Maternal and Child Health Journal最新文献

Objectives: Overdoses are a leading cause of maternal mortality in the US, but limited evidence exists about patterns of nonfatal overdose, a key risk factor for subsequent fatal overdose, or of other drug-related harms. Here, we estimate prevalences of nonfatal overdose and injection-related endocarditis and abscesses/cellulitis across the 21 months spanning pregnancy and the postpartum year.

Methods: Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated the prevalences of hospital-based diagnoses of nonfatal overdose and of injection-related bacterial infections (i.e., endocarditis, abscesses, and cellulitis) across these 21 months; by trimester and postpartum quarter; and by social position (e.g., race/ethnicity, rurality, payor).

Results: The 21-month nonfatal overdose prevalence was 158/100,000 births (CI: 145/100,000, 172/100,000); the 21-month prevalence of injection-related bacterial infections was 56/100,000 births (CI: 49/100,000, 65/100,000). There was a trend such that rates of overdose and of injection-related bacterial infections declined as pregnancy progressed and rebounded postpartum. Rates of all outcomes were highest outside of large metropolitan areas and among publicly insured residents.

Conclusions for practice: The trend toward diminished rates during pregnancy is supported by past qualitative studies. If confirmed by future research in other geographical regions and with larger sample sizes, this finding holds promise for programmatic and policy interventions. Interventions co-designed with people who use drugs could complement and support harm reduction efforts that pregnant people are already engaging in independently. Such efforts can help people who use drugs survive the pregnancy and postpartum year.

Introduction: This study aimed to examine the association between adverse childhood experiences (ACEs) and antenatal depression among women in Taiwan and investigate the mediating effects of partner support and social support on that relationship.

Methods: An online survey was conducted, and 456 women aged ≥ 20 years with childbirth experience responded. The participants were asked to recall and self-report their childhood experiences and their perceived social support and mental health status during pregnancy. Linear regression was used to test the association between ACEs and antenatal depression, and causal mediation analysis was performed to analyze the mediating effects of partner support and social support.

Results: More than 85% of the participants had experienced at least one type of ACE, and 25.8% reported experiencing four or more ACEs. Our findings indicated that ACEs were associated with antenatal depression. We also found that participants who reported emotional abuse had the highest scores for antenatal depression, followed by those who reported a household member being treated violently and those who reported sexual abuse. Moreover, women with more ACEs were more likely to suffer from antenatal depression. Mediation analysis revealed that partner support and social support accounted for 20.23% and 36.83%, respectively, of the associations between ACEs and antenatal depression.

Discussion: The findings of this study suggest that ACEs have a pervasive impact on antenatal depression. Early intervention to prevent ACEs as well as improvements to the availability of social support for pregnant women should be provided to prevent antenatal depression, which will in turn improve fetal growth and development.

Aims: This meta-analysis aimed to investigate the association between maternal depression and exposure to air pollution.

Review methods: A meta-analysis following PRISMA methodology was conducted to examine the association between maternal depression and exposure to air pollution. From inception to February 2025, five online databases (PubMed, Cochrane Library, Web of Science, Embase, and PsycINFO) were used to search studies. Summary estimates with 95% confidence intervals were calculated to assess the correlation between each pollutant and the risk of depression. We aggregated the cumulative estimates were pooled using random-effects models. To evaluate within-study heterogeneity, Cochran's Q test and I² statistics were applied. Additionally, subgroup and sensitivity analyses were performed to explore potential sources of heterogeneity.

Results: The analysis revealed distinct associations between various air pollutants and depression. While no significant correlation was found for CO, PM_2.5 and SO_2, an elevated risk of depression was observed for PM₁₀ and NO₂ with every 10 µg/m3 increase in these pollutants. Surprisingly, O₃ was negatively associated with maternal depression.

Conclusions: This meta-analysis highlights air pollution as a potential risk factor for maternal depression, revealing variations in risk across different pollutants. These findings emphasize the importance of tailored interventions and the need for further research to gain a deeper understanding and effectively address the impact of air pollution on maternal mental health.

Objectives: This study examined disparities in prenatal care utilization by race/ethnicity and payer using three measures of inadequate prenatal care: (1) fewer than the recommended number of prenatal care visits, (2) late initiation of prenatal care (at or after 4 months gestation), or (3) no prenatal care.

Methods: Birth records data from the National Center for Health Statistics were used. The study population consisted of singleton live births in all 50 U.S. states and the District of Columbia between January 1, 2014, and December 31, 2022 (N = 33,107,382).

Results: The average number of reported prenatal care visits was 11.2 (SD = 1.2), 36.8% reported fewer than the recommended number of prenatal care visits, 22.7% reported late initiation of prenatal care, and 1.8% reported no prenatal care. Women with a Medicaid-covered delivery were 1.06 times more likely to have fewer than the recommended number of visits, 1.36 times more likely to initiate prenatal care late, and 1.72 times more likely to have no prenatal visits (all p < 0.001). There were significant disparities in prenatal care utilization by race/ethnicity, particularly for NHPI and AIAN women, with all minoritized racial/ethnic groups having greater risk for multiple measures of inadequate prenatal care utilization relative to White populations.

Conclusions for practice: Racial/ethnic and economic disparities in perinatal health in the U.S. are of national concern. Differences in prenatal care utilization between women with Medicaid and private/other insurance suggest modifications to Medicaid policies may improve prenatal care access among beneficiaries.

Objectives: This study investigated whether county COVID-19 infection rates during the first trimester were associated with adverse pregnancy outcomes and whether those disproportionately impacted Black or Hispanic women.

Methods: This study used birth outcomes data 2018 through 2022 for four of Florida's five largest counties. Outcomes were paired with census tract socioeconomic characteristics and with COVID-19 infection rates during the first trimester in the woman's home county. Outcome measures included preterm birth, low birthweight and very low birthweight. Multivariate regression was used to test the association between infection rates and all outcomes. Then, a difference-in-difference approach was used to assess the impact of infection rates on racial and ethnic outcome disparities.

Results: County infection rates during the first trimester were significantly associated with worse pregnancy outcomes for all women. Each 1% point increase in COVID-19 cases during the first trimester was associated with a 5.16% point increase in the probability of preterm birth, a 4.35% point increase in the probability of low birth weight, and a 2.59% point increase in the probability of very low birth weight. Compared to White women, each 1% point increase in cases of COVID-19 during the first trimester caused a 1.21% point increase in the probability of preterm births, a 1.57% point increase in the probability of low birthweight, and a 1.28% point increase in the probability of very low birthweight among Black women. While no significant differences were observed in the probabilities of preterm birth and low birthweight between White and Hispanic women, the result revealed that each 1% point increase in cases of COVID-19 during the first trimester caused a 0.23% point increase in the probability of very low birthweight among Hispanic women compared to White women.

Conclusions for practice: This study found evidence that local COVID-19 infection rates during the first trimester are associated with worse pregnancy outcomes. Moreover, the findings indicate that local COVID-19 infection rates during the first trimester exacerbate racial disparities in these outcomes.

Objectives: To assess racial/ethnic differences in gestational diabetes mellitus (GDM) prevalence in Hawai'i.

Methods: This retrospective cross-sectional study included hospital deliveries at Kapi'olani Medical Center for Women and Children (Honolulu, Hawai'i) from 2009 to 2019. For birthing people with multiple deliveries during the study interval, only the last delivery was included. Birthing people with pregestational diabetes, delivery < 29 weeks, and multifetal gestations were excluded. GDM was identified through ICD-9 and -1 0 codes. Race and ethnicity were self-reported. Maternal body mass index (BMI) was recorded at delivery admission. GDM prevalence was determined for each race and the odds examined using logistic regression, also adjusting for maternal age and BMI. For analysis, three racial groups were sub-grouped into six ethnic categories as described: the three major racial groups were: (i) Asian, (ii) Native Hawaiian/Pacific Islander, and (iii) White. Six major ethnic sub-categories in the Asian racial group included: East Asians-identified as (1) Chinese/Taiwanese, (2) Japanese/Okinawan, (3) South East Asians identified as Filipino, (4) Native Hawaiian and (5) Pacific Islander identified as Micronesian/Samoan, and (6) White.

Results: Of 57,031 deliveries, 31,663 were included in this study. Overall crude prevalence of GDM was estimated at 11.7%. The three Asian ethnic sub-categories had approximately twice the risk of GDM when compared to Whites (Filipina: OR 2.59, 95% CI = [2.27-2.96], Chinese/Taiwanese: OR = 2.38, 95% CI = [2.01-2.82], and Japanese/Okinawan: OR = 1.71, 95% CI = [1.47-1.99]). Native Hawaiians also had higher GDM prevalence estimates compared to Whites (OR = 1.50, 95% CI = [1.31-1.71]), though there was no significant difference for Pacific Islanders (OR = 1.14, 95% CI = [0.97-1.33]).

Conclusions: Prevalence of GDM in hospitalized deliveries in Hawai'i's multi-ethnic population of women has increased nearly 2-fold in the last two decades. All Asian Americans remain at highest risk despite lower maternal BMI at delivery. NH women are younger yet have similar frequency of co-morbidities and comprise the largest proportion of GDM cases overall.

Background and objective: Children's healthcare providers have important roles in kindergarten readiness. We sought to understand children's primary care providers' (PCP) current approaches to fostering kindergarten readiness for their patients, perceptions of barriers, and ideas for improvement.

Methods: Children's PCPs were recruited and interviewed between June and August 2021. Interviews were audio recorded, transcribed, and iteratively analyzed to identify and refine emerging themes.

Results: Eleven PCPs were interviewed from eleven unique practices across rural and urban settings in North Carolina. Key themes included (1) Integrating kindergarten readiness in the primary care clinic, (2) Partnering with communities to improve kindergarten readiness, and (3) Promoting equity to improve kindergarten readiness. Within the clinic, PCPs valued extended care teams and dedicated assessment tools. PCPs reported wanting greater collaboration with schools and community organizations and more transparent assessment and referral processes. PCPs identified inequities within existing systems and called for more culturally inclusive, equitable kindergarten readiness promotion. Recommendations included removing cultural and language bias from assessments, improving racial/ethnic concordance, and advocating for supportive systems-level policies.

Conclusions: Children's PCPs identified many current and future opportunities to partner with families and communities to optimize children's school readiness throughout early childhood. Many school readiness promoting activities recommended by PCPs in this study could be supported through quality measures that track and provide financing for these specific actions.

Objectives: The aim of this study was to examine the relationship between Medicaid dental coverage for pregnant adults and receipt of a dental cleaning during pregnancy among adults with Medicaid.

Methods: In this cross-sectional study, 2019 Pregnancy Risk Assessment Monitoring System data were used to measure individuals' receipt of a dental cleaning during pregnancy and in the year prior to pregnancy. The independent variable was the state-level degree of Medicaid dental coverage for pregnant adults as of 2019, ranging from none to extensive. Weighted logistic regression models estimated the odds of having a dental cleaning during pregnancy, both for the full sample and stratified by whether or not a cleaning was received pre-pregnancy.

Results: Approximately one-third (31%) of respondents reported receiving a dental cleaning during pregnancy. In multivariable results, pregnant adults living in states with emergency (OR 0.58, 95% CI 0.41-0.83, p = 0.002) or no (OR 0.60, 95% CI 0.41-0.86, p = 0.006) dental coverage had significantly lower odds of having a dental cleaning during pregnancy than those living in states with extensive dental coverage. This association was concentrated among people who did not have a dental cleaning pre-pregnancy; those without a cleaning pre-pregnancy who lived in a state with extensive dental coverage had approximately twice the odds or more of having a dental cleaning during pregnancy than those who lived in states with emergency or no dental coverage.

Conclusions: Having dental insurance is critically important to be able to access needed dental care and avoid substantial out-of-pocket costs. This study found that for pregnant adults in Medicaid who who hadn't had a dental cleaning in the year prior to pregnancy, having extensive dental coverage was significantly associated with much higher odds of having a dental cleaning during pregnancy relative to having emergency or no dental coverage. Our findings, together with the body of evidence on the impact of Medicaid dental coverage on dental care access, underscore the importance of providing comprehensive dental coverage in Medicaid regardless of age and pregnancy status.