Maternal and Child Health Journal最新文献

Background: Baby-Friendly Hospitals (BFH) in the United States (U.S.) are associated with higher breastfeeding initiation rates. Breastfeeding is associated with a myriad of favorable health outcomes for both mother and child. However, few studies have examined the impact of breastfeeding support resources, like BFH, on breastfeeding initiation among minority groups. The objective of this study is to evaluate the association between birth at a BFH and the breastfeeding initiation in Florida.

Methods: A retrospective exploratory analysis of BFH and birth certificate data (n=3,321,022 ) from 2004-2022 from Florida was conducted.  A logistic regression model was fit to examine the main and interaction effects of race/ethnicity and birth at a BFH on breastfeeding initiation. Time was included as a sequential variable to adjust for temporal effects. Covariates known to impact breastfeeding initiation rates, including maternal education and prenatal care utilization, were included in multivariate analyses.

Results: Of births at a BFH, 89% of mothers initiated breastfeeding. Comparatively, of the births at a non-BFH, 84% of mothers initiated breastfeeding. Giving birth at a BFH increased the odds of breastfeeding initiation by at least 42% (OR = 1.42, CI: 1.38-1.45, p <0.001, Hispanic White mothers) in unadjusted models and 10% (OR = 1.10, CI: 1.03-1.17, p = 0.004, other non-Hispanic mothers) in adjusted models. However, BFH may have differential effects by maternal race and ethnicity. In the multivariate model adjusting for relevant covariates, non-Hispanic Black mothers who gave birth at a BFH were 27% less likely to initiate breastfeeding compared to mothers that gave birth at a non-BFH (OR = 0.73, CI: 0.61- 0.88, p < 0.001; interaction term for BFH*maternal race/ethnicity). Similar trends were observed for Hispanic Black, Hispanic White, and other non-Hispanic mothers.

Conclusions: Giving birth at a BFH is associated with greater odds of breastfeeding initiation. However, when considering the race and ethnicity of mothers, these odds significantly decline, indicating a need to further explore the barriers that may preclude non-Hispanic Black and Hispanic moms from receiving the same benefits of BFH.

Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with biological, multicausal and polygenic origins. The true prevalence of ASD has not been clearly established. The aim of this study was to estimate the prevalence of ASD in children aged 3 to 14 years in Spain and to analyze the factors associated with it.

Methods: A cross-sectional observational study using data from the 2017 National Survey of Health in Minors in Spain. Primary outcome was the diagnosis of ASD, and sociodemographic, behavioral, health-related, the use of health services, household and medication use variables was analyzed. Multivariable logistic regression model with a correction for modelling rare events was fitted. Complex sampling was undertaken, using the survey elevation factor in the analysis.

Results: A total of 4409 children were included, and there were 26 children with ASD, for a prevalence of 0.59%, representing 29,143 children with ASD. Factors significantly associated were male sex, having visited a psychologist, and/or a speech therapist in the past year, presenting probable problems with peers, antisocial behavior, taking antibiotics and taking other medications.

Conclusion: The findings of this study may be useful to inform health policies and develop strategic plans to identify and address the needs of children with ASD.

Objectives: To investigate the association between maternal cervical cancer (CC) screening status and child human papillomavirus (HPV) vaccination uptake. To understand if child sex or social deprivation index (SDI) modify this association.

Methods: We used a national cohort of children linked to at least one parent using electronic health record (EHR) data from a network of community health centers across the United States. We used SDI scores and child sex as moderating variables. We performed the analysis (1) for the whole sample (with SDI and child sex added as covariates), (2) stratified by SDI quartile (with child sex added as a covariate), and (3) stratified by SDI quartile and child sex, to examine whether associations vary by SDI quartile and by child sex.

Results: N = 52,919 linked mother-child pairs. Mother's receipt of CC screening was positively associated with the linked child's odds of receiving HPV vaccination [adjusted odds ratio (AOR) 1.39, 95% confidence interval (CI) 1.32, 1.47]. Neither sex or SDI modified this association. There were no significant differences in odds of HPV vaccination in children between SDI quartiles or between male and female children.

Conclusions for practice: An effective way to improve rates of HPV vaccination among children and adolescents may be to target attention towards increasing CC screening rates among mothers. Further, focusing resources and efforts on CC screenings and care of both mothers and their children may be more worthwhile than isolated efforts targeting HPV vaccination for children and adolescents.

Objectives: To study how access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during the prenatal and early childhood periods affects long-term health outcomes of the affected cohorts.

Methods: In order to identify the effects of the WIC program, we exploit variations in the timing of its introduction in different counties and analyze future health indicators of affected cohorts. We use the restricted version of the Panel Study of Income Dynamics, which includes county-level identifiers through the interview year 2019.

Results: Our findings suggest that extending WIC access by one month correlates with a 0.2-0.3% point decrease in asthma incidence (p < 0.1 to p < 0.01) of affected cohorts. Although the connection between WIC and asthma is not fully understood, existing studies suggest potential pathways. Micronutrient deficiencies during early life can impact immune function and inflammation, both relevant to asthma. Moreover, adopting healthier dietary habits may improve microbiome composition, lowering asthma risk. Other indirect benefits of WIC, such as increased use of preventive healthcare services, may also contribute to the prevention of asthma. Despite uncertainties, these estimates remain robust across various model specifications.

Conclusions for practice: Our study implies that early-life nutritional support programs such as WIC may alleviate the burden of asthma, although the specific mechanisms and effect sizes remain unclear. Given the substantial impact of asthma in the U.S., our findings underscore the potential long-term benefits of early-life nutritional support programs for lifelong health.

Background: Since 1990, childhood overweight and obesity have been rising on every continent and have almost doubled worldwide. The deleterious consequences include hypertension, type 2 diabetes mellitus, and dyslipidemia leading to metabolic syndrome in childhood and myocardial infarction, stroke, cancer and other disabling conditions in adulthood.

Purpose: In Southern Europe, including Greece, Italy, and Spain, 10 to 15% of children are obese. Obesity in Eastern European countries is somewhat lower, but the rates of rise are very steep and will approach those in Southern Europe during the next few years. Worldwide, Asia accounts for nearly half of all overweight children under the age of 5, while Africa is home to one quarter of overweight children under 5. In Latin America, about 20% of children under 20 are overweight. Further, children living in poverty can suffer simultaneous overweight and obesity as well as malnutrition. In the US, the risk of being overweight in adolescence is several times higher when a younger child has a body mass index (BMI) in the 50th or greater percentile.

Findings: If the clinical, non-clinical and public health communities ignore these challenges, such inaction will surely portend an unprecedented future pandemic of overweight and obesity in children and adolescents leading to future premature morbidity and mortality. All clinical, non-clinical and public health professionals should exert concerted efforts concerning their individual patients, their families, communities, and policymakers.

Conclusions: Such coordinated interdisciplinary efforts may curb these alarming trends and secure healthier futures for children and their families throughout the world.

Objective: To investigate the reliability of parental recall of birth weight, birth length and gestational age several years after birth.

Methods: Parentally recalled birth parameters were obtained from the European multicentric cohort study IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) and compared to the corresponding data externally recorded in the child's medical check-up booklet. The agreement between the two sources was examined using Bland-Altman plots, intraclass correlation coefficients and Cohen's kappa for clinically relevant categories. Additionally, logistic regression models were used to identify factors related to parental recall accuracy.

Results: A total of 4930 children aged 2 to 11 years were included. Accuracy of birth weight within 100 g was 88%, 94% of the recalled birth length was within 2 cm, and 99% of the parents could recall with 2 weeks accuracy how many weeks their child was delivered preterm. Discrepancies of more than two weeks or more than 100 g were more likely in parents of low or medium socioeconomic status. Non-biological parents were 3.4 times more likely to have a discrepancy of more than 100 g compared to biological mothers (95% CI 1.7-6.7). Moreover, parents were less likely to accurately recall their child's birth parameters with increasing number of children within a family.

Conclusions for practice: In general, parents' information matched well with the medical check-up booklet. However, accuracy varied among different groups which should be taken into consideration when using birth data recalled by parents in studies of child health.

Background: Asthma is a leading cause of pediatric hospitalization and morbidity, necessitating the development of educational interventions for its management and control.

Objective: To evaluate the effectiveness of an educational intervention in promoting parent/caregiver self-efficacy in the management and control of their children's asthma.

Methods: A clinical trial was conducted in Fortaleza, Ceará, Brazil, involving two randomized groups of parents/caregivers of children: the comparison group (CG) (n = 42) and the intervention group (IG) (n = 42). Data collection took place in two phases: the first included face-to-face sessions followed by the educational intervention in the IG, and the second included telephone follow-up. The educational intervention included the use of an educational booklet and a brief motivational interview.

Results: The groups were homogeneous at baseline. After the intervention, the mean self-efficacy scores of the IG were significantly higher than those of the CG (p < 0.05), and children whose parents/caregivers were in the CG were 1.43 times more likely to experience an asthma crisis than those in the IG.

Conclusions: The educational intervention proved effective in increasing parent/caregiver self-efficacy in asthma management and control. Furthermore, children whose parents/caregivers did not receive the educational intervention were more likely to experience an asthma crisis.

Background: Infants who are not exclusively breastfed are more vulnerable to gastroenteritis, respiratory illness, and type 1 diabetes mellitus. Mothers who do not breastfeed their infants are at a higher risk of cancer. This systematic review and meta-analysis aimed to synthesize evidence regarding the effectiveness of applying lanolin, aloe vera, and peppermint for alleviating nipple pain and nipple trauma among lactating mothers.

Methods: Electronic databases, including PubMed (MEDLINE), Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, Scopus, and Clinical Key, were searched for studies published in English from January 2000 to December 2022. Nipple pain and nipple trauma were the primary outcomes analysed, and a meta-analysis was conducted via RevMan v5.4.

Results: The reviewed trials involved 1,495 participants from 11 studies, with an average participant age of 29 ± 5 years. The application of lanolin significantly reduced nipple pain and nipple trauma in lactating mothers. The application of peppermint significantly reduced nipple trauma in lactating mothers.

Conclusion: The application of lanolin or peppermint is a beneficial preventive intervention for reducing nipple trauma and pain.

Objectives: Development and validation of risk prediction models at mid-pregnancy and delivery to predict admission to the neonatal care unit.

Methods: We used data from all singleton deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019. Admission to the neonatal care unit was assumed if length of stay in the unit was > 24 h. Multivariable logistic regression with backward stepwise selection was used to develop the models. Discrimination was assessed using the ROC curve C-statistic, and internal validation was assessed using bootstrapping techniques. We conducted temporal external validation using data from all singleton deliveries at CUMH during 2020.

Results: Out of 6,077 women, 5,809 (95.6%) with complete data were included in the analyses. A total of 612 infants (10.54%) were admitted to the neonatal care unit for > 24 hours. Six variables were informative at mid-pregnancy: male infants, maternal smoking, advancing maternal age, maternal overweight/obesity, nulliparity and history of gestational diabetes (C-statistic: 0.600, 95% CI: 0.567, 0.614). Seven variables were informative at delivery: male infants, nulliparity, public antenatal care, gestational age < 39 weeks', non-spontaneous vaginal delivery, premature rupture of membranes and time of birth between 17:01-07.59 h (C-statistic: 0.738, 95% CI: 0.715, 0.760). Using these predictors, we developed nomograms to calculate individualised risk of neonatal care unit admission. Bootstrapping indicated good internal performance and external validation suggested good reproducibility.

Discussion: Our nomograms allow the user to quickly estimate individualised risk of neonatal care unit admission. Future research should aim to improve accuracy in early pregnancy to better assist counselling of parents.

Objectives: The New Orleans Maternal Child Health Coalition convenes to support and amplify the work of New Orleans-based individuals and organizations working to reduce disparities and protect the health of birthing families in the New Orleans area. The objectives of this qualitative study were to identify successes, challenges, and areas of growth for the Coalition and develop broadly generalizable recommendations for similar groups seeking to mobilize and advance health equity in their own communities.

Methods: Using purposive sampling, we conducted semi-structured interviews with 12 key informants from within and outside of the Coalition. Interviews were transcribed verbatim, and data was analyzed using inductive and deductive coding approaches.

Results: We identified themes relating to the barriers and facilitators to the maintenance of the Coalition, as well as opportunities to advance the mission of the Coalition. Some themes included structural- and systemic-level barriers to achieving the mission, varying perspectives on the effectiveness of the Coalition, opportunities to enhance the operations of the Coalition's work, and opportunities to involve other individuals, particularly those with lived experience, and non-MCH related sectors in Coalition's work.

Conclusions for practice: As the maternal health crisis continues, coalitions like the New Orleans MCH Coalition provide a vehicle to amplify the mission-driven work of people and organizations. Recommendations put forth by the Coalition can also be utilized by coalitions in other jurisdictions.