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Developmental Biology - Birth Complications

Premature Baby and Maternal Complications

Coordinated care needed for 'dual burden' families...


A quarter of women who have serious maternal complications during childbirth also have premature births, posing a "dual burden" on families, finds research from New York University (NYU) Rory Meyers College of Nursing, the University of California, San Francisco (UCSF) California Preterm Birth Initiative, and Stanford University.
One in 270 births have the "dual burden" of baby born premature and mom's severe complications.

The study of 3 million California births, published online in The Journal of Maternal-Fetal & Neonatal Medicine is the first to focus specifically on "dual burden" births, shows that these complications occur in one of 270 births and are twice as likely to affect Black mothers.
"The situation of combined maternal and newborn complications is likely to be extremely stressful for families concerned for both the mother's and the infant's heath. However, healthcare providers may not fully recognize this, especially when maternal and newborn care are delivered by different specialists. There's not enough attention to the combined effect on the family,"

Audrey Lyndon, PhD, RN, FAAN, Professor of Nnursing, Assistant Dean for Clinical Research, NYU Rory Meyers College of Nursing, and study lead author.

Premature infants, born at less than 37 weeks, experience a range of health issues. These include problems with breathing, digestion, heart rate, and other developmental crisis.

Mothers can also face serious to potentially life-threatening health issues during childbirth. Maternal complications, known as severe maternal morbidity, include serious bleeding requiring blood transfusion, blood clots, heart failure, emergency hysterectomies, and more.
Research shows that severe maternal morbidity is rare but increasing nationally. Rates have more than doubled from 2002 to 2014, with ongoing consequences for women and families.

While prior studies show associations between premature birth and severe maternal morbidity, the risk of experiencing the "dual burden" of both has never been studied until now. Lyndon and colleagues examined data from all California births from 2007 through 2012 for a total of 3.1 million births. California keeps robust data on childbirth, accounting for approximately one in eight of all births in the USA.

Researchers found rates of preterm birth were 876 per 10,000 births, while rates of severe maternal morbidity were 140 per 10,000 births. A quarter of women experiencing severe maternal morbidity, one per 270 births, also had their babies prematurely. The majority of "dual burden" births occurred in cases of preterm labor (61 percent) as opposed to births needing to occur early for medical reasons (23 percent).
Factors associated with "dual burden" birth include:

1. cesarean birth
2. carrying multiples
3. smoking during pregnancy
4. mother underweight
5. high blood pressure
6. diabetes
7. being a Black woman

Black women are twice as likely to have a "dual burden" birth as White women after controlling for all other factors.

Lyndon explains: "Racial disparities in health outcomes should be considered markers of exposure to racism, where poorer health reflects chronic stress from discrimination and structural inequity, rather than race as a 'risk factor' for disease or poor health outcomes. Our study suggests combined maternal and infant health challenges may result from exposure to racism for Black families illustrating the transgenerational impact of such exposure."

Dual burden births have immediate and persistent physical, psychological, social, and financial consequences for women and their families. The experience may trigger post-traumatic stress disorder (PTSD) for women and their partners, leading to consequences including: (1) impaired parent-infant attachment, (2) damaged partner relationships, and (3) prolonged suffering and feelings of failure.

Such consequences aggravate racialized birth experiences for Black families, as Black women report disrespectful encounters engaging reproductive health care services and Black preterm infants are less likely to be referred for developmental follow-up.
"Imagine the deep trauma a family experiences when both mother and newborn child are simultaneously fighting for their lives. This is the reality for 1,900 families in California, and it can have rippling effects across generations, particularly for Black families who are more likely to have a dual burden birth."

Laura Jelliffe-Pawlowski PhD, MS, Associate Professor, Epidemiology & Biostatistics, UCSF School of Medicine, Director of Precision Health and Discovery, UCSF California Preterm Birth Initiative, and study senior author.

Given that mothers and newborns are cared for by different teams of specialists, researchers point to the need for new models of care. Families need explicitly coordinated infant and maternal health care teams to provide proactive support for transition home and for long-term health of mother, baby and family members.

Abstract
Background
Prior studies have documented associations between preterm birth and severe maternal morbidity (SMM) but the prevalence and correlates of dual burden are not adequately understood, despite significant family implications.

Purpose
To describe the prevalence and correlates of the dual burden of SMM and preterm birth and to understand profiles of SMM by dual burden of preterm birth.

Approach
This retrospective cohort study included all California live births in 20072012 with gestations 2044 weeks and linked to a birth cohort database maintained by the California Office of Statewide Health Planning and Development (n = 3,059,156). Dual burden was defined as preterm birth (<37 weeks) with severe maternal morbidity (SMM, defined by Centers for Disease Control). Predictors for dual burden were assessed using Poisson logistic regression, accounting for hospital variance.

Results
Rates of preterm birth and SMM were 876 and 140 per 10,000 births, respectively. The most common indications of SMM both with and without preterm birth were blood transfusions and a combination of cardiac indications. One-quarter of women with SMM experienced preterm birth with a dual burden rate of 37 per 10,000 births. Risk of dual burden was over threefold higher with cesarean birth (primiparous primary aRR = 3.3, CI = 3.03.6; multiparous primary aRR = 8.1, CI = 7.29.1; repeat aRR = 3.9, CI = 3.54.3). Multiple gestation conferred a six-fold increased risk (aRR = 6.3, CI = 5.86.9). Women with preeclampsia superimposed on gestational hypertension (aRR = 7.3, CI = 6.87.9) or preexisting hypertension (aRR = 11.1, CI = 9.912.5) had significantly higher dual burden risk. Significant independent predictors for dual burden included smoking during pregnancy (aRR = 1.5, CI = 1.41.7), preexisting hypertension without preeclampsia (aRR = 3.3, CI = 3.03.7), preexisting diabetes (aRR = 2.6, CI = 2.33.0), Black race/ethnicity (aRR = 2.0, CI = 1.82.2), and prepregnancy body mass index <18.5 (aRR = 1.4, CI = 1.31.5).

Conclusions
Dual burden affects 1900 California families annually. The strongest predictors of dual burden were hypertensive disorders with preeclampsia and multiparous primary cesarean.

Authors
Anna Sliz, Kathryn C. S. Locker, Kristin Lampe, Alzbeta Godarova, David R. Plas, Edith M. Janssen, Helen Jones, Andrew B. Herr and Kasper Hoebe.

Acknowledgements
This study was supported by the UCSF California Preterm Birth Initiative, funded by Marc and Lynne Benioff. In addition to Lyndon and Jelliffe-Pawlowski, study authors include Rebecca Baer of the University of California, San Diego and the California Preterm Birth Initiative; Caryl Gay of UCSF School of Nursing and the California Preterm Birth Initiative; Alison M. El Ayadi of UCSF; and Henry Lee of Stanford University and the California Perinatal Quality Care Collaborative.

About NYU Rory Meyers College of Nursing (@NYUNursing)
NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers BS, MS, DNP, and PhD degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has three programs ranked in the top 10 by U.S. News & World Report and is among the top five nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to healthcare worldwide.

Citation: Gab3 is required for IL-2- and IL-15-induced NK cell expansion and limits trophoblast invasion during pregnancy. A. Sliz, K. C. S. Locker, K. Lampe, A. Godarova, D. R. Plas, E. Janssen, H. Jones, A. B. Herr, K. Hoebe. DOI 10.1126/sciimmunol.aav3866.

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Aug 15 2019   Fetal Timeline   Maternal Timeline   News  




Black women are twice as likely to have a "dual burden" birth as White women.
Black mothers report disrespectful encounters with reproductive health care services,
and Black preterm infants are also less likely to be referred for developmental follow-up.


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