Women of color are disproportionately impacted by gestational diabetes (GDM), a common pregnancy complication, and are two to four times at greater risk of developing type 2 diabetes after having GDM. Our mixed-methods A1c in Pregnancy and Postpartum Linkage for Equity (APPLE) NYC Cohort Study investigates the association between social and built neighborhood environments and postpartum hemoglobin A1c trajectories, how policies influence both neighborhood and individual risk factors of the progression from gestational diabetes to type 2 diabetes. We are also exploring what are the lived experiences of women of color, living in NYC, who had GDM during pregnancy and how their neighborhoods, social support, and healthcare teams shaped diabetes postpartum. The APPLE Cohort study is made possible by our collaborative teams at Icahn School of Medicine at Mount Sinai and the Bureaus of Vital Statistics and Equitable Health Systems at the New York City Department of Health and Mental Hygiene.
The GLOBE Initiative
Increasing awareness of structural racism and health care inequities has fueled new urgency to train medical students in the social and structural determinants of health. In collaboration with our colleagues at Icahn School of Medicine at Mount Sinai, our Galvanizing Learning in Obstetric and Gynecologic Equity (GLOBE Initiative) program seeks to address the know-do gap in equity training among medical students. The GLOBE Initiative aims to provide medical students with the skills to use an intersectional framework to improve clinical interactions with racial gender, and sexual orientation diverse patient population, and use research to improve equity and quality in OB/GYN care. Our GLOBE Community Advisory Board will be comprised of medical students and advocates from reproductive justice and LGBTQ+ communities who will ensure that core competencies in antisexist and antiracist frameworks are embedded in our program.
Under longstanding federal law Pregnancy Medicaid and CHIP are guaranteed to cover healthcare up to 60 days postpartum. Our “Postpartum Outcomes and Extension of Medicaid: POEM for Equity” study evaluates the maternal health equity impact of expanding postpartum Medicaid coverage to up to 12 months under COVID-19 related policy changes. We are using an adaptive concurrent mixed methods design to understand how the extension affected rates and utilization of postpartum Medicaid coverage, as well as racial, ethnic, and nativity disparities in access to and utilization of postpartum healthcare services. Through qualitative interviews, we are gathering stories about how these changes affected the experiences of birthing people with Medicaid and CHIP, healthcare workers, and policymakers involved in the postpartum coverage extension. POEM for Equity is conducted through collaboration with our research partners at Icahn School of Medicine at Mount Sinai, NYU Grossman School of Medicine, the SUNY University at Albany, and UTHealth Houston.
The COVID-19 pandemic has pushed long-standing racial-ethnic disparities in health and health care into the spotlight, and pregnancy is no exception. Our coronavirus Impact on Birth Equity Study looks at how racism and the COVID-19 pandemic effects postpartum outcomes. Our overarching goal was to better understand the association between experiences of racism, COVID-19 related stress, community resilience, and postpartum cardiovascular and mental health outcomes among Asian, Black, and Hispanic birthing people in Philadelphia and New York City. This research project wouldn’t have been possible without our research collaborators at the University of Pennsylvania, Icahn School of Medicine at Mount Sinai, and our Community Working Group comprised of birth justice advocates.
Research Collaborations
Postpartum, aka the “4th Trimester” is increasingly seen as an important period for preventing Maternal morbidity and mortality which disproportionately impacts Global Majority birthing. Delivery admission presents an opportunity to screen patients for risk of adverse outcomes, such as depressive symptoms and hypertension, resulting in postpartum readmissions and emergency department visits. We developed a novel equity-informed prediction model of postpartum hospital utilization (PHU) using LASSO logistic regression and machine learning approaches. Our model predicts all causes of PHU performed better than “standard” stratification approaches in racial-ethnic disparity reduction and could be used to identify patients at high risk of developing postpartum complications. Our 4th Trimester study is part of a larger project led by Dr. Elizabeth Howell at the University of Pennsylvania. This work was conducted in collaboration with investigators at the University of Pennsylvania Perelman School of Medicine, Icahn School of Medicine at Mount Sinai, Paris Descartes University, and the University of Washington.
The VIBE Research Lab is currently funded by the Helmsley Foundation, National Institutes for Health, the National Institute on Minority and Health Disparities, the National Institute of Diabetes and Digestive Kidney Diseases, the Office of Research on Women’s Health, and the Robert Wood Johnson Foundation.