Maternal and Child Health Journal最新文献

Objectives: Experiencing a maternal complication of pregnancy conveys a significantly higher risk of developing premature cardiovascular disease compared to having an uncomplicated pregnancy. Postpartum interventions that aim to improve lifestyle and modifiable risk factors for people in this cohort may reduce cardiovascular disease risk. This study will explore the experiences and barriers to attendance of patients referred to one such clinic located in South Australia.

Methods: This qualitative study conducted six focus groups comprised of two-six patients who had attended at least one postpartum intervention clinic appointment (N = 19). Audio recordings were captured and transcribed and NVivo was used to perform a thematic analysis.

Results: Participants found the clinic informative as it educated them on their greater risk of cardiovascular disease and how to reduce this risk. They reported wanting more frequent appointments and the ability to opt in for additional contact, including newsletters and social media groups. We also identified several barriers to attendance, including an unclear clinic referral and appointment booking process, and missing clinic correspondence including appointment letters and pathology forms.

Conclusions for practice: This study provides insight into the experiences of patients who attended a postpartum cardiovascular disease prevention clinic. The clinic model can be operated in different health care settings to become part of standardized care in the postpartum period for patients who have had a pregnancy complication. Refinement of the clinic model referral and booking processes could reduce potential barriers to patient attendance.

Objectives: To inform the development and adaptation of lifestyle programs to prevent type 2 diabetes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes (GDM).

Methods: Participants are from the Balance after Baby Intervention (BABI) study, a two-year randomized clinical trial of a lifestyle program for women with recent GDM conducted in Boston, MA, and Denver, CO between 2016 and 2019. The Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered at an average of 8-weeks postpartum. We defined an EPDS score of ≥ 9 as depressive symptoms and reviewed medical records for medical history. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of postpartum depressive symptoms using multivariable logistic regression and selected the best fit model.

Results: Our analysis included 181 women. Thirty-five (19%) scored ≥ 9 on the EPDS. While both perceived stress and whether this was the first pregnancy complicated by GDM were significant in the bivariate analysis, only perceived stress remained a significant predictor of postpartum depressive symptoms in the multivariate regression model (OR 4.34, 95% CI [2.58-7.31]). The effect of first GDM pregnancy was no longer significant in the multivariate model (OR 2.00, 95% CI [0.63-6.33]). Additionally, a mediation model determined that perceived stress fully mediated the effect of first GDM pregnancy on depressive symptoms (Effect ratio, 0.5507/1.5377 = 0.358, p = 0.036).

Conclusions for practice: Perceived stress was predictive of postpartum depressive symptoms in women with recent GDM and was found to mediate the relationship between first pregnancy complicated by GDM and postpartum depressive symptoms. Addressing perceived stress in the early postpartum period may be an important target for future lifestyle programs to maximize diabetes prevention efforts.

Background: In collaboration with community research partners, a national cross-sectional online Childbirth Experience Survey (CBEX) of pregnant and postpartum birthing people was administered in 2016. The linked antepartum-postpartum survey included items across 18 domains (e.g., labor management, pain management, newborn care and feeding), and identified 23 childbirth-specific postpartum patient-reported outcomes (PROs) that were associated with hospital satisfaction. CBEX was implemented in 16 California hospitals to identify hospital-specific opportunities for improvement in care. We analyzed postpartum qualitative survey responses (1) to evaluate the content validity to test the representativeness of existing CBEX domains, (2) to assess for any potential new domains or topics of interest within existing domains, and (3) to use these data to provide hospitals with actionable information for practice improvement.

Methods: This was an analysis of qualitative survey data based on the following CBEX item: "Is there anything else you would like to share about your birth experience?" Patients could provide multiple comments. Using Atlas.ti Version 8, we mapped participant responses to the 18 existing CBEX domains.

Results: Of 525 surveys completed between Oct 2018 and Sept 2020, 172 patients responded to the qualitative item. A total of 235 comments were analyzed and all were able to be mapped to the 18 domains. Qualitative responses highlighted subtleties within several CBEX domains: (1) labor management: pressure from the care team to have a labor induction; (2) pain management: epidural effectiveness, timing, dosage, and education; (3) empathy and respect: issues related to students and residents; and (4) newborn feeding: rough physical handling of patients by nurses, specifically during lactation consults.

Discussion: CBEX survey data is currently being utilized in hospitals to inform childbirth-specific quality improvement initiatives. By capturing detailed voluntary participant responses, CBEX provides the opportunity to document and explore nuanced aspects of the childbirth experience and subtleties that may be contributing to maternal dissatisfaction.

Introduction: Antenatal education (ANE) equips pregnant women with knowledge and skills for pregnancy, birth, and the postnatal period. It should facilitate preparation for the whole spectrum of the maternal journey and empower women to make informed decisions. This study aimed to explore the antenatal education needs and preferences of women who are currently pregnant or planning a pregnancy.

Methods: A UK wide cross-sectional survey was conducted (September 2019 to July 2020), recruiting women living in the UK, above 16, who were currently pregnant or planning a pregnancy. The survey gathered demographic information, details of current or planned class attendance, preferred ANE providers and desired skills and information. Quantitative data were analysed descriptively, and free-text responses underwent thematic analysis.

Results: Of 553 participants included in the analyses, 77% preferred free National Health Service (NHS) classes and 60% planned to attend multiple class types, including paid options. Participants valued practical skills, particularly for labour and the postpartum period, and actively sought perinatal social networks. Multiparous women were less likely to attend classes, citing prior experience or practical barriers. Despite high interest in NHS classes, regional variations in availability and limited accessibility were noted.

Conclusion: NHS antenatal classes are a trusted source of ANE, forming a core element of many women's antenatal journey. However, inconsistent provision highlights the need for a standardised, comprehensive curriculum. Flexible delivery models and tailored content are crucial to address diverse needs, particularly for multiparous women and underrepresented groups. Enhanced accessibility could reduce inequalities in ANE provision and improve maternal outcomes.

Objectives: The specific aims of the project are: (1) Examine the impact of COVID-19 on pregnancy experiences and outcomes; (2) Examine the mental health impact of COVID-19 in pregnant women and mothers of children 12 months or younger; (3) Identify risk and protective factors among this population in Puerto Rico.

Methods: Participants were recruited from the Puerto Rico Team for Exploring Contamination Threats (PROTECT) Superfund Program, which is composed of pregnant women and mothers from the northern karst region of Puerto Rico. The research had a mixed methods approach with a quantitative survey (n = 184) and qualitative interviews (n = 10); data collection was done in virtual mode.

Results: Findings from the qualitative interviews highlight the experiences regarding access to healthcare services, pregnancy and birth experiences, social support, and mental health during the pandemic among women with young children. These narratives serve to illustrate the particular challenges and opportunities that the participants faced during the year 2021 in regard to maternal health in Puerto Rico.

Conclusions for practice: COVID-19 restrictions impacted the experiences in receiving healthcare services, particularly regarding the birthing process and the participants' mental health. Social support, particularly from family, was found to be a protective factor for facing the challenges during pandemic times. We expect that the findings can lead to the development of interventions for community health centers, prenatal clinics, non-governmental organizations, and parents/caretakers in Puerto Rico.

Introduction: Although there are acceptable medical reasons for the use of food supplements, most prescriptions for newborns do not comply with current recommendations, putting continued breastfeeding at risk. This study aimed to create and validate a flowchart for newborn supplement prescription.

Methods: The flowchart was created and submitted to two rounds of assessments by a panel of judges, who calculated the content validity index (CVI) (acceptable > 0.80). Flowchart use in clinical practice (applicability) was validated by professional prescribers through the resolution of 3 clinical cases. Data were analyzed using Pearson`s chi-squared test (p < 0.05).

Results: The flowchart was assessed by 17 judges and validated regarding its content (CVI = 0.84). Took part in validating the applicability of this study 169 doctors and nutritionists who work in maternal and child health. There was a statistical association between correct case resolution and flowchart utilization in two of the three clinical cases (p < 0.05). In situation 1, the use of a validated flowchart increased the likelihood of correct answers 7.76 times.

Discussion: Prescribing baby formula is complex and requires careful assessment of several factors. Thus, knowledge translation is an effective intervention to eliminate the gaps between knowledge and clinical practice. The validated flowchart allows more assertive conduct regarding breastfeeding management and food supplement prescription for newborns.

Objective: To evaluate whether Covid-19 related workflow changes to a clinically-integrated breastfeeding peer counseling (ci-BPC) program were associated with poorer breastfeeding outcomes for Medicaid-enrolled patients.

Methods: This retrospective chart review included patients who received ci-BPC care during January 2017-March 2020 ("Pre-Pandemic," N = 318); March 2020-September 2020 ("During-Peak," N = 53); and September 2020-May 2021 ("Post-Peak," N = 97). ANOVA evaluated differences in encounter type frequencies for each time point, as well as differences in breastfeeding initiation, exclusivity during inpatient admission, and continuation of breastfeeding at least 6 weeks post-delivery.

Results: In-person prenatal counseling significantly decreased from Pre-Pandemic to During-Peak (43.9-8.2%, p < 0.05). Breastfeeding at 6 weeks postpartum significantly increased from the Pre-Pandemic cohort to the During-Peak cohort (67-85%, p < 0.05), and returned to baseline for the Post-Peak cohort (74%).

Conclusions for practice: Covid-19 related workflow changes for the peer counselor did not decrease breastfeeding outcomes as anticipated.

Introduction: Referrals to peer support (PS) can help families of children with special health care needs in providing emotional support, reducing feelings of stress and anxiety, and improving the care experience. This study aimed to gain providers' perspectives about PS referrals for families of children with special health care needs, including their perspectives on logistics of, barriers to, and facilitators of making referrals as well as the perceived impacts of PS referrals.

Methods: This study builds on a 2022 survey of California pediatric subspecialists about the value and challenges of PS. The study team conducted 20 semistructured interviews with people from pediatric subspecialty practices in California and used a priori themes derived from the interview protocol to develop a codebook, code interview transcripts, conduct a thematic analysis, and summarize findings.

Results: Respondents offered a variety of PS referrals inside and outside their institutions, tailoring referrals to each family's needs and preferences. Social workers and family liaisons were most commonly responsible for making PS referrals. Respondents found that care team collaboration and ease of sharing information about PS resources among colleagues facilitated the referral process. Respondents noted a need for more PS resources, including funding, education, and the need for a network where providers can identify PS resources.

Discussion: Encouraging PS program information-sharing within and across organizations could help connect more families to PS services. Future research should assess families' experiences with PS referrals and services to understand approaches that can best meet their needs for information, instrumental, and emotional supports.

Objectives: This study examines the associations between race and ethnicity and receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals.

Methods: National data from 2016 to 2019 CDC PRAMS were analyzed. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We conducted adjusted regression analyses to compare the odds of receiving individual key clinical practices that support breastfeeding, as well as the percent of key clinical practices received.

Results: While some key clinical practices were received at high rates, less than 25% of mothers received 100% of recommended key clinical practices. Compared to White non-Hispanic mothers, mothers from various racial and ethnic groups were at lower odds of receiving 100% of key clinical practices: Black non-Hispanic [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) (0.47-0.65)], English-Speaking Hispanic [AOR 0.79, 95% CI (0.71-0.88)], Spanish-speaking Hispanic [AOR 0.63, 95% CI (0.53-0.73)], and Asian/Pacific Islander non-Hispanic [AOR 0.54, 95% CI (0.47-0.63)].

Conclusions for practice: Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group.

Background: This study aimed to evaluate the construct validity and reliability of the newly adapted German version of the Parental Bonding Questionnaire (PBQ) in a group of mothers drawn from the general population, with children aged 12-24 weeks. This assessment followed a thorough linguistic validation, which was conducted through a systematic, multi-step translation process.

Methods: 363 women completed the PBQ online 12-24 weeks after delivery. Cronbach's alpha and exploratory factor analysis (EFA) were used to assess internal consistency reliability and construct validity.

Results: The original 4-factor model could not be confirmed. The new PBQ provides a single factor solution. Ten items were removed from the original 25-item PBQ to produce the abbreviated German PBQ-15, which showed strong internal consistency. The Cronbach's alpha for this version was 0.86.

Conclusion: While further research is needed to establish diagnostic thresholds and strengthen the construct validity of the shortened version, the German-language 15-item version of the PBQ holds promise as an accessible tool for recognizing bonding issues in a general population of German-speaking women 3-6 months postpartum.