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Gannon M, Hand D, Short V, McLaughlin K, Flood T, Shaffer K, Lenegan N, Abatemarco D, DiDonato S. Maternal Perspective of Inpatient Methadone Initiation: Opportunities to Increase Retention in Treatment. J Addict Med 2024; 18:122-128. [PMID: 38039080 DOI: 10.1097/adm.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Recent trends demonstrate increases in the rates of opioid use among pregnant and parenting women. Treatment for pregnant people with opioid use disorder (OUD) includes medications for OUD, like methadone, as well as comprehensive support services. Still, inpatient treatment engagement is suboptimal and treatment drop out is common. There is little research examining the maternal perspective of the inpatient methadone initiation experience. The primary aim of this qualitative methods study was to explore patient experience and perspective of the inpatient methadone initiation period. METHODS All participants were recruited from a single urban university affiliated hospital and OUD treatment program. Data were collected from 30 maternal participants in OUD treatment about their inpatient methadone initiation experience while pregnant using semistructured interviews. Thematic analyses were conducted using an inductive approach after an iterative process of code development and application among a multidisciplinary team of 3 coders. Validity was accounted for through 2 participant feedback interviews and study team review and discussion of findings. RESULTS Four themes emerged from the maternal interview data: (1) Barriers to Inpatient Methadone Initiation, (2) Facilitators to Inpatient Methadone Initiation, (3) Transition From Hospital Inpatient to Outpatient or Residential OUD Treatment Services, and (4) Opportunities for Enhanced Clinical Support. CONCLUSION Maternal participants reported multiple barriers and facilitators to inpatient care during methadone initiation, highlighting opportunities for improvement to effectively engage pregnant individuals in treatment.
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Affiliation(s)
- Meghan Gannon
- From the College of Nursing, Thomas Jefferson University, Philadelphia, PA
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Panushka KA, Kozlowski Z, Dalessandro C, Sanders JN, Millar MM, Gawron LM. "It's Not a Top Priority": A Qualitative Analysis of Provider Views on Barriers to Reproductive Healthcare Provision for Homeless Women in the United States. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:428-436. [PMID: 38361354 PMCID: PMC10908250 DOI: 10.1080/19371918.2024.2315180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Women experiencing housing insecurity are at an elevated risk for adverse reproductive health outcomes due to the prevalence of chronic health conditions and higher risk behaviors. Social service and healthcare providers are front line in addressing women's needs when they seek support. Thus, we sought to explore reproductive healthcare barriers using in-depth interviews with 17 providers at 11 facilities serving housing-insecure women in Salt Lake County, Utah, USA from April to July 2018. Providers noted a number of system-, provider-, and individual-level barriers. Dominant themes include reliance on unstable funding, lack of provider training on reproductive health, and perceived logistical challenges to care. Due to the prevalence of immediate needs among housing-insecure women, providers attest that reproductive health needs often do not emerge as their urgent concern. Our findings suggest that addressing policy and funding challenges to prioritizing reproductive needs among housing-insecure women can help mitigate the potential for long-term adverse reproductive outcomes.
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Affiliation(s)
| | - Zoe Kozlowski
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Morgan M. Millar
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lori M. Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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Robinson KN, Gresh A, Russell N, Jeffers NK, Alexander KA. Housing instability: Exploring socioecological influences on the health of birthing people. J Adv Nurs 2023; 79:4255-4267. [PMID: 37313997 DOI: 10.1111/jan.15684] [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: 09/01/2022] [Revised: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 06/15/2023]
Abstract
STUDY AIM To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people. DESIGN We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews. METHODS We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences. RESULTS Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression. CONCLUSION Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement. IMPACT This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting. PATIENT OR PUBLIC CONTRIBUTION Members of the public participated in this study as key informants for study interviews.
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Affiliation(s)
| | - Ashley Gresh
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | | | - Noelene K Jeffers
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kamila A Alexander
- Department of Population, Family, and Reproductive Health, Johns Hopkins School of Nursing, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bitnun A, Sauvé L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Paediatr Child Health 2023; 28:307-323. [PMID: 37484040 PMCID: PMC10362956 DOI: 10.1093/pch/pxad014] [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: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Bitnun A, Sauvé L, Fanella S. La réduction du risque d'infection périnatale chez les nouveau-nés de mères dont les soins prénatals étaient inappropriés. Paediatr Child Health 2023; 28:307-323. [PMID: 37484035 PMCID: PMC10362960 DOI: 10.1093/pch/pxad015] [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: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Le risque que des infections maternelles ne soient ni décelées ni traitées augmente lorsque les soins prénatals sont inappropriés, ce qui met la santé de la mère et de son nouveau-né à risque. Lorsqu'une femme enceinte se présente tardivement pour recevoir des soins, les tests systématiques qui influent sur la prise en charge du nouveau-né devraient inclure l'antigène de surface de l'hépatite B (AgHBs), la sérologie du virus de l'hépatite C (VHC), du virus de l'immunodéficience humaine (VIH) et de la syphilis, de même que le dépistage de la Chlamydia trachomatis et de la Neisseria gonorrhoeae. Si la mère ne s'est pas soumise aux dépistages avant ou après l'accouchement et qu'elle n'est pas disponible pour s'y soumettre, il faudrait procéder au dépistage du VIH, du virus de l'hépatite B (VHB), du VHC et de la syphilis chez le nouveau-né. Le dépistage de la C. trachomatis et de la N. gonorrhoeae est toutefois réservé aux cas où le nouveau-né démontre des manifestations cliniques compatibles avec ces infections. Il est optimal d'obtenir rapidement les résultats du dépistage du VIH, du VHB et de la syphilis, car l'utilisation des traitements préventifs est circonscrite dans le temps. Il existe des interventions préventives précoces et efficaces pour les nouveau-nés à risque de VIH, de VHB, de syphilis ou de gonorrhée. Un suivi clinique étroit et des tests de suivi s'imposent auprès des nouveau-nés de mères dont les soins prénatals étaient inappropriés, car il est impossible d'exclure pleinement toutes les infections pendant la période périnatale.
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Affiliation(s)
- Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Laura Sauvé
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Sergio Fanella
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
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Green JM, Fabricant SP, Duval CJ, Panchal VR, Cahoon SS, Mandelbaum RS, Ouzounian JG, Wright JD, Matsuo K. Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy. JAMA Netw Open 2023; 6:e2326352. [PMID: 37523185 PMCID: PMC10391303 DOI: 10.1001/jamanetworkopen.2023.26352] [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] [Received: 01/19/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023] Open
Abstract
Importance Unhoused status is a substantial problem in the US. Pregnancy characteristics and maternal outcomes of individuals experiencing homelessness are currently under active investigation to optimize health outcomes for this population. Objective To assess the trends, characteristics, and maternal outcomes associated with unhoused status in pregnancy. Design, Setting, and Participants This cross-sectional study analyzed data from the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample. The study population included hospitalizations for vaginal and cesarean deliveries from January 1, 2016, to December 31, 2020. Unhoused status of these patients was identified from use of International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code Z59.0. Statistical analysis was conducted from December 2022 to June 2023. Main Outcomes and Measures Primary outcomes were (1) temporal trends; (2) patient and pregnancy characteristics associated with unhoused status, which were assessed with a multivariable logistic regression model; (3) delivery outcomes, including severe maternal morbidity (SMM) and mortality at delivery, which used the Centers for Disease Control and Prevention definition for SMM indicators and were assessed with a propensity score-adjusted model; and (4) choice of long-acting reversible contraception method and surgical sterilization at delivery. Results A total of 18 076 440 hospital deliveries were included, of which 18 970 involved pregnant patients who were experiencing homelessness at the time of delivery, for a prevalence rate of 104.9 per 100 000 hospital deliveries. These patients had a median (IQR) age of 29 (25-33) years. The prevalence of unhoused patients increased by 72.1% over a 5-year period from 76.1 in 2016 to 131.0 in 2020 per 100 000 deliveries (P for trend < .001). This association remained independent in multivariable analysis. In addition, (1) substance use disorder (tobacco, illicit drugs, and alcohol use disorder), (2) mental health conditions (schizophrenia, bipolar, depressive, and anxiety disorders, including suicidal ideation and past suicide attempt), (3) infectious diseases (hepatitis, gonorrhea, syphilis, herpes, and COVID-19), (4) patient characteristics (Black and Native American race and ethnicity, younger and older age, low or unknown household income, obesity, pregestational hypertension, pregestational diabetes, and asthma), and (5) pregnancy characteristics (prior uterine scar, excess weight gain during pregnancy, and preeclampsia) were associated with unhoused status in pregnancy. Unhoused status was associated with extreme preterm delivery (<28-week gestation: 34.3 vs 10.8 per 1000 deliveries; adjusted odds ratio [AOR], 2.76 [95% CI, 2.55-2.99]); SMM at in-hospital delivery (any morbidity: 53.8 vs 17.7 per 1000 deliveries; AOR, 2.30 [95% CI, 2.15-2.45]); and in-hospital mortality (0.8 vs <0.1 per 1000 deliveries; AOR, 10.17 [95% CI, 6.10-16.94]), including case fatality risk after SMM (1.5% vs 0.3%; AOR, 4.46 [95% CI, 2.67-7.45]). Individual morbidity indicators associated with unhoused status included cardiac arrest (AOR, 12.43; 95% CI, 8.66-17.85), cardiac rhythm conversion (AOR, 6.62; 95% CI, 3.98-11.01), ventilation (AOR, 6.24; 95% CI, 5.03-7.74), and sepsis (AOR, 5.37; 95% CI, 4.53-6.36). Conclusions and Relevance Results of this national cross-sectional study suggest that unhoused status in pregnancy gradually increased in the US during the 5-year study period and that pregnant patients with unhoused status were a high-risk pregnancy group.
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Affiliation(s)
- Jessica M. Green
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Sonya P. Fabricant
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Christina J. Duval
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Viraj R. Panchal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Sigita S. Cahoon
- Division of Obstetrics, Gynecology and Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Rachel S. Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Joseph G. Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Jason D. Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Single-Centre Retrospective Cohort Study of Demographic Characteristics and Perinatal Outcomes in Pregnant Refugee Patients in Toronto, Canada. J Immigr Minor Health 2023; 25:529-538. [PMID: 36637689 DOI: 10.1007/s10903-022-01447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
Pregnant refugee patients are especially vulnerable to adverse perinatal outcomes. Detailed characterization of this heterogenous population will identify risk factors and thus guide contextualized initiatives for improved patient care. A retrospective cohort study of obstetrical refugee patients at a tertiary-care hospital in Toronto, Ontario. Of 196 pregnant refugees, 48% were fluent English speaking, 57% had poor social support, and 42% lived in a shelter. Eighty-seven percent started prenatal care after the first trimester, which was associated with delivery of a large-for-gestational-age infant (p = 0.043). Sixteen percent experienced family violence, which was associated with poor fetal aggregate outcomes (p = 0.03). There were significantly higher rates of pre-eclampsia and Cesarean sections in refugee versus non-refugee patients (p < 0.05). Pregnant refugees are at risk for psychosocial challenges and experience significantly worse obstetrical outcomes compared with non-refugees. Quality improvement initiatives should focus on access to early prenatal care, stable housing, and support for victims of family violence.
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Carlson JM, Zanobetti A, Ettinger de Cuba S, Poblacion AP, Fabian PM, Carnes F, Rhee J, Lane KJ, Sandel MT, Janulewicz PA. Critical windows of susceptibility for the effects of prenatal exposure to heat and heat variability on gestational growth. ENVIRONMENTAL RESEARCH 2023; 216:114607. [PMID: 36279910 DOI: 10.1016/j.envres.2022.114607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Studies have shown that prenatal heat exposure may impact fetal growth, but few studies have examined the critical windows of susceptibility. As extreme heat events and within season temperature variability is expected to increase in frequency, it is important to understand how this may impact gestational growth. OBJECTIVES We investigated associations between various measures of weekly prenatal heat exposure (mean and standard deviation (SD) of temperature and heat index (HI), derived using temperature in °C and dew point) and term birthweight or odds of being born small for gestational age (SGA) to identify critical windows of susceptibility. METHODS We analyzed data from mother-child dyads (n = 4442) in the Boston-based Children's HealthWatch cohort. Birthweights were collected from survey data and electronic health records. Daily temperature and HI values were obtained from 800 m gridded spatial climate datasets aggregated by the PRISM Climate Group. Distributed lag-nonlinear models were used to assess the effect of the four weekly heat metrics on measures of gestational growth (birthweight, SGA, and birthweight z-scores). Analyses were stratified by child sex and maternal homelessness status during pregnancy. RESULTS HI variability was significantly associated with decreased term birthweight during gestational weeks 10-29 and with SGA for weeks 9-26. Cumulative effects for these time periods were -287.4 g (95% CI: -474.1 g, -100.8 g for birthweight and 4.7 (95% CI: 1.6, 14.1) for SGA. Temperature variability was also significantly associated with decreased birthweight between weeks 15 and 26. The effects for mean heat measures on term birthweight and SGA were not significant for any gestational week. Stratification by sex revealed a significant effect on term birthweight in females between weeks 23-28 and in males between weeks 9-26. Strongest effects of HI variability on term birthweight were found in children of mothers who experienced homelessness during pregnancy. Weekly HI variability was the heat metric most strongly associated with measures of gestational growth. The effects observed were largest in males and those who experienced homelessness during pregnancy. DISCUSSION Given the impact of heat variability on birthweight and risk of SGA, it is important for future heat warnings to incorporate measure of heat index and temperature variability.
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Affiliation(s)
- Jeffrey M Carlson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie Ettinger de Cuba
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA; Children's HealthWatch, USA
| | - Ana P Poblacion
- Children's HealthWatch, USA; Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Patricia M Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Fei Carnes
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jongeun Rhee
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Megan T Sandel
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA; Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Beldick SR, Rohde JF, Short VL, Abatemarco D, Goyal NK. Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure. J Health Care Poor Underserved 2023; 34:161-179. [PMID: 37464487 PMCID: PMC10483573 DOI: 10.1353/hpu.2023.0011] [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: 02/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care. METHODS Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated. RESULTS Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties). CONCLUSIONS Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.
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Affiliation(s)
| | | | - Vanessa L. Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Diane Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Neera K. Goyal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
- Nemours Children’s Health, Philadelphia, PA
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Henriques E, Schmidt C, Pascoe R, Liss K, Begun S. Counter-Narratives of Structural Oppressions, Stigma and Resistance, and Reproductive and Sexual Health Among Youth Experiencing Homelessness. QUALITATIVE HEALTH RESEARCH 2022; 32:1447-1463. [PMID: 35739061 PMCID: PMC9411701 DOI: 10.1177/10497323221110694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Youth experiencing homelessness (YEH) face myriad injustices regarding their reproductive and sexual health and rights. Reproductive and sexual health research with YEH often explores condom-use and sexually transmitted infections, potentially contributing to narrow conceptualizations of YEH as "unclean" or in need of disease-screening. A narrative theory perspective was applied to this study, which allowed for the emergence of alternative storylines, or counter-narratives, which attend to manifestations of power and oppression within the lives of marginalized individuals. Qualitative interviews engaged 30 young people (ages 18-21) accessing shelter services. Narrative analyses identified YEHs' documentations of dominant narratives related to structural oppressions, stigma, and numerous dimensions of reproductive and sexual health including how they create, through their resistance, counter-narratives that include their preferred futures. YEH emphasized systemic sources of stigma and outlined their criticisms of the state. Within-group stigma emerged as a noteworthy theme, with YEH showing both empathy and ambivalence towards other YEH, along with internalization of stigmatizing narratives about pregnancy and homelessness. Approaches to service provision that further amplify youths' voices in naming and challenging the many oppressions and stigmas they face should be prioritized. Moreover, policies should be implemented to dismantle the actual root causes of challenges faced by YEH, rather than perpetuating them through measures rooted in interlocking oppressions of discrimination, inequity, and judgment.
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Affiliation(s)
- Emilia Henriques
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Catherine Schmidt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachael Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kira Liss
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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The Effect of COVID-19 Infection During Pregnancy; Evaluating Neonatal Outcomes and the Impact of the B.1.1.7. Variant. Pediatr Infect Dis J 2021; 40:e475-e481. [PMID: 34620797 PMCID: PMC8575080 DOI: 10.1097/inf.0000000000003352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with adverse perinatal outcomes. We aim to evaluate the neonatal outcomes including the incidence of preterm birth, admission to the neonatal unit and incidence of congenital anomalies in this cohort. We will also describe these outcomes in the context of the B.1.1.7. variant outbreak, the dominant variant in Ireland since January 2021, which has had a greater impact on pregnant patients. METHODS This was a retrospective study of liveborn infants, delivered between 1st March 2020 and 1st March 2021, to women with a severe acute respiratory syndrome coronavirus 2 diagnosis during pregnancy, in a tertiary maternity hospital (8,500 deliveries/year). Clinical data were collected, and analyses were performed to evaluate the impact of maternal symptom status, time from diagnosis to delivery and the B.1.1.7. variant on neonatal outcome. RESULTS In total 133 infants (1.6%) were born to women with severe acute respiratory syndrome coronavirus 2 identified during pregnancy. The median birth weight was 3.45 kg and gestational age at birth was 39.3 weeks. 14 infants (10.5%) were preterm. 22 infants (16.5%) required admission to the neonatal unit and 7 (5.3%) were small for gestational age. There was no difference in growth, preterm birth or neonatal unit admission based on maternal symptom status or infection after the outbreak of B.1.1.7. as the dominant strain. CONCLUSIONS Following a COVID-19 infection in pregnancy, there was no increase in the incidence of preterm birth or neonatal intensive care unit admission compared with 5-year hospital data. Maternal symptom status did not influence neonatal outcomes. Further studies to evaluate the impact of COVID-19 in early pregnancy, the variants of concern, particularly the emerging Delta variant and COVID-19 placentitis are required.
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12
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Homelessness in pregnancy: perinatal outcomes. J Perinatol 2021; 41:2742-2748. [PMID: 34404925 PMCID: PMC9507167 DOI: 10.1038/s41372-021-01187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/03/2021] [Accepted: 08/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Investigate the association between maternal homelessness at the time of delivery and perinatal outcomes, with a focus on neonatal health outcomes. STUDY DESIGN Population-based cohort using California's statewide database included 1,520,253 women with linked birth and maternal discharge data, 2008-2012. Multivariable analysis assessed homelessness at time of delivery on perinatal outcomes, preterm delivery, and neonatal intensive care unit admission. RESULT A total of 672 women (0.05%) were homeless at the time of delivery. Homelessness was associated with premature delivery at multiple gestational age cutoffs (34w0d-36w6d; 32w0d-33w6d; 28w0d-31w6d; <28w0d) (range of aORs:1.62-2.19), and neonatal intensive care unit admission (aOR = 1.66, 95% CI:1.31-2.09). Among term infants, homelessness remained associated with increased odds of neonatal intensive care unit admission (aOR = 1.84, 95% CI:1.34-2.53), low birthweight (aOR = 1.99, 95% CI:1.36-2.90), neonatal abstinence syndrome (aOR = 2.13, 95% CI:1.35-2.53), hypoxic-ischemic encephalopathy (aOR = 14.38, 95% CI:3.90-53.01), and necrotizing enterocolitis (aOR = 14.94, 95% CI:2.68-83.20). CONCLUSION Homelessness in pregnancy was associated with adverse perinatal outcomes including increased odds of preterm delivery across all gestational ages, and increased risk of neonatal intensive care unit admission and low birth weight independent of preterm delivery.
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Alamneh TS, Teshale AB, Worku MG, Tessema ZT, Yeshaw Y, Tesema GA, Liyew AM, Alem AZ. Preterm birth and its associated factors among reproductive aged women in sub-Saharan Africa: evidence from the recent demographic and health surveys of sub-Sharan African countries. BMC Pregnancy Childbirth 2021; 21:770. [PMID: 34781891 PMCID: PMC8591945 DOI: 10.1186/s12884-021-04233-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally, preterm birth is the leading cause of neonatal and under-five children mortality. Sub-Saharan African (SSA) accounts for the majority of preterm birth and death following its complications. Despite this, there is limited evidence about the pooled prevalence and associated factors of preterm birth at SSA level using nation-wide representative large dataset. Therefore, this study aimed to determine the pooled prevalence and associated factors of preterm birth among reproductive aged women. METHODS The recent Demographic and Health Surveys (DHSs) data of 36 SSA countries were used. We included a total weighted sample of 172,774 reproductive-aged women who were giving birth within five years preceding the most recent survey of SSA countries were included in the analysis. We used a multilevel logistic regression model to identify the associated factors of preterm birth in SSA. We considered a statistical significance at a p-value less than 0.05. RESULTS In this study, 5.33% (95% CI: 5.23, 5.44%) of respondents in SSA had delivered preterm baby. Being form eastern Africa, southern Africa, rural area, being educated, substance use, having multiple pregnancy, currently working history, having history of terminated pregnancy, and previous cesarean section delivery, primi-parity, and short birth interval were associated with higher odds of preterm birth among reproductive aged women. However, having better wealth index, being married, wanted pregnancy, and having four or more antenatal care visit were associated with lower odds for a preterm birth among reproductive aged women. CONCLUSION The prevalence of preterm birth among reproductive-aged women remains a major public health problem in SSA. Preterm birth was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during intervention to prevent the short-term and long-term consequences of preterm birth.
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Affiliation(s)
- Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [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: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Conard PL, Keller MJ, Armstrong ML. The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless. Nurs Womens Health 2021; 25:471-481. [PMID: 34736917 DOI: 10.1016/j.nwh.2021.09.007] [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: 03/14/2021] [Revised: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.
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DiTosto JD, Holder K, Soyemi E, Beestrum M, Yee LM. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM 2021; 3:100477. [PMID: 34481998 PMCID: PMC9057001 DOI: 10.1016/j.ajogmf.2021.100477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the published literature on housing instability during pregnancy and adverse pregnancy outcomes and perinatal healthcare utilization. DATA SOURCES We performed a systematic search in November 2020 using Embase, MEDLINE, Cochrane Library, and Scopus using terms related to housing instability during pregnancy, adverse pregnancy outcomes, and perinatal healthcare utilization. The search was limited to the United States. STUDY ELIGIBILITY CRITERIA Studies examining housing instability (including homelessness) during pregnancy and adverse pregnancy outcomes (including preterm birth, low birthweight neonates, and maternal morbidity) and perinatal healthcare utilization were included. METHODS Two authors screened abstracts and full-length articles for inclusion. The final cohort consisted of 14 studies. Two authors independently extracted data from each article and assessed the study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Risk of bias was assessed using the National Institutes of Health Study Quality Assessment Tools. RESULTS All included studies were observational, including retrospective cohort (n=10, 71.4%), cross-sectional observational (n=3, 21.4%), or prospective cohort studies (n=1, 7.1%). There was significant heterogeneity in the definitions of housing instability and homelessness. Most of the studies only examined homelessness (n=9, 64.3%) and not lesser degrees of housing instability. Housing instability and homelessness during pregnancy were significantly associated with preterm birth, low birthweight neonates, neonatal intensive care unit admission, and delivery complications. Among studies examining perinatal healthcare utilization, housing instability was associated with inadequate prenatal care and increased hospital utilization. All studies exhibited moderate, low, or very low study quality and fair or poor internal validity. CONCLUSION Although data on housing instability during pregnancy are limited by the lack of a standardized definition, a consistent relationship between housing instability and adverse pregnancy outcomes has been suggested by this systematic review. The evaluation and development of a standardized definition and measurement of housing instability among pregnant individuals is warranted to address future interventions targeted to housing instability during pregnancy.
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Affiliation(s)
- Julia D DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Ms Holder, Ms Soyemi, and Dr Yee); Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum)
| | - Kai Holder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Ms Holder, Ms Soyemi, and Dr Yee); Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum)
| | - Elizabeth Soyemi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Ms Holder, Ms Soyemi, and Dr Yee); Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum)
| | - Molly Beestrum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Ms Holder, Ms Soyemi, and Dr Yee); Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum)
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Ms Holder, Ms Soyemi, and Dr Yee); Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum).
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Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation 2021; 144:e251-e269. [PMID: 34493059 DOI: 10.1161/cir.0000000000001000] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association's mission "to be a relentless force for longer, healthier lives," this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers' lives.
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18
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Freedman AA, Smart BP, Keenan-Devlin LS, Borders A, Ernst LM, Miller GE. Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery. J Epidemiol Community Health 2021; 76:398-403. [PMID: 34607891 DOI: 10.1136/jech-2020-215377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes. METHODS We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups. RESULTS Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies. CONCLUSION Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.
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Affiliation(s)
- Alexa A Freedman
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA .,Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Linda M Ernst
- Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Gregory E Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA.,Department of Psychology, Northwestern University, Evanston, Illinois, USA
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Yamamoto A, Gelberg L, Needleman J, Kominski G, Vangala S, Miyawaki A, Tsugawa Y. Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness. JAMA Netw Open 2021; 4:e217491. [PMID: 33885772 PMCID: PMC8063065 DOI: 10.1001/jamanetworkopen.2021.7491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Women and families constitute the fastest-growing segments of the homeless population. However, there is limited evidence on whether women experiencing homelessness have poorer childbirth delivery outcomes and higher costs of care compared with women not experiencing homelessness. OBJECTIVE To compare childbirth delivery outcomes and costs of care between pregnant women experiencing homelessness vs those not experiencing homelessness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 15 029 pregnant women experiencing homelessness and 308 242 pregnant women not experiencing homelessness who had a delivery hospitalization in 2014. The study used statewide databases that included all hospital admissions in 3 states (ie, Florida, Massachusetts, and New York). Delivery outcomes and delivery-associated costs were compared between pregnant women experiencing homelessness and those not experiencing homelessness cared for at the same hospital (analyzed using the overlap propensity-score weighting method and multivariable regression models with hospital fixed effects). The Benjamini-Hochberg false discovery rate procedure was used to account for multiple comparisons. Data were analyzed from January 2020 through May 2020. EXPOSURE Housing status at delivery hospitalization. MAIN OUTCOMES AND MEASURES Outcome variables included obstetric complications (ie, antepartum hemorrhage, placental abnormalities, premature rupture of the membranes, preterm labor, and postpartum hemorrhage), neonatal complications (ie, fetal distress, fetal growth restriction, and stillbirth), delivery method (ie, cesarean delivery), and delivery-associated costs. RESULTS Among 15 029 pregnant women experiencing homelessness (mean [SD] age, 28.5 [5.9] years) compared with 308 242 pregnant women not experiencing homelessness (mean [SD] age, 29.4 [5.8] years) within the same hospital, those experiencing homelessness were more likely to experience preterm labor (adjusted probability, 10.5% vs 6.7%; adjusted risk difference [aRD], 3.8%; 95% CI, 1.2%-6.5%; adjusted P = .03) and had higher delivery-associated costs (adjusted costs, $6306 vs $5888; aRD, $417; 95% CI, $156-$680; adjusted P = .02) compared with women not experiencing homelessness. Those experiencing homelessness also had a higher probability of placental abnormalities (adjusted probability, 4.0% vs 2.0%; aRD, 1.9%; 95% CI, 0.4%-3.5%; adjusted P = .053), although this difference was not statistically significant. CONCLUSIONS AND RELEVANCE This study found that women experiencing homelessness, compared with those not experiencing homelessness, who had a delivery and were admitted to the same hospital were more likely to experience preterm labor and incurred higher delivery-associated costs. These findings suggest wide disparities in delivery-associated outcomes between women experiencing homelessness and those not experiencing homelessness in the US. The findings highlight the importance for health care professionals to actively screen pregnant women for homelessness during prenatal care visits and coordinate their care with community health programs and social housing programs to make sure their health care needs are met.
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Affiliation(s)
- Ayae Yamamoto
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
- Department of Healthcare Economics, UnitedHealthcare, Cypress, California
| | - Lillian Gelberg
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
- University of California, Los Angeles Center for Health Policy Research
| | - Gerald Kominski
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
- University of California, Los Angeles Center for Health Policy Research
| | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles
| | - Atsushi Miyawaki
- Department of Public Health, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Tsugawa
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
- University of California, Los Angeles Center for Health Policy Research
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles
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Modern Contraceptive Utilization and Determinant Factors among Street Reproductive-Aged Women in Amhara Regional State Zonal Towns, North West Ethiopia, 2019: Community-Based Study. Int J Reprod Med 2020; 2020:7345820. [PMID: 33354561 PMCID: PMC7737461 DOI: 10.1155/2020/7345820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/04/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Reproductive-aged women living on the street, with no doubt, are with lesser benefits of exercising their reproductive rights. Pregnancies from this marginalized population are likely to be unplanned, unwanted, and unsupported. The aim of this study, therefore, was to assess modern contraception utilization and associated factors among street reproductive-aged women in Amhara regional state zonal towns. Method A community-based cross-sectional study was conducted among street reproductive-aged women in Amhara regional state zonal towns. A single population proportion formula was used to calculate the sample size, a similar literature-based tool adaptation was done, and a semistructured, pretested sectioned questionnaire was used. Cluster sampling technique was used to reach the study participants. Data was entered into Epi Info version 7 and exported to SPSS version 23 for analysis. A multivariable logistic regression model was fitted to control the possible effect of confounders, and finally, the independent variables were identified on the basis of OR, with 95% CI and p values less than 0.05. Results 604 street reproductive-aged women were interviewed in the study which make the response rate 94.2%. The study revealed that current modern contraceptive utilization among the study participants was found to be 38.9%. Having history of pregnancy in street life (AOR = 1.70, 1.1-2.7), having three or more live children (AOR = 6.4, 2.0-20.4), undesiring to have additional children in the future (AOR = 2.7, 1.4-5.1), mentioning three to four (AOR = 2.2, 1.5-3.3) and five or more modern contraceptive types (AOR = 5.5, 1.4-21.0), and discussion with sexual partners for contraceptive use (AOR = 6.6, 4.3-10.1) were variables significantly associated with modern contraceptive utilization. Modern contraceptive utilization among the street reproductive-aged women was low. Authors suggest that awareness creation and male partner involvement in the maternal services may be important to increase contraceptive utilization.
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McGeough C, Walsh A, Clyne B. Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: A qualitative evidence synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1380-1393. [PMID: 32147895 DOI: 10.1111/hsc.12972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Evidence indicates that homelessness is increasing within Europe and the United States (US), particularly for women. Pregnancy rates among homeless women are exceptionally high compared to their housed counterparts and homeless women engage poorly with antenatal care. The aim of this review is to explore the barriers and facilitators perceived by homeless women, while pregnant, or within six weeks postpartum in accessing antenatal and/or postnatal healthcare. A qualitative systematic review and synthesis was conducted. Key words and search terms were derived using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Titles and abstracts were screened in accordance with inclusion and exclusion criteria. The methodological quality of included papers was assessed using criteria described by the Critical Appraisal Skills Programme (CASP) with data analysis using thematic synthesis. Two primary linked themes were generated: (a) lack of person-centred care; (b) complexity of survival. At an organisational level, a fragmented health service and accessibility to the health system were barriers, and resulted in poor person-centred care. At a clinical level, attitude & treatment from healthcare providers together with health knowledge all combined to illustrate poor person-centred care as barriers to homeless women accessing antenatal/postnatal healthcare. Sub-themes associated with complexity of survival included: disillusion with life, distrust of services, competing lifestyle demands and support and relationships. The findings of this review highlight that poor engagement may be partly explained by the complex interplay between both the healthcare system (person-centred care) and the individual (complexity of survival). Future services should be delivered in a way that recognises homeless people's complex and diverse needs, and should be reconfigured in order to try to meet them, through decreasing fragmentation of health services and staff training.
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Affiliation(s)
- Christine McGeough
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Our Lady of Lourdes Hospital, Royal College of Surgeons Hospital Group, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Begun S, Weber A, Spring J, Arora SRA, Frey C, Fortin A. "This Research Is Cool": Engaging Youth Experiencing Homelessness in Research on Reproductive and Sexual Health. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:271-281. [PMID: 32631161 DOI: 10.1080/19371918.2020.1791296] [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: 06/11/2023]
Abstract
Youth experiencing homelessness face myriad barriers and inequities regarding their reproductive and sexual health and rights. Moreover, homeless youth are often characterized as "disaffiliated" and depicted as difficult to engage in research. This study qualitatively explored homeless youths' attitudes, beliefs, and needs regarding reproductive and sexual health, and sought their perspectives on being involved in research on such topics, which are often thought of as "taboo" or sensitive. Youth were enthusiastic about openly discussing such issues, which they deemed as highly relevant to their daily lives. Youth identified that how they were engaged in such research, and having opportunities for longer-term contributions to such efforts, were both important and exciting to them. Future social work and public health research efforts should seek to further disrupt narratives of homeless youth as "disaffiliated" and difficult to engage, and in doing so, develop more creative, participatory, and youth-led opportunities for including this group in reproductive and sexual health research.
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Affiliation(s)
- Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Ariel Weber
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Joshua Spring
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Simran R A Arora
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Cressida Frey
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Alicia Fortin
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
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Colciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women's vulnerability within the childbearing continuum: A scoping review. Eur J Midwifery 2020; 4:18. [PMID: 33537620 PMCID: PMC7839125 DOI: 10.18332/ejm/120003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The aim of this scoping review is to explore the concept of ‘vulnerability’ affecting pregnant women and to identify an appropriate definition of this term. METHODS Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue. RESULTS Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers. CONCLUSIONS The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.
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Affiliation(s)
| | - Beatrice Merazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Haile K, Umer H, Ayano G, Fejo E, Fanta T. A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia. BMC Psychiatry 2020; 20:204. [PMID: 32375717 PMCID: PMC7203867 DOI: 10.1186/s12888-020-02626-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia. METHODS A qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis. RESULTS Four major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances. CONCLUSION Factors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.
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Affiliation(s)
- Kibrom Haile
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Halima Umer
- Clinical Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Edao Fejo
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tolesa Fanta
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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Milaney K, Williams N, Lockerbie SL, Dutton DJ, Hyshka E. Recognizing and responding to women experiencing homelessness with gendered and trauma-informed care. BMC Public Health 2020; 20:397. [PMID: 32216770 PMCID: PMC7099814 DOI: 10.1186/s12889-020-8353-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/13/2020] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study is to highlight the experiences of women who are often hidden in what we know and understand about homelessness, and to make policy and practice recommendations for women-centred services including adaptations to current housing interventions. Methods Three hundred survey interviews were conducted with people experiencing homelessness in Calgary, Alberta, Canada. The survey instrument measured socio-demographics, adverse childhood experiences, mental and physical health, and perceived accessibility to resources. Eighty-one women participants were identified as a subsample to be examined in greater depth. Descriptive statistics and logistic regressions were calculated to provide insight into women respondents’ characteristics and experiences of homelessness and how they differed from men’s experiences. Results Women’s experiences of homelessness are different from their male counterparts. Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma. The results should not be considered in isolation, as the literature suggests, because they are highly interconnected. Conclusion In order to ensure that women who are less visible in their experiences of homelessness are able to access appropriate services, it is important that service provision is both gender specific and trauma-informed. Current Housing First interventions should be adapted to ensure women’s safety is protected and their unique needs are addressed.
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Affiliation(s)
- Katrina Milaney
- Community Rehabilitation and Disability Studies, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Nicole Williams
- University of Calgary's School of Public Policy, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Stacy Lee Lockerbie
- Department of Nursing, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Daniel J Dutton
- Department of Community Health and Epidemiology at Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Elaine Hyshka
- School of Public Health at the University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
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Oni HT, Buultjens M, Blandthorn J, Davis D, Abdel-Latif M, Islam MM. Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives' experience. Midwifery 2019; 81:102595. [PMID: 31838337 DOI: 10.1016/j.midw.2019.102595] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/08/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience. AIM The study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs. DESIGN/SETTING A semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data. FINDINGS Of the seven themes identified under barriers, five could be categorised as "institution and provider-related", namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as 'client-related', namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were "institution and provider-related." They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE To the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives' willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.
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Affiliation(s)
- Helen Tosin Oni
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Melissa Buultjens
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, Royal Women's Hospital, Melbourne, VIC 3052, Australia
| | - Deborah Davis
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Mohamed Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, ACT 2605, Australia
| | - M Mofizul Islam
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia
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Rhee J, Fabian MP, Ettinger de Cuba S, Coleman S, Sandel M, Lane KJ, Yitshak Sade M, Hart JE, Schwartz J, Kloog I, Laden F, Levy JI, Zanobetti A. Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM 2.5 on Birthweight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4154. [PMID: 31661898 PMCID: PMC6862522 DOI: 10.3390/ijerph16214154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023]
Abstract
Few studies examined the impact of maternal socioeconomic status and of its combined effects with environmental exposures on birthweight. Our goal was to examine the impact of maternal homelessness (mothers ever homeless or who lived in shelters during pregnancy) and participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy in conjunction with air pollution exposure on birthweight in the Boston-based Children's HealthWatch cohort from 2007 through 2015 (n = 3366). Birthweight was obtained from electronic health records. Information on maternal homelessness and WIC participation during pregnancy were provided via a questionnaire. Prenatal fine particulate matter (PM2.5) exposures, estimated at the subject's residential address, were calculated for each trimester. We fit linear regression models adjusting for maternal and child characteristics, seasonality, and block-group-level median household income and examined the interactions between PM2.5 and each covariate. Prenatal maternal homelessness was associated with reduced birthweight (-55.7 g, 95% CI: -97.8 g, -13.7 g), while participating in WIC was marginally associated with increased birthweight (36.1 g, 95% CI: -7.3 g, 79.4 g). Only average PM2.5 during the second trimester was marginally associated with reduced birthweight (-8.5 g, 95% CI: -19.3, 2.3) for a 1 µg/m3 increase in PM2.5. The association of PM2.5 during the second trimester with reduced birthweight was stronger among non-Hispanic Black mothers and trended toward significance among immigrants and single mothers. Our study emphasizes the independent and synergistic effects of social and environmental stressors on birthweight, particularly the potentially protective effect of participating in WIC for vulnerable populations.
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Affiliation(s)
- Jongeun Rhee
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - M Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA.
| | | | - Sharon Coleman
- Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, MA 02118, USA.
| | - Megan Sandel
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118, USA.
- Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA.
| | - Kevin James Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA.
| | - Maayan Yitshak Sade
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Jaime E Hart
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Joel Schwartz
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Francine Laden
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA.
| | - Antonella Zanobetti
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
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Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. Am J Obstet Gynecol MFM 2019; 1:100053. [PMID: 33345843 DOI: 10.1016/j.ajogmf.2019.100053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization. OBJECTIVE The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth. STUDY DESIGN This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (<37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery, >4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression. RESULTS Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P < .001). CONCLUSION Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.
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Oni HT, Khan MN, Abdel-Latif M, Buultjens M, Islam MM. Short-term health outcomes of newborn infants of substance-using mothers in Australia and New Zealand: A systematic review. J Obstet Gynaecol Res 2019; 45:1783-1795. [PMID: 31313404 DOI: 10.1111/jog.14051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/22/2019] [Indexed: 12/22/2022]
Abstract
AIM Substance use is not unusual among women of childbearing age. Pregnant women who use a substance and the consequent impacts on a newborn vary across studies and settings. We reviewed New Zealand and Australian literature to examine the short-term health outcomes of newborn of substance-using mothers and their demographic characteristics. METHODS Five medical/nursing databases and google scholar were searched in April 2017. Studies were considered eligible if they described outcomes of newborn of substance-using mothers. Mixed Methods Appraisal Tool was used for quality assessment of candidate studies. Relevant data were extracted and analyzed using narrative synthesis. Based on data availability, a subset of studies was included in meta-analysis. RESULTS Although findings of individual studies vary, there are some evidence that the infants born to substance-using mothers were likely to have preterm birth, low birthweight, small-for-gestational age, low Apgar score, and admission to neo-natal intensive care unit. The likelihood of adverse health outcomes was much higher for newborns of polysubstance-using mothers, than newborns of mothers using a single substance. Pregnant women who use illicit substance are predominantly socially disadvantaged, in their twenties and or of Aboriginal descent. CONCLUSION Infants of substance-using mothers suffer a range of adverse health outcomes. Multidisciplinary and integrated approach of services that ensure supportive social determinants of health may result in a better outcome for newborn and positive behavioral change among mothers.
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Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Md Nuruzzaman Khan
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Mohamed Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australia
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
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Begun S, Combs KM, Torrie M, Bender K. "It seems kinda like a different language to us": Homeless youths' attitudes and experiences pertaining to condoms and contraceptives. SOCIAL WORK IN HEALTH CARE 2019; 58:237-257. [PMID: 30407128 DOI: 10.1080/00981389.2018.1544961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 06/08/2023]
Abstract
Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources.
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Affiliation(s)
- Stephanie Begun
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Katie Massey Combs
- b Graduate School of Social Work , University of Denver , Denver , CO USA
| | - Michaela Torrie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kimberly Bender
- b Graduate School of Social Work , University of Denver , Denver , CO USA
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Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness Contributes To Pregnancy Complications. Health Aff (Millwood) 2019; 38:139-146. [DOI: 10.1377/hlthaff.2018.05156] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robin E. Clark
- Robin E. Clark is a professor of family medicine and community health, University of Massachusetts Medical School, in Worcester
| | - Linda Weinreb
- Linda Weinreb is a professor of family medicine and community health, University of Massachusetts Medical School, and vice president and medical director for Medicaid at Fallon Health, in Worcester
| | - Julie M. Flahive
- Julie M. Flahive is a biostatistician in the Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Robert W. Seifert
- Robert W. Seifert is interim director of the Center for Health Law and Economics, University of Massachusetts Medical School
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32
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Reilly KH, Zimmerman R, Huynh M, Kennedy J, McVeigh KH. Characteristics of Mothers and Infants Living in Homeless Shelters and Public Housing in New York City. Matern Child Health J 2018; 23:572-577. [DOI: 10.1007/s10995-018-2672-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Oni HT, Buultjens M, Abdel-Latif ME, Islam MM. Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis. Women Birth 2018; 32:479-486. [PMID: 30528816 DOI: 10.1016/j.wombi.2018.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Maternal alcohol or other drug use during pregnancy is associated with a range of adverse health outcomes for mothers and their unborn child. The antenatal period presents an opportunity for health professionals to offer routine screening for alcohol or other drugs, to then provide intervention and referral for treatment and/or specialised support services. However, literature indicates that limited screening practices currently exist in maternity care settings. AIM To identify barriers to screening pregnant women for alcohol or other drugs in maternity care settings, from the perspectives of healthcare professionals. METHODS A comprehensive literature search was conducted in October 2017 to identify relevant studies. Seven databases that index health and social sciences literature, and google scholar, were searched. Eligible articles were subjected to critical appraisal. Extracted data from the eligible studies were synthesised using narrative synthesis. FINDINGS Nine studies were eligible for this review. The review identified seven key barriers to screening for alcohol or other drugs in pregnancy, namely competing priorities and time constraint; lack of adequate screening skills and clear protocol; relationship between healthcare providers and pregnant women; healthcare providers' perceptions; under-reporting or none/false disclosure; inconclusive evidence regarding the risk of alcohol or other drug use in pregnancy; and concerns about guilt and anxiety. CONCLUSIONS The narrative review revealed a range of barriers to screening for alcohol or other drugs in pregnancy. Further research in minimising the barriers is required to establish women-centred, evidence-base screening practices.
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Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia.
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
| | | | - M Mofizul Islam
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
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Sandel M, Sheward R, Ettinger de Cuba S, Coleman S, Heeren T, Black MM, Casey PH, Chilton M, Cook J, Cutts DB, Rose-Jacobs R, Frank DA. Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children. Pediatrics 2018; 142:peds.2017-4254. [PMID: 30177513 DOI: 10.1542/peds.2017-4254] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear. METHODS We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months. RESULTS After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58). CONCLUSIONS After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.
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Affiliation(s)
- Megan Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
| | - Richard Sheward
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | | | - Timothy Heeren
- Department of Biostatistics, School of Public Health, and
| | - Maureen M Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Patrick H Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mariana Chilton
- Department of Health Management and Policy, Dornfife School of Public Health, Drexel University, Philadelphia, Pennsylvania; and
| | - John Cook
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Diana Becker Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Ake T, Diehr S, Ruffalo L, Farias E, Fitzgerald A, Good SD, Howard LB, Kostelyna SP, Meurer LN. Needs Assessment for Creating a Patient-Centered, Community-Engaged Health Program for Homeless Pregnant Women. J Patient Cent Res Rev 2018; 5:36-44. [PMID: 31413995 DOI: 10.17294/2330-0698.1591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Women who experience homelessness during pregnancy have poorer birth outcomes than the general population. This exploratory research describes the needs assessment of homeless women currently living at a shelter in Milwaukee, Wisconsin, to identify unmet needs related to maternal and infant perinatal health as the first step in designing a mutually beneficial patient-centered service-learning program for medical students to address these needs. Methods Two 1-hour focus groups were held at a shelter for women who are homeless and/or victims of domestic violence. A total of 13 women participated in each session; four medical students and a physician served as facilitators and scribes at each session. The facilitators alternated asking predetermined open- and close-ended questions, followed by discussion among participants. Questions elicited experiences during pregnancy, what went well, what women living in the shelter struggled with, and what support they wished for but did not have. Scribes captured the conversation through hand-written notes and used content analysis in order of frequency. Results Thirteen themes were identified. The 5 most frequently identified themes were a need for pregnancy education, access/transportation, baby care, advocacy, and material necessities. Participating shelter residents and the medical students expressed interest in working with one another and forming a long-term partnership with the shelter. Conclusions Results of this needs assessment will inform the creation of a new shelter-based medical education program that will meet homeless women's needs while preparing medical students for patient-centered, community-responsive care.
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Affiliation(s)
- Tegan Ake
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sabina Diehr
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Leslie Ruffalo
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Emily Farias
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Ashton Fitzgerald
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Samuel D Good
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Lindsay B Howard
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Stefan P Kostelyna
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Linda N Meurer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
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Sutter MB, Gopman S, Leeman L. Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence. Obstet Gynecol Clin North Am 2017; 44:95-107. [DOI: 10.1016/j.ogc.2016.11.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Umo I. Esen
- Department of Obstetrics & Gynaecology, South Tyneside NHS Foundation Trust, Harton Lane, South Shields, Tyne and Wear, UK
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Wurst KE, Zedler BK, Joyce AR, Sasinowski M, Murrelle EL. A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:89-97. [PMID: 27679504 PMCID: PMC5026197 DOI: 10.4137/sart.s38887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/10/2016] [Accepted: 05/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. OBJECTIVE The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. METHODS Pregnant women and their corresponding births during 2005–2011 were identified in the Swedish Medical Birth Register. Data on stillbirth, neonatal/infant death, mode of delivery, gestational age at birth, Apgar score, growth outcomes, neonatal abstinence syndrome, and congenital malformations were examined. Frequencies were compared using two-sided Fisher’s exact tests. Unadjusted estimates of birth outcomes for women treated with buprenorphine or methadone were compared to the registered general population. RESULTS A total of 746,257 pregnancies among 538,178 unique women resulted in 746,485 live births. Among the 194 women treated with buprenorphine (N = 176) or methadone (N = 52), no stillbirths or neonatal/infant deaths occurred. Neonatal abstinence syndrome developed in 23.3% and 38.5% of infants born to mothers treated with buprenorphine and methadone, respectively. The frequency of the selected adverse birth outcomes assessed in women treated with buprenorphine as compared to the general population was not significantly different. However, a significantly higher frequency of preterm birth and congenital malformations was observed in women treated with methadone as compared to the general population. Compared with the general population, methadone-treated women were significantly older than buprenorphine-treated women, and both treatment groups began prenatal care later, were more likely to smoke cigarettes, and did not cohabitate with the baby’s father. CONCLUSIONS An increased frequency of the selected adverse birth outcomes was not observed with buprenorphine treatment during pregnancy. Twofold increased frequency of preterm birth [2.21 (1.11, 4,41)] and congenital malformations [2.05 (1.08, 3.87)] was observed in the methadone group, which may be partly explained by older average maternal age and differences in other measured and unmeasured confounders.
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Kenyon S, Jolly K, Hemming K, Hope L, Blissett J, Dann SA, Lilford R, MacArthur C. Lay support for pregnant women with social risk: a randomised controlled trial. BMJ Open 2016; 6:e009203. [PMID: 26936901 PMCID: PMC4785315 DOI: 10.1136/bmjopen-2015-009203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought evidence of effectiveness of lay support to improve maternal and child outcomes in disadvantaged families. DESIGN Prospective, pragmatic, individually randomised controlled trial. SETTING 3 Maternity Trusts in West Midlands, UK. PARTICIPANTS Following routine midwife systematic assessment of social risk factors, 1324 nulliparous women were assigned, using telephone randomisation, to standard maternity care, or addition of referral to a Pregnancy Outreach Worker (POW) service. Those under 16 years and teenagers recruited to the Family Nurse Partnership trial were excluded. INTERVENTIONS POWs were trained to provide individual support and case management for the women including home visiting from randomisation to 6 weeks after birth. Standard maternity care (control) included provision for referring women with social risk factors to specialist midwifery services, available to both arms. MAIN OUTCOME MEASURES Primary outcomes were antenatal visits attended and Edinburgh Postnatal Depression Scale (EPDS) 8-12 weeks postpartum. Prespecified, powered, subgroup comparison was among women with 2 or more social risks. Secondary outcomes included maternal and neonatal birth outcomes; maternal self-efficacy, and mother-to-infant bonding at 8-12 weeks; child development assessment at 6 weeks, breastfeeding at 6 weeks, and immunisation uptake at 4 months, all collected from routine child health systems. RESULTS Antenatal attendances were high in the standard care control and did not increase further with addition of the POW intervention (10.1 vs 10.1 (mean difference; MD) -0.00, 95% CI (95% CI -0.37 to 0.37)). In the powered subgroup of women with 2 or more social risk factors, mean EPDS (MD -0.79 (95% CI -1.56 to -0.02) was significantly better, although for all women recruited, no significant differences were seen (MD -0.59 (95% CI -1.24 to 0.06). Mother-to-infant bonding was significantly better in the intervention group for all women (MD -0.30 (95% CI -0.61 to -0.00) p=0.05), and there were no differences in other secondary outcomes. CONCLUSIONS This trial demonstrates differences in depressive symptomatology with addition of the POW service in the powered subgroup of women with 2 or more social risk factors. Addition to existing evidence indicates benefit from lay interventions in preventing postnatal depression. This finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes. TRIAL REGISTRATION NUMBER ISRCTN35027323; Results.
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Affiliation(s)
- Sara Kenyon
- Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | | | - Jackie Blissett
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Sophie-Anna Dann
- Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Department of Population Evidence & Technologies, University of Warwick, Warwick Medical School, Coventry, UK
| | - Christine MacArthur
- Institute of Applied Health Research, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
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Characteristics of Mothers Caring for Children During Episodes of Homelessness. Community Ment Health J 2015; 51:913-20. [PMID: 25536936 PMCID: PMC4722539 DOI: 10.1007/s10597-014-9794-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.
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Lamy S, Laqueille X, Thibaut F. Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l’enfant : revue de littérature. Encephale 2015; 41 Suppl 1:S13-20. [DOI: 10.1016/j.encep.2014.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/30/2014] [Indexed: 12/17/2022]
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Begun S. The paradox of homeless youth pregnancy: a review of challenges and opportunities. SOCIAL WORK IN HEALTH CARE 2015; 54:444-460. [PMID: 25985287 DOI: 10.1080/00981389.2015.1030058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Compared to their housed counterparts, homeless youth become pregnant at exceptionally high rates. Causes of such pregnancies are multifaceted, while a paradoxically high proportion of these pregnancies are intended. This review discusses causes and risk factors associated with homeless youth pregnancies, and notes experiences of pregnancy decision-making discord, challenges encountered during and following pregnancy, and difficulties faced by homeless youth when or if they become parents. Because homeless youth face a wide array of unique risks, future research would benefit from exploring alternative approaches to prevention to reduce pregnancies and improve sexual and reproductive health outcomes among this population.
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Affiliation(s)
- Stephanie Begun
- a Graduate School of Social Work, University of Denver , Denver , Colorado , USA
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Saddichha S, Fliers JM, Frankish J, Somers J, Schuetz CG, Krausz MR. Homeless and incarcerated: an epidemiological study from Canada. Int J Soc Psychiatry 2014; 60:795-800. [PMID: 24595262 DOI: 10.1177/0020764014522776] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incarceration and homelessness are closely related yet studied rarely. This article aimed to study the incarcerated homeless and identify specific vulnerabilities, which rendered them different from the nonincarcerated homeless. It also aimed to describe the homeless population and its significant involvement with the criminal justice and enforcement system. METHODS Data were derived from the British Columbia Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada: the large urban center Vancouver (n = 250), Victoria (n = 150) and Prince George (n = 100). Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ) and the Mini International Neuropsychiatric Interview (MINI) Plus. RESULTS Incarcerated homeless were more often male (66.6%), were in foster care (56.4%) and had greater substance use especially of crack cocaine (69.6%) and crystal methamphetamine (78.7%). They also had greater scores on emotional and sexual abuse domains of CTQ, indicating greater abuse. A higher prevalence of depression (57%) and psychotic disorders (55.3%) was also observed. Risk factors identified which had a positive predictor value were male gender (p < .001; odds ratio (OR) = 2.8; 95% confidence interval (CI): 1.7-4.4), a diagnosis of depression (p = .02; 95% CI: 1.1-4.4) and severe emotional neglect (p = .02; 95% CI: 1.1-3.2) in the childhood. CONCLUSION Homeless individuals may be traumatized at an early age, put into foster care, rendered homeless, initiated into substance use and re-traumatized on repeated occasions in adult life, rendering them vulnerable to incarceration and mental illness.
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Affiliation(s)
- Sahoo Saddichha
- Department of Psychiatry, Melbourne Health, Melbourne, VIC, Australia
| | - Joelle M Fliers
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jim Frankish
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Julian Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Christian G Schuetz
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Michael R Krausz
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
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Cutts DB, Coleman S, Black MM, Chilton MM, Cook JT, de Cuba SE, Heeren TC, Meyers A, Sandel M, Casey PH, Frank DA. Homelessness During Pregnancy: A Unique, Time-Dependent Risk Factor of Birth Outcomes. Matern Child Health J 2014; 19:1276-83. [DOI: 10.1007/s10995-014-1633-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fortin R, Jackson SF, Maher J, Moravac C. I WAS HERE: young mothers who have experienced homelessness use Photovoice and participatory qualitative analysis to demonstrate strengths and assets. Glob Health Promot 2014; 22:8-20. [PMID: 24830441 DOI: 10.1177/1757975914528960] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inspired by Photovoice, a participatory research methodology, I WAS HERE was a photoblogging workshop in Toronto, Canada, for young mothers who, when they joined, were either homeless or had past experience of homelessness. A participatory qualitative analysis process was developed to support workshop participants in collectively conducting qualitative analysis on a selection of their photoblogs exploring how they view their lives. Five mothers engaged in the participatory qualitative analysis process to categorize their photoblogs into themes. Participants selected over 70 of their personal photoblogs, discussed the meaning of their photoblogs, and categorized them into qualitative themes. One of the mothers continued work on the research by contributing to the write-up of the themes for publication. Participants, through the reflective dialogue, developed nine themes from the photoblogs that describe how they experience motherhood. The resulting nine themes were as follows: 'Family', 'Reality Check', 'Sacrifice for Positive Change', 'Support', 'Guidance', 'Growth and Transition', 'Proud of Becoming/Being a Mother', 'Passing on/Teaching Values' and 'Cherished Moments/Reward for Being a Mother'. These themes illustrate the satisfaction that comes from motherhood, strengths and goals for the future, and the desire for support and guidance. The themes developed from this participatory analysis illustrate that young mothers have a positive view of themselves and their ability to be mothers. This constructive view of young mothers provides an alternative to the negative stereotypes commonly attributed to them. This paper also discusses the strengths and challenges of using a participatory analysis approach. As a research methodology, incorporating procedures for participatory qualitative analysis into the Photovoice process provides an effective mechanism to meaningfully engage participants in qualitative analysis. From a health promotion perspective, using the participatory analysis process expanded the Photovoice methodology to facilitate self-reflection and an empowering collective dialogue among a group of women whose strengths and assets are rarely showcased.
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Affiliation(s)
- Rebecca Fortin
- University of Toronto - Dalla Lana School of Public Health, Toronto, Canada
| | - Suzanne F Jackson
- University of Toronto - Dalla Lana School of Public Health, Toronto, Canada
| | - Jessica Maher
- I WAS HERE Photoblogging Workshop Participant, Toronto, Canada
| | - Catherine Moravac
- St. Michael's Hospital - Women's Health Care Centre, Department of Obstetrics and Gynecology, Toronto, Canada
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Kennedy S, Grewal M, Roberts EM, Steinauer J, Dehlendorf C. A qualitative study of pregnancy intention and the use of contraception among homeless women with children. J Health Care Poor Underserved 2014; 25:757-70. [PMID: 24858884 PMCID: PMC4232303 DOI: 10.1353/hpu.2014.0079] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We undertook a qualitative analysis informed by grounded theory to explore pregnancy intention and the barriers to contraceptive use as perceived by homeless women with children. Semi-structured interviews (n = 22) were performed in English and in Spanish. The dominant theme emerging from the interviews was a strong desire to avoid pregnancy while homeless. However, few women in our sample used contraception or accessed reproductive health care consistently. There were multiple barriers to using contraception and to accessing reproductive health care services that homeless women reported: (1) inability to prioritize health due to competing demands, (2) shelter-related obstacles and restrictive provider practices that impede access to reproductive health care services and the use of contraception, and (3) change in the power dynamics of sexual relationships while homeless, making women more vulnerable to sexual exploitation. Findings suggest a multifactorial approach is needed to help homeless women use contraception and access reproductive health services.
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Obstetric Risks and Outcomes of Refugee Women at a Single Centre in Toronto. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:296-302. [DOI: 10.1016/s1701-2163(15)30604-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
: Homelessness continues to be a significant problem in the United States. Women and families represent the fastest growing segment of the homeless population. Health care for these women is a challenge but an important issue that needs to be addressed. Homeless women are at higher risk of injury and illness and are less likely to obtain needed health care than women who are not homeless. It is essential to undertake efforts to prevent homelessness, to expand community-based services for the homeless, and to provide adequate health care for this underserved population. Health care providers can help address the needs of homeless individuals by identifying their own patients who may be homeless or at risk of becoming homeless, educating these patients about available resources in the community, treating their health problems, and offering preventive care.
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Murphy CC, Mill C, Fordham J, Gorman A. Homeless and pregnant: a public health unit's innovative response. Canadian Journal of Public Health 2013; 104:e271. [PMID: 23823896 DOI: 10.17269/cjph.104.3902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/21/2013] [Accepted: 04/20/2013] [Indexed: 11/17/2022]
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Dawson A, Jackson D, Cleary M. Mothering on the margins: homeless women with an SUD and complex mental health co-morbidities. Issues Ment Health Nurs 2013; 34:288-93. [PMID: 23566192 DOI: 10.3109/01612840.2013.771522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Angela Dawson
- University of Technology-Sydney, Sydney, New South Wales, Australia.
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