Maternal and Child Health Journal最新文献

Objectives: This qualitative study explored experiences of 15 women in New York City who suffered physical, emotional, and socioeconomic consequences of severe maternal morbidity (SMM). This study aimed to increase our understanding of additional burdens these mothers faced during the postpartum period.

Methods: Qualitative analysis of in-depth interviews (n = 15) with women who had given birth in NYC hospitals and experienced SMM. We focused on how experiences of SMM impacted postpartum recoveries. Grounded theory methodology informed analysis of participants' one-on-one interviews. To understand the comprehensive experience of postpartum recovery after SMM, we drew on theories about social stigma, reproductive equity, and quality of care to shape constant-comparative analysis and data interpretation.

Findings: Three themes were generated from data analysis: 'Caring for my body' defined by challenges during physical recuperation, 'caring for my emotions' which highlighted navigation of mental health recovery, and 'caring for others' defined by care work of infants and other children. Most participants identified as Black, Latinx and/or people of color, and reported the immense impacts of SMM across aspects of their lives while receiving limited access to resources and insufficient support from family and/or healthcare providers in addressing postpartum challenges.

Conclusions for practice: Findings confirm the importance of developing a comprehensive trauma-informed approaches to postpartum care as a means of addressing SMM consequences.

Background: Maternal depression and anxiety occurring beyond the 1-year postpartum period can lead to significant suffering for both mother and child. This study aimed to systematically review and synthesize studies reporting the prevalence and incidence of maternal depression and anxiety beyond 1 year post-childbirth.

Methods: A systematic literature review of the PsycINFO, Medline, and Embase databases identified studies reporting on the prevalence and/or incidence of depression and/or anxiety among mothers between 1 and 12 years post-childbirth. The quality of the included studies was assessed. Findings were synthesized qualitatively.

Results: Twenty-one studies were identified that met the inclusion and exclusion criteria. All studies reported the prevalence of depression, with 31 estimates ranging from 6.6% at 3 to 11 years post-childbirth to 41.4% at 3 to 4 years post-childbirth. Five of these studies also reported the prevalence of depression in subgroups (e.g., ethnic origin, income, marital status). Four studies reported the prevalence of anxiety, with nine estimates ranging from 3.7% at 5 years post-childbirth to 37.0% at 3 to 4 years post-childbirth. Only one study reported incidence. The quality of the included studies was variable, with most studies scoring above 7/9.

Conclusion: Maternal anxiety and depression remain prevalent beyond the first year postpartum, particularly in marginalized subgroups. Current observational studies lack consistency and produce highly variable prevalence rates, calling for more standardized measures of depression and anxiety. Clinical practice and research should consider the prevalence of maternal anxiety and depression beyond this period.

Objectives: Maternal mortality and morbidity disproportionately affect birthing people from racialized populations. Unfortunately, researchers can often compound these poor outcomes through a lack of authentic community engagement in research beyond the role of the research subject, leading to ineffective strategies for improving care and increasing equity. This article details the real-life strategies utilized to develop a community-engaged research project of a phased federally funded grant employing community engagement principles of co-leadership and co-creation. It also includes reflections from the researchers and advisory board on promising practices and lessons learned for equitably engaging patients and community partners in research.

Methods: This article details the application of principles of community-engaged research in a federally funded phased research project focused on understanding disparities in maternal sepsis to develop better clinical and community interventions. Specifically, it discusses early steps in the research partnership to create a sustainable partnership with a Community Leadership Board guided by the principles of transparency, respect, compensation, and increasing research justice.

Results: Based on the authors' experience, recommendations are provided for funders, researchers, and institutions to improve the quality and outcomes of communityengaged research. This work adds to community-based participatory and community-engaged research literature by providing concrete and practical steps for equitably engaging in research partnerships with a variety of collaborators.

Conclusions: In conclusion, integrated patient and community co-leadership enhances research by providing insight, access to communities for education and dissemination of information, and identifying critical areas needing change. This report may help others address fundamental principles in this journey.

Introduction: The COVID-19 pandemic affected child health behaviors, leading to worse physical health. Given the importance of good family health in improved child health outcomes, this secondary cohort analysis tested the hypothesis that family health would improve from baseline to 12-week follow-up after participation in a novel family nutrition program.

Methods: Diverse parent-child dyads participated in a home-based virtual Teaching Kitchen Outreach (vTKO) program (11 weekly healthy, low-cost recipes, cooking videos, and associated groceries delivered). The primary outcome was the Family Healthy Lifestyle Subscale (FHLS). Secondary outcomes were parent and child nutrition, and food insecurity. Statistical testing and modeling were used to evaluate pre-post outcomes.

Results: Of 123 enrolled dyads, 114 (93%) had sufficient data for analysis. Participants were 11% Hispanic, 54% Black, and 28% White; 31% completed high school or less; and 30% indicated food insecurity. Cohort mean pre-post FHLS scores significantly increased (25.5 vs. 27.3; p < 0.001). There were significant improvements in parent nutrition (p < 0.001) and child nutrition (p = 0.02 to < 0.001), but not in food security. After adjusting for baseline covariates, tobit regression found statistically significant pre-post FHLS differences (2.3; 95% CI=[1.4, 3.3]; p < 0.001).

Discussion: Participants in the novel home-based vTKO program reported improved family health over 12 weeks.

Introduction: Pregnancy and the postpartum period is a difficult time for women living with HIV (WLWH) and postpartum engagement with HIV care is often reduced, with implications for health and well-being. We aimed to explore the postpartum health experiences of WLWH in relation to engagement in HIV care.

Methods: The NESTOR (iNvESTigating the pregnancy and pOst-paRtum health experience of women living with HIV) study was a UK based qualitative semi-structured interview study. 61 eligible women were identified. We used a purposive sampling technique to recruit women with differing levels of engagement in HIV care. Interviews were conducted via telephone or video call. Interviews were audio recorded and fully transcribed. We used a thematic approach for data analysis, and two researchers independently coded the data and established the key themes.

Results: 11 of 61 (18%) eligible women participated in the interviews, and the three main themes were 'infant feeding decisions', 'managing the risk of mother to child transmission', and 'managing the knowledge of their HIV status'. These themes offer detailed insights into the significant psychological and emotional challenges these women had experienced, and the practical support from healthcare professionals in both HIV and maternity services that had enabled them to navigate those challenges.

Discussion: There have been life-changing developments in the treatment and care for people living with HIV. However, even in the U = U (undetectable = untransmittable) era, traditional concerns about breastfeeding, risk of transmission to the infant and stigma continue to shape the postpartum experience of WLWH. As these impact on their emotional and psychological wellbeing, support in these areas needs to be prioritised.

Objectives: To examine US in-hospital exclusive breastfeeding (EBF) and the associations with Baby-Friendly designation and neighborhood sociodemographic factors.

Methods: Hospital data from the 2018 Maternity Practices in Infant Nutrition and Care survey were linked to hospital zip code tabulation area (ZCTA) sociodemographic data from the 2014-2018 American Community Survey (n = 2,024). The percentages of residents in the hospital ZCTA were dichotomized based on the relative mean percentage of the hospital's metropolitan area, which were exposure variables (high/low Black hospitals, high/low poverty hospitals, high/low educational attainment hospitals) along with Baby-Friendly designation. Using linear regression, we examined the associations and effect measure modification between Baby-Friendly designation and hospital sociodemographic factors with in-hospital EBF prevalence.

Results: US mean in-hospital EBF prevalence was 55.1%. Baby-Friendly designation was associated with 9.1% points higher in-hospital EBF prevalence compared to non-designated hospitals [95% confidence interval (CI): 7.0, 11.2]. High Black hospitals and high poverty hospitals were associated with lower EBF prevalence (difference= -3.3; 95% CI: -5.1, -1.4 and - 3.8; 95% CI: -5.7, -1.8). High educational attainment hospitals were associated with higher EBF prevalence (difference = 6.7; 95% CI: 4.1, 9.4). Baby-Friendly designation was associated with significant effect measure modification of the in-hospital EBF disparity attributed to neighborhood level poverty (4.0% points higher in high poverty/Baby-Friendly designated hospitals than high poverty/non-Baby-Friendly designated hospitals).

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity.

Despite recommendations for ongoing care after pregnancy, many individuals do not see a primary care clinician within the first postpartum year, missing a critical window to engage reproductive-age individuals in primary care. We administered an anonymous, cross-sectional, trilingual survey at a large urban safety-net hospital to assess postpartum individuals' preferences, health concerns, and anticipated barriers to primary care during the year after pregnancy. While 90% of respondents preferred a visit within one year, most individuals - including those with complicated pregnancies - did not recall a primary care recommendation from their pregnancy care team. Respondents reported a variety of primary care-amenable health concerns, and many social and logistical barriers to care. Preference for virtual care increased if self-monitoring tools were hypothetically available, indicating virtual visits may improve primary care access.

Introduction: We investigated 2018 gestational diabetes mellitus (GDM) prevalence estimates in three surveillance systems (National Vital Statistics System, State Inpatient Database, and Pregnancy Risk Assessment Monitoring Survey).

Methods: We calculated GDM prevalence for jurisdictions represented in each system; a subset of data was analyzed for people 18-39 years old in 22 jurisdictions present in all three systems to observe dataset-specific demographics and GDM prevalence using comparable categories.

Results: GDM prevalence estimates varied widely by data system and within the data subset despite comparable demographics.

Discussion: Understanding the differences between GDM surveillance data systems can help researchers better identify people and places at higher risk of GDM.

The purpose of this study was to evaluate disparities in urine drug testing (UDT) during perinatal care at a single academic medical center. This retrospective cohort study included patients who had a live birth and received prenatal care at our institution between 10/1/2015 and 9/30/2020. The primary outcomes were maternal UDT during pregnancy (UDTPN) and UDT only at delivery (UDTDEL). Secondary outcomes included the number of UDTs (UDTNUM) and the association between a positive UDT test result and race/ethnicity. Mixed model logistic regression and negative binomial regression with clustering based on prenatal care locations were used to control for confounders. Of 6,240 live births, 2,265 (36.3%) and 167 (2.7%) received UDTPN and UDTDEL, respectively. Black (OR 2.09, 95% CI 1.54-2.84) and individuals of Other races (OR 1.64, 95% CI 1.03-2.64) had greater odds of UDTPN compared to non-Hispanic White individuals. Black (beta = 1.12, p < 0.001) and Hispanic individuals (beta = 0.78, p < 0.001) also had a positive relationship with UDTNUM. Compared to individuals with non-Medicaid insurance, those insured by Medicaid had greater odds of UDTPN (OR 1.66, 95% CI 1.11-2.49) and had a positive relationship with UDTNUM (beta = 0.89, p < 0.001). No significant associations were found for UDTDEL and race/ethnicity. Despite receiving more UDT, Black individuals were not more likely to have a positive test result compared to non-Hispanic White individuals (OR 0.95, 95% CI 0.72-1.25). Our findings demonstrate persistent disparities in substance use testing during the perinatal period.