Maternal and Child Health Journal最新文献

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.

Objectives: The role of partner substance use as a risk factor for prenatal substance use remains understudied. This study aimed to investigate the association between self-reported partner history of problematic substance use and pregnant persons use of alcohol, cannabis, e-cigarettes, and tobacco during early pregnancy.

Methods: A total of 82,180 pregnant individuals screened for substance use in Kaiser Permanente Northern California at their first prenatal visit (approximately 8-10 weeks gestation) during 2021-2022 were included. Partner substance use and prenatal substance use were determined via a self-administered questionnaire. Cannabis use was additionally determined by urine toxicology. Adjusted odds ratios (aOR) were calculated using binomial and multinomial logistic regression.

Results: Among 82,180 pregnant people, 1,010 (1.2%) reported having a partner with history of problematic substance use. Partner history of problematic substance use was associated with higher adjusted odds of any prenatal substance use (aOR = 1.80; 95%CI:1.56-2.08) and prenatal alcohol (aOR = 1.58; 95%CI:1.33-1.87), cannabis (aOR = 1.89; 95%CI:1.57-2.27), e-cigarette (aOR = 3.38; 95%CI:2.43-4.58), and tobacco use (aOR = 3.66; 95%CI:2.63-4.96). Additionally, frequency analyses showed that a partner history of problematic substance use was associated with higher odds of weekly or daily and monthly or less substance use compared to no use.

Conclusions: Self-reported partner history of problematic substance use was associated with increased odds of prenatal use of alcohol, cannabis, e-cigarettes, and tobacco during early pregnancy. Findings suggest that individuals with a partner with problematic substance use may benefit from targeted prevention prior to pregnancy to reduce substance use during pregnancy.

Introduction: In 2018 approximately 2400 Afghan refugees resettled in Washington state, and with approximately 16% arriving pregnant, many were in need of immediate prenatal care and psycho-social support. Because it has been shown to alleviate disparities in pregnancy outcomes, CenteringPregnancy, a group prenatal care model, was chosen as an evidence-based program to meet the needs of this community. This article aims to describe the feasibility and experience of CenteringPregnancy for pregnant refugees from Afghanistan as piloted in a community health center setting in Washington State.

Methods: This retrospective cohort and qualitative analysis utilized pregnancy-related outcome data extracted from electronic health records, as well as post-participation surveys to inform the feasibility of offering CenteringPregnancy in languages other than English. Two separate groups were conducted in 2018-2019 (n = 21) in Dari.

Results: Of 21 participants, 95% were reported to have adequate prenatal care as defined by Healthy People 2030 (> 9 visits during pregnancy). Delivery outcomes were generally positive, with no "very low birth weight" babies, and 86% vaginal delivery. Attendance at postpartum visits was 100% and 90% reported using contraception at 3 months postpartum. Post-participation surveys were generally positive; staff and physicians also reported positive views on the program and their participation in it.

Discussion: Group prenatal care, delivered as CenteringPregnancy in a community health center, is a feasible option for Afghan refugee women with this pilot demonstrating that patient experience and pregnancy related outcomes are largely positive; in addition to providing staff and physicians high levels of satisfaction with care.

Objectives: The purpose of this study was to determine the frequency of postpartum depression (PPD) screening, the prevalence of PPD, and the factors associated with PPD screening amongst adolescents and young adults (AYA) at a free urban teen clinic.

Methods: We conducted a retrospective chart review of postpartum visits at a free urban teen health clinic serving AYA ages 13-24. Two trained researchers extracted study data including patient demographics, pregnancy outcomes, time from delivery to first postpartum clinic visit, prenatal mental health diagnoses, and postpartum mental health assessments from charts between 2017 and 2022 with a postpartum visit billing code.

Results: 280 charts were retrieved from which nine were excluded. The majority of subjects identified as White and Hispanic or Latino. Ages ranged from 14 to 24 years and most were 18-24 at the time of the infant's birth. 103 (35.2%) were publicly insured and the remainder were uninsured. 140 (51.7%) of patients received PPD screening with the Edinburgh Postpartum Depression Screen or a validated alternative, though the rate of PPD screening significantly improved (p < 0.00001) after clinic flow was changed in 2020. Of those screened (n = 140), the rate of positive scores was 9.9%, lower than expected.

Conclusions for practice: Despite clinical recommendations, only just over half of AYA women had documented mental health screening at the time of postpartum visits. Rates of PPD in this sample were low. As PPD is an adverse childhood event with lifelong implications for the parent and child, efforts to improve PPD screening are warranted.

Objectives: Out-of-school-time recreational activities are linked to numerous socioemotional, health, and academic benefits for children. Racial and income disparities in participation persist, yet there is a lack of qualitative studies eliciting the experiences and input of primary caregivers to improve equitable access to high-quality recreational activities in marginalized communities. This study explores caregiver perceptions of the factors influencing motivations to enroll their child in activities, barriers to participation, how caregivers define quality programming, and caregiver recommendations to improve activity access and quality within under-resourced communities.

Methods: We recruited primary caregivers of children aged 6-17 from under-resourced communities in an urban county by purposive sampling through urban parks and recreation and community organizations. We conducted semi-structured interviews using descriptive methodology with content thematic analysis.

Results: Thirty-four interviews (17 English, 17 Spanish) revealed three key themes: primary caregivers (1) were highly motivated, believing that activities were facilitators of lifelong healthy living and wellbeing for children, families, and communities, (2) identified ongoing participation barriers while recognizing opportunities to improve equitable access, (3) described high-quality activities as those promoting safety, inclusivity, and enjoyment. Parents highlighted strategies to promote equitable, high-quality programming, including broad outreach, easy enrollment with accessible activities, low financial barriers, structural investments, staff and volunteer training, and family engagement.

Conclusions for practice: Organizations offering youth out-of-school-time activities should consider caregiver practical suggestions to potentially improve the uptake and equity of these programs, with the ultimate goal of supporting the well-being and healthy development of all children.

Introduction: Monitoring cerebral palsy (CP) prevalence and co-occurring conditions is crucial for planning lifelong support, but recent national estimates are somewhat limited.

Methods: We analyzed data on U.S. children aged 2-17 years from the 2016-2021 National Survey of Children's Health, conducted annually using a cross-sectional design, to calculate nationally representative prevalence estimates of ever-diagnosed CP, overall and by selected demographic and perinatal characteristics. Three-year estimates were compared to evaluate changes over time. Co-occurring conditions were assessed among children aged 3-17 years with a current CP diagnosis. We estimated prevalence ratios (PR) to quantify differences between groups.

Results: The overall prevalence of CP was 3.1 per 1,000 children, with a higher prevalence among boys (3.6/1,000) than girls (2.5/1,000) and children born with low and very low birthweight (46.6 and 7.1/1,000, respectively) and premature (12.7/1,000); differences by race/ethnicity did not reach statistical significance (non-Hispanic [NH] White: 2.9, NH Black: 4.2, and NH other: 4.5/1,000. There were no clear changes in CP prevalence over time, but caregiver-rated severe CP increased from 16.8% (2016-2018) to 30.3% (2019-2021). Most children with CP had at least one co-occurring condition, about four times more prevalent than in children without CP, with the largest differences for intellectual disability (PR = 43) and epilepsy or seizure disorder (PR = 69).

Discussion: There is a significantly higher prevalence of co-occurring developmental, neurological, and mental health conditions among children with CP compared to those without, highlighting the diverse services and resources that may be needed to optimally support this population as they transition into adulthood.