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Kern-Goldberger AR, Madden N, Baptiste C, Friedman A, Gyamfi-Bannerman C. Maternal and Neonatal Morbidities by Race in College-Educated Women. AJP Rep 2024; 14:e57-e61. [PMID: 38288160 PMCID: PMC10824592 DOI: 10.1055/s-0043-1778000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/22/2023] [Indexed: 01/31/2024] Open
Abstract
Objective Non-Hispanic black and Hispanic women experience significantly higher adverse maternal and neonatal outcomes compared with non-Hispanic white women. The purpose of this study is to explore whether disparities in obstetric outcomes exist by race among women who are college-educated. Study Design This is a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Women were defined as "college-educated" if they reported completion of a 4-year college degree. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal morbidity, and a composite of neonatal morbidity was evaluated as a secondary outcome. A multivariable logistic regression model was then utilized to assess associations of race with the primary and secondary outcomes. Results A total of 2,540 women were included in the study. After adjusting for potential confounding variables, maternal morbidity was found to be significantly higher for college-educated non-Hispanic black women compared with non-Hispanic white women (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.12-2.80). The incidence of neonatal morbidity was significantly higher for non-Hispanic black (OR 1.91, 95% CI 1.31-2.79) and Hispanic (OR 3.34, 95% CI 2.23-5.01) women. Conclusion In this cohort, the odds of cesarean-related maternal and neonatal morbidities were significantly higher for college-educated non-Hispanic black women, compared with their non-Hispanic white counterparts. This demonstrates that even among women with higher level education, racial and ethnic disparities persist in obstetric outcomes.
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Affiliation(s)
- Adina R. Kern-Goldberger
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Nigel Madden
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Caitlin Baptiste
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alexander Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
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Ahlers-Schmidt CR, Okut H, Jacobson LT, Hervey A, Schunn C, Torres M, Kuhlmann Z. Characteristics Associated with Sudden Unexpected Infant Death in a Rural Hispanic Population: A Case-Control Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01854-5. [PMID: 37947954 DOI: 10.1007/s40615-023-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sudden unexpected infant death (SUID) is the leading cause of death among U.S. infants aged 28 days to 1 year. In Kansas, Hispanic infant mortality is nearly 50% higher than non-Hispanic White. Further, the SUID rate did not change between 2005-2018, while rates for non-Hispanic Black and White infants decreased significantly. This study sought to identify characteristics and behaviors of Hispanic birthing persons related to SUID. METHODS Linked Kansas birth/death vital statistics data (2005-2018) identified Hispanic birthing persons with a singleton birth who experienced SUID. To reduce confounding effects, greedy nearest neighbor matching paired each SUID case sequentially with the four nearest controls based on age, race, payor source and parity. Matching procedures, likelihood-ratio χ2, Fisher exact test and multiple logistic regression model with Firth's penalized maximum likelihood estimation were computed. RESULTS Of 86,052 Hispanic singleton births, 66 involved SUID and were matched with 264 controls. No differences were related to marital status, population density of residence, education level, language spoken, prenatal BMI, weight gained during pregnancy, adequacy of prenatal care, enrollment in WIC, or state immunization registry participation (all p>0.05). However, tobacco use during pregnancy contributed to a three times greater risk of SUID (OR=3.208; 95% CI=1.438 to 7.154). Multivariable models for behavioral variables revealed low predictive accuracy with area under the ROC curve=0.6303. CONCLUSION This study suggests SUID deaths to rural Hispanic families are likely multifaceted. Study results inform educational programs on the importance of addressing tobacco cessation in SUID risk reduction interventions for Hispanic families.
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Affiliation(s)
- Carolyn R Ahlers-Schmidt
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA.
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
| | - Ashley Hervey
- Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, 3243 E. Murdock, Suite 604, Wichita, KS, 67208, USA
| | - Christy Schunn
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Maria Torres
- Kansas Infant Death and SIDS (KIDS) Network, 300 W. Douglas, Suite 145, Wichita, KS, 67202, USA
| | - Zachary Kuhlmann
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS, 67214, USA
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Elliott T, Floyd James K, Coleman KJ, Skrine Jeffers K, Nau CL, Choi K. Cross-sectional Comparison of Disparities by Race Using White vs Hispanic as Reference Among Children and Youths With Developmental Disabilities Referred for Speech Therapy. JAMA Netw Open 2022; 5:e2234453. [PMID: 36194413 PMCID: PMC9533182 DOI: 10.1001/jamanetworkopen.2022.34453] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Health care research on racial disparities among children and youths has historically used the White race as a reference category with which other racial and ethnic groups are compared, which may inadvertently set up Whiteness as a standard for health. OBJECTIVE To compare 2 interpretations of an analysis of racial disparities in speech therapy receipt among children and youths with developmental disabilities: a traditional, White-referenced analysis and a Hispanic majority-referenced analysis. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used multiple logistic regression to analyze speech therapy referrals for children, adolescents, and transition age youths in an integrated health care system in Southern California from 2017 to 2020. Eligible participants were children and youths up to age 26 years with 1 or more diagnosed intellectual or developmental disability (eg, autism spectrum disorder, speech or language delay, developmental delay, Down syndrome, and others). EXPOSURES Child or youth race and ethnicity as reported by parents or caregivers (Asian, Black and African American, Hispanic and Latinx, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, White, multiple, and other). MAIN OUTCOMES AND MEASURES Receipt of speech therapy within 1 year of referral. RESULTS A total 66 402 referrals were included; 65 833 referrals (99.1%) were for children under age 17 years, 47 323 (71.3%) were for boys, and 39 959 (60.2%) were commercially insured. A majority of participants were identified as Hispanic (36 705 [55.3%]); 6167 (9.3%) were identified as Asian, 4810 (7.2%) as Black, and 14 951 (22.5%) as White. In the traditional racial disparities model where the reference category was White, referrals of children and youths who identified as Hispanic, Black, Pacific Islander, and other had lower odds of actual receipt of speech therapy compared with referrals for White children and youths (Hispanic: OR, 0.79; 95% CI, 0.75-0.83; Black: OR, 0.72; 95% CI, 0.66-0.78; Pacific Islander: OR, 0.74; 95% CI, 0.57-0.98). When using the majority race group (Hispanic) as the reference category, referrals for children and youths who identified as White (OR, 1.26; 95% CI, 1.20-1.30), Asian (OR, 1.21; 95% CI, 1.12-1.30), and multiracial (OR, 1.35; 95% CI, 1.08-1.71) had higher odds of resulting in actual service receipt in comparison with referrals for Hispanic children and youths. CONCLUSIONS AND RELEVANCE The cross-sectional study demonstrates the value of decentering Whiteness in interpreting racial disparities research and considering racial differences against multiple referents. Racial disparities researchers should consider investigating multiple between-group differences instead of exclusively using White as the default reference category.
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Affiliation(s)
- Thomas Elliott
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Kortney Floyd James
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Karen J. Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena
| | | | - Claudia L. Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristen Choi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- School of Nursing, University of California, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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Racial and Ethnic Disparities in Health Care and Health Outcomes for Pregnant Women With Diabetes. Nurs Womens Health 2021; 25:437-449. [PMID: 34634249 DOI: 10.1016/j.nwh.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022]
Abstract
This article summarizes the current literature on racial and ethnic differences among women with diabetes in pregnancy. The PubMed, Scopus, CINAHL, and Embase databases were searched for original qualitative or quantitative studies published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded. Results of this synthesis indicate that racial and ethnic differences exist among pregnant women with diabetes, including social determinants of health, disparities in maternity care and perinatal care, and maternal and neonatal health outcomes. Health care providers should implement tailored interventions that specifically target racial and ethnic disparities in maternal and neonatal health to promote health equity in pregnant women with diabetes and their offspring, including later in life.
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Edelblute HB, Altman CE. The Interaction and Impact of Social Support and Father Absence on Breastfeeding. Breastfeed Med 2021; 16:629-634. [PMID: 33913762 DOI: 10.1089/bfm.2020.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Behaviors related to early childhood nutrition are influenced by a mother's social environment. In many low- and middle-income countries, breastfeeding rates have steadily declined. At the same time, many communities have a history of domestic or international migration that affects the family support systems for women and children remaining in these communities. While social support has been shown to be important to health behaviors conducive to maternal and child health, scant research examines whether social support moderates the impact of an absent father on breastfeeding. Objective: We aim to assess the relationship between father absence and breastfeeding duration and test whether social support moderates the impact of father absence on breastfeeding duration. Methods: We use data from the Social Networks and Health Information Survey (n = 292), a random household survey conducted in a municipality in Guanajuato, Mexico, to estimate Poisson regression models of breastfeeding duration. Results: In multivariate models, an absent father is negatively associated with breastfeeding, whereas social support is positively associated. A significant and positive interaction between father absence and social support suggests that at high levels of support, breastfeeding duration for women with absent fathers does not appear to be meaningfully different from women with present fathers. This suggests that receiving high levels of social support during pregnancy may mitigate the absence of the child's father. Conclusions: Social support interventions for mothers of infants should target mothers and children in households without a father. More research should also be directed at understanding how social support processes during pregnancy can affect breastfeeding in other low- and middle-income countries with high rates of emigration.
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Affiliation(s)
- Heather B Edelblute
- Department of Health, West Chester University, West Chester, Pennsylvania, USA.,Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Claire E Altman
- Department of Health, West Chester University, West Chester, Pennsylvania, USA.,Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
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Hopkins AL, Yeoman M, Ritenbaugh C. Healthy foods prepared at home: Diet and support as protective strategies during pregnancy for Hispanic women. Ecol Food Nutr 2018; 57:140-161. [PMID: 29323534 DOI: 10.1080/03670244.2018.1423971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Birth outcomes tend to be better among Hispanics than among other ethnic groups, even when matched for poverty and education, and foreign-born Latinas compared to their US-born counterparts. These patterns suggest that sociocultural factors exhibited by recent immigrants have the potential to protect birth outcomes against the instability of minority and low socioeconomic status. To discover potential sociocultural factors, a pilot qualitative study was carried out in Tucson, Arizona, with 18 Hispanic mothers. The two most prevalent factors reported were (1) a healthy diet prepared at home from minimally processed ingredients, and (2) constant and comprehensive social support. When comparing responses related to diet by interview language preference, a proxy for acculturation, there was very little difference between participants who interviewed in Spanish and those who interviewed in English. This result may be explained by greater maternal social support and higher education levels among those who interviewed in English.
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Affiliation(s)
- Allison L Hopkins
- a Department of Anthropology , Texas A&M University, College Station , Texas , USA
| | - Michelle Yeoman
- b Departments of Veterinary Integrative Biosciences and Anthropology , Texas A&M University, College Station , Texas , USA
| | - Cheryl Ritenbaugh
- c Department of Family and Community Medicine , University of Arizona, Tucson , Arizona , USA
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Chao SM, Wakeel F, Nazinyan Y, Sun S. Does Preconception Health Differ by Nativity?: Findings from the Los Angeles Mommy and Baby (LAMB) Study. Matern Child Health J 2016; 20:769-77. [PMID: 26728899 PMCID: PMC4794372 DOI: 10.1007/s10995-015-1907-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare certain preconception health (PCH) behaviors and conditions among US-born (USB) and foreign-born (FB) mothers in Los Angeles County (LAC), regardless of race/ethnicity, and to determine if any identified differences vary among Asian/Pacific Islanders (API's) and Hispanics. METHODS Data are from the 2012 Los Angeles Mommy and Baby study (n = 6252). PCH behaviors included tobacco use, multivitamin use, unintended pregnancy, and contraception use. PCH conditions comprised being overweight/obese, diabetes, asthma, hypertension, gum disease, and anemia. The relationship between nativity and each PCH behavior/condition was assessed using multivariable logistic regression models. RESULTS USB women were more likely than FB women to smoke (AOR 2.12, 95 % CI 1.49-3.00), be overweight/obese (AOR 1.57, 95 % CI 1.30-1.90), and have asthma (AOR 2.04, 95 % CI 1.35-3.09) prior to pregnancy. They were less likely than FB women to use contraception before pregnancy (AOR 0.59, 95 % CI 0.49-0.72). USB Hispanics and API's were more likely than their FB counterparts to be overweight/obese (AOR 1.57, 95 % CI 1.23-2.01 and AOR 2.37, 95 % CI 1.58-3.56, respectively) and less likely to use contraception (AOR 0.58, 95 % CI 0.45-0.74 and AOR 0.46, 95 % CI 0.30-0.71, respectively). USB Hispanic mothers were more likely than their FB counterparts to smoke (AOR 2.47, 95 % CI 1.46-4.17), not take multivitamins (AOR 1.30, 95 % CI 1.02-1.66), and have asthma (AOR 2.35, 95 % CI 1.32-4.21) before pregnancy. CONCLUSIONS US nativity is linked to negative PCH among LAC women, with many of these associations persisting among Hispanics and API's. As PCH profoundly impacts maternal and child health across the lifecourse, culturally-appropriate interventions that maintain positive behaviors among FB reproductive-aged women and encourage positive behaviors among USB women should be pursued.
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Affiliation(s)
- Shin M Chao
- Los Angeles County Department of Maternal, Child and Adolescent Health Programs, 600 Commonwealth Avenue, 8th Floor, Los Angeles, CA, 90095, USA.
| | - Fathima Wakeel
- Public Health Programs, College of Health Professions, Ferris State University, Big Rapids, MI, USA
| | | | - Stacy Sun
- Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD, USA
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Liu J, Whitaker KM, Yu SM, Chao SM, Lu MC. Association of Provider Advice and Pregnancy Weight Gain in a Predominantly Hispanic Population. Womens Health Issues 2016; 26:321-8. [PMID: 26922386 DOI: 10.1016/j.whi.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study sought to determine whether women's report of gestational weight gain (GWG) advice from a health care provider is consistent with the Institute of Medicine (IOM) guidelines and the association between provider advice and women's weight gain during pregnancy. METHODS Data came from the 2007 Los Angeles Mommy and Baby study (n = 3,402). The 1990 IOM GWG guidelines were used to define whether the provider's advice on weight gain and women's weight gain were below, within, or above the guidelines. RESULTS Approximately 4 months after delivery, 18.8% of the women reported having not discussed weight gain with any health care providers during pregnancy. Among those who reported such discussions, 42% reported receiving weight gain advice from a health care provider within IOM guidelines, 16.5% below guidelines, and 10% above. An additional 13.5% reported the discussion but did not report the recommended weight gain amount. Compared with women who reported provider advice on weight gain within guidelines, women who reported advice below guidelines were 1.7 times (95% confidence interval [CI], 1.3-2.2) more likely to gain less than the IOM recommended amount. Women who reported provider advice above IOM guidelines were 2.0 times (95% CI, 1.4-2.9) more likely to exceed guidelines. CONCLUSIONS There is a need for more women to receive advice consistent with the IOM GWG guidelines from their prenatal care providers. Intervention strategies are needed to educate providers about IOM guidelines and how to counsel on GWG.
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Affiliation(s)
- Jihong Liu
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Office of Research and Epidemiology, Maternal & Child Health Bureau, Health Resources & Services Administration, Rockville, Maryland.
| | - Kara M Whitaker
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Stella M Yu
- Office of Research and Epidemiology, Maternal & Child Health Bureau, Health Resources & Services Administration, Rockville, Maryland
| | - Shin M Chao
- Research Evaluation and Planning Division, Maternal, Child, and Adolescent Health Programs, County of Los Angeles, Department of Public Health, Los Angeles, California
| | - Michael C Lu
- Office of Research and Epidemiology, Maternal & Child Health Bureau, Health Resources & Services Administration, Rockville, Maryland
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Chao SM, Wakeel F, Herman D, Higgins C, Shi L, Chow J, Sun S, Lu MC. The 2007 los angeles mommy and baby study: a multilevel, population-based study of maternal and infant health in los angeles county. Adv Prev Med 2014; 2014:293648. [PMID: 25580305 PMCID: PMC4279178 DOI: 10.1155/2014/293648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/12/2014] [Accepted: 11/16/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives. In order to comprehensively examine the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes, the Los Angeles County Department of Public Health and the University of California, Los Angeles, joined efforts to design and implement the 2007 Los Angeles Mommy and Baby (LAMB) study. This paper aims to present the conceptual frameworks underlying the study's development, highlight the successful collaboration between a research institution and local health department, describe the distinguishing characteristics of its methodology, and discuss the study's implications for research, programs, and policies. Methods. The LAMB study utilized a multilevel, multistage cluster design with a mixed-mode methodology for data collection. Two samples were ultimately produced: the multilevel sample (n = 4,518) and the augmented final sample (n = 6,264). Results. The LAMB study allowed us to collect multilevel data on the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes. Both samples were more likely to be Hispanic, aged 20-34 years, completed at least 12 years of schooling, and spoke English. Conclusions. The LAMB study represents the successful collaboration between an academic institution and local health department and is a theoretically based research database and surveillance system that informs effective programmatic and policy interventions to improve outcomes among LAC's varied demographic groups.
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Affiliation(s)
- Shin M. Chao
- Research, Evaluation and Planning Division, Los Angeles County Department of Maternal, Child and Adolescent Health Programs, 600 Commonwealth Avenue, 8th Floor, Los Angeles, CA 90095, USA
| | - Fathima Wakeel
- Ferris State University College of Health Professions, 200 Ferris Drive, VFS 428, Big Rapids, MI 49307, USA
| | - Dena Herman
- Department of Family and Consumer Sciences, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Chandra Higgins
- Research, Evaluation and Planning Division, Los Angeles County Department of Maternal, Child and Adolescent Health Programs, 600 Commonwealth Avenue, 8th Floor, Los Angeles, CA 90095, USA
| | - Lu Shi
- Clemson University Department of Public Health Sciences, 505 Edwards Hall, Clemson, SC 29634, USA
| | - Jessica Chow
- University of California, Berkeley-San Francisco Joint Medical Program, 50 University Hall, No. 7360, San Francisco, CA 94720, USA
| | - Stacy Sun
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287, USA
| | - Michael C. Lu
- University of California, Los Angeles (UCLA) School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90024, USA
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Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014:530769. [PMID: 24693433 PMCID: PMC3945081 DOI: 10.1155/2014/530769] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/25/2013] [Accepted: 12/24/2013] [Indexed: 11/18/2022] Open
Abstract
This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care.
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The balance between stress and personal capital during pregnancy and the relationship with adverse obstetric outcomes: findings from the 2007 Los Angeles Mommy and Baby (LAMB) study. Arch Womens Ment Health 2013; 16:435-51. [PMID: 23812738 PMCID: PMC3833901 DOI: 10.1007/s00737-013-0367-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
Stress during pregnancy is a salient risk factor for adverse obstetric outcomes. Personal capital during pregnancy, defined as internal and social resources that help women cope with or decrease their exposure to stress, may reduce the risk of poor obstetric outcomes. Using data from the 2007 Los Angeles Mommy and Baby study (N = 3,353), we examined the relationships between the balance of stress and personal capital during pregnancy, or the stress-to-capital ratio (SCR), and adverse obstetric outcomes (i.e., pregnancy complications, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA)). Women with a higher SCR (i.e., greater stress relative to personal capital during pregnancy) were significantly more likely to experience at least one pregnancy complication, PTB, and lower gestational age, but not LBW or SGA. Accounting for pregnancy complications completely mediated the association between the SCR and PTB. Our findings indicate that experiencing greater stress relative to personal capital during pregnancy is associated with an increased risk for pregnancy complications, PTB, and lower gestational age and that pregnancy complications may be a mechanism by which the SCR is related to adverse obstetric outcomes.
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