Cardiovascular disease and maternal mortality: perceptions in a Midwest birthing population.

BACKGROUND: Missouri has one of the highest rates of maternal mortality in the United States. To date, there are currently no studies describing birthing peoples' knowledge or perceptions of contributing causes of maternal mortality. An improved understanding of population-specific knowledge can help to define how best to design targeted interventions to reduce disease-specific causes of maternal mortality. OBJECTIVE: This study aimed to examine the knowledge and understanding of maternal mortality in a Missouri birthing population. STUDY DESIGN: A 46-question, cross-sectional survey to assess the familiarity with local maternal mortality rates, groups affected, and causality was developed by the Missouri Perinatal Quality Collaborative and the Maternal-Child Learning and Action Network and emailed to a random sample of birthing people across Missouri. Those who identified as someone with birthing potential with a Missouri zip code and who were ≥18 years of age were eligible for inclusion. Unadjusted descriptive statistics were generated and stratified by age, race, and region. RESULTS: Among 2196 surveys sent, 1738 people completed the survey. Of those who responded, 78.2% were aware of the risk of pregnancy-related death with 14.7% reporting that they intimately knew someone who died. When asked if a certain group is affected disproportionately more, 66.4% responded affirmatively. Black (58.7%), uninsured (61.8%), poor (71.0%), those with substance abuse disorders (57.4%), and Native American (28.8%) birthing people were identified as groups that were perceived as suffering higher rates of maternal death. When polled on etiology, severe bleeding (56.9%) was believed to be the leading cause of death, and the second stage of labor was thought to be the period of highest risk (42.3%). Beliefs about the timing of death differed by age (P=.042) but not race (P=.81) or region (P=.191). CONCLUSION: Missouri birthing people are cognizant of the social factors associated with increased maternal mortality but are unaware of the leading causes of death, namely cardiovascular disease and mental health conditions. Future Perinatal Quality Collaborative work should focus on campaigns that raise public awareness about cardiovascular disease and mental health-related birthing risks and the importance of monitoring early warning signs after delivery.

A Summary of Maternal Mortality in Missouri: A Historical Perspective (1999-2018).

The rate of maternal mortality in the United States (U.S.) is higher than any other industrialized nation, at 23.8 per 100,000 deliveries from 2000-2014. Although maternal mortality ratios decreased by 44% globally from 1990 to 2015, emerging evidence suggests that maternal mortality in the U.S. has been increasing.2-4 One study quotes 700 maternal deaths every year, with 50,000 "near misses."1 By one metric, Missouri ranks as the 44th-worst state for maternal mortality in the U.S.5.

Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health.

Adverse pregnancy outcomes (APOs) collectively represent the leading causes of maternal and neonatal morbidity and mortality. Beyond the potentially devastating impact of APOs during pregnancy and the puerperium, women diagnosed with APOs have a 2-fold to 4-fold increased risk of future cardiovascular disease. Fortunately, APOs occur at an opportune time, in early-adulthood to mid-adulthood, when primary and secondary prevention strategies can alter the disease trajectory and improve long-term health outcomes. This chapter takes a life-course approach to (1) the epidemiology of APOs, (2) evidence-based strategies for clinicians to manage APOs, and (3) future directions for APO research and clinical practice.

Sources of Vaccine Hesitancy: Pregnancy, Infertility, Minority Concerns, and General Skepticism.

The coronavirus disease 2019 (COVID-19) epidemic continues to evolve, with variants of concern and new surges of COVID-19 noted over the past months. The limited data and evolving recommendations regarding COVID-19 vaccination in pregnancy have led to some understandable hesitancy among pregnant individuals. On social media, misinformation and unfounded claims linking COVID-19 vaccines to infertility are widespread, leading to vaccine skepticism among many men and women of reproductive age. The disproportionate impact of COVID-19 on communities of color, coupled with the unfortunate and troubled history of abuses of African Americans by the biomedical research community in the US, has also led to hesitancy and skepticism about the COVID-19 vaccines among some of our most vulnerable. The complex nature of vaccine hesitancy is evidenced by further divides between different demographic, political, age, geographical, and socioeconomic groups. Better understanding of these concerns is important in the individualized approaches to each patient.

STAR FORMATION AT Z = 2.481 IN THE LENSED GALAXY SDSS J1110+6459: STAR FORMATION DOWN TO 30 PARSEC SCALES.

We present measurements of the surface density of star formation, the star-forming clump luminosity function, and the clump size distribution function, for the lensed galaxy SGAS J111020.0+645950.8 at a redshift of z =2.481. The physical size scales that we probe, radii r = 30-50 pc, are considerably smaller scales than have yet been studied at these redshifts. The star formation surface density we find within these small clumps is consistent with surface densities measured previously for other lensed galaxies at similar redshift. Twenty-two percent of the rest-frame ultraviolet light in this lensed galaxy arises from small clumps, with r <100 pc. Within the range of overlap, the clump luminosity function measured for this lensed galaxy is remarkably similar to those of z ∼ 0 galaxies. In this galaxy, star-forming regions smaller than 100 pc-physical scales not usually resolved at these redshifts by current telescopes-are important locations of star formation in the distant universe. If this galaxy is representative, this may contradict the theoretical picture in which the critical size scale for star formation in the distant universe is of order 1 kiloparsec. Instead, our results suggest that current telescopes have not yet resolved the critical size scales of star-forming activity in galaxies over most of cosmic time.

Compliance with regulations on weight gain 6 months after delivery in active duty military women.

OBJECTIVE: To determine factors associated with active duty military women being within Navy weight standards 6 months following childbirth. METHODS: Inclusion criteria for this study were active duty women who delivered a nonanomalous fetus at a Naval Hospital and who remained in the area and their weight was recorded 6 months following childbirth. Multivariate logistic regressions, adjusted for 14 covariates, determined the factors for achieving acceptable weight. RESULTS: Among 1,009 women who participated in this prospective cohort study, 68% began within Navy body weight standards and 52% had a normal body mass index (BMI) (<25). Six months after childbirth, 48% were within Navy body weight standards and 32% had a BMI <25. Only 2 factors, BMI at first visit and cesarean delivery, significantly influenced the percentage of women who met the weight standards at 6 months. CONCLUSIONS: Lowering the prepregnancy BMI and avoiding a cesarean delivery may improve the percentage of active duty women who meet weight standards 6 months after childbirth.