Maternal and Child Health Journal最新文献

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.

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.