Maternal and Child Health Journal最新文献

Objectives: Perinatal palliative care, defined as support for creating birth plans that include treatment and care decisions, is crucial for families facing life-threatening fetal conditions. However, the variability in medical resources across communities necessitates the development of tailored, community-based perinatal palliative care systems that support shared decision-making through multidisciplinary care. This study uses child death review (CDR) data to examine the current status and challenges of perinatal palliative care delivery in regional communities, focusing on decision-making processes, care planning, and transition to home care. It also compares cases in which families selected comfort care with those choosing intensive care to explore differences in care processes and outcomes.

Methods: A retrospective cohort study was conducted using regional CDR data from children under 18 years who died in Shiga Prefecture, Japan, between 2018 and 2020. Data on children eligible for perinatal palliative care were primarily collected from perinatal centers and perinatal cooperative hospitals participating in the CDR.

Results: Among 131 deaths, 19 involved life-threatening conditions considered for perinatal palliative care. Two lacked prenatal diagnoses, while 17 discussed care plans, including medical intervention options, and mode of delivery. Of these, 65% (11/17) chose comfort care, while 35% (6/17) opted for intensive care. A comparison between these groups showed that the comfort care group had a longer decision-making period (median, 29 vs. 9 days; p = 0.044). Decision support before birth, which included accurate information about fetal conditions, care planning options, and psychological support, was not provided by clinical psychologists or palliative care specialists. Of the 17, four patients were discharged home, and one died at home.

Conclusions for practice: This study highlights the challenges of implementing perinatal palliative care in communities. The prolonged decision-making process associated with comfort care may reflect the significant psychological burden on families. Factors such as care plans influence family burden, emphasizing the need for individualized support. The absence of specialized support and low rates of transition to home care for end-of-life care are critical issue for improvement in community-based perinatal palliative care.

Objective: To evaluate the efficacy of an online nursing consultation on the Red Sinapsis (RS) Internet platform in increasing maternal self-efficacy and exclusive breastfeeding rates during the first month postpartum.

Methods: This study employed a controlled, randomised experimental design with two groups. Ninety women who had undergone caesarean sections were randomly assigned to either an intervention group (n = 45) or a control group (n = 45). The intervention group received follow-up care from a breastfeeding expert nurse on the RS online platform, while the control group received standard follow-up care from a midwife or primary care nurse. Breastfeeding success was measured using the LATCH scale at 15 days postpartum and the BSES-SF scale at 30 days postpartum. For comparative analysis between study groups, Fisher's exact test or the chi-squared test was used, depending on the contingency table dimensions. Missing values were not imputed. P-values below the 0.05 threshold were considered statistically significant.

Results: A total of 84% of the intervention group showed greater confidence in providing breast milk to their children, compared to 44% of the control group (p < 0.001). The intervention group also achieved better outcomes in terms of believing that breastfeeding alone is sufficient to nourish their baby, with 82% expressing confidence, compared to 59% in the control group (p = 0.041).

Conclusions: Online nursing follow-up during the immediate postpartum period improves maternal confidence in breastfeeding, promoting its initiation and establishment during the first month postpartum.

Objectives: To investigate the association between maternal liver enzyme concentrations during pregnancy and the risk of abnormal birth weight.

Methods: This is a prospective birth cohort study querying the pregnant women from Fujian Maternal and Child Health Hospital, affiliated with Fujian Medical University, China. Liver enzyme levels, including gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), were measured in the first and third trimesters, and changes in liver enzyme levels were calculated based on these measurements. The outcomes were birth weight, small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), and macrosomia.

Results: The study analyzed 19,003 singleton pregnancies with live births. The mean age of the pregnant individuals was 30.3 ± 3.9 years, 18,594 patients (97.8%) were Han. GGT in the first trimester is positively correlated with the risks of macrosomia and LBW, mediated through gestational diabetes mellitus (GDM) and gestational age at birth, respectively. Nonlinear regression models suggested that there was a linear relationship of liver enzyme levels during pregnancy with LBW and SGA (P for non-linear > 0.05). According to regression analysis, changes in liver enzyme levels during pregnancy were negatively correlated with birth weight, LGA, and macrosomia, and positively correlated with the risk of SGA. Similar results were found for liver enzymes in late pregnancy.

Conclusions: The concentration and even the changes of liver enzymes during pregnancy may influence the fetus's birth weight to different degrees. Thereby, monitoring liver enzyme levels during pregnancy could help prevent abnormal fetal development.

Background: While it is well established that trying to conceive while experiencing infertility and undergoing fertility treatment is associated with anxiety, little is known about the mental health toll of trying to conceive without fertility treatment. Minimal contact with the healthcare system while trying to conceive without treatment contributes to low rates of detection and support for this population.

Objective: This research aims to provide formative insights into the prevalence of mental health distress and desire for emotional support among people who are trying to conceive without treatment, and how this compares to people who are considering or using fertility treatment.

Methods: This retrospective cohort study included 3,458 US-based individuals who used Maven, a comprehensive digital platform for reproductive and women's health. Descriptive statistics and bivariate tests were used to determine differences in prevalence of depression, anxiety, conception-specific anxiety, and interest in receiving emotional support at various stages of the trying to conceive pathway.

Results: Users trying to conceive without treatment, considering treatment, and using treatment screened positive at comparable rates for depression (4.1%, 4.2%, 4.6%; p = 0.82), generalized anxiety (7.5%, 8.9%, 8.8%; p = 0.77), and conception-specific anxiety (22.0%, 23.5%, 20.4%; p = 0.13). Interest in receiving emotional support was lowest in people trying to conceive without treatment, higher among people considering treatment, and highest among people using treatment (32.0%, 34.6%, 39.5%; p = 0.005), respectively.

Conclusions: People trying to conceive without treatment had comparable rates of anxiety and depression to users considering or undergoing treatment. Across all groups, more than 30% of users reported interest in support for their emotional well-being. Primary care providers and digital health platforms can screen and support this population.

Background: Toilet training practices vary across cultures and time. Assisted Infant Toilet Training (AITT) is commonly used in low- and middle-income countries.

Objectives: To synthesise the literature on AITT, including timing of initiation and completion, infant elimination signalling, and associations with bladder and bowel dysfunction.

Methods: An integrative review methodology was employed. Comprehensive searches of Scopus, Medline, CINAHL, Web of Science, PsycINFO, and Google Scholar identified relevant studies. Two reviewers independently screened and appraised studies using GRADE and JBI tools.

Results: Of 2,069 studies identified, 21 met inclusion criteria. Six observational studies reported reduced rates of bladder and bowel dysfunction when AITT was practised.

Discussion: AITT is widely practised in low-income, non-English speaking countries. While observational studies suggest a potential protective effect on bladder and bowel health, the evidence is at serious risk of bias. Further prospective research in high-income contexts is warranted.

Introduction: Care coordination can be an essential source of support to families of children with special health care needs and should ideally lead to improvements in the organization of care.

Purpose: This publication aims to share the experience of one statewide Title V organization's work to develop and validate a care coordination satisfaction survey.

Description: UIC-DSCC engaged with the Family Advisory Council and a Family Survey Committee to revise existing surveys measuring different care coordination domains. The overall consensus was to apply a 13-item annual care coordination satisfaction survey. The survey was administered to families between January and April 2023. Psychometric reviews included exploratory Factor Analysis for the underlying structure of the items and Cronbach α for reliability. A top-box approach was used to represent item proportion.

Assessment: 899 families completed the 13-item measure. The Exploratory Factor Analysis determined a 2-factor solution: (1) Care Coordination Satisfaction and (2) Engagement and Impact on Quality of Life-none of the items required removal. Factor 1's top-box results show families' positive experience with care coordination, with 6.37 of the seven questions being answered with the most favorable answer. Similarly, in factor 2, 5.28 of the six questions were responded to with the top or most favorable answer.

Conclusion: Family partnership is a crucial part of the care coordination process, and UIC-DSCC has learned that this partnership is also critical when evaluating family satisfaction with care coordination services. The 13-item care coordination survey demonstrated adequacy and can assist with quality improvement in care coordination programs.

Introduction: Both emotional reaction to pregnancy and pregnancy intention have been independently found to predict postpartum depressive symptoms (PDS). However, while pregnancy intention has been widely studied, there is minimal research on emotional reaction to pregnancy, and even less research on how these two factors interact.

Methods: Data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) survey in the state of Maine were analyzed for this study. Weighted logistic regressions were performed to predict both PDS and negative emotional reactions to pregnancy, with Odds Ratios and 95% Confidence Intervals calculated.

Results: Of 4,520 respondents, 38.8% reported unplanned pregnancies, 5.7% reported negative initial emotional reactions to pregnancy, and 4.2% reported unplanned pregnancies and negative initial emotional reactions. Approximately 11% reported PDS, and 15.1% had unplanned pregnancies and PDS, while 9% had planned pregnancies and PDS. Individuals with unplanned pregnancies had higher PDS risk than individuals with planned pregnancies, individuals with negative or unsure reactions had higher PDS risk than those with positive reactions, and individuals with unplanned pregnancies and all emotional reactions had increased PDS risk compared to those with planned pregnancies and positive reactions. After adjusting for covariates, only those indicating negative initial emotional reactions (independently) and those indicating negative emotional reactions and unplanned pregnancy (interactively) were at greater risk for PDS. Predictors of negative emotional reactions to pregnancy included lower income, greater number of previous live births, depression diagnosis in the 3 months before pregnancy, intimate partner abuse, and unplanned pregnancy.

Discussion: Negative emotional reaction to pregnancy and unplanned pregnancy independently and interactively predicted PDS. Findings highlight the importance of considering emotional and sociodemographic factors when evaluating the relationship between unplanned pregnancy and PDS.

Objectives: Prior to the Affordable Care Act (ACA), over two-thirds of states mandated that children had to be uninsured for set periods of time before enrolling in the Children's Health Insurance Program (CHIP), referred to as waiting periods. The ACA required that waiting periods could not exceed 90 days, leading states to reduce and eliminate waiting periods in response. This study aimed to examine the association between state waiting period elimination under the ACA with children's enrollment in CHIP.

Methods: We used 2010-2019 annual state enrollment data from the Centers for Medicare & Medicaid Services to calculate the proportion of children enrolled in CHIP among 20 states that eliminated waiting periods compared to 14 who maintained them. We estimated difference-in-difference models to assess the association between waiting period elimination with children's CHIP enrollment.

Results: In states that eliminated waiting periods, there were significant increases from 10.86% (95% CI: 9.51-12.21) of children enrolled in CHIP in the pre-policy period to 13.43% (95% CI: 12.21-14.66) after the ACA policy change. In adjusted difference-in-difference models, state waiting period elimination was associated with a 1.75% point (95% CI: 0.43-3.11) increase in children's enrollment in CHIP relative to states that maintained waiting periods, representing a 16% enrollment increase from pre-policy baseline levels.

Conclusions: Waiting period elimination under the ACA led to modest but significant increases in CHIP enrollment among children. Our results suggest potential CHIP enrollment benefits from the elimination of waiting periods that were maintained in 9 states.

Introduction: Low birth weight (LBW) is one of the most important factors affecting neonatal mortality and is a determinant of post-neonatal mortality. This study aimed to assess the effectiveness of the Pathways Community HUB Institute^® Model (PCHI^® Model) in improving birth outcomes among high-risk pregnant women.

Methods: In this retrospective study, data were drawn from the Pathways Community HUB Program (Community Health Access Project - CHAP) in Richland, Ohio, and the Ohio Department of Health from 2014 to 2017. We employed a 1:1 nearest neighbor propensity score matching for 315 participating and 315 non-participating women and used conditional logistic regression to analyze our data. The pregnancy outcomes we assessed included preterm birth and birth weight.

Results: The incidence of LBW in the Community Health Access Program (CHAP) group was 8.6% compared to 12.4% in the non-CHAP group. CHAP participants had a 43% lower chance of low birth weight births (OR = 0.572, 95% CI = 0.335-0.979), while the program's effect on preterm delivery approached but did not achieve statistical significance (OR = 0.640, 95% CI = 0.407-1.007). We also found that those who entered the CHAP program and those who had their first prenatal care appointment in the first trimester of their pregnancies were less likely to deliver a LBW infant than those who entered the program and had their first prenatal care appointment later in their pregnancies.

Conclusions: Among high-risk pregnant women, the PCHI^® Model can significantly improve prenatal care utilization and reduce the incidence of LBW infants. In addition, pregnant women participating in the Pathways Community HUB program appeared to benefit more if they entered the program in their first trimester rather than later in their pregnancy, suggesting that longer durations of program participation are associated with better birth outcomes.