Maternal and Child Health Journal最新文献

Objective: To characterize pain and its evolution during the breastfeeding process among primiparous women.

Method: Longitudinal study nested within a clinical trial with 102 Brazilian primiparous women, with conditions and intentions favorable to breastfeeding. Pain level was measured using the Visual Analogue Scale and the descriptors, according to McGill. Follow-up was carried out via telephone in the first and second weeks postpartum. Failure to contact within 15 days was considered a loss. Fisher's exact test was applied to evaluate the association between the occurrence of pain and exclusive breastfeeding rates, and to evaluate the evolution of pain over the period, repeated measures ANOVA and Sidak's posthoc were applied. Values ​​of p ≤ 0.05 were considered significant.

Results: Most participants reported moderate-intensity pain more frequently at the beginning of breastfeeding. The pain was classified as sensory and commonly described as 'pulling.' Notably, the study found pain scores, severe pain scores, and pain sensation descriptors reduced from hospitalization to two weeks after birth (p < 0.001). The study also found that pain in the second week postpartum was associated with lower rates of exclusive breastfeeding (p = 0.017), highlighting the need for early intervention and support to ensure successful breastfeeding.

Conclusion: The study revealed nipple pain scores and qualifiers, its sensation during the breastfeeding process, and its evolution. Assessment and support in cases of this complaint are recommended.

Prenatal care provides an opportunity for the promotion of healthy parent and neonatal outcomes, but there are gaps in understanding the consequences and antecedents of prenatal care experiences during pregnancy. The objective of the current study was to provide insight into the mediational processes of sociodemographic and pregnancy characteristics on neonatal health and postpartum maternal wellbeing outcomes through prenatal care experiences. Data were analyzed from the publicly available Listening to Mothers III dataset comprised of 2,400 online-survey participants (ages 18-45) who gave birth to singleton infants in hospitals between July 2011 and June 2012 in the U.S. Primary analyses were conducted using two separate path analysis models examining maternal characteristics (i.e., sociodemographic and pregnancy factors) and the mediation of prenatal care experiences (i.e., responsive provider behavior, week of first prenatal visit, and attendance in group prenatal care) on infant health (i.e., preterm, low birthweight, NICU stays) and postpartum maternal wellbeing (i.e., social support, depression, confidence). The perceived need for treatment of depression and smoking during pregnancy resulted in 0.15 and 0.20 larger proportions of infants admitted into the NICU, respectively. Women who reported responsive provider behavior indicated higher social support (b = 0.29, p <.001), less depressive symptomology (b = -0.20, p <.001), and felt more confident (b = 0.07, p =.005). While maternal characteristics were related to neonatal health, the interpersonal experiences during prenatal care related to postpartum maternal wellbeing, indicating a need for providers to bolster their responsiveness to women during prenatal visits.

Objectives: Fear of childbirth (FOC) is a psychological symptom, prevalent among pregnant women, which negatively impacts women's health and well-being. The objective of this study is to analyze existing literature regarding pregnant women in China, evaluating the prevalence, risk elements, and interventions to alleviate severe childbirth fear.

Methods: A comprehensive search was done across nine bibliographic databases to retrieve published research from their earliest records to August 2023. The Joanna Briggs Institute (JBI) Critical Appraisal instruments were employed to evaluate the quality of each article. Data were independently extracted by pairs of reviewers and synthesized through a narrative analysis.

Results: The review comprised ten studies: seven cross-sectional studies and three randomized controlled trials. The results revealed varied prevalence rates of FOC. Risk factors identified were categorized into three main groups: sociodemographic characteristics, pregnancy and birth-related aspects, and mood-related aspects. Identified interventions included relaxation therapy and cognitive behavioral therapy.

Conclusions: Studies are scarce concerning FOC among Chinese pregnant women. However, existing research indicates that FOC remains prevalent within the population. Moreover, these studies reveal that risk factors for this fear are multifaceted, and limited intervention approaches are available. This study highlights the urgent need for further research to deepen the understanding of FOC among Chinese women and develop more comprehensive and tailored interventions to improve the overall maternal health and childbirth experiences in China.

Objectives: To analyze the impact of COVID-19 and subsequent lockdowns on maternal and child health services in India and investigate whether certain population groups that are disadvantaged along social, economic and geographical dimensions experienced differential impacts.

Methods: Utilizing an unintended disruption in the fifth round of the National Family Health Survey (NFHS V) due to nationwide COVID-19 related lockdown, we create a sample of children and mothers who were 'exposed' to COVID-19 pandemic and lockdowns, and those who were not 'exposed'. We use multivariable regression to examine whether and to what extent antenatal care, pregnancy and post-pregnancy care of the 'exposed' mothers and children were adversely impacted as compared to those who were 'unexposed'.

Results: The 'exposed' mothers were less likely to receive two tetanus injections, and iron folic acid tablets during pregnancy, and were less likely to stay in medical facility for 48 hours post-delivery as recommended by the government guidelines. More critically, 'exposed' children had lower probability of receiving immunizations due at birth, 6-weeks, 10-weeks, and 14-weeks, with the magnitude of decline increasing for successive immunizations. The impacts were even more adverse in rural areas as reflected in heterogeneity analysis.

Conclusions: COVID-19 pandemic and lockdowns adversely affected MCH services in India, and even more so in rural India. Policy interventions targeted specifically at groups who were impacted would be needed to restore MCH services to pre-pandemic levels.

Clinical trial registration: Not Applicable.

Introduction: Preterm birth represents about 10% of all births in the United States and is known to be influenced by maternal factors, including pre-pregnancy adiposity, measured using BMI. Pre-pregnancy adiposity is influenced by environmental and sociodemographic factors. This exploratory analysis aimed to explore the complex relationship between pre-pregnancy adiposity, sociodemographic factors, and delivery outcomes among preterm deliveries.

Methods: In this retrospective record review study, participants were mothers of infants born before 34 weeks and 6 days gestational age (GA) and admitted to the NICU at Loyola University Medical Center between 2018 and 2020. Maternal data were extracted using EPIC electronic medical record review. We used Chi-square test/Fisher's exact test for categorical variables and Kruskal-Wallis or Mann-Whitney U tests for continuous variables to test for significance across BMI categories. An exploratory multiple linear regression analysis to test the association between gestational age at delivery, obesity/overweight, socioeconomic status, and ethnicity/race was performed and supplemented with permutation testing. Statistical significance was set at p < 0.05.

Results: Among the 27 included participants, the median maternal age was 34 years. The prevalence of pre-pregnancy obesity was 42.9%. Women with obesity/overweight tended to have a lower GA at delivery than women with a normal pre-pregnancy BMI (29.5 weeks vs. 31 weeks, p = 0.073). GA at delivery trended positively with higher socioeconomic status (B = 4.2, 95%CI 1.4-7.0, p = 0.007), and inversely with having overweight/obesity (B=-3.6, 95%CI -5.7- -1.6, p = 0.002), and identifying as non-Hispanic Asian or non-Hispanic Black race/ethnicity (B=-6.3, 95%CI -10.3- -2.4, p = 0.005 and B=-0.50, 95%CI -7.8- -2.2, p = 0.002, respectively).

Discussion: In addition to adiposity, race, ethnicity, and socioeconomic status may be associated with more severe preterm delivery (lower GA). While this exploratory study is limited by the small sample size, our findings highlight the impact of sociodemographic factors on maternal obesity and severity of pregnancy complications in the context of preterm birth with NICU admission.

Introduction: Social factors impact survival for infants with birth defects. This analysis describes the impact of social factors on one-year survival for infants with congenital diaphragmatic hernia (CDH), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF).

Methods: Survival estimates were generated using the Kaplan-Meier method and the log-rank test with 0.05 significance stratified by social factors for infants born 2011-2019 with CDH (N = 942), TGA (N = 1,102), or TOF (N = 1,545). Crude hazard ratios (HR) and adjusted hazard ratios (AHR) with 95% confidence intervals (CI) were calculated for infant death using the Cox proportional hazards models.

Results: One-year survival was 88.7% for TOF, 88.0% for TGA, and 72.7% for CDH. Infants with CDH whose mother resided along the Texas-Mexico border had an increased risk of death compared to non-border residents (HR = 1.68, p =.003). Lower maternal education attainment was associated with increased risk of death for infants with TGA (HR = 1.75, p =.002) or TOF (HR = 1.54, p =.005) compared to infants whose mother had more than a high school education. Maternal Hispanic ethnicity increased the risk of death for infants with TGA (HR = 1.75, p =.005) or TOF (HR = 1.74, p =.002) compared to NH White infants.

Discussion: Hispanic maternal ethnicity, lower maternal educational attainment, and residence along the Texas-Mexico border negatively impact infant one-year survival.

Among pregnant women, influenza increases the risk of complications such as hospitalization, intensive care unit admission, and death. To prepare for new pandemics in the future, pregnant women's perceptions of influenza vaccines during the COVID-19 pandemic should be investigated. This study used the theory of planned behavior (TPB) to identify the determinants of pregnant women's intention to receive the influenza vaccine and their uptake of it during the COVID-19 pandemic. A cross-sectional study was conducted among pregnant or postpartum women within one year of delivery from the largest online panel (n = 351). Data were collected using an online survey during April 1-15, 2022. Path analysis was performed to investigate the pathways of the TPB constructs' effects on influenza vaccine uptake. The influenza vaccination rate among pregnant women during the pandemic was 51%. Attitude towards vaccine (β = 0.60, p < 0.001) and subjective norms (β = 0.28, p < 0.001) directly and positively affected intention, which directly and positively affected uptake (β = 0.48, p < 0.001). Attitude towards vaccine (β = 0.29, p = 0.006) and subjective norms (β = 0.134, p = 0.015) also positively and indirectly affected uptake. Influenza vaccine uptake remains suboptimal among pregnant women in many countries. Attitude towards vaccine is the strongest determinant of the intention to receive the vaccine and its uptake during pregnancy. More active efforts are required to improve pregnant women's attitudes toward the vaccine.

Objective: To examine the association of health services utilization and family frustration in getting health care services with the intersection of consistent and adequate health insurance coverage and access to medical home care among children in the US.

Methods: We conducted a pooled, cross-sectional data analysis using the 2016-2023 National Survey of Children's Health data. Survey-weighted multivariable logistic regressions were used to estimate the association of emergency department (ED) visits, preventive care utilization, and family frustration in getting services with the intersection of having consistent and adequate health insurance coverage and comprehensive access to medical home care.

Results: Of 279,789 children representing 61.9 million children from 2016 to 2023, 79.0% had one or more preventive care visits, 17.9% had at least one ED visit, and 18.7% of families reported being frustrated in efforts to get care for their children in the past 12 months. Overall, 33.1% of children were consistently and adequately insured and had access to medical home care, while 21.0% had neither. Compared to children with consistent and adequate health insurance coverage and access to a medical home, children without either or both consistent and adequate health insurance coverage and access to medical home care were less likely to have at least one preventive care visit and, their families were more likely to report frustration in obtaining services.

Conclusion for practice: Improving access to medical home care is critical to minimize disparities in preventive care use and to improve health outcomes for children, beyond comprehensive health insurance coverage.

Objectives: Previous research has linked adverse childhood experiences (ACEs) to maternal smoking, but the role of socioeconomic status (SES) in adulthood and perinatal abuse remains unclear. This study examined the strength of the association between ACEs and maternal smoking behaviors before, during, and after pregnancy and investigated whether maternal SES and perinatal abuse modify this association.

Methods: This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System survey (2017-2020). The weighted prevalence of self-reported ACEs and smoking was calculated. Multivariate logistic regression models were conducted to examine the association between ACEs and maternal smoking throughout pregnancy, accounting for maternal SES and perinatal abuse.

Results: Of the 6,595 respondents, nearly 20% of mothers reported experiencing one ACEs, while 29.3% reported three or more. Smoking prevalence was significantly higher among those with ACEs: 2.3% (95% CI 1.7%-3.2%) for mothers reporting zero ACEs, compared to 18.7% (95% CI 16.7%-20.8%) for those reporting three or more ACEs. While SES and perinatal abuse partially explained the association, women with three or more ACEs still had over four times the odds of smoking during pregnancy (aOR = 4.84, 95% CI 3.29-7.10), even after full adjustment.

Conclusions: These results highlight the long-lasting consequences of adversities encountered in early life, which can shape the smoking behaviors of women even during the critical stages of their own pregnancy. There is a need for tobacco control interventions among the most vulnerable that extend beyond the traditional services and address deeply rooted factors from past experiences.