Maternal and Child Health Journal最新文献

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.

Background: If not managed appropriately, diarrheal disease can lead to severe outcomes such as dehydration, secondary bacterial infections, and mortality. Seeking health care in a timely manner is known to improve the prognosis of diarrheal disease episodes. The aim of this study was to determine the drivers of delay in health seeking among children's caregivers notably in urban settings.

Methods: We conducted a cross-sectional study at two health centers, Weyzero Beletshachew Public Health Center and Lideta Health Center in Addis Ababa, Ethiopia. Caregivers of infants and children aged 6-59 months who sought treatment for a child's diarrhea at the two health centers were included in the study. A semi-structured questionnaire was administered to 330 caregivers. Multivariate logistic regression analysis was used to identify factors associated with a 24-hour delay in health care seeking.

Results: We found that 65.2% of caregivers waited 24 h after the onset of diarrhea before seeking health care. Delay in health care seeking was significantly associated with the child's age being 6-23 months (AOR, 2.12; 95% CI 1.16-3.86), caregivers poor knowledge about diarrhea (2.11; 95% CI 1.17-3.77), caregivers not using rice water to manage child's diarrhea at home (AOR, 0.47; 95% CI 0.24-0.92), and caregivers who didn't immediately go to the health center during the first diarrhea episode (AOR, 2.17; 95% CI 1.11-4.24).

Conclusion: Delay in seeking health service to manage child diarrhea is significant. Educating caregivers about the signs, prevention and mode of transmission of diarrhea and appropriate home management can reduce delay in health care seeking thus improving the prognosis of diarrheal disease episodes.

Objectives: The Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) program provided funding to federally qualified health centers (FQHCs) to hire and embed a dental hygienist in the obstetrics clinic, with the goal of increasing the provision of dental care during pregnancy. Ten sites participated in two cohorts. Our objective was to assess the impact of the MIMIOH program on receipt of dental visits during pregnancy.

Methods: Using Medicaid paid claims, we documented quarterly trends in dental visits during pregnancy, describing trends for each MIMIOH sites and comparing aggregate results for MIMIOH Cohorts 1 and 2 vs. FQHCs that did not participate in MIMIOH.

Results: The proportion of women with a dental visit during pregnancy varied across MIMIOH sites, and was higher during periods of active participation. For both MIMIOH Cohorts 1 and 2, the aggregate proportions of dental visits during periods of active participation was higher than that for non-MIMIOH FQHCs. In contrast, dental visits were lower for Cohort 1 after MIMIOH participation ended, and for Cohort 2 before MIMIOH began.

Conclusions: The MIMIOH program was successful at increasing dental visits among pregnant women during periods of active participation.

Objectives: Maternal HIV is associated with preterm birth (PTB). In resource-rich settings, spontaneous preterm birth (SPTB) has been linked to biomarkers of stress. We examined the association between allostatic load and SPTB among women with HIV.

Methods: In a nested case-cohort analysis of a randomized trial of intramuscular progesterone to prevent PTB in women with HIV in Lusaka, Zambia, we measured 15 midtrimester plasma biomarkers from 4 domains: cardiovascular, immune, metabolic, and neuroendocrine. SPTB was defined as delivery <37wks preceded by spontaneous labor or membrane rupture. A composite ALI was calculated by summing Z-scores from all markers (ALI-15); another was calculated from a 7 marker subset (ALI-7) with Z-score differences >0.1 between outcome groups. We estimated SPTB time-to-event curves and hazard ratios (HR) between ALI quartiles.

Results: Of 800 women enrolled in IPOP (2015-2017), 51 (6%) had SPTB. We randomly selected 107 participants, including 6 with SPTB (cases). We then selected all remaining cases (n=45), yielding a final sample of 152. Z-score distributions of systolic blood pressure, heart rate, HDL, triglycerides, hemoglobin A1C, albumin, and 25-OH Vitamin D were included in ALI-7. Participants in the fourth quartile of ALI-7 were more likely to experience SPTB (HR 2.49, 95% CI 1.15-5.40) than participants in the second quartile; this association was attenuated when quartile groups were defined by ALI-15 (HR 1.24, 95% CI 0.59-2.60).

Conclusions: High ALI among women with HIV was associated with SPTB. A seven marker ALI appeared a more meaningful indicator of risk than one composed of all measured markers.

Introduction: Child vaccination is a crucial public health indicator, especially in conflict-affected regions. Despite the benefits, vaccination rates in Yemen remain suboptimal. This study evaluates vaccination coverage and its correlates among children aged 12-35 months in Yemen.

Methods: Data from the Yemen Multiple Indicator Cluster Survey (MICS) 2022-23 were used. The survey covered 22 governorates, using a two-stage household selection process, and included 7,796 children. Vaccination status was assessed using a binary composite variable for full immunization. Multilevel logistic regression with robust error variance identified predictors of full vaccination.

Results: The overall vaccination coverage was 29%, with urban areas (41%) having higher rates compared to rural areas (25%). Female children had slightly lower odds of being fully vaccinated than male children, though not statistically significant. First-born children had the highest vaccination rates (31%), with odds decreasing with higher birth order. Mothers' secondary or higher education (AOR: 1.59, 95% CI: 1.19-2.13), receiving prenatal care (AOR: 1.97, 95% CI: 1.26-3.07), and reading newspapers at least once a week (AOR: 1.72, 95% CI: 1.21-2.44) were significant positive predictors. Higher fathers' education, fewer children under five in the household, higher household wealth, and urban residence were also associated with higher vaccination rates. Other factors such as hospital delivery, TV watching, internet access, and mobile phone ownership were not significantly associated with full vaccination after adjustment.

Conclusion: Significant gaps in immunization coverage among children in Yemen, particularly in rural areas, highlight the need for educational programs for parents, enhanced healthcare infrastructure, and improved health communication strategies.

Purpose: Persistent racial inequities and inadequate healthcare for Black women during childbirth and postpartum have led to disturbing maternal and infant mortality disparities in the United States. The purpose of the current manuscript is to describe community-based approaches to inform the development of a maternal and child health intervention.

Description: To address these health disparities, a community-based research team was formed to develop a population-specific community-level intervention that pairs social workers and doulas to improve Black maternal and infant health.

Assessment: A community-based research team was established with a birth doula, a clinical social worker, a Black mother, community research scientists, and a community research assistant from the San Francisco Bay Area, California. Moreover, the team members brought their lived experiences and professional expertise, which informed our research approach. The community team members were integral in developing research protocols and approaches. We leveraged university infrastructure, trained team members in research methods, and compensated team members for their expertise.

Conclusion: This ongoing community-based research approach will build long-term capacity and engagement to develop a community-level population-specific intervention to improve Black maternal and infant health outcomes.

Objectives: California has taken various actions with the goal of advancing maternal health equity. We analyze recent California laws and regulations using a novel conceptual model to understand whether and how they target expert-identified drivers of inequities in maternal health.

Methods: Using policy review and deductive thematic analysis, we evaluated whether recent state laws and regulations in California sought to directly intervene on healthcare-based drivers of racial inequities in maternal health as conceptualized by a CDC-convened expert workgroup.

Results: We identified 13 laws/regulations enacted between 2019-2023 that aimed to improve maternal health. All intervened on one or more healthcare-based drivers of inequities. Two (15%) targeted Driver 1 - Problems in communication, stereotyping, and other interpersonal interactions, resulting from interpersonal racism, by e.g., requiring provider anti-bias training. One (8%) targeted Driver 2 - Differential and/or suboptimal treatment for minoritized populations within healthcare settings (e.g., lower-quality care, inequitable burdens of hospital policies; resulting from institutional racism), by making reporting discrimination easier for patients. Twelve (92%) targeted Driver 3 - Lack of resources and/or policies that could support the health and healthcare of minoritized populations, stemming from structural racism, by e.g., expanding access to midwifery and doula care or diversifying the maternal health workforce.

Discussion: California's recent maternal health-focused laws/regulations have primarily targeted inadequate or inequitable structural resources (Driver 3). Few directly intervened on Drivers 1 or 2. These findings provide a useful grounding for future policy research and reveal the advantages of assessing policies in terms of mechanism-focused intervention targets. Policy implications and potential levers are discussed.