Maternal and Child Health Journal最新文献

Objectives: Common maternal digestive symptoms, such as nausea, vomiting, and constipation during pregnancy, can impair pregnant women's quality of life. The Mediterranean diet (MedDiet), characterized by a high consumption of olive oil, vegetables, fruits, legumes, and grains; moderate fish and dairy intake; and low meat consumption, could alleviate these symptoms. This study aims to study the prevalence of maternal digestive symptoms in the different pregnancy trimesters and to examine the association between baseline MedDiet adherence and the prevalence of maternal digestive symptoms during pregnancy.

Methods: A secondary analysis of the Walking Preg_Project trial was conducted in a cohort of adult Spanish pregnant women (N = 237) who provided data about MedDiet adherence and maternal digestive symptoms (nausea, vomiting, constipation) at baseline (12th ), 19^th, and 32nd Gestational Week (GW). MedDiet adherence was appraised through a 13-item questionnaire and categorized into low, medium, and high adherence. Digestive symptoms were assessed by the Pregnancy Symptoms Inventory. The association between baseline MedDiet adherence and maternal digestive symptoms was evaluated through adjusted multinomial analysis.

Results: Differences among MedDiet adherence categories were considerable during pregnancy. Some of the greatest decreases were observed in high adherence to MedDiet in comparison with low MedDiet adherence at 32nd GW vs. 19th GW for the prevalence of nausea (10.0% vs. 18.8%, p < 0.001) and vomiting (5.0% vs. 8.7%, p < 0.001). Constipation remained during pregnancy. There was no significant association between the baseline MedDiet adherence and maternal gastrointestinal symptoms.

Conclusion for practice: Baseline adherence to the MedDiet was not proven to influence nausea, vomiting, and constipation during pregnancy. For all MedDiet adherence groups, nausea and vomiting prevalence decreased throughout pregnancy, but not constipation.

Introduction: Only half of U.S. children with mental health conditions receive treatment annually, and children from lower-income households face greater barriers to treatment. Medicaid and the Children's Health Insurance Program (CHIP) facilitate children and families to access mental health services by providing government-funded insurance coverage. However, household income eligibility thresholds for children in Medicaid and CHIP vary greatly across states, and children from low-income households in states with a higher threshold are more likely to access healthcare. Using national data, we examine the relationship between eligibility thresholds across Medicaid and CHIP and receipt of mental health services among children from low-income households.

Methods: We used data from the 2016-2020 National Survey of Children's Health to identify children ages 6-17 with household incomes below 400% of the federal poverty line. We conducted multivariable logistic regressions to estimate the associations between eligibility thresholds and children's (1) use of any mental health services as well as (2) caregiver-reported unmet mental health need in the past year.

Results: Controlling for child, family, and state characteristics, we did not find a significant relationship between eligibility thresholds and use of any mental health services. However, we found that a one standard deviation increment in the eligibility threshold above the mean was associated with 20% lower odds of caregiver-reported unmet mental health need (OR: 0.79, p < 0.01).

Discussion: More generous eligibility thresholds in Medicaid and CHIP are associated with less unmet need for mental health care among children from families with low incomes.

Objectives: The current study examined differential rates of child protective services (CPS) involvement between infants with one or two legally established parents at birth.

Methods: Vital birth records were used to document all children with a registered birth in California in 2017 (N = 470,854). This birth cohort was then prospectively followed in linked CPS records through age 1 year.

Results: Birth records indicated that 7.1% of infants (n = 33,597) had only one legally established parent. Adjusting for sociodemographic factors, infants with only one parent documented on the birth record were more than twice as likely to be reported for maltreatment (IRR = 2.20; 99% CI [2.12, 2.29]). In the overall birth cohort, significant differences in the likelihood of a CPS report were observed by parental sociodemographic factors (education, age, public insurance, race and ethnicity); however, these same factors were attenuated, to varying degrees, among infants with a single legal parent.

Conclusions for practice: Infants born with a single legal parent had a higher concentration of factors associated with heightened rates of CPS involvement. Assessing the circumstances associated with single parenthood, such as understanding household composition and who is involved in the infant's care, may explain potential vulnerability and identify service needs.

Objectives: Nutritionists for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), along with healthcare providers, can influence beverage choices for young children in WIC-enrolled families. Coordination of messaging about beverages and between-provider communication may be important for facilitating behavior change.

Methods: In preparation for a planned intervention, during Spring through Fall of 2021, we conducted a qualitative study to understand perceptions around family beverage choice discussions across three groups: parents of WIC-enrolled children, WIC nutritionists and practicing clinicians. Semi-structured interviews were conducted with 25 individuals, with sample size determined a priori. Thematic content analysis was used to summarize transcribed data.

Results: There was broad agreement that children should not consume sugar-sweetened beverages (SSB), but disagreement on tap water safety. Both clinicians and WIC nutritionists reported educating families about healthy drink choices, and parents recalled similar messages during these conversations. Parents were very supportive of fruit juice as part of the WIC package, with near universal opposition among clinicians. Many parents expressed concerns about tap water. Both provider groups perceived difficulty in reaching out to each other, and felt more communication would be helpful.

Conclusions for practice: Our findings highlight a need for more regular communication between WIC nutritionists and children's healthcare providers within our system, and more consistent parental education on juice and tap water safety. Future studies could evaluate whether these types of communication gaps and perceptions are regional or more widespread across the US.

Objective: Prevalence rates of perinatal depression are especially high among women living in lower-middle-income countries (LMICs) when compared to higher-income countries. This is especially true for women living in Bangladesh, an LMIC in South Asia, a country that has limited mental health infrastructure and high rates of poverty. Women living in rural, impoverished communities in Bangladesh have been identified as being at high risk for prenatal depression. However, there is limited understanding of variability of prevalence rates across rural communities. To address this gap in understanding, we examined prevalence rates and correlates of prenatal depression among women living in two rural Bangladesh communities, Matlab and Ariahizar.

Methods: During a prenatal health care visit, 60 women in two rural communities in Bangladesh, completed a survey battery asking about household income, education, depression symptoms, autonomy over household technology, and financial decision-making ability.

Results: On average, prenatal depression was experienced by 31.6%, of women enrolled in this study, although rates varied significantly across communities. Around 50% of all women in the higher-risk, more underserved, Arihaizar community experienced clinically significant symptoms of prenatal depression in comparison with only 13.3% of women who experienced clinically significant levels of prenatal depression in Matlab, a higher resourced rural community. Across both communities, perceived autonomy and independence (based on reports of having control over resources in the home) were associated with lower depression symptoms.

Conclusions for practice: Prevalence of prenatal depression is highest in the most underserved communities. Additionally, we found preliminary associations between women's autonomy and depression during pregnancy.

Objective: To document the prevalence of parental alcohol and drug misuse (PADM) in infants' first and subsequent child welfare cases, and to assess the risk of subsequent injury for infants exposed to PADM.

Methods: This study used linked Medicaid and child welfare system (CWS) data in Pennsylvania to identify all children born between 2016 and 2018 who had a confirmed CWS case by age one (N = 20,998). The injury analyses focused on children whose initial case included PADM and who were covered by Medicaid at birth (N = 11,180). Survival analyses and Cox Proportional Hazard models were used to assess risk of any physical harm, severe harm and head injuries among infants who remained in home following PADM exposure.

Results: Study documented that 64% of infants' first cases included PADM. Infants with a PADM case who remained at home (versus entered care) were at increased risk of experiencing subsequent physical harm, severe physical harm, and head injuries. Few differences in harm outcomes were observed between infants with and without medically diagnosed prenatal substance exposure.

Conclusions: The Child Abuse Prevention and Treatment Act instructs medical professionals to create 'plans of safe care' for infants affected by substances, however, limitations in PADM identification as well as an insufficient public health response has resulted in many families not receiving the support and services needed. Coordinated efforts are needed to prevent, detect, and treat substance use disorders.

Introduction: Caring for a child with disabilities is challenging and sometimes overwhelming. Self-care and use of respite services can be important strategies for caregivers to relieve stress, prevent burnout, and reduce the risk of poor physical and mental health. Little is known about the use of self-care and respite care services among Hispanic/Latino caregivers of children with developmental disabilities.

Objectives: The purpose of this study was to identify: (1) if Hispanic/Latina mothers of children with developmental disabilities in Nebraska practiced self-care or used respite support services, (2) what types of self-care practices were used, and (3) what if anything prevented these mothers from practicing self-care or using respite services.

Methods: A total of 75 Hispanic/Latina mothers were interviewed between August-September 2022.

Results: We found that 73.3% of participants reported practicing self-care, but even more (80%) reported engaging in specific self-care activities. Participants who were living in the United States without legal permission were significantly less likely to report practicing self-care compared to those who were U.S. citizens, residents, or were in process for residency (38.2% vs. 61.8%), p = .02. Only 6.8% of participants reported using respite services. Of those who did not use respite services, 60% reported that they did not know about such services.

Conclusions for practice: Promoting the availability of supportive resources for caregivers in culturally, linguistically, and contextually relevant formats (especially those that are available regardless of immigration status) could be valuable. Institutionalizing caregiver navigation programs and addressing cultural and structural barriers to respite service uptake could have positive benefits for caregivers of children with disabilities.

Objectives: Effective interventions for the prevention and treatment of postnatal depression and anxiety are important for family functioning and infant development. Group psychotherapy is one such intervention used in the postnatal period. This evaluation tests the efficacy of an eight-week group psychotherapy on participants' symptoms of postnatal depression and anxiety. The study also reports on the addition of a sequential attachment-based parenting program on participants' symptoms of depression and anxiety.

Methods: The study setting was a child and family health service in New South Wales, Australia. 141 women participating in a group psychotherapy program consented to participate in the study. A pre-test post-test design with four week follow up was used. Depression was measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety with the anxiety subscale (EPDS-3a). Repeated measures analysis of variance and multiple factorial mixed analysis of variance were conducted.

Results: The mean EPDS score reduced significantly from 14.11 pre-intervention to 9.99 (p < .001). The mean EPDS-3a score reduced significantly from 5.68 pre-intervention to 4.37 (p < .001). These improvements were still present four weeks after completion of the program at a 'group reunion' session. The addition of a sequential attachment-based parenting program was not shown to be effective in further reducing symptoms of depression or anxiety (p =.183).

Conclusions for practice: These findings support the efficacy of group psychotherapy interventions for reducing both depression and anxiety symptoms in the postnatal period. This intervention demonstrated lower depression symptoms in the post test compared to the pre-test periods for women with and without previous history of mental illness and those with varied baseline depression symptoms.