School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Subject: search.filters.subject.Pregnancy

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Now showing 1 - 6 of 6
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    Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States
    (Springer Nature, 2021-05-08) Williams, Andrew D.; Ha, Sandie; Shenassa, Edmond; Messer, Lynne C.; Kanner, Jenna; Mendola, Pauline
    Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM. We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002–2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures. Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester. API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
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    Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: the first national data based on the 2003 birth certificate revision, United States, 2016
    (Springer Nature, 2019-09-13) Kondracki, Anthony J.
    The objective of this study was to examine the prevalence of smoking by intensity status before pregnancy and during early (first and second trimester) and late (third trimester) pregnancy according to race/ethnicity, age, and educational attainment of women who gave birth in the United States in 2016.
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    THE PREVALENCE OF MATERNAL SMOKING INTENSITY STATUS IN EARLY AND LATE PREGNANCY AND ITS ASSOCIATION WITH EARLY MORBIDITY IN SINGLETON TERM BIRTHS IN THE UNITED STATES, 2016
    (2019) Kondracki, Anthony; Moser Jones, Marian; Thoma, Marie; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Relatively little is known about how maternal cigarette smoking influences the health of infants delivered at term. This study was based on the 2016 United States Natality File of live births (N= 3,956,112). The first aim was to examine the prevalence and patterns of smoking in the three months before and during pregnancy and the distribution of smoking intensity in early (1st and 2nd trimester) and late (3rd trimester) pregnancy across race/ethnicity, age, and educational attainment of mothers with all births and with singleton term births (37-41 completed weeks gestation) in the United States in 2016. The second aim was to compare the odds of low birthweight (LBW), low 5-minute Apgar score, and neonatal intensive care unit (NICU) transfer/admission in term singletons with changing maternal smoking status in early and late pregnancy indicating a potential prenatal exposure effect. The third aim was to test and identify the role of low birthweight, as a potential mediator, in the association with maternal smoking status and NICU transfer/admission of a newborn delivered at term. The prevalence of smoking in the three months before pregnancy was 9.42% among all mothers and 9.20% among mothers of term singletons, and high intensity smoking was the highest in the first trimester among non-Hispanic White women, 20-24 years of age, and less educated women for all births and for singleton term births. High intensity smoking in early and late pregnancy was associated with a greater risk of LBW (aOR 3.33; 95% CI: 3.23, 3.44), low 5-min Apgar score (aOR 1.46; 95% CI: 0.88, 2.44), and NICU transfer/admission (aOR 1.62; 95% CI: 1.58, 1.67) in term neonates. The odds ratios of the natural direct and natural indirect effects of NICU transfer/admission were aOR 1.52 (95% CI: 1.47, 1.57) vs. aOR 1.07 (95% CI: 1.07, 1.09) and the proportion mediated through LBW (18.3%) indicated partial mediation. This study has important implications for clinical practice, public health policy and research, and it is particularly timely because of an information gap on the health of infants delivered at term with LBW to mothers who continue smoking at high intensity during pregnancy.
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    Examining the Association Between Infertility, Pregnancy Intention, and Postpartum Depression
    (2019) Barber, Gabriela Anita; Steinberg, Julia R; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    While much research has studied postpartum depression (PPD), few studies have examined PPD in women who become pregnant through the use of fertility treatments. The process of experiencing infertility and its treatment may alter the risk of developing PPD. We utilized data from The Pregnancy Risk Assessment Monitoring System (PRAMS; unweighted N=145,036) to compare PPD symptomatology between women who had unintended pregnancies (an at-risk group for PPD), women who conceived naturally/intentionally, and women who conceived using fertility services. We show that women who used fertility treatments did not differ from women who conceived naturally in regards to PPD. The women who utilized fertility enhancing drugs in comparison to insemination or assisted reproductive technologies had higher depressive symptoms. Therefore, our results suggest that the type of fertility treatment utilized may be important for clinicians to consider when working with these women as they transition into the postpartum period.
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    Determinants of urinary bisphenol A concentrations in Mexican/Mexican-American pregnant women.
    (Elsevier, 2013-09) Quiros-Alcala, Lesliam; Eskenazi, Brenda; Bradman, Asa; Ye, Xiaoyun; Calafat, Antonia M; Harley, Kim
    Prenatal exposure to bisphenol A (BPA) may be associated with adverse health effects in the developing fetus; however, little is known about predictors of BPA exposure during pregnancy. We examined BPA exposure in 491 pregnant women from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort and explored the role of living in the United States on significant dietary predictors of BPA exposure. Women provided urine samples up to two times during pregnancy (n = 866 total samples). We computed the intraclass correlation coefficient (ICC) to evaluate variability in concentrations between collections and used generalized estimating equation (GEE) models to assess predictors of exposure. Geometric mean (GSD) BPA concentrations were 0.9 (2.8) μg/L and 1.0 (2.6) μg/L at the first and second prenatal visits, respectively. We observed greater within- than between-woman variability in urinary BPA concentrations (ICC = 0.22). GEE models suggest that women who lived in the United States their entire life had 38% (CI: − 0.1, 89.3) higher urinary BPA concentrations compared with other immigrant women. Additionally, women who consumed ≥ 3 sodas per day or hamburgers three times a week or more had 58% (CI: 18.0, 112.1) and 20% (CI: − 0.2, 45.2) higher urinary BPA concentrations, respectively, compared with women who consumed no sodas or hamburgers. A higher percentage of women who lived their entire life in the United States reported increased consumption of sodas and hamburgers compared with other immigrant women. Independent of other factors, BPA urinary concentrations were slightly higher when the sample was collected later in the day. As in previous studies, high within-woman variability in urinary BPA concentrations confirms that several samples are needed to properly characterize exposure during pregnancy. Results also suggest that some factors could be modified to minimize exposures during pregnancy in our study participants (e.g., reducing soda and hamburger intake) and that factors associated with acculturation might increase BPA concentrations.
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    The Association Between Inadequate Gestational Weight Gain and Infant Death Among U.S. Infants Born 2004-2008
    (2012) Davis, Regina R.; Hofferth, Sandra L.; Shenassa, Edmond; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Infant mortality is of great public health importance and its prevalence is often used as a summary indicator of a population's reproductive health status. Programmatic and policy focus on prematurity and birth weight stems largely from their known relationship to infant mortality and morbidity. A large body of literature exists linking poor gestational weight gain to prematurity and low birth weight, but its association with infant mortality is less well understood. Few nationally representative studies have examined infant death as an important pregnancy outcome of inadequate gestational weight gain and even fewer have explored its psychosocial and demographic correlates.

    As a measure of healthy gestational weight gain, the Institute of Medicine (IOM) published guidelines which provide a recommended weight gain for each category of pre-pregnancy Body Mass Index (BMI). Informed by the Biomedical and Biopsychosocial models, this study examined the association between the IOM measure of inadequate gestational weight gain and risk of infant mortality by conducting secondary analyses of the 2005 Birth Cohort Linked Birth-Infant Death Data File (Cohort Linked File) and Phase 5 of the Pregnancy Risk Assessment Monitoring System (PRAMS). An analysis of 160,011 women who participated in PRAMS between 2004 and 2008 was used to replicate the IOM guidelines and examine the link between gestational weight gain and risks of infant mortality within four months of birth. The PRAMS dataset was also used to analyze the association between maternal pre-pregnancy BMI, weight gain, and infant death, as well as the influence of maternal stress on gestational weight gain. A separate analysis of 2,046,725 infants in the 2005 cohort linked file was conducted to quantify the risk of infant death associated with inadequate gestational weight gain as well as cause-specific mortality. Results from logistic and proportional hazards regression analyses suggest there is a substantial and significant association between inadequate gestational weight gain and infant death; however weight gain beyond the recommended amount may be protective. Inadequate gestational weight gain was associated with infant death from disorders relating to short gestation, fetal malnutrition, respiratory conditions, and birth defects. Receipt of adequate prenatal care was protective against inadequate gestational weight gain, but a positive association was not found between inadequate gestational weight gain and maternal stress. Implications for public health programs, policy, and future research are presented.