Systematic Reviews to Inform Practice, November/December 2022

In the last decade there has been an increasing focus on social determinants of health and their role in outcomes. Twenty years ago Geronimus proposed weathering hypothesis, which posited that early experience repeated exposures economic adversity political marginalization experienced by Black people lead to a cumulative allostatic load resulting more rapid deterioration health.1 Since then many observational studies, summarized meta-analysis 41 studies examining as explanation for racial disparities outcomes, have supported this hypothesis.2 Additionally, few focused biological mechanism stress cause measuring premature shortening telomere length.2 Anyone can stress, especially if they low income, live unstable housing, limited employment options. The question is, does discrimination different or differential effect load, physiologic functioning, outcomes? Race is social, not biological, construct. It used promote racism, according Merriam-Webster.com Dictionary 3 aspects: (1) “belief race fundamental determinant human traits capacities differences produce inherent superiority particular race”; (2) “systemic oppression group economic, advantage another”; (3) “political system founded racism designed execute its principles.”3 To answer question, accurate methods measure experiences are essential. Many measures developed, mostly United States, effects over person's lifetime everyday exposure.4 These instruments range from single states Pregnancy Risk Assessment Monitoring System surveys longer ones such Perceived Racism Scale (51 items) Telephone-Administered (61 items).4 Most scales appropriately tested Americans who subjected long history States. Fewer scales, Krieger's scale, were developed using working class population white, Black, Latino persons.5 good psychometric properties, although some lacking important criteria, adequate sample size, replicated samples.4 Several documented poor general health, both physical mental, unrelated age, sex, birthplace.6 systematic review van Daalen colleagues sought determine pregnancy outcomes.7 search strategy was extensive, 8 electronic databases without any time limit language restriction. A study included it measured self-perceived had adverse neonatal maternal outcome. authors preidentified 6 outcomes but only able analyze preterm birth (PTB), weight (LBW) small gestational age (SGA) neonates, hypertensive disorders pregnancy. Study quality assessed Newcastle-Ottawa converted good, fair, Agency Healthcare Research Quality criteria. GRADE (Grading Recommendations Assessment, Development, Evaluation) scores risk bias. should be noted because all topic observational, start at level increase one with large accounting confounders. ended up including 24 4 taking place Over half cohort (n = 14) followed cross-sectional case-control studies. All published 20 number participants ranging 39 nearly 9500. table characteristics detailed, clearly identifying populations studied used. Half judged “good” quality, 10 identified “poor” 2 “fair.” overall score very and, pregnancy, low. Racial least scale adaptation most frequently 11); experience. other dealt daily recent experiences. Thirteen contributed summary estimate PTB largest contributing about 2200 1450 each. pooled calculated increased odds ratio (OR) 40% (OR, 1.40; 95% CI, 1.17-1.68). There moderate heterogeneity among (I2 60%), when influential excluded, ORs still statistically significant 1.33 1.48. When analysis African American persons OR (95% 1.13-1.57). assessing publication bias, estimated 5 missing possibly attenuating 1.20. Although LBW (VLBW) possible, showed positive association between LBW, trended toward association. Compared medium exposure those high past year 2.5 times neonate, 1.5 odds. Similarly, experiencing discriminatory events higher VLBW neonate. Three SGA. Among 1588 290 SGA 1.23; 0.76-1.99). Americans, also no 0.90; 0.82-1.10), older 1.45. Only perinatal specifically This did find explained disparity prevalence hypertension multiethnic, geographically diverse nulliparous women.8 Authors include postpartum mental disorder potential outcome, shown mood disorders.9-11 summary, reinforces findings integrative done Alhusen colleagues12 15 found rate probably LBW. evidence given difficulties confounding variables. Whether timing life compared later makes difference really studied. hypothesis would posit does, even utero, may causes hypothalamic-pituitary axis dysfunction. during exert triggering leading inflammatory cascade vascular dysfunction contribute PTB.13 conceptual model fits versus exerted stronger PTB. highlights poorly relation deserve further research. However, studying require meticulously course perspective, includes combination epigenetic, environmental, variables historical effects.14,15 limitations review, point out. Nearly take means generalizable context pregnant people. Because embedded established institutions, States translate same attributes global contexts. someone's self-identified ethnicity socially perceived identity, important. being assigned matter what self-assigned category was, resulted similar white much poorer nonwhite, regardless self-identity.16 phenomenon partially explain lesser Hispanic individuals living acculturation lens through view discrimination, demonstrating shortened length Latinx associated discrimination.17 Midwives concerned providing care patients help them achieve best possible responsibility midwives tackle issue country striving anti-racist. plethora resources available grow learn goal becoming Equity Library Journal Midwifery & Women's Health website where relevant articles collated easy searching. Highly recommended editorial Michelle Drew, annotated bibliography readings.18 Smith ER, Oakley E, Grandner GW, et al. Clinical factors women COVID-19 period: sequential, prospective [published online August 23, 2022]. Am J Obstet Gynecol. doi: 10.1016/j.ajog.2022.08.038 known changes severe respiratory illness viral infections, particularly coronaviruses influenza A, varicella, acute syndrome.1 Infection syndrome coronavirus (SARS-CoV-2) exception, many, Centers Disease Control Prevention, highlighted infected disease, complications, deaths rates than comparable nonpregnant women.2 With disease 2019 (COVID-19) cases declining rapidly, data now emerging. interim meta-analyses series 2020 2021.3-5 current 22,000 suspected confirmed SARS-CoV-2 infection date. data, person 42 days after birth. limitation heterogenous COVID-19; example, centers screened everyone coming hospital labor issues, others symptomatic. Therefore, incidence complications hard interpret. rated having sampling frame primary reason lower study's bias assessment tool. examined related severity; maternal, fetal, morbidities; nature present could examine conditions comorbidities, comparing condition without, account presence absence another comorbidity. Cases occurred January December 2021. They came 33 countries broad representation across globe World Bank income levels, source, Mexico. majority third trimester caveat Mexico unknown. mean 29.4 varied younger Puerto Rico, India, Kenya. severity, intensive unit admissions, critical need, ventilation well fetal visually depicted levels. interpretation these difficult identified. Of note, outcome parity. Unsurprisingly, like population, chronic Those diabetes, hypertension, cardiovascular (CVD) significantly likely (2-3 risk) (5-6 risk). importantly, size enabled pregnancy-related death, (relative [RR], 2.75; 1.76-4.28), diabetes (RR, 3.79; 2.61-5.50), CVD 16.76; 4.42-63.63). Hypertensive elevated disorders, birth, small. More notably, placental abruption 7 times. RR stillbirth, around 6.5 9.0, CVD, respectively, extent 3.4). Perinatal, neonatal, markedly conditions, highest CVD. novel finding documentation HIV infection. co-occurrence 2.7 death 8.63; 1.40-53.31). Examination nutritional obesity, underweight, anemia provided fresh insights. SARS-CoV-2–infected obesity ≤2) preeclampsia cesarean deaths. On hand, underweight 5.7 9.3 ventilation, 14 death. Being neonate (< 34 weeks). Anemia 1.78), 2.36; 1.15-4.81), stillbirth 3.75; 1.00-14.11). beyond morbidities severity HIV, anemia. What cannot controlling comorbidities. For independent contribution anemia, common hematologic HIV?6 An additional mortality HIV. consequences acquire SARS-CoV-2, delta variant, real. But true we fewer 50% receiving vaccine second season.7 acceptance globally below 50%, lowest high-income countries.8, 9 understandable might hesitant accept produced record speed unfamiliar process, messenger RNA (mRNA). truth, long-term safety mRNA vaccines lacking, longest type prior 2021 rabies phase I 101 participants.10 collected date promising short-term except rare problem myocarditis people, men.11, 12 said Canada, depended self-reported biased.13, Longer-term, well-designed will needed provide best, unbiased information. traditional administered years. Yet time, high-quality randomized clinical trial carried out.15, 16 Vaccine hesitancy complex behavior, 5C framework (confidence, complacency, convenience, calculation, collective responsibility) understand it.17, 18 assist providers engaging each patient individually concerns honestly acknowledging our knowledge. Chen Q, Qiu X, Fu Han Y. Effect prenatal perineal massage injury complications: meta-analysis. Comput Math Methods Med. 2022;2022:3315638. births flaws. instructive reviewing wanting use change practice. following criteria inclusion identified: design, intervention prenatally starting 36 weeks’ gestation, control massage, effects. No restriction imposed search. previously 2020, 11 eligible 20191 Cochrane 2013.2 study, trial, 2019. new missed meta-analyses.3 discrepancies highlight importance terms hand searching references papers clear issues meet null results, accounted 13% final laceration 28.6% first- second-degree lacerations, performed stage prenatally.4 publications twice meta-analyses, thereby 13.8% 26.4% 29% lacerations.5,6 Lastly, trials—2 quasi-experimental—and therefore criteria.7-9 results published, estimates favoring smaller, mentioned issues. 44% decreased third- fourth-degree lacerations 0.56; 0.47-0.67) smaller larger 64% 0.36; 0.14-0.89).1 similar, 20% decrease massage. Probably practicing report less pain days. support reminder worthwhile spend discussing simple handout Share Women massage.10