Bibliography Tag: pregnancy

Buckley et al., 2022

Jessie P. Buckley, Jordan R. Kuiper, Deborah H. Bennett, Emily S. Barrett, Tracy Bastain, Carrie V. Breton, Sridhar Chinthakindi, Anne L. Dunlop, Shohreh F. Farzan, Julie B. Herbstman, Margaret R. Karagas, Carmen J. Marsit, John D. Meeker, Rachel Morello-Frosch, Thomas G. O’Connor, Megan E. Romano, Susan Schantz, Rebecca J. Schmidt, Deborah J. Watkins, Hongkai Zhu, Edo D. Pellizzari, Kurunthachalam Kannan, and Tracey J. Woodruff. “Exposure to Contemporary and Emerging Chemicals in Commerce among Pregnant Women in the United States: The Environmental influences on Child Health Outcome (ECHO) Program.” Environmental Science & Technology (2022) 56 (10), 6560-6573 DOI: 10.1021/acs.est.1c08942.
Prenatal chemical exposures can influence maternal and child health; however, few industrial chemicals are routinely biomonitored. We assessed an extensive panel of contemporary and emerging chemicals in 171 pregnant women across the United States (U.S.) and Puerto Rico in the Environmental influences on Child Health Outcomes (ECHO) Program. We simultaneously measured urinary concentrations of 89 analytes (103 total chemicals representing 73 parent compounds) in nine chemical groups: bactericides, benzophenones, bisphenols, fungicides and herbicides, insecticides, organophosphate esters (OPEs), parabens, phthalates/alternative plasticizers, and polycyclic aromatic hydrocarbons (PAHs). We estimated associations of creatinine-adjusted concentrations with sociodemographic and specimen characteristics. Among our diverse prenatal population (60% non-Hispanic Black or Hispanic), we detected 73 of 89 analytes in ≥1 participant and 36 in >50% of participants. Five analytes not currently included in the U.S. biomonitoring were detected in ≥90% of samples: benzophenone-1, thiamethoxam, mono-2-(propyl-6-carboxy-hexyl) phthalate, monocarboxy isooctyl phthalate, and monohydroxy-iso-decyl phthalate. Many analyte concentrations were higher among women of Hispanic ethnicity compared to those of non-Hispanic White women. Concentrations of certain chemicals decreased with the calendar year, whereas concentrations of their replacements increased. Our largest study to date identified widespread exposures to prevalent and understudied chemicals in a diverse sample of pregnant women in the U.S.


Eaton et al., 2022

Eaton JL, Cathey AL, Fernandez JA, Watkins DJ, Silver MK, Milne GL, Velez-Vega C, Rosario Z, Cordero J, Alshawabkeh A, Meeker JD; “The association between urinary glyphosate and aminomethyl phosphonic acid with biomarkers of oxidative stress among pregnant women in the PROTECT birth cohort study;” Ecotoxicology and Environmental Safety, 2022, 233:113300; DOI: 10.1016/j.ecoenv.2022.113300.

Background: Glyphosate is a widely used herbicide in global agriculture. Glyphosate and its primary environmental degradate, aminomethyl phosphonic acid (AMPA), have been shown to disrupt endocrine function and induce oxidative stress in in vitro and animal studies. To our knowledge, these relationships have not been previously characterized in epidemiological settings. Elevated urinary levels of glyphosate and AMPA may be indicative of health effects caused by previous exposure via multiple mechanisms including oxidative stress.

Methods: Glyphosate and AMPA were measured in 347 urine samples collected between 16 and 20 weeks gestation and 24-28 weeks gestation from pregnant women in the PROTECT birth cohort. Urinary biomarkers of oxidative stress, comprising 8-isoprostane-prostaglandin-F2α (8-iso-PGF2α), its metabolite 2,3-dinor-5,6-dihydro-15-F2 t-isoprostane (8-isoprostane metabolite) and prostaglandin-F2α (PGF2α), were also measured. Linear mixed effect models assessed the association between exposures and oxidative stress adjusting for maternal age, smoking status, alcohol consumption, household income and specific gravity. Potential nonlinear trends were also assessed using tertiles of glyphosate and AMPA exposure levels.

Results: No significant differences in exposure or oxidative stress biomarker concentrations were observed between study visits. An interquartile range (IQR) increase in AMPA was associated with 9.5% (95% CI: 0.5-19.3%) higher 8-iso-PGF2α metabolite concentrations. Significant linear trends were also identified when examining tertiles of exposure variables. Compared to the lowest exposure group, the second and third tertiles of AMPA were significantly associated with 12.8% (0.6-26.5%) and 15.2% (1.8-30.3%) higher 8-isoprostane metabolite, respectively. An IQR increase in glyphosate was suggestively associated with 4.7% (-0.9 to 10.7%) higher 8-iso-PGF2α.

Conclusions: Urinary concentrations of the main environmental degradate of glyphosate, AMPA, were associated with higher levels of certain oxidative stress biomarkers. Associations with glyphosate reflected similar trends, although findings were not as strong. Additional research is required to better characterize the association between glyphosate exposure and biomarkers of oxidative stress, as well as potential downstream health consequences.


Lesseur et al., 2022

Corina Lesseur, Khyatiben V. Pathak, Patrick Pirrotte, Melissa N. Martinez, Kelly K. Ferguson, Emily S. Barrett, Ruby H.N. Nguyen, Sheela Sathyanarayana, Daniele Mandrioli, Shanna H. Swan, Jia Chen; “Urinary glyphosate concentration in pregnant women in relation to length of gestation;” Environmental Research, 2022, 203, 0013-9351; DOI:10.1016/j.envres.2021.111811.


Human exposure to glyphosate-based herbicides (GBH) is increasing rapidly worldwide. Most existing studies on health effects of glyphosate have focused on occupational settings and cancer outcomes and few have examined this common exposure in relation to the health of pregnant women and newborns in the general population. We investigated associations between prenatal glyphosate exposure and length of gestation in The Infant Development and the Environment Study (TIDES), a multi-center US pregnancy cohort. Glyphosate and its primary degradation product [aminomethylphosphonic acid (AMPA)] were measured in urine samples collected during the second trimester from 163 pregnant women: 69 preterm births (<37 weeks) and 94 term births, the latter randomly selected as a subset of TIDES term births. We examined the relationship between exposure and length of gestation using multivariable logistic regression models (dichotomous outcome; term versus preterm) and with weighted time-to-event Cox proportional hazards models (gestational age in days). We conducted these analyses in the overall sample and secondarily, restricted to women with spontaneous deliveries (n = 90). Glyphosate and AMPA were detected in most urine samples (>94 %). A shortened gestational length was associated with maternal glyphosate (hazard ratio (HR): 1.31, 95 % confidence interval (CI) 1.00–1.71) and AMPA (HR: 1.32, 95%CI: 1.00–1.73) only among spontaneous deliveries using adjusted Cox proportional hazards models. In binary analysis, glyphosate and AMPA were not associated with preterm birth risk (<37 weeks). Our results indicate widespread exposure to glyphosate in the general population which may impact reproductive health by shortening length of gestation. Given the increasing exposure to GBHs and the public health burden of preterm delivery, larger confirmatory studies are needed, especially in vulnerable populations such as pregnant women and newborns. FULL TEXT

Lopez-Yañez Blanco et al., 2022

Lopez-Yañez Blanco A, Díaz-López KM, Vilchis-Gil J, Diaz-Garcia H, Gomez-Lopez J, Medina-Bravo P, Granados-Riveron JT, Gallardo JM, Klünder-Klünder M, Sánchez-Urbina R.; “Diet and Maternal Obesity Are Associated with Increased Oxidative Stress in Newborns: A Cross-Sectional Study.” Nutrients, 2022; 14(4):746; DOI:10.3390/nu14040746.


Overweight and obesity have become a world-health public problem, mainly for developing countries. Both health conditions have a higher prevalence among women of childbearing age. Physiopathology, overweight and obesity are characterized by a chronic oxidative stress status, which has deleterious effects on mothers and children. Hence, we determine whether the qualities of diet during pregnancy and maternal pregestational body mass index (BMI) are associated with increased oxidative stress markers in mothers and newborns. Two hundred forty-two (242) mother-newborn pairs were classified according to their pregestational BMI. Information on food intake was collected using a food frequency questionnaire in the third trimester of pregnancy. Levels of Malondialdehyde (MDA) and Nitric Oxide (NO) were measured in plasma from mothers at the end of the third trimester of pregnancy and from cord blood at birth. MDA and NO levels in mother–newborn pairs with maternal pregestational overweight or obesity were higher than in mother–newborn pairs with pregestational normal weight. For women (and newborns) who had a higher intake of fruit and vegetables, the levels of NO and MDA were lower. Lastly, women with pregestational obesity had lower fruit and vegetable intake during pregnancy and higher levels of oxidative stress and in their newborns. FULL TEXT

American College of Obstetricians and Gynecologists, 2014

The American College of Obstetricians and Gynecologists; “Health Disparities in Rural Women;” Committee Opinion, 2014, 586.


Rural women experience poorer health outcomes and have less access to health care than urban women. Many rural areas have limited numbers of health care providers, especially women’s health providers. Rural America is heterogeneous where problems vary depending on the region and state. Health care professionals should be aware of this issue and advocate for reducing health disparities in rural women. FULL TEXT

Diepietro Mager, 2020

DiPietro Mager, Natalie Ann. (2020). Preconception and Interconception Health and Routine Health Service Use Among Women in a Rural Midwestern County (Doctor of Philosophy), Indiana University.


Advancement of preconception and interconception health is a key element to improve women’s health as well as pregnancy outcomes. Little is known about the preconception and interconception health status of rural Midwestern populations in the United States. The primary objective of this study was to determine the preconception and interconception health status as well as behaviors of reproductive age women living in a rural Midwestern area. Secondary objectives were to quantify process measures of health care access and barriers to care, as well as determine disparities in preconception and interconception health status among women in this rural area as compared to statewide estimates. As existing national or state secondary data sources often have limitations in data derived from areas with low population densities or insufficient sample sizes to generate reliable estimates, a cross-sectional study was performed using a 34item survey. Data were collected from February to May 2019 from 315 non-pregnant women ages 18-45 years in a rural county in northwestern Ohio. Nearly all women surveyed had at least one risk factor associated with poor pregnancy outcomes, many of which were modifiable. Nearly half of all respondents reported at least one barrier to receipt of health care services. Women in this rural county fared worse for several preconception and interconception health measures when compared to statewide estimates derived from Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey data. These findings illustrate the need for continued development of interventions to improve preconception and interconception health for rural women as well as improved methods to capture and analyze data on important subpopulations at risk.

Bloom et al., 2012

Bloom, T. L., Bullock, L. F., & Parsons, L.; “Rural pregnant women’s stressors and priorities for stress reduction;” Issues in Mental Health Nursing, 2012, 33(12), 813-819; DOI: 10.3109/01612840.2012.712087.


Rural residence and maternal stress are risk factors for adverse maternal-child health outcomes across the globe, but rural women have been largely overlooked in maternal stress research. We recruited low-income, rural pregnant women for qualitative interviews to explore their stress exposures during pregnancy, reactions to stress, and priorities for stress reduction. We also used quantitative measures (Perceived Stress Scale, Center for Epidemiologic Studies of Depression Scale-Revised, Posttraumatic Stress Disorder Checklist-Civilian, Lifetime Exposure to Violence Scale) to describe stress exposures and reactions. We interviewed 24 pregnant rural women from a Midwestern US state, who were primarily young, white, partnered, and unemployed. Women’s predominant stressor was financial stress, compounded by a lack of employment, transportation, and affordable housing options; extended family interdependence; small-town gossip; isolation/loneliness; and boredom. Quantitative measures revealed high levels of global perceived stress, violence exposure, and symptoms of depression and posttraumatic stress disorder among the sample. Women most commonly reported that employment and interventions to increase their employability would most effectively decrease their stress, but faced numerous barriers to education or job training. Tested maternal stress interventions to date include nurse-case management, teaching women stress management techniques, and mind-body interventions. Pregnant women’s own priorities for stress-reduction intervention may differ, depending on the population under study. Our findings suggest that rural clinicians should address maternal stress, violence exposure, and mental health symptoms in prenatal care visits and that clinicians and researchers should include the voices of rural women in the conceptualization, design, implementation, and evaluation of maternal stress-reduction interventions.

Casey et al., 2004

Casey, Michelle M., Blewett, Lynn A., & Call, Kathleen T.; “Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest;” American Journal of Public Health, 2004, 94(10), 1709-1711; DOI: 10.2105/AJPH.94.10.1709.


We examined case studies of 3 rural Midwestern communities to assess local health care systems response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.  FULL TEXT

Askelson et al., 2020

Askelson, N., Ryan, G., Pieper, F., Bash-Brooks, W., Rasmusson, A., Greene, M., & Buckert, A.; “Perspectives on Implementation: Challenges and Successes of a Program Designed to Support Expectant and Parenting Community College Students in Rural, Midwestern State;” Maternal Child Health Journal, 2020, 24(Suppl 2), 152-162; DOI: 10.1007/s10995-020-02879-6.


OBJECTIVES: Expectant and parenting students (EPS) at community colleges are an underserved and often under-resourced group. In a rural, Midwestern state, the department of public health was awarded the Pregnancy Assistance Fund (PAF) grant to assist this population. This paper outlines the results of the implementation evaluation and offers suggestions for programs and evaluators working with this population in the community college setting.

METHODS: We conducted a multicomponent evaluation utilizing quantitative and qualitative methods. Evaluation activities included tracking activities/services, surveys and interviews with participants, and interviews with community college staff implementing grant activities. The research team calculated frequencies for quantitative data and coded qualitative data for themes.

RESULTS: Data from the community colleges and students’ self-reports revealed that EPS most commonly received concrete support from the program, often in the form of stipends or gift cards. Students reported that concrete support was beneficial and helped to relieve financial stress during the semester. Students’ major barriers to participation were lack of knowledge about the program and busy schedules that prevented them from accessing PAF services. Staff reported that difficulty identifying EPS and the short one-year project period were major implementation challenges.

CONCLUSIONS FOR PRACTICE: We recommend that community colleges work to identify EPS, use fellow EPS to recruit program participants, and implement programming that works with the students’ schedules.


Luke et al., 2021

Luke, A. A., Huang, K., Lindley, K. J., Carter, E. B., & Joynt Maddox, K. E.; “Severe Maternal Morbidity, Race, and Rurality: Trends Using the National Inpatient Sample, 2012-2017;” J Womens Health (Larchmt), 2021, 30(6), 837-847; DOI: 10.1089/jwh.2020.8606.


BACKGROUND: Severe maternal morbidity is related to maternal mortality and an important measure of maternal health outcomes. Our objective was to evaluate differences in rates of severe maternal morbidity and mortality (SMM&M) by rurality and race, and examine these trends over time.

MATERIALS AND METHODS: It involves the retrospective cohort study of delivery hospitalizations from January 1, 2012 to December 31, 2017 from the National Inpatient Sample. We identified delivery hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis and procedure codes and diagnosis-related groups. We used hierarchical regression models controlling for insurance status, income, age, comorbidities, and hospital characteristics to model odds of SMM&M.

RESULTS: The eligible cohort contained 4,494,089 delivery hospitalizations. Compared with women from small cities, women in the most urban and most rural areas had higher odds of SMM&M (urban adjusted odds ratio [aOR] 1.09, 95% confidence interval [1.04-1.14]; noncore rural aOR 1.24 [1.18-1.31]). Among White women, the highest odds of SMM&M were in noncore rural counties (aOR 1.20 [1.12-1.27]), while among Black women the highest odds were in urban (aOR 1.21 [1.11-1.31]) and micropolitan areas (aOR 1.36 [1.19-1.57]). Findings were similar for Hispanic, Native American, and other race women. Rates of SMM&M increased from 2012 to 2017, especially among urban patients.

CONCLUSIONS: Women in the most urban and most rural counties experienced higher odds of SMM&M, and these relationships differed by race. These findings suggest particular areas for clinical leaders and policymakers to target to reduce geographic and racial disparities in maternal outcomes.