Shalmali Bane

All Publications

• Risk factors for the recurrence of Severe Maternal Morbidity in first and second births in California, 1997-2020. American journal of obstetrics and gynecology Bane, S., Magalhães, M., Snowden, J. M., Kan, P., Lyndon, A., Carmichael, S. L. 2025

  Abstract

  To examine the recurrence risk of SMM and SMM subtypes among specific subgroups, such as age, race/ethnicity, educational status, and insurance status.We used vital records (live birth and fetal death certificates) from 1997 to 2020 that were linked to maternal hospital discharge records to identify 1,989,104 first and second birth pairs. The outcomes, SMM and non-transfusion SMM (nt-SMM), were identified using ICD-9/10 codes for 21 indicators and further categorized into 8 subtypes based on the organ systems impacted (cardiac SMM, renal SMM, respiratory SMM, hemorrhage SMM, sepsis SMM, other obstetric SMM, other medical SMM, and transfusion SMM). We used sequentially adjusted modified Poisson regression model with bootstrapped errors to estimate the recurrences of composite SMM,SMM subtypes, and SMM indicators between first and second birth. Risk ratios were stratified by the following: age, education, insurance, interpregnancy interval, nativity, plurality, race/ethnicity, and the Expanded Obstetric Comorbidity Index.The recurrence risk ratio of overall SMM and nt-SMM between first and second births were 3.4 (95% CI: 2.9-4.1) and 3.7 (95% CI: 2.6-5.3), respectively, adjusted for sociodemographic and clinical factors. Among the SMM subtypes, the adjusted risk of recurrence was particularly elevated among individuals who experienced other medical SMM (RR: 119, 95% CI: 30-267) and cardiac SMM (RR: 32.6, 95% CI: 6.6-88.4). In stratified analyses, recurrence risk ratios were highest among individuals with higher education, private insurance, singleton pregnancies, and lower co-morbidity scores (all groups with lower absolute prevalence of SMM). Hispanic populations had a notably lower recurrence risk ratios for SMM compared with White, Black and Asian subgroups. For nt-SMM, Black individuals were the only group that had both higher absolute prevalence and higher recurrence risk ratios for nt-SMM (relative to other racial and ethnic subgroups).The recurrence risk of SMM and nt-SMM varies by SMM subtypes as well as among sociodemographic subgroups. This recurrence risk remains elevated after adjustment for sociodemographic and clinical factors. We identify subgroups among whom additional counseling and monitoring may be warranted after an initial SMM occurrence, if additional pregnancies are desired. Some groups that typically have a lower absolute prevalence of SMM had higher recurrence risk ratios relative to their counterparts, which suggests the importance of close monitoring for the potential recurrence of SMM, regardless of baseline prevalence based on known risk factors.

  View details for DOI 10.1016/j.ajog.2025.11.005

  View details for PubMedID 41223958

• Severe maternal morbidity in Louisiana by race, rurality, poverty, and availability of care. Public health Gillispie-Bell, V., Bane, S., Martin, J., Kan, P., Mujahid, M. S., Carmichael, S. L. 2025; 246: 105824

  Abstract

  OBJECTIVES: Race-ethnicity and place-based variables such as rurality, ZIP code-level poverty, and county maternity care desert status have been associated with severe maternal morbidity and maternal mortality rates in the US. We examined these associations in Louisiana, which has one of the highest maternal mortality rates in the US.STUDY DESIGN: This was a birth cohort study.METHODS: We used state-wide inpatient birth hospitalization discharge data in Louisiana between 2016 and 2021. Mixed-effects logistic regression models with individuals nested within ZIP codes were used to estimate adjusted odds ratios (aOR) for non-transfusion severe maternal morbidity (nt-SMM, defined using the CDC index) according to race-ethnicity and place-based variables (overall and stratified by race-ethnicity).RESULTS: Among 326,597 birth hospitalizations, 2486 (0.77%) involved nt-SMM. Non-Hispanic Black and Hispanic individuals had increased risk of nt-SMM compared to Non-Hispanic White individuals, after adjustment for sociodemographic factors, a comorbidity index, and place-placed variables (aORs 1.36, 95%CI 1.23-1.51 and 1.39, 95%CI 1.21-1.59, respectively). Residence in a maternity care desert county or rural ZIP code did not increase risk; however, residence in a ZIP code in the highest quartile of poverty was associated with increased risk (aOR 1.26, 95%CI 1.04-1.51). When stratified by race and ethnicity, an increased risk remained for Non-Hispanic Black and Hispanic individuals residing in the highest-poverty ZIP codes (aORs 1.33, 95% CI 1.00-1.78 and 1.32, 95% CI 1.05-1.65, respectively), and a potential increased risk associated with living in a maternity care desert emerged for Black individuals (aOR 1.33, 95% CI 1.00-1.76), but confidence intervals included 1.00.CONCLUSIONS: In Louisiana, to reduce the rate of nt-SMM, social factors must be addressed, especially for non-Hispanic Black individuals living in areas with the highest levels of poverty and in maternity care deserts, as they had the highest risks in this population.

  View details for DOI 10.1016/j.puhe.2025.105824

  View details for PubMedID 40543228

• Can Birth Hospital Explain Racial/Ethnic Differences in Cesarean Birth Among Low-Risk Births? An Analysis of California Data, 2007-2018. Journal of racial and ethnic health disparities Bane, S., Mujahid, M. S., Kan, P., Main, E. K., Carmichael, S. L. 2025

  Abstract

  BACKGROUND: In the US, there is substantial variability in low-risk cesarean birth rate by hospitals and race/ethnicity. The contribution of inequitable hospital quality to disparities in low-risk cesarean births is uncertain. We examine the contribution of birth hospital to racial/ethnic disparities in low-risk cesarean births.METHODS: We used vital records linked with maternal birth hospitalization data (California, 2007-18). We examined self-reported race/ethnicity and low-risk cesarean birth, i.e., nulliparous, term, singleton, and vertex (NTSV) births. Poisson regression models with a mixed effect for hospital and bootstrapped errors were used to compare racial/ethnic differences in cesarean prevalence, adjusted for maternal and hospital characteristics. We used G-computation to assess how the prevalence of cesarean section by racial/ethnic group would change if all births occurred at the same distribution of hospitals as births to White individuals.RESULTS: Among 1,594,277 NTSV births at 212 hospitals, 26.9% were cesarean. After adjustment for hospital characteristics, risk ratios for cesarean birth ranged from 1.05 for foreign-born Hispanic (95% CI 1.02-1.09) to 1.28 for Black (95% CI 1.22-1.33) individuals, relative to White individuals. In the G-computation substitution, cesarean prevalence among NTSV births was reduced for some race/ethnicities and increased for others, ranging from 87 excess events (0.3% increase) in Black populations to 6473 avoided events (5.6% decrease) among US-born Hispanic populations.CONCLUSIONS: Racial/ethnic disparities in cesarean prevalence among low-risk births in California are not explained by individual-level maternal or hospital characteristics.

  View details for DOI 10.1007/s40615-025-02464-z

  View details for PubMedID 40327292

• Episiotomy and severe perineal laceration among Asian American, Native Hawaiian, and Pacific Islander nulliparous individuals in California. AJOG global reports Chidyausiku, T., Bane, S., Sperling, M. M., Main, E. K., Carmichael, S. L. 2025; 5 (1): 100450

  Abstract

  Asian American, Native Hawaiian, and Pacific Islander individuals have increased risks for episiotomy and severe perineal laceration during vaginal delivery. The Asian American, Native Hawaiian, and Pacific Islander population in the US is diverse yet few studies disaggregate results within specific ethnicity populations.This study investigated the variability in risks for episiotomy and severe perineal laceration among 16 disaggregated Asian American, Native Hawaiian, and Pacific Islander groups, compared to Non-Hispanic White nulliparous individuals, and assessed what factors may explain the variability in risk.Birth and fetal death certificate files linked to hospital discharge records were used to identify nulliparous, term, singleton, vertex vaginal deliveries among California births, 2007 to 2020. Poisson regression models were used to examine risks of episiotomy and severe perineal laceration among 16 Asian American, Native Hawaiian, and Pacific Islander ethnicity subgroups compared with Non-Hispanic White individuals. Sequential adjustment was utilized to assess if maternal social, health-related, and delivery-related factors may explain the variability in risk for episiotomy and severe perineal laceration.Among the 224,964 Asian American, Native Hawaiian, and Pacific Islander individuals in this study cohort, the overall prevalence of episiotomy was 18.5% (N = 41,559) and prevalence of severe perineal laceration was 8.9% (N = 20,013); the prevalence of both outcomes declined during the study period. Within subgroups, prevalence of episiotomy ranged from 9.8% among Other-Pacific Islander individuals to 24.5% among Korean individuals. Prevalence of severe perineal laceration ranged from 3.4% in Guamanian individuals to 15.2% in Indian individuals. In fully adjusted models, risk ratios were greater than 1.0 (with confidence intervals excluding 1.0) for 6 subgroups for episiotomy and 9 subgroups for severe perineal laceration, compared to Non-Hispanic White individuals. After adjustment, Korean individuals were at highest risk of episiotomy (adjusted risk ratio 1.80 [95% CI 1.75, 1.85]), and Indian individuals were at highest risk of severe perineal laceration (adjusted risk ratio 2.14 [95% CI 2.07, 2.21]). Adjustment for social factors (nativity; education; payer) tended to attenuate risk ratios; subsequent adjustment for maternal health and delivery-related factors including maternal age, height, pre-pregnancy body mass index, hypertension, diabetes, gestational weight gain, fetal stress/incomplete fetal head rotation (occiput transverse or posterior), large infant size or shoulder dystocia, and forceps/vacuum did not impact risk ratios substantially.Prevalence and risks of episiotomy and severe perineal laceration varied widely among Asian American, Native Hawaiian, and Pacific Islander births in California from 2007 to 2020. The variability in risks was more influenced by differences in social rather than maternal health and delivery-related factors. This study adds to the growing understanding of disparities in health outcomes among Asian American, Native Hawaiian, and Pacific Islander subgroups.

  View details for DOI 10.1016/j.xagr.2025.100450

  View details for PubMedID 40093873

  View details for PubMedCentralID PMC11909455

• Unanswered Questions from Abortion Seekers: An application of the Research Prioritization by the Affected Community (RPAC) protocol in the Central Valley, California. Contraception Bane, S., Rivera, M., Soh, J. S., Yakzan, A., Lopez, K., Henkel, A., Cahill, E., Espinosa, P. R., Carmichael, S., Mastey, N. 2024: 110803

  Abstract

  Despite protections offered in California, there is limited understanding of abortion access in underserved regions, including the Central Valley. Furthermore, there has been limited community involvement, especially from those directly affected, in the development of research priorities in abortion care. We utilized the Research Prioritization of Affected Communities (RPAC) protocol to identify research priority topics and research questions for future abortion-related research.This project was designed and implemented through a partnership between a community-based reproductive justice organization and academic and community researchers. We recruited individuals ≥18 years old, English or Spanish speaking, who previously accessed abortion care in Central California. Over two RPAC sessions, participants shared their uncertainties about the abortion care they received (session 1) and ranked their unanswered questions (session 2). The audio recording of both sessions was transcribed and analyzed using rapid qualitative analysis to identify themes.Participants (n=7) raised 79 unique questions, 57 of which were deemed unanswered and categorized into 11 prioritized topics. Topics with the most questions included costs associated with care (n=9); the role of community; interactions with clinicians; and resources for patients (n=7 for each topic). Participants discussed challenging experiences, barriers, and the importance of social support when receiving abortion care.Using a community-centered approach, we identified topics and questions for future abortion-related research; these could guide researchers and funders. Many questions raised by participants have already been answered in prior research, suggesting that implications of research are not clearly conveyed to those impacted the most.Using a community-centered approach, this study convened individuals who previously received abortion care in the Central Valley of California to identify key research priority topics and questions for future abortion-related research. The list of prioritized topics and questions is a guide for researchers, advocacy groups, and funders.

  View details for DOI 10.1016/j.contraception.2024.110803

  View details for PubMedID 39708943

• Pathways to parenthood among transgender men and gender diverse people assigned female or intersex at birth in the United States: analysis of a Cross-Sectional 2019 Survey. AJOG global reports Bane, S. S., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Tordoff, D. M., Moseson, H. 2024; 4 (3): 100381

  Abstract

  To assess pathways to parenthood, pregnancy outcomes, future pregnancy desire, and fertility counseling experiences among a cross-sectional sample of transgender men and gender diverse individuals assigned female or intersex at birth in the United States.Participants were recruited from The Population Research in Identity and Disparities for Equality (PRIDE) Study and the general public. Eligible participants for this analysis were able to read and understand English, assigned female or intersex at birth, US residents, 18+ years old, and identified as transgender, nonbinary, or gender diverse. We analyzed responses to close-ended survey questions, overall and stratified by gender identity, race/ethnicity, and testosterone use. We also qualitatively assessed open-text responses on fertility counseling.Among the 1694 participants, median age was 27 years (range: 18-72), 12% had ever been pregnant, and 12% were parents. Carrying a pregnancy where the individual was the egg source (36%) was the most common pathway to parenthood. Individuals with an exclusively binary gender identity (ie, transgender man or man) more often reported becoming parents through adoption than individuals with gender diverse identities (19% vs 12%). A third of individuals did not receive fertility counseling prior to initiating testosterone; individuals who exclusively reported nonbinary identities were recommended to investigate fertility preservation options less often (36%) compared to transgender men (50%).Transgender men and gender diverse individuals who were assigned female or intersex at birth build their families through a variety of pathways, including pregnancy, stepparenting, and adoption. Clinicians should avoid making assumptions about reproductive desires in these populations based on gender identities or testosterone use and should provide consistent fertility counseling prior to and after hormone initiation.

  View details for DOI 10.1016/j.xagr.2024.100381

  View details for PubMedID 39253027

  View details for PubMedCentralID PMC11381974

• A Counterfactual Analysis of Impact of Cesarean Birth in a First Birth on Severe Maternal Morbidity in the Subsequent Birth. Epidemiology (Cambridge, Mass.) Bane, S., Snowden, J. M., Simard, J. F., Odden, M., Kan, P., Main, E. K., Carmichael, S. L. 2024

  Abstract

  It is known that cesarean birth affects maternal outcomes in subsequent pregnancies, but specific effect estimates are lacking. We sought to quantify the effect of cesarean birth reduction among nulliparous, term, singleton, vertex (NTSV) births (i.e., preventable cesarean births) on severe maternal morbidity (SMM) in the second birth.We examined birth certificates linked with maternal hospitalization data (2007-19) from California for NTSV births with a second birth (N = 779,382). The exposure was cesarean delivery in first birth and the outcome was SMM in the second birth. We used adjusted Poisson regression models to calculate risk ratios and population attributable fraction for SMM in the second birth and conducted a counterfactual impact analysis to estimate how lowering NTSV cesarean births could reduce SMM in second birth.The adjusted risk ratio for SMM in the second birth given a prior cesarean birth was 1.7 (95% CI 1.5-1.9); 15.5% (95% CI 15.3%-15.7%) of this SMM may be attributable to prior cesarean birth. In a counterfactual analysis where 12% of the California population least likely to get a cesarean birth instead delivered vaginally, we observed 174 fewer SMM events in a population of individuals with a low-risk first birth and a subsequent birth.In our counterfactual analysis, lowering primary cesarean birth among a NTSV population was associated with fewer downstream SMM events in subsequent births and overall. Additionally, our findings reflect the importance of considering the cumulative accrual of risks across the reproductive life-course.

  View details for DOI 10.1097/EDE.0000000000001775

  View details for PubMedID 39058553

• Misdiagnosis, missed diagnosis and delayed diagnosis of lupus: A qualitative study of rheumatologists. Arthritis care & research Bane, S., Falasinnu, T., Rodriguez Espinosa, P., Simard, J. F. 2024

  Abstract

  Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette-based experimental study revealed that demographic factors influenced rheumatologists' diagnoses of SLE, raising concerns about potential diagnostic biases. We conducted a qualitative study to contextualize these results to generate insights about diagnostic challenges and biases, and root causes.We conducted 41 semi-structured interviews among U.S. rheumatologists. Transcripts were independently coded by at least two coders using a hybrid deductive-inductive approach and thematic analysis. A team of four researchers reviewed and defined themes collectively, and also resolved any discrepancies.Participants were 66% women and 49% had >10 years of post-fellowship experience. Five major themes were generated, including receiving training through the lens of race or gender, the role of the documented epidemiology of SLE, pattern recognition and test-taking strategies, case vignettes as an imperfect proxy for patient interactions, and varied consequences to patients from diagnostic bias. Participants noted that the consequences of diagnostic bias could include progressed disease from delayed diagnosis, unnecessary and inappropriate treatment due to missed diagnosis or misdiagnosis, and increased cost and harm.This study underscores the unique challenges of diagnosing SLE, with complex factors contributing to diagnosis bias and delays. Interventions during medical education could prevent downstream diagnostic biases. Future research should explore interventions to mitigate diagnostic bias and refine vignettes to better mirror real-world clinical scenarios. Understanding diagnostic bias in SLE is crucial for improving patient outcomes and refining medical training practices.

  View details for DOI 10.1002/acr.25405

  View details for PubMedID 39037219

• Considering pregnancies as repeated versus independent events: An empirical comparison of common approaches across selected perinatal outcomes. American journal of obstetrics & gynecology MFM Bane, S., Carmichael, S. L., Mathur, M. B., Simard, J. F. 2024: 101434

  Abstract

  In population-based research, pregnancy may be a repeated event. Despite published guidance on how to address repeated pregnancies to the same individual, a variety of approaches are observed in perinatal epidemiological studies. While some of these approaches are supported by the chosen research question, others are consequences of constraints inherent to a given dataset (e.g., missing parity information). These decisions determine how appropriately a given research question can be answered and overall generalizability.To compare common cohort selection and analytic approaches used for perinatal epidemiological research by assessing the prevalence of two perinatal outcomes and their association with a clinical and a social independent variable STUDY DESIGN: Using vital records linked to maternal hospital discharge records for singleton births, we created four cohorts: (1) all-births (2) randomly selected one birth per individual (3) first observed birth per individual (4) primiparous-births (parity 1). Sampling of births was not conditional on cluster (i.e., we did not sample all births by a given mother, but rather sampled individual births). Study outcomes were severe maternal morbidity and preeclampsia/eclampsia, and the independent variables were self-reported race/ethnicity (as a social factor) and systemic lupus erythematosus. Comparing the four cohorts, we assessed the distribution of maternal characteristics, the prevalence of outcomes, overall and stratified by parity, and risk ratios for the associations of outcomes with independent variables. Among all-births, we then compared risk ratios from three analytic strategies: with standard inference that assumes independently sampled births to the same mother in the model, with cluster-robust inference, and adjusting for parity.We observed minor differences in the population characteristics between the all-birth (N=2,736,693), random-selection, and first-observed birth cohorts (both N=2,284,660), with more substantial differences between these cohorts and the primiparous-births cohort (N=1,054,684). Outcome prevalence was consistently lowest among all-births and highest among primiparous-births (e.g., severe maternal morbidity 18.9 per 1,000 births among primiparous-births vs. 16.6 per 1,000 births among all-births). When stratified by parity, outcome prevalence was always the lowest in births of parity 2 and highest among births of parity 1 for both outcomes. Risk ratios differed for study outcomes across all four cohorts, with the most pronounced differences between the primiparous-birth cohort and other cohorts. Among all-births, robust inference minimally impacted the confidence bounds of estimates, compared to the standard inference, i.e., crude estimates (e.g., lupus-severe maternal morbidity association: 4.01, 95% CI 3.54-4.55 vs. 4.01, 95% CI 3.53-4.56 for crude estimate), while adjusting for parity slightly shifted estimates, towards the null for severe maternal morbidity and away from the null for preeclampsia/eclampsia.Researchers should consider the alignment between the methods they use, their sampling strategy, and their research question. This could include refining the research question to better match inference possible for available data, considering alternative data sources, and appropriately noting data limitations and resulting bias, as well as the generalizability of findings. If parity is an established effect modifier, stratified results should be presented.

  View details for DOI 10.1016/j.ajogmf.2024.101434

  View details for PubMedID 38996915

• Socioeconomic disadvantage and racial/ethnic disparities in low-risk cesarean birth in California. American journal of epidemiology Bane, S., Mujahid, M. S., Main, E. K., Carmichael, S. L. 2024

  Abstract

  Our objective was to assess the relationship of socioeconomic disadvantage and race/ethnicity with low-risk cesarean birth. We examined birth certificates (2007-18) linked with maternal hospitalization data from California; the outcome was cesarean birth among low-risk deliveries (i.e., nulliparous, term, singleton, vertex [NTSV]). We used GEE Poisson regression with an interaction term for race/ethnicity (7 groups) and a measure of socioeconomic disadvantage (census tract-level neighborhood deprivation index [NDI], education, or insurance). Among 1,815,933 NTSV births, 26.6% were cesarean. When assessing the joint effect of race/ethnicity and socioeconomic disadvantage among low-risk births, risk of cesarean birth increased with socioeconomic disadvantage for most racial/ethnic groups, and disadvantaged Black individuals had the highest risks; e.g., Black individuals with a high school education or less had a risk ratio of 1.49 (95% CI 1.45-1.53), relative to White individuals with a college degree. The disparity in risk of cesarean birth between Black and White individuals was observed across all strata of socioeconomic disadvantage. Asian American and Hispanic individuals had higher risks than White individuals at lower socioeconomic disadvantage; this disparity was not observed at higher levels of disadvantage. Black individuals have a persistent, elevated risk of cesarean birth, relative to White individuals, regardless of socioeconomic disadvantage.

  View details for DOI 10.1093/aje/kwae157

  View details for PubMedID 38932570

• Epidemiology of elective induction of labour: a timeless exposure. International journal of epidemiology Snowden, J. M., Bane, S., Osmundson, S. S., Odden, M. C., Carmichael, S. L. 2024; 53 (4)

  View details for DOI 10.1093/ije/dyae088

  View details for PubMedID 38964853

• Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment. JMIR formative research Hawa, S., Bane, S., Kinsler, K., Rector, A., Chaichian, Y., Falasinnu, T., Simard, J. F. 2024; 8: e54343

  Abstract

  Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion.This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States.We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion.For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10).As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

  View details for DOI 10.2196/54343

  View details for PubMedID 38743466

• Antihypertensive Medication Use before and during Pregnancy and the Risk of Severe Maternal Morbidity in Individuals with Prepregnancy Hypertension. American journal of perinatology Bane, S., Wall-Wieler, E., Druzin, M. L., Carmichael, S. L. 2022

  Abstract

  OBJECTIVE: Our objective is to examine severe maternal morbidity (SMM) and patterns of antihypertensive medication use before and during pregnancy among individuals with chronic hypertension.STUDY DESIGN: We examined 11,759 pregnancies resulting in a live birth or stillbirth to individuals with chronic hypertension and one or more antihypertensive prescription 6 months before pregnancy (Optum, 2007-17). We examined whether study outcomes were associated with the use of medication as compared to no use during pregnancy. In addition, patterns of medication use based on the Food and Drug Administration guidance and literature were evaluated. Medication use was divided into prepregnancy and during pregnancy use and classified as pregnancy recommended (PR) or not pregnancy recommended (nPR) or no medication use. SMM was defined per the Centers for Disease Control and Prevention definition of 21 indicators. Risk ratios (RR) reflecting the association of SMM with the use of antihypertensive medications were computed using modified Poisson regression with robust standard errors and adjusted for maternal age, education, and birth year.RESULTS: Overall, 83% of individuals filled an antihypertensive prescription during pregnancy and 6.3% experienced SMM. The majority of individuals with a prescription prior to pregnancy had a prescription for the same medication in pregnancy. Individuals with any versus no medication use in pregnancy had increased adjusted RR (aRR) of SMM (1.18, 95% confidence interval [CI]: 0.96-1.44). Compared to the use of PR medications before and during pregnancy, aRRs were 1.42 (95% CI: 1.18-1.69, 12.4% of sample) for nPR use before and during pregnancy, 1.52 (1.23-1.86; 12.4%) for nPR (before) and PR (during) use, and 2.67 (1.73-4.15) for PR and nPR use. Patterns with no medication use during pregnancy were not statistically significant.CONCLUSION: Pattern of antihypertensive medication use before and during pregnancy may be associated with an elevated risk of SMM. Further research is required to elucidate whether this association is related to the severity of hypertension, medication effectiveness, or suboptimal quality of care.KEY POINTS: · Individuals with any medication use compared to no medication use in pregnancy had an increased risk of SMM.. · Specific medication use patterns were associated with an elevated risk of SMM.. · Pattern of antihypertensive medication use before and during pregnancy may be associated with an increased risk of SMM..

  View details for DOI 10.1055/s-0042-1757354

  View details for PubMedID 36261063

• Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California. Annals of epidemiology Bane, S., Abrams, B., Mujahid, M., Ma, C., Shariff-Marco, S., Main, E., Profit, J., Xue, A., Palaniappan, L., Carmichael, S. L. 2022

  Abstract

  OBJECTIVE: To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.METHODS: Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n=904,232).RESULTS: AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors.CONCLUSIONS: Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.

  View details for DOI 10.1016/j.annepidem.2022.09.004

  View details for PubMedID 36115627

• Subsequent risk of stillbirth, preterm birth, and small for gestational age: A cross-outcome analysis of adverse birth outcomes. Paediatric and perinatal epidemiology Bane, S., Simard, J. F., Wall-Wieler, E., Butwick, A. J., Carmichael, S. L. 2022

  Abstract

  BACKGROUND: Stillbirth, preterm birth, and small for gestational age (SGA) birth have an increased recurrence risk. The occurrence of one of these biologically related outcomes could also increase the risk for another one of these outcomes in a subsequent pregnancy.OBJECTIVES: We assessed cross-outcome risks for subsequent stillbirth, preterm birth, and SGA.METHODS: We used live birth and fetal death records to identify singleton, sequential birth pairs in California (1997-2017). Stillbirth was defined as delivery at ≥20weeks of gestation of a foetus that died in utero; preterm birth as live birth at 20-36weeks; and small for gestational age as sex-specific birthweight <10th percentile for gestational age. Risk ratios (RR) were computed using modified Poisson regression and adjusted for potential confounders. Sensitivity analyses included analysing a cohort restricted to primiparous index births and using inverse-probability censoring weights.RESULTS: Of 3,108,532 birth pairs, 16,668 (0.5%), 260,596 (8.4%) and 331,109 (10.7%) of index births were stillborn, preterm and SGA, respectively. Among individuals with an index stillbirth, the adjusted RRs were 1.90 (95% confidence interval [CI] 1.83, 1.98) for subsequent preterm and 1.35 (95% CI 1.28, 1.41) for subsequent SGA. Among those with index preterm birth, the adjusted RRs were 2.02 (95% CI 1.92, 2.13) for stillbirth and 1.42 (95%CI1.41, 1.44) for SGA. Among those with index SGA, the adjusted RRs were 1.54 (95% CI 1.46, 1.63) for stillbirth and 1.45 (95% CI 1.44, 1.47) for preterm birth. Similar results were reported for sensitivity analyses.CONCLUSIONS: Individuals experiencing stillbirth, preterm birth, or SGA in one pregnancy had an increased risk of one of these biologically related outcomes in a subsequent pregnancy. These findings could encourage enhanced surveillance for individuals who experience stillbirth, preterm birth, or SGA and desire a subsequent pregnancy.

  View details for DOI 10.1111/ppe.12881

  View details for PubMedID 35437809

• Does active treatment in infants born at 22-23 weeks correlate with outcomes of more mature infants at the same hospital? An analysis of California NICU data, 2015-2019. Journal of perinatology : official journal of the California Perinatal Association Bane, S., Rysavy, M. A., Carmichael, S. L., Lu, T., Bennett, M., Lee, H. C. 2022

  Abstract

  OBJECTIVE: To investigate whether hospital rates of active treatment for infants born at 22-23 weeks is associated with survival of infants born at 24-27 weeks.STUDY DESIGN: We included all liveborn infants 22-27 weeks of gestation delivered at California Perinatal Quality Care Collaborative hospitals from 2015 to 2019. We assessed (1) the correlation of active treatment (e.g., endotracheal intubation, epinephrine) in 22-23 week infants and survival until discharge for 24-27 week infants and (2) the association of active treatment with survival using multilevel models.RESULT: The 22-23 week active treatment rate was associated with infant outcomes at 22-23 weeks but not 24-27 weeks. A 10% increase in active treatment did not relate to 24-25 week (adjusted OR: 1.00 [95% CI: 0.95-1.05]), or 26-27 week survival (aOR: 1.02 [0.95-1.09]).CONCLUSION: The hospital rate of active treatment for infants born at 22-23 weeks was not associated with improved survival for 24-27 week infants.

  View details for DOI 10.1038/s41372-022-01381-x

  View details for PubMedID 35361887

• Does Severe Maternal Morbidity impact the probability of subsequent birth? A population-based study of women in California from 1997-2012. Annals of epidemiology Bane, S., Carmichael, S. L., Snowden, J. M., Liu, C., Lyndon, A., Wall-Wieler, E. 2021

  Abstract

  Complications during pregnancy and birth can impact whether an individual has more children. Our objective was to assess whether experiencing severe maternal morbidity (SMM) during first birth affected the probability of having another child. This study used linked vital records and maternal discharges from 1997 to 2012 for all California births, and SMM was identified using a Centers for Disease Control and Prevention index. Individuals whose first birth was a singleton live birth (n = 3,062,619) were followed until their second birth or December 31, 2012, whichever came first. Hazard ratios for having a subsequent birth were estimated using Cox proportional hazard regression models. This association was assessed overall and stratified by maternal factors of a priori interest: age, race/ethnicity, and payer. Of the 3,062,619individuals in our study, 34,729 (1.1%) experienced SMM at first birth. Compared to those who do not experience SMM, individuals who had SMM had a lower hazard, or instantaneous rate, of subsequent birth (adjusted HR 0.81, 95% CI: 0.80, 0.83); this association was observed in all levels of stratification and all indicators of SMM. Individuals who experience SMM at the time of their first birth are less likely to have another child.

  View details for DOI 10.1016/j.annepidem.2021.08.017

  View details for PubMedID 34418536

• Success of community approach to HPV vaccination in school-based and non-school-based settings in Haiti PLOS ONE Riviere, C., Bell, T., Cadot, Y., Perodin, C., Charles, B., Bertil, C., Cheung, J., Bane, S., Cheung, H., Pape, J., Deschamps, M. 2021; 16 (6): e0252310

  Abstract

  To assess the success of a human papillomavirus (HPV) vaccination program among adolescent girls aged 9-14 years in Haiti and to understand predictors of completion of a two-dose HPV vaccination series.Data collection was conducted during HPV vaccination campaigns in Port-au-Prince between August 2016 and April 2017. Descriptive statistics and logistic regression models were used to examine characteristics associated with vaccination series completion of school based and non-school based vaccination delivery modalities.Of the 2,445 adolescent girls who participated in the awareness program, 1,994 participants (1,307 in non-school program, 687 in school program) received the first dose of the vaccine; 1,199 (92%) in the non-school program and 673 (98%) in the school program also received the second dose. Menarche (OR: 1.87; 95% CI, 1.11-3.14), if the participant was a prior patient at the GHESKIO clinics (OR: 2.17; 95% CI, 1.32-3.58), and participating in the school-based program (OR: 4.17; 95% CI, 2.14-8.12) were significantly associated with vaccination completion.Vaccination in school- and non-school-based settings was successful, suggesting that a nationwide HPV vaccination campaign using either approach would be successful using either approach.

  View details for DOI 10.1371/journal.pone.0252310

  View details for Web of Science ID 000671692800099

  View details for PubMedID 34166437

  View details for PubMedCentralID PMC8224934

• Recurrence of severe maternal morbidity: A population-based cohort analysis of California women. Paediatric and perinatal epidemiology Bane, S., Wall-Wieler, E., Lyndon, A., Carmichael, S. L. 2020

  Abstract

  BACKGROUND: Severe maternal morbidity (SMM) has increased in the United States by 45% in the last decade. While the recurrence of several adverse pregnancy outcomes from one pregnancy to the next has been established, the recurrence risk of SMM is unknown.OBJECTIVE: To determine whether women who have SMM in a first pregnancy are at increased risk of SMM in their second pregnancy, compared to women who did not have SMM in their first pregnancy.METHODS: This is a population-based study using linked vital statistics and hospital discharge records from the Office of Statewide Health Planning and Development in California from 1997 to 2012. The study population had their first two singleton births (live births or stillbirths) in California between 1997 and 2012 (n=1180357). The primary exposure was SMM during the hospitalisation at first birth, and the primary outcome was SMM during the hospitalisation at second birth. Prevalence and risk ratios of SMM at second birth were computed for women who did and did not have SMM at first birth, as well as for certain specific indicators of SMM.RESULTS: Of the 1180357 women included in this analysis, 9088 (77 per 10000 births) experienced SMM at first birth. Among these women, the prevalence of SMM at second birth was 470 per 10000 births, compared to 68 per 10000 births among women without SMM at first birth. This corresponded to an unadjusted risk ratio of 6.87 (95%CI 6.23, 7.57), which did not differ substantially when adjusted for factors known to be associated with SMM (6.42, 95% CI 5.86, 7.13).CONCLUSION: Women experiencing SMM in their first pregnancy were at an approximately sixfold increased risk of experiencing SMM in their second pregnancy.

  View details for DOI 10.1111/ppe.12714

  View details for PubMedID 33155710

• Severe Maternal Morbidity among US- and Foreign-born Asian and Pacific Islander women in California. Annals of epidemiology Wall-Wieler, E. n., Bane, S. n., Lee, H. C., Carmichael, S. L. 2020

  Abstract

  To examine risk of severe maternal morbidity (SMM) - a composite of serious, potentially life-threatening conditions related to childbirth - among subgroups of nulliparous women with Asian and Pacific Islander race/ethnicity.This study used linked hospital discharge and vital record data California to identify nulliparous Asian and Pacific Islander women from 1997 to 2012 (n = 453,525). We examined risk of SMM for 15 Asian and Pacific Islander subgroups and compared risk between US- and foreign-born women.Risk of SMM was higher among Pacific Islander women than Asian women (148 and 127 cases per 10,000 births, respectively). Among Asian women, risk of SMM ranged from 94 (Korean) to 165 (Filipina) cases per 10,000 births, and among Pacific Islander women, risk ranged from 125 (Hawaiian) to 162 (Other). With the exception of Korean and Filipina women, relative risks of SMM for US- versus foreign-born Asian and Pacific Islander women were similar.Differences in risk of SMM exist between subgroups of the Asian and Pacific Islander community. These differences should be considered when conducting research on racial and ethnic differences of SMM and when counselling Asian and Pacific Islander women regarding their risk of SMM.

  View details for DOI 10.1016/j.annepidem.2020.07.016

  View details for PubMedID 32795600

• Tumor Mutational Burden as a Predictive Biomarker for Response to Immune Checkpoint Inhibitors: A Review of Current Evidence ONCOLOGIST Klempner, S. J., Fabrizio, D., Bane, S., Reinhart, M., Peoples, T., Ali, S. M., Sokol, E. S., Frampton, G., Schrock, A. B., Anhorn, R., Reddy, P. 2020; 25 (1): E147–E159

  Abstract

  Treatment with immune checkpoint inhibitors (ICPIs) extends survival in a proportion of patients across multiple cancers. Tumor mutational burden (TMB)-the number of somatic mutations per DNA megabase (Mb)-has emerged as a proxy for neoantigen burden that is an independent biomarker associated with ICPI outcomes. Based on findings from recent studies, TMB can be reliably estimated using validated algorithms from next-generation sequencing assays that interrogate a sufficiently large subset of the exome as an alternative to whole-exome sequencing. Biological processes contributing to elevated TMB can result from exposure to cigarette smoke and ultraviolet radiation, from deleterious mutations in mismatch repair leading to microsatellite instability, or from mutations in the DNA repair machinery. A variety of clinical studies have shown that patients with higher TMB experience longer survival and greater response rates following treatment with ICPIs compared with those who have lower TMB levels; this includes a prospective randomized clinical trial that found a TMB threshold of ≥10 mutations per Mb to be predictive of longer progression-free survival in patients with non-small cell lung cancer. Multiple trials are underway to validate the predictive values of TMB across cancer types and in patients treated with other immunotherapies. Here we review the rationale, algorithm development methodology, and existing clinical data supporting the use of TMB as a predictive biomarker for treatment with ICPIs. We discuss emerging roles for TMB and its potential future value for stratifying patients according to their likelihood of ICPI treatment response. IMPLICATIONS FOR PRACTICE: Tumor mutational burden (TMB) is a newly established independent predictor of immune checkpoint inhibitor (ICPI) treatment outcome across multiple tumor types. Certain next-generation sequencing-based techniques allow TMB to be reliably estimated from a subset of the exome without the use of whole-exome sequencing, thus facilitating the adoption of TMB assessment in community oncology settings. Analyses of multiple clinical trials across several cancer types have demonstrated that TMB stratifies patients who are receiving ICPIs by response rate and survival. TMB, alongside other genomic biomarkers, may provide complementary information in selecting patients for ICPI-based therapies.

  View details for DOI 10.1634/theoncologist.2019-0244

  View details for Web of Science ID 000491932900001

  View details for PubMedID 31578273

  View details for PubMedCentralID PMC6964127

• Reentrainment Impairs Spatial Working Memory until Both Activity Onset and Offset Reentrain. Journal of biological rhythms Ruby, N. F., Patton, D. F., Bane, S., Looi, D., Heller, H. C. 2015; 30 (5): 408-416

  Abstract

  Compression of the active phase (α) during reentrainment to phase-shifted light-dark (LD) cycles is a common feature of circadian systems, but its functional consequences have not been investigated. This study tested whether α compression in Siberian hamsters (Phodopus sungorus) impaired their spatial working memory as assessed by spontaneous alternation (SA) behavior in a T-maze. Animals were exposed to a 1- or 3-h phase delay of the LD cycle (16 h light/8 h dark). SA behavior was tested at 4 multiday intervals after the phase shift, and α was quantified for those days. All animals failed at the SA task while α was decompressing but recovered spatial memory ability once α returned to baseline levels. A second experiment exposed hamsters to a 2-h light pulse either early or late at night to compress α without phase-shifting the LD cycle. SA behavior was impaired until α decompressed to baseline levels. In a third experiment, α was compressed by changing photoperiod (LD 16:8, 18:6, 20:4) to see if absolute differences in α were related to spatial memory ability. Animals performed the SA task successfully in all 3 photoperiods. These data show that the dynamic process of α compression and decompression impairs spatial working memory and suggests that α modulation is a potential biomarker for assessing the impact of transmeridian flight or shift work on memory.

  View details for DOI 10.1177/0748730415596254

  View details for PubMedID 26224657