Maternal and Child Health Journal最新文献

Objectives: We explored social, demographic, and health risk factors for occipitofrontal circumference (OFC) growth in infants living in a rural, low-resource region of Guatemala.

Methods: OFC was measured at enrollment (0.1-2.9 months of age) and one year later (11.5-16.1 months of age) for 430 infants participating in a prospective cohort study conducted between 2017 and 2019. Potential predictors were collected at enrollment or were measured during the year of the study. We performed a two-stage risk factor analysis, using univariate regression modeling to identify potential risk factors, followed by multivariable regression modeling to identify independent, significant risk factors for smaller OFC at birth and 1 year in this low resource setting.

Results: Mean OFC at enrollment was -0.4 (1.2) and at 1 year was -1.1 (0.9). Probable zika exposure in utero and shorter maternal height were independently, significantly associated with smaller OFC at both enrollment and 1 year. Exposure to cigarette smoking in utero was independently significantly associated with smaller OFC at enrollment. Infant complications at birth, microcephaly at enrollment and stunting at enrollment were also independently significantly associated with smaller OFC at 1 year (all p-values < 0.05). No exposures measured during the study were associated with OFC at 1 year.

Conclusions: All the independent predictors of small OFC during the study period were present at enrollment (within the first 3 months of life), including maternal height, and smoking and ZIKV exposure during pregnancy. Exposures after the first three months of life were not predictive of OFC at one year. Continued work to identify specific risk factors and develop targeted prevention programs is warranted.

Introduction: Both hypertension and polycystic ovary syndrome (PCOS) are risk factors for future cardiovascular diseases among women of reproductive age (18-44 years). We constructed an electronic health record (EHR)-based PCOS phenotype, reported PCOS prevalence, and investigated the association of PCOS and hypertension in the United States (US).

Methods: This cross-sectional study used 2022 IQVIA's Ambulatory Electronic Medical Record (AEMR)-US data (May 2023 release). We constructed a phenotype for PCOS and reported PCOS prevalence for eligible women. We then described hypertension prevalence and hypertension control estimates stratified by PCOS status. Lastly, we calculated adjusted prevalence ratios (aPR) for hypertension and hypertension control by PCOS status, adjusting for age, race, and body mass index (BMI).

Results: We analyzed records for 1,301,425 eligible women, with mean (standard deviation) age of 31.5 (7.9) years. The prevalence of PCOS was 2.1%, but increased with weight category, reaching 6.7% among those with class 3 obesity (BMI ≥ 40 kg/m²). Women with PCOS had 50% higher prevalence of hypertension than those without PCOS (aPR 1.50; 95% confidence interval [CI]: 1.48-1.52; p < 0.001), and slightly higher hypertension control prevalence (aPR 1.14; 95% CI: 1.12-1.17; p < 0.001).

Discussion: Using a nationwide EHR dataset, we observed that women with PCOS had substantially higher hypertension prevalence than those without PCOS. PCOS prevalence was lower than previous estimates from global surveys. Following guideline-recommended blood pressure screening for women with PCOS could reduce the risk of long-term cardiovascular disease.

Objectives: Zambia's Scaling Up Nutrition (SUN) Program is a multi-sectoral program with a package of nutrition-specific and nutrition-sensitive interventions to reduce stunting in children. The purpose of the study was to conduct an economic analysis of the SUN Most Critical Days Program (MCDP) II activities during 2018-2022.

Methods: The economic analysis evaluated SUN/MCDP II nutrition interventions through three analyses: (i) estimating their impact on mortality and morbidity since 2018 with the LiST tool, (ii) identifying the determinants of stunting with a Oaxaca Blinder counterfactual decomposition, and (iii) assessing the efficient resource allocation of SUN/MCDP II resources using the Optima Nutrition Tool.

Results: The LiST modelling analysis estimated that since 2018, SUN/MCDP II interventions reduced deaths, diarrhoeal incidence, and stunting among children under 5 years of age in all 30 districts. Vitamin A supplementation was the largest contributor to reductions in deaths and diarrhoeal incidence, The Oaxaca Blinder counterfactual decomposition analysis found that the main contributors to stunting decline were access to piped water, maternal education, child birth weight, and basic sanitation in Zambia. The Optima Nutrition analysis revealed that stunting decline could be maximized if more funding is put into the interventions of Vitamin A and WASH interventions as well as adding some other interventions.

Conclusion for practice: The SUN Program has led to a reduction in childhood stunting as well as mortality. The Program's package of interventions could be further enhanced through optimizing the allocation of resources.

Objectives: This study uses 2022 National Vital Statistics System natality data to identify characteristics associated with infertility treatment among nulliparous individuals 35 years or older, comparing pregnancy and birth outcomes between no infertility treatment and assisted reproductive technology (ART) or fertility-enhancing drugs or intrauterine insemination (IUI).

Methods: The likelihood of infertility treatment was estimated after controlling for maternal age, education, race and ethnicity, insurance status, Women, Infants and Children (WIC) support, pre-pregnancy body mass index (BMI), chronic hypertension, diabetes, and smoking during pregnancy. Maternal outcomes (gestational diabetes, hypertensive disorders of pregnancy, cesarean birth, maternal morbidity) and neonatal outcomes (preterm birth, low birth weight, neonatal intensive care, and congenital anomalies) were compared for singleton and multifetal births separately.

Results: Among 173,399 births, 13.6% had infertility treatment (10.9% ART, 2.4% IUI). As compared to people who identified as white or Asian, infertility treatment was over one-third less likely for non-Hispanic Black and Hispanic individuals and 2.4 times more likely for those with a graduate degree as compared to those with less than high school. Infertility treatment was associated with significantly higher rates of all adverse maternal and neonatal outcomes, and among multifetal births, ART was associated with a higher rate of maternal morbidity and more frequent gestational diabetes.

Conclusions for practice: Disparities in infertility treatment exist. ART was associated with modest but significantly worse outcomes, particularly for singleton births. Continued monitoring of infertility treatment selection and birth outcomes is needed for informed clinical and public policy decisions.

Objectives: Perinatal palliative care, defined as support for creating birth plans that include treatment and care decisions, is crucial for families facing life-threatening fetal conditions. However, the variability in medical resources across communities necessitates the development of tailored, community-based perinatal palliative care systems that support shared decision-making through multidisciplinary care. This study uses child death review (CDR) data to examine the current status and challenges of perinatal palliative care delivery in regional communities, focusing on decision-making processes, care planning, and transition to home care. It also compares cases in which families selected comfort care with those choosing intensive care to explore differences in care processes and outcomes.

Methods: A retrospective cohort study was conducted using regional CDR data from children under 18 years who died in Shiga Prefecture, Japan, between 2018 and 2020. Data on children eligible for perinatal palliative care were primarily collected from perinatal centers and perinatal cooperative hospitals participating in the CDR.

Results: Among 131 deaths, 19 involved life-threatening conditions considered for perinatal palliative care. Two lacked prenatal diagnoses, while 17 discussed care plans, including medical intervention options, and mode of delivery. Of these, 65% (11/17) chose comfort care, while 35% (6/17) opted for intensive care. A comparison between these groups showed that the comfort care group had a longer decision-making period (median, 29 vs. 9 days; p = 0.044). Decision support before birth, which included accurate information about fetal conditions, care planning options, and psychological support, was not provided by clinical psychologists or palliative care specialists. Of the 17, four patients were discharged home, and one died at home.

Conclusions for practice: This study highlights the challenges of implementing perinatal palliative care in communities. The prolonged decision-making process associated with comfort care may reflect the significant psychological burden on families. Factors such as care plans influence family burden, emphasizing the need for individualized support. The absence of specialized support and low rates of transition to home care for end-of-life care are critical issue for improvement in community-based perinatal palliative care.

Objectives: To investigate the association between maternal liver enzyme concentrations during pregnancy and the risk of abnormal birth weight.

Methods: This is a prospective birth cohort study querying the pregnant women from Fujian Maternal and Child Health Hospital, affiliated with Fujian Medical University, China. Liver enzyme levels, including gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), were measured in the first and third trimesters, and changes in liver enzyme levels were calculated based on these measurements. The outcomes were birth weight, small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), and macrosomia.

Results: The study analyzed 19,003 singleton pregnancies with live births. The mean age of the pregnant individuals was 30.3 ± 3.9 years, 18,594 patients (97.8%) were Han. GGT in the first trimester is positively correlated with the risks of macrosomia and LBW, mediated through gestational diabetes mellitus (GDM) and gestational age at birth, respectively. Nonlinear regression models suggested that there was a linear relationship of liver enzyme levels during pregnancy with LBW and SGA (P for non-linear > 0.05). According to regression analysis, changes in liver enzyme levels during pregnancy were negatively correlated with birth weight, LGA, and macrosomia, and positively correlated with the risk of SGA. Similar results were found for liver enzymes in late pregnancy.

Conclusions: The concentration and even the changes of liver enzymes during pregnancy may influence the fetus's birth weight to different degrees. Thereby, monitoring liver enzyme levels during pregnancy could help prevent abnormal fetal development.

Objective: To evaluate the efficacy of an online nursing consultation on the Red Sinapsis (RS) Internet platform in increasing maternal self-efficacy and exclusive breastfeeding rates during the first month postpartum.

Methods: This study employed a controlled, randomised experimental design with two groups. Ninety women who had undergone caesarean sections were randomly assigned to either an intervention group (n = 45) or a control group (n = 45). The intervention group received follow-up care from a breastfeeding expert nurse on the RS online platform, while the control group received standard follow-up care from a midwife or primary care nurse. Breastfeeding success was measured using the LATCH scale at 15 days postpartum and the BSES-SF scale at 30 days postpartum. For comparative analysis between study groups, Fisher's exact test or the chi-squared test was used, depending on the contingency table dimensions. Missing values were not imputed. P-values below the 0.05 threshold were considered statistically significant.

Results: A total of 84% of the intervention group showed greater confidence in providing breast milk to their children, compared to 44% of the control group (p < 0.001). The intervention group also achieved better outcomes in terms of believing that breastfeeding alone is sufficient to nourish their baby, with 82% expressing confidence, compared to 59% in the control group (p = 0.041).

Conclusions: Online nursing follow-up during the immediate postpartum period improves maternal confidence in breastfeeding, promoting its initiation and establishment during the first month postpartum.

Background: While it is well established that trying to conceive while experiencing infertility and undergoing fertility treatment is associated with anxiety, little is known about the mental health toll of trying to conceive without fertility treatment. Minimal contact with the healthcare system while trying to conceive without treatment contributes to low rates of detection and support for this population.

Objective: This research aims to provide formative insights into the prevalence of mental health distress and desire for emotional support among people who are trying to conceive without treatment, and how this compares to people who are considering or using fertility treatment.

Methods: This retrospective cohort study included 3,458 US-based individuals who used Maven, a comprehensive digital platform for reproductive and women's health. Descriptive statistics and bivariate tests were used to determine differences in prevalence of depression, anxiety, conception-specific anxiety, and interest in receiving emotional support at various stages of the trying to conceive pathway.

Results: Users trying to conceive without treatment, considering treatment, and using treatment screened positive at comparable rates for depression (4.1%, 4.2%, 4.6%; p = 0.82), generalized anxiety (7.5%, 8.9%, 8.8%; p = 0.77), and conception-specific anxiety (22.0%, 23.5%, 20.4%; p = 0.13). Interest in receiving emotional support was lowest in people trying to conceive without treatment, higher among people considering treatment, and highest among people using treatment (32.0%, 34.6%, 39.5%; p = 0.005), respectively.

Conclusions: People trying to conceive without treatment had comparable rates of anxiety and depression to users considering or undergoing treatment. Across all groups, more than 30% of users reported interest in support for their emotional well-being. Primary care providers and digital health platforms can screen and support this population.