Research Spotlights: December 2021

Homicide is a leading cause of maternal mortality in the U.S.

Recently published research supported by the NICHD took a closer look at the incidence of pregnancy-associated homicide in the U.S. Previous research using single cities, states, or other geographic subsets have shown that homicide is a leading cause of death during pregnancy and the postpartum period. However, maternal mortality estimates do not include homicide and other violent causes of death. In this current study, researchers analyzed the first 2 years of nationally available maternal mortality data and reported the national prevalence of pregnancy-associated homicide.

Using data from the National Center for Health Statistics (2018, 2019), the researchers identified female decedents (ages 10-44) and estimated 2-year pregnancy-associated homicide mortality ratios and compared them with homicide mortality among nonpregnant, nonpostpartum women and to mortality ratios for direct maternal causes of death (hemorrhage, sepsis, etc.). They compared characteristics (age, race and ethnicity, mechanism (gunshot, stabbing, etc.), and place of injury) and estimated homicide mortality rate ratios between pregnant or postpartum and nonpregnant, nonpostpartum women for the total population and with stratification by race and ethnicity and age.

The researchers found that women who are pregnant or were recently pregnant die by homicide at more than twice the rate that they die of direct maternal causes (hemorrhage, placental disorders, sepsis). Becoming pregnant increases the risk of death by homicide at a rate 16% higher than nonpregnant women. Black women who are pregnant or recently pregnant have a nearly three-fold higher risk of death by homicide than those who are not pregnant. Age is also a factor in pregnancy-related homicide, with women ages 10-24 at higher risk of homicide while pregnant than women who are older. Additionally, the majority of pregnancy-associated homicides occurred in the home, implicating the likelihood of involvement by persons known to the victim. Of these incidents, nearly 7 of 10 involved a firearm, making firearms the most common means of perpetrating pregnancy-associated homicide.

The study findings have some limitations including the lack of circumstantial information and incomplete data on victim characteristics, and the potential for false-positives and false-negatives when recording pregnancy status, which could lead to underestimates of pregnancy-associated homicides, and the lack of data on pregnancy outcomes for women who experienced live birth, abortion, or miscarriage within the year prior to their death.

In summary, this study found that homicide is a leading cause of death during pregnancy and the postpartum period in the U.S. Pregnancy and the postpartum period are times of elevated risk for homicide among all women, but especially for Black and young women. This research highlights the need for action on recommendations and interventions to prevent maternal deaths from homicide.

Wallace M, Gillispie-Bell V, Cruz K, Davis K, Vilda D. Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019. Obstet Gynecol. 2021 Nov 1;138(5):762-769. doi: 10.1097/AOG.0000000000004567. PMID: 34619735.

The biological impacts of social isolation among older adults

Social isolation is a risk factor for morbidity and mortality, but what are biological mechanisms underpinning this connection? In a study funded by the NIA, NIMHD, and the Secunda Family Foundation, researchers explored this question among older adults by combining social isolation information with two biological markers of inflammation that have been linked to a range of negative health outcomes.

Researchers utilized data from the National Health and Aging Trends Study (NHATS), which is a representative cohort of Medicare beneficiaries aged 65 years and older. Participants completed two-hour interviews, including physical activities and blood spot collection. Participants who could not provide consent, did not live independently, or did not have biological marker assay results were excluded. The analytic sample for the current study included 4,648 respondents, and included measures of sociodemographics (age, gender, race/ethnicity, income), health factors (smoking, BMI, number of chronic diseases, dementia, depressive symptoms, and frailty), self-reported social isolation, and biological markers of inflammation measured via Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (CRP) gathered from the dried blood spot collection.

Over 20% of the sample identified as socially isolated (4% severely socially isolated, 17% socially isolated). Furthermore, researcher identified an important association between social isolation and biological markers of inflammation. In the unadjusted models, older adults that experienced social isolation had higher levels of CRP and IL-6 than their peers who did not. In the models adjusted for both sociodemographic and health factors, individuals with social isolation had significantly higher levels of CRP than those not isolated. Although the results for IL-6 followed a similar pattern, the differences between groups were not statistically significant.

In sum, social isolation is a significant health problem, particularly among the aging population. This novel research contributes to the understanding of the association between social isolation and its impacts on the body’s inflammation response among older adults living in the community. This research may also help to inform future clinical and/or social interventions to address social isolation among older adults as well as potential biomarker development for social isolation interventions. These findings are important because clinical and social interventions to address social isolation among older adults may influence these biological processes and their potentially negative effects. Furthermore, biomarkers may serve as an important outcome measure for social isolation interventions. These findings are important because clinical and social interventions to address social isolation among older adults may influence these biological processes and their potentially negative effects. Furthermore, biomarkers may serve as an important outcome measure for social isolation interventions.

Cudjoe, T. K. M., Selvakumar, S., Chung, S. E., Latkin, C. A., Roth, D. L., Thorpe, R. J., & Boyd, C. M. (2021). Getting under the skin: Social isolation and biological markers in the National Health and Aging Trends Study. Journal of the American Geriatrics Society (online version ahead of print).

The COVID-19 pandemic altered food-related parenting practices of parents with young children

Public health measures used to mitigate the spread of COVID-19 has created changes to many family routines. Nationwide mandates in the U.S. were used to reduce large gatherings of individuals through closure of businesses and the cancellation of social activities. Thus, many family centered activities such as schools, parks, and engagement of social support were significantly reduced which caused changes to daily family routines such as food and eating patterns, sleep quality, and work changes (at home-virtual). The COVID-19 pandemic may have impacted maternal and child nutrition by altering feeding behaviors in the family environment. Researchers funded by the NCATS, NHLBI, and NICHD investigated changes in food related parenting practices before and during COVID-19. More specifically, they evaluated parents’ daily use of coercive, indulgent, structured, and autonomy supportive food parenting practices before and during COVID-19. Secondly, they evaluated potential contributions of parent and child mood/behavior with use of specific food related parenting practices during the pandemic.

Parents and their preschooler dyads were recruited from the EAT (Eating and Activity Timing, n=1491) parent study. A subset of data was collected to study food parenting practices among preschoolers ages 2-5 from 2010-2018 from 119 participants. Ecological Momentary Assessment (EMA) was used to assess momentary use of food related parenting practices and child mood/behaviors over multiple days, at baseline, and followed up via surveys. Follow up began at the end of March 2020 which included questions to understand the impact of COVID-19 and EMA data collected after survey completion. COVID-19 follow up surveys and a second ten-day EMA were collected from 72 participants during April 2020. Pairwise t test was used to compare the individualized mean values of domain in pre-COVID and during survey.

Most parents of preschoolers were found to use coercive control, indulgence, structure, and/or autonomy support methods of food parenting practices. Healthy dietary intake and eating patterns in children decreased during the COVID-19 pandemic. Parental negative mood during COVID-19 was associated with higher coercive control and with lower levels of structure. Positive child mood was associated with more use of autonomy support food parenting methods.

In summary, this research demonstrates that the COVID-19 pandemic has impacted the feeding patterns of young children and effects family behavioral associations of parents of preschoolers. Food parenting practices during COVID-19 show lower levels of structure and autonomy support and were found to change based on parent and child mood. As practitioners began development of programs to address COVID-19 impact on families, stress and mood in parents and children should be considered as factors that influence family dynamics as shifts in behaviors were observed during the COVID-19 pandemic.

Loth, K. A., Ji, Z., Wolfson, J., Berge, J. M., Neumark-Sztainer, D., & Fisher, J. O. (2021). COVID-19 pandemic shifts in food-related parenting practices within an ethnically/racially and socioeconomically diverse sample of families of preschool-aged children. Appetite, 105714. Advance online publication.