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September 2021 highlights from the American Journal of Public Health

Date: Aug 27 2021

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health September issue highlights:

  • Black women face far higher maternal death rate than white peers
  • Mental health impacts of pandemic especially bad for LGBTQ+ people
  • Restricting access to abortion may increase maternal mortality risk
  • Many cases of infant opioid withdrawal due to medically appropriate use during pregnancy

Black women face higher maternal death rate than white peers

Racial and ethnic disparities in the U.S maternal death rate remain a critical public health problem, concludes a new study published in the September issue of AJPH.

Using 2016-2017 vital statistics data, researchers found that the maternal mortality rate among Black women was 3.55 times that for white women. Leading causes of death among Black women were eclampsia and preeclampsia and postpartum cardiomyopathy, with rates five time those of their white peers. Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were also up to 2.6 times those for white women.

Researchers wrote that the data suggest racial and ethnic disparities in the U.S maternal mortality rate may be even more “pronounced” than previously known.

“The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period,” the study stated. “Many of these deaths are preventable.”

[Author contact: Marian F. MacDorman, Maryland Population Research Center, College Park, Maryland. “Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016-2017”]

Mental health impacts of pandemic especially bad for LGBTQ+ people

Lesbian, gay, bisexual, transgender and queer communities often experienced worse mental health during the COVID-19 pandemic than their straight counterparts, finds a new study in September’s AJPH.

To conduct the study, researchers used data gathered between May 21-July 15, 2020, from more than 3,200 adults in five U.S. cities: Atlanta, Chicago, New Orleans, New York and Los Angeles. They found that cisgender straight people reported the lowest levels of depression, anxiety and problem drinking, compared with all other sexual orientation, sexual behavior and gender identity groups.

LGBTQ+ people were also more likely to report that such health problems were “more than usual” during the pandemic. In general, cisgender bisexual people reported the highest levels of depression and anxiety, and were more likely to say such issues worsened during the pandemic.

“Future research needs to expand surveillance efforts to include assessment of sexual identity, sexual behavior and gender identity to better understand the concurrent and long-term impact of the COVID-19 pandemic on health inequities experienced by LGBTQ+ people,” the study stated.

[Author contact: Ellesse-Roselee Akré, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire. “Depression, Anxiety and Alcohol Use Among LGBTQ+ People During the COVID-19 Pandemic”]

Restricting access to abortion may increase maternal mortality risk

State policies that make it harder to access abortion care may increase the risk of maternal death, according to new findings in the September issue of AJPH.

To conduct the study, researchers developed an abortion policy composite index for each state based on eight state-level abortion restrictions, such as mandatory waiting periods and counseling, and used models to estimate the effect on maternal mortality.

They found that states with higher index scores had a 7% increase in total maternal mortality, which was defined as a death while pregnant or within one year following the end of pregnancy from any cause related to or exacerbated by pregnancy and its care.

Among the abortion restrictions studied, states with a licensed physician requirement — which prohibits non-physicians such as advanced practice registered nurses or nurse midwives from providing abortion — had a 51% higher total maternal mortality rate. States with restrictions on Medicaid coverage of abortion care had a 29% higher total maternal mortality rate.

“It is critical that state-level policies related to women’s access to comprehensive reproductive health care services, including abortion, are evidence-based and guided by the primary goal of improving women’s health and reducing maternal mortality,” researchers wrote.

[Author contact: Dovile Vilda, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. “State Abortion Policies and Maternal Death in the United States, 2015-2018”]

Many cases of infant opioid withdrawal due to medically appropriate use during pregnancy

A significant number of babies born with neonatal opioid withdrawal syndrome may be the result of medically appropriate opioid use during pregnancy, finds a study in the September issue of AJPH.

Researchers analyzed data on births and maternal Medicaid claims in North Carolina between 2016 and 2018. They found that among mothers of infants with neonatal opioid withdrawal syndrome, more than 38% were using medication for an opioid use disorder, about 14% had a claim for prescription opioids, and about 8% had a claim for both. Just more than 39% did not have a coverage claim for either during pregnancy.

According to the study, Black women were less likely than white women to have a claim for using medication to treat an opioid use disorder. The percentage of babies carried to full term and born at a normal weight was highest among women with claims for opioid addiction medication or both medication and prescription opioids.

“By highlighting the use of treatment and opioids as prescribed by a health care provider among mothers of infants with [neonatal opioid withdrawal syndrome], these results provide insights for intervention and can be used to reduce stigma associated with [the syndrome],” researchers wrote.

[Author contact: Anna E. Austin, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. “Prenatal Use of Medication for Opioid Use Disorder and other Prescription Opioids in Cases of Neonatal Opioid Withdrawal Syndrome: North Carolina Medicaid, 2016-2018”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to APHA Media Relations. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or email us.

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