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Bello JK, Xu KY, Salas J, Kelly J, Grucza RA. Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100248. [PMID: 39040479 PMCID: PMC11261297 DOI: 10.1016/j.dadr.2024.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024]
Abstract
Background Using contraception to delay pregnancy allows people with opioid use disorder (OUD) to choose when they are ready to continue their families. Yet, postpartum contraceptive uptake among people with OUD has not been well characterized. Methods Analyses used 73,811 pregnancy episodes among 61,221 people (2016-2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. Contraceptive uptake was defined within 90-days after delivery. We used Generalized Estimating Equations-type multinomial logit models to assess association of OUD +/- co-occurring substance use disorders (SUDs) with any contraception (yes/no) and type of contraception (effective - pills, patch, ring, injection; or highly effective - long-acting reversible, LARC methods [intrauterine device, implant] and sterilization). Results The sample was 66.0 % white and average age was 27.7 years (±5.6). 32.5 % of pregnancies were followed by contraception initiation, 2.3 % had an OUD diagnosis, and 1.3 % OUD with co-occurring SUD. There was no association between OUD and postpartum contraception receipt, but OUD was associated with decreased highly effective compared to effective method initiation (aOR=0.76; 95 % CI: [0.64-0.91]). OUD plus co-occurring SUD was associated with decreased uptake across all contraception types (aOR=0.81[0.70-0.93]), specifically, highly-effective methods (aOR=0.48[0.38-0.61]). Conclusions Overall postpartum contraception uptake among people with OUD is comparable to uptake in the non-OUD population. People with OUD plus co-occurring SUDs are particularly unlikely to receive contraception. The reasons people choose contraceptive methods are complex and may differ by SUD severity. More information is needed to understand factors that impact postpartum contraception initiation.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
| | - Kevin Y. Xu
- Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Joanne Salas
- Advanced Health Data Institute, Department of Health and Outcomes Research, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO 63104, USA
| | - Jeannie Kelly
- Division of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4901 Forest Park Ave. Suite 710, St. Louis, MO 63108, USA
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, USA
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Thompson-Lastad A, Harrison JM, Taiwo TK, Williams C, Parimi M, Wilborn B, Chao MT. Postpartum care for parent-infant dyads: A community midwifery model. Birth 2024; 51:637-648. [PMID: 38590170 DOI: 10.1111/birt.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.
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Affiliation(s)
- Ariana Thompson-Lastad
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Jessica M Harrison
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | | | - Chanda Williams
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | - Mounika Parimi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Briana Wilborn
- Department of Family Health Care Nursing (*alum), School of Nursing, University of California, San Francisco, California, USA
| | - Maria T Chao
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
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Lyerly AD. Research, pregnancy, and the ethics of parental consent. THE LANCET. RHEUMATOLOGY 2024; 6:e500-e501. [PMID: 38876125 DOI: 10.1016/s2665-9913(24)00155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
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Niles PM, Nack A, Eniola F, Searing H, Morton C. "We don't really address the trauma": Patients' Perspectives on Postpartum Care Needs after Severe Maternal Morbidities. Matern Child Health J 2024; 28:1432-1441. [PMID: 38864991 DOI: 10.1007/s10995-024-03927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
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.
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Affiliation(s)
- P Mimi Niles
- Meyers College of Nursing, New York University, New York, NY, USA.
| | - Adina Nack
- California Lutheran University, Thousand Oaks, CA, USA
| | - Folake Eniola
- Research and Evaluation, NYC Department of Health and Mental Hygiene, Home Visiting Programs, New York, NY, USA
| | - Hannah Searing
- Research and Evaluation, NYC Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, New York, NY, USA
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Stanhope KK, Stallworth T, Forrest AD, Vuncannon D, Juarez G, Boulet SL, Geary F, Dunlop AL, Blake SC, Green VL, Jamieson DJ. Planning for the forgotten fourth trimester of pregnancy: A parallel group randomized control trial to test a postpartum planning intervention vs. standard prenatal care. Contemp Clin Trials 2024; 143:107586. [PMID: 38838985 PMCID: PMC11283948 DOI: 10.1016/j.cct.2024.107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Black and brown birthing people experience persistent disparities in adverse maternal health outcomes, partially due to inadequate perinatal care. The goal of this study is to design and evaluate a patient-centered intervention for obstetric patients with one or more cardiometabolic risk factors for severe maternal morbidity [gestational diabetes, diabetes mellitus, hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, eclampsia, or gestational hypertension), or preconception obesity (BMI > 30)] to promote postpartum visit attendance. METHODS To address identified unmet needs for postpartum support and barriers to postpartum care, we developed 20 thematic postpartum planning modules, each with corresponding patient educational materials, community resources, care coordination protocols, and clinician support tools (decision aids, electronic medical record prompts and fields). During prenatal care encounters, a research coordinator delivers the educational content (in English or Spanish), facilitates the participant's planning and shared decision-making, provides the participant with resources, and documents decisions in the electronic medical record. We will randomize 320 eligible patients with a 1:1 ratio to the intervention or standard prenatal care and evaluate the impact on postpartum visit attendance at 4-12 weeks and secondary outcomes (postpartum mental health, perceived future maternal and cardiometabolic risk, contraceptive use, primary care use, readmission, and patient satisfaction with care). DISCUSSION Through engagement with patients and community stakeholders, we developed a guideline-based, locally tailored intervention to address drivers of engagement with postpartum care for high-risk obstetric patients. If demonstrated to be effective, the educational materials and electronic medical record based-tool can be adapted to other settings. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov (NCT05430815) on June 23, 2022.
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Affiliation(s)
- Kaitlyn K Stanhope
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States; Emory University Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE Office 3023, Atlanta, Georgia, United States.
| | - Taé Stallworth
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Alexandra D Forrest
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Danielle Vuncannon
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Gabriela Juarez
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Sheree L Boulet
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Franklyn Geary
- Morehouse School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia, United States
| | - Anne L Dunlop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Sarah C Blake
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta, Georgia, United States
| | - Victoria L Green
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Denise J Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States; University of Iowa, School of Medicine, Johnson County, Iowa, United States
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Klittmark S, Niit JKP, Nerström E, Grundström H, Nieminen K, Wells MB, Malmquist A. LBTQ parents' needs for support postpartum following a complicated birth: A matter of reproductive justice. JOURNAL OF LESBIAN STUDIES 2024:1-18. [PMID: 39049779 DOI: 10.1080/10894160.2024.2367869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth.
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Affiliation(s)
- Sofia Klittmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jaqueline K P Niit
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Nerström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Grundström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katri Nieminen
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michael B Wells
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Sposato MF, Miller WR. Concept Analysis of Woman-Centered Care: Implications for Postpartum Care. MCN Am J Matern Child Nurs 2024:00005721-990000000-00061. [PMID: 39012337 DOI: 10.1097/nmc.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making; 2) communication and collaboration in the caregiver-woman relationship; 3) individualized and holistic care; and 4) continuity of care. Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period.
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Daubert MA, Stebbins A, Peragallo-Urrutia R, Chiswell K, Loop MS, Harding C, Price T, Wang TY. Early postpartum blood pressure screening is associated with increased detection of cardiovascular risk factors in women with hypertensive disorders of pregnancy. Am Heart J 2024; 273:130-139. [PMID: 38582139 PMCID: PMC11162911 DOI: 10.1016/j.ahj.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia, are risk factors for cardiovascular (CV) disease. Guidelines recommend that women with HDP be screened for the development of hypertension (HTN) within 6-12 months postpartum. However, the extent to which this early blood pressure (BP) screening is being performed and the impact on detection of CV risk factors is unknown. METHODS Women with HDP and without pre-existing hypertension (HTN) who had at least 6 months of clinical follow-up were categorized by postpartum BP screening status: early BP screen (6-12 months after delivery) or late BP screen (≥12 months after delivery). Multivariable logistic regression identified factors associated with early screening. Multivariable Cox proportional hazards modeling examined the association between early screening and detection of incident CV risk factors: HTN, prediabetes, diabetes mellitus type 2, or hyperlipidemia. RESULTS Among 4194 women with HDP, 1172 (28%) received early BP screening. Older age, pre-existing hyperlipidemia, diabetes, sickle cell disease, hypothyroidism, gestational diabetes, and delivery during or after 2014 were independently associated with early BP screening, whereas Hispanic ethnicity was associated with late BP screening. Early BP screening was most commonly performed at a primary care visit. After a median follow-up of 3.7 years, 1012 (24%) women had at least 1 new risk factor detected. Even after adjustment for baseline risk, women receiving early BP screening had a significantly higher rate of incident CV risk factor detection than women receiving late BP screening (56% vs 28%; adj. HR 2.70, 95%CI: 2.33-3.23, P < .001). CONCLUSIONS Early postpartum BP screening was performed in a minority of women with HDP, but was associated with greater detection of CV risk factors. More intensive postpartum CV screening and targeted interventions are needed to optimize CV health in this high-risk population of women with HDP.
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Affiliation(s)
- Melissa A Daubert
- Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | | | | | | | | | | | | | - Tracy Y Wang
- Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Green HM, Diaz L, Carmona-Barrera V, Grobman WA, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Zera C, Yee LM. Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals. J Womens Health (Larchmt) 2024; 33:975-985. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [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] [Indexed: 01/25/2024] Open
Abstract
Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.
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Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Chen Yeh
- Department of Preventive Medicine, Biostatistics Collaboration Center, 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
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- 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 Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Albanese AM, Geller PA, Steinkamp JM, Elwy AR, Frank HE, Barkin JL. The education of experience: Mixed methods evidence demonstrates the benefit of multiparity. Midwifery 2024; 134:104015. [PMID: 38688050 DOI: 10.1016/j.midw.2024.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AIM This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. METHODS Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FINDINGS Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants' qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. CONCLUSIONS The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.
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Affiliation(s)
- Ariana M Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Pamela A Geller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | | | - A Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
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Phillips SEK, Celi AC, Margo J, Wehbe A, Karlage A, Zera CA. Improving Care Beyond Birth: A Qualitative Study of Postpartum Care After High-Risk Pregnancy. J Womens Health (Larchmt) 2024. [PMID: 38860345 DOI: 10.1089/jwh.2024.0108] [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: 06/12/2024] Open
Abstract
Background: The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care. Methods: This is a qualitative study of high-risk pregnant and postpartum individuals. We conducted in-depth interviews with 20 high-risk pregnant or postpartum people. Interviews explored personal experiences of postpartum care planning, coordination of care between providers, and patients' perception of ideal care transitions. We performed thematic analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change as a framework. COM-B allowed for a formal structure to assess participants' ability to access postpartum care and primary care reengagement after delivery. Results: Participants universally identified difficulty accessing primary care in the postpartum period, with the most frequently reported barriers being lack of knowledge and supportive environments. Insufficient preparation, inadequate prenatal counseling, and lack of standardized care transitions were the most significant barriers to primary care reengagement. Participants who most successfully engaged in primary care had postpartum care plans, coordination between obstetric and primary care, and access to material resources. Conclusions: High-risk postpartum individuals do not receive effective counseling on the importance of primary care engagement after delivery. System-level challenges and lack of care coordination also hinder access to primary care. Future interventions should include prenatal education on the benefits of primary care follow-up, structured postpartum planning, and system-level improvements in obstetric and primary care provider communication.
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Affiliation(s)
- Sara E K Phillips
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ann C Celi
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Divisions of General Medicine and Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Judy Margo
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexandra Wehbe
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ami Karlage
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chloe A Zera
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Kuipers YJ, Van de Craen N, Van den Branden L, Mestdagh E. The midwife's support during transition to motherhood: A modified Delphi study among care providers and childbearing women. Scand J Caring Sci 2024; 38:461-475. [PMID: 38450770 DOI: 10.1111/scs.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/18/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood. METHODS A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1-year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1. FINDINGS In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies. CONCLUSION The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.
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Affiliation(s)
- Yvonne J Kuipers
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
| | - Natacha Van de Craen
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
| | - Laura Van den Branden
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
| | - Eveline Mestdagh
- Department of Health and Life Science, School of Midwifery, AP University of Applied Sciences, Antwerp, Belgium
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13
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Falde DL, Dyre LJ, Mehta RA, Branda ME, Butler Tobah YS, Theiler RN, Rivera-Chiauzzi EY. Clinical and Demographic Characteristics of Patient-Initiated Encounters Before the 6-Week Postpartum Visit. Matern Child Health J 2024:10.1007/s10995-024-03933-3. [PMID: 38822926 DOI: 10.1007/s10995-024-03933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit. METHODS We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables. RESULTS A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P < .001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge. CONCLUSION Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits.
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Affiliation(s)
- Danielle L Falde
- Department of Obstetrics and Gynecology, Olmsted Medical Center, Rochester, MN, USA
| | - Lillian J Dyre
- Mayo Clinic Alix School of Medicine - Arizona campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Ramila A Mehta
- Division of Clinical Trials and Biostatistics and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Megan E Branda
- Division of Clinical Trials and Biostatistics and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Yvonne S Butler Tobah
- Division of Clinical Trials and Biostatistics and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Division of Clinical Trials and Biostatistics and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Enid Y Rivera-Chiauzzi
- Division of Clinical Trials and Biostatistics and Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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14
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Agarwala A, Dixon DL, Gianos E, Kirkpatrick CF, Michos ED, Satish P, Birtcher KK, Braun LT, Pillai P, Watson K, Wild R, Mehta LS. Dyslipidemia management in women of reproductive potential: An expert clinical consensus from the national lipid association. J Clin Lipidol 2024:S1933-2874(24)00188-0. [PMID: 38824114 DOI: 10.1016/j.jacl.2024.05.005] [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: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women and its incidence has been increasing recently, particularly among younger women. Across major professional society guidelines, dyslipidemia management remains a central tenet for atherosclerotic CVD prevention for both women and men. Despite this, women, particularly young women, who are candidates for statin therapy are less likely to be treated and less likely to achieve their recommended therapeutic objectives for low-density lipoprotein cholesterol (LDL-C) levels. Elevated LDL-C and triglycerides are the two most common dyslipidemias that should be addressed during pregnancy due to the increased risk for adverse pregnancy outcomes, such as preeclampsia, gestational diabetes mellitus, and pre-term delivery, as well as pancreatitis in the presence of severe hypertriglyceridemia. In this National Lipid Association Expert Clinical Consensus, we review the roles of nutrition, physical activity, and pharmacotherapy as strategies to address elevated levels of LDL-C and/or triglycerides among women of reproductive age. We include a special focus on points to consider during the shared decision-making discussion regarding pharmacotherapy for dyslipidemia during preconception planning, pregnancy, and lactation.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA (Dr Agarwala).
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA (Dr Dixon); Center for Pharmacy Practice Innovation, Virginia Commonwealth University, Richmond, Virginia, USA (Dr Dixon)
| | - Eugenia Gianos
- Department of Cardiology, Northwell Health, New Hyde Park, Cardiovascular Institute, Lenox Hill Hospital Northwell, New York, NY, USA (Dr Gianos)
| | - Carol F Kirkpatrick
- Midwest Biomedical Research, Addison, IL, USA (Dr Kirkpatrick); Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA (Dr Kirkpatrick)
| | - Erin D Michos
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore, MD, USA (Dr Michos)
| | - Priyanka Satish
- The University of Texas at Austin Dell School of Medicine, Ascension Texas Cardiovascular, Austin, TX, USA (Dr Satish)
| | - Kim K Birtcher
- University of Houston College of Pharmacy, Houston, TX, USA (Dr Birtcher)
| | - Lynne T Braun
- Rush University College of Nursing, Rush Heart Center for Women, Chicago, IL, USA (Dr Braun)
| | - Priyamvada Pillai
- Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA (Dr Pillai)
| | - Karol Watson
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (Dr Watson)
| | - Robert Wild
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA (Dr Wild)
| | - Laxmi S Mehta
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA (Dr Mehta)
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15
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Nazarenko DN, Daniel AL, Durfee S, Agbemenu K. Parent-identified gaps in preparation for the postpartum period in the United States: An integrative review. Birth 2024. [PMID: 38798177 DOI: 10.1111/birt.12832] [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] [Received: 06/15/2023] [Revised: 12/16/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND In the United States, 35% of all pregnancy-related deaths occur between 24 h and 6 weeks after delivery, yet the first outpatient visit is not typically scheduled until 6 weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well-being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence. Therefore, the purpose of this integrative review is to describe parent-identified gaps in preparation for the postpartum period in the United States. METHODS Using the Integrative Review framework by Whittemore and Knafl, a systematic search of Medline, CINAHL, PsychInfo, Web of Science, and a hand-search was conducted for peer-reviewed articles published in English between 1995 and 2023. Results were reported according to PRISMA 2020 guidelines. Studies that met eligibility criteria were synthesized in a literature matrix. RESULTS Twenty-two studies met inclusion criteria. Four themes were identified: Mental Health Concerns, Physical Concerns, Infant Feeding and Care Concerns, and General Concerns and Recommendations. Many women, regardless of parity, reported feeling unprepared for numerous postpartum experiences, including depression, anxiety, physical recovery, breastfeeding, and infant care. Parents reported difficulty differentiating normal postpartum symptoms from complications. Hospital discharge teaching was viewed as simultaneously overwhelming and inadequate. Parent recommendations included the need for earlier and more comprehensive postpartum preparation during pregnancy, delivered in multiple formats and settings. Parents also reported the need for earlier postpartum visits and improved outpatient support. CONCLUSIONS Our findings indicate that many parents in the United States feel unprepared to navigate a wide variety of emotional, physical, breastfeeding, and infant-care experiences. Future research should explore innovative educational approaches to postpartum preparation during pregnancy as well as outpatient programs to bridge the current gaps in postpartum care.
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Affiliation(s)
| | - Ariel L Daniel
- School of Nursing, University at Buffalo, Buffalo, New York, USA
| | - Stephanie Durfee
- School of Nursing, University at Buffalo, Buffalo, New York, USA
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, Buffalo, New York, USA
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16
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Viswanathan R, Little SE, Wilkins-Haug L, Seely EW, Berhie SH. The patient experience of a postpartum readmission for hypertension: a qualitative study. BMC Pregnancy Childbirth 2024; 24:358. [PMID: 38745136 PMCID: PMC11094995 DOI: 10.1186/s12884-024-06564-2] [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] [Received: 08/06/2023] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this study is to understand the perspective of patients readmitted for postpartum hypertension. METHODS This was a qualitative study with data generated through semi-structured interviews. Patients readmitted with postpartum HDP at an urban academic medical center from February to December 2022 were approached and consented for an interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n = 9). Two coders coded all interviews using Nvivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus among the two coders. Themes were identified through an initial a priori template of codes which were expanded upon using grounded theory, and researchers were reflexive in their thematic generation. RESULTS Six themes were generated: every pregnancy is different, symptoms of preeclampsia are easily dismissed or minimized by both patient and providers, miscommunication regarding medical changes can increase the risk of readmissions, postpartum care coordination and readmission logistics at our hospital could be improved to facilitate caring for a newborn, postpartum care is often considered separately from the rest of pregnancy, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSIONS This qualitative research study revealed patient-identified gaps in care that may have led to readmission for hypertensive disorders of pregnancy. The specific recommendations that emerge from these themes include addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.
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Affiliation(s)
- Radhika Viswanathan
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, NY, USA.
| | - Sarah E Little
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Louise Wilkins-Haug
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ellen W Seely
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Saba H Berhie
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
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17
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Picon M, Stanhope KK, Jamieson DJ, Boulet SL. Identification of Distinct Risk Factors for Antepartum and Postpartum Preeclampsia in a High-Risk Safety-Net Hospital. Am J Perinatol 2024; 41:e267-e274. [PMID: 35709733 DOI: 10.1055/a-1878-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Postpartum preeclampsia (PE), defined as de novo PE that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia (PPPE). STUDY DESIGN In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between demographic, medical, and obstetric factors and development of PE, categorized as a three-level outcome: no PE, antepartum/intrapartum preeclampsia (APE) (diagnosed prior to or < 48 hours of delivery), and late PPPE (diagnosed ≥ 48-hour postpartum). RESULTS Among 3,681 deliveries, women were primarily of ages 20 to 35 years (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). PE was diagnosed prior to delivery or within 48-hour postpartum in 12% (n = 477) of the study population, and 1.5% (57) developed PE greater than 48-hour postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pregestational or gestational diabetes, and chronic hypertension were associated with increased odds of APE only, while maternal obesity (OR: 1.9; 95% CI: 1.0-3.5) and gestational hypertension (OR: 2.7; 95% CI: 1.5-4.8) were uniquely associated with PPPE. Multifetal gestations and cesarean delivery predicted both PPPE and APE; however, the association was stronger for PPPE. CONCLUSION Patients with obesity, gestational hypertension, multifetal gestations, or cesarean delivery may benefit from additional follow-up in the early postpartum period to detect PPPE. KEY POINTS · Late postpartum preeclampsia may go undetected, particularly in low-income patients.. · In a delivery cohort in Georgia, 1.5% of patients developed late postpartum preeclampsia.. · Maternal obesity and gestational hypertension were strongly associated only with late postpartum preeclampsia..
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Affiliation(s)
- Michelle Picon
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Sylvetsky AC, Hughes SA, Kuttamperoor JT, Moore HR, Murphy J, Sacheck J, Smith ER. Mothers' Experiences During the 2022 Infant Formula Shortage in Washington D.C. Matern Child Health J 2024; 28:873-886. [PMID: 38147276 PMCID: PMC11001681 DOI: 10.1007/s10995-023-03860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION An unprecedented shortage of infant formula occurred in the United States (U.S.) in 2022 and posed widespread challenges to infant feeding nationwide. The purpose of this study is to investigate mothers' experiences during the 2022 infant formula shortage and its perceived impacts on infants' diet and health. METHODS Mothers (n = 45) of infants under 8 months old from Washington D.C. were invited to participate in a virtual study meeting during the summer of 2022. Mothers completed surveys regarding their demographics, infants' anthropometrics, infant feeding practices, information they have received about infant feeding, and knowledge about infant feeding practices. They then participated in a qualitative interview about their experiences during the infant formula shortage. RESULTS Overarching themes were: the shortage (1) had adverse impacts on mothers' mental and emotional health; (2) had significant financial and intangible costs; (3) led to changes in infant feeding practices; (4) social and family networks were helpful in navigating the shortage; and (5) mothers felt fortunate to have resources to breastfeed and/or obtain formula. DISCUSSION The infant formula shortage adversely impacted mothers' mental and emotional health, and was costly, in terms of financial and intangible costs. Findings demonstrate the need to develop clinical and policy approaches to support mothers in feeding their infants and provide education about safe infant feeding practices.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA.
| | - Sarah A Hughes
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Janae T Kuttamperoor
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Hailey R Moore
- Division of Psychology, Children's National Hospital, 111 Michigan Ave NW, Washington, D.C., 20010, USA
| | - Jeanne Murphy
- School of Nursing, The George Washington University, 1919 Pennsylvania Ave. NW, Washington, D.C., 20006, USA
| | - Jennifer Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Emily R Smith
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
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19
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Liga AD, Jabir YN, Assefa S, Debelew GT, Worku BT. Identifying associated factors in relation to health-related quality of life among postpartum women in Jimma town: A community-based cross-sectional study. Heliyon 2024; 10:e29328. [PMID: 38644852 PMCID: PMC11033102 DOI: 10.1016/j.heliyon.2024.e29328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background The quality of life (QoL) of women during the postpartum period is affected by their living circumstances, reproductive history, exposure to and use of antenatal care, etc. The quality of life (QoL) issues associated to postpartum health among Ethiopian women have not been adequately examined in studies. Therefore, this study identified associated factors in relation to the health-related quality of life (QOL) among postpartum women in Jimma Town, Ethiopia. Methods A structured face-to-face interview and a self-administered questionnaire were utilized in a community-based cross-sectional study to obtain data from 397 postpartum women from May 15 to June 14, 2022, using a multistage sampling strategy. The data analysis utilized several descriptive statistics. Multiple logistic models were run on factors that were significant at the 25 % level in univariate analysis. Adjusted odds ratios and 95 % confidence intervals were computed to identify associated factors. Results The majority (51.2 %) of postpartum women had a low health-related quality of life, with a mean score of 50.58. Women poor health-related quality of life (QoL) was associated with age (AOR = 10.09; CI: 3.45-29.51), non-formal education of partners (AOR = 3.67; CI: 1.25-10.72), multiparousness (AOR = 2.21; CI: 1.14-4.29), unplanned pregnancy (AOR = 7.36; CI: 1.98-27.37), giving birth to a dead baby (AOR = 3.15; CI: 1.54-6.42), and not admitted to the hospital while pregnant (AOR = 5.50; CI: 3.86-26.30). Conclusion The finding revealed that the majority of postpartum women reported poorer health-related QoL. Thus, stakeholders should give attention to significant factors to set up measures to prevent and improve women's postpartum health-related QoL, and should be aware of women about the risk associated with poor health-related QoL.
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Affiliation(s)
- Abebe Debu Liga
- Department of Statistics, College of Natural and Computational Sciences,
Wolkite University, Wolkite, Ethiopia
| | - Yasin Negash Jabir
- Department of Statistics, College of Natural Science, Jimma University,
Jimma, Ethiopia
| | - Seble Assefa
- Department of Nursing, Faculty of Health Sciences, Jimma University,
Jimma, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health,
Jimma University, Jimma, Ethiopia
| | - Bekalu Teka Worku
- Department of Population and Family Health, Faculty of Public Health,
Jimma University, Jimma, Ethiopia
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Choy CC, McAdow ME, Rosenberg J, Grimshaw AA, Martinez-Brockman JL. Dyadic care to improve postnatal outcomes of birthing people and their infants: A scoping review protocol. PLoS One 2024; 19:e0298927. [PMID: 38625992 PMCID: PMC11020692 DOI: 10.1371/journal.pone.0298927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/30/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Dyadic care, which is the concurrent provision of care for a birthing person and their infant, is an approach that may improve disparities in postnatal health outcomes, but no synthesis of existing dyadic care studies has been conducted. This scoping review seeks to identify and summarize: 1) dyadic care studies globally, in which the birthing person-infant dyad are cared for together, 2) postnatal health outcomes that have been evaluated following dyadic care interventions, and 3) research and practice gaps in the implementation, dissemination, and effectiveness of dyadic care to reduce healthcare disparities. MATERIALS AND METHODS Eligible studies will (1) include dyadic care instances for the birthing person and infant, and 2) report clinical outcomes for at least one member of the dyad or intervention outcomes. Studies will be excluded if they pertain to routine obstetric care, do not present original data, and/or are not available in English or Spanish. We will search CINAHL, Ovid (both Embase and Medline), Scopus, Cochrane Library, PubMed, Google Scholar, Global Health, Web of Science Core Collection, gray literature, and WHO regional databases. Screening will be conducted via Covidence and data will be extracted to capture the study design, dyad characteristics, clinical outcomes, and implementation outcomes. The risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tool. A narrative synthesis of the study findings will be presented. DISCUSSION This scoping review will summarize birthing person-infant dyadic care interventions that have been studied and the evidence for their effectiveness. This aggregation of existing data can be used by healthcare systems working to improve healthcare delivery to their patients with the aim of reducing postnatal morbidity and mortality. Areas for future research will also be highlighted. TRAIL REGISTRATION This review has been registered at Open Science Framework (OSF, https://osf.io/5fs6e/).
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Affiliation(s)
- Courtney C. Choy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Molly E. McAdow
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Julia Rosenberg
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, United States of America
| | - Josefa L. Martinez-Brockman
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Galvin AM, Akpan IN, Lewis MA, Walters ST, Thompson EL. Reproductive Interconception Care Among Women Recently Pregnant and Homeless: A Qualitative Analysis. HEALTH EDUCATION & BEHAVIOR 2024; 51:302-310. [PMID: 37846846 PMCID: PMC10981174 DOI: 10.1177/10901981231204583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Reproductive interconception care provided at maternal postpartum visits may help reduce unintended pregnancies and elongate birth intervals for women experiencing homelessness. To improve interconception care uptake, this qualitative study aimed to identify barriers and facilitators to reproductive interconception care from the perspectives of women who were recently pregnant and homeless. A semi-structured interview guide and demographic survey were developed based on epidemiological findings, Information-Motivation-Behavioral Skill framework components, and a review by community health workers for content validity. After conducting 12 interviews with women recently pregnant and homeless in a local continuum of care in 2022, audio-recorded interviews were transcribed, iteratively coded using a priori and emerging codes, and thematically analyzed. Key themes were identified to determine implications and next steps to improving reproductive interconception care uptake. Interrelated themes focused on information (e.g., knowledge and misconceptions about pregnancy, birth intervals, contraception), motivation (e.g., attitudes about interconception care experiences, perinatal social influences), behavioral skills (e.g., objective ability to obtain interconception care and perceived self-efficacy related to attending maternal postpartum visits and increasing birth intervals), and macro-level factors (e.g., obtaining housing, contextualizing socioeconomic factors, navigating COVID-19). The findings suggest the need for flexible, streamlined, and personalized interconception care delivery that acknowledges pressing housing and relationship considerations and supports women's autonomy. Improvements to reproductive interconception care may reduce future unintended pregnancies, increase birth intervals, and improve birth outcomes among women experiencing homelessness.
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Affiliation(s)
- Annalynn M. Galvin
- The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Idara N. Akpan
- The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Melissa A. Lewis
- The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Scott T. Walters
- The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Erika L. Thompson
- The University of North Texas Health Science Center, Fort Worth, TX, USA
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22
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Baker H, Cuomo B, Femia C, Lin D, Stobbie C, McLean B, Hatfield M. Occupational therapy in maternal health: Exploring the Barkin Index of Maternal Functioning as a potential tool. Aust Occup Ther J 2024; 71:279-290. [PMID: 38221771 DOI: 10.1111/1440-1630.12926] [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] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Transitioning into the role of a mother encompasses many physical and psychosocial changes, affecting the way a woman may function. Maternal health is an emerging area of practice for occupational therapists, and therefore, screening and assessment tools to support work in this area are needed. The Barkin Index of Maternal Functioning (BIMF) is a quantitative outcome measure that is used by health professionals to assess maternal functioning. Currently, its ability to measure occupational performance is unclear. METHODS Utilising a mixed methods design, this study analysed the extent to which the BIMF assesses maternal function from an occupational perspective. Thirteen first-time mothers with a baby 12 months of age or younger participated in the study. Results from the BIMF were compared with themes developed from semi-structured qualitative interviews that explored the occupational experiences of first-time mothers. FINDINGS Seven themes were developed from the interviews. The BIMF addressed three themes, including changes to engagement in basic activities of daily living and leisure, transitioning into motherhood, emotions, self-efficacy, and social support. However, four themes were not captured by the BIMF, including changes to partner relationships, identity shift, influence of 'person' factors, and changes to social experiences in early motherhood. CONCLUSION Findings suggest that a new tool with a holistic perspective of mothers as occupational beings is needed to be able to identify occupational performance issues and the potential need for occupational therapy support. This study identified key experiences of occupational performance for new mothers.
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Affiliation(s)
- Hanna Baker
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Belinda Cuomo
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Ciarn Femia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Daniel Lin
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Claire Stobbie
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Belinda McLean
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Megan Hatfield
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Scroggins JK, Brandon D, Reuter-Rice K, Min SH, Yang Q. Changes in maternal psychological symptom profiles from 2 to 6 months postpartum: an application of latent transition analysis. Arch Womens Ment Health 2024; 27:309-316. [PMID: 38044340 DOI: 10.1007/s00737-023-01407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
To identify subgroups of postpartum women with different psychological symptom profiles at 2 and 6 months postpartum and to examine how they transition between symptom profiles over time using latent transition analysis (LTA). We used secondary data from the Family Life Project (N = 1,117) and performed LTA based on observed variables (depression, anxiety, somatization, and hostility). We examined transition probabilities and changes in latent status prevalence from 2 to 6 months postpartum. Considering the known influences of social determinants of health on psychological symptoms, bivariate analyses were conducted to describe the characteristics of different transition patterns. A 3-class model with better fit indices, entropy, and interpretability was selected. Based on symptom severity, the identified profiles were Profile 1: Low, Profile 2: Moderate, and Profile 3: High. From 2 to 6 months postpartum, the prevalence of low symptom profile decreased (82 to 78.2%) while the prevalence increased for moderate (15.8 to 17.5%) and high symptom profiles (2.2 to 4.4%). For all profiles, it was most likely for postpartum women to stay in the same profile from 2 to 6 months (low to low, moderate to moderate, and high to high). Those in persistent or worsening transition patterns were significantly younger or had less social support or education. Postpartum women in moderate or high symptom profiles at 2 months were most likely to stay in the same profile at 6 months postpartum, indicating persistent symptom burden. Clinicians should consider providing early, targeted support to prevent persistent symptom burden.
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Affiliation(s)
- Jihye Kim Scroggins
- School of Nursing, Duke University, Durham, NC, USA.
- School of Nursing, Columbia University, 560 W 168th Street, New York, NY, 10032, USA.
| | - Debra Brandon
- School of Nursing, Duke University, Durham, NC, USA
- School of Medicine, Duke University, Durham, NC, USA
| | - Karin Reuter-Rice
- School of Nursing, Duke University, Durham, NC, USA
- School of Medicine, Duke University, Durham, NC, USA
| | - Se Hee Min
- School of Nursing, Columbia University, 560 W 168th Street, New York, NY, 10032, USA
| | - Qing Yang
- School of Nursing, Duke University, Durham, NC, USA
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Hernandez-Green N, Davis MV, Beshara MS, Hernandez-Spalding K, Francis S, Parker A, Farinu O, Chandler R. Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review. Health Promot Pract 2024:15248399241234636. [PMID: 38556711 DOI: 10.1177/15248399241234636] [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: 04/02/2024]
Abstract
Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.
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Anguzu R, Livergood CM, Hoppe KK, Kulinski J, Fitzgerald GD, Palatnik A. Association between body mass index and chronic hypertension in patients with hypertension disorders of pregnancy one-year postpartum. Pregnancy Hypertens 2024; 35:32-36. [PMID: 38134483 PMCID: PMC10939881 DOI: 10.1016/j.preghy.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To determine the association between body mass index (BMI) and chronic hypertension (CHTN) one-year postpartum following pregnancies complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN A retrospective cohort study of patients with HDP (gestational hypertension or preeclampsia) in a single Midwestern academic center from 2014 to 2018. The primary outcome was CHTN at one-year postpartum, defined as systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg or taking antihypertensive medication at one-year postpartum. The primary exposure variable was BMI at one-year postpartum, categorized as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-<30 kg/m2), and obese (≥30 kg/m2) and as continuous BMI variable. Descriptive statistics and adjusted logistic regression analysis were performed. RESULTS Out of 596 patients with HDP included in this analysis, 275 (46.1 %) had CHTN one-year postpartum. Mean one-year postpartum BMI was 27.9 ± 5.2 kg/m2. Prevalence of CHTN at one-year postpartum was higher in obese (38.1 %) and overweight (30.0 %) groups compared to the normal weight group (29.9 %), p < 0.001. In multivariate logistic regression, obesity at one-year postpartum, compared to normal, was associated with 73 % higher likelihood of CHTN following HDP (adjusted OR 1.73, 95 % CI 1.06-2.84). With BMI as a continuous variable, each unit increase in BMI one-year postpartum was associated with 6 % higher likelihood of CHTN (adjusted OR 1.06, 95 % CI 1.02-1.15). CONCLUSIONS Obesity at one-year postpartum following HDP was associated with a higher risk of CHTN compared with normal BMI. Weight is a modifiable risk factor that should be targeted in postpartum interventions to reduce cardiovascular disease following HDP.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Christine M Livergood
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kara K Hoppe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, WI, USA
| | - Jacquelyn Kulinski
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Garrett D Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Borrero L, Dietsch A, Santurri LE, Ewen HH. New Mothers With Postpartum Depression: A Qualitative Exploration of Healthcare Decision-Making. QUALITATIVE HEALTH RESEARCH 2024; 34:217-226. [PMID: 37997365 DOI: 10.1177/10497323231206783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Postpartum depression (PPD) is a significant health issue for many new mothers in the weeks and months following a child's birth. Quantitative data suggest that a mother's PPD negatively impacts healthcare decision-making for the child via routine well-baby visits and pediatric care. However, little is known from a qualitative perspective about the factors that challenge or facilitate these healthcare decisions. The purpose of this descriptive qualitative study was to understand the perceptions of new mothers about factors contributing to their healthcare decision-making, for themselves and for their children, while living with PPD. The researchers used purposive sampling to recruit eight women from clinics, community organizations, and social media support groups who met the study's inclusion criteria. Individual semi-structured interviews were carried out with eight participants about their PPD experiences, motherhood, and healthcare decision-making influences. Transcribed interviews and initial themes were shared with participants to verify researcher interpretations and aid in the analysis process. The researchers analyzed interview data using thematic analysis to cultivate an understanding of the phenomenon by identifying and interpreting patterns in the data. Three primary themes were drawn from the data analysis: (1) Importance of Clinician Trust and Support; (2) Balancing the Health of the Mother and Child; and (3) Other Support Structures That Facilitate Healthcare Decision-Making for the Mother and Baby Dyad. Participant experiences underscored the need for cohesive approaches by clinical providers of pre- and postnatal care. Group model approaches to postnatal care appear to mitigate or reduce the impact of PPD.
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Affiliation(s)
- Lisa Borrero
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Aimee Dietsch
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Laura E Santurri
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Heidi H Ewen
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
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Ahrens KA, Palmsten K, Grantham CO, Lipkind HS, Ackerman‐Banks CM. Acute health care utilization in the first 24 months postpartum by rurality and pregnancy complications: A prospective cohort study. Health Serv Res 2024; 59:e14247. [PMID: 37827521 PMCID: PMC10771903 DOI: 10.1111/1475-6773.14247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE To estimate the rate of acute health care use (hospitalizations and emergency department [ED] visits) among postpartum persons by rurality of residence and pregnancy complications. DATA SOURCES AND STUDY SETTING 2006-2021 data from the Maine Health Data Organization's All Payer Claims Data. STUDY DESIGN We estimated the rates of hospitalizations and ED visits during the first 24 months postpartum, separately, overall and by four-level rurality of residence (urban, large rural, small rural, and isolated rural) and by pregnancy complications (prenatal depression, hypertensive disorders of pregnancy [HDP], and gestational diabetes mellitus [GDM]). We used Poisson regression models, adjusting for potential confounders. Data were weighted to account for censoring before 24 months postpartum. DATA EXTRACTION METHODS Deliveries during 2007-2019 (n = 122,412). PRINCIPAL FINDINGS Approximately 4% of persons had at least one hospitalization within 24 months postpartum (mean monthly rate per 100 deliveries = 0.35). Adjusted rates were not different by rurality. Persons with prenatal depression (adjusted rate ratio [aRR] = 1.9; 95% confidence interval [CI] 1.5-2.5), HDP (aRR = 1.4; 1.0-2.0), and GDM (aRR = 1.4; 0.9-2.0) had higher hospitalization rates than those without these conditions. Approximately 44% of persons had at least one ED visit within 24 months postpartum (mean monthly rate per 100 deliveries = 5.4). Adjusted ED rates were higher for persons living in small rural areas as compared with urban areas (aRR = 1.3; 1.2-1.4). Persons with prenatal depression (aRR = 1.8; 1.7-1.9), HDP (aRR = 1.1; 1.0-1.2), and GDM (aRR = 1.3; 1.2-1.4) had higher ED rates than those without these conditions; ED rates were highest among those living in small rural areas. CONCLUSION New policies and care practices may be needed to prevent acute health care encounters in the first 24 months after delivery for persons with common pregnancy conditions. Efforts to identify why postpartum people living in small rural areas have higher rates of ED visits are warranted.
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Affiliation(s)
| | - Kristin Palmsten
- Pregnancy and Child Health Research CenterHealthPartners InstituteBloomingtonMinnesotaUSA
| | | | - Heather S. Lipkind
- Department of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Gregory EF, Beidas RS, Fiks AG, Lorch SA, Levine LD, Rubin DM, Maddox AI, O'Sullivan AL, Wu KK, Cronholm PF. Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study. Matern Child Health J 2024; 28:351-361. [PMID: 37980700 PMCID: PMC11197049 DOI: 10.1007/s10995-023-03848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable. METHODS We conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes. RESULTS We interviewed 33 women (10/2018-7/2021) and 24 clinicians (3/2021-8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability. CONCLUSIONS FOR PRACTICE Dyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Research Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David M Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ann L O'Sullivan
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - Katherine K Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Meyer JA, Alton S, Seung H, Pahlavan A, Trilling AR, Coghlan M, Goetzinger KR, Cojocaru L. Enhanced recovery after cesarean from the patient perspective: a prospective study of the ERAC Questionnaire (ERAC-Q). J Perinat Med 2024; 52:14-21. [PMID: 37609844 DOI: 10.1515/jpm-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To evaluate the impact of an Enhanced Recovery After Cesarean (ERAC) protocol on the post-cesarean recovery experience using a validated ten-item questionnaire (ERAC-Q). METHODS This is a prospective cohort study of patients completing ERAC quality-of-life questionnaires (ERAC-Q) during inpatient recovery after cesarean delivery (CD) between October 2019 and September 2020, before and after the implementation of our ERAC protocol. Patients with non-Pfannenstiel incision, ICU admission, massive transfusion, bowel injury, existing chronic pain disorders, acute postpartum depression, or neonatal demise were excluded. The ERAC-Q was administered on postoperative day one and day of discharge to the pre- and post-ERAC implementation cohorts, rating aspects of their recovery experience on a scale of 0 (best) to 10 (worst). The primary outcome was ERAC-Q scores. Statistical analysis was performed with SAS software. RESULTS There were 196 and 112 patients in the pre- and post-ERAC cohorts, respectively. The post-ERAC group reported significantly lower total ERAC-Q scores compared to the pre-ERAC group, reflecting fewer adverse symptoms and greater perceived recovery on postoperative day one (1.6 [0.7, 2.8] vs. 2.7 [1.6, 4.3]) and day of discharge (0.8 [0.3, 1.5] vs. 1.4 [0.7, 2.2]) (p<0.001). ERAC-Q responses did not predict the time to achieve objective postoperative milestones. However, worse ERAC-Q pain and total scores were associated with higher inpatient opiate use. CONCLUSIONS ERAC implementation positively impacts patient recovery experience. The administration of ERAC-Q can provide real-time feedback on patient-perceived recovery quality and how healthcare protocol changes may impact their experience.
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Affiliation(s)
- Jessica A Meyer
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Suzanne Alton
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice & Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Autusa Pahlavan
- Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Ariel R Trilling
- Department of Obstetrics, Gynecology & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martha Coghlan
- Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Anesthesia Critical Care, Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Staten Island University Hospital of Northwell Health, New York, NY, USA
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Henrich N, Brinson A, Arnold A, Jahnke HR. Digital Health Needs and Preferences During Pregnancy and the Postpartum Period: Mixed Methods Study. JMIR Form Res 2024; 8:e48960. [PMID: 38214971 PMCID: PMC10818239 DOI: 10.2196/48960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Digital health is increasingly used to meet the needs of perinatal people, with estimates of pregnancy-related internet use ranging from 90% to 97% of pregnant people. As digital health takes on greater importance during the perinatal period, it is essential that providers and developers of digital health content understand why perinatal people use these resources and the features that enhance their experience. However, gaps remain in understanding the content that is most helpful and how the platforms are navigated. Learning directly from perinatal people about their needs will help ensure alignment between perinatal needs and available content. OBJECTIVE This formative study aims to identify the reasons why perinatal people use digital health resources; the features of the digital health platforms that are of greatest importance to them; and how these differ by perinatal stage (pregnancy vs post partum), mental health conditions, parity, and demographics (race and ethnicity). METHODS This mixed methods study used interviews; surveys; and secondary data on demographic, health, and pregnancy characteristics to identify the digital health needs and preferences of pregnant and postpartum people who used the Maven digital health platform in the United States during their pregnancy or postpartum period. The interviews informed the content of the surveys and provided additional insights and examples for interpreting the survey results. The surveys were used to collect data from a sample of Maven users, and the results were linked to the secondary data set. The interviews were thematically analyzed, and survey data were analyzed using descriptive statistics and stratified by parity, race, and mental health status. RESULTS Overall, 13 people were interviewed (including n=4, 31% pilot interviews), and 147 pregnancy and 110 postpartum survey respondents completed the surveys and had linkable secondary data. Top reasons for using digital health resources during pregnancy were to (1) know what is normal or typical during pregnancy, (2) have access to a health care provider when needed, and (3) know how the baby is developing. Top reasons for postpartum use were to (1) help with breastfeeding, (2) know what normal baby development is, and (3) help with the baby's health issues. Top platform features during pregnancy and the postpartum period were (1) credible and trustworthy information and providers, (2) nonjudgmental information and support, and (3) no cost to the user. In general, more reasons for using digital resources were identified as extremely important during pregnancy compared with post partum. The results showed minor variations across strata. CONCLUSIONS This formative research found minor differences in digital resource needs and preferences across user characteristics among perinatal people in the United States. Future work should examine whether there are variations in interests within topics by user characteristics, which may provide additional opportunities to better meet user needs.
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Affiliation(s)
| | - Alison Brinson
- Maven Clinic, New York, NY, United States
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Planey AM, Bozkurt B, Aijaz M, Weinstein J, Khairat S, Shea CM. Telehealth Use by Pregnancy Stage Among Commercially Insured Patients in the United States, 2016-2019. Telemed J E Health 2024; 30:93-102. [PMID: 37327021 DOI: 10.1089/tmj.2022.0516] [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] [Indexed: 06/17/2023] Open
Abstract
Introduction: Relatively little is known about the proportion of maternal health services utilized through telehealth and whether rural-urban disparities in telehealth use exist throughout antenatal, delivery, and postpartum phases of maternal services. In this study, we describe patterns of care, including telehealth utilization, by rurality and racial/ethnic composition of the health service area during the antenatal, labor/delivery, and postpartum stages of pregnancy among commercially insured patients between 2016 and 2019. Methods: We present univariate and comparative descriptive statistics of patient and facility characteristics and site of care by the degree of rurality and racial/ethnic composition of the health service area (defined as geozips). The individual-level utilization data for 238,695 patients were aggregated to the geo-zip level (n = 404). Results: Between 2016 and 2019, 3.5% of pregnancy, delivery, and postpartum-related visits among commercially insured patients were delivered through telehealth. Telehealth use was higher in the antenatal (3.5% of claim lines) and postpartum (4.1% of claim lines) periods, compared with labor and delivery (0.7% of claim lines). We also found that the proportion of telehealth services (of total services billed) increased with the share of Black and Latinx residents at the geozip level. Discussion: Our findings highlight disparities in telehealth use, consistent with findings from studies using different data sources and time periods. Future research is needed to examine whether the relative differences in proportion of telehealth services, even if small, are associated with telehealth capacity in the hospital or community and why the proportion of telehealth services differs across community-level characteristics, specifically rurality and proportion of Black and Latinx residents.
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Affiliation(s)
- Arrianna Marie Planey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Burcu Bozkurt
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Josh Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Saif Khairat
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher M Shea
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Melov SJ, Elhindi J, White L, McNab J, Lee VW, Donnolley K, Alahakoon TI, Padmanabhan S, Cheung NW, Pasupathy D. Previous High-Intensity Breastfeeding Lowers the Risk of an Abnormal Fasting Glucose in a Subsequent Pregnancy Oral Glucose Tolerance Test. Nutrients 2023; 16:28. [PMID: 38201858 PMCID: PMC10780944 DOI: 10.3390/nu16010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38-0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21-0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36-2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk.
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Affiliation(s)
- Sarah J. Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
| | - Lisa White
- Women’s Health Maternity, Blacktown and Mt Druitt Hospitals, Blacktown, NSW 2148, Australia;
| | - Justin McNab
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
| | - Vincent W. Lee
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
- Department of Renal Medicine, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
| | - Kelly Donnolley
- Consumer Representative, Western Sydney Local Health District, Sydney, NSW 2151, Australia
| | - Thushari I. Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
| | - Suja Padmanabhan
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - N. Wah Cheung
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
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Gregory EF, Cronholm PF, Levine LD, Beidas RS, DeMarco MP, O'Sullivan AL, Lorch SA, Maddox AI, Wu K, Fiks AG. Integrating Care for Mother-Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:642-650. [PMID: 38155873 PMCID: PMC10754422 DOI: 10.1089/whr.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/30/2023]
Abstract
Objective There are gaps in receipt of maternal preventive services in the interconception period. Yet mother-infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results We interviewed 24 physicians, nurses, midwives, and social workers (March-November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.
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Affiliation(s)
- Emily F. Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa D. Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mario P. DeMarco
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann L. O'Sullivan
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, PA
| | - Scott A. Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I. Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G. Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Bose-Brill S, Gillespie SL, Venkatesh KK. Can We Implement Multispecialty Mother-Infant Dyadic Care to Systematize Interpregnancy Services After a Preterm Birth? WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:651-655. [PMID: 38155872 PMCID: PMC10754421 DOI: 10.1089/whr.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Seuli Bose-Brill
- Combined Internal Medicine and Pediatrics Section, Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shannon L. Gillespie
- The Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K. Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Macdonald D, Publow C, Ross-White A, Aston M, Snelgrove-Clarke E. Postpartum experiences of women, birthing people, and their families during COVID-19: a qualitative systematic review protocol. JBI Evid Synth 2023; 21:2446-2454. [PMID: 37641817 DOI: 10.11124/jbies-22-00453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The objective of the review is to explore and understand the postpartum experiences of birthing people and their families during COVID-19. INTRODUCTION Positive postpartum experiences are formative for the long-term health and well-being of parents and babies. However, the COVID-19 pandemic has complicated the transition to parenthood and existing postpartum challenges through evolving policies and practices, including visiting limitations, masking requirements, and reduced accessibility of supports. Understanding the impact of COVID-19 on the postpartum experiences of women, birthing people (people who give birth but may not identify as women), and their families through the synthesis of qualitative evidence can help inform public health and government directives in comparable future contexts. INCLUSION CRITERIA Studies including women, birthing people, and their families who experienced postpartum during the COVID-19 pandemic will be considered. This review will include studies published after January 2020 that explore postpartum experiences up to 1 year following birth. We will examine qualitative data, including, but not limited to, research designs such as phenomenology, ethnography, grounded theory, feminist research, and action research. METHODS The following databases will be searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), and LitCovid. PsyArXiv and Google Scholar will be searched for gray literature. Studies will be assessed and appraised independently by 2 reviewers and disagreements will be resolved through discussion or with a third reviewer. Data extraction will be completed by 2 reviewers. The JBI tools and resources will be used for assessing confidence and meta-aggregation, including the creation of categories and synthesized findings. REVIEW REGISTRATION PROSPERO CRD42022364030.
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Affiliation(s)
- Danielle Macdonald
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Chelsea Publow
- School of Nursing, Queen's University, Kingston, ON, Canada
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
- Queen's University Libraries, Queen's University, Kingston, ON, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Halifax, NS, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
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Gonzales AM, Barcelo TI. Quality of prenatal care and maternal fetal attachment among primigravid mothers in the Philippines: A cross sectional study. Midwifery 2023; 127:103842. [PMID: 37871420 DOI: 10.1016/j.midw.2023.103842] [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] [Received: 04/30/2022] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The prenatal period is a proper chance for evaluating maternal-fetal attachment. AIM To determine the relationship between quality of prenatal care and maternal-fetal attachment among primigravida mothers during late pregnancy period. METHODS The study conducted a survey using a 46-item Quality of Prenatal Care Questionnaire and 24-item Maternal-Fetal Attachment Scale among 343 primigravida mothers in village health stations. Pearson correlation was used to correlate maternal-fetal attachment scores and quality of prenatal scores. Linear regression was used to determine relationships between variables. RESULTS Maternal-fetal attachment scores is correlated with: age ≤19 years (4.10 [95 % CI 1.81-6.39]), companion during visits (2.76 [95 % CI 0.34-5.18]), education (3.45 [95 % CI 0.93-5.97]). On multivariate analysis, the following were significantly associated with maternal-fetal attachment scores: information sharing (8.67 [95 % CI 4.74 - 12.60]), sufficient time (-2.34 [95 % CI -3.45 - -1.24]), support and respect (8.49 [95 % CI 4.54 - 12.45]), maternal age < 19 years (-3.78 [-5.81 to -1.75]), and unmarried (2.55 [95 % CI 0.70 - 4.41]). CONCLUSION The quality of prenatal care is correlated significantly with maternal-fetal attachment. Women valued the care given when it was individualized and the health workers were approachable in their ways and addressed their own particular needs. Combination of prenatal education and counselling tailored to address own particular emotional and social concerns of pregnant mothers are interventions that should be integrated in maternal care services.
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Affiliation(s)
- Artemio M Gonzales
- College of Arts, Sciences, and Technology, Occidental Mindoro State College, Occidental Mindoro, San Jose 5100, Philippines; Faculty of Management and Development Studies, University of the Philippines, Los Baños, Laguna 4030, Philippines.
| | - Teresita I Barcelo
- Faculty of Management and Development Studies, University of the Philippines, Los Baños, Laguna 4030, Philippines
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Overton E, Wen T, Friedman AM, Azad H, Nhan-Chang CL, Booker WA, Khoury-Collado F, Mourad M. Outcomes associated with peripartum hysterectomy in the setting of placenta accreta spectrum disorder. Am J Obstet Gynecol MFM 2023; 5:101174. [PMID: 37802412 DOI: 10.1016/j.ajogmf.2023.101174] [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] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Although peripartum hysterectomy for placenta accreta spectrum disorder is known to be associated with complications at the time of delivery, there are limited data on postpartum outcomes and readmission risk in this population. OBJECTIVE This study aimed to analyze risks for adverse outcomes and postpartum readmissions in the setting of peripartum hysterectomy for placenta accreta spectrum disorder by severity of placenta accreta spectrum disorder subcategory. STUDY DESIGN Using the 2016-2020 Nationwide Readmissions Database, this retrospective cohort study identified peripartum hysterectomies with a diagnosis of placenta accreta spectrum disorder. The primary exposure was placenta accreta spectrum disorder, subcategorized as placenta accreta vs increta/percreta. The primary outcome was readmission rate and delivery complications. Complications evaluated included the following: (1) nontransfusion severe maternal morbidity (ntSMM), (2) venous thromboembolism, (3) reoperation, (4) intraoperative complications, (5) hemorrhage, (6) sepsis, and (7) surgical site complications. We additionally evaluated delivery hospitalization and readmission mean length of stay, and hospital costs. Unadjusted and adjusted logistic regression models were fit for outcomes adjusting for clinical, demographic, and hospital factors. The association measures were expressed as unadjusted and adjusted odds ratios with 95% confidence intervals. RESULTS Between 2016 and 2020, 7864 hysterectomies during a delivery hospitalization with a diagnosis of placenta accreta spectrum disorder were identified (66.5% with placenta accreta and 33.5% with placenta increta/percreta diagnoses). The overall 60-day all-cause readmission rate was 7.3%. Most readmissions (57.2%) occurred within 10 days of hospital discharge. Compared with peripartum hysterectomy with a diagnosis of placenta accreta, hysterectomies with placenta increta/percreta diagnoses carried significantly increased risk of 60-day readmission (adjusted odds ratio, 1.31; 95% confidence interval, 1.01-1.71), inpatient mortality (odds ratio, 13.23; 95% confidence interval, 3.35-52.30), nontransfusion severe maternal morbidity (adjusted odds ratio, 1.43; 95% confidence interval, 1.20-1.71), intraoperative complications (adjusted odds ratio, 2.31; 95% confidence interval, 1.93-2.77), and surgical site complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.95). The median length of stay during delivery hospitalization was longer for placenta increta/percreta (5.8 days; 95% confidence interval, 5.4-6.1) than for placenta accreta (4.2 days; 95% confidence interval, 4.1-4.3; P<.05). In addition, delivery hospitalization costs were higher in cases of placenta increta/percreta (median, $30,686; 95% confidence interval, $28,922-$32,449) than placenta accreta (median, $21,321; 95% confidence interval, $20,480-$22,163). CONCLUSION Complication and readmission risks after peripartum hysterectomy with placenta accreta spectrum disorder are high. Compared with patients with placenta accreta, patients with placenta increta/percreta had increased risk for delivery and postoperative complications and postpartum readmission, and increased costs and length of stay.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad).
| | - Timothy Wen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA (Dr Wen)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Hooman Azad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Fady Khoury-Collado
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
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West BS, Choi S, Terplan M. In our responses to the overdose epidemic, we cannot forget pregnant and postpartum people. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104153. [PMID: 37572587 DOI: 10.1016/j.drugpo.2023.104153] [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: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
In 2021, there were over 100,000 drug overdose deaths in the United States (US). Death rates have increased faster among women than men, particularly among Black and Indigenous people. Although drug overdose is a leading cause of pregnancy-associated deaths, birthing people are rarely emphasized in discussions of overdose and research and services remain limited. Data show increases in drug use and deaths among women of child-bearing age, with risks continuing in the postpartum period. Harms experienced by birthing people who use drugs occur in the context of broader inequities in maternal morbidity and mortality that lead to disparate reproductive health outcomes. Shared structural antecedents (e.g. intersecting sexism and racism, stigma, and punitive policies) underlie overlapping epidemics of overdose and maternal morbidity and mortality. Here we discuss the unique challenges placed on birthing people who use drugs and make recommendations on how to mitigate harms by improving access to and delivery of quality care and addressing unjust policies and practices. We highlight the need for integrated health services, clearer guidelines rooted in equity, and the need for changes to policy and practice that support rather than punish. To better serve individuals and families impacted by substance use, we need multilevel solutions that advance gender equity and racial justice to reshape and/or dismantle the systems that undergird oppression.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, United States.
| | - Sugy Choi
- Department of Population Health, New York University Langone Health, United States
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Lis-Kuberka J, Pupek M, Orczyk-Pawiłowicz M. The Mother-Child Dyad Adipokine Pattern: A Review of Current Knowledge. Nutrients 2023; 15:4059. [PMID: 37764842 PMCID: PMC10535905 DOI: 10.3390/nu15184059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
An important role in the network of interconnections between the mother and child is played by adipokines, which are adipose tissue hormones engaged in the regulation of metabolism. Alternations of maternal adipokines translate to the worsening of maternal insulin resistance as well as metabolic stress, altered placenta functions, and fetal development, which finally contribute to long-term metabolic unfavorable conditions. This paper is the first to summarize the current state of knowledge concerning the concentrations of individual adipokines in different biological fluids of maternal and cord plasma, newborn/infant plasma, milk, and the placenta, where it highlights the impact of adverse perinatal risk factors, including gestational diabetes mellitus, preeclampsia, intrauterine growth restriction, preterm delivery, and maternal obesity on the adipokine patterns in maternal-infant dyads. The importance of adipokine measurement and relationships in biological fluids during pregnancy and lactation is crucial for public health in the area of prevention of most diet-related metabolic diseases. The review highlights the huge knowledge gap in the field of hormones participating in the energy homeostasis and metabolic pathways during perinatal and postnatal periods in the mother-child dyad. An in-depth characterization is needed to confirm if the adverse outcomes of early developmental programming might be modulated via maternal lifestyle intervention.
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Affiliation(s)
- Jolanta Lis-Kuberka
- Department of Biochemistry and Immunochemistry, Division of Chemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland
| | | | - Magdalena Orczyk-Pawiłowicz
- Department of Biochemistry and Immunochemistry, Division of Chemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland
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Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Chen KK, Peahl AF, Danilack-Fekete VA, Stuebe AM, Balk EM. Delivery Strategies for Postpartum Care: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:529-542. [PMID: 37535967 DOI: 10.1097/aog.0000000000005293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To systematically review the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. DATA SOURCES We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022. METHODS OF STUDY SELECTION We used duplicate screening for studies comparing health care-delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels. TABULATION, INTEGRATION, AND RESULTS We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13-1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months (summary effect size 1.10-1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07-1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A 1c testing (moderate strength of evidence). CONCLUSION Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022309756 .
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Affiliation(s)
- Ian J Saldanha
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Center for Evidence Synthesis in Health, the Department of Health Services, Policy, and Practice, and the Department of Epidemiology, Brown University School of Public Health, and the Departments of Emergency Medicine, Pediatrics, Medicine, and Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; the Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Daw JR, Joyce NR, Werner EF, Kozhimannil KB, Steenland MW. Variation in Outpatient Postpartum Care Use in the United States: A Latent Class Analysis. Womens Health Issues 2023; 33:508-514. [PMID: 37301723 PMCID: PMC10997033 DOI: 10.1016/j.whi.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/14/2023] [Accepted: 05/03/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Despite efforts to improve postpartum health care in the United States, little is known about patterns of postpartum care beyond routine postpartum visit attendance. This study aimed to describe variation in outpatient postpartum care patterns. METHODS In this longitudinal cohort study of national commercial claims data, we used latent class analysis to identify subgroups of patients (classes) with similar outpatient postpartum care patterns (defined by the number of preventive, problem, and emergency department outpatient visits in the 60 days after birth). We also compared classes in terms of maternal sociodemographics and clinical characteristics measured at childbirth, as well as total health spending and rates of adverse events (all-cause hospitalizations and severe maternal morbidity) measured from childbirth to the late postpartum period (61-365 days after birth). RESULTS The study cohort included 250,048 patients hospitalized for childbirth in 2016. We identified six classes with distinct outpatient postpartum care patterns in the 60 days after birth, which we classified into three broad groups: no care (class 1 [32.4% of the total sample]); preventive care only (class 2 [18.3%]); and problem care (classes 3-6 [49.3%]). The prevalence of clinical risk factors at childbirth increased progressively from class 1 to class 6; for example, 6.7% of class 1 patients had any chronic disease compared with 15.5% of class 5 patients. Severe maternal morbidity was highest among the high problem care classes (classes 5 and 6): 1.5% of class 6 patients experienced severe maternal morbidity in the postpartum period and 0.5% in the late postpartum period, compared with less than 0.1% of patients in classes 1 and 2. CONCLUSIONS Efforts to redesign and measure postpartum care should reflect the current heterogeneity in care patterns and clinical risks in the postpartum population.
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Affiliation(s)
- Jamie R Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York.
| | - Nina R Joyce
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island; Center for Gerontology and Health Care Research, Brown School of Public Health, Providence, Rhode Island; Population Studies and Training Center, Brown University, Providence, Rhode Island
| | - Erika F Werner
- Department of Obstetrics & Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Maria W Steenland
- Population Studies and Training Center, Brown University, Providence, Rhode Island
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Frey HA, Ashmead R, Farmer A, Kim YH, Shellhaas C, Oza-Frank R, Jackson RD, Costantine MM, Lynch CD. A Prediction Model for Severe Maternal Morbidity and Mortality After Delivery Hospitalization. Obstet Gynecol 2023; 142:585-593. [PMID: 37535951 PMCID: PMC10526683 DOI: 10.1097/aog.0000000000005281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To develop a risk stratification model for severe maternal morbidity (SMM) or mortality after the delivery hospitalization based on information available at the time of hospital discharge. METHODS This population-based cohort study included all pregnancies among Ohio residents with Medicaid insurance from 2012 to 2017. Pregnant individuals were identified using linked live birth and fetal death records and Medicaid claims data. Inclusion was restricted to those with continuous postpartum Medicaid enrollment and delivery at 20 or more weeks of gestation. The primary outcome of the study was SMM or mortality after the delivery hospitalization and was assessed up to 42 days postpartum and up to 1 year postpartum separately. Variables considered for the model included patient-, obstetric health care professional-, and system-level data available in vital records or Medicaid claims data. Parsimonious models were created with logistic regression and were internally validated. Receiver operating characteristic curves were used to evaluate model performance, and model calibration was assessed. RESULTS There were 343,842 pregnant individuals who met inclusion criteria with continuous Medicaid enrollment through 42 days postpartum and 287,513 with continuous enrollment through 1 year. After delivery hospitalization discharge, the incidence of SMM or mortality was 140.5 per 10,000 pregnancies through 42 days of delivery and 330.7 per 10,000 pregnancies through 1 year postpartum. The final model predicting SMM or mortality through 42 days postpartum included maternal prepregnancy body mass index, age, gestational age at delivery, mode of delivery, chorioamnionitis, and maternal diagnosis of cardiac disease, preeclampsia or gestational hypertension, or a mental health condition. Similar variables were included in the model predicting SMM or mortality through 365 days with chronic hypertension, pregestational diabetes, and illicit substance use added and chorioamnionitis removed. Both models demonstrated moderate prediction (area under the curve [AUC] 0.77, 95% CI 0.76-0.78 for 42-day model; AUC 0.72, 95% CI 0.71-0.73 for the 1-year model) and good calibration. CONCLUSION A prediction model for SMM or mortality up to 1 year postpartum was created and internally validated with information available to health care professionals at the time of hospital discharge. The utility of this model for patient counseling and strategies to optimize postpartum care for high-risk individuals will require further evaluation.
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Affiliation(s)
- Heather A Frey
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, the Ohio Colleges of Medicine Government Resource Center and the Departments of Internal Medicine/Endocrinology and Diabetes and Metabolism, The Ohio State University, and the Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
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Tarasoff LA, Lunsky Y, Welsh K, Proulx L, Havercamp SM, Parish SL, Brown HK. Unmet needs, limited access: A qualitative study of postpartum health care experiences of people with disabilities. J Adv Nurs 2023; 79:3324-3336. [PMID: 36932042 PMCID: PMC10440283 DOI: 10.1111/jan.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
AIM To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives. DESIGN A qualitative study with semi-structured interviews. METHODS Between July 2019 and February 2020, in-person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes. RESULTS We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance. CONCLUSION Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns. IMPACT Birthing people with disabilities need multidisciplinary, proactive, and strengths-based postpartum care to mitigate risk for health complications. Further, disability-related training and guidelines for health and social service providers is required. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION Our research team included two peer researchers with physical disabilities who served as co-interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives.
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Affiliation(s)
- Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | | | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Bully P, Artieta-Pinedo I, Paz-Pascual C, García-Álvarez A, Espinosa M. Development and evaluation of the psychometric properties of a digital questionnaire for the self-management of health and well-being in the postpartum period. BMC Pregnancy Childbirth 2023; 23:610. [PMID: 37626320 PMCID: PMC10463739 DOI: 10.1186/s12884-023-05899-6] [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] [Received: 04/17/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite the fact that the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) recognises the special importance of care for women during the postpartum period, thus highlighting the need to identify and measure any condition that may affect the welfare of pregnant women in any way, this is one of the most neglected stages in the health system. Given the absence in our area of global, efficient instruments, the objective of this study was to design a complete, specific measurement tool with good metric qualities in digital format for the evaluation of self-reported health and well-being during the puerperium, to conform to what was proposed by the ICHOM. METHODS A cross-sectional study was carried out to evaluate the psychometric characteristics of a digital measurement tool. The development of the tool was carried out in 4 steps, following the recommendations of the International Test Commission. It was tested on 280 puerperas attending primary healthcare appointments in the Basque Healthcare System (Osakidetza), and they did the newly created survey, answering all the questions that had been selected as the gold standard. The average age of the women was 34.93 (SD = 4.80). The analysis of the psychometric characteristics was based on mixed procedures of expert judgment (a focus group of healthcare professionals, an item evaluation questionnaire and interviews with users) and quantitative evaluations (EFA, CFA, and correlation with gold standard, ordinal alpha and McDonald's omega). RESULTS The final version of the tool comprised 99 items that evaluate functional state, incontinence, sexuality, breastfeeding, adaptation to the role of mother and mental health, and all of these questions can be used globally or partially. It was found that the scores were valid and reliable, which gives metric guarantees for using the tool in our area. CONCLUSIONS The use of this comprehensive concise tool with good psychometric properties will allow women to take stock of their situation, assess if they have the necessary resources, in psychological and social terms, and work together with midwives and other healthcare professionals on the most deficient areas.
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Affiliation(s)
- Paola Bully
- University of the Basque Country, Barrio Sarriena, S/N, 48940, Leioa, Spain.
- Paola Bully Methodological and Statistical Consultant, C/ Barrio La Sota, Sopuerta, 48190, Spain.
| | - Isabel Artieta-Pinedo
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
- Primary Care Midwife Zuazo Health Centre, Osi Barakaldo-Sestao-Osakidetza, C/ Lurkizaga Kalea, S/N, 48902, Barakaldo, Spain
- School of Nursing, University of the Basque Country, C/ Barrio Sarriena S/N, Leioa, 48940, Spain
| | - Carmen Paz-Pascual
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
- School of Nursing, University of the Basque Country, C/ Barrio Sarriena S/N, Leioa, 48940, Spain
- Midwifery Training Unit of the Basque Country, Hospital de Basurto-Osakidetza, C/ Montevideo Etorbidea 18, Bilbao, 48013, Spain
- Primary Care Midwife Markonzaga Health Centre, OSI Barakaldo-Sestao-Osakidetza, C/ Antonio Trueba Kalea, 17, Sestao, 48910, Spain
| | - Arturo García-Álvarez
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
| | - Maite Espinosa
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
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Fant M, Rhoads S, Tucker J. Recognizing Early Warning Signs of Acute Hypertensive Crisis of the Postpartum Mother: An Important Role for Neonatal Nurses. Neonatal Netw 2023; 42:284-290. [PMID: 37657805 DOI: 10.1891/nn-2022-0060] [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: 05/08/2023] [Indexed: 09/03/2023]
Abstract
A delay in detecting acute hypertensive crisis in postpartum mothers can exacerbate complications in the mother. Neonatal nurses are uniquely qualified to identify postpartum warning signs in mothers while they are in the NICU with their infants. Few research studies have explored the use of neonatal nurse screenings for acute hypertensive crisis in postpartum mothers. NICU nurses screening mothers for postpartum depression has yielded success in improving outcomes, and this model could be translated into screening for acute hypertensive crisis. Further education should be implemented for NICU nurses that include a review of adult blood pressure monitoring, early warning signs, and symptoms of preeclampsia that the mother should report. This article discusses the importance of the neonatal nurse's role in identifying early warning signs of maternal postpartum hypertensive crisis.
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Adams YJ, Miller ML, Agbenyo JS, Ehla EE, Clinton GA. Postpartum care needs assessment: women's understanding of postpartum care, practices, barriers, and educational needs. BMC Pregnancy Childbirth 2023; 23:502. [PMID: 37420215 DOI: 10.1186/s12884-023-05813-0] [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: 09/06/2022] [Accepted: 06/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Complications in the postpartum period pose substantial risks to women and can result in significant maternal morbidity and mortality. However, there is much less attention on postpartum care compared to pregnancy and childbirth. The goal of this study was to gather information on women's knowledge of postpartum care and complications, recovery practices after childbirth, perceived barriers to receiving care during the postpartum period, and educational needs in four health centers. The findings can inform the development of appropriate curriculum and interventions for postnatal care education in similar settings. METHODS A descriptive qualitative study design was employed. Eight focus group discussions were conducted among 54 postpartum women who delivered in four health centers in Sagnarigu District in Tamale, Ghana. Audio recordings of focus group data were transcribed and translated, and thematic analysis was conducted. RESULTS There were six main themes that emerged from the focus group discussions: 1) baby focused postpartum care; 2) postpartum practices; 3) inadequate knowledge ofpostpartum danger signs; 4) barriers to accessing postpartum care 5) experiences of poor mental health; and 6) need for postpartum education. CONCLUSIONS Postpartum care for women in this study was primarily perceived as care of the baby post-delivery and missing key information on physical and mental health care for the mother. This can result in poor adjustment postpartum and critically, a lack of knowledge on danger signs for common causes of morbidity and mortality in the postpartum period. Future research needs to understand how to communicate important information on postpartum mental and physical health to better protect mothers in the region.
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Ahrens KA, Palmsten K, Lipkind HS, Pfeiffer M, Gelsinger C, Ackerman-Banks C. Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions. J Womens Health (Larchmt) 2023; 32:787-800. [PMID: 37192449 PMCID: PMC10354313 DOI: 10.1089/jwh.2022.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Objective: The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. Materials and Methods: This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately. Models were adjusted for maternal demographics and pregnancy characteristics. Results: Of the 123,125 deliveries, the cumulative risk of being diagnosed in the first 24 months postpartum with depression was 28%, anxiety 25%, bipolar disorder 3%, post-traumatic stress disorder 6%, and schizophrenia/psychotic disorder 1%. Women with prenatal depression were at higher risk of having a postpartum mental health diagnosis compared with women without prenatal depression (adjusted hazard ratios [aHRs] ranged from 2.5 [for anxiety] to 4.1 [for postpartum depression]). Risk of having postpartum depression was modestly higher among women with HDP, as was the risk of postpartum bipolar disorder among those with GDM. Findings were generally similar between women living in rural versus urban areas. Conclusions: Effective interventions to prevent, screen, and treat mental health conditions among women with pregnancy complications for an extended time postpartum are warranted.
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Affiliation(s)
- Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariah Pfeiffer
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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Ackerman‐Banks CM, Lipkind HS, Palmsten K, Pfeiffer M, Gelsinger C, Ahrens KA. Association of Prenatal Depression With New Cardiovascular Disease Within 24 Months Postpartum. J Am Heart Assoc 2023; 12:e028133. [PMID: 37073814 PMCID: PMC10227220 DOI: 10.1161/jaha.122.028133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 04/20/2023]
Abstract
Background Although depression is well established as an independent risk factor for cardiovascular disease (CVD) in the nonpregnant population, this association has largely not been investigated in pregnant populations. We aimed to estimate the cumulative risk of new CVD in the first 24 months postpartum among pregnant individuals diagnosed with prenatal depression compared with patients without depression diagnosed during pregnancy. Methods and Results Our longitudinal population-based study included pregnant individuals with deliveries during 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Data. We excluded those with prepregnancy CVD, multifetal gestations, or no continuous health insurance during pregnancy. Prenatal depression and CVD (heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease, and chronic hypertension) were identified by International Classification of Diseases, Ninth Revision (ICD-9)/International Classification of Diseases, Tenth Revision (ICD-10) codes. Cox models were used to estimate hazard ratios (HRs), adjusting for potential confounding factors. Analyses were stratified by hypertensive disorder of pregnancy. A total of 119 422 pregnancies were examined. Pregnant individuals with prenatal depression had an increased risk of ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, and new hypertension (adjusted HR [aHR], 1.83 [95% CI, 1.20-2.80], aHR, 1.60 [95% CI, 1.10-2.31], aHR, 1.61 [95% CI, 1.15-2.24], and aHR, 1.32 [95% CI, 1.17-1.50], respectively). When the analyses were stratified by co-occurring hypertensive disorders of pregnancy, several of these associations persisted. Conclusions The cumulative risk of a new CVD diagnosis postpartum was elevated among individuals with prenatal depression and persists even in the absence of co-occurring hypertensive disorders of pregnancy. Further research to determine the causal pathway can inform postpartum CVD preventive measures.
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Affiliation(s)
| | - Heather S. Lipkind
- Yale School of MedicineNew HavenCT
- Cornell Medical CollegeNew York CityNY
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, Health Partners InstituteMinneapolisMN
| | - Mariah Pfeiffer
- Muskie School of Public ServiceUniversity of Southern MainePortlandME
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Kramer MR, Labgold K, Zertuche AD, Runkle JD, Bryan M, Freymann GR, Austin D, Adams EK, Dunlop AL. Severe Maternal Morbidity in Georgia, 2009-2020. Med Care 2023; 61:258-267. [PMID: 36638324 PMCID: PMC10079300 DOI: 10.1097/mlr.0000000000001819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The increasing focus of population surveillance and research on maternal-and not only fetal and infant-health outcomes is long overdue. The United States maternal mortality rate is higher than any other high-income country, and Georgia is among the highest rates in the country. Severe maternal morbidity (SMM) is conceived of as a "near miss" for maternal mortality, is 50 times more common than maternal death, and efforts to systematically monitor SMM rates in populations have increased in recent years. Much of the current population-based research on SMM has occurred in coastal states or large cities, despite substantial geographical variation with higher maternal and infant health burdens in the Southeast and rural regions. METHODS This population-based study uses hospital discharge records linked to vital statistics to describe the epidemiology of SMM in Georgia between 2009 and 2020. RESULTS Georgia had a higher SMM rate than the United States overall (189.2 vs. 144 per 10,000 deliveries in Georgia in 2014, the most recent year with US estimates). SMM was higher among racially minoritized pregnant persons and those at the extremes of age, of lower socioeconomic status, and with comorbid chronic conditions. SMM rates were 5 to 6 times greater for pregnant people delivering infants <1500 grams or <32 weeks' gestation as compared with those delivering normal weight or term infants. Since 2015, SMM has increased in Georgia. CONCLUSION SMM represents a collection of life-threatening emergencies that are unevenly distributed in the population and require increased attention. This descriptive analysis provides initial guidance for programmatic interventions intending to reduce the burden of SMM and, subsequently, maternal mortality in the US South.
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Affiliation(s)
| | | | | | - Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, NC
| | - Michael Bryan
- Division of Epidemiology, Maternal and Child Health Epidemiology Unit, Georgia Department of Public Health
| | - Gordon R. Freymann
- Georgia Department of Public Health, Office of Health Indicators for Planning
| | - David Austin
- Georgia Department of Public Health, Office of Health Indicators for Planning
| | - E. Kathleen Adams
- Department of Health Policy and Management, Rollins School of Public Health
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA
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Geronimus AT, Bound J, Hughes L. Trend Toward Older Maternal Age Contributed To Growing Racial Inequity In Very-Low-Birthweight Infants In The US. Health Aff (Millwood) 2023; 42:674-682. [PMID: 37126758 PMCID: PMC10559944 DOI: 10.1377/hlthaff.2022.01066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In 2016 the Centers for Disease Control and Prevention reported that for the first time, US women in their thirties were bearing more children than those in their twenties. Analyzing US vital statistics data from the period 1989-2019, we simulated the effect that the distributional shift to older maternal ages at first birth had on health inequity between Black and White infants. Net of maternal socioeconomic indicators, this shift increased the relative odds that White women gave birth to very-low-birthweight (VLBW) infants by 10 percent, versus 19 percent for Black women, largely accounting for the rise in VLBW and the increase in racial inequity seen in the years analyzed. Reductions in infant mortality over the period were dampened by the maternal age shift, especially among Black babies, exacerbating Black-White inequity. Policy implications for promoting reproductive justice include universal tertiary care access, increasing the supply and distribution of maternity care providers, addressing the holistic needs of mothers throughout pregnancy and postpartum, and expanding family support policies. Conceptually, we recommend centering the realities of pregnancy and parenting from the perspective of the populations at highest risk-centering on the margins-and taking into account their implications for maternal weathering (accelerated deterioration due to disparate impacts of structural racism).
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