Maternal and Child Health Journal最新文献

Objective: To ascertain whether former small for gestational age (weight-for-gestational age < 10th percentile, SGA), compared to non-SGA, US-born women have greater SGA rates in their grandchildren.

Methods: A multi-step strategy utilizing mother's date of birth and full name was used to link the vital records of Chicago-born infants (born 2005-2017) to the Illinois transgenerational birth-file of their mothers (born 1989-1991) and maternal grandmothers (born 1956-1976). These matches accounted for differing naming practices, misspellings, and typographical errors. Our population was used to define generation-one women's SGA based on sex. A population-based reference was used to define generation-three infant's SGA based on sex average birthweight. Stratified and multivariable log binomial regression analyses were performed on singleton births. The Population Attributable Risk (PAR) percentages were calculated: P_E|D * [(adjRR-1)/adjRR] were calculated.

Result: Former SGA women (n = 1510) had a greater percentage of SGA births in their grandchildren than former non-SGA women (n = 9466): 23.3% versus 17.6%; RR = 1.30 (1.14, 1.52). The adjusted (controlling for daughters' selected covariates including race, education, prenatal care usage, and cigarette smoking) RR of grandchildren SGA among former SGA (compared to non-SGA) women equaled 1.22 (1.09, 1.36). The PAR of maternal grandmother's SGA status equaled 4.3% percent among African-Americans. There were too few non-Latina White women to calculate a meaningful PAR%.

Conclusions: In the US, urban women who were themselves born SGA (compared to non-SGA) have a modest increased SGA frequency in their grandchildren. A small percentage of SGA African-American births is attributable to their maternal grandmother's SGA status.

Objectives: Perinatal Mood and Anxiety Disorders (PMADs) are an important public health issue that can have detrimental consequences to both the woman and the child. Despite our extensive understanding about the consequences and the availability of treatments, only 3% individuals with PMADs are treated to remission. Our aim was to understand the community's needs, barriers to accessing care for PMADs, and obtain feedback on current services.

Methods: In this study, we carried out qualitative interviews with 32 relevant individuals from varied backgrounds to understand the complexities related to PMADs and barriers to help-seeking. These narratives were transcribed, and an inductive thematic analysis approach was used to identify codes which were used in an iterative manner until data saturation was reached.

Results: Three broad themes were identified related to the key questions including prevalence, barriers to care and finally, service needs and home visiting programs. All participants acknowledged the high prevalence of PMADs, particularly during and after the COVID-19 pandemic. They identified multiple barriers related to individual attitudes, knowledge, and stigma; health systems knowledge, attitude and access; and social determinants including poverty, race, geography, childcare and insurance. They also identified societal and cultural attitudes and the role of social support systems in help-seeking. All participants acknowledged the importance of home-visiting programs in addressing the needs of peripartum individuals.

Conclusion: Our findings provide an in-depth insight into the complex underpinnings of PMADs, particularly barriers to accessing care. This information, along with the positive feedback on home-visiting programs, can contribute to the development of innovative programs.

Background: What is considered 'evidence' in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE).

Objectives: This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V.

Methods: This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach.

Results: CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity.

Conclusions for practice: Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided.

Background: Most mothers in the UK are not meeting the breastfeeding recommendations set by the World Health Organisation (WHO, Breastfeeding - Recommendations. https://www.who.int/health-topics/breastfeeding#tab=tab_2 , 2023). Maternal obesity has variably been associated with lower initiation and shorter duration of breastfeeding, but few studies have examined the impact of maternal adiposity estimated from skinfold thicknesses.

Aim: To investigate the relationship between maternal adiposity and breastfeeding initiation and duration.

Methods: Data from 2,873 mother-offspring pairs in the Southampton Women's Survey (SWS) mother-offspring cohort study were used to assess the relationship between a mother's adiposity and breastfeeding initiation and duration. The exposure variables were body mass index (BMI) and body fat percentage, calculated from 4-site skinfold thickness measurements measured prior to conception. The outcome variables were breastfeeding initiation and duration. All analyses were adjusted for confounders identified using a Directed Acyclic Graph.

Results: After adjustment for confounders, no associations were found between maternal BMI (RR 0.99 per 5 kg/m², 95% CI 0.97, 1.01) or body fat percentage (RR 0.99 per 5%, 95% CI 0.97, 1.00) and initiation of breastfeeding. After adjustment for confounders, amongst women who initiated breastfeeding, higher maternal BMI (β -0.09 SDs per 5 kg/m², 95% CI -0.13, -0.04) and body fat percentage (β -0.10 SDs per 5%, 95% CI -0.16, -0.04) were associated with shorter breastfeeding duration.

Conclusions: In this study maternal adiposity had little impact on breastfeeding initiation but higher maternal adiposity was associated with shorter breastfeeding duration. This study suggests that more support should be given to mothers with overweight and obesity to promote longer duration of breastfeeding.

Background: Child malnutrition remains a major public health concern in low and middle-income countries, and Uttar Pradesh (UP), India, continues to experience some of the highest levels of stunting, wasting, and underweight among children under five.

Objectives: This study examines the determinants of child malnutrition and its association with morbidity using data from the National Family Health Survey (NFHS-5).

Methods: Univariate and bivariate analyses, generalized Structural Equation Modeling (GSEM), and spatial analysis (Moran's I statistics and LISA cluster maps) were applied to assess both individual-level and district-level patterns. The NFHS-5 sample for Uttar Pradesh included 59,232 children under five, providing statistically robust estimates at both state and district levels.

Results: GSEM results indicated that maternal height, place of delivery, child age, caste, wealth index, and maternal education were significantly associated with stunting. Wasting was influenced by maternal height, birth order, child age, caste, wealth index, place of residence, and maternal education. Underweight was associated with maternal height, work status, child age, caste, wealth index, and maternal education. Malnutrition had a significant positive association with childhood morbidity (β = 0.032), indicating higher morbidity levels among malnourished children. Spatial analysis revealed clear geographic clustering of stunting, wasting, and underweight across districts, identifying several high-burden hotspots.

Conclusion: These findings highlight the need for integrated, geographically targeted interventions addressing socio-economic inequalities, healthcare access, maternal factors, and environmental conditions to improve child nutrition and health outcomes in Uttar Pradesh.

Objective: The primary goal of this study is to investigate whether a race/ethnicity match between parents and home visitors (HV) is associated with their relationship quality and whether quality ratings differ depending on parent or HV report.

Methods: Participants included 1,461 parent/HV dyads who participated in the Maternal Infant Health Program, Michigan's largest evidence-based home visiting program for Medicaid-eligible pregnant people and infants. At the time of discharge, parents and HVs were asked to complete a brief survey and reported on their background, program experiences, and relationship quality. We ran a series of multivariable logistic regression analyses and regressed HV- and parent-reported relationship quality ratings on race/ethnicity (mis)match controlling for covariates that likely contribute to the HV-parent relationship quality.

Main findings: Both parents and HVs rated the relationship quality positively, but their ratings were only moderately correlated, which suggests that parents and HVs use different criteria to determine relationship quality. When there is a race/ethnicity match, HVs rate the relationship quality higher, but match is not associated with parents' relationship quality ratings. In general, Black parents reported lower relationship quality ratings compared to White parents, which suggests that Black parents' dissatisfaction is stemming from sources other than a race/ethnicity mismatch.

Objective: To investigate evidence regarding the association between carbohydrate intake (general and sugar) during pregnancy and offspring's diet pattern and/or food preference in animals and humans until adolescence.

Methods: Interventional and observational studies with animals (AS) and humans (HS) were included. Six databases and gray literature were consulted. Risk of bias was assessed using the SYRCLE tool for AS and the Newcastle-Ottawa Scale (NOS, 9 stars in total) for HS. The certainty of evidence was evaluated using GRADE.

Results: Eleven articles were included. In AS (n = 6), general carbohydrate intake during pregnancy was associated with offspring's preference for high-fat and high-fat-protein diets, while in HS (n = 5) it was associated with increased carbohydrate consumption by children (p = 0.002) and a Western diet pattern in infants. AS studies on maternal sugar intake during pregnancy showed inconsistent results, with some associating it with offspring's sucrose preference and others finding no effect. In HS, maternal sugar intake was linked to the consumption of high-sugar products by infants up to adolescence. A high risk of bias was attributed to most categories in AS. In HS, NOS scores ranged from 7 (n = 2) to 8 (n = 3) stars, indicating methodological flaws. All studies were classified as having low certainty of evidence.

Conclusion: Maternal carbohydrate intake during pregnancy was associated in some studies with offspring's dietary patterns and preferences, supporting nutritional guidance during this period to promote healthier long-term habits. However, the evidence remains limited, reinforcing the need for further research.

Purpose: Giving birth to a premature infant is a major risk factor for maternal postpartum depression (PPD), which may negatively impact parent-child bonding and result in long lasting behavioral and neurodevelopmental risks for the infant. Strong Foundations: An Occupational Therapist-Led, Activity-Based Support Group was developed to address the increased risk of PPD for mothers in the Neonatal Intensive Care Unit (NICU). The objectives of this formative pilot program evaluation were to assess the feasibility and potential effectiveness of this unique program.

Methods: Participants were selected from mothers with infants in the Level II NICU of a community hospital in the Greater Boston area. Group sessions, led by a certified neonatal occupational therapist, included Infant-Care Techniques, Meditation and Gentle Movement, and Creative Discussion Activity Classes provided over 4 weeks. Participants completed pre- and post-surveys on self-efficacy, stress, social support, and program feedback.

Results: This program was found to be moderately feasible. Comparison of pre- and post-Likert scale scores demonstrated neutral or positive change. Two areas, "perception of maternal role" and "desire to remain in contact with other participants" revealed a directional, however not statistically significant, increase. Participant responses to open-ended questions demonstrated that the program was well received.

Conclusion: Using an activity-based support group, such as the Strong Foundations program, is an avenue to support mothers in the NICU as it addresses the three main contributing factors of maternal confidence, stress level, and support network. PPD is a critical health care problem. The opportunity to reach the NICU mothers while they visit their infants is one that should not be overlooked.

Objectives: The study aimed to analyze the prevalence, trends, and sociodemographic factors associated with the use of conventional cigarettes (CCs), electronic cigarettes (ECs), hookahs, or polytobacco products (PTPs) among women of childbearing age.

Methods: The U.S. Pregnancy Risk Assessment Monitoring System Phase 8 (2016‒2022) surveys women who have recently given birth on various tobacco products during the preceding two years. The study included 228,353 women (weighted count: 11,656,616), comparing exclusive CC, EC, and hookah users to non-users. Multiple logistic regression was used to estimate adjusted odds ratios (AORs) with 95% confidence intervals (95%CIs). Tobacco use preferences in the Health and Human Services regions were mapped.

Results: Approximately 21.5% of respondents reported tobacco product use, with CC (11.7%) widely prevalent. Trends showed a decline in CC and PTP use alongside increased EC use. CC users were defined by low-income (AOR:2.2; 95%CI:2.0‒2.4) and low-education (AOR:1.6; 95%CI:1.5‒1.7). Significant correlates for EC use were the survey year 2022 (AOR:5.8; 95%CI:4.5-7.6) and age under 20 (AOR:3.5; 95%CI:2.8-4.4). Hookah use was higher among Blacks (AOR:8.3; 95%CI:7.2-9.5) and Hispanics (AOR:4.6; 95%CI:4.0-5.3). PTP use correlated with low income (AOR:1.9; 95%CI:1.7-2.1) and young age (AOR:1.3; 95%CI:1.2-1.4). Variations within the U.S. were noted, with a high prevalence of hookahs in New York and Philadelphia and CC and PTP in Atlanta, Dallas, Chicago, and the Kansas City regions.

Conclusions for practice: The findings underscore the need for targeted pre-pregnancy counseling based on sociodemographic and regional correlates. Public health strategies should incorporate ECs and hookahs into pre-pregnancy and prenatal care counseling.