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Roman LA, Raffo JE, Strutz KL, Luo Z, Johnson ME, Meulen PV, Henning S, Baker D, Titcombe C, Meghea CI. The Impact of a Population-Based System of Care Intervention on Enhanced Prenatal Care and Service Utilization Among Medicaid-Insured Pregnant Women. Am J Prev Med 2022; 62:e117-e127. [PMID: 34702604 DOI: 10.1016/j.amepre.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigates the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization. METHODS This quasi-experimental, population-based, difference-in-differences study used linked birth certificates, Medicaid claims, and enhanced prenatal care data from complete statewide Medicaid birth cohorts (2009 to 2015), and was analyzed in 2019-2020. The population-based system intervention included cross-agency leadership and work groups, delivery system redesign with clinical-community linkages, increased enhanced prenatal care-Community Health Worker care, and patient empowerment. Outcomes included enhanced prenatal care participation and early participation, prenatal care adequacy, emergency department contact, and postpartum care. RESULTS Enhanced prenatal care (7.4 percentage points, 95% CI=6.3, 8.5) and first trimester enhanced prenatal care (12.4 percentage points, 95% CI=10.2, 14.5) increased among women served by practices with established clincial-community linkages, relative to that among the comparator group. First trimester enhanced prenatal care improved in the county (17.9, 95% CI=15.7, 20.0), emergency department contact decreased in the practices (-11.1, 95% CI= -12.3, -9.9), and postpartum care improved in the county (7.1, 95% CI=6.0, 8.2). Enhanced prenatal care participation for Black women served by the practices improved (4.4, 95% CI=2.2, 6.6) as well as early enhanced prenatal care (12.3, 95% CI=9.0, 15.6) and use of postpartum care (10.4, 95% CI=8.3, 12.4). CONCLUSIONS A population systems approach improved selected enhanced prenatal care participation and service utilization for Medicaid-insured women in a county population, those in practices with established clinical-community linkages, and Black women.
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Affiliation(s)
- Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | | | - Peggy Vander Meulen
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Susan Henning
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Dianna Baker
- Kent County Health Department, Grand Rapids, Michigan
| | | | - Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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Chorbadjian TN, Deavenport-Saman A, Higgins C, Chao SM, Yang JH, Koolwijk I, Vanderbilt DL. Maternal Depressive Symptoms and Developmental Delay at Age 2: A Diverse Population-Based Longitudinal Study. Matern Child Health J 2020; 24:1267-1277. [PMID: 32780269 DOI: 10.1007/s10995-020-02990-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children raised by depressed mothers perform lower on measures of cognitive, emotional, and behavioral skills, compared to children of non-depressed mothers. It is unclear how maternal depressive symptoms (MDS), which persist and accrue over time, impact child development. The purpose of this study was to determine whether cumulative MDS from pre-pregnancy to postpartum influences child development in children by age 2.5. METHODS Using a longitudinal population-based study design, 2679 racially and ethnically diverse mothers completed the 2014 Los Angeles Mommy and Baby (LAMB) and 2016 Follow-Up surveys. A total MDS score was created based on responses to standardized questions, including the Patient Health Questionnaire-2 (PHQ-2). Data was collected for before pregnancy, during pregnancy, and 4 months postpartum in the 2014 survey, and at 2.5 years postpartum in the 2016 survey. Child development was measured using the CDC's Learn the Signs. Act Early Milestones Checklist. Bivariate and multivariate logistic regressions were conducted. RESULTS The prevalence of any cumulative MDS was 45.2%. Language, cognitive/adaptive, motor, and social-emotional delays for surveyed toddlers were 7.7%, 4.0%, 1.2%, and 14.2%. After adjusting for covariates, mothers reporting depressive symptoms at all four time points were significantly more likely to report a social-emotional delay in their child (aOR = 4.39, 95% CI - 1.72 to 11.18). CONCLUSIONS FOR PRACTICE Mothers with cumulative depressive symptoms are at-risk of reporting social-emotional delays by age 2.5. Understanding these effects may help direct resources to target interventions that support mothers with depressive symptoms early-on and promote positive developmental outcomes among their children.
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Affiliation(s)
- Tamar Nazerian Chorbadjian
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA.
- Kaiser Permanente Baldwin Park, 1011 Baldwin Park Blvd., Baldwin Park, CA, 91706, USA.
| | - Alexis Deavenport-Saman
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
| | - Chandra Higgins
- Los Angeles Department of Public Health, Los Angeles County Department of Public Health Maternal, Child, and Adolescent Health Programs, 600 S. Commonwealth Av #800, Los Angeles, CA, 90005, USA
| | - Shin Margaret Chao
- Los Angeles Department of Public Health, Los Angeles County Department of Public Health Maternal, Child, and Adolescent Health Programs, 600 S. Commonwealth Av #800, Los Angeles, CA, 90005, USA
| | - Jeffrey H Yang
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
| | - Irene Koolwijk
- Department of General Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 3300, Los Angeles, CA, 90095, USA
| | - Douglas L Vanderbilt
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
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Chen L, Shi L, Chao MS, Tong X, Wang F. Stressful life events, hypertensive disorders, and high blood sugar during pregnancy. Stress Health 2020; 36:160-165. [PMID: 31714017 DOI: 10.1002/smi.2911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/29/2019] [Accepted: 11/04/2019] [Indexed: 01/04/2023]
Abstract
The objective of this study was to examine the association of life events stressors with risk of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) by using the multilevel sample from the 2007 Los Angeles Mommy and Baby (LAMB) survey. Four multilevel logistic regression models were applied while accounting for the multilevel design of the LAMB study. The following demographic variables were used as covariates: maternal age, race/ethnicity, maternal educational attainment, household income level in the previous year, physical exercise, and prepregnancy body weight status. The scale for total number of stressors was positively associated with GDM in Model 1, but the association did not reach the significance threshold of 0.05. In Model 2 where four specific domains of stressors (financial, traumatic, spousal, and emotional stressors) were used as the key exposure variables, the number of financial stressors during pregnancy was significantly associated with a higher risk of GDM. The scale for total number of stressors was associated with HDP in Model 3. Experience of financial stressors during pregnancy was significantly associated with a higher risk of HDP in Model 4. In conclusion, exposure to higher number of financial stressors was associated with an elevated risk of GDM and HDP.
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Affiliation(s)
- Liwei Chen
- Department of Epidemiology, University of California, Los Angeles, California
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Margaret Shin Chao
- Maternal, Child, and Adolescent Health Programs, Los Angeles County Department of Public Health, Los Angeles, California
| | - Xia Tong
- Department of Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fan Wang
- Department of Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Chen L, Shi L, Zhang D, Chao SM. Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women. Prev Chronic Dis 2019; 16:E158. [PMID: 31808419 PMCID: PMC6896832 DOI: 10.5888/pcd16.190212] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Asian women have a higher prevalence of gestational diabetes mellitus than women of other races/ethnicities. We aimed to compare the prevalence of gestational diabetes among Asian American women to other racial/ethnic groups and explore whether the higher occurrence of the disorder among Asian women can be explained by acculturation. Methods We conducted a population-based, cross-sectional study among 5,562 women who participated in the 2007 Los Angeles Mommy and Baby Study (LAMB) in Los Angeles County, California. All women included in this study had a live delivery in 2007 and did not have pre-pregnancy type I or II diabetes. We applied multivariate, weighted logistic regressions to compare gestational diabetes prevalence among racial/ethnic groups, adjusting for its known risk factors. We conducted mediation analysis to test whether the difference in prevalence across racial/ethnic groups could be explained by acculturation. Results Among the 5,562 women studied, the weighted prevalence of gestational diabetes was 15.5% among Asian American women, followed by 9.0% among non-Hispanic black women, 10.7% among Hispanic women, and 7.9% among non-Hispanic white women. Compared with non-Hispanic white women, Asian women had 2.44 (95% confidence interval [CI], 1.81–3.29; P < .001) times the odds of having gestational diabetes, independent of maternal age, education, marital status, income, prenatal care adequacy, prepregnancy BMI, and physical activity. Acculturation was negatively associated with having gestational diabetes (odds ratio [OR] = 0.93; 95% CI, 0.86–0.99) and explained 15.9% (95% CI, 11.38%–25.08%; P < .001) of the association between Asian race and the condition. Conclusion We found that Asian race was an independent risk factor for gestational diabetes, and higher acculturation may play a protective role against it in Asian American women.
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Affiliation(s)
- Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634-0745.
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, Georgia
| | - Shin Margaret Chao
- Department of Public Health Los Angeles County, Maternal, Child, and Adolescent Health Programs, Los Angeles, California
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Shi L, MacLeod KE, Zhang D, Wang F, Chao MS. Travel distance to prenatal care and high blood pressure during pregnancy. Hypertens Pregnancy 2016; 36:70-76. [PMID: 27835033 DOI: 10.1080/10641955.2016.1239733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether poor geographic accessibility to prenatal care, as indicated by long distance trips to prenatal care, produced high blood pressure (HPB) during pregnancy. METHODS Using the 2007 Los Angeles Mommy and Baby Study for women without hypertension prior to pregnancy (n = 3405), we compared self-reported HBP by travel distance to prenatal care controlling for age, race/ethnicity, marital status, education, household income, weight status, and physical activity. RESULTS Results of the multilevel logistic regression shows traveling more than 50 mi to prenatal care is associated with an increased odds for having HPB during pregnancy (odds ratio [OR] = 2.867, 95% confidence interval [CI] = 1.079,7.613), as compared with a travel distance shorter than 5 mi. Traveling 5-14 mi (OR = 0.917, 95% CI = 0.715-1.176), 15-29 mi (OR = 0.955, 95% CI = 0.634-1.438), or 30-50 mi (OR = 1.101, 95% CI = 0.485-2.499) were not significantly associated with more risk of HBP during pregnancy. CONCLUSION To our knowledge, no previous studies have examined the association between poor geographic accessibility to care and the possible harms of travel burdens for pregnant women. Future research that replicates these findings can assist in developing recommendations for pregnant women and health-care accessibility.
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Affiliation(s)
- Lu Shi
- a Department of Public Health Sciences , Clemson University , Clemson , South Carolina , USA
| | - Kara E MacLeod
- b Department of Environmental Health Sciences , UCLA Fielding School of Public Health , Los Angeles , California , USA
| | - Donglan Zhang
- c Department of Health Policy and Management, College of Public Health , University of Georgia , Athens , Georgia , USA
| | - Fan Wang
- d Department of Obstetrics, The Second Affiliated Hospital , Wenzhou Medical University , Wenzhou , China
| | - Margaret Shin Chao
- e Department of Public Health Los Angeles County , Maternal, Child, and Adolescent Health Programs , Los Angeles , California , USA
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Chao SM, Wakeel F, Nazinyan Y, Sun S. Does Preconception Health Differ by Nativity?: Findings from the Los Angeles Mommy and Baby (LAMB) Study. Matern Child Health J 2016; 20:769-77. [PMID: 26728899 PMCID: PMC4794372 DOI: 10.1007/s10995-015-1907-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare certain preconception health (PCH) behaviors and conditions among US-born (USB) and foreign-born (FB) mothers in Los Angeles County (LAC), regardless of race/ethnicity, and to determine if any identified differences vary among Asian/Pacific Islanders (API's) and Hispanics. METHODS Data are from the 2012 Los Angeles Mommy and Baby study (n = 6252). PCH behaviors included tobacco use, multivitamin use, unintended pregnancy, and contraception use. PCH conditions comprised being overweight/obese, diabetes, asthma, hypertension, gum disease, and anemia. The relationship between nativity and each PCH behavior/condition was assessed using multivariable logistic regression models. RESULTS USB women were more likely than FB women to smoke (AOR 2.12, 95 % CI 1.49-3.00), be overweight/obese (AOR 1.57, 95 % CI 1.30-1.90), and have asthma (AOR 2.04, 95 % CI 1.35-3.09) prior to pregnancy. They were less likely than FB women to use contraception before pregnancy (AOR 0.59, 95 % CI 0.49-0.72). USB Hispanics and API's were more likely than their FB counterparts to be overweight/obese (AOR 1.57, 95 % CI 1.23-2.01 and AOR 2.37, 95 % CI 1.58-3.56, respectively) and less likely to use contraception (AOR 0.58, 95 % CI 0.45-0.74 and AOR 0.46, 95 % CI 0.30-0.71, respectively). USB Hispanic mothers were more likely than their FB counterparts to smoke (AOR 2.47, 95 % CI 1.46-4.17), not take multivitamins (AOR 1.30, 95 % CI 1.02-1.66), and have asthma (AOR 2.35, 95 % CI 1.32-4.21) before pregnancy. CONCLUSIONS US nativity is linked to negative PCH among LAC women, with many of these associations persisting among Hispanics and API's. As PCH profoundly impacts maternal and child health across the lifecourse, culturally-appropriate interventions that maintain positive behaviors among FB reproductive-aged women and encourage positive behaviors among USB women should be pursued.
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Affiliation(s)
- Shin M Chao
- Los Angeles County Department of Maternal, Child and Adolescent Health Programs, 600 Commonwealth Avenue, 8th Floor, Los Angeles, CA, 90095, USA.
| | - Fathima Wakeel
- Public Health Programs, College of Health Professions, Ferris State University, Big Rapids, MI, USA
| | | | - Stacy Sun
- Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD, USA
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Association of Mothers' Perception of Neighborhood Quality and Maternal Resilience with Risk of Preterm Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9427-43. [PMID: 26274966 PMCID: PMC4555289 DOI: 10.3390/ijerph120809427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 11/17/2022]
Abstract
We examined the associations of mothers’ perception of neighborhood quality and maternal resilience with risk of preterm birth and whether maternal resilience moderated the effect of neighborhood quality perception. We analyzed data from 10,758 women with singleton births who participated in 2010–2012 Los Angeles Mommy and Baby surveys. Multilevel logistic regression models assessed the effects of mothers’ perception of neighborhood quality and maternal resilience on preterm birth (yes/no), controlling for potential confounders and economic hardship index, a city-level measure of neighborhood quality. Interaction terms were assessed for moderation. Mothers’ perception of neighborhood quality and maternal resilience were each uniquely associated with preterm birth, independent of potential confounders (p-values < 0.05). The risk of preterm birth among mothers who perceived their neighborhood as of poor quality was about 30% greater compared to mothers who perceived their neighborhood as of good quality; the risk was 12% greater among mothers with low resilience compared to those with high resilience. Effects of neighborhood quality were not modified by maternal resilience. The findings suggest that mothers’ perception of neighborhood quality and resilience are associated with the risk of preterm birth. Further research should explore whether initiatives aimed at improving neighborhood quality and women’s self-esteem may improve birth outcomes.
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