Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

Poverty is connected to a number of negative health outcomes. An investigation examines whether receiving a home eviction during pregnancy is linked to adverse birth outcomes, a determinant of a child’s lifelong health.

Research continues to find more data that show the negative health outcomes that are associated with poverty and facing difficult life events, such as eviction from home. The financial fallout of the pandemic has increased the number of people at risk for such an incident. An 

 examined whether a mother’s eviction during pregnancy was linked to adverse birth outcomes, which can be a determinant of a person’s lifetime health.1

The investigators looked at births in Georgia. The state was selected because of its large and diverse population, longitudinally linked birth records, and mostly complete eviction data. Additionally, the 2016 rate of eviction, 4.71 for every 100 renter homes, was more than double the national average. 

The data on all births from January 2000 to December 2016 were from the state’s Department of Health. Eviction data came from LexisNexis Risk Solutions. In Georgia, evictions can happen because of rental/lease agreement violations and late payment or nonpayment for any duration of time.

During the study period, there were 88,862 births to 45,122 mothers and 99,517 births in total. There were 10,135 births to mothers who had an eviction action occur during pregnancy and 78,727 births to mothers who had eviction action that occurred outside of her pregnancy. 

When compared to mothers who had eviction actions at other times, evictions during pregnancy were linked to lower infant birth weight (difference, −26.88 [95% CI, −39.53 to 14.24] g), lower gestational age (difference, −0.09 [95% CI, −0.16 to −0.03] weeks), increased rates of low birth weight (0.88 [95% CI, 0.23-1.54] percentage points), and increase rates of prematurity (1.14 [95% CI, 0.21-2.06] percentage points). 

A nonsignificant increase in mortality (1.85 [95% CI, −0.19 to 3.89] per 1000 births) was also noted. The investigators also found that the link between eviction and birth weight was strongest in the second and third trimesters, with birth weight reductions of 34.74 (95% CI, −57.51 to −11.97) and 35.80 (95% CI, −52.91 to −18.69) g, respectively.

The investigators’ findings appear to indicate that eviction occurring during pregnancy was linked to adverse outcomes, which can have long-ranging consequences. Advocating for housing assistance for pregnant women could be an important way to improve infants’ health.

This article was originally published on 

1. Himmelstein G, Desmond M. Association of eviction with adverse birth outcomes among women in Georgia, 2000 to 2016. 

. March 1, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.6550

Articles

The investigators’ findings appear to indicate that eviction occurring during pregnancy was linked to adverse outcomes. Advocating for housing assistance for pregnant women could be an important way to improve infants’ health.

Eviction during pregnancy may lead to adverse birth outcomes

The Centers for Disease Control and Prevention (CDC) have produced the first set of 

 for people who have received either 2 doses of the Pfizer/BioNTech or Moderna vaccine or the 1 dose of the Johnson & Johnson/Janssen vaccine.1

For the purposes of the guidance, a person is considered fully vaccinated for COVID-19, ≥2 weeks after receiving the second dose of the 2-dose vaccines and the ≥2 weeks after receiving the vaccine of the single-dose vaccine. The recommendations are also only for non-health care settings.

Visit with other fully vaccinated people in an indoor space without mask wearing or social distancing.

Visit with unvaccinated people from a single household without mask wearing or social distancing, if the unvaccinated people are at low risk for severe COVID-19 disease

Abstain from quarantine and testing after a known exposure, if the exposure was to asymptomatic people.

The guidance also recommends that fully vaccinated people continue to:

Wear a well-fitted face covering in public

Continue mask wearing, social distancing, and other infection control measures when visiting with unvaccinated people at increased risk of severe disease or if visiting with unvaccinated people from multiple households

Undergo testing if COVID-19 symptoms occur

Follow CDC and health department travel requirements

Continue avoiding medium- and large-sized in-person gatherings.

For those who are still waiting for a vaccine, as a 

briefing from Infectious Diseases in America

 noted, face masking, testing, and social distancing remain key to controlling the spread. Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of 

 noted, “It is still recommended that whether or not you have had a COVID-19 vaccine, you wear a mask, practice social distancing, good hand hygiene etc. Vaccinated persons can still transmit virus if they are asymptomatically infected. Wearing a mask is especially important in enclosed spaces that may not have good ventilation ie, indoors.”

1. Centers for Disease Control and Prevention. Interim public health recommendations for fully vaccinated people. Published March 8, 2021. Accessed March 8, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

The Centers for Disease Control and Prevention (CDC) has issued interim guidance for masking, social distancing, hand hygiene, and other infection control measures for people who are fully vaccinated for coronavirus 2019 disease (COVID-19).

CDC issues first recommendations for people fully vaccinated for COVID-19

	Women who develop menarche early in life may be at an increased risk of developing gestational diabetes mellitus (GDM), according to a new study in the 

	Researchers used data from 4749 women who participated in the Australian Longitudinal Study on Women’s Health between 2000 and 2012. The women were aged 22 to 27 years at the start of the study when they reported their age at start of menstruation. During the 12 years of the study, information on GDM diagnosis was obtained for every live birth. Log-binomial analysis was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) and analyses were adjusted for body mass index, polycystic ovary syndrome, mother’s highest educational qualification, nulliparity, and physical activity.

	The mean age at start of menstruation was 12.9 years (standard deviation, 1.4) and a first diagnosis of GDM was reported by 357 women (7.5%). When compared to women who started menstruation at 13 years, women who started menstruation at age ≤ 11 years had a 51% higher risk of developing GDM (95% confidence interval: 1.10 - 2.07) following adjustment for known GDM risk factors.

	The investigators believe their findings illustrate that young age at the start of menarche may be a way of identifying women who are higher risk of developing GDM. They say that further studies are needed to confirm these initial results and to illuminate the role of early start of menarche and later risk of GDM.

NEXT: USPSTF issues final recommendation on pelvic exam

USPSTF issues final recommendation on pelvic exam

	Evidence is insufficient to assess balance versus risk of screening pelvic examination for asymptomatic, nonpregnant adult women, according to a Recommendation Statement issued by the US Preventive Services Task Force (USPSTF). Published in 

, the findings are based on a review of abstracts and full-text articles on screening pelvic examination published from 1946 to January 13, 2016.

	The report also took into consideration comments from the public received after release of a 

, which was posted from June 28, 2016 to July 25, 2016.

	The literature review was designed to answer 3 questions:

What is the direct evidence for the effectiveness of the pelvic examination in reducing all-cause mortality, cancer- and disease-specific morbidity and mortality, and improving quality of life?;

What are the test performance characteristics of the pelvic examination in screening for gynecologic cancers and other gynecologic conditions?; and

What are the adverse effects of screening using the pelvic examination?

	The investigators found inadequate evidence on the accuracy or benefits of pelvic examination for detection of a range of gynecologic conditions. Evidence was similarly inadequate on harms of screening for a variety of gynecologic conditions. No studies were found that looked at pelvic examination’s benefit on all-cause mortality, disease-specific morbidity or quality of life.

	The USPSTF acknowledged the difficulty of performing studies on the effectiveness of screening pelvic examination. The panel said that their findings do not apply to screening for cervical cancer, gonorrhea, or chlamydia, although some public comments mentioned that misperception. The authors also clarified, in response to public comments, that costs of preventive service are not considered when determining a recommendation grade.

	“In the absence of clear evidence on the balance of benefits and harm of using pelvic examination to screen for asymptomatic gynecologic conditions,” USPSTF said in summary, “clinicians are encouraged to consider the patient’s risk factors for various gynecologic conditions and the patient’s values and preferences, and engage in shared decision making with the patient to determine whether to perform pelvic examination.”

	The American College of Obstetricians and Gynecologists recommends performing pelvic examinations annually in all patients age 21 and older. 

NEXT: Can vaginal progesterone reduce PTB in women with twins?

	Can vaginal progesterone reduce PTB in women with twins?

	According to a meta-analysis published in 

, using vaginal progesterone may reduce the risk of preterm birth.

	Researchers searched Google Scholar, research registers of ongoing trials, MEDLINE, EMBASE, POPLINE, CINAHL, LILACS, and the Cochrane Central Register to look for randomized controlled trials (RCTs) which compared vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25mm and that had individual patient data. Primary measured outcome was preterm birth < 33 weeks’ gestation. Two reviewers selected the studies independently, assessed the risk of bias and extracted the data. They found data for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from 6 RCTs. One study provided 74% of the total sample size.

	When compared with placebo or no treatment, vaginal progesterone was linked with a statistically significant reduction in the risk of preterm birth at < 33 weeks’ gestation (31.4% vs 43.1%; relative risk [RR], 0.69 [95% confidence interval {CI}, 0.51–0.93]; moderate-quality evidence). It was also linked with significant decrease in birth weight < 1500 g (RR, 0.53 [95% CI, 0.35–0.80]), neonatal death (RR, 0.53 [95% CI, 0.35–0.81]), preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), composite neonatal morbidity and mortality (RR, 0.61 [95% CI, 0.34–0.98]), use of mechanical ventilation (RR, 0.54 [95% CI, 0.36–0.81]), and respiratory distress syndrome (RR, 0.70 [95% CI, 0.56–0.89]), all moderate evidence. Additionally, no significant difference was seen between vaginal progesterone and placebo groups in the neurodevelopmental outcomes for the children at 4 to 5 years of age.

	The researchers concluded that administering vaginal progesterone to mothers with twin gestation and a short cervix mid-trimester will reduce the risk of preterm vaginal birth, neonatal mortality, and some neonatal morbidities. The use of progesterone also appears to show no negative effects on the neurodevelopment of offspring.

A new study looks at whether who begin menarche early in life are more likely to develop GDM. Plus: USPSTF issues their final recommendations on pelvic exams. Also, a look at the efficacy of vaginal progesterone in preventing preterm birth in twin pregnancy.

Does early menstruation increase risk of GDM?

	Preterm delivery may put women at increased risk of cardiovascular disease (CVD) later in lifem according to a study in 

	Researchers looked at the 70,182 parous women in Nurses’ Health Study II to examine the link between delivering an infant preterm (< 37 weeks) and CVD. They used multivariable Cox proportional-hazards to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular events (myocardial infarction and stroke, n = 949).

	Following adjustment for age, race, parental education, and prepregnancy lifestyle and cardiovascular risk factors, a preterm delivery in a woman’s first pregnancy was linked with an increased risk of CVD (HR, 1.42; 95% CI, 1.16–1.72) when compared to women who had a term delivery (≥ 37 weeks) in their first pregnancy. When split into moderate preterm (≥ 32 to < 37 weeks) and very preterm (< 32 weeks), the HRs were 1.22 (95% CI, 0.96–1.54) and 2.01 (95% CI, 1.47–2.75), respectively.

Recommended: Can a patient safety bundle prevent deaths from PE?

	Even among women who had first pregnancies uncomplicated by hypertensive disorders of pregnancy, the increased rate of CVD persisted in the very preterm group (HR, 2.01; 95% CI, 1.38–2.93). When compared to women with at least 2 pregnancies all delivered at term, women with a preterm first birth and at least 1 more later preterm birth had an HR for CVD of 1.65 (95% CI, 1.20–2.28). The link between moderate preterm first birth and CVD was accounted for in part by the development of changes in body mass index, type 2 diabetes, postpartum chronic hypertension, and hypercholesterolemia (proportion accounted for, 14.5%; 95% CI, 4.0–41.1), as was the very-preterm-CVD relationship (13.1%; 95% CI, 9.0–18.7).

	The researchers concluded that preterm delivery was independently predictive of CVD and could prove useful in CVD efforts. Because only a relatively modest proportion of the association between preterm birth and CVD was accounted for with development of convention CVD risk factors, the researchers say that further research could help identify other pathways.

NEXT: Night shifts, physical labor, and fecundity

	Night shifts, physical labor, and fecundity

	Women who work at night and perform physically demanding jobs may have lower fecundity, according to researchers from Harvard University. Their findings, published in 

, are from a first-of-its-kind study that looked at the association between occupational factors and markers of ovarian response in women of reproductive age.

	Participants in the prospective cohort were 786 women aged 18 to 45 with mean body mass index (BMI) 23 who planned to use their own gametes and were being treated at an academic fertility center between 2004 and 2015. Unexplained infertility was the primary diagnosis for most of the patients and 80% had undergone examination for infertility but only 48% had previously been treated for the condition.

	A questionnaire was used to collect information on the women’s occupational factors and electronic medical records were used to identify reproductive outcomes in the cohort. Compared with women who worked only day shifts, those who worked evening/night/rotating shifts had 2.3 fewer mature oocytes, on average (

<0.001). Moving heavy objects at work was associated with trends toward fewer total oocytes, mature oocytes, and antral follicles (

	The inverse association between heavy lifting and oocyte yield was stronger in women older than age 37 and with a BMI of at least 25 and when evening/night shift workers were considered as separate category (3.2 fewer mature oocytes in evening/night shift workers versus 8 in women working days). None of the occupational exposures were associated with Day 3 follicle-stimulating hormone or peak estradiol levels. Adjustment for total leisure time physical activity and smoking status did not affect the results.

	Their results, the authors said, “suggest that occupational factors may be more specifically affecting oocyte production and quality, rather than accelerating ovarian ageing, in this study population of women attending a fertility centre.” They cautioned that it may not be possible to generalize the findings to couples conceiving without medical intervention and note that they were not able to control for other work factors that might have been correlated with shift and physically demanding work. “Future work in other studies is needed,” the researchers said, “to further disentangle the effects of rotating shift work with and without nights and current versus lifetime exposure to shift work on fecundity.”

NEXT: Does a false-positive mammogram lead to delay in future screenings?

	Does a false-positive mammogram lead to delay in future screenings?

	Following a false-positive result from a screening mammogram, women may be more likely to delay or even forgo subsequent screenings, according to a new study published in 

Cancer Epidemiology, Biomarkers & Prevention

	The researchers used data from women who had mammogram screenings through a large healthcare organization with multiple facilities in the greater Chicago metropolitan area, which covered 741,150 screening mammograms for 261,767 women.

	Of the mammograms included, 650,232 produced true-negative results and 90,918 produced false-positive results. The likelihood of undergoing a subsequent mammogram was higher among women who had true-negative than those who had a false-positive result (85.0% vs 77.9%, 

 < 0.001). Median delay in being screened again was higher among women who had a false-positive result than a true-negative (13 months vs 3 months, 

 < 0.001). Additionally, women with a true-negative screening were 36% more likely to have a screening in the next 36 months than women who had a false-positive (hazard ratio = 1.36; 95% confidence interval, 1.35-1.37). Also women who have a false-positive mammogram are at increased risk of late-stage disease at time of diagnosis compared to those who have a true-negative mammogram (

Next: Are you in compliance with breast density laws?

	The investigators concluded that a false-positive mammogram is likely to cause a woman to delay subsequent screening, which could increase the 4-year cumulative risk of late-stage disease at time of diagnosis.

A study looks at the impact of a preterm birth on the mother's future risk of cardiovascular disease. Plus: Do shift work and physical labor negatively impact a woman's fertility? Also, are women who get a false-positive mammogram more likely to delay their future screenings?

Miranda Hester

Articles

Eviction during pregnancy may lead to adverse birth outcomes

CDC issues first recommendations for people fully vaccinated for COVID-19

Does early menstruation increase risk of GDM?

Is there a link between CVD and preterm birth?