Browsing by Author "Silver, Robert"

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    Association between asthma and hypertensive disorders of pregnancy: a secondary analysis of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b) prospective cohort study
    (Elsevier, 2023) Meislin, Rachel; Bose, Sonali; Huang, Xiaoning; Wharton, Robert; Ponce, Jana; Simhan, Hyagriv; Haas, David; Saade, George; Silver, Robert; Chung, Judith; Mercer, Brian M.; Grobman, William A.; Khan, Sadiya S.; Bianco, Angela; Obstetrics and Gynecology, School of Medicine
    Objective:: Asthma is one of the most common comorbid conditions in pregnancy. While asthma has been identified as an independent risk factor for cardiovascular disease in the general population, the influence of active asthma during pregnancy on future cardiac risk is unclear. Growing evidence has linked maternal active asthma to adverse pregnancy outcomes (APOs), such as hypertensive disorders of pregnancy (HDP), including preeclampsia which is a well-defined risk factor for future cardiovascular disease including altered cardiac structure and diastolic dysfunction. A thorough understanding of the relationship between pre-existing asthma and APOs may be instrumental in identifying upstream factors contributing to lifetime maternal cardiovascular risk. However, current knowledge of these relationships has been largely derived from retrospective clinical studies, which limit the precision of capturing APOs. Therefore, we investigated associations between pre-existing asthma and individual subtypes of APOs in a secondary analysis of a prospective multi-center cohort of nulliparous individuals with rigorously adjudicated pregnancy outcomes. Study design:: We included participants from the multisite Nulliparous Outcomes in Pregnancy: Monitoring Mothers to be (nuMom2b) cohort, which recruited nulliparous individuals with a viable, singleton gestation between 60/7 and 136/7 weeks. Details of the study design have been previously described, which included medical histories in standardized interviews. This secondary analysis included individuals aged 18 years or older with a live birth and excluded those with a history of pre-pregnancy hypertension or diabetes. For the purposes of this analysis, we defined active asthma as a self-reported history of asthma and on current asthma treatment, including use of bronchodilator, inhaled steroid, or immune modulator, captured at the first trimester visit. The primary outcome was HDP and secondary outcomes included other APOs. Characteristics between participants who did and did not have asthma were compared. Univariate and multivariate logistic regression, described using odds ratios (ORs) and adjusted ORs (aORs) and 95% confidence intervals (95% CI), was used to determine risk of APOs. Models were adjusted for maternal age, study site, insurance type (marker of socioeconomic status), and smoking status at the first trimester visit. Race/ethnicity and body mass index (BMI) were excluded from fully adjusted models as race/ethnicity was considered as a factor reflective of the social determinants of health and BMI was conceptualized as within the casual pathway for developing HDP. The study was approved by all local institutional review boards, and participants gave written informed consent. Analyses were conducted using STATA (MP 17, College Station, TX). Results: Of 8,741 individuals included, 1,521 (17.4%) reported a diagnosis of asthma at the first trimester visit, of whom 588 (38.7%) reported the use of any asthma medication. When comparing participants with and without asthma, a higher proportion of those with asthma reported smoking tobacco in the three months prior to pregnancy (20.7% vs 16.5%) (Table 1). Univariate logistic regression revealed that a diagnosis of asthma was associated with a significantly higher risk of HDP (OR: 1.21 [1.04, 1.42]). Following adjustment, risk of HDP remained significantly higher (aOR: 1.23 [1.06, 1.42]), specifically preeclampsia (aOR: 1.21, [1.02, 1.45]). Secondary analyses in participants with active asthma (ie additional reported use of asthma medication during or before the first trimester) demonstrated a significantly higher risk of HDP (aOR 1.32 [1.06–1.65]) including preeclampsia (aOR 1.27 [1.07–1.51]; in addition to spontaneous preterm birth (aOR 1.60 [1.30–1.96]). Conclusions: In a diverse, nationally representative sample of nulliparous individuals,, a diagnosis of asthma was associated with a significantly higher risk of HDP. Active asthma increased the risk of both spontaneous preterm birth and HDP. This analysis supports the importance of identifying active asthma as a risk factor for APOs associated with a higher risk of future cardiovascular disease.
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    Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes
    (American Medical Association, 2021-09-01) Yee, Lynn M.; Silver, Robert; Haas, David M.; Parry, Samuel; Mercer, Brian M.; Wing, Deborah A.; Reddy, Uma; Saade, George R.; Simhan, Hyagriv; Grobman, William A.; Obstetrics and Gynecology, School of Medicine
    Importance: Health literacy is considered an important social determinant of health that may underlie many health disparities, but it is unclear whether inadequate health literacy among pregnant individuals is associated with adverse maternal and neonatal outcomes. Objective: To assess the association between maternal health literacy and maternal and neonatal outcomes among nulliparous individuals. Design, setting, and participants: This was a secondary analysis of a large, multicenter cohort study of 10 038 nulliparous individuals in the US (2010-2013). Participants underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted. Data analysis was performed from July to December 2019. Exposures: Between 16 and 21 weeks of gestation, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form, a validated 7-item word recognition test. In accordance with standard scoring, results were dichotomized as inadequate vs adequate health literacy. Main outcomes and measures: On the basis of theoretical causal pathways between health literacy and health outcomes, a priori maternal and neonatal outcomes (determined via medical records) were selected for this analysis. Multivariable Poisson regression models were constructed to estimate the associations between health literacy and outcomes. Sensitivity analyses in which education was removed from models and that excluded individuals who spoke English as a second language were performed. Results: Of 9341 participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form, the mean (SD) age was 27.0 (5.6) years, and 2540 (27.4%) had publicly funded prenatal care. Overall, 1638 participants (17.5%) had scores indicative of inadequate health literacy. Participants with inadequate health literacy were more likely to be younger (mean [SD] age, 22.9 [5.0] vs 27.9 [5.3] years), have less educational attainment (some college education or greater, 1149 participants [73.9%] vs 5279 participants [94.5%]), have publicly funded insurance (1008 participants [62.2%] vs 1532 participants [20.0%]), and report they were a member of an underrepresented racial or ethnic group (non-Hispanic Black, 506 participants [30.9%] vs 780 participants [10.1%]; Hispanic, 516 participants [31.5%] vs 948 participants [12.3%]) compared with those with adequate health literacy. Participants who had inadequate health literacy had greater risk of cesarean delivery (adjusted risk ratio [aRR], 1.11; 95% CI, 1.01-1.23) and major perineal laceration (aRR, 1.44; 95% CI, 1.03-2.01). The adjusted risks of small-for-gestational-age status (aRR, 1.34; 95% CI, 1.14-1.58), low birth weight (aRR, 1.33; 95% CI, 1.07-1.65), and 5-minute Apgar score less than 4 (aRR, 2.78; 95% CI, 1.16-6.65) were greater for neonates born to participants with inadequate health literacy. Sensitivity analyses confirmed these findings. Conclusions and relevance: These findings suggest that inadequate maternal health literacy is associated with a variety of adverse maternal and neonatal outcomes.
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    Low-Dose Aspirin for the Prevention of Preterm Delivery in Nulliparous Women with a Singleton Pregnancy: A Randomised Multi-country Placebo Controlled Trial
    (Elsevier, 2020) Hoffman, Matthew K.; Goudar, Shivaprasad S.; Kodkany, Bhalachandra S.; Metgud, Mrityunjay; Somannavar, Manjunath; Okitawutshu, Jean; Lokangaka, Adrien; Tshefu, Antoinette; Bose, Carl L.; Mwapule, Abigail; Mwenechanya, Musaku; Chomba, Elwyn; Carlo, Waldemar A.; Chicuy, Javier; Figueroa, Lester; Garces, Ana; Krebs, Nancy F.; Jessani, Saleem; Zehra, Farnaz; Saleem, Sarah; Goldenberg, Robert L.; Kurhe, Kunal; Das, Prabir; Patel, Archana; Hibberd, Patricia L.; Achieng, Emmah; Nyongesa, Paul; Esamai, Fabian; Liechty, Edward A.; Goco, Norman; Hemingway-Foday, Jennifer; Moore, Janet; Nolen, Tracy L.; McClure, Elizabeth M.; Koso-Thomas, Marion; Miodovnik, Menachem; Silver, Robert; Derman, Richard J.; Pediatrics, School of Medicine
    Background: Preterm birth remains a common cause of neonatal mortality with a disproportionate burden occurring in low and middle-income countries. Meta-analyses of low-dose aspirin to prevent preeclampsia suggest that the incidence of preterm birth may also be decreased, particularly if initiated before 16 weeks. Methods: We completed a randomised multi-country (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) double masked trial of aspirin (81 mg) daily compared to placebo initiated between 6 weeks and 0 days and 13 weeks and 6 days of pregnancy in nulliparous women between14 and 40 years of age with an ultrasound confirming gestational age and singleton viable pregnancy. Randomisation (1:1) was stratified by site. The primary outcome of preterm birth, defined as delivery prior to 37 weeks gestational age, was analyzed in randomised women with pregnancy outcomes at or after 20 weeks. This study is registered with ClinicalTrials.gov, number NCT02409680, and the Clinical Trial Registry, India, number CTRI/2016/05/006970. Findings: From March 2016 through June 2018, 11,976 women were assigned to aspirin (5,990 women) or placebo (5,986 women). Amongst randomised women, an evaluable birth outcome beyond 20 weeks occurred in 5787 women who received Aspirin and 5771 women who received placebo Preterm birth occurred in 11.6% of women randomised to aspirin and 13.1% randomised to placebo (Relative Risk [RR], 0.89; 95% CI, 0.81 to 0.98; Risk Difference, −0·02; 95% CI, −0·03, −0·01). Women randomised to aspirin were less likely to experience perinatal mortality (45.7/1000 vs 53.6/1000; RR, 0.86; 95%CI, 0.73 to 1.00). Other adverse maternal/neonatal events were similar between the two groups. Interpretation: In nulliparous women with singleton pregnancies, low dose aspirin initiated between 6 weeks and 0 days and 13 weeks and 6 days results in lower rates of preterm delivery before 37 weeks and perinatal mortality.
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    Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b
    (Oxford University Press, 2023) Yan, Qi; Guerrero, Rafael F.; Khan, Raiyan R.; Surujnarine, Andy A.; Wapner, Ronald J.; Hahn, Matthew W.; Raja, Anita; Salleb-Aouissi, Ansaf; Grobman, William A.; Simhan, Hyagriv; Blue, Nathan R.; Silver, Robert; Chung, Judith H.; Reddy, Uma M.; Radivojac, Predrag; Pe’er, Itsik; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWASs) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display extensive results, we developed a web-based tool GnuMoM2b (https://gnumom2b.cumcobgyn.org/) for searching, visualizing, and sharing results from a GWAS of 479 pregnancy traits as well as phenome-wide association studies of more than 17 million single nucleotide polymorphisms. The genetic results from 3 ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.