Maternal and Child Health Journal最新文献

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.

Objectives: Adenomyosis is a common gynecologic disease involving the uterus, with its effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes.

Methods: Using the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.03, with the remaining pregnancies being the reference group. Then, ICD-10 codes were used to identify obstetrical and neonatal outcomes and multivariable logistic regression models, adjusted for baseline maternal demographics, were used to determine the impact of adenomyosis on these outcomes. Also, in light of the potential detection bias inherent in births by cesarean delivery, adjustment for mode of delivery was included in all regression analyses.

Results: Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases/100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (adjusted OR 1.7, 95% CI 1.2-2.4), preterm delivery (1.4, 1.2-1.6), preterm premature rupture of membranes (1.3, 1.1-1.6), postpartum hemorrhage (2.7, 2.1-3.3), post-partum transfusion (2.2, 1.6-3.0), disseminated intravascular coagulation (9.3, 4.2-20.9), sepsis (2.7, 1.6-4.5), congenital anomalies (2.0, 1.3-2.8), and intrauterine fetal demise (2.0, 1.0-3.8). Also, these pregnancies had an elevated risk of delivering by cesarean (15.7, 12.7-19.3).

Conclusion: Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. As such, pregnancies in patients with adenomyosis should be considered high-risk and should be delivered in centers capable of managing the potential poor events associated with these pregnancies.

Objectives: ExPAND Mifepristone is a one-year learning collaborative providing support for mifepristone provision in primary care for early pregnancy loss (EPL) or abortion. This study measured change in prevalence of medical management of EPL at a federally qualified health center (FQHC) that participated in ExPAND Mifepristone's pilot year. Secondary objectives were to describe changes in referral patterns and medication choice for EPL.

Methods: To quantify changes in medical management of EPL, we conducted a retrospective data query using International Classification of Diseases-10 codes during two time periods: pre-implementation (January 1, 2019 - February 29, 2020) and post-implementation (August 1, 2021 - June 30, 2022). Manual chart review was used to assess change in referral patterns for EPL.

Results: There were 193 patients with EPL in the pre-implementation period and 115 post-implementation. Pre-implementation, 8.3% (n=16) of EPL patients received medical management versus 15.7% (n=18) post-implementation (p=0.046). The percentage of all patients with EPL who received misoprostol alone was 8.3% pre- and 8.7% (p=0.91) post-implementation. Treatment with mifepristone plus misoprostol increased to 44.4%. EPL referrals to Obstetrics/Gynecology (OB/GYN) decreased from 14.0% to 1.7% (p=0.001). The most frequent reason for referral was procedural management.

Conclusion: After participation in ExPAND Mifepristone, there was an increase in medical management for EPL by PCPs and referrals to OB/GYN declined. ExPAND Mifepristone can help facilitate PCP use of mifepristone plus misoprostol for medical management of EPL.

Key words: Primary Care, Early Pregnancy Loss, Mifepristone, Women's Health, Referral.

Objectives: To examine associations between food insecurity and parenting stress and assess the extent to which parent and child mental health explain these associations.

Methods: Cross-sectional data from the 2016-2019 National Survey of Children's Health (N = 72,763) were pooled to compare parenting stress between households experiencing different levels of food insecurity. Tests were then performed to determine whether parent and child mental health mediates the association between food insecurity and parenting stress.

Results: Parents in households experiencing mild food insecurity had parenting stress scores that were 0.23 standard deviations higher than parents in food secure households. These parents were also 1.23% points (161.84%) more likely to report handling the demands of parenting poorly compared to parents in food secure households. The association between parenting stress and food insecurity increased in magnitude with more severe household food insecurity; parents in households experiencing moderate-to-severe food insecurity had parenting stress scores that were 0.46 standard deviations higher than parents in food secure households, and these parents were 4.3% points (565.79%) more likely to report handling the demands of parenting poorly compared to parents in food secure households. Differences in child and parent mental health explained only some of the identified disparities in parenting stress.

Background: Infertility poses a significant emotional burden on couples, leading to increased stress levels. This study aimed to investigate the effectiveness of cognitive-behavioral stress management training in reducing infertility-related stress among infertile couples.

Methods: A randomized clinical trial was conducted involving 20 infertile couples (40 individuals) who sought treatment at the Saboohi Infertility Center of Mahdieh in Tehran, Iran, between May and June 2018. Participants were selected using convenience sampling and randomly assigned to either the control group, which received routine infertility counseling, or the intervention group, which received cognitive-behavioral stress management training in addition to routine counseling. Independent t-tests and analysis of covariance (ANCOVA) were used.

Results: In the post-time period, the intervention group demonstrated a significant decrease in total stress scores compared to the control group for both men (B =  - 15.07, p < 0.001) and women (B =  - 2.82, p = 0.003), controlling for pre-time values. Subscale analyses revealed that the intervention group had lower scores in social concern, sexual concern, communication concern, rejection of childfree lifestyle, and the need to be a parent compared to the control group, for both men and women (p < 0.001).

Conclusions: In conclusion, our study highlights the effectiveness of a behavioral-based stress management intervention alongside infertility counseling in controlling infertility-related stress. These findings support the inclusion of this comprehensive counseling approach in the care package for infertile couples, enabling healthcare professionals to reduce stress and improve overall well-being.

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.