Maternal and Child Health Journal最新文献

Objective: To investigate evidence regarding the association between carbohydrate intake (general and sugar) during pregnancy and offspring's diet pattern and/or food preference in animals and humans until adolescence.

Methods: Interventional and observational studies with animals (AS) and humans (HS) were included. Six databases and gray literature were consulted. Risk of bias was assessed using the SYRCLE tool for AS and the Newcastle-Ottawa Scale (NOS, 9 stars in total) for HS. The certainty of evidence was evaluated using GRADE.

Results: Eleven articles were included. In AS (n = 6), general carbohydrate intake during pregnancy was associated with offspring's preference for high-fat and high-fat-protein diets, while in HS (n = 5) it was associated with increased carbohydrate consumption by children (p = 0.002) and a Western diet pattern in infants. AS studies on maternal sugar intake during pregnancy showed inconsistent results, with some associating it with offspring's sucrose preference and others finding no effect. In HS, maternal sugar intake was linked to the consumption of high-sugar products by infants up to adolescence. A high risk of bias was attributed to most categories in AS. In HS, NOS scores ranged from 7 (n = 2) to 8 (n = 3) stars, indicating methodological flaws. All studies were classified as having low certainty of evidence.

Conclusion: Maternal carbohydrate intake during pregnancy was associated in some studies with offspring's dietary patterns and preferences, supporting nutritional guidance during this period to promote healthier long-term habits. However, the evidence remains limited, reinforcing the need for further research.

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.

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.

The maternal health crisis in the United States continues to affect some communities more severely than others, often due to historic and systemic barriers to care. Addressing these challenges requirehs solutions that are built with, and trusted by, the communities they serve. This supplement highlights the Safer Childbirth Cities initiative, a multi-year investment by Merck for Mothers and philanthropic partners that supported twenty community-based organizations across the country. These organizations implemented a wide range of approaches-including community-based doula care, storytelling initiatives, health information exchange systems, and new ways of defining and measuring evidence-to improve maternal health outcomes in their cities. By elevating local leadership, building trust through collaboration, and tailoring care to reflect the knowledge and needs of patients, the efforts featured here provide valuable lessons on how maternal health systems can be reshaped to deliver high quality, accessible, and culturally responsive care.

Purpose: The purpose of this paper is to describe the design and implementation of the storytelling component of a multiprong, community-based project that shares the lived experience of Black and Brown women's birthing journey to reduce maternal mortality.

Description: Beginning 2021, the Southeast Michigan Perinatal Quality Improvement Coalition (SEMPQIC) worked with community perinatal care providers to administer a multiprong project to reduce maternal mortality in Detroit. The goal of the project was to build upon existing community assets to examine and replicate circumstances and conditions where Black mothers thrive. This article will focus on one component of this four-part effort that included production of storytelling videos of the birthing journey by Black and Brown women.

Assessment: A partnership with SEMPQIC and trusted, established community perinatal service providers was the operational foundation to identify 110 perinatal women from Detroit, willing to engage in storytelling training to tell their unique birthing journey story. 22 videos were professionally produced for use in Detroit to offer the lived experience of the current perinatal system of care. The engagement of the women for storytelling led to the development of a broader campaign and tool kit about maternal health called Our Voices Our Births: Hear Us! - Detroit Mothers Speak.

Conclusion: SEMPQIC works to reduce maternal mortality and improve the perinatal care system through promotion of racial health equity, using community collaboration for collective impact. This storytelling initiative demonstrates the transformative power of storytelling in addressing the maternal mortality crisis.

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.

Background: What is considered 'evidence' in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE).

Objectives: This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V.

Methods: This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach.

Results: CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity.

Conclusions for practice: Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided.

Purpose: Racial disparities in maternal health outcomes are a public health crisis in the U.S. Adequate connection to pregnancy-related resources is a strategy for improving maternal outcomes (Trost et al., in Pregnancy-related deaths: Data from maternal mortality review committees in 36 States, 2017-2019. Centers for disease control and prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html , 2022), yet patients receive little support navigating complex systems. We tested the feasibility of a transition-of-care program that identifies individuals in early pregnancy who visit the emergency department (ED) and facilitates connections to needed healthcare and supportive resources.

Description: This pilot used a regional Health Information Exchange (HIE) to identify people from EDs across four counties in South Jersey with evidence of a current or recent pregnancy and limited connection to care. Eligible patients were assigned to a partner site who contacted them to offer scheduling support for pregnancy-related care and connection to supportive resources. The pilot initially focused on prenatal care but expanded to include other supports based on patient needs.

Assessment: Of the 2073 eligible patients, 896 were contacted, and 379 accepted one or more types of support. Support was accepted across racial, ethnic, age, and insurance groups.

Conclusion: This pilot illustrated that a perinatal transition of care program from the ED to appropriate pregnancy-related services and resources is feasible. The ED provides a unique opportunity to identify and engage people early in pregnancy who might face barriers to accessing timely care. The model reduced reliance on self-navigation and addressed common access challenges.

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.