Maternal and Child Health Journal最新文献

Objective: Evaluate screening practices for congenital cytomegalovirus (cCMV), the most common infectious cause of childhood deafness, in American birthing hospitals.

Study design: A survey was developed and distributed to hospitals across the US including the Northeast, Midwest, West, and Southwest between November-December 2023 to understand cCMV screening practices. Summary data were calculated. Hospital characteristics associated with screening were analyzed using a logistic regression model. Hospital practice was reported as a function of legislative mandate.

Results: 134 responses were received (28.5% response rate). 78 respondents (58.2%) indicated their hospital screens for cCMV. Common screening indications were newborn hearing screen referral (67.5%) and symptoms that could be attributed to cCMV (57.1%). Odds ratio of cCMV screening for states with screening legislation versus without was 18.0 (p < 0.001). Odds ratio of cCMV screening for urban, level 3 facilities versus rural, level 1 facilities was 6.7 (p < 0.02).

Conclusion: Wide variability exists in cCMV screening practices. Legislative screening mandates are associated with higher screening rates. Opportunity exists for development of screening guidelines for newborns at risk for cCMV infection.

Objectives: To determine which of the available predisposing, enabling, and need factors are related to receipt of postpartum depression (PPD) treatment among postpartum women with Texas Medicaid.

Methods: This retrospective database analysis used Texas Medicaid claims (1/1/2018-6/30/2022) and included women 12-55 years, continuously enrolled 84 days pre- to 12 months post-delivery, with a PPD diagnosis. The outcome was receipt of PPD treatment (psychotherapy and/or antidepressant medication) within 12 months post-delivery. Independent variables were guided by the Andersen Behavioral Model and included predisposing (age, race/ethnicity), enabling (urbanicity, prenatal care), and need (depression/anxiety, substance use disorder [SUD], cesarean delivery, preterm birth, pregnancy complications) factors. Multivariable logistic regression was used.

Results: Included women (N = 25,976) were 26.7 ± 5.9 years and 42.1% were Hispanic. Most women resided in urban counties (80.6%) and had 6.2 ± 3.4 prenatal visits, 3.3 ± 2.8 postpartum visits, and 1.4 ± 0.9 pregnancy complications. Nearly half (44.7%) had baseline depression/anxiety, 17.4% had baseline SUD, 35.8% had cesarean delivery, and 13.5% had preterm birth. Approximately, three-fourths (76.2%) received treatment within 12 months after delivery. Logistic regression (p < 0.0001) revealed that the likelihood of treatment receipt was significantly associated with age (25-29:odds ratio [OR] = 1.155, 95% confidence interval 1.039-1.284, 30-34: OR = 1.186;1.058-1.330, > 34: OR = 1.295;1.134-1.479; reference:<20), race (White: OR = 1.700;1.556-1.857; Hispanic: OR = 1.179;1.087-1.277; reference: Black), urbanicity (OR = 0.869;0.799-0.944), prenatal care (4-6 visits: OR = 1.178;1.039-1.336, 7-9 visits: OR = 1.156;1.020-1.311, > 9 visits: OR = 1.406;1.217-1.625; reference:0 visits), and cesarean delivery (OR = 1.099;1.031-1.173).

Conclusions for practice: While over 75% of women with PPD received treatment, additional efforts to mitigate disparate consequences of untreated PPD should be focused on younger, Black, and urban women.

Objective: To test whether parent restriction, pressure to eat, and maternal concern for child weight mediated the positive association between food insecurity and child body mass index (BMI) in cross-sectional and longitudinal analysis.

Methods: Data were from mother-child pairs (n = 202 at baseline). Children were M = 10.1 y (range 8-12) at baseline, 56% Hispanic, and 49% female; mothers were M = 41.2 y, and 58% had a college education or higher. Mediation models with maximum likelihood multiple imputation were conducted in MPlus, controlling for child age, child gender, and baseline scores on mediator and outcome variables (in longitudinal models).

Results: Greater maternal concern for child weight mediated the association between greater food insecurity and higher child BMI in the cross-sectional model (indirect effect = 0.115, p < .010) but not the longitudinal model (indirect effect = < .001, p =.960). No evidence of mediation was found for pressure to eat or restriction in cross-sectional or longitudinal models. In cross-sectional models, food insecurity was associated with higher child BMI (B_{restriction model} = 0.20; B_{pressure model} = 0.24; B_{concern model} = 0.90, ps <.01); and greater concern with child weight (B = 0.19, p < .01, which was a precondition for mediation).

Conclusions: Current findings suggest that food insecurity is associated with higher subsequent maternal concern for child weight and in turn higher child BMI (cross-sectionally). However, there was no support for feeding practices or concern as longitudinal mediators of food insecurity and child BMI change.

Objective: To determine the extent to which African-American women's early-life residence in urban neighborhoods with mortgage discrimination (compared to neighborhoods without mortgage discrimination) is associated with preterm birth (< 37 weeks, PTB).

Methods: Stratified and multivariable binominal regression analyses were performed on a Chicago transgenerational dataset of African-American women (born 1989-1991) and their infants (born 2005-2017) with appended Home Mortgage Disclosure Act and Index of Concentration at the Extremes (ICE) data.

Results: In mortgage discriminated neighborhoods, the proportion of non-Hispanic White residents exceeded that of neighborhoods without mortgage discrimination: 84% vs. 31%, p < 0.01. Additionally, mean ICE_{race/ethnicity} for mortgage discriminated neighborhoods equaled 0.78 (0.64-0.91) confirming the greater concentrations of non-Hispanic White populations. African-American women (n = 735) with early-life residence in mortgage discriminated neighborhoods had a PTB rate of 15.8% compared to 13.1% for those (n = 23,369) with early-life residence in non-mortgage discriminated neighborhoods; RR = 1.20 (1.01, 1.43). The adjusted (controlling for trimester of prenatal care usage and cigarette smoking) RR of early (< 34 weeks), late (34-36 weeks), and total PTB for African-American women with early-life residence in mortgage (compared to non-mortgage discriminated) neighborhoods equaled 1.60 (1.20, 2.14), 1.18 (0.92,1.53), and 1.31 (1.09,1.57), respectively. The subgroup of African-American women (n = 536) with early-life residence in mortgage discriminated neighborhoods and adulthood residence in non-mortgage discriminated neighborhoods had an early PTB rate of 8.0% versus 5.1% for those (n = 20,298) with a lifelong residence in non-mortgage discriminated neighborhoods; RR = 1.58 (1.18, 2.12).

Conclusions: Urban African-American women's early-life residence in predominately non-Hispanic White, mortgage discriminated neighborhoods is associated with an increased risk of PTB, particularly its' early component, independent of adulthood risk status.

Objectives: Pregnant women who have no experience in the transition to motherhood may face various problems such as low self-evaluation, physically problems, low maternal attachment both in the prenatal and postpartum period.

Methods: This research was conducted as a randomized, controlled, single-blind pretest-post-test experimental study, was performed with primiparous women registered 73 pregnant meeting the inclusion criteria between December 2019 and December 2021. Pretest was applied to the experimental and control groups, Transition to Motherhood program based on Meleis' Transition Theory was applied to the experimental group; two post-tests were applied to the experimental and control groups group at the postpartum sixth week and fourth month.

Results: The mean age of the experimental group was 26.91 ± 3.10, 45.7% of them had university or higher education level, 77.1% of them had a planned pregnancy, 88.6% of them had fear of birth. There was no statistically significant difference in terms of characteristic features between the experimental and control groups (p < 0.05). There was no statistically significant difference between the total mean scores of Prenatal Self-Evaluation Questionnaire and Prenatal Attachment Inventory applied as pretest of the pregnant women in the experimental and control groups (p > 0.05). A statistically significant difference was found between the groups; in terms of the Postpartum Self-Assessment Scale, Postpartum Physical Symptoms Severity, and the Maternal Attachment Inventory scores which were applied as the first post-test (postpartum sixth week), and the scores of the Maternal Attachment Inventory applied as the second posttest (postpartum fourth month) (p < 0.05).

Conclusion: The Transition to Motherhood program had positive effects on postpartum self-assessment, postpartum physical symptom severity and maternal attachment of the primiparas.

Clinical trial registration: This report was prepared in line with the Consort and TIDieR guideline. The research was also registered with Clinical Trials under no. NCT05272527.

Introduction/purpose: Postpartum opioid prescription rates remain high, leading to increased morbidity and mortality and increased licit opioid medications diverted into communities. This scoping analysis examined the current processes of postpartum opioid prescribing patterns in America and the implications to maternal and public health.

Methods: From the databases PubMed, Medline, and Web of Science, a scoping review was performed utilizing the PRISMA-ScR checklist (Tricco et al. in Ann Intern Med 169(7):467-473, 2018, https://doi.org/10.7326/M18-0850 ). The primary objective of the search strategy was to identify studies that focused on the postpartum timeframe (obstetric delivery to one year postpartum) and prescribed opioids.

Results: A total of 26 articles met inclusion criteria. Articles were broken down into four themes: trends or current state of postpartum opioid prescribing practices (n = 7); postpartum opioid related risk factors (n = 6); rates of new persistent opioid use and opioid use disorder (OUD; n = 5); protocols or research into reducing postpartum opioid use (n = 8).

Discussion/conclusion: A variety of interventions and protocols have been found to be advantageous in reducing postpartum opioid use. Despite many of these successful efforts, postpartum opioid prescription rates remain high. Implementation of any number of interventions and protocols may be beneficial to reducing postpartum opioid use. Initiating a postpartum pain task force protocol (PPTFP) before obstetric delivery is recommended.

More than 80% of US maternal deaths are preventable yet maternity care in the United States (US) is becoming increasingly difficult to access. Recent years have seen the rise of maternity care deserts, defined as an area with no hospitals or birth centers offering obstetric care and without any obstetric providers. The number of counties without a birthing facility continues to grow, and 1/3 of US counties lack an obstetric clinician. The US has a maternal mortality rate that is 2-3 times greater than similar high-income countries, a steady rise in severe maternal morbidity, and markedly high infant mortality rates compared to similar countries. Traveling long distances to obtain obstetric care can impact whether a woman and infant survive an obstetric emergency such as hemorrhage. Nearly 2/3 of maternity care deserts are in rural areas, with the greatest need for maternity care located in the southern US. Maternity care deserts disproportionately impact rural, low-income, and Black women. The reasons for maternity closures are multifactorial, but are driven by hospital financial pressures and staff shortages. Government interventions are necessary to expand access to care and to keep critical obstetric units open. These interventions include increasing Medicaid reimbursements, expanding Medicaid access, expanding the perinatal workforce, setting standards for what constitutes safe distances between maternity units, and exploring mechanisms to leverage/reimagine existing programs to keep units open in critical areas. We call for urgent action given the serious public health threat to women and infants. We draw from diverse sources not commonly cited to comprehensively summarize the issues related to obstetric closures, outline the drawbacks of many previously proposed solutions, and propose some novel solutions.

Objective: This study aimed to develop and evaluate the psychometric properties of a diarrhea management scale for mothers with children aged 0-24 months.

Methods: This methodological study was conducted between February and June 2023 with 449 mothers in the pediatric emergency department of a training and research hospital in Istanbul. Data were collected using a sociodemographic data form and the Diarrhea Management Scale for Mothers (DiMaM). The scale's validity and reliability were analyzed using the Kaiser-Meyer-Olkin coefficient, Bartlett's Test of Sphericity, Cronbach's alpha reliability coefficient, fit indices, independent samples t-test, test-retest analysis, mean item scores of the 27% lower and upper groups, and item-total correlation statistics.

Results: Factor analysis revealed five factors explaining 71.466% of the total variance. The Cronbach's alpha coefficient was 0.887 for the overall scale, 0.913 for the intestinal and stool monitoring subscale, 0.762 for the symptom monitoring subscale, 0.735 for the therapeutic interventions subscale, 0.683 for the hygiene and responsibility subscale, and 0.743 for the nutrition and fluid supplementation subscale. Confirmatory factor analysis indicated acceptable fit indices for the scale. Standardized factor loadings ranged from 0.549 to 0.930, and Intraclass Correlation Coefficient values ranged from 0.886 to 0.916.

Conclusions for practice: DiMaM was determined to be a valid and reliable tool for assessing diarrhea management in the home environment for mothers with children aged 0-24 months.

Introduction: Neurodivergence affects how women experience the world and life transitions such as motherhood and the postpartum period. Postpartum supports are designed from a neurotypical perspective and may not meet the needs of neurodivergent women. For example, breastfeeding groups may not support the sensory needs of autistic women. The aim of this scoping review was to document postpartum experiences of neurodivergent women.

Methods: A scoping review methodology underpinned this review. The socio-ecological model was used to report findings and generate recommendations.

Results: 18 records were included primarily representing experiences of autistic women and women with ADHD. Women reported that acting in the best interests of their baby was their highest priority. This often involved making adaptations that disrupted their coping strategies and engaging in social situations such as baby groups, which required them to accept cultural norms and adopt expected neurotypical behaviours. Healthcare professionals did not always account for the needs of neurodivergent women; in some cases, this led to situations whereby neurodivergent women experienced greater parenting scrutiny.

Discussion: This review highlighted a small but growing body of research relating to the postpartum experiences of neurodivergent women. Neurodivergent women need access to tailored supports during the postpartum period as they balance managing the needs of an infant with necessary neurodiversity adjustments. However, there is also a need for greater healthcare professional training specific to supporting neurodivergent women and better public understanding of neurodiversity to ensure neurodivergent women feel safe to be their authentic selves in motherhood.

Introduction: Breastfeeding is associated with many health benefits for both mothers and children, yet U.S. breastfeeding rates are far below the Healthy People 2030 goals. Furthermore, disparities in breastfeeding rates exist, whereby some demographic groups have even lower rates. This study examines the association between dosage of breastfeeding conversations with a home visitor on breastfeeding continuation in participants who enrolled postnatally.

Methods: This cohort study examines the impact of breastfeeding conversations with a home visitor on breastfeeding continuation on 1,422 mother-child pairs enrolled postnatally in Healthy Families New York (HFNY), a family support home visiting program. Multivariable logistic regression models analyzed longitudinal data, adjusting for several known predictors of breastfeeding that could confound the association between breastfeeding conversations and breastfeeding continuation.

Results: The analyses reveal a significant association between the rate of breastfeeding conversations during home visits in the preceding period and increased odds of breastfeeding continuation for 1-2 months (p = 0.013), 2-3 months (p < 0.001), 3-6 months (p < 0.001), and six months or greater (p = 0.001). The dose-response relationship and longitudinal nature of the data could suggest causality. Importantly, the impact of breastfeeding conversations is more pronounced among mothers born in the U.S., a group with known disparate breastfeeding outcomes. Further, this study finds that the number of home visits predicts breastfeeding continuation past six months (p < 0.001).

Discussion: This study offers important insights into the role of a home visiting intervention to promote breastfeeding and reduce breastfeeding disparities without the excessive costs of an intervention designed solely for breastfeeding.