The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes.

COVID-19 / diagnosis Female Humans Infant Infant, Newborn Infant, Newborn, Diseases Obesity Pandemics Pregnancy Premature Birth / epidemiology Prospective Studies SARS-CoV-2 Systemic Racism
COVID-19 SARS-CoV-2 preterm birth racism small-for-gestational-age unemployment

Journal

American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609

Informations de publication

Date de publication:
07 2022
Historique:
received: 01 04 2022
accepted: 13 04 2022
pubmed: 25 4 2022
medline: 7 6 2022
entrez: 24 4 2022
Statut: ppublish

Résumé

Structural racism and pandemic-related stress from the COVID-19 pandemic may increase the risk of adverse birth outcomes. Our objective was to examine associations between neighborhood measures of structural racism and pandemic stress with 3 outcomes: SARS-CoV-2 infection, preterm birth, and delivering small-for-gestational-age newborns. Our secondary objective was to investigate the joint association of SARS-CoV-2 infection during pregnancy and neighborhood measures with preterm birth and delivering small-for-gestational-age newborns. We analyzed data of 967 patients from a prospective cohort of pregnant persons in New York City, comprising 367 White (38%), 169 Black (17%), 293 Latina (30%), and 87 Asian persons (9%), 41 persons of other race or ethnicity (4%), and 10 of unknown race or ethnicity (1%). We evaluated structural racism (social/built structural disadvantage, racial-economic segregation) and pandemic-related stress (community COVID-19 mortality, community unemployment rate increase) in quartiles by zone improvement plan code. SARS-CoV-2 serologic enzyme-linked immunosorbent assay was performed on blood samples from pregnant persons. We obtained data on preterm birth and small-for-gestational-age newborns from an electronic medical record database. We used log-binomial regression with robust standard error for clustering by zone improvement plan code to estimate associations of each neighborhood measure separately with 3 outcomes: SARS-CoV-2 infection, preterm birth, and small-for-gestational-age newborns. Covariates included maternal age, parity, insurance status, and body mass index. Models with preterm birth and small-for-gestational-age newborns as the dependent variables additionally adjusted for SARS-CoV-2 infection. A total of 193 (20%) persons were SARS-CoV-2-seropositive, and the overall risks of preterm birth and small-for-gestational-age newborns were 8.4% and 9.8%, respectively. Among birthing persons in neighborhoods in the highest quartile of structural disadvantage (n=190), 94% were non-White, 50% had public insurance, 41% were obese, 32% were seropositive, 11% delivered preterm, and 12% delivered a small-for-gestational-age infant. Among birthing persons in neighborhoods in the lowest quartile of structural disadvantage (n=360), 39% were non-White, 17% had public insurance, 15% were obese, 9% were seropositive, 6% delivered preterm, and 10% delivered a small-for-gestational-age infant. In adjusted analyses, structural racism measures and community unemployment were associated with both SARS-CoV-2 infection and preterm birth, but not small-for-gestational-age infants. High vs low structural disadvantage was associated with an adjusted relative risk of 2.6 for infection (95% confidence interval, 1.7-3.9) and 1.7 for preterm birth (95% confidence interval, 1.0-2.9); high vs low racial-economic segregation was associated with adjusted relative risk of 1.9 (95% confidence interval, 1.3-2.8) for infection and 2.0 (95% confidence interval, 1.3-3.2) for preterm birth; high vs low community unemployment increase was associated with adjusted relative risk of 1.7 (95% confidence interval, 1.2-1.5) for infection and 1.6 (95% confidence interval, 1.0-2.8) for preterm birth. COVID-19 mortality rate was associated with SARS-CoV-2 infection but not preterm birth or small-for-gestational-age infants. SARS-CoV-2 infection was not independently associated with birth outcomes. We found no interaction between SARS-CoV-2 infection and neighborhood measures on preterm birth or small-for-gestational-age infants. Neighborhood measures of structural racism were associated with both SARS-CoV-2 infection and preterm birth, but these associations were independent and did not have a synergistic effect. Community unemployment rate increases were also associated with an increased risk of preterm birth independently of SARS-CoV-2 infection. Mitigating these factors might reduce the impact of the pandemic on pregnant people.

Sections du résumé

BACKGROUND
Structural racism and pandemic-related stress from the COVID-19 pandemic may increase the risk of adverse birth outcomes.
OBJECTIVE
Our objective was to examine associations between neighborhood measures of structural racism and pandemic stress with 3 outcomes: SARS-CoV-2 infection, preterm birth, and delivering small-for-gestational-age newborns. Our secondary objective was to investigate the joint association of SARS-CoV-2 infection during pregnancy and neighborhood measures with preterm birth and delivering small-for-gestational-age newborns.
STUDY DESIGN
We analyzed data of 967 patients from a prospective cohort of pregnant persons in New York City, comprising 367 White (38%), 169 Black (17%), 293 Latina (30%), and 87 Asian persons (9%), 41 persons of other race or ethnicity (4%), and 10 of unknown race or ethnicity (1%). We evaluated structural racism (social/built structural disadvantage, racial-economic segregation) and pandemic-related stress (community COVID-19 mortality, community unemployment rate increase) in quartiles by zone improvement plan code. SARS-CoV-2 serologic enzyme-linked immunosorbent assay was performed on blood samples from pregnant persons. We obtained data on preterm birth and small-for-gestational-age newborns from an electronic medical record database. We used log-binomial regression with robust standard error for clustering by zone improvement plan code to estimate associations of each neighborhood measure separately with 3 outcomes: SARS-CoV-2 infection, preterm birth, and small-for-gestational-age newborns. Covariates included maternal age, parity, insurance status, and body mass index. Models with preterm birth and small-for-gestational-age newborns as the dependent variables additionally adjusted for SARS-CoV-2 infection.
RESULTS
A total of 193 (20%) persons were SARS-CoV-2-seropositive, and the overall risks of preterm birth and small-for-gestational-age newborns were 8.4% and 9.8%, respectively. Among birthing persons in neighborhoods in the highest quartile of structural disadvantage (n=190), 94% were non-White, 50% had public insurance, 41% were obese, 32% were seropositive, 11% delivered preterm, and 12% delivered a small-for-gestational-age infant. Among birthing persons in neighborhoods in the lowest quartile of structural disadvantage (n=360), 39% were non-White, 17% had public insurance, 15% were obese, 9% were seropositive, 6% delivered preterm, and 10% delivered a small-for-gestational-age infant. In adjusted analyses, structural racism measures and community unemployment were associated with both SARS-CoV-2 infection and preterm birth, but not small-for-gestational-age infants. High vs low structural disadvantage was associated with an adjusted relative risk of 2.6 for infection (95% confidence interval, 1.7-3.9) and 1.7 for preterm birth (95% confidence interval, 1.0-2.9); high vs low racial-economic segregation was associated with adjusted relative risk of 1.9 (95% confidence interval, 1.3-2.8) for infection and 2.0 (95% confidence interval, 1.3-3.2) for preterm birth; high vs low community unemployment increase was associated with adjusted relative risk of 1.7 (95% confidence interval, 1.2-1.5) for infection and 1.6 (95% confidence interval, 1.0-2.8) for preterm birth. COVID-19 mortality rate was associated with SARS-CoV-2 infection but not preterm birth or small-for-gestational-age infants. SARS-CoV-2 infection was not independently associated with birth outcomes. We found no interaction between SARS-CoV-2 infection and neighborhood measures on preterm birth or small-for-gestational-age infants.
CONCLUSION
Neighborhood measures of structural racism were associated with both SARS-CoV-2 infection and preterm birth, but these associations were independent and did not have a synergistic effect. Community unemployment rate increases were also associated with an increased risk of preterm birth independently of SARS-CoV-2 infection. Mitigating these factors might reduce the impact of the pandemic on pregnant people.

Identifiants

DOI: 10.1016/j.ajogmf.2022.100649 PMID: 35462058 PMC: PMC9022447
pubmed: 35462058
pii: S2589-9333(22)00084-2
doi: 10.1016/j.ajogmf.2022.100649
pmc: PMC9022447
pii:
doi:

Types de publication

Journal Article Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

100649

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

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Auteurs

Teresa Janevic (T)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch). Electronic address: Teresa.janevic@mountsinai.org.

Whitney Lieb (W)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch).

Erona Ibroci (E)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Jezelle Lynch (J)

Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb and Ms Lynch).

Molly Lieber (M)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Nina M Molenaar (NM)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Anna-Sophie Rommel (AS)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Lotje de Witte (L)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Sophie Ohrn (S)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Juan Manuel Carreño (JM)

Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer).

Florian Krammer (F)

Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer).

Lauren B Zapata (LB)

COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA (Drs Zapata and Snead).

Margaret Christine Snead (MC)

COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA (Drs Zapata and Snead).

Rachel I Brody (RI)

Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Brody).

Rebecca H Jessel (RH)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Stephanie Sestito (S)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Alan Adler (A)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Omara Afzal (O)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Frederieke Gigase (F)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Roy Missall (R)

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Daniel Carrión (D)

Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT (Dr Carrión).

Joanne Stone (J)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan).

Veerle Bergink (V)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Ms Ibroci, Drs Molenaar, Rommel, and de Witte, Ms. Gigase, Mr. Missall, and Dr Bergink).

Siobhan M Dolan (SM)

Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic and Lieb, Ms Lieber, Ms. Ohrn, Dr Jessel, Ms Sestito, and Drs Adler, Afzal, Stone, Bergink, and Dolan); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Janevic, Lieb, Bergink, and Dolan).

Elizabeth A Howell (EA)

Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Howell).
Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr. Carreño, Krammer Serology Core Study Group, and Dr Krammer).

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Classifications MeSH

questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › The influence of structural racism, pandemic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The influence of structural racism, pandemic...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › The influence of structural racism, pandemic...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › The influence of structural racism, pandemic...
questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies néonatales › The influence of structural racism, pandemic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Obésité › The influence of structural racism, pandemic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Épidémies › Pandémies › The influence of structural racism, pandemic...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › The influence of structural racism, pandemic...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Travail obstétrical prématuré › Naissance prématurée › The influence of structural racism, pandemic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › The influence of structural racism, pandemic...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › The influence of structural racism, pandemic...
questionsmedicales.fr › Sciences sociales › Sociologie › Problèmes sociaux › Ségrégation sociale › Relations raciales › Racisme › Racisme systémique › The influence of structural racism, pandemic...