Maternal and Child Health Journal最新文献

Introduction: A prenatal fruit and vegetable prescription program (FVPP) was introduced in Flint, Michigan to increase access to fresh produce during pregnancy. This program provides $15 fresh fruit and vegetable prescriptions to all prenatal patients during office visits, redeemable at a local farmers market and mobile market/food hub. The current study assessed changes in diet and food security throughout pregnancy among patients exposed to the prenatal FVPP.

Methods: This non-controlled longitudinal trial included prenatal patients at two low-income urban clinics presenting before 16 weeks' gestation. Participants completed surveys to assess diet (one automated 24-hour dietary recall) and food security (US Household Food Security Module: Six Item Short Form - National Center for Health Statistics), with follow-up surveys at mid-pregnancy and postpartum.

Results: A total of 118 pregnant women (mean age 26.32 ± 5.04 years, range 18-39 years) enrolled in the current study. Most identified as Black/African American (54.2%, n = 64), received Medicaid (66.9%, n = 79), and participated in The Special Supplemental Nutrition Program for Women, Infants, and Children or WIC (62.4% at midpoint). Participants received an average of 8.81 ± 2.30 fruit and vegetable prescriptions, with two-thirds redeeming at least one (66.9%, n = 79). Household food security worsened from baseline to midpoint (p = 0.076) but improved from midpoint to postpartum (p = 0.013). Participants reported notable changes in dietary behaviors at critical points during their pregnancy. Primarily, significant improvements in mean daily consumption of fruits and vegetables (p = 0.027); total vegetables (p = 0.015); and vegetables excluding potatoes (p = 0.030) were observed from early pregnancy to midpoint. Alternatively, mean daily intake of fruits and vegetables (p = 0.007) and total vegetables (p = 0.029) decreased between midpoint in pregnancy and the early postpartum period.

Discussion: This study reveals the influence of a prenatal FVPP on diet and food security among prenatal patients living in one low-income, urban community. Results signal an urgent need for coordinated and comprehensive maternal supports that better address food and nutrition security during pregnancy and the early postpartum period.

Objectives: The aim of this study was to assess whether the combination of home visits and traditional antenatal care leads to better perinatal outcomes than standard antenatal care alone does and to assess the level of perinatal knowledge.

Methods: A randomized controlled trial design was used in this study. The study was conducted with pregnant women in their first trimester who were registered at Family Health Centers (primary care) in a district of Istanbul. The study sample consisted of 32 women in the intervention group and 32 women in the control group. Pregnant women in the intervention group participated in an antenatal care program integrated with home visits, whereas those in the control group participated in a standard antenatal care program. The primary outcome of this randomized controlled trial was the change in perinatal knowledge score, which was assessed using a validated perinatal knowledge questionnaire administered before the intervention (pretest) and after program completion (posttest). Secondary outcomes included birth-related characteristics such as mode of delivery, maternal postpartum depressive symptoms as measured by the Edinburgh Postnatal Depression Scale, and breastfeeding self-efficacy as assessed by the Breastfeeding Self-Efficacy Scale.

Results: No statistically significant difference was observed between the intervention and control groups in terms of sociodemographic characteristics. Following the intervention, perinatal knowledge scores significantly increased in both groups; however, the increase was significantly greater in the intervention group (P < .05). Whereas pretest knowledge scores were comparable between groups, posttest scores were significantly higher in the intervention group. Additionally, the quality and completeness of antenatal care received were markedly better among women in the intervention group. The rate of term deliveries (≥ 40 weeks) was significantly greater and the rate of preterm/early-term deliveries was significantly lower in the intervention group than in the control group (P < .05). Although there was a statistically significant relationship between group allocation and the planned mode of delivery, there were no significant differences between groups in terms of postpartum depression scores or breastfeeding self-efficacy levels.

Conclusions for practice: Integrating structured home visits into routine antenatal care significantly improves the level of perinatal knowledge and quality of care received. This intervention increases maternal readiness and contributes to more informed and confident decision-making during pregnancy and childbirth.

Clinical study registration: Since our research constituted a randomised controlled study, it was registered on the ClinicalTrials.gov website under ClinicalTrials ID No. NCT04628598.

Objective: Unintentional injury poses a health threat to children, and toddlerhood (2 to 4 years) is a particularly vulnerable period. At this stage, parental intervention and monitoring are essential for mitigating injury risk. Maternal depressive symptoms are associated with greater frequency of injuries to young children in the home, however, our understanding of why remains limited. This study examined associations between maternal depressive symptoms and reactions to children's injury-risk behaviors, as well as children's injury rates.

Method: The sample comprised 84 mothers of children (24-47 months) and included a broad range of scores for symptoms of depression. Participants provided questionnaire and observational data.

Results: Mothers with more elevated depressive symptoms had children who experienced higher injury rates. These mothers showed frequent reactions to intervene when children were engaging in risk behaviors, however, they responded with ineffective strategies (i.e., increased prohibitions, reduced teaching).

Conclusion: Mothers having greater depressive symptoms focused more on stopping children's risk behaviors than teaching about safety, and children had higher injury rates.

Objectives: This study aimed to investigate the dietary calcium intake in high-risk pregnant women and determine the factors associated with the adequacy of the calcium requirements.

Methods: A prospective cohort study was carried out with adult high-risk pregnant women, in the third trimester of pregnancy. Sociodemographic data, obstetric history, maternal comorbidity, pre-gestational body mass index were collected from medical records and three 24-h dietary recalls were performed.

Results: A total of 125 pregnant women were included. The mean calcium intake was 652.76 ± 294.58 mg/day and 24.8% of women had adequate calcium intake. We found a correlation between low daily calcium intake (< 800 mg) with non-white pregnant women (p 0.017), and obesity (p = 0.010). Eating frequency demonstrated an inverse correlation with low daily calcium intake (p < 0.001).

Conclusions for practice: Dietary calcium intake was insufficiente for most high risk pregnant women in this study. Eating frequency was associated with improved calcium intake, while obesity and non-White race/ethnicity were risk factors for inadequate intake.

Objectives: Having a child is a shared experience where partners influence each other's adaptation to parenthood. While much research focuses on mother-infant bonding, the impact of partners' psychological functioning on this outcome is underexplored. This study investigated how mothers' perceptions of partners' pre- and postnatal depressive and anxiety symptoms affect mother-infant bonding difficulties and whether mothers' own symptoms mediate these relationships.

Method: A sample of 525 Portuguese women (M age = 32.85, SD = 5.13) with infants < 24 months completed an online survey from February to March 2020. Assessments included history of depression and anxiety, current symptoms, perceptions of partners' symptoms, and mother-infant bonding difficulties. Multiple hierarchical linear regressions and mediation analyses were conducted.

Results: Women's current depressive symptoms and perceptions of partners' current anxiety symptoms were associated with greater bonding difficulties. In contrast, perceptions of partners' prenatal anxiety symptoms were associated with fewer bonding difficulties. Perceptions of higher levels of partners' current depressive symptoms were indirectly related to increased bonding difficulties through mothers' own depressive symptoms.

Conclusions: Partners' psychological functioning impacts mothers' adaptation to motherhood differently across the perinatal period. Perceived prenatal anxiety in partners may serve as a protective factor, whereas postpartum depressive and anxiety symptoms contribute to bonding difficulties. These findings highlight the importance of considering dyadic processes in understanding and supporting parent-infant relationships.

Introduction: This study aimed to examine the association between adverse childhood experiences (ACEs) and antenatal depression among women in Taiwan and investigate the mediating effects of partner support and social support on that relationship.

Methods: An online survey was conducted, and 456 women aged ≥ 20 years with childbirth experience responded. The participants were asked to recall and self-report their childhood experiences and their perceived social support and mental health status during pregnancy. Linear regression was used to test the association between ACEs and antenatal depression, and causal mediation analysis was performed to analyze the mediating effects of partner support and social support.

Results: More than 85% of the participants had experienced at least one type of ACE, and 25.8% reported experiencing four or more ACEs. Our findings indicated that ACEs were associated with antenatal depression. We also found that participants who reported emotional abuse had the highest scores for antenatal depression, followed by those who reported a household member being treated violently and those who reported sexual abuse. Moreover, women with more ACEs were more likely to suffer from antenatal depression. Mediation analysis revealed that partner support and social support accounted for 20.23% and 36.83%, respectively, of the associations between ACEs and antenatal depression.

Discussion: The findings of this study suggest that ACEs have a pervasive impact on antenatal depression. Early intervention to prevent ACEs as well as improvements to the availability of social support for pregnant women should be provided to prevent antenatal depression, which will in turn improve fetal growth and development.

Objectives: Overdoses are a leading cause of maternal mortality in the US, but limited evidence exists about patterns of nonfatal overdose, a key risk factor for subsequent fatal overdose, or of other drug-related harms. Here, we estimate prevalences of nonfatal overdose and injection-related endocarditis and abscesses/cellulitis across the 21 months spanning pregnancy and the postpartum year.

Methods: Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated the prevalences of hospital-based diagnoses of nonfatal overdose and of injection-related bacterial infections (i.e., endocarditis, abscesses, and cellulitis) across these 21 months; by trimester and postpartum quarter; and by social position (e.g., race/ethnicity, rurality, payor).

Results: The 21-month nonfatal overdose prevalence was 158/100,000 births (CI: 145/100,000, 172/100,000); the 21-month prevalence of injection-related bacterial infections was 56/100,000 births (CI: 49/100,000, 65/100,000). There was a trend such that rates of overdose and of injection-related bacterial infections declined as pregnancy progressed and rebounded postpartum. Rates of all outcomes were highest outside of large metropolitan areas and among publicly insured residents.

Conclusions for practice: The trend toward diminished rates during pregnancy is supported by past qualitative studies. If confirmed by future research in other geographical regions and with larger sample sizes, this finding holds promise for programmatic and policy interventions. Interventions co-designed with people who use drugs could complement and support harm reduction efforts that pregnant people are already engaging in independently. Such efforts can help people who use drugs survive the pregnancy and postpartum year.

Objectives: This study examined disparities in prenatal care utilization by race/ethnicity and payer using three measures of inadequate prenatal care: (1) fewer than the recommended number of prenatal care visits, (2) late initiation of prenatal care (at or after 4 months gestation), or (3) no prenatal care.

Methods: Birth records data from the National Center for Health Statistics were used. The study population consisted of singleton live births in all 50 U.S. states and the District of Columbia between January 1, 2014, and December 31, 2022 (N = 33,107,382).

Results: The average number of reported prenatal care visits was 11.2 (SD = 1.2), 36.8% reported fewer than the recommended number of prenatal care visits, 22.7% reported late initiation of prenatal care, and 1.8% reported no prenatal care. Women with a Medicaid-covered delivery were 1.06 times more likely to have fewer than the recommended number of visits, 1.36 times more likely to initiate prenatal care late, and 1.72 times more likely to have no prenatal visits (all p < 0.001). There were significant disparities in prenatal care utilization by race/ethnicity, particularly for NHPI and AIAN women, with all minoritized racial/ethnic groups having greater risk for multiple measures of inadequate prenatal care utilization relative to White populations.

Conclusions for practice: Racial/ethnic and economic disparities in perinatal health in the U.S. are of national concern. Differences in prenatal care utilization between women with Medicaid and private/other insurance suggest modifications to Medicaid policies may improve prenatal care access among beneficiaries.