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Yakubu RA, Ajayi KV, Dhaurali S, Carvalho K, Kheyfets A, Lawrence BC, Amutah-Onukagha N. Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis. Matern Child Health J 2023; 27:166-176. [PMID: 37737325 PMCID: PMC10692264 DOI: 10.1007/s10995-023-03773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. METHODS The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. RESULTS A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. CONCLUSIONS FOR PRACTICE Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.
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Affiliation(s)
- Rauta Aver Yakubu
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA.
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63104, USA.
| | - Kobi V Ajayi
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- Texas A&M University, College Station, TX, 77845, USA
| | - Shubhecchha Dhaurali
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Arts & Sciences, Tufts University, Medford, MA, 02155, USA
| | - Keri Carvalho
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Anna Kheyfets
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
| | - Blessing Chidiuto Lawrence
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Ndidiamaka Amutah-Onukagha
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
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Syed G, Sims J, House SH, Bruno B, Boulware A, Tang K, Curenton SM. Innovations and Opportunities in Care for Black Mothers and Birthing People. FAMILY & COMMUNITY HEALTH 2023; 46:87-94. [PMID: 36799941 DOI: 10.1097/fch.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In recent years, there has been increased attention given to how racism fuels health inequities, including the inadequacy of prenatal care (PNC) that Black women and Black birthing people receive. This increase of attention has brought notable advancements in research, practice, and policy that intend to better understand and address these systemic inequities within the health care system. This review aims to provide an overview of promising developments in the study of Black mothers' and birthing people's experiences in PNC and delivery, to detail current research surrounding interventions to improve quality and mitigate bias in obstetric care, and to offer ways in which legislation can support such strategies targeting the root causes of inequities in care.
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Affiliation(s)
- Gullnar Syed
- SRI International, Arlington, Virginia (Ms Syed); Wheelock College of Education & Human Development, Boston University, Boston, Massachusetts (Mss Syed, Bruno, and Tang and Drs Sims and Curenton); Center for Youth, Family, and Community Partnerships, Durham County Cooperative Extension, North Carolina State University (Dr House); and Comparative Human Development, University of Chicago, Chicago, Illinois (Dr Boulware)
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Moore N, Abouhala S, Maleki P, Kheyfets A, Carvalho K, Amutah-Onukagha N. The Efficacy of Provider-Based Prenatal Interventions to Reduce Maternal Stress: A Systematic Review. Womens Health Issues 2023; 33:300-311. [PMID: 37019762 DOI: 10.1016/j.whi.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Exposure to stress during the prenatal period is often associated with adverse maternal and neonatal health outcomes and is increasing in prevalence in the United States. Health care providers play a crucial role in addressing and mitigating this stress, but there is a lack of consensus in effective interventions. This review evaluates the effectiveness of prenatal provider-based interventions that reduce stress for pregnant people, especially those who are disproportionately affected by stress. METHODS A search of relevant English-language literature was conducted using PubMed, CINAHL, Web of Science, Embase, and PyscInfo. Inclusion criteria were 1) the target population was pregnant people, 2) the intervention was delivered within the U.S. health care system, and 3) the study intervention had the goal of reducing stress (stress-reducing intervention). RESULTS A total of 3,562 records were identified in the search and 23 were included in analysis. The four identified categories for provider-led stress-reducing prenatal interventions included in the review are 1) skills-building, 2) mindfulness, 3) behavioral therapy, and 4) group support. Findings suggest an increased overall likelihood of mood and maternal stress improvement among pregnant people who complete provider-based stress-reducing interventions, especially group-based therapies that integrated resource allocation, skills-building, mindfulness, and/or behavioral therapy into an intersectional program. However, the efficacy of each type of intervention varies by category and type of maternal stress targeted. CONCLUSIONS Although few studies demonstrated a significant reduction in stress for pregnant people, this review highlights the critical need for increased research and attention to stress-reducing interventions in the prenatal period, especially as it pertains to minoritized populations.
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Affiliation(s)
- Nichole Moore
- Tufts University School of Medicine, Boston, Massachusetts.
| | | | - Pegah Maleki
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Kheyfets
- Tufts University School of Medicine, Boston, Massachusetts
| | - Keri Carvalho
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Davis KM, Lu L, Williams B, Roas-Gomez MV, Leziak K, Jackson J, Feinglass J, Yee LM. The Stress of Parenting in the Postpartum Period During the COVID-19 Pandemic. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:895-903. [PMID: 36479375 PMCID: PMC9712040 DOI: 10.1089/whr.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
Background The COVID-19 pandemic produced a major shift in parental roles, which disproportionally exacerbated existing challenges for low-income new parents. Our objective was to identify pandemic-related parenting challenges experienced by low-income postpartum individuals in the context of the early months of the COVID-19 pandemic. Methods Semistructured interviews with 40 low-income postpartum individuals were conducted within 10 weeks after giving birth in April 2020-June 2020. Interviews addressed maternal health and well-being, parental stress, including COVID-related barriers to providing for children, and access to essential services. Interview themes were developed using the constant comparative method. Results Half (n = 20) the participants identified as non-Hispanic Black and 38% (n = 15) as Hispanic; 75% (n = 30) were parents of multiple children. Parenting-related themes included challenges of parenting multiple children, barriers to maintaining self-care, and novel barriers to providing for children. Participants discussed handling new roles as educators, struggles with entertaining, allocating time among children, and effects of the pandemic on older children. Participants frequently described their lack of alone time, changes in self-care and coping strategies due to continuous parenting, and effects on maternal mental health like increased anxiety. Many participants reported lack of communal support, financial stress, and difficulty accessing services. Conclusions New burdens introduced by the pandemic challenged low-income individuals' health and well-being. Understanding these psychosocial stressors and developing interventions to ameliorate these burdens may be key to promoting family health during difficult times; one potential solution for preventing postpartum depression is offering continual social services. Clinical Trial No.: NCT03922334.
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Affiliation(s)
- Ka'Derricka M. Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Layna Lu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria V. Roas-Gomez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karolina Leziak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jenise Jackson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Address correspondence to: Lynn M. Yee, MD, MPH, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, Suite 5-2145, Chicago, IL 60611, USA,
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