case-Control Study Cassandra M. Gibbs Pickens MPH. Stillbirth Collaborative Research Network and Emory University Rollins School of Public Health, Department of Epidemiology Purpose: We examined the association between stillbirth (fetal death 20 weeks’ gestation) and weekly rate of gestational weight gain (GWG) in the second and third trimesters. Existing studies suffer from low power, poor data quality, or uncontrolled confounding. Hypotheses: GWG below Institute of Medicine (IOM) guidelines will increase the odds of stillbirth in underweight, normal weight, or overweight women (pre-pregnancy body mass index [BMI] 18.5, 18-24.99, or 25-29.99 kg/m2, respectively) but decrease the odds among the obese (BMI 30 kg/m2). GWG above IOM guidelines will increase the odds of stillbirth among overweight and obese women. Methods: SCRN was a multi-site, population-based case-control study of stillbirth conducted 2006-2008. Data were obtained via medical record abstraction and maternal interview. We restricted to singletons (N1¼620 stillbirths and N0¼1,871 live births). The exposure, average weekly GWG in the second and third trimesters, was calculated as: (total GWGdestimated first-trimester GWG)/(gestational aged14 weeks), and categorized using IOM guidelines. We used multivariable logistic regression, weighting for study design and non-participation. Results: Excluding 12.4% of individuals with missing exposure information, mothers of stillbirths were more likely than mothers of live births to gain weight below IOM guidelines (32.6% versus 18.2%, respectively; OR for below versus within guidelines: 2.17 [95% CI 1.50-3.14]). The association remained significant upon adjustment for maternal demographic characteristics, pregnancy history, substance use, preexisting disease, and BMI (aOR: 2.06 [95% CI 1.38-3.08]).