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      Indications for Outpatient Antenatal Fetal Surveillance : ACOG Committee Opinion, Number 828

      Obstetrics & Gynecology

      Ovid Technologies (Wolters Kluwer Health)

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          Structural racism and health inequities in the USA: evidence and interventions

          The Lancet, 389(10077), 1453-1463
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            Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.

            Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.
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              Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study.

              Maternal obesity has been positively associated with risk of adverse pregnancy outcomes, but evidence of a causal relation is scarce. Causality would be lent support if temporal changes in weight affected risk of adverse pregnancy outcomes. We examined the associations between change in prepregnancy body-mass index (BMI) from the first to the second pregnancies, and the risk of adverse outcomes during the second pregnancy in a nationwide Swedish study of 151 025 women who had their first two consecutive singleton births between 1992 and 2001. Compared with women whose BMI changed between -1.0 and 0.9 units, the adjusted odds ratios for adverse pregnancy outcomes for those who gained 3 or more units during an average 2 years were: pre-eclampsia, 1.78 (95% CI 1.52-2.08); gestational hypertension 1.76 (1.39-2.23); gestational diabetes 2.09 (1.68-2.61); caesarean delivery 1.32 (1.22-1.44); stillbirth 1.63 (1.20-2.21); and large-for-gestational-age birth 1.87 (1.72-2.04). The associations were linearly related to the amount of weight change and were also noted in women who had a healthy prepregnancy BMI for both pregnancies. These findings lend support to a causal relation between being overweight or obese and risks of adverse pregnancy outcomes. Additionally they suggest that modest increases in BMI before pregnancy could result in perinatal complications, even if a woman does not become overweight. Our results provide robust epidemiological evidence for advocating weight loss in overweight and obese women who are planning to become pregnant and, to prevent weight gain before pregnancy in women with healthy BMIs.
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                Author and article information

                Journal
                Obstetrics & Gynecology
                Ovid Technologies (Wolters Kluwer Health)
                0029-7844
                2021
                June 2021
                : 137
                : 6
                : e177-e197
                Article
                10.1097/AOG.0000000000004407
                023fad22-b5f5-43ab-aece-71a9fbe8bb4e
                © 2021

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