Maternal and Child Health Journal最新文献

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: 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.

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.

Objectives: This study aimed to investigate the dietary calcium intake in high-risk pregnant women and determine the factors associated with the adequacy of the calcium requirements.

Methods: A prospective cohort study was carried out with adult high-risk pregnant women, in the third trimester of pregnancy. Sociodemographic data, obstetric history, maternal comorbidity, pre-gestational body mass index were collected from medical records and three 24-h dietary recalls were performed.

Results: A total of 125 pregnant women were included. The mean calcium intake was 652.76 ± 294.58 mg/day and 24.8% of women had adequate calcium intake. We found a correlation between low daily calcium intake (< 800 mg) with non-white pregnant women (p 0.017), and obesity (p = 0.010). Eating frequency demonstrated an inverse correlation with low daily calcium intake (p < 0.001).

Conclusions for practice: Dietary calcium intake was insufficiente for most high risk pregnant women in this study. Eating frequency was associated with improved calcium intake, while obesity and non-White race/ethnicity were risk factors for inadequate intake.

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 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.

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.