Womens Health Issues最新文献_第8页

“I Wasn't Presented With Options”: Perspectives of Black Veterans Receiving Care for Uterine Fibroids in the Veterans Health Administration “我没有选择”:在退伍军人健康管理局接受子宫肌瘤护理的黑人退伍军人的观点。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.07.006

Cathea Carey MPH , Molly Silvestrini MA , Lisa S. Callegari MD, MPH , Jodie G. Katon PhD, MS , Andrew S. Bossick PhD, MPH , Kemi M. Doll MD, MCSR , Alicia Christy MD, MHSCR, FACOG , Donna L. Washington MD, MPH, FACP , Shanise Owens MA, MSc

Introduction

Black women with uterine fibroids experience greater symptom severity and worse treatment outcomes compared with their White counterparts. Black veterans who use Veterans Health Administration (VA) health care experience similar disparities. This study investigated the experiences of Black veterans receiving care for uterine fibroids at VA.

Methods

We identified Black veterans aged 18 to 54 years with newly diagnosed symptomatic uterine fibroids between the fiscal years 2010 and 2012 using VA medical record data, and we recruited participants for interviews in 2021. We used purposive sampling by the last recorded fibroid treatment in the data (categorized as hysterectomy, other uterine-sparing treatments, and medication only/no treatment) to ensure diversity of treatment experiences. In-depth semistructured interviews were conducted to gather rich narratives of veterans’ uterine fibroid care experiences. Transcribed interviews were analyzed using content analysis.

Results

Twenty Black veterans completed interviews. Key themes that emerged included the amplified impact of severe fibroid symptoms in male-dominated military culture; the presence of multilevel barriers, from individual to health care system factors, that delayed access to high-quality treatment; insufficient treatments offered; experiences of interpersonal racism and provider bias; and the impact of fertility loss related to fibroids on mental health and intimate relationships. Veterans with positive experiences stressed the importance of finding a trustworthy provider and self-advocacy.

Conclusions

System-level interventions, such as race-conscious and person-centered care training, are needed to improve care experiences and outcomes of Black veterans with fibroids.

与白人女性相比，患有子宫肌瘤的黑人女性症状更严重，治疗效果更差。使用退伍军人健康管理局(VA)医疗保健的黑人退伍军人也经历了类似的差异。本研究调查了在VA接受子宫肌瘤护理的黑人退伍军人的经历。方法:我们使用VA医疗记录数据确定了2010年至2012年财政年度新诊断为症状性子宫肌瘤的18至54岁黑人退伍军人，并在2021年招募参与者进行访谈。为了确保治疗经验的多样性，我们对数据中最后一次记录的肌瘤治疗(包括子宫切除术、其他保留子宫的治疗和仅用药/不用药)进行了有目的的抽样。通过深入的半结构化访谈，收集退伍军人子宫肌瘤护理经验的丰富叙述。访谈记录采用内容分析进行分析。结果:20名黑人退伍军人完成访谈。出现的关键主题包括严重肌瘤症状在男性主导的军事文化中的放大影响;存在从个人因素到卫生保健系统因素的多重障碍，延误了获得高质量治疗的机会;治疗不足;人际种族主义与提供者偏见的经验以及与肌瘤相关的生育能力丧失对心理健康和亲密关系的影响。有积极经历的退伍军人强调了寻找值得信赖的提供者和自我宣传的重要性。结论:需要系统层面的干预措施，如种族意识和以人为本的护理培训，以改善黑人退伍军人肌瘤的护理经验和结果。

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引用次数: 0

Maternity Care at the Intersections of Language, Ethnicity, and Immigration Status: A Qualitative Study 语言、种族和移民身份交叉点的产妇护理:一项定性研究。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.04.004

May Sudhinaraset PhD , Rebecca A. Kolodner MD , Michelle Kao Nakphong PhD

Introduction

Women of color and immigrant women are more likely than US-born White women to report mistreatment and poor quality of care during their reproductive health care. Surprisingly little research exists on how language access may impact immigrant women's experiences of maternity care, particularly by race and ethnicity.

Methods

We conducted qualitative in-depth, one-on-one semi-structured interviews from August 2018 to August 2019 with 10 Mexican and eight Chinese/Taiwanese women (n = 18) living in Los Angeles or Orange County who gave birth within the past 2 years. Interviews were transcribed and translated, and data were initially coded based on the interview guide questions. We identified patterns and themes using thematic analysis methods.

Results

Participants described how a lack of translators and language- and cultural-concordant health care providers and staff impeded their access to maternity care services; in particular, they described barriers to communication with receptionists, providers, and ultrasound technicians. Despite Mexican immigrants’ ability to access Spanish-language health care, both Mexican and Chinese immigrant women described how lack of understanding medical concepts and terminology resulted in poor quality of care, lack of informed consent for reproductive procedures, and subsequent psychological and emotional distress. Undocumented women were less likely to report using strategies that leveraged social resources to improve language access and quality care.

Conclusions

Reproductive autonomy cannot be achieved without access to culturally and linguistically appropriate health care. Health care systems should ensure that comprehensive information is given to women, in a language and manner they can understand, with particular attention toward providing in-language services across multiple ethnicities. Multilingual staff and health care providers are critical in providing care that is responsive to immigrant women.

引言:有色人种妇女和移民妇女比美国出生的白人妇女更有可能报告在生殖保健期间受到虐待和护理质量差。令人惊讶的是，很少有研究表明语言的获取会如何影响移民妇女的产科护理经历，特别是在种族和民族方面。方法:2018年8月至2019年8月，我们对居住在洛杉矶或奥兰治县的10名墨西哥妇女和8名中国/台湾妇女(n = 18)进行了定性深入的一对一半结构化访谈。采访被转录和翻译，数据最初是根据采访指导问题编码的。我们使用主题分析方法识别模式和主题。结果:与会者描述了缺乏翻译人员以及语言和文化一致的保健提供者和工作人员如何阻碍了她们获得产妇保健服务;特别是，他们描述了与接待员、供应商和超声波技术人员沟通的障碍。尽管墨西哥移民有能力获得西班牙语医疗保健，但墨西哥和中国移民妇女都描述了由于缺乏对医学概念和术语的理解，导致护理质量差，缺乏对生殖程序的知情同意，以及随后的心理和情绪困扰。无证妇女不太可能报告使用利用社会资源改善语言获取和优质护理的策略。结论:如果不能获得文化和语言上适当的保健服务，就无法实现生殖自主。卫生保健系统应确保以妇女能理解的语言和方式向妇女提供全面的信息，特别注意提供跨多种族的语言服务。多语种工作人员和保健提供者在为移民妇女提供护理方面至关重要。

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引用次数: 1

Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment “选择良好的避孕方法获取倡议”对参加南卡罗来纳州医疗补助计划的妇女使用方法的影响:一项中线评估。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.07.003

Nathan Hale PhD , Wondimu S. Manalew PhD , Edward Leinaar MPH , Michael Smith DrPH , Bisakha Sen PhD , Amal Khoury PhD

Introduction

A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well.

Methods

Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups.

Results

Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p < .001), with IUD use increasing from 4.3% to 5.2% (p < .001) and implant use increasing from 4.6% to 6.0% (p < .001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311–0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006–0.020) per month beyond expected values.

Conclusions

At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.

导语:从2017年开始，南卡罗来纳州在全州范围内实施了一项为期六年的避孕药具获取倡议，重点是公平获得避孕药具、消除成本障碍、能力建设和培训、提高消费者意识以及扩大安全网诊所的避孕护理。这项研究评估了在“选择好”计划的前三年，参加南卡罗来纳医疗补助计划的妇女避孕方法使用的变化。方法:回顾性分析2012年至2020年在南卡罗来纳州医疗补助计划登记的15至45岁女性的避孕使用情况。采用中断时间序列回归分析评估2012 - 2016年和2017 - 2020年期间宫内节育器(iud)和避孕植入物使用的变化。对所有女性进行了分析，并按年龄组分层。结果:长效可逆避孕方法的使用从预选井期间的8.5%增加到预选井期间的10.9% (p)。结论:在预选井评估的中点，宫内节育器方法的使用明显增加，超出了预选井趋势持续的预期。这在20至25岁的妇女中尤为明显。这些发现表明，“选择好”计划成功地减少了使用宫内节育器的障碍。

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引用次数: 0

Maternal Health Experiences of Black Deaf and Hard of Hearing Women in the United States 美国黑人聋人和重听妇女的孕产妇健康经历。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.07.005

Kaila V.T. Helm BA , Tiffany L. Panko MD, MBA , Melanie Herschel CCRP , Lauren D. Smith MPH , Monika Mitra PhD , Michael M. McKee MD, MPH

Introduction

Deaf and hard of hearing (DHH) women are faced with numerous health inequities, including adverse pregnancy and birth outcomes. These outcomes are likely exacerbated for Black DHH women because of the intersection of disability and race. This study aimed to explore the pregnancy and birth experiences of Black DHH women to identify factors that influence their pregnancy outcomes.

Methods

Semistructured interviews were conducted between 2018 and 2019 with 67 DHH women who gave birth in the past five years. The present study represents a subgroup analysis of eight of the 67 women who self-identified as Black. Interviews were recorded, transcribed, and analyzed for emerging themes.

Results

Primary themes centered on unmet needs, barriers, and facilitators. Barriers included limited access to health information owing to communication difficulties and challenges obtaining accommodations. Key facilitators included the availability of sign language interpreters, familial support, and cultural understanding from providers. Participants emphasized these facilitators in their recommendations to providers and DHH women. Findings also underscored the critical role of recognizing cultural identity in perinatal health care delivery.

Conclusions

This study outlines themes that affect pregnancy and birthing experiences among Black DHH women in the United States. Study implications include a call to action for providers to prioritize communication accommodations, accessible information, and compassionate care for all Black DHH women. Furthermore, future work should explore the impact of cultural and racial concordance between patients and their health care providers and staff. Understanding how intersectional identities affect perinatal health care access is crucial for reducing disparities among Black DHH women.

引言：聋人和重听症妇女面临着许多健康不平等问题，包括不良的怀孕和分娩结果。由于残疾和种族的交叉，DHH黑人女性的这些结果可能会加剧。本研究旨在探讨黑人DHH妇女的妊娠和分娩经历，以确定影响其妊娠结局的因素。方法：在2018年至2019年间，对过去5年中分娩的67名DHH妇女进行了半结构化访谈。本研究对67名自称黑人的女性中的8名进行了亚组分析。访谈被记录、转录，并针对新出现的主题进行分析。结果：主要主题集中在未满足的需求、障碍和促进者。障碍包括由于沟通困难和获得住宿的困难，获得健康信息的机会有限。关键的促进者包括手语翻译的可用性、家庭支持和提供者的文化理解。与会者在向提供者和DHH妇女提出的建议中强调了这些促进者。研究结果还强调了承认文化认同在提供围产期保健方面的关键作用。结论：这项研究概述了影响美国黑人DHH妇女怀孕和分娩经历的主题。研究影响包括呼吁提供者采取行动，优先考虑为所有黑人DHH妇女提供沟通便利、可获取的信息和富有同情心的护理。此外，未来的工作应该探讨患者与其医疗保健提供者和工作人员之间文化和种族和谐的影响。了解跨部门身份如何影响围产期保健的获得，对于减少黑人DHH妇女之间的差距至关重要。

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引用次数: 0

Canadian Newspapers Support Mifepristone Medication Abortion to Improve Fulfillment of the AAAQ Right to Health Framework (2015–2019) 加拿大报纸支持米非司酮药物流产，以改善AAAQ健康权框架的实现(2015-2019)。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.05.008

Tamil Kendall PhD , Pallavi Sriram MD , Amrit Parmar BA , Wendy V. Norman MD, MHSc

Background

In 2015, mifepristone in combination with misoprostol, the international gold standard for medication abortion, was approved for use in Canada. By 2019, all Canadian provinces had included the medication as a publicly insured health benefit.

Methods

Our content analysis of Canadian newspaper coverage describes arguments in favor of or against medication abortion and the evolving regulatory framework for mifepristone from 6 months before regulatory approval until the last significant regulatory barrier to use was removed (2015–2019).

Results

Our study found an exceptionally high level of support for the approval of, introduction of, and removal of regulatory barriers to mifepristone for medication abortion. Of 402 pieces, 67% were pro-medication abortion, 25% presented balanced or neutral coverage, and only 8% presented solely anti-medication abortion viewpoints. Of the 761 individuals quoted, more than 90% made positive or neutral statements about medication abortion. Most pieces discussed medication abortion as a health issue and described how liberalization of the regulatory framework would improve abortion availability (68%), accessibility (87%), acceptability (34%), and quality (28%).

Conclusions

Rather than formal balance, which presents contrasting arguments as equally valid even when the scientific evidence for one vastly outweighs the other, our study identified evidentiary balance, in which coverage aligned with the weight of evidence and expert opinion. Our results differ from analyses in other high-income countries (United Kingdom, United States) where media outlets frame abortion in relation to morality or electoral politics rather than as a health issue. The Canadian print media presented overwhelmingly favorable arguments toward the expansion of mifepristone medication abortion and framed the introduction and universal coverage of medication abortion as advancing the “Availability, Accessibility, Acceptability, and Quality” (AAAQ) Right to Health Framework that establishes international human rights standards for health information, facilities, goods, and services.

背景:2015年，国际药物流产金标准米非司酮联合米索前列醇在加拿大获批准使用。到2019年，加拿大所有省份都将这种药物纳入公共保险健康福利。方法:我们对加拿大报纸报道的内容分析描述了从监管批准前6个月到最后一个重大使用监管障碍被消除(2015-2019)，米非司酮的支持或反对药物流产的争论和不断发展的监管框架。结果:我们的研究发现，对米非司酮用于药物流产的批准、引入和消除监管障碍的支持程度异常高。402篇文章中，67%为支持药物流产，25%为平衡或中立报道，仅8%为完全反对药物流产的观点。在引用的761个人中，超过90%的人对药物流产做出了积极或中立的陈述。大多数文章将药物流产作为健康问题进行了讨论，并描述了监管框架的自由化将如何提高流产的可获得性(68%)、可获得性(87%)、可接受性(34%)和质量(28%)。结论:我们的研究确定了证据平衡，即覆盖范围与证据和专家意见的权重一致，而不是正式的平衡，即在一个科学证据远远超过另一个的情况下，将对比的论点视为同样有效。我们的结果与其他高收入国家(英国、美国)的分析不同，在这些国家，媒体将堕胎与道德或选举政治联系起来，而不是作为健康问题。加拿大印刷媒体对扩大米非司酮药物流产提出了压倒性的有利论点，并将药物流产的引入和普遍覆盖定义为促进"可获得性、可获得性、可接受性和质量" (AAAQ)健康权框架，该框架为健康信息、设施、商品和服务建立了国际人权标准。

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引用次数: 0

(Re)Framing Strength: How Superwoman Schema May Impact Perinatal Anxiety and Depression among African American Women 框架强度:女超人图式如何影响非裔美国妇女围产期焦虑和抑郁。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.05.003

Tamara Nelson PhD, MPH , Cecelela L. Tomi MSW , Samrawit B. Gebretensay BA

引用次数: 0

Comparison of Health Outcomes Over Time Among Women 1990–1991 Gulf War Veterans, Women 1990–1991 Gulf Era Veterans, and Women in the U.S. General Population 1990-1991年海湾战争女性退伍军人、1990-1991年海湾战争女性退伍军人和美国普通人群女性的长期健康结果比较

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.06.006

Erin K. Dursa PhD, MPH , Guichan Cao MS , William J. Culpepper PhD, MA , Aaron Schneiderman PhD, MPH, RN

Introduction

The aim of this study is to examine health over almost 20 years of follow-up among women Gulf War veterans and women Gulf Era veterans and compare their health to that of women in the U.S. general population.

Methods

We used data from a health survey of 1,274 women Gulf War veteran and Gulf Era veteran participants of the Gulf War Longitudinal Study who responded to all three waves. Data on the U.S. population of women came from the 1999–2000, 2005–2006, and 2011–2014 National Health and Nutrition Examination Survey (NHANES). Generalized estimating equations (GEEs) were used to compare the report of disease over time in women Gulf War and Gulf Era veterans. Differences in prevalence at the three survey timepoints were calculated between women Gulf War veterans and the NHANES women population, and women Gulf War Era veterans and the NHANES women population.

Results

Women veterans who deployed to the 1990–1991 Gulf War report poorer health than women veterans who served during the same time but did not deploy. Women veterans reported a lower prevalence of hypertension, stroke, and diabetes than women in the NHANES sample. Women veterans also reported a higher prevalence of arthritis, chronic obstructive pulmonary disease, and skin cancer than women in the NHANES sample.

Conclusions

This study is the first to characterize the health of a population-based cohort of women Gulf War and women Gulf Era veterans over time and compare it with women's health in a civilian NHANES population. This demonstrates the value of epidemiological research on women veterans and the importance of developing longitudinal cohorts across genders.

简介:本研究的目的是对海湾战争女性退伍军人和海湾时代女性退伍军人进行近20年的随访，并将她们的健康状况与美国普通人群中的女性进行比较。方法:我们使用了1274名女性海湾战争退伍军人和海湾战争时期退伍军人的健康调查数据，这些人参与了海湾战争纵向研究，对所有三波都有反应。美国女性人口数据来自1999-2000年、2005-2006年和2011-2014年国家健康与营养检查调查(NHANES)。使用广义估计方程(GEEs)比较海湾战争和海湾时代女性退伍军人疾病随时间的报告。计算了三个调查时间点海湾战争女性退伍军人和NHANES女性人群之间的患病率差异，以及海湾战争女性退伍军人和NHANES女性人群之间的患病率差异。结果:在1990-1991年海湾战争中服役的女性退伍军人的健康状况比在同一时期服役但没有服役的女性退伍军人差。在NHANES样本中，女性退伍军人报告的高血压、中风和糖尿病患病率低于女性。据报道，女性退伍军人患关节炎、慢性阻塞性肺病和皮肤癌的比例也高于NHANES样本中的女性。结论:本研究首次描述了海湾战争时期女性和海湾时代女性退伍军人的健康状况，并将其与NHANES平民人群中的女性健康状况进行了比较。这表明了对女性退伍军人进行流行病学研究的价值，以及发展跨性别纵向队列的重要性。

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引用次数: 0

Association of Medicaid Expansion Under the Affordable Care Act With Medicaid Coverage in the Prepregnancy, Prenatal, and Postpartum Periods 根据《平价医疗法案》，医疗补助扩大协会在孕前、产前和产后期间提供医疗补助。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.08.002

Jiajia Chen PhD , Lijing Ouyang PhD , David A. Goodman PhD , Ekwutosi M. Okoroh MD , Lisa Romero DrPH, MPH , Jean Y. Ko PhD , Shanna Cox MSPH

Introduction

We evaluated how the Affordable Care Act (ACA) Medicaid eligibility expansion affected perinatal insurance coverage patterns for Medicaid-enrolled beneficiaries who gave birth overall and by race/ethnicity. We also examined state-level heterogeneous impacts.

Methods

Using the 2011–2013 Medicaid Analytic eXtract and the 2016–2018 Transformed Medicaid Statistical Information System Analytic File databases, we identified 1.4 million beneficiaries giving birth in 2012 (pre-ACA expansion cohort) and 1.5 million in 2017 (post-ACA expansion cohort). We constructed monthly coverage rates for the two cohorts by state Medicaid expansion status and obtained difference-in-differences estimates of the association of Medicaid expansion with coverage overall and by race/ethnicity group (non-Hispanic White, non-Hispanic Black, and Hispanic). To explore state-level heterogeneous impacts, we divided the expansion and non-expansion states into groups based on the differences in the income eligibility limits for low-income parents in each state between 2012 and 2017.

Results

Medicaid expansion was associated with 13 percentage points higher coverage in the 9 to 12 months before giving birth, and 11 percentage points higher coverage at 6 to 12 months postpartum. Hispanic birthing individuals had the greatest relative increases in coverage, followed by non-Hispanic White and non-Hispanic Black individuals. In Medicaid expansion states, those who experienced the greatest increases in income eligibility limits for low-income parents generally saw the greatest increases in coverage. In non-expansion states, there was less heterogeneity between state groupings.

Conclusions

Pregnancy-related Medicaid eligibility did not have major changes in the 2010s. However, states’ adoption of ACA Medicaid expansion after 2012 was associated with increased Medicaid coverage before, during, and after pregnancy. The increases varied by race/ethnicity and across states.

引言:我们评估了《平价医疗法案》(ACA)医疗补助资格扩大对总体上和按种族/民族生育的医疗补助登记受益人的围产期保险覆盖模式的影响。我们还研究了州一级的异质性影响。方法:使用2011-2013年医疗补助分析提取和2016-2018年转化医疗补助统计信息系统分析文件数据库，我们确定了2012年(aca扩展前队列)和2017年(aca扩展后队列)分娩的140万受益人。我们根据州医疗补助扩张状况构建了两个队列的每月覆盖率，并获得了医疗补助扩张与总体覆盖率和种族/族裔群体(非西班牙裔白人、非西班牙裔黑人和西班牙裔)之间的差异估计。为了探讨州一级的异质性影响，我们根据2012年至2017年每个州低收入父母收入资格限制的差异，将扩张州和非扩张州分为不同的组。结果:医疗补助扩大与分娩前9至12个月的覆盖率提高13个百分点有关，产后6至12个月的覆盖率提高11个百分点。西班牙裔生育个体的覆盖率相对增长最大，其次是非西班牙裔白人和非西班牙裔黑人。在扩大医疗补助计划的州，低收入父母的收入资格限制增加最多的州，其覆盖范围的增长幅度也最大。在非扩张状态中，状态组之间的异质性较小。结论:与妊娠相关的医疗补助资格在2010年代没有重大变化。然而，各州在2012年之后采用ACA医疗补助扩大与怀孕前，怀孕期间和怀孕后医疗补助覆盖范围的增加有关。增幅因种族/民族和各州而异。

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引用次数: 0

Racial/Ethnic and Nativity Inequalities in Gestational Diabetes Mellitus: The Role of Psychosocial Stressors 种族/民族和出生不平等在妊娠糖尿病:社会心理应激源的作用。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.06.007

Kristin Erbetta PhD, MPH, MSW , Joanna Almeida ScD, MPH, MSW, Kristie A. Thomas PhD, MSW

Introduction

Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM.

Methods

We used New York City Pregnancy Risk and Assessment Monitoring System data (2009–2014) linked with birth certificate items (n = 7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM.

Results

U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio, 2.18; 95% confidence interval, 1.53–3.11), Hispanic (adjusted risk ratio, 1.57; 95% confidence interval, 1.10–2.25), or Asian/Pacific Islander (adjusted risk ratio, 4.10; 95% confidence interval, 3.04–5.52) women compared with U.S.-born White women.

Conclusions

Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant women and women from minoritized racial/ethnic groups. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.

在美国，妊娠期糖尿病(GDM)的种族/民族和出生差异持续存在。与这些差异相关的已确定因素并不能完全解释这些差异。研究已经认识到心理社会压力是GDM的一个潜在的可改变的危险因素。方法:我们使用纽约市妊娠风险和评估监测系统数据(2009-2014年)与出生证明项目(n = 7632)进行双变量和多变量分析，以检验12种社会心理压力源(以三种方式建模:个体压力源、分组压力源、压力结构)与GDM在种族/民族和出生地之间的关系，以及压力源是否解释了GDM的种族/民族/出生地差异。结果:美国和外国出生的黑人和西班牙裔女性报告的压力源高于美国出生的白人女性。在完全调整的模型中，金融压力结构与GDM调整风险增加51%相关，并且添加所有压力源使风险增加一倍。心理社会压力因素不能解释外国出生的黑人患GDM的风险升高(调整后的风险比，2.18;95%可信区间，1.53-3.11)，西班牙裔(调整风险比，1.57;95%可信区间，1.10-2.25)，或亚洲/太平洋岛民(调整后的风险比，4.10;95%可信区间(3.04-5.52)，与美国出生的白人女性相比。结论:与美国出生的白人女性相比，历史上少数种族/民族和移民女性患心理社会压力源和GDM的风险更高。尽管经济和所有压力因素预测GDM的风险更高，但它们并不能解释移民妇女和少数种族/民族妇女GDM风险的增加。为了促进更健康的怀孕和分娩结果，有必要进一步研究种族/民族和出生地在压力暴露和GDM发生率方面的不平等。

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引用次数: 0

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019 孕产妇体重差异趋势:2012年至2019年明尼苏达州农村和城市居民的全州差异

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.07.001

Rebecca L. Emery Tavernier PhD , Marcia B. McCoy MPH , Catherine A. McCarty PhD, MPH, HEC-C , Susan M. Mason PhD, MPH

Introduction

Despite research showing substantial weight disparities along the rural–urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

Methods

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

Results

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5–5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9–3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

Conclusions

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

导言:尽管有研究显示城乡之间存在着巨大的体重差异，但很少有研究试图确定农村和城市分娩人群在孕前体重状况或妊娠期体重增加(GWG)结果方面的差异。因此，本研究的目标是1)记录农村和城市生育人群孕前超重、肥胖和过量GWG的流行情况;2)检查农村和城市孕前超重、肥胖和过量GWG随时间的变化。方法:出生证明数据提供了2012年至2019年在明尼苏达州分娩的465,709名受访者的社会人口统计学变量、孕前体重指数、GWG和农村状况。在控制相关协变量的情况下，一系列回归模型估计了农村和城市受访者在1)孕前体重状况和2)过量GWG随时间的风险差异。结果:农村个体孕前超重或肥胖的风险比城市个体高4.9个百分点(95%置信区间，4.5-5.3)，妊娠体重过重的风险比城市个体高2.6个百分点(95%置信区间，1.9-3.3)。随着时间的推移，农村和城市个体在孕前超重或肥胖和妊娠体重过高方面的差异越来越大。结论:这些发现有助于积累证据，证明农村和城市个体在围产期之间存在显著的健康差异，并支持需要开展预防和治疗工作，重点改善生活在农村社区的个体的体重相关健康。

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引用次数: 0