Browsing by Author "Yee, Lynn M."
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Item Association of Genetic Predisposition and Physical Activity With Risk of Gestational Diabetes in Nulliparous Women(American Medical Association, 2022-08-01) Pagel, Kymberleigh A.; Chu, Hoyin; Ramola, Rashika; Guerrero, Rafael F.; Chung, Judith H.; Parry, Samuel; Reddy, Uma M.; Silver, Robert M.; Steller, Jonathan G.; Yee, Lynn M.; Wapner, Ronald J.; Hahn, Matthew W.; Natarajan, Sriraam; Haas, David M.; Radivojac, Predrag; Obstetrics and Gynecology, School of MedicineImportance: Polygenic risk scores (PRS) for type 2 diabetes (T2D) can improve risk prediction for gestational diabetes (GD), yet the strength of the association between genetic and lifestyle risk factors has not been quantified. Objective: To assess the association of PRS and physical activity in existing GD risk models and identify patient subgroups who may receive the most benefits from a PRS or physical activity intervention. Design, settings, and participants: The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort was established to study individuals without previous pregnancy lasting at least 20 weeks (nulliparous) and to elucidate factors associated with adverse pregnancy outcomes. A subcohort of 3533 participants with European ancestry was used for risk assessment and performance evaluation. Participants were enrolled from October 5, 2010, to December 3, 2013, and underwent genotyping between February 19, 2019, and February 28, 2020. Data were analyzed from September 15, 2020, to November 10, 2021. Exposures: Self-reported total physical activity in early pregnancy was quantified as metabolic equivalents of task (METs). Polygenic risk scores were calculated for T2D using contributions of 84 single nucleotide variants, weighted by their association in the Diabetes Genetics Replication and Meta-analysis Consortium data. Main outcomes and measures: Estimation of the development of GD from clinical, genetic, and environmental variables collected in early pregnancy, assessed using measures of model discrimination. Odds ratios and positive likelihood ratios were used to evaluate the association of PRS and physical activity with GD risk. Results: A total of 3533 women were included in this analysis (mean [SD] age, 28.6 [4.9] years). In high-risk population subgroups (body mass index ≥25 or aged ≥35 years), individuals with high PRS (top 25th percentile) or low activity levels (METs <450) had increased odds of a GD diagnosis of 25% to 75%. Compared with the general population, participants with both high PRS and low activity levels had higher odds of a GD diagnosis (odds ratio, 3.4 [95% CI, 2.3-5.3]), whereas participants with low PRS and high METs had significantly reduced risk of a GD diagnosis (odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .01). Conclusions and relevance: In this cohort study, the addition of PRS was associated with the stratified risk of GD diagnosis among high-risk patient subgroups, suggesting the benefits of targeted PRS ascertainment to encourage early intervention.Item 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 MedicineImportance: 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.Item Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk(American Heart Association, 2023) Khan, Sadiya S.; Petito, Lucia C.; Huang, Xiaoning; Harrington, Katharine; McNeil, Rebecca B.; Bello, Natalie A.; Bairey Merz, C. N.; Miller, Eliza C.; Ravi, Rupa; Scifres, Christina; Catov, Janet; Pemberton, Victoria; Varagic, Jasmina; Zee, Phyllis C.; Yee, Lynn M.; Ray, Mitali; Kim, Jin Kyung; Lane-Cordova, Abbi; Lewey, Jennifer; Theilen, Lauren H.; Saade, George R.; Greenland, Philip; Grobman, William A.; Obstetrics and Gynecology, School of MedicineBackground: Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors. Methods: The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks-13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels. Results: Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10-1.18]), hyperlipidemia (1.11 [95% CI, 1.08-1.14]), and diabetes (1.03 [95% CI, 1.01-1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61-2.40]) and hyperlipidemia (1.31 [95% CI, 1.03-1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%-15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth. Conclusions: There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.Item Neighborhood Socioeconomic Disadvantage and Abnormal Birth Weight(Wolters Kluwer, 2023) Venkatesh, Kartik K.; Yee, Lynn M.; Johnson, Jasmine; Wu, Jiqiang; McNeil, Becky; Mercer, Brian; Simhan, Hyagriv; Reddy, Uma M.; Silver, Robert M.; Parry, Samuel; Saade, George; Chung, Judith; Wapner, Ronald; Lynch, Courtney D.; Grobman, William A.; Obstetrics and Gynecology, School of MedicineObjective: To examine whether exposure to community or neighborhood socioeconomic disadvantage as measured by the ADI (Area Deprivation Index) is associated with risk of abnormal birth weight among nulliparous individuals with singleton gestations. Methods: This was a secondary analysis from the prospective cohort NuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be). Participant addresses at cohort enrollment between 6 and 13 weeks of gestation were geocoded at the Census tract level and linked to the 2015 ADI. The ADI, which incorporates the domains of income, education, employment, and housing quality into a composite national ranking of neighborhood socioeconomic disadvantage, was categorized by quartiles (quartile 1, least disadvantaged, reference; quartile 4, most disadvantaged). Outcomes were large for gestational age (LGA; birth weight at or above the 90th percentile) and small for gestational age (SGA; birth weight below the 10th percentile) compared with appropriate for gestational age (AGA; birth weight 10th-90th percentile) as determined with the 2017 U.S. natality reference data, standardized for fetal sex. Multinomial logistic regression models were adjusted for potential confounding variables. Results: Of 8,983 assessed deliveries in the analytic population, 12.7% (n=1,143) were SGA, 8.2% (n=738) were LGA, and 79.1% (n=7,102) were AGA. Pregnant individuals living in the highest ADI quartile (quartile 4, 17.8%) had an increased odds of delivering an SGA neonate compared with those in the lowest referent quartile (quartile 1, 12.4%) (adjusted odds ratio [aOR] 1.32, 95% CI 1.09-1.55). Pregnant individuals living in higher ADI quartiles (quartile 2, 10.3%; quartile 3, 10.7%; quartile 4, 9.2%) had an increased odds of delivering an LGA neonate compared with those in the lowest referent quartile (quartile 1, 8.2%) (aOR: quartile 2, 1.40, 95% CI 1.19-1.61; quartile 3, 1.35, 95% CI 1.09-1.61; quartile 4, 1.47, 95% CI 1.20-1.74). Conclusion: Neonates of nulliparous pregnant individuals living in U.S. neighborhoods with higher area deprivation were more likely to have abnormal birth weights at both extremes.Item Persistent Short Sleep Duration From Pregnancy to 2 to 7 Years After Delivery and Metabolic Health(American Medical Association, 2024-12-02) Kim, Minjee; Wiener, Laura Elizabeth; Gilbert, Jace; McNeil, Rebecca B.; Reid, Kathryn J.; Grobman, William A.; Facco, Francesca; Haas, David M.; Silver, Robert M.; Greenland, Philip; Yee, Lynn M.; Zee, Phyllis C.; Obstetrics and Gynecology, School of MedicineImportance: Short sleep duration during pregnancy and the perimenopausal period has been associated with adverse cardiometabolic outcomes. However, it remains unclear how sleep duration changes after delivery and whether such changes are associated with the cardiometabolic health of birthing people. Objective: To investigate whether persistently short sleep during pregnancy and after delivery is associated with incident hypertension and metabolic syndrome. Design, setting, and participants: This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (NuMoM2b-HHS), an ongoing prospective cohort study, was conducted between September 5, 2023, and March 1, 2024, in 8 US academic medical centers. Participants were aged 18 years or older at NuMoM2b enrollment; recruited during their first pregnancy between October 1, 2010, and September 30, 2013; and followed up for a mean (SD) of 3.1 (0.9) years after delivery. Exposures: Self-reported short sleep duration (<7 hours) during pregnancy and 2 to 7 years after delivery was defined as persistent short sleep. Main outcomes and measures: Incident hypertension and metabolic syndrome (MetS) at follow-up. Regression models were used to estimate relative risks of incident hypertension and MetS by sleep duration pattern. Hypertension analyses excluded participants with hypertension at baseline, and MetS analyses excluded participants with MetS at baseline. Multivariable models included a priori covariates of baseline age and time from delivery to follow-up. Incident hypertension analyses included an additional covariate of body mass index at baseline. Results: Among 3922 participants (mean [SD] age, 27.3 [5.4] years; 598 Hispanic [15.2%], 485 non-Hispanic Black [12.4%], and 2542 non-Hispanic White [64.8%]), 565 individuals (14.4%) experienced persistent short sleep. Non-Hispanic Black (adjusted odds ratio [aOR], 2.17; 95% CI, 1.59-2.97) and unmarried (aOR, 1.68, 95% CI, 1.29-2.19) participants were significantly more likely to experience persistent short sleep compared with non-Hispanic White and married participants, respectively. Persistent short sleep was associated with higher odds of incident MetS (aOR, 1.60; 95% CI, 1.21-2.11) but not incident hypertension (aOR, 0.91; 95% CI, 0.69-1.19). Conclusions and relevance: In this study, short sleep duration that persisted from pregnancy to 2 to 7 years after delivery was associated with a greater risk for adverse cardiometabolic outcomes. Future studies should explore whether sleep-targeted interventions during and after pregnancy are associated with improved cardiometabolic health outcomes, particularly among populations at increased risk.Item Quality of periconceptional dietary intake and maternal and neonatal outcomes(Elsevier, 2020-01) Yee, Lynn M.; Silver, Robert M.; Haas, David M.; Parry, Samuel; Mercer, Brian M.; Iams, Jay; Wing, Deborah; Parker, Corette B.; Reddy, Uma M.; Wapner, Ronald J.; Grobman, William A.; Obstetrics and Gynecology, School of MedicineBackground Periconceptional diet quality is commonly suboptimal and sociodemographic disparities in diet quality exist. However, it is unknown whether individual periconceptional diet quality is associated with obstetric outcomes. Objective Our objective was to assess differences in maternal and neonatal outcomes according to maternal periconceptional diet quality. Study Design This is a secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous women receiving obstetrical care at 8 United States centers. Women underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted by trained research personnel. In the first trimester (between 6 and 13 weeks), women completed the modified Block 2005 Food Frequency Questionnaire, a semiquantitative assessment of usual dietary intake for the 3 months around conception. Responses were scored using the Healthy Eating Index–2010, which assesses adherence to the 2010 Dietary Guidelines for Americans. Higher scores on the Healthy Eating Index represent better adherence. Healthy Eating Index scores were analyzed by quartile; quartile 4 represents the highest dietary quality. Bivariable and multivariable analyses were performed to assess associations between diet quality and outcomes. A sensitivity analysis in which markers of socioeconomic status were included in the multivariable Poisson regression models was performed. Results In the cohort of 8259 women with Healthy Eating Index data, the mean Healthy Eating Index score was 63 (±13) of 100. Women with the lowest quartile Healthy Eating Index scores were more likely to be younger, non-Hispanic black and Hispanic, publicly insured, low income, and tobacco users. They were more likely to have comorbidities (obesity, chronic hypertension, pregestational diabetes, mental health disorders), a higher prepregnancy body mass index, and less education. Women with lowest quartile scores experienced less frequent major perineal lacerations and more frequent postpartum hemorrhage requiring transfusion and hypertensive disorders of pregnancy, which persisted on multivariable analyses (controlling for age, body mass index, tobacco use, chronic hypertension, pregestational diabetes mellitus, and mental health disorders) comparing women in each quartile with quartile 4. Additionally, women in quartiles 1 and 2 experienced greater adjusted relative risk of cesarean delivery compared with women in quartile 4. Neonatal outcomes also differed by dietary quartile, with women in the lowest Healthy Eating Index quartile experiencing greater adjusted relative risk of preterm birth, neonatal intensive care unit admission, small for gestational age infant, and low birthweight, and lower risk of macrosomia; all neonatal findings also persisted in multivariable analyses. The sensitivity analysis with inclusion of markers of socioeconomic status (race/ethnicity, insurance status, marital status) in the multivariable models supported these findings. Conclusion Periconceptional diet quality among women in the United States is poor. Poorer periconceptional dietary quality is associated with adverse maternal and neonatal outcomes, even after controlling for potential comorbidities and body mass index, suggesting periconceptional diet may be an important social or biological determinant of health underlying existing health disparities.