Maternal and Child Health Journal最新文献

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.

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.

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.

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.