Maternal and Child Health Journal最新文献

Background: Recent findings indicate a sharp increase in childhood anxiety/depression, necessitating investigation into factors influencing these rates. We aimed to provide more current nationwide rates of childhood anxiety and depression and their association with caregiver mental and emotional health.

Methods: This retrospective cross-sectional study analyzes self-reported data from the National Survey of Children's Health (NSCH) to examine associations between childhood anxiety and depression and their severity levels, and the mental and emotional health of primary caregivers. A series of binary and ordinal logistic regression was carried out to assess such associations.

Results: 54,103 caregiver reported responses were analyzed. 12.0% and 5.8% reported anxiety and depression in their children, respectively. Caregivers who report "very good" mental and emotional health have 1.905 (1.757-2.066; p < 0.001) higher adjusted odds of their children having anxiety compared those whose who answered "excellent." Logistic regression results showed that caregivers with "excellent" (0.449; 0.312-0.649; p < 0.001) and "very good" (0.547; 0.384-0.778; p < 0.001) mental and emotional health reported lower adjusted odds of anxiety severity in their children compared to those with "poor" mental and emotional health. Additionally, caregivers with "excellent" (0.328; 0.195-0.550; p < 0.001) and "very good" (0.463; 0.287-0.745; p = 0.002) mental and emotional health reported lower adjusted odds of depression severity in their children compared to those with "poor" mental and emotional health.

Conclusion: Addressing social determinants of health, such as caregiver mental well-being, is essential in reducing the prevalence of mental health issues among children and ensuring the efficacy of evidence-based interventions.

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.

Objective: To document the impact of diaper banks' provision of free diapers on diaper dermatitis incidence and related treatment, as well as quantify the societal burden of diaper insecurity and the cost of addressing it.

Methods: The present study was a cross-sectional study of diaper bank recipient households. Data were collected from July 2021 to April 2022. Participating diaper banks (n = 65), located across the United States, were members of the National Diaper Bank Network. A sample of parents/caregivers (n = 5,598) receiving free diaper bank products for a child in their home completed anonymous surveys in English and Spanish.

Results: Children's ages ranged 0-47 months old, average 23.9 months. Most children had Medicaid healthcare coverage (80.7%; n = 5,154) or were uninsured (9.4%; n = 647). Fewer children experienced diaper dermatitis after receiving diaper bank products (p < .001) resulting in fewer healthcare visits and treatments (p < .001). Overall, participants reported children receiving diaper bank products experienced 41% fewer cases of diaper rash and 50% fewer cases of severe diaper rash. The annual cost of providing each child with a supplemental supply of diaper bank diapers ($211.56) is smaller than the annual societal cost of diaper insecurity ($659.10).

Conclusions for practice: The distribution of diapers by community diaper banks reduces the burden of pediatric illness and associated healthcare costs. Pediatric healthcare professionals and public practitioners are in an optimal position to screen for diaper need and refer to local diaper banks and diaper resources. Addressing diaper insecurity has implications for reducing the burden of social isolation and caregiver mental health.

Objectives: Following calls to reduce the prevalence of non-medically indicated cesarean deliveries (CD), there has been increased focus on trials of labor after cesarean (TOLAC). TOLAC requires a risk-benefit analysis, as unsuccessful TOLAC resulting in CD may compound morbidity. Prior work has attempted to develop risk prediction models that guide TOLAC counseling and account for sociostructural barriers. This study examined associations between social vulnerability and birth outcomes among patients with a history of one prior CD.

Methods: This retrospective case-control study included patients who attempted a TOLAC at term from 2016 - 2020. We divided patients into two groups: vaginal birth after cesarean (VBAC) and CD. We analyzed social disparities including race and ethnicity, health insurance type, and Social Vulnerability Index (SVI). Chi-squared tests examined proportional differences between groups and multivariable logistic regressions examined adjusted odds ratios of a CD.

Results: We included 976 births. There were significant sociodemographic disparities in VBAC success. Greater rates of morbidity were observed in the CD group. Multivariable regression models revealed that patients with high vulnerability had a 1.2 (1.1, 1.5) greater adjusted odds ratio (aOR) of CD. Patients who identified as Black had a 2.0 (1.1, 3.3) greater aOR of CD compared to White patients. Patients with public (0.6 [0.4,0.9]) or no (0.3 [0.1,0.9]) health insurance coverage had lower aOR of CD.

Conclusions: Our findings suggest that socially vulnerable patients may be more likely to have a CD, and social disparities persist in TOLAC outcomes. This suggests inclusion of social measures be considered with VBAC risk prediction.

Background: Racial and ethnic disparities in obstetric care persist in the United States. Veterans enrolled in Department of Veterans Affairs (VA) care receive obstetric care from community providers enrolled in the VA Community Care Network (CCN), yet little is known about Veterans' prenatal care decision-making. This study described how Black, Indigenous, and People of Color (BIPOC) Veterans select prenatal care providers and perceive hospital-level obstetric quality measures.

Methods: Pregnant BIPOC Veterans (n = 27) were identified from a community-based doula pilot (N = 29) at two VA medical centers. During semi-structured telephone surveys conducted around 20 weeks gestation, Veterans described factors influencing provider selection and rated the importance of three Joint Commission obstetric quality measures-cesarean birth, unexpected complications in term newborns, and exclusive breast milk feeding-on a 3-point scale ("not," "somewhat," or "very" important). Open-ended responses contextualized these ratings, and participants were asked if they knew how to access hospital-level quality data.

Results: Participants (mean age = 33 years) were predominantly Black (85.2%) and multiparous (70.4%). Provider selection was most influenced by geographic proximity (48.2%) and VA insurance coverage (44.4%). Hospital-level unexpected complications in term newborns was rated "very important" by 66.7%, followed by cesarean birth (48.1%) and exclusive breast milk feeding (40.7%). Most Veterans valued measures perceived as related to infant well-being. However, 74.1% did not know how to access quality data.

Conclusions for practice: BIPOC Veterans valued hospital-level obstetric quality measures related to infant outcomes and prioritized geographic accessibility and insurance coverage when selecting providers. Relevant, accessible quality information may allow Veterans to make better informed prenatal care decisions.

Objective: To evaluate the impact of BMI class increase during pregnancy on perinatal outcomes.

Methods: This retrospective cohort study from 2009 to 2022 included singleton pregnancies with a pre-gravid BMI ≥ 30 kg/m² that then increased ≥ 3 BMI points by the time of delivery. Patients without obesity and those who decreased BMI class were excluded. The primary composite outcome included fetal growth abnormalities, cesarean delivery, oligohydramnios, polyhydramnios, and stillbirth. Both superiority and equivalence analyses were performed.

Results: 16,835 pregnancies were included. The majority of patients were White/not Hispanic (80.3%) and multiparous (65.6%); co-morbidities increased as BMI increased. An increase from BMI class I to II led to more adverse outcomes than maintaining class I BMI (aOR 1.17, 95% CI 1.06, 1.28), and equivalent outcomes as those who had a pre-gravid class II BMI (adjusted 90% CI, -0.022, 0.019; p < 0.01). This increased odds of adverse outcomes doubled when the BMI increase from I to II occurred prior to 30 weeks gestation (aOR 1.34, 95% CI 1.21, 1.48). An increase from BMI class II to III led to higher odds of adverse outcomes than maintaining BMI class II (aOR 1.40, 95% CI 1.25, 1.58). The data does not provide sufficient evidence that the outcomes were equivalent to those with a pre-gravid BMI class III (adjusted 90% CI, -0.52, -0.017; p = 0.26).

Conclusions for practice: For pregnant patients with obesity, recommendations for pregnancy management should be based on current BMI, rather than pre-gravid BMI.

Background: Global concern about unwarranted childbirth interventions has intensified, with calls for respectful, evidence-based intrapartum care that supports physiologic birth. While antenatal education for expectant parents is common, the impact of multidisciplinary childbirth education for obstetricians has been underexplored.

Methods: In a study of obstetricians (N = 112, M_age = 44.1 years, SD = 6.8, 57% female), those completing the Istanbul Birth Academy's Childbirth Educator and Doula Training (CEDT) program (n = 67) were compared with obstetricians without such training (n = 45) via a survey. Group differences were tested with independent-samples t test (Bonferroni-adjusted) and ANCOVA controlling for age, academic title, experience, low-risk caseload, and employer.

Results: Of 31 practices, 26 differed by t test; 19 remained significant after correction. In adjusted models, 21 practices differed. CEDT-trained clinicians reported lower routine enemas, frequent digital exams, continuous CTG, routine IV lines, and IV fluids to shorten labor, with greater oral intake and nonpharmacologic pain relief; they more often supported instinctive pushing, upright positions, and delayed cord clamping, and less often used lithotomy and routine neonatal suctioning. Primary cesarean in nulliparas was lower.

Conclusion: This study's significance is that multidisciplinary childbirth educator-doula training for obstetricians is associated with fewer routine interventions and lower nulliparous primary cesarean rates. Prospective studies are warranted.

Objective: To describe a Patients as Partners maternity care quality improvement initiative. At the time the initiative was developed, the patient-provider relationship had emerged as a focal point in discussions of factors contributing to racial disparities in maternal health outcomes. The experiences of Black maternity patients have been the subject of many studies and have yielded consistent findings, particularly around patient-provider communication failures during childbirth.

Methods: Baltimore Healthy Start partnered with the Preeclampsia Foundation to collect and curate the stories of Baltimore women who suffered maternal health complications. During 2020-2021, a total of 34 women participated in focus groups facilitated by the Preeclampsia Foundation in order to share and draw lessons from their recent birthing experiences. All of these women were Black. Six women presented their experiences and recommendations to improve care at three hospital forums in Baltimore, MD held at Mercy Medical Center, Johns Hopkins Hospital, and Sinai Hospital. Together, these three hospitals account for the majority of births in Baltimore. Combined, over 100 medical, nursing, and administrative staff attended the Patients as Partners in Maternity Care Forums.

Result: Women reported feeling not listened to regarding pain, their birth plan, or being excluded from discussions and decisions regarding their care. Many women reported a belief that women of color are perceived as uneducated, therefore their opinion is viewed as less relevant; some women reported they believed this perception and treatment is exacerbated by preconceptions held by providers in relation to the education and intelligence of women receiving Medicaid coverage. Women offered a number of recommendations to improve the quality of care.