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Bihan H, Nachtargeale C, Vicaud E, Sal M, Berkane N, Pinto S, Tatulashvili S, Fermaut M, Carbillon L, Cosson E. Impact of experiencing multiple vulnerabilities on fetal growth and complications in women with hyperglycemia in pregnancy. BMC Pregnancy Childbirth 2023; 23:740. [PMID: 37853313 PMCID: PMC10585815 DOI: 10.1186/s12884-023-06048-9] [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] [Received: 09/26/2022] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND In women with hyperglycemia in pregnancy living in France, psychosocial deprivation is associated with both earlier and greater exposure to the condition, as well as poorer maternofetal prognosis. We explored the impact of this and two other socioeconomic vulnerability indicators-food insecurity and poor language proficiency-on adherence to prenatal care and maternal and fetal outcomes. METHODS In a socially deprived suburb of Paris, we selected women who delivered between 01/01/2012 and 31/12/2018 and received care (nurse, dietician, diabetologist evaluation, advice, regular follow-up to adjust insulin doses if requested) for hyperglycemia in pregnancy. We analyzed the associations between individual psychosocial deprivation, food insecurity, French language proficiency (variables assessed by individual questionnaires) and fetal growth (main outcome), as well as other core maternal and fetal outcomes. RESULTS Among the 1,168 women included (multiethnic cohort, 19.3% of whom were Europeans), 56%, 17.9%, and 27.5% had psychosocial deprivation, food insecurity, and poor French language proficiency, respectively. Forty-three percent were prescribed insulin therapy. Women with more than one vulnerability had more consultations for diabetes. The rates for small (SGA), appropriate (AGA), and large-for-gestational-age (LGA) infant were 11.4%, 76.5% and 12.2%, respectively. These rates were similar in women with and without psychosocial deprivation, and in those with and without food insecurity. Interestingly, women with poor French language proficiency had a higher odds ratio of delivering a small- or large-for-gestational age infant than those with good proficiency. CONCLUSION We found similar pregnancy outcomes for women with hyperglycemia in pregnancy living in France, irrespective of whether or not they had psychosocial deprivation or food insecurity. Optimized single-center care with specialized follow-up could contribute to reduce inequalities in maternal and fetal outcomes in women with hyperglycemia in pregnancy.
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Affiliation(s)
- Helene Bihan
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, CRNH-IdF, CINFO, Université Sorbonne Paris Nord Bobigny, France.
- Laboratoire Educations Et Promotion de La Santé, LEPS, Université Sorbonne Paris Nord Bobigny, UR3412, Villetaneuse, France.
| | - Charlotte Nachtargeale
- AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, 75009, Paris, France
| | - Eric Vicaud
- AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, 75009, Paris, France
| | - Meriem Sal
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, CRNH-IdF, CINFO, Université Sorbonne Paris Nord Bobigny, France
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, CRNH-IdF, CINFO, Université Sorbonne Paris Nord Bobigny, France
| | - Sara Pinto
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier Hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Sopio Tatulashvili
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, CRNH-IdF, CINFO, Université Sorbonne Paris Nord Bobigny, France
| | - Marion Fermaut
- Department of Obstetrics and Gynecology, AP-HP, Jean Verdier Hospital, Paris 13 University, 93143, Sorbonne Paris Cité, Bondy, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynecology, AP-HP, Jean Verdier Hospital, Paris 13 University, 93143, Sorbonne Paris Cité, Bondy, France
| | - Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, CRNH-IdF, CINFO, Université Sorbonne Paris Nord Bobigny, France
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Inserm (U1153), Université Paris 13, COMUE Sorbonne-Paris-Cité, Inra (U1125), Centre d'Epidémiologie Et Statistiques Paris Cité, 93017, CnamBobigny, France
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Ahlers-Schmidt CR, Schunn C, Hervey AM, Torres M, Cordoba AP. Safe sleep community baby showers to reduce infant mortality risk factors for women who speak Spanish. Sleep Health 2021; 7:603-609. [PMID: 34417149 DOI: 10.1016/j.sleh.2021.07.002] [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: 02/10/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES In the United States, sleep-related deaths are one of the primary causes of death for infants age 28 days to one year. The American Academy of Pediatrics (AAP) developed Safe Sleep Recommendations which provide risk reduction strategies for sleep-related infant deaths. Interventions such as Safe Sleep Community Baby Showers have increased knowledge and intentions to engage in these safe sleep behaviors for women who speak English. This study assessed the feasibility, acceptability and initial outcomes of Safe Sleep Community Baby Showers for women who speak Spanish. METHODS Six Spanish Safe Sleep Community Baby Showers were held in Sedgwick County, Kansas. One hundred forty-six pregnant or recently delivered women who spoke Spanish completed pre- and post-assessments. Univariate comparisons were made using McNemar's test for paired dichotomous variables. RESULTS Participants had a high school diploma/General Educational Diploma (GED) or less (75.3%), and were uninsured (52.1%) or had Medicaid (n = 49; 33.6%). The majority reported being very satisfied (n = 130; 89.0%) or satisfied (n = 8; 5.5%). Compared to baseline, significant increases in intentions and confidence to follow the AAP Safe Sleep Recommendations were observed following the events. The majority of participants reported intending to place their infant on the back to sleep (98.6%), use only a safe surface (crib, portable crib, bassinet; 99.3%), and only include safe items (firm mattress, fitted sheet; 93.5%) (all p < .001). CONCLUSIONS Study findings support both feasibility and acceptability of modifying Safe Sleep Community Baby Showers to provide culturally and linguistically appropriate education for women who speak Spanish. Initial outcomes suggest increased intentions to follow safe sleep recommendations.
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Affiliation(s)
- Carolyn R Ahlers-Schmidt
- University of Kansas School of Medicine-Wichita, Center for Research for Infant Birth and Survival, Wichita, Kansas, USA.
| | - Christy Schunn
- Kansas Infant Death and SIDS (KIDS) Network, Wichita, Kansas, USA
| | - Ashley M Hervey
- University of Kansas School of Medicine-Wichita, Center for Research for Infant Birth and Survival, Wichita, Kansas, USA
| | - Maria Torres
- Kansas Infant Death and SIDS (KIDS) Network, Wichita, Kansas, USA
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Relationship Between Maternal Economic Vulnerability and Childhood Neurodevelopment at 2 and 5 Years of Life. Obstet Gynecol 2021; 138:379-388. [PMID: 34352828 DOI: 10.1097/aog.0000000000004503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the relationship between economic vulnerability during pregnancy and childhood neurodevelopment. METHODS This is a secondary analysis of two parallel multicenter, randomized, controlled trials of administration of levothyroxine to pregnant individuals with subclinical hypothyroidism or hypothyroxinemia in the United States. All participants who delivered a live, nonanomalous neonate and completed the WPPSI-III (Weschler Preschool & Primary Scale of Intelligence) at 5 years of life and the Bayley-III (Bayley Scales of Infant Development) test at 2 years were included. The primary outcome is WPPSI-III score. Secondary outcome included Bayley-III subtest scores. Multivariable analyses were used to assess the relationships between economic vulnerability during the index pregnancy-defined as a household income less than 200% of the estimated federal poverty level, part-time or no employment, and use of government insurance-and the prespecified outcomes. Tests of interaction were performed to assess whether the magnitude of association differed according to whether participants were married or completed more than a high school education. A sensitivity analysis was performed to limit the income criteria for economic vulnerability to household income of less than 100% of the estimated federal poverty level. RESULTS Of 955 participants who met inclusion criteria, 406 (42.5%) were considered economically vulnerable. In bivariate analysis, the WPPSI-III score and Bayley-III subtest scores were significantly lower among children of the economically vulnerable. For the WPPSI-III, Bayley-III cognitive subtest, and Bayley-III language subtest scores, the associations between economic vulnerability and lower childhood neurodevelopmental scores were primarily seen only among those who were married or completed more than a high school education (P for interaction<.05). A similar pattern was noted when restricting the income criteria for economic vulnerability to less than 100% of the federal poverty level. CONCLUSION Economic vulnerability during pregnancy is associated with an increased risk of adverse neurodevelopmental outcomes in their children at 2 and 5 years of life, particularly among those who are married or completed more than a high school education.
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Mandelbaum J, Mesa A, Alhabas M, Blake CE. Early Initiation of Combination Feeding among Latina Mothers in the Deep South: Perspectives for Clinicians. South Med J 2021; 114:32-34. [PMID: 33398358 DOI: 10.14423/smj.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jennifer Mandelbaum
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Anna Mesa
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Maryam Alhabas
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Christine E Blake
- From the Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
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Sentell T, Chang A, Ahn HJ, Miyamura J. Maternal language and adverse birth outcomes in a statewide analysis. Women Health 2015; 56:257-80. [PMID: 26361937 DOI: 10.1080/03630242.2015.1088114] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34-3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.
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Affiliation(s)
- Tetine Sentell
- a Office of Public Health Studies , University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - Ann Chang
- b Department of Obstetrics, Gynecology, and Women's Health , John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Hyeong Jun Ahn
- c Biostatistics Core, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Jill Miyamura
- d Hawaii Health Information Corporation , Honolulu , Hawaii , USA
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Carolan-Olah M, Steele C, Krenzin G. Development and initial testing of a GDM information website for multi-ethnic women with GDM. BMC Pregnancy Childbirth 2015; 15:145. [PMID: 26142482 PMCID: PMC4491240 DOI: 10.1186/s12884-015-0578-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) affects approximately 5–15 % of pregnant women in Australia. Highest rates are seen among women who are obese, from specific ethnic backgrounds and low socio-economic circumstance. These features also impact on uptake of self-management recommendations. GDM that is not well managed can give rise to serious pregnancy complications. The aim of this project was to develop and test an intervention to improve knowledge of GDM and GDM self-management principles. Methods A web-based intervention, consisting of resources aimed at a low level of literacy, was developed and tested among multi-ethnic women at a metropolitan hospital in Melbourne Australia. A basic one-group pre-test/post-test design was used to explore the impact of the intervention on knowledge, in 3 domains: (1) Knowledge of GDM; (2) food values, and;(3) GDM self-management principles. Questionnaire data was analysed using Statistical Package for the Social Sciences (SPSS), version 21.0. Fisher’s exact test was used to test for an improvement in each knowledge scale. Results Twenty-one women with GDM, from multi-ethnic backgrounds, participated in the testing of the intervention. Results indicated that the intervention was effective at improving knowledge scores and this effect was greatest in the first domain, knowledge of GDM. Although some improvement of knowledge scores occurred in the other two domains, food values and self-management principles, these improvements were less than expected. This finding may relate to a number of misunderstandings in the interpretation of the web resource and survey questions. These issues will need to be resolved prior to proceeding to a clinical trial. Conclusion Initial results from this study look promising and suggest that with some improvements, the intervention could prove a useful adjunct support for women with GDM from multi-ethnic and low socio-economic backgrounds. Conducting a randomised controlled trial is feasible in the future and will provide a useful means of examining efficacy of the intervention.
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Affiliation(s)
- Mary Carolan-Olah
- Nursing and Midwifery, College of Health and Biomedicine, Victoria University, St Alban's Campus, PO Box 14228, Melbourne, 8001, Australia.
| | - Cheryl Steele
- Western Health, Diabetes Education Service, Western Hospital, Gordon St., Footscray, VIC, 3011, Australia.
| | - Gillian Krenzin
- Western Health, Diabetes Education Service, Western Hospital, Gordon St., Footscray, VIC, 3011, Australia.
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Abstract
Health care organizations often struggle with issues related to communication with patients who have limited English proficiency. Providing quality interpreter services is necessary to comply with regulatory mandates and to provide safe, effective health care. Maternity care presents a unique situation due to the intimate and unpredictable nature of birth. A unique interpreter/doula program in which trained medical interpreters received additional education in labor and postpartum doula skills was tested at a large urban hospital maternity center with a large population of Spanish-speaking patients. Results showed that interpreter/doulas can offer timely, competent care in a variety of maternity situations. They also were cost-effective and associated with increased patient and staff satisfaction.
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Affiliation(s)
- Sandra Maher
- IU Health/Methodist Hospital in Indianapolis, IN, USA
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Brown HL, Small M, Taylor YJ, Chireau M, Howard DL. Near Miss Maternal Mortality in a Multiethnic Population. Ann Epidemiol 2011; 21:73-7. [DOI: 10.1016/j.annepidem.2010.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/06/2010] [Accepted: 10/05/2010] [Indexed: 11/28/2022]
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Carolan M, Steele C, Margetts H. Knowledge of gestational diabetes among a multi-ethnic cohort in Australia. Midwifery 2010; 26:579-88. [DOI: 10.1016/j.midw.2009.01.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 10/28/2008] [Accepted: 01/11/2009] [Indexed: 12/16/2022]
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Carolan M, Steele C, Margetts H. Attitudes towards gestational diabetes among a multiethnic cohort in Australia. J Clin Nurs 2010; 19:2446-53. [DOI: 10.1111/j.1365-2702.2010.03305.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Campbell-Grossman C, Hudson DB, Keating-Lefler R, Yank JR, Obafunwa T. Community Leaders' Perceptions of Hispanic, Single, Low-Income Mothers' Needs, Concerns, Social Support, and Interactions with Health Care Services. ACTA ACUST UNITED AC 2009; 32:31-46. [DOI: 10.1080/01460860802610194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
In response to federal requests for investigation into measures to eradicate health disparities, a concept analysis of the term health disparity was conducted. Health-related and multidisciplinary literature was reviewed. Multiple terms were explored alone and in combination with no limitations on search date parameters. Findings indicated several definitions of the concept,with the term health care disparity being used interchangeably with the term health disparity. New theoretical and operational definitions, antecedents, characteristics, and consequences of the concept are proffered. Model, borderline, and contrary cases are developed to illustrate the concept. Nursing implications and recommendations for future research are discussed.
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Affiliation(s)
- Fiona Cross-Sudworth
- Community Midwifery Office, Birmingham Heartlands Hospital, Bordesley Green, Birmingham
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