Maternal and Child Health Journal最新文献

Introduction: A prenatal fruit and vegetable prescription program (FVPP) was introduced in Flint, Michigan to increase access to fresh produce during pregnancy. This program provides $15 fresh fruit and vegetable prescriptions to all prenatal patients during office visits, redeemable at a local farmers market and mobile market/food hub. The current study assessed changes in diet and food security throughout pregnancy among patients exposed to the prenatal FVPP.

Methods: This non-controlled longitudinal trial included prenatal patients at two low-income urban clinics presenting before 16 weeks' gestation. Participants completed surveys to assess diet (one automated 24-hour dietary recall) and food security (US Household Food Security Module: Six Item Short Form - National Center for Health Statistics), with follow-up surveys at mid-pregnancy and postpartum.

Results: A total of 118 pregnant women (mean age 26.32 ± 5.04 years, range 18-39 years) enrolled in the current study. Most identified as Black/African American (54.2%, n = 64), received Medicaid (66.9%, n = 79), and participated in The Special Supplemental Nutrition Program for Women, Infants, and Children or WIC (62.4% at midpoint). Participants received an average of 8.81 ± 2.30 fruit and vegetable prescriptions, with two-thirds redeeming at least one (66.9%, n = 79). Household food security worsened from baseline to midpoint (p = 0.076) but improved from midpoint to postpartum (p = 0.013). Participants reported notable changes in dietary behaviors at critical points during their pregnancy. Primarily, significant improvements in mean daily consumption of fruits and vegetables (p = 0.027); total vegetables (p = 0.015); and vegetables excluding potatoes (p = 0.030) were observed from early pregnancy to midpoint. Alternatively, mean daily intake of fruits and vegetables (p = 0.007) and total vegetables (p = 0.029) decreased between midpoint in pregnancy and the early postpartum period.

Discussion: This study reveals the influence of a prenatal FVPP on diet and food security among prenatal patients living in one low-income, urban community. Results signal an urgent need for coordinated and comprehensive maternal supports that better address food and nutrition security during pregnancy and the early postpartum period.

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.

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.

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.

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.