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Noroña-Zhou AN, Ashby BD, Richardson G, Ehmer A, Scott SM, Dardar S, Marshall L, Talmi A. Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care. Health Equity 2023; 7:562-569. [PMID: 37731783 PMCID: PMC10507928 DOI: 10.1089/heq.2023.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.
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Affiliation(s)
- Amanda N. Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Bethany D. Ashby
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Georgette Richardson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Psychological Health and Learning Sciences, College of Education, University of Houston, Houston, Texas, USA
| | - Amelia Ehmer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen M. Scott
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shaleah Dardar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ladean Marshall
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ayelet Talmi
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Yu NKK, Shum KKM, Lam YY, Kwan QKL, Ng SYP, Chan NTT. Sensitivity Training for Mothers With Premature Infants: A Randomized Controlled Trial. J Pediatr Psychol 2022; 47:1167-1184. [PMID: 35666133 DOI: 10.1093/jpepsy/jsac051] [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: 06/04/2021] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This single-blind parallel design randomized controlled trial evaluated the feasibility and effectiveness of a modified version of the Mother-Infant Transaction Program (MITP) in enhancing Chinese mothers' sensitivity towards their premature infants' physiological and social cues. METHODS Sixty mothers of hospitalized premature infants (mean gestational age = 32.1 weeks; SD = 2.8) were randomly assigned to either the MITP group or the treatment-as-usual control group. The intervention group (n = 30) received four sessions of parental sensitivity training adapted from the MITP, delivered by clinical psychologists before the infants were discharged. The control group (n = 30) received standard care provided by the hospitals. Each dyad was assessed at baseline (Time 1), immediately after intervention (Time 2), and when the infants were at the gestation-corrected ages of 3, 6, 9, and 12 months (Times 3-6). Maternal sensitivity, mother-infant interaction quality, parenting stress, postpartum depression, and mother's perception of infant's temperament were measured at Times 1-4, whereas infants' weight gain and developmental performance were assessed at Times 3-6. RESULTS The MITP group showed significantly higher maternal sensitivity and better mother-infant interaction quality after completing the training. They also reported less parenting stress and postnatal depression than the control group at Time 2 and subsequent follow-ups. The intervention significantly predicted better weight gain and developmental outcomes in infants across Times 3-6, mediated by maternal wellbeing and interaction quality. CONCLUSION Our results demonstrated the feasibility and effectiveness of this adapted sensitivity training among Chinese mothers with premature infants. [ClinicalTrials.gov NCT04383340].
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Affiliation(s)
- Nicky Ka Ki Yu
- Department of Psychology, The University of Hong Kong, Hong Kong.,Department of Clinical Psychology, Kwong Wah Hospital, Hong Kong
| | | | - Yuen Yu Lam
- Department of Pediatrics, Kwong Wah Hospital, Hong Kong
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Spiegler J, Mendonca M, Wolke D. Prospective Study of Physical Activity of Preterm Born Children from Age 5 to 14 Years. J Pediatr 2019; 208:66-73.e7. [PMID: 30879733 DOI: 10.1016/j.jpeds.2018.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/12/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether level of prematurity (very, moderate, late preterm, vs full term) is associated with physical activity from childhood to adolescence and to identify factors in childhood that predict moderate-vigorous physical activity in early adolescence. STUDY DESIGN Parents reported on physical activity at the age 5, 7, and 11 years (n = 12 222-14 639) and adolescents self-reported on moderate-vigorous physical activity at 14 years (n = 10 974). At age 14 years, a subgroup was also assessed by wrist accelerometer (n = 4046). RESULTS Prematurity was associated with a small or no difference in physical activity at each time point. At age 14 years, moderate-vigorous physical activity in self-report and accelerometer was higher in male adolescents, those of white ethnicity, or higher parental education, having been taken to live sport events at age 5 or 7 years or having taken part in organized physical activity at 5 or 7 years. CONCLUSIONS In this representative national cohort study in the United Kingdom, preterm birth was not found to be associated with physical activity between 5 and 14 years. Organized physical activity and watching sport events early in life may increase moderate to vigorous physical activity in adolescents.
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Affiliation(s)
- Juliane Spiegler
- Department of Psychology and Division of Mental Health and Well-Being, University of Warwick, Coventry, United Kingdom; Department of Pediatrics, University of Lübeck, Lübeck, Germany.
| | - Marina Mendonca
- Department of Psychology and Division of Mental Health and Well-Being, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology and Division of Mental Health and Well-Being, University of Warwick, Coventry, United Kingdom
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Lungu C, Hirtz D, Damiano D, Gross P, Mink JW. Report of a workshop on research gaps in the treatment of cerebral palsy. Neurology 2016; 87:1293-8. [PMID: 27558377 DOI: 10.1212/wnl.0000000000003116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/08/2016] [Indexed: 01/10/2023] Open
Abstract
Cerebral palsy (CP) is heterogeneous in etiology and manifestations, making research into relevant therapies difficult and limiting the generalizability of the results. We report here on the NIH CP symposium, where stakeholders from academic, clinical, regulatory, and advocacy backgrounds discussed the major challenges and needs for moving forward with clinical research in CP, and outlined priorities and action items. New information is constantly generated through research into pathogenesis and etiology. Clinical research and new therapeutic approaches need to keep pace, through large data registry integration and new research designs. Development of standardized data collection, increasing academic focus on CP research, and iterative approaches to treatment throughout the patients' lives, have all been identified as areas of focus. The workshop identified critical gaps and areas of focus to increase the evidence base for therapeutic approaches to determine which treatments work best for which patients in the near future. These include consolidation and optimization of databases and registries, updates to the research methodology, and better integration of resources and stakeholders.
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Affiliation(s)
- Codrin Lungu
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY.
| | - Deborah Hirtz
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Diane Damiano
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Paul Gross
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Jonathan W Mink
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
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