Maternal and Child Health Journal最新文献

Objectives: The study aimed to compare anxiety, stress, sleep quality, occupational pattern and leisure satisfaction of pregnant women in different trimesters.

Methods: Pregnant women who came for routine check-ups (n = 156) were evaluated in clinics and family health centers. The pregnant women's anxiety, perceived stress levels, sleep quality, occupational pattern, occupational balance, and leisure time satisfaction were measured using the Perinatal Anxiety Screening Scale (PASS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Inventory (PSQI), Modified Activity Questionnaire (MOQ), Occupational Balance Questionnaire (OBQ11-T), and Leisure Satisfaction Scale (LSS), respectively.

Results: The PASS and PSS total scores in the second and third trimesters were similar, yet higher than in the first trimester (F = 13.496, F = 39.401; p < 0.001, respectively). The PSQI and QBQ11-T total scores were highest in the first trimester and gradually decreased in the second and third trimesters (F = 25.029, F = 30.108; p < 0.001, respectively). The mean sports repetition was similar in the second and third trimesters and lower than in the first trimester (F = 14.087, p < 0.001). The LSS total scores were similar in the second and third trimesters and lower than in the first trimester (p < 0.05).

Conclusions for practice: The anxiety and perceived stress levels increased, and occupational balance and sleep quality deteriorated gradually throughout the trimesters. It may be important for the pregnancy curriculum for health professionals working with pregnant women to consider the impact of the changes on participation in daily life.

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.

Introduction: Most congenital heart disease (CHD) is due to a combination of genetic and environmental factors. Recent findings suggest a polygenic inheritance in more complex CHD, highlighting a role for environmental factors in final disease presentation. Using data linkage, this study investigated the association of prenatal factors and maternal chronic health conditions with CHD severity.

Method: Patients from the Kids Heart BioBank (n = 2389) were linked to the NSW Perinatal Data Collection and the NSW Admitted Patient Data Collection containing prenatal and maternal health records. CHD cases were grouped into two categories according to disease severity: (i) complex CHD (comprising patients requiring neonatal intervention, n = 581) and (ii) other CHD (comprising patients requiring intervention after the neonatal period, n = 1808). Prenatal factors and chronic health conditions were coded using ICD-10-AM classification and compared across severity groups and healthy controls (n = 58,624).

Results: Analyses identified a significant increase in preexisting diabetes mellitus (p = 0.003), and urinary tract infections (p = 0.01) in mothers of infants with complex CHD compared to other CHD. Conversely, circulatory system disorders and preeclampsia/gestational hypertension were reduced in mothers of infants with complex CHD compared to other CHD (p = 0.01 and p = 0.06, respectively). These risks remained after adjusting for confounding factors including socioeconomic status, smoking, age at pregnancy, gestational age and year of birth.

Conclusion: These findings suggest an important role for prenatal factors and maternal chronic health conditions in CHD severity, in line with previous reports supporting polygenic inheritance in complex disease with contributions from environmental 'stressors' in the final disease presentation. Importantly, these findings hold promise for future primary prevention for complex CHD through therapeutic treatments of potentially modifiable factors in pregnancy.

Objectives: California has taken various actions with the goal of advancing maternal health equity. We analyze recent California laws and regulations using a novel conceptual model to understand whether and how they target expert-identified drivers of inequities in maternal health.

Methods: Using policy review and deductive thematic analysis, we evaluated whether recent state laws and regulations in California sought to directly intervene on healthcare-based drivers of racial inequities in maternal health as conceptualized by a CDC-convened expert workgroup.

Results: We identified 13 laws/regulations enacted between 2019-2023 that aimed to improve maternal health. All intervened on one or more healthcare-based drivers of inequities. Two (15%) targeted Driver 1 - Problems in communication, stereotyping, and other interpersonal interactions, resulting from interpersonal racism, by e.g., requiring provider anti-bias training. One (8%) targeted Driver 2 - Differential and/or suboptimal treatment for minoritized populations within healthcare settings (e.g., lower-quality care, inequitable burdens of hospital policies; resulting from institutional racism), by making reporting discrimination easier for patients. Twelve (92%) targeted Driver 3 - Lack of resources and/or policies that could support the health and healthcare of minoritized populations, stemming from structural racism, by e.g., expanding access to midwifery and doula care or diversifying the maternal health workforce.

Discussion: California's recent maternal health-focused laws/regulations have primarily targeted inadequate or inequitable structural resources (Driver 3). Few directly intervened on Drivers 1 or 2. These findings provide a useful grounding for future policy research and reveal the advantages of assessing policies in terms of mechanism-focused intervention targets. Policy implications and potential levers are discussed.

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: 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.

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: Poor weight gain in infants under one month old is a common reason for hospitalization.

Objectives: We aimed to study the etiologies of poor weight gain in hospitalized full-term infants under one month old, as well as the type of population epidemiology and diagnostic tests performed.

Methods: The design was a retrospective study, with data obtained from four French hospitals, evaluating full-term infants less than one month who were hospitalized for poor weight gain.

Results: Of the 313 children hospitalized for poor weight gain included in our study, the main etiologies were intake deficiency (72.8%), jaundice (12.1%) and infections (8.3%). Our study population comprised 55.9% male, the mean age at the time of hospitalization was 11.4 days (+/- 5), and 64.5% were exclusively breastfed. We found no predisposing factors for intake deficiency.

Conclusion: In full-term infants hospitalized for poor weight gain in their first month of life, intake deficiency appears to be the most frequent diagnosis, without other identifiable distinctive factors in our study. Identifying risk factors for intake deficiency and suggesting increased surveillance of at-risk infants could help limit its occurrence, reduce the need for invasive tests carried out and decrease the resulting number of hospitalizations.