ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Author(s): Anne L. Dunlop, Alicynne Glazier-Essalmi, et al. 

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

 

What were the study results?

There were differences in how early the baby was born based on the mother’s race and ethnicity. Compared to non-Hispanic white women, women of all other races had a higher chance of PTB. For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB. This link between education level and PTB was mostly seen in non-Hispanic white women and those who lived in the South and Midwest regions of the US. This study also collected data on neighborhood factors; non-Hispanic white women living in a rural area had a higher chance of PTB delivery compared to women living in an urban area.

 

What was the study's impact?

This study explored an important gap in the field of children’s health. It gathered information on how factors such as the mother’s race/ethnicity, location, education level, and SES affect if a baby is born early. The results show that higher education among women could help decrease the chances of PTB in the US, especially in the South and Midwest regions.

 

Why was this study needed?

There are high rates of preterm birth (PTB) in the US. Previous studies show that the rates of PTB are different based on race and location, but there is not much information available on what causes these differences. This study also explored the link between the mother’s SES, race, and location and how they affect the baby’s age at birth. Socioeconomic status (SES) is a combination of factors such as education, income, and occupation.

 

Who was involved?

Women enrolled in the ECHO Program who delivered a baby were included in this study. They provided all of the required information about themselves and their infant. More than 20,000 mother-infant pairs participated.

 

What happened during the study?

Researchers studied a variety of information including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and how many weeks they were at birth. They took this information and looked for patterns and connections between factors that affect PTB.

 

What happens next?

Non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB. Future studies in these populations will help explore the causes for these differences and figure out ways to prevent PTB.

 

Where can I learn more?

View the full journal article, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts” in PLOS One.

 

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 

Published: January 8, 2021

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Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

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Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

 

What was done?

The medical records of babies born between July 1, 2016 and June 30, 2017 and their mothers were reviewed at 30 U.S. hospitals. From these records, 1377 babies were selected for the study.

For the babies, we looked at how many were given medicines for their NOWS symptoms and what they ate. We also looked at how long they were in the hospital, and who they went home with. For the mothers, we looked at what types of care they had during their pregnancy.

 

What was found?

The hospitals in this study varied in how they took care of pregnant women with opioid use and their babies.

In the babies:

  • 6% to 100% received medicine for NOWS symptoms,
  • 22% to 83% were fed breast milk,
  • length of hospital stay was 2 to 28 days, and
  • 33% to 91% went home with their parents.

In the mothers:

  • 6% to 100% were given medicine for their opioid use disorder,
  • 31% to 100% received adequate medical care during their pregnancy, and
  • 2% to 75% received prenatal counseling.

 

What do the results mean?

This study suggests that the care for pregnant women who use opioids and their babies differs widely in the U.S. This means that some mothers and babies may not be getting the best care.

More research into the care we provide will help doctors find a standardized way to care for babies with NOWS. Standardized care will help all babies with NOWS get the best care possible.

 

Why was this study conducted?

Babies exposed to opioids in the womb may show signs of withdrawal after birth. This is called neonatal opioid withdrawal syndrome (NOWS). Babies with NOWS may tremble, have increased crying, or be more difficult to calm. They also may not sleep or eat well.

In the U.S., there is not a standard way to care for babies with NOWS after they are born. That means U.S. doctors may be treating babies with NOWS in different ways. This study looked at the variation in the care provided to babies with NOWS in the U.S.

 

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible. The authors thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

 

Access the full journal article, titled "Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal," published in Pediatrics.

Published January 2021

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 

Resources

Centers for Disease Control and Prevention (CDC)

About Opioid Use During Pregnancy

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The ACT NOW Clinical Practice Survey:  Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s):  Jessica Snowden, Akshatha, Robert Annett, et al

 

What was done?

In the fall of 2017, 54 sites within two research networks were surveyed.  The sites were asked about the protocols and practices they used to treat NOWS infants.  They were also asked how NOWS infants were diagnosed, what drugs they were given, what non-drug methods were used, and what areas of the hospital cared for NOWS infants.

 

What was found?

Sites could be divided into those that were NICUs (neonatal intensive care units) and those that were not ICUs (non-ICUs).  NICUs were more likely to have protocols for screening mothers and diagnosing NOWs.  They were also more likely to have protocols for how to give drugs for NOWS symptoms and encouraging breastfeeding.  NICUs were more likely to use non-drug methods to treat NOWS infants.

Non-drug methods included swaddling, cuddling, massage, and low-stimulation environments.  Morphine was the first drug of choice for NOWS symptoms at a majority of sites, regardless of their type.

 

What do the results mean?

Non-ICU sites need targeted training and standardized care plans for NOWS infants.  However, it is not clear which practices are the most beneficial.  Some variations in care may be best for some NOWS infants.  The long-term effects of drug therapy and non-drug methods in these infants are unknown.  The variations seen in this study show the need for multisite clinical trials in infants with NOWS.  These studies will help define the best policies and practices to use with NOWS infants.

 

Why was this study conducted?

Neonatal opioid withdrawal syndrome (NOWS) often occurs when the mothers of unborn babies use opioids.  The number of babies with NOWS has dramatically increased in the last 10 years due to the opioid crisis in the US.  Doctors and hospitals have developed standard protocols on how best to care for these babies.  The goal of this study was to collect information on how hospitals care for NOWS infants and to use this information for future clinical studies on the best methods to care for them.

 

Appreciation:

The authors especially thank the sites of the Institutional Development Award States Pediatric Clinical Trials Network and the Neonatal Research Network for contributing participating in the survey.  The authors would also like to thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

 

You may learn more about this publication here:  https://www.ncbi.nlm.nih.gov/pubmed/31324654

 

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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