Purpose This paper is a historical account of an initiative, as recalled by the authors who were ... more Purpose This paper is a historical account of an initiative, as recalled by the authors who were directly involved, that brought to the forefront the long-standing and unjust reproductive health inequities in the United States. It is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. Description This paper is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. Part I recounts the history and achievements of a Centers for Disease for Control and Prevention initiative in the 1980–90’s, led by the Prematurity Research Group in the Division of Reproductive Health, Pregnancy and Infant Health Branch. This initiative stimulated a paradigm shift in how we understand and address black infant mortality and the inequities in this outcome. Part II illustrates examples of some exem...
In 1986, two thirds (65%) of all infant deaths in the United States occurred within the first 27 ... more In 1986, two thirds (65%) of all infant deaths in the United States occurred within the first 27 days of life. The underlying cause of death in almost one-half (47%) of all infant deaths was nonteratologic conditions originating in the perinatal period. Maternal complications of pregnancy was the fifth leading cause of infant mortality.1 National estimates of morbidity associated with conditions originating in the perinatal period have been examined in a study using the National Hospital Discharge Survey (NHDS).2 A high proportion (33.7%) of newborns experienced morbidity due to conditions arising in the perinatal period.2 In the present study, we sought to quantify the severity of conditions originating in the perinatal period by estimating the proportion of deaths that occur among them.
From July through September 1984, acute convulsions caused by endrin poisoning occurred in the su... more From July through September 1984, acute convulsions caused by endrin poisoning occurred in the subdistrict of Talagang, Attock District, Punjab province, Pakistan. Eighteen of the 21 affected villages were surveyed; 70% of the cases for which ages were known (106 of 152) were in children 1 to 9 years of age; 9.8% of all affected persons (19 of 194) died. The outbreak occurred in villages on the main roads of the subdistrict and peaked in early September. Endrin was detected in the blood of 12 of 18 patients with a history of convulsions but was not found in the blood of four hospitalized control patients. One composite sugar sample taken from the homes of three persons had an endrin level of 0.04 ppm. Because of the high toxicity, repeated association with large-scale outbreaks of neurologic illness, and the difficulties of monitoring distribution, endrin should not be used for agricultural purposes.
Morbidity estimates of conditions originating in the perinatal period have not been reported in t... more Morbidity estimates of conditions originating in the perinatal period have not been reported in the United States. Conditions originating in the perinatal period were identified according to the International Classification of Diseases. The National Hospital Discharge Survey provided a weighted, nationally representative sample of newborns discharged each year from short-stay, nonfederal hospitals. From 1986 through 1987, 33.7% of all newborns had at least one nonteratologic perinatal condition. However, 6.8% of all newborns had physiologic jaundice as their only discharge diagnosis. Nonphysiologic jaundice was diagnosed in 4.4%, maternal causes of perinatal morbidity in 3.1%, birth trauma in 2.5%, fetal distress in 2.3%, birth asphyxia in 2.1%, and infections specific to the perinatal period in 2.0% of all newborn discharges. The average hospital stay for all newborns was 3.5 days, but it was 5.3 days for newborns with at least one nonteratologic perinatal condition and 2.6 for new...
In recent years, the rate of decline for the black infant mortality risk (IMR) has been slower th... more In recent years, the rate of decline for the black infant mortality risk (IMR) has been slower than that for whites. The resultant widening in the black-white infant mortality gap has been accompanied by an increased percentage of very low birthweight (VLBW) infants (227 g-1,499 g) among black live births. Restricting our analysis to non-Hispanic black and white single live births, we used the 1983 national linked birth-death file to assess the relative contribution of VLBW infants to the black-white gap in IMR. VLBW occurred among 2.3% of all black live births and among 0.8% of all white live births. Deaths among VLBW infants accounted for 62.5% of the black-white gap in IMR. Although VLBW newborns represent a fraction of all live births in the United States, they account for almost two-thirds of the black-white gap in IMR. Since preterm delivery is associated with most VLBW infant deaths, our findings indicate the crucial need to identify strategies that reduce preterm births, among blacks in particular, to reduce significantly the infant mortality gap in the United States.
Reproductive outcomes were investigated in black and white female college graduates, presumed to ... more Reproductive outcomes were investigated in black and white female college graduates, presumed to be of similar socioeconomic status and similar risk profile with respect to environmental factors. Data were gathered by mail survey from graduates (1973-1985) of four Atlanta, Georgia, colleges between February and June 1988. Of 6,867 alumnae to whom questionnaires were mailed, 3,084 responded. A follow-up study of black nonrespondents yielded responses from 14% (335) of those who did not respond to the mail survey. For all graduates with a first live born at the time of survey (n = 1,089), the rates of preterm delivery, low birth weight, and infant mortality were 80.8, 82.6, and 14.6 per thousand births (primigravida), respectively. Compared with white graduates, black graduates had 1.67 times the risk of preterm delivery and 2.48 times the risk of low birth weight. Measures of social and economic status differed significantly by race. However, adjustment for these variables did not reduce the estimated risk for black graduates compared with whites. Analysis of the nonresponder survey suggested that respondent data alone overestimates the incidence of adverse outcomes in blacks; using nonresponder data, relative risks of 1.28 (preterm delivery) and 1.75 (low birth weight) were calculated as lower limits of the increased risk for blacks.
... Health and Injury Control, CDC, Atlanta, Georgia, 30333 2Department of Community Medicine, Mo... more ... Health and Injury Control, CDC, Atlanta, Georgia, 30333 2Department of Community Medicine, Morehouse School of Medicine, Atlanta, Georgia, 30333 3Mempbis ... 980 Brilliant, BL, Amburg, GV, Isbister, J., Humphrey, H., Wilcox, R., Eyster, J., Bloomer, AW, and Price, H. Lancet, 2 ...
American Journal of Obstetrics and Gynecology, 1993
Placenta previa can cause serious, occasionally fatal complications for fetuses and mothers; howe... more Placenta previa can cause serious, occasionally fatal complications for fetuses and mothers; however, data on its national incidence and sociodemographic risk factors have not been available. STUDY DESIGN: We analyzed data from the National Hospital Discharge Survey for the years 1979 through 1987 and from the Retrospective Maternal Mortality Study (1979 through 1986). RESULTS: We found that placenta previa complicated 4.8 per 1000 deliveries annually and was fatal in 0.03% of cases. Incidence rates remained stable among white women but increased among black and other minority women (p < 0.1). In addition, the risk of placenta previa was higher for black and other minority women than for white women (rate ratio 1.3, 95% confidence interval 1.0 to 1.7), and it was higher for women ;::35 years old than for women <20 years old (rate ratio 4.7,95% confidence interval 3.3 to 7.0). Women with placenta previa were at an increased risk of abruptio placentae (rate ratio 13.8), cesarean delivery (rate ratio 3.9), fetal malpresentation (rate ratio 2.8), and postpartum hemorrhage (rate ratio 1.7). CONCLUSION: Our findings support the need for improved prenatal and intrapartum care to reduce the serious complications and deaths associated with placenta previa.
BACKGROUND: Due to the advancement of screening and treatment options for cancer, more people are... more BACKGROUND: Due to the advancement of screening and treatment options for cancer, more people are able to live fruitful lives after a cancer diagnosis, yet for pre-menopausal breast cancer survivors the effects of disease and treatment on birth outcomes is not well documented. POPULATION: Linked North Carolina birth record-cancer registry data were used to examine the birth outcomes of pre-menopausal breast cancer survivors. Out of the 2,213,464 eligible live births that occurred between 1990 and 2009 in North Carolina, 539 of the mothers are breast cancer survivors and 10.6% (n=235,262) of the mothers experienced a preterm birth (which is below the national average of 12%). A vast majority of the women have a high school diploma or are college educated (81.4%; n=1,796,594), 14.0% (n=309,208) of the women reported that they smoked during pregnancy, and about two-thirds of the women were not married at the time of the birth of their child (67.7%; n=1,499,053). A majority of the study population is non-Hispanic White (62.6%; n=1,385,393) followed by non-Hispanic Blacks (24.0%; n=531,584), Hispanics/Latinos (9.7%; 215,224), and non-Hispanics of other races (3.7%; n=81,250). METHODS: The aim of this study was to determine if breast cancer survivors of reproductive age (ages 18-49) who had a live birth after their diagnosis have a greater prevalence of preterm birth than women who were not diagnosed with breast cancer. Binomial regression was used to estimate the exposure-outcome association in this case-cohort study. FINDINGS: The crude prevalence of preterm birth for pre-menopausal breast cancer survivors is 2.01 (95% CI: 1.71-2.36) times the crude prevalence of preterm birth for women who were not diagnosed with breast cancer. When the data were stratified by race/ethnicity, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.27 (1.85-2.79) for Whites, 1.45 (1.10-1.91) for Blacks, 2.23 (0.64-7.81) for Hispanics/Latinos, and 1.83 (0.52-6.50) for other races. Controlling for the mother’s education level, marital status, and smoking status during pregnancy, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.37 (1.93-2.91) for Whites, 1.50 (1.14-1.98) for Blacks, 2.28 (0.65-7.97) for Hispanics/Latinos, and 1.79 (0.51-6.31) for other races. CONCLUSION: Women diagnosed with breast cancer during their reproductive years are potentially at greater risk of experiencing a preterm birth and may benefit from targeted preconception health interventions. Citation Format: Kristin Z Black, Diane L Rowley. The birth outcomes of pre-menopausal breast cancer survivors: Do they have a greater prevalence of delivering a preterm infant? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-07.
INTRODUCTION U.S. disparities in Black:White infant mortality are persistent. National trends, ho... more INTRODUCTION U.S. disparities in Black:White infant mortality are persistent. National trends, however, may obscure local successes. METHODS Zero-corrected, negative binomial multivariable modeling was used to predict Black infant mortality (1999-2003) in all U.S. counties with reliable rates. Independent variables included county population size, racial composition, educational attainment, poverty, income and geographic origin. Resilient counties were defined as those whose Black infant mortality rate residual score was < 2.0. Mortality data was accessed from the Compressed Mortality File compiled by the National Center for Health Statistics and found on the CDC WONDER website. Demographic information was obtained from the US Census. RESULTS The final model included the percentage of Blacks, age 18 to 64 years, speaking little or no English (P < .008), a socioeconomic index comprising educational attainment, poverty, and per capita income (P < .001), and household income i...
During the past two decades, there has been an increased use of community-based participatory res... more During the past two decades, there has been an increased use of community-based participatory research in public health activities, especially as part of efforts to understand health disparities affecting communities of color. This article describes the history and lessons learned of a long-standing community participatory project, Healthy African American Families (HAAF), in Los Angeles, California. HAAF evolved from a partnership formed by a community advisory board, university, and federal health agency to an independent, incorporated community organization that facilitates and brokers research and health promotion activities within its community. HAAF created mechanisms for community education and networks of community relationships and reciprocity through which mutual support, research, and interventions are integrated. These sustained, institutionalized relationships unite resources and both community and scientific expertise in a community-partnered participatory research mod...
This study assessed the associations between nine differentially methylated regions (DMRs) of imp... more This study assessed the associations between nine differentially methylated regions (DMRs) of imprinted genes in DNA derived from umbilical cord blood leukocytes in males and females and (1) birth weight for gestational age score, (2) weight-for-length (WFL) score at 1 year, and (3) body mass index (BMI) score at 3 years. We conducted multiple linear regression in = 567 infants at birth, = 288 children at 1 year, and = 294 children at 3 years from the Newborn Epigenetics Study (NEST). We stratified by sex and adjusted for race/ethnicity, maternal education, maternal pre-pregnancy BMI, prenatal smoking, maternal age, gestational age, and paternal race. We also conducted analysis restricting to infants not born small for gestational age. We found an association between higher methylation of the sequences regulating paternally expressed gene 10 () and anthropometric scores at 1 year ( = 0.84; 95% CI = 0.34, 1.33; = 0.001) and 3 years ( = 1.03; 95% CI = 0.37, 1.69; value = 0.003) in...
Diet is dictated by the surrounding environment, as food access and availability may change depen... more Diet is dictated by the surrounding environment, as food access and availability may change depending on where one lives. Maternal diet during pregnancy is an important part of the in utero environment, and may affect the epigenome. Studies looking at overall diet pattern in relation to DNA methylation have been lacking. The Mediterranean diet is known for its health benefits, including decreased inflammation, weight loss, and management of chronic diseases. This study assesses the association between maternal adherence to a Mediterranean diet pattern during pregnancy and infant DNA methylation at birth. Mediterranean diet adherence in early pregnancy was measured in 390 women enrolled in the Newborn Epigenetic Study, and DNA methylation was assessed in their infants at birth. Multinomial logistic regression was used to assess the association between adherence to a Mediterranean diet and infant methylation at the maternally expressed gene 3, maternally expressed gene 3-intergenic region, pleiomorphic adenoma gene-like 1, insulin-like growth factor 2 gene, H19, mesoderm-specific transcript, neuronatin, paternally expressed gene 3, epsilon sarcoglycan and paternally expressed gene 10 promoter region, measured by pyrosequencing. Infants of mothers with a low adherence to a Mediterranean diet had a greater odds of hypo-methylation at the MEG3-IG differentially methylated region (DMR). Sex-stratified models showed that this association was present in girls only. This study provides early evidence on the association between overall diet pattern and methylation at the 9 DMRs included in this study, and suggests that maternal diet can have a sex-specific impact on infant DNA methylation at specific imprinted DMRs.
Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading c... more Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011. Controls were frequency-matched 2:1 to 12,513 hypertensive women by age and questionnaire cycle. Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.
Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about ... more Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors. We examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) by breast cancer history and effect modification by race. We analyzed linked North Carolina birth records and Central Cancer Registry files from 1990 to 2009 (n = 2,325,229). We used multivariable negative log-binomial regression to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between breast cancer history and PTB, LBW, and SGA. Of 1,912,269 eligible births, 512 births were to mothers with a previous breast cancer diagnosis history. Average age at breast cancer diagnosis was 31.8 years (SD = 4.7). Mean time from diagnosis to delivery was 3.3 years (SD = 2.8). After multivariable adjustment, the PR was 1.67 (95% CI, 1.42-1.97) for PTB, 1.50 (95% CI...
Purpose This paper is a historical account of an initiative, as recalled by the authors who were ... more Purpose This paper is a historical account of an initiative, as recalled by the authors who were directly involved, that brought to the forefront the long-standing and unjust reproductive health inequities in the United States. It is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. Description This paper is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. Part I recounts the history and achievements of a Centers for Disease for Control and Prevention initiative in the 1980–90’s, led by the Prematurity Research Group in the Division of Reproductive Health, Pregnancy and Infant Health Branch. This initiative stimulated a paradigm shift in how we understand and address black infant mortality and the inequities in this outcome. Part II illustrates examples of some exem...
In 1986, two thirds (65%) of all infant deaths in the United States occurred within the first 27 ... more In 1986, two thirds (65%) of all infant deaths in the United States occurred within the first 27 days of life. The underlying cause of death in almost one-half (47%) of all infant deaths was nonteratologic conditions originating in the perinatal period. Maternal complications of pregnancy was the fifth leading cause of infant mortality.1 National estimates of morbidity associated with conditions originating in the perinatal period have been examined in a study using the National Hospital Discharge Survey (NHDS).2 A high proportion (33.7%) of newborns experienced morbidity due to conditions arising in the perinatal period.2 In the present study, we sought to quantify the severity of conditions originating in the perinatal period by estimating the proportion of deaths that occur among them.
From July through September 1984, acute convulsions caused by endrin poisoning occurred in the su... more From July through September 1984, acute convulsions caused by endrin poisoning occurred in the subdistrict of Talagang, Attock District, Punjab province, Pakistan. Eighteen of the 21 affected villages were surveyed; 70% of the cases for which ages were known (106 of 152) were in children 1 to 9 years of age; 9.8% of all affected persons (19 of 194) died. The outbreak occurred in villages on the main roads of the subdistrict and peaked in early September. Endrin was detected in the blood of 12 of 18 patients with a history of convulsions but was not found in the blood of four hospitalized control patients. One composite sugar sample taken from the homes of three persons had an endrin level of 0.04 ppm. Because of the high toxicity, repeated association with large-scale outbreaks of neurologic illness, and the difficulties of monitoring distribution, endrin should not be used for agricultural purposes.
Morbidity estimates of conditions originating in the perinatal period have not been reported in t... more Morbidity estimates of conditions originating in the perinatal period have not been reported in the United States. Conditions originating in the perinatal period were identified according to the International Classification of Diseases. The National Hospital Discharge Survey provided a weighted, nationally representative sample of newborns discharged each year from short-stay, nonfederal hospitals. From 1986 through 1987, 33.7% of all newborns had at least one nonteratologic perinatal condition. However, 6.8% of all newborns had physiologic jaundice as their only discharge diagnosis. Nonphysiologic jaundice was diagnosed in 4.4%, maternal causes of perinatal morbidity in 3.1%, birth trauma in 2.5%, fetal distress in 2.3%, birth asphyxia in 2.1%, and infections specific to the perinatal period in 2.0% of all newborn discharges. The average hospital stay for all newborns was 3.5 days, but it was 5.3 days for newborns with at least one nonteratologic perinatal condition and 2.6 for new...
In recent years, the rate of decline for the black infant mortality risk (IMR) has been slower th... more In recent years, the rate of decline for the black infant mortality risk (IMR) has been slower than that for whites. The resultant widening in the black-white infant mortality gap has been accompanied by an increased percentage of very low birthweight (VLBW) infants (227 g-1,499 g) among black live births. Restricting our analysis to non-Hispanic black and white single live births, we used the 1983 national linked birth-death file to assess the relative contribution of VLBW infants to the black-white gap in IMR. VLBW occurred among 2.3% of all black live births and among 0.8% of all white live births. Deaths among VLBW infants accounted for 62.5% of the black-white gap in IMR. Although VLBW newborns represent a fraction of all live births in the United States, they account for almost two-thirds of the black-white gap in IMR. Since preterm delivery is associated with most VLBW infant deaths, our findings indicate the crucial need to identify strategies that reduce preterm births, among blacks in particular, to reduce significantly the infant mortality gap in the United States.
Reproductive outcomes were investigated in black and white female college graduates, presumed to ... more Reproductive outcomes were investigated in black and white female college graduates, presumed to be of similar socioeconomic status and similar risk profile with respect to environmental factors. Data were gathered by mail survey from graduates (1973-1985) of four Atlanta, Georgia, colleges between February and June 1988. Of 6,867 alumnae to whom questionnaires were mailed, 3,084 responded. A follow-up study of black nonrespondents yielded responses from 14% (335) of those who did not respond to the mail survey. For all graduates with a first live born at the time of survey (n = 1,089), the rates of preterm delivery, low birth weight, and infant mortality were 80.8, 82.6, and 14.6 per thousand births (primigravida), respectively. Compared with white graduates, black graduates had 1.67 times the risk of preterm delivery and 2.48 times the risk of low birth weight. Measures of social and economic status differed significantly by race. However, adjustment for these variables did not reduce the estimated risk for black graduates compared with whites. Analysis of the nonresponder survey suggested that respondent data alone overestimates the incidence of adverse outcomes in blacks; using nonresponder data, relative risks of 1.28 (preterm delivery) and 1.75 (low birth weight) were calculated as lower limits of the increased risk for blacks.
... Health and Injury Control, CDC, Atlanta, Georgia, 30333 2Department of Community Medicine, Mo... more ... Health and Injury Control, CDC, Atlanta, Georgia, 30333 2Department of Community Medicine, Morehouse School of Medicine, Atlanta, Georgia, 30333 3Mempbis ... 980 Brilliant, BL, Amburg, GV, Isbister, J., Humphrey, H., Wilcox, R., Eyster, J., Bloomer, AW, and Price, H. Lancet, 2 ...
American Journal of Obstetrics and Gynecology, 1993
Placenta previa can cause serious, occasionally fatal complications for fetuses and mothers; howe... more Placenta previa can cause serious, occasionally fatal complications for fetuses and mothers; however, data on its national incidence and sociodemographic risk factors have not been available. STUDY DESIGN: We analyzed data from the National Hospital Discharge Survey for the years 1979 through 1987 and from the Retrospective Maternal Mortality Study (1979 through 1986). RESULTS: We found that placenta previa complicated 4.8 per 1000 deliveries annually and was fatal in 0.03% of cases. Incidence rates remained stable among white women but increased among black and other minority women (p < 0.1). In addition, the risk of placenta previa was higher for black and other minority women than for white women (rate ratio 1.3, 95% confidence interval 1.0 to 1.7), and it was higher for women ;::35 years old than for women <20 years old (rate ratio 4.7,95% confidence interval 3.3 to 7.0). Women with placenta previa were at an increased risk of abruptio placentae (rate ratio 13.8), cesarean delivery (rate ratio 3.9), fetal malpresentation (rate ratio 2.8), and postpartum hemorrhage (rate ratio 1.7). CONCLUSION: Our findings support the need for improved prenatal and intrapartum care to reduce the serious complications and deaths associated with placenta previa.
BACKGROUND: Due to the advancement of screening and treatment options for cancer, more people are... more BACKGROUND: Due to the advancement of screening and treatment options for cancer, more people are able to live fruitful lives after a cancer diagnosis, yet for pre-menopausal breast cancer survivors the effects of disease and treatment on birth outcomes is not well documented. POPULATION: Linked North Carolina birth record-cancer registry data were used to examine the birth outcomes of pre-menopausal breast cancer survivors. Out of the 2,213,464 eligible live births that occurred between 1990 and 2009 in North Carolina, 539 of the mothers are breast cancer survivors and 10.6% (n=235,262) of the mothers experienced a preterm birth (which is below the national average of 12%). A vast majority of the women have a high school diploma or are college educated (81.4%; n=1,796,594), 14.0% (n=309,208) of the women reported that they smoked during pregnancy, and about two-thirds of the women were not married at the time of the birth of their child (67.7%; n=1,499,053). A majority of the study population is non-Hispanic White (62.6%; n=1,385,393) followed by non-Hispanic Blacks (24.0%; n=531,584), Hispanics/Latinos (9.7%; 215,224), and non-Hispanics of other races (3.7%; n=81,250). METHODS: The aim of this study was to determine if breast cancer survivors of reproductive age (ages 18-49) who had a live birth after their diagnosis have a greater prevalence of preterm birth than women who were not diagnosed with breast cancer. Binomial regression was used to estimate the exposure-outcome association in this case-cohort study. FINDINGS: The crude prevalence of preterm birth for pre-menopausal breast cancer survivors is 2.01 (95% CI: 1.71-2.36) times the crude prevalence of preterm birth for women who were not diagnosed with breast cancer. When the data were stratified by race/ethnicity, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.27 (1.85-2.79) for Whites, 1.45 (1.10-1.91) for Blacks, 2.23 (0.64-7.81) for Hispanics/Latinos, and 1.83 (0.52-6.50) for other races. Controlling for the mother’s education level, marital status, and smoking status during pregnancy, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.37 (1.93-2.91) for Whites, 1.50 (1.14-1.98) for Blacks, 2.28 (0.65-7.97) for Hispanics/Latinos, and 1.79 (0.51-6.31) for other races. CONCLUSION: Women diagnosed with breast cancer during their reproductive years are potentially at greater risk of experiencing a preterm birth and may benefit from targeted preconception health interventions. Citation Format: Kristin Z Black, Diane L Rowley. The birth outcomes of pre-menopausal breast cancer survivors: Do they have a greater prevalence of delivering a preterm infant? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-07.
INTRODUCTION U.S. disparities in Black:White infant mortality are persistent. National trends, ho... more INTRODUCTION U.S. disparities in Black:White infant mortality are persistent. National trends, however, may obscure local successes. METHODS Zero-corrected, negative binomial multivariable modeling was used to predict Black infant mortality (1999-2003) in all U.S. counties with reliable rates. Independent variables included county population size, racial composition, educational attainment, poverty, income and geographic origin. Resilient counties were defined as those whose Black infant mortality rate residual score was < 2.0. Mortality data was accessed from the Compressed Mortality File compiled by the National Center for Health Statistics and found on the CDC WONDER website. Demographic information was obtained from the US Census. RESULTS The final model included the percentage of Blacks, age 18 to 64 years, speaking little or no English (P < .008), a socioeconomic index comprising educational attainment, poverty, and per capita income (P < .001), and household income i...
During the past two decades, there has been an increased use of community-based participatory res... more During the past two decades, there has been an increased use of community-based participatory research in public health activities, especially as part of efforts to understand health disparities affecting communities of color. This article describes the history and lessons learned of a long-standing community participatory project, Healthy African American Families (HAAF), in Los Angeles, California. HAAF evolved from a partnership formed by a community advisory board, university, and federal health agency to an independent, incorporated community organization that facilitates and brokers research and health promotion activities within its community. HAAF created mechanisms for community education and networks of community relationships and reciprocity through which mutual support, research, and interventions are integrated. These sustained, institutionalized relationships unite resources and both community and scientific expertise in a community-partnered participatory research mod...
This study assessed the associations between nine differentially methylated regions (DMRs) of imp... more This study assessed the associations between nine differentially methylated regions (DMRs) of imprinted genes in DNA derived from umbilical cord blood leukocytes in males and females and (1) birth weight for gestational age score, (2) weight-for-length (WFL) score at 1 year, and (3) body mass index (BMI) score at 3 years. We conducted multiple linear regression in = 567 infants at birth, = 288 children at 1 year, and = 294 children at 3 years from the Newborn Epigenetics Study (NEST). We stratified by sex and adjusted for race/ethnicity, maternal education, maternal pre-pregnancy BMI, prenatal smoking, maternal age, gestational age, and paternal race. We also conducted analysis restricting to infants not born small for gestational age. We found an association between higher methylation of the sequences regulating paternally expressed gene 10 () and anthropometric scores at 1 year ( = 0.84; 95% CI = 0.34, 1.33; = 0.001) and 3 years ( = 1.03; 95% CI = 0.37, 1.69; value = 0.003) in...
Diet is dictated by the surrounding environment, as food access and availability may change depen... more Diet is dictated by the surrounding environment, as food access and availability may change depending on where one lives. Maternal diet during pregnancy is an important part of the in utero environment, and may affect the epigenome. Studies looking at overall diet pattern in relation to DNA methylation have been lacking. The Mediterranean diet is known for its health benefits, including decreased inflammation, weight loss, and management of chronic diseases. This study assesses the association between maternal adherence to a Mediterranean diet pattern during pregnancy and infant DNA methylation at birth. Mediterranean diet adherence in early pregnancy was measured in 390 women enrolled in the Newborn Epigenetic Study, and DNA methylation was assessed in their infants at birth. Multinomial logistic regression was used to assess the association between adherence to a Mediterranean diet and infant methylation at the maternally expressed gene 3, maternally expressed gene 3-intergenic region, pleiomorphic adenoma gene-like 1, insulin-like growth factor 2 gene, H19, mesoderm-specific transcript, neuronatin, paternally expressed gene 3, epsilon sarcoglycan and paternally expressed gene 10 promoter region, measured by pyrosequencing. Infants of mothers with a low adherence to a Mediterranean diet had a greater odds of hypo-methylation at the MEG3-IG differentially methylated region (DMR). Sex-stratified models showed that this association was present in girls only. This study provides early evidence on the association between overall diet pattern and methylation at the 9 DMRs included in this study, and suggests that maternal diet can have a sex-specific impact on infant DNA methylation at specific imprinted DMRs.
Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading c... more Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011. Controls were frequency-matched 2:1 to 12,513 hypertensive women by age and questionnaire cycle. Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.
Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about ... more Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors. We examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) by breast cancer history and effect modification by race. We analyzed linked North Carolina birth records and Central Cancer Registry files from 1990 to 2009 (n = 2,325,229). We used multivariable negative log-binomial regression to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between breast cancer history and PTB, LBW, and SGA. Of 1,912,269 eligible births, 512 births were to mothers with a previous breast cancer diagnosis history. Average age at breast cancer diagnosis was 31.8 years (SD = 4.7). Mean time from diagnosis to delivery was 3.3 years (SD = 2.8). After multivariable adjustment, the PR was 1.67 (95% CI, 1.42-1.97) for PTB, 1.50 (95% CI...
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Papers by Diane Rowley