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Boama-Nyarko E, Flahive J, Zimmermann M, Allison JJ, Person S, Moore Simas TA, Byatt N. Examining racial/ethnic inequities in treatment participation among perinatal individuals with depression. Gen Hosp Psychiatry 2024; 88:23-29. [PMID: 38452405 DOI: 10.1016/j.genhosppsych.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE A cluster randomized controlled trial (RCT) of two interventions for addressing perinatal depression treatment in obstetric settings was conducted. This secondary analysis compared treatment referral and participation among Minoritized perinatal individuals compared to their non-Hispanic white counterparts. METHODS Among perinatal individuals with depression symptoms, we examined rates of treatment 1) referral (i.e., offered medications or referred to mental health clinician), 2) initiation (i.e., attended ≥1 mental health visit or reported prescribed antidepressant medication), and 3) sustainment (i.e., attended >1 mental health visit per study month or prescribed antidepressant medication at time of study interviews). We compared non-Hispanic white (NHW) (n = 149) vs. Minoritized perinatal individuals (Black, Asian, Hispanic/Latina, Pacific Islander, Native American, Multiracial, and white Hispanic/Latina n = 157). We calculated adjusted odds ratios (aOR) for each outcome. RESULTS Minoritized perinatal individuals across both interventions had significantly lower odds of treatment referral (aOR = 0.48;95% CI = 0.27-0.88) than their NHW counterparts. There were no statistically significant differences in the odds of treatment initiation (aOR = 0.64 95% CI:0.36-1.2) or sustainment (aOR = 0.54;95% CI = 0.28-1.1) by race/ethnicity. CONCLUSIONS Perinatal mental healthcare inequities are associated with disparities in treatment referrals. Interventions focusing on referral disparities across race and ethnicity are needed.
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Affiliation(s)
- Esther Boama-Nyarko
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Martha Zimmermann
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Jeroan J Allison
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Sharina Person
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Tiffany A Moore Simas
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Pediatrics, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, UMass Memorial Health Care, Worcester, MA 01655, United States of America.
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Psychiatry, UMass Memorial Health Care, Worcester, MA 01655, United States of America.
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Qu M, Lu P, Lifshitz LM, Moore Simas TA, Delpapa E, ZhuGe R. Phenanthroline relaxes uterine contractions induced by diverse contractile agents by decreasing cytosolic calcium concentration. Eur J Pharmacol 2024; 968:176343. [PMID: 38281680 PMCID: PMC10939717 DOI: 10.1016/j.ejphar.2024.176343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
Uterine contractions during labor and preterm labor are influenced by a complex interplay of factors, including hormones and inflammatory mediators. This complexity may contribute to the limited efficacy of current tocolytics for preterm labor, a significant challenge in obstetrics with 15 million cases annually and approximately 1 million resulting deaths worldwide. We have previously shown that the myometrium expresses bitter taste receptors (TAS2Rs) and that their activation leads to uterine relaxation. Here, we investigated whether the selective TAS2R5 agonist phenanthroline can induce relaxation across a spectrum of human uterine contractions and whether the underlying mechanism involves changes in intracellular Ca2+ signaling. We performed experiments using samples from pregnant women undergoing scheduled cesarean delivery, assessing responses to various inflammatory mediators and oxytocin with and without phenanthroline. Our results showed that phenanthroline concentration-dependently inhibited contractions induced by PGF2α, U46619, 5-HT, endothelin-1 and oxytocin. Furthermore, in hTERT-infected human myometrial cells exposed to uterotonics, phenanthroline effectively suppressed the increase in intracellular Ca2+ concentration induced by PGF2α, U46619, oxytocin, and endothelin-1. These results suggest that the selective TAS2R5 agonist may not only significantly reduce uterine contractions but also decrease intracellular Ca2+ levels. This study highlights the potential development of TAS2R5 agonists as a new class of uterine relaxants, providing a novel avenue for improving the management of preterm labor.
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Affiliation(s)
- Mingzi Qu
- Department of Microbiology and Physiological Systems, UMass Chan Medical School, 363 Plantation St., Worcester, MA, USA
| | - Ping Lu
- Department of Microbiology and Physiological Systems, UMass Chan Medical School, 363 Plantation St., Worcester, MA, USA
| | - Lawrence M Lifshitz
- Program in Molecular Medicine, UMass Chan Medical School, 373 Plantation St., Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, UMass Chan Medical School/UMass Memorial Health, 119 Belmont St, Worcester, MA, USA
| | - Ellen Delpapa
- Department of Obstetrics and Gynecology, UMass Chan Medical School/UMass Memorial Health, 119 Belmont St, Worcester, MA, USA.
| | - Ronghua ZhuGe
- Department of Microbiology and Physiological Systems, UMass Chan Medical School, 363 Plantation St., Worcester, MA, USA.
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Masters GA, Julce C, Carroll S, Person SD, Allison J, Byatt N, Moore Simas TA. Association of perinatal depression and postpartum contraception intent, choice, and actual use. Contraception 2024:110447. [PMID: 38583583 DOI: 10.1016/j.contraception.2024.110447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Depression is common during pregnancy and the year following childbirth (the perinatal period). This study assessed the association of depressive symptoms and contraception decisions in perinatal individuals. STUDY DESIGN We conducted a secondary analysis using data from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of active interventions which aimed to address perinatal depression. This analysis included 191 individuals aged 18-45 who screened positive for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥10) during pregnancy or up to 3 months postpartum. We assessed contraception intent and method choice at 1-3 months postpartum. At 5-7 months postpartum, we assessed contraceptive method used and EPDS depression scores. We used logistic regressions to examine the relationship between depression and contraceptive use/method. RESULTS At 1-3 months postpartum, the majority of participants (76.4%) expressed an intention to use contraception. Of those, over half (53.4%) indicated a preference for higher effectiveness contraception methods. Participants with persistent depression symptoms (positive EPDS) at 5-7 months were significantly less likely to report using higher effectiveness contraceptive methods (aOR = 0.28, 95% CI = 0.11-0.70) compared to those without. Among participants with persistent depressive symptoms, 21.1% reported using a contraception method of lower effectiveness than had originally intended. CONCLUSION Perinatal individuals with persistent depressive symptoms at 5-7 months postpartum reported greater use of less-effective contraception methods than originally planned. IMPLICATIONS We found associations between perinatal depression and use of less effective contraception use. Provider discussions regarding contraception planning is important, particularly in those with perinatal depression symptoms.
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Affiliation(s)
- Grace A Masters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Clevanne Julce
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Smita Carroll
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA; Department of Pediatrics, UMass Memorial Health, Worcester, MA, USA
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Moore Simas TA, Whelan A, Byatt N. Screening Recommendations and Treatments for Postpartum Depression-Reply. JAMA 2024; 331:1154. [PMID: 38563838 DOI: 10.1001/jama.2024.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester
| | - Anna Whelan
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester
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Schaefer AJ, Mackie T, Veerakumar ES, Sheldrick RC, Moore Simas TA, Valentine J, Cowley D, Bhat A, Davis W, Byatt N. Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model. Health Aff (Millwood) 2024; 43:557-566. [PMID: 38560809 DOI: 10.1377/hlthaff.2023.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.
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Affiliation(s)
- Ana J Schaefer
- Ana J. Schaefer , Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | | | - Deborah Cowley
- Deborah Cowley, University of Washington, Seattle, Washington
| | | | - Wendy Davis
- Wendy Davis, Postpartum Support International, Portland, Oregon
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Waring ME, Arigo D, Rudin LR, Pagoto SL, Moore Simas TA, Horkachuck AB. Interest in an Instagram-delivered gestational weight gain intervention among pregnant women with pre-pregnancy overweight or obesity. Mhealth 2024; 10:12. [PMID: 38689614 PMCID: PMC11058595 DOI: 10.21037/mhealth-23-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/03/2023] [Indexed: 05/02/2024] Open
Abstract
Background Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention. Methods English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed. Results Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences. Conclusions Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.
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Affiliation(s)
- Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
| | - Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Lauren R. Rudin
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sherry L. Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
| | - Tiffany A. Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Alexa B. Horkachuck
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Karabayir I, Wilkie G, Celik T, Butler L, Chinthala L, Ivanov A, Moore Simas TA, Davis RL, Akbilgic O. Development and validation of an electrocardiographic artificial intelligence model for detection of peripartum cardiomyopathy. Am J Obstet Gynecol MFM 2024; 6:101337. [PMID: 38447673 DOI: 10.1016/j.ajogmf.2024.101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND This study used electrocardiogram data in conjunction with artificial intelligence methods as a noninvasive tool for detecting peripartum cardiomyopathy. OBJECTIVE This study aimed to assess the efficacy of an artificial intelligence-based heart failure detection model for peripartum cardiomyopathy detection. STUDY DESIGN We first built a deep-learning model for heart failure detection using retrospective data at the University of Tennessee Health Science Center. Cases were adult and nonpregnant female patients with a heart failure diagnosis; controls were adult nonpregnant female patients without heart failure. The model was then tested on an independent cohort of pregnant women at the University of Tennessee Health Science Center with or without peripartum cardiomyopathy. We also tested the model in an external cohort of pregnant women at Atrium Health Wake Forest Baptist. Key outcomes were assessed using the area under the receiver operating characteristic curve. We also repeated our analysis using only lead I electrocardiogram as an input to assess the feasibility of remote monitoring via wearables that can capture single-lead electrocardiogram data. RESULTS The University of Tennessee Health Science Center heart failure cohort comprised 346,339 electrocardiograms from 142,601 patients. In this cohort, 60% of participants were Black and 37% were White, with an average age (standard deviation) of 53 (19) years. The heart failure detection model achieved an area under the curve of 0.92 on the holdout set. We then tested the ability of the heart failure model to detect peripartum cardiomyopathy in an independent University of Tennessee Health Science Center cohort of pregnant women and an external Atrium Health Wake Forest Baptist cohort of pregnant women. The independent University of Tennessee Health Science Center cohort included 158 electrocardiograms from 115 patients; our deep-learning model achieved an area under the curve of 0.83 (0.77-0.89) for this data set. The external Atrium Health Wake Forest Baptist cohort involved 80 electrocardiograms from 43 patients; our deep-learning model achieved an area under the curve of 0.94 (0.91-0.98) for this data set. For identifying peripartum cardiomyopathy diagnosed ≥10 days after delivery, the model achieved an area under the curve of 0.88 (0.81-0.94) for the University of Tennessee Health Science Center cohort and of 0.96 (0.93-0.99) for the Atrium Health Wake Forest Baptist cohort. When we repeated our analysis by building a heart failure detection model using only lead-I electrocardiograms, we obtained similarly high detection accuracies, with areas under the curve of 0.73 and 0.93 for the University of Tennessee Health Science Center and Atrium Health Wake Forest Baptist cohorts, respectively. CONCLUSION Artificial intelligence can accurately detect peripartum cardiomyopathy from electrocardiograms alone. A simple electrocardiographic artificial intelligence-based peripartum screening could result in a timelier diagnosis. Given that results with 1-lead electrocardiogram data were similar to those obtained using all 12 leads, future studies will focus on remote screening for peripartum cardiomyopathy using smartwatches that can capture single-lead electrocardiogram data.
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Affiliation(s)
- Ibrahim Karabayir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Karabayir, Celik, Butler, Ivanov, and Akbilgic)
| | - Gianna Wilkie
- Department of Obstetrics & Gynecology, UMass Chan Medical School, Worcester, MA (Drs Wilkie and Simas)
| | - Turgay Celik
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Karabayir, Celik, Butler, Ivanov, and Akbilgic)
| | - Liam Butler
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Karabayir, Celik, Butler, Ivanov, and Akbilgic)
| | - Lokesh Chinthala
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN (Mr Chinthala and Dr Davis)
| | - Alexander Ivanov
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Karabayir, Celik, Butler, Ivanov, and Akbilgic)
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, UMass Chan Medical School, Worcester, MA (Drs Wilkie and Simas)
| | - Robert L Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN (Mr Chinthala and Dr Davis)
| | - Oguz Akbilgic
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Karabayir, Celik, Butler, Ivanov, and Akbilgic).
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Zimmermann M, Moore Simas TA, Howard M, Byatt N. The Pressing Need to Integrate Mental Health into Obstetric Care. Clin Obstet Gynecol 2024; 67:117-133. [PMID: 38281172 DOI: 10.1097/grf.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Mental health and substance use conditions are prevalent among perinatal individuals. These conditions have a negative impact on the health of perinatal individuals, their infants, and families, yet are underdiagnosed and undertreated. Populations that have been marginalized disproportionately face barriers to accessing care. Integrating mental health into obstetric care could address the perinatal mental health crisis. We review perinatal mental health conditions and substance use, outline the impact associated with these conditions, and describe the promise and potential of integrating mental health into obstetric settings to improve outcomes for patients receiving obstetric and gynecologic care.
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Affiliation(s)
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, UMass Chan Medical School/UMass Memorial Health Memorial Campus, Worcester, Massachusetts
| | - Margaret Howard
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, Shrewsbury
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Gimbel LA, Zimmermann M, Byatt N, Moore Simas TA, Hoffman MC. Screening, Assessment, and Treatment of Perinatal Mental Health in Obstetrical Settings. Clin Obstet Gynecol 2024; 67:134-153. [PMID: 38281173 DOI: 10.1097/grf.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs) are common, yet obstetricians receive little training prior to independent practice on screening, assessing, diagnosing, and treating patients with depression and anxiety. Untreated PMADs lead to adverse pregnancy and fetal outcomes. Obstetricians are in a unique position to address PMADs. The following serves as a resource for addressing PMADs in obstetric practice.
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Affiliation(s)
- Lauren A Gimbel
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Martha Zimmermann
- Department of Psychiatry, UMass Chan Medical School, Shrewsbury, Massachusetts
| | - Nancy Byatt
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, UMass Chan Medical School/UMass Memorial Health, Worcester, Mssachusetts
| | - M Camille Hoffman
- Departments of Obstetrics & Gynecology and Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Turrentine M, Nguyen BH, Choby B, Kendig S, King TL, Kotelchuck M, Moore Simas TA, Srinivas SK, Zahn CM, Peahl AF. Frequency of Prenatal Care Visits: A Core Outcome Set for Prenatal Care Schedules. J Womens Health (Larchmt) 2024. [PMID: 38306165 DOI: 10.1089/jwh.2023.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Objective: The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. Material and Methods: A consensus development study was conducted in the United States with participants, including 31 health care professionals, 12 public policy members or public health payers, and 18 public members, representing 24 states. A modified Delphi method and modified nominal group technique were utilized. Results: Twenty-one potential core outcomes were developed by combining the outcomes reported in three systematic reviews that evaluated the frequency of prenatal care visits or modality of prenatal visit type (e.g., in person, telemedicine, or hybrids of both). Eighteen consensus outcomes were identified from the Delphi process, following which 10 maternal and 4 neonatal outcomes were agreed at the consensus development meeting. Maternal core outcomes include maternal quality of life; maternal mental health outcomes; the experience of maternity care; lost time; attendance of recommended visits; unplanned care utilization; completion of the American College of Obstetricians and Gynecologists-recommended services; diagnosis of obstetric complications-proportion and timing; disparities in care outcomes; and severe maternal morbidity or mortality. Neonatal core outcomes include gestational age at birth, birth weight, stillbirth or perinatal death, and neonatal intensive care unit admissions. Conclusions: The core outcome set for the frequency and modality of prenatal visits should be utilized in forthcoming randomized controlled trials and systematic reviews. Such application will warrant that in future research, consistent reporting will enrich care and improve outcomes. Clinical Trial Registration number: 2021.
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Affiliation(s)
- Mark Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Buu-Hac Nguyen
- University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan, USA
| | - Beth Choby
- Baptist University College of Osteopathic Medicine, Baptist Health Sciences University, Memphis, Tennessee, USA
| | - Susan Kendig
- Maternal Services, SSM Health St. Louis Region, Shiloh, Illinois, USA
| | - Tekoa L King
- Department of Family Health Care Nursing, San Francisco School of Nursing, University of California, San Francisco, California, USA
| | - Milton Kotelchuck
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sindhu K Srinivas
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher M Zahn
- Clinical Practice and Health Equity and Quality, American College of Obstetricians and Gynecologists, Washington, District of Columbia, USA
| | - Alex Friedman Peahl
- Department of Obstetrics and Gynecology, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Lu P, Simas TAM, Delpapa E, ZhuGe R. Bitter taste receptors in the reproductive system: Function and therapeutic implications. J Cell Physiol 2024; 239:e31179. [PMID: 38219077 PMCID: PMC10922893 DOI: 10.1002/jcp.31179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
Type 2 taste receptors (TAS2Rs), traditionally known for their role in bitter taste perception, are present in diverse reproductive tissues of both sexes. This review explores our current understanding of TAS2R functions with a particular focus on reproductive health. In males, TAS2Rs are believed to play potential roles in processes such as sperm chemotaxis and male fertility. Genetic insights from mouse models and human polymorphism studies provide some evidence for their contribution to male infertility. In female reproduction, it is speculated that TAS2Rs influence the ovarian milieu, shaping the functions of granulosa and cumulus cells and their interactions with oocytes. In the uterus, TAS2Rs contribute to uterine relaxation and hold potential as therapeutic targets for preventing preterm birth. In the placenta, they are proposed to function as vigilant sentinels, responding to infection and potentially modulating mechanisms of fetal protection. In the cervix and vagina, their analogous functions to those in other extraoral tissues suggest a potential role in infection defense. In addition, TAS2Rs exhibit altered expression patterns that profoundly affect cancer cell proliferation and apoptosis in reproductive cancers. Notably, TAS2R agonists show promise in inducing apoptosis and overcoming chemoresistance in these malignancies. Despite these advances, challenges remain, including a lack of genetic and functional studies. The application of techniques such as single-cell RNA sequencing and clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated endonuclease 9 gene editing could provide deeper insights into TAS2Rs in reproduction, paving the way for novel therapeutic strategies for reproductive disorders.
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Affiliation(s)
- Ping Lu
- Department of Microbiology and Physiological System, UMass Chan Medical School, 363 Plantation St., Worcester, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, UMass Chan Medical School/UMass Memorial Health, Memorial Campus 119 Belmont St., Worcester, MA, USA
| | - Ellen Delpapa
- Department of Obstetrics and Gynecology, UMass Chan Medical School/UMass Memorial Health, Memorial Campus 119 Belmont St., Worcester, MA, USA
| | - Ronghua ZhuGe
- Department of Microbiology and Physiological System, UMass Chan Medical School, 363 Plantation St., Worcester, MA, USA
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Byatt N, Brenckle L, Sankaran P, Flahive J, Ko JY, Robbins CL, Zimmermann M, Allison J, Person S, Moore Simas TA. Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an active-controlled cluster-randomised trial. Lancet Public Health 2024; 9:e35-e46. [PMID: 38176840 DOI: 10.1016/s2468-2667(23)00268-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Perinatal depression is a common and undertreated condition, with potential deleterious effects on maternal, obstetric, infant, and child outcomes. We aimed to compare the effectiveness of two systems-level interventions in the obstetric setting-the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and the PRogram In Support of Moms (PRISM)-in improving depression symptoms and participation in mental health treatment among women with perinatal depression. METHODS In this cluster-randomised, active-controlled trial, obstetric practices across Massachusetts (USA) were allocated (1:1) via covariate adaptive randomisation to either continue participating in the MCPAP for Moms intervention, a state-wide, population-based programme, or to participate in the PRISM intervention, which involved MCPAP for Moms plus a proactive, multifaceted, obstetric practice-level intervention with intensive implementation support. English-speaking women (aged ≥18 years) who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥10) were recruited from the practices. Patients were followed up at 4-25 weeks of gestation, 32-40 weeks of gestation, 0-3 months postpartum, 5-7 months postpartum, and 11-13 months postpartum via telephone interview. Participants were masked to the intervention; investigators were not masked. The primary outcome was change in depression symptoms (EPDS score) between baseline assessment and 11-13 months postpartum. Analysis was done by intention to treat, fitting generalised linear mixed models adjusting for age, insurance status, education, and race, and accounting for clustering of patients within practices. This trial is registered with ClinicalTrials.gov, NCT02760004. FINDINGS Between July 29, 2015, and Sept 20, 2021, ten obstetric practices were recruited and retained; five (50%) practices were randomly allocated to MCPAP for Moms and five (50%) to PRISM. 1265 participants were assessed for eligibility and 312 (24·7%) were recruited, of whom 162 (51·9%) were enrolled in MCPAP for Moms practices and 150 (48·1%) in PRISM practices. Comparing baseline to 11-13 months postpartum, EPDS scores decreased by 4·2 (SD 5·2; p<0·0001) among participants in MCPAP for Moms practices and by 4·3 (SD 4.5; p<0·0001) among those in PRISM practices (estimated difference between groups 0·1 [95% CI -1·2 to 1·4]; p=0·87). INTERPRETATION Both the MCPAP for Moms and PRISM interventions were equally effective in improving depression symptoms. This finding is important because the 4-point decrease in EPDS score is clinically significant, and MCPAP for Moms has a lower intensity and greater population-based reach than does PRISM. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA.
| | - Linda Brenckle
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Padma Sankaran
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jean Y Ko
- Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service, Commissioned Corps, Rockville, MD, USA
| | | | - Martha Zimmermann
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sharina Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, UMass Memorial Health, Worcester, MA, USA; Department of Obstetrics and Gynecology, UMass Memorial Health, Worcester, MA, USA
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Heelan-Fancher L, Moore Simas TA, Mazzawi J, Dumont T, Edmonds JK. Nulliparous Women's Expectations and Experiences of Early Labor. MCN Am J Matern Child Nurs 2024; 49:22-28. [PMID: 37773194 DOI: 10.1097/nmc.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
PURPOSE To describe the expectations of early labor by nulliparous pregnant women in their third trimester and first-time mothers' experiences of early labor after they had given birth. STUDY DESIGN AND METHODS A descriptive qualitative approach involving semi-structured, video-call interviews conducted between September 2020 and April 2021. Data were analyzed using content analysis. RESULTS Twenty-two women took part in this study. Only 3 of the 10 nulliparous pregnant participants reported pain as an expected symptom of early labor. There were two themes identified from interviews with pregnant participants: Desire to stay at home in early labor and Lack of knowledge and two themes from interviews from postpartum participants: Expectations didn't match experiences and Feelings of anxiety and uncertainty during early labor . CLINICAL IMPLICATIONS Nulliparous women lack knowledge of and skills to effectively cope with pain during early labor while at home. There is a need for an innovative labor support program for childbearing women to remain safely at home in early labor.
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Moore Simas TA, Whelan A, Byatt N. Postpartum Depression-New Screening Recommendations and Treatments. JAMA 2023; 330:2295-2296. [PMID: 38010647 DOI: 10.1001/jama.2023.21311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
This Insights in the Women’s Health series describes perinatal depression (occurring prepregnancy through postpartum periods) and new recommendations and treatment guidelines for this condition.
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Affiliation(s)
- Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
| | - Anna Whelan
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
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McNicholas E, Boama-Nyarko E, Julce C, Nunes AP, Flahive J, Byatt N, Moore Simas TA. Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History. J Womens Health (Larchmt) 2023; 32:1111-1119. [PMID: 37582274 PMCID: PMC10541927 DOI: 10.1089/jwh.2022.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Depression affects one in seven perinatal individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at an even greater risk of perinatal depression, but it is unclear how their experiences with the depression care pathway may differ from individuals without a psychiatric history. Methods: We conducted a secondary analysis evaluating care access and barriers to care in perinatal individuals who screened positive for depression using the Edinburgh Postnatal Depression Scale (N = 280). Data were analyzed from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of two interventions for perinatal depression. Results: Individuals with no prepregnancy psychiatric history (N = 113), compared with those with a history (N = 167), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, although equally likely to attend if referred. When examining how these differences affected outcomes, those without a psychiatric history had 46% lower odds of attending therapy (95% confidence interval [CI]: 0.19-1.55), 79% lower odds of taking medication (95% CI: 0.08-0.54), and 80% lower odds of receiving any depression care (95% CI: 0.08-0.47). Barriers were similar across groups, except for concerns regarding available treatments and beliefs about self-resolution of symptoms, which were more prevalent in individuals without a psychiatric history. Conclusions: Perinatal individuals without a prepregnancy psychiatric history were less likely to be screened, referred, and treated for depression. Differences in screening and referrals resulted in missed opportunities for care, reinforcing the urgent need for universal mental health screening and psychoeducation during the perinatal period. Clinical Trial Registration No.: NCT02935504.
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Affiliation(s)
- Eileen McNicholas
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Esther Boama-Nyarko
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Clevanne Julce
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Anthony P. Nunes
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Julie Flahive
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Nancy Byatt
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Xu L, Masters GA, Moore Simas TA, Bergman AL, Byatt N. Labor and Delivery Clinician Perspectives on Impact of Traumatic Clinical Experiences and Need for Systemic Supports. Matern Child Health J 2023:10.1007/s10995-023-03708-2. [PMID: 37278845 DOI: 10.1007/s10995-023-03708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. METHODS Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. RESULTS Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = - 0.27, p < 0.01), and burnout (r = - 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. CONCLUSIONS FOR PRACTICE Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.
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Affiliation(s)
- Lulu Xu
- Department of Psychiatry, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA.
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA.
- Department of Pediatrics, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Grace A Masters
- Department of Psychiatry, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- Department of Psychiatry, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Obstetrics and Gynecology, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Pediatrics, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Obstetrics and Gynecology, UMass Memorial Health Care, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Aaron L Bergman
- Department of Psychiatry, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Emergency Medicine, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Obstetrics and Gynecology, UMass Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
- Department of Psychiatry, UMass Memorial Health Care, 55 N Lake Avenue, Worcester, MA, 01655, USA
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Turrentine M, Nguyen BH, Choby B, Kendig S, King T, Kotelchuck M, Moore Simas TA, Srinivas S, Zahn CM, Peahl AF. Frequency Of pRenatal CAre viSiTs (FORCAST): study protocol to develop a core outcome set for prenatal care schedules. JMIR Res Protoc 2023. [PMID: 37261946 PMCID: PMC10366963 DOI: 10.2196/43962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Prenatal care, one of the most common preventive care services in the United States, endeavors to improve pregnancy outcomes through evidence-based screenings and interventions. Despite the prevalence of prenatal care and its importance to maternal and infant health, there are several debates about the best methods of prenatal care delivery, including the most appropriate schedule frequency and content of prenatal visits. Current U.S. national guidelines recommend that low-risk individuals receive a standard schedule of 12 to 14 in-office visits, a care delivery model that has remained unchanged for almost a century. OBJECTIVE In early 2020, to mitigate individuals' exposure to the SARS-CoV-2 virus, prenatal care providers implemented new paradigms that altered the schedule frequency, interval, and modality (e.g., telemedicine) of how prenatal care services were offered. In this manuscript, we describe development of a core outcome set (COS) that can be used to evaluate the effect of the frequency of prenatal care schedules on maternal and infant outcomes. METHODS We will systematically review the literature to identify previously reported outcomes important to individuals who receive prenatal care and the people who care for them. Stakeholders with expertise in prenatal care delivery (i.e., patients/family members, healthcare providers, and public health professionals and policymakers) will rate the importance of identified outcomes in an online survey using a three-round Delphi process. A virtual consensus meeting will be held for a group of stakeholder representatives to discuss and vote on the outcomes to include in the final COS. RESULTS The Delphi survey was initiated in July 2022 with 71 stakeholders invited. A virtual consensus conference was conducted on October 11, 2022. Data is currently under analysis with plans to submit in a subsequent manuscript. CONCLUSIONS More research about the optimal schedule frequency and modality for prenatal care delivery is needed. Standardizing outcomes that are measured and reported in evaluations of the recommended prenatal care schedules will assist evidence synthesis and results reported in systematic reviews and meta-analyses. Overall, this COS will expand the consistency and patient-centeredness of reported outcomes for various prenatal care delivery schedules and modalities, hopefully improving the overall efficacy of recommended care delivery for pregnant people and their families. CLINICALTRIAL This study was registered in the Core Outcome Measures for Effectiveness (COMET) database on January 18, 2022, registration #2021 http://www.comet-initiative.org/Studies/Details/2021.
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Affiliation(s)
- Mark Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, US
| | - Buu-Hac Nguyen
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, US
| | - Beth Choby
- Department of Medical Education, University of Tennessee College of Medicine, Memphis, US
| | - Susan Kendig
- Maternal Services, SSM Health-St. Louis Region, Shiloh, US
| | - Tekoa King
- Department of Family Health Care Nursing, University of California, San Francisco School of Nursing, San Francisco, US
| | | | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, US
| | - Sindu Srinivas
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, US
| | - Christopher M Zahn
- Clinical Practice and Health Equity and Quality, American College of Obstetricians and Gynecologists, Washington, US
| | - Alex Friedman Peahl
- Department of Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Rd.Building 14, Ann Arbor, US
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Masters GA, Yuan Y, Li NC, Straus J, Moore Simas TA, Byatt N. Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Arch Womens Ment Health 2023; 26:401-410. [PMID: 37188798 DOI: 10.1007/s00737-023-01324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Perinatal mood disorders (PMDs) are common, yet many patients are undertreated. The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms is designed to increase clinicians' willingness to address PMDs. We examined utilization of MCPAP for Moms and associations with PMDs treatment, including the more complex bipolar disorder (BD). Analyses of MCPAP for Moms data examined utilization from 7/2014 to 6/2020 and associated treatment outcomes. Participants were clinicians (n = 1006) in obstetrics/gynecology, family medicine, and pediatrics. Encounters included (1) resource and referrals and (2) psychiatric consultations (program psychiatrist consultation with clinicians or patients). Utilization sub-groups were identified using group-based trajectory modeling. Higher utilization of MCPAP for Moms was associated with increased rates of treating PMDs (incidence rate ratio [IRR] = 1.07, 95% CI: 1.06-1.07). Examining by encounter type, psychiatric consultations resulted in more frequent rates of clinicians treating PMDs than resource and referral encounters. Utilization of direct patient consultation was associated with the greatest increase in rates of clinicians treating BD (IRR = 2.12, 95% CI: 1.82-2.41). Clinicians with highest utilization rates of psychiatric consultations longitudinally had strongest predictive associations with providing direct mental healthcare to patients with BD (IRR = 13.5, 95% CI: 4.2-43.2). Utilization of MCPAP for Moms facilitates clinicians' ability to provide mental health treatment to patients.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Yiyang Yuan
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | | | - John Straus
- Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
- UMass Memorial Health Care, Worcester, MA, USA
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
- UMass Memorial Health Care, Worcester, MA, USA
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Londoño Tobón A, McNicholas E, Clare CA, Ireland LD, Payne JL, Moore Simas TA, Scott RK, Becker M, Byatt N. The end of Roe v. Wade: implications for Women's mental health and care. Front Psychiatry 2023; 14:1087045. [PMID: 37215676 PMCID: PMC10196497 DOI: 10.3389/fpsyt.2023.1087045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/07/2023] [Indexed: 05/24/2023] Open
Abstract
The Supreme Court decision in Dobbs v. Jackson in June 2022 reversed precedent which had previously protected abortion prior to fetal viability as a universal right within the United States. This decision almost immediately led to abortion restrictions across 25 states. The resulting lack of access to abortion care for millions of pregnant people will have profound physical and mental health consequences, the full effects of which will not be realized for years to come. Approximately 1 in 5 women access abortions in the U.S. each year. These women are diverse and represent all American groups. The Supreme court decision, however, will affect populations that have and continue to be marginalized the most. Forcing pregnant individuals to carry unwanted pregnancies worsens health outcomes and mortality risk for both the perinatal individual and the offspring. The US has one of the highest maternal mortality rates and this rate is projected to increase with abortion bans. Abortion policies also interfere with appropriate medical care of pregnant people leading to less safe pregnancies for all. Beyond the physical morbidity, the psychological sequelae of carrying a forced pregnancy to term will lead to an even greater burden of maternal mental illness, exacerbating the already existing maternal mental health crisis. This perspective piece reviews the current evidence of abortion denial on women's mental health and care. Based on the current evidence, we discuss the clinical, educational, societal, research, and policy implications of the Dobbs v. Jackson Supreme Court decision.
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Affiliation(s)
- Amalia Londoño Tobón
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States
| | | | - Camille A. Clare
- Department of Obstetrics and Gynecology, Downstate Health Sciences University, Brooklyn, NY, United States
| | - Luu D. Ireland
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jennifer L. Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Tiffany A. Moore Simas
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Rachel K. Scott
- MedStar Health Research Institute, Georgetown University School of Medicine, Washington, DC, United States
| | - Madeleine Becker
- Departments of Psychiatry and Human Behavior, Sydney Kimmel Medical College, Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Byatt
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Waring ME, Pagoto SL, Moore Simas TA, Blackman Carr LT, Eamiello ML, Libby BA, Rudin LR, Heersping GE. Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial. JMIR Mhealth Uhealth 2023; 11:e41545. [PMID: 37103991 PMCID: PMC10176149 DOI: 10.2196/41545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 03/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. OBJECTIVE This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. METHODS Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. RESULTS Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. CONCLUSIONS Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, United States
| | - Sherry L Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, United States
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, United States
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, United States
| | - Loneke T Blackman Carr
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, United States
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, United States
| | - Madison L Eamiello
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Brooke A Libby
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Lauren R Rudin
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Grace E Heersping
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
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Wilkie GL, Leftwich HK, Delpapa E, Moore Simas TA, Nunes AP. Trends in Screening for Diabetes in Early Pregnancy in the United States. J Womens Health (Larchmt) 2023; 32:416-422. [PMID: 36795976 PMCID: PMC10329152 DOI: 10.1089/jwh.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objective: The aim of this study was to characterize current diabetes screening practices in the first trimester of pregnancy in the United States, evaluate patient characteristics and risk factors associated with early diabetes screening, and compare perinatal outcomes by early diabetes screening. Methods: This was a retrospective cohort study of US medical claims data of persons diagnosed with a viable intrauterine pregnancy and who presented for care with private insurance before 14 weeks of gestation, without pre-existing pregestational diabetes, from the IBM MarketScan® database for the period January 1, 2016, to December 31, 2018. Univariate and multivariate analyses were used to evaluate perinatal outcomes. Results: A total of 400,588 pregnancies were identified as eligible for inclusion, with 18.0% of persons receiving early screening for diabetes. Of those with laboratory order claims, 53.1% underwent hemoglobin A1c testing, 30.0% underwent fasting glucose testing, and 16.9% underwent oral glucose tolerance testing. Compared with those who did not undergo early diabetes screening, those who did were more likely to be older; obese; having a history of gestational diabetes, chronic hypertension, polycystic ovarian syndrome, or hyperlipidemia; and having a family history of diabetes. In adjusted logistic regression, history of gestational diabetes (adjusted odds ratio 3.99; 95% confidence interval 3.73-4.26) had the strongest association with early diabetes screening. Adverse perinatal outcomes, including a higher rate of cesarean delivery, preterm delivery, preeclampsia, and gestational diabetes, occurred more frequently among women who underwent early diabetes screening. Conclusions: First-trimester early diabetes screening was mostly commonly performed by hemoglobin A1c evaluation, and persons who underwent early diabetes screening were more likely to experience adverse perinatal outcomes.
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Affiliation(s)
- Gianna L. Wilkie
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Heidi K. Leftwich
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ellen Delpapa
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Anthony P. Nunes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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22
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Deichen Hansen ME, Londoño Tobón A, Kamal Haider U, Moore Simas TA, Newsome M, Finelli J, Boama-Nyarko E, Mittal L, Tabb KM, Nápoles AM, Schaefer AJ, Davis WN, Mackie TI, Flynn HA, Byatt N. The role of perinatal psychiatry access programs in advancing mental health equity. Gen Hosp Psychiatry 2023; 82:75-85. [PMID: 36989766 DOI: 10.1016/j.genhosppsych.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
This editorial presents: 1) a review of Perinatal Psychiatry Access Programs as an integrated care model with potential for promoting perinatal mental health equity; and 2) a summary of how the model has been and can be further adapted to help achieve perinatal mental health equity in geographically diverse settings. Within the editorial, we highlight Access Programs as a promising model for promoting perinatal mental health equity. This editorial is supported by original descriptive data on the Lifeline for Moms National Network of Perinatal Psychiatric Access Programs. Descriptive data is additionally provided on three statewide Access Programs. The Access Program model, and the accompanying Network of Access Programs, is a multi-level approach demonstrating promise in reducing perinatal mental health inequities. Access Programs demonstrate potential to implement interventions to address well-documented inequities in perinatal mental healthcare access at the patient-, clinician-, practice-, community-, and policy-levels. For Access Programs to leverage their potential to advance perinatal mental health equity, systematic efforts are needed that include partnership with impacted communities and implementation teams.
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Affiliation(s)
- Megan E Deichen Hansen
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America.
| | - Amalia Londoño Tobón
- Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC 20007, United States of America
| | - Uruj Kamal Haider
- Department of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, Memorial Campus,119 Belmont Street, Jaquith Building Room 2.060, Worcester, MA 01605, United States of America
| | - Melissa Newsome
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Julianna Finelli
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 131 S Robertson St, New Orleans, LA 70112, United States of America
| | - Esther Boama-Nyarko
- Departments of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States of America
| | - Karen M Tabb
- Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, United States of America; Social of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, United States of America
| | - Ana J Schaefer
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Wendy N Davis
- Postpartum Support International, 6706 SW 54th Avenue, Portland, OR 97219, United States of America
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Heather A Flynn
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Nancy Byatt
- Departments of Psychiatry, Obstetrics & Gynecology, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, 222 Maple Ave - Chang Building, Shrewsbury, MA 01545, United States of America
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23
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Meyerovitz CV, Juraschek SP, Ayturk D, Moore Simas TA, Person SD, Lemon SC, McManus DD, Kovell LC. Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018. J Am Heart Assoc 2023; 12:e027169. [PMID: 36847043 PMCID: PMC10111464 DOI: 10.1161/jaha.122.027169] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/30/2022] [Indexed: 03/01/2023]
Abstract
Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US women of childbearing age with hypertension. Methods and Results We studied women (aged 20-50 years) with hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or use of antihypertensive medication) in the National Health and Nutrition Examination Surveys 2001 to 2018. SDoH and BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) were examined by race and ethnicity (White race, Black race, Hispanic ethnicity, and Asian race). Using multivariable logistic regression, odds of uncontrolled BP by race and ethnicity were modeled, adjusting for SDoH, health factors, and modifiable health behaviors. Responses on hunger and affording food determined food insecurity status. Across women of childbearing age with hypertension (N=1293), 59.2% were White race, 23.4% were Black race, 15.8% were Hispanic ethnicity, and 1.7% were Asian race. More Hispanic and Black women experienced food insecurity than White women (32% and 25% versus 13%; both P<0.001). After SDoH, health factor, and modifiable health behavior adjustment, Black women maintained higher odds of uncontrolled BP than White women (odds ratio, 2.31 [95% CI, 1.08-4.92]), whereas Asian and Hispanic women showed no difference. Conclusions We identified racial inequities in uncontrolled BP and food insecurity among women of childbearing age with hypertension. Further exploration beyond the SDoH measured is needed to understand the inequity in hypertension control in Black women.
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Affiliation(s)
| | - Stephen P. Juraschek
- Division of General MedicineBeth Israel Deaconess Medical Center/Harvard Medical SchoolBostonMA
| | - Didem Ayturk
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - Tiffany A. Moore Simas
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
- Departments of Obstetrics and Gynecology, Pediatrics and PsychiatryUMass Chan Medical SchoolWorcesterMA
| | - Sharina D. Person
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of MedicineUMass Chan Medical SchoolWorcesterMA
| | - Lara C. Kovell
- Division of Cardiovascular Medicine, Department of MedicineUMass Chan Medical SchoolWorcesterMA
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Chin E, Leung K, Moore Simas TA, Kumaraswami T. Changes in postpartum contraception utilization rates during the early stage of the COVID-19 pandemic. Womens Health (Lond) 2023; 19:17455057231175311. [PMID: 37334467 DOI: 10.1177/17455057231175311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. OBJECTIVES To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. DESIGN Retrospective cohort review. METHODS Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. RESULTS The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). CONCLUSION Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.
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Affiliation(s)
- Emily Chin
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Katherine Leung
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
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Waring ME, Moore Simas TA, Heersping GE, Rudin LR, Balakrishnan K, Burdick AR, Pagoto SL. Development and feasibility of a web-based gestational weight gain intervention for women with pre-pregnancy overweight or obesity. Mhealth 2023; 9:13. [PMID: 37089268 PMCID: PMC10119439 DOI: 10.21037/mhealth-22-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Excessive gestational weight gain is associated with negative maternal and infant health outcomes. Digital health approaches may help overcome barriers to participating in lifestyle interventions requiring in-person visits. The purpose of this study was to develop and examine the feasibility of a web-based gestational weight gain intervention. Methods Intervention development included feedback and input from pregnant women. We conducted a 12-week one-arm pilot study during which participants engaged in an online discussion board with coaches and other pregnant women, tracked their weight gain with an interactive graph, and accessed a list of online resources for pregnancy health. Feasibility outcomes were recruitment, retention, engagement and sustained participation, intervention acceptability, and website usability. Gestational weight gain was an exploratory outcome. Results Participants (n=12) were on average 16.8 [standard deviation (SD): 2.0] weeks gestation with average pre-pregnancy body mass index of 30.5 (SD: 4.8) kg/m2. Participant retention was 92% (n=11). Participants logged into the website a median of 21 times [interquartile range (IQR), 8-37; range, 2-98] over 12 weeks, and 58% (n=7) logged into the website during the last week of the intervention. All participants said they would be very likely or likely to participate again, and 100% said they would be very likely or likely to recommend the intervention to a pregnant friend. In post-intervention interviews, 64% (n=7) explicitly said that the website was easy to use, but 100% (n=11) mentioned usability issues. When asked their preferred intervention platform, 18% (n=2) somewhat or strongly preferred a private website, 18% (n=2) had no preference, and 64% (n=7) somewhat or strongly preferred Facebook. Seventy percent (n=7) had excessive gestational weight gain, 10% (n=1) inadequate gestational weight gain, and 20% (n=2) gained within recommended ranges. Conclusions Additional development work is needed before moving to efficacy testing. Most notably, usability issues with the investigator-developed website and participant preference suggest a switch to a commercial social media platform.
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Affiliation(s)
- Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Tiffany A. Moore Simas
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Grace E. Heersping
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lauren R. Rudin
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Kavitha Balakrishnan
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abigail R. Burdick
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sherry L. Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth & Social Media, University of Connecticut, Storrs, CT, USA
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Nagle-Yang S, Sachdeva J, Zhao LX, Shenai N, Shirvani N, Worley LLM, Gopalan P, Albertini ES, Spada M, Mittal L, Moore Simas TA, Byatt N. Trauma-Informed Care for Obstetric and Gynecologic Settings. Matern Child Health J 2022; 26:2362-2369. [PMID: 36346563 DOI: 10.1007/s10995-022-03518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Trauma is common among those seeking Ob-Gyn care and may have pervasive impact on obstetrical and gynecological health, social functioning, and healthcare engagement. While guidelines exist on the detection and treatment of perinatal mood and anxiety disorders within Ob-Gyn care, the role of Ob-gyn clinicians in identifying and addressing patients' traumatic experiences and related symptoms is less clearly delineated. This manuscript provides an overview of trauma-related symptoms in the context of Ob-Gyn care and practical guidance of clinicians aiming to improve their detection and response to trauma in their clinical practice. DESCRIPTION Posttraumatic stress disorder (PTSD) describes a psychiatric illness which develops as a response to a traumatic event. Women who have experienced trauma are also at increased risk for borderline personality disorder and other psychiatric comorbidities. Postpartum PTSD has particular relevance to obstetrical care. ASSESSMENT Screening for trauma in Ob-Gyn care can provide an opportunity to address risk and offer targeted intervention. Several brief evidence-based screening tools are available. Individuals who screen positive require assessment of immediate safety and targeted referrals. Trauma informed care describes an approach to healthcare aimed to enhance physical and emotional safety for patients and clinicians. CONCLUSION Given the prevalence and the potentially devastating and enduring impact of trauma and trauma-related symptoms, there is a critical need to address trauma within Ob-Gyn care. By recognizing the signs of trauma and initiating or referring to appropriate treatments, Ob-Gyn clinicians have a unique opportunity to better understand their patients and to improve their care.
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Affiliation(s)
- Sarah Nagle-Yang
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place; MS F546, 80045, Aurora, CO, USA.
| | - Jyoti Sachdeva
- Departments of Psychiatry and Behavioral Neuroscience and Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Lulu X Zhao
- Department of Obstetrics & Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Linda L M Worley
- Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Meredith Spada
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, UMass Memorial Health, Worcester, MA, USA
| | - Nancy Byatt
- Departments of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, UMass Memorial Health, Worcester, MA, USA
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Wilkie G, Leung K, Moore Simas TA, Tucker KL, Chasan-Taber L. The Association Between Acculturation and Diet and Physical Activity Among Pregnant Hispanic Women with Abnormal Glucose Tolerance. J Womens Health (Larchmt) 2022; 31:1791-1799. [PMID: 36040352 PMCID: PMC9805839 DOI: 10.1089/jwh.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Hispanic women are disproportionately affected by gestational diabetes mellitus (GDM), yet few studies have assessed the impact of acculturation on health behaviors that may reduce GDM risk. Materials and Methods: We assessed relationships between acculturation and meeting American Diabetes Association guidelines for macronutrient intake and American College of Obstetricians and Gynecologists guidelines for physical activity (PA) using baseline data from Estudio Project Aiming to Reduce Type twO diabetes, a randomized trial conducted in Massachusetts (2013-2017) among 255 Hispanic pregnant women with hyperglycemia. Acculturation was assessed via the Psychological Acculturation Scale, duration of time and generation in the continental United States, and language preference; diet with 24-hours dietary recalls; and PA with the Pregnancy Physical Activity Questionnaire (PPAQ). Results: The majority of participants who reported low psychological acculturation (74.9%), preferred English (78.4%), were continental U.S. born (58.0%), and lived in the continental United States ≥5 years (91.4%). A total of 44.8%, 81.8%, 22.9%, and 4.6% of women met guidelines for carbohydrate, protein, fat, and fiber intakes, respectively; 31.9% met guidelines for PA. Women with higher acculturation were less likely to meet carbohydrate guidelines (English preference: adjusted risk ratios [aRR] 0.45, 95% confidence intervals [CI] 0.23-0.75; U.S. born: aRR 0.60, 95% CI 0.36-0.91; duration of time in United States: aRR 0.96, 95% CI 0.92-0.99). Women with higher acculturation were more likely to meet PA guidelines (U.S. born: aRR 1.95, 95% CI 1.11-3.44). Conclusions: In summary, higher acculturation was associated with lower likelihood of meeting dietary guidelines but greater likelihood of meeting PA guidelines during pregnancy. Interventions aimed at reducing GDM in Hispanics should be culturally informed and incorporate acculturation. Clinical Trial Registration: clinicaltrials.gov NCT01679210.
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Affiliation(s)
- Gianna Wilkie
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine Leung
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, and University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
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Thadhani R, Lemoine E, Rana S, Costantine MM, Calsavara VF, Boggess K, Wylie BJ, Moore Simas TA, Louis JM, Espinoza J, Gaw SL, Murtha A, Wiegand S, Gollin Y, Singh D, Silver RM, Durie DE, Panda B, Norwitz ER, Burd I, Plunkett B, Scott RK, Gaden A, Bautista M, Chang Y, Diniz MA, Karumanchi SA, Kilpatrick S. Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy. NEJM Evid 2022; 1:EVIDoa2200161. [PMID: 38319832 DOI: 10.1056/evidoa2200161] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Circulating Angiogenic Factor in Hypertension in PregnancyThis study measured serum soluble fms-like tyrosine kinase 1 to placental growth factor values in pregnant women hospitalized with hypertension. In women with a hypertensive disorder of pregnancy presenting between 23 and 35 weeks' gestation, a soluble fms-like tyrosine kinase 1:placental growth factor ratio ≥40 provided stratification of the risk of progressing to severe preeclampsia within 2 weeks.
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Affiliation(s)
- Ravi Thadhani
- Cedars-Sinai Medical Center, Los Angeles
- Massachusetts General Hospital, Boston
| | - Elizabeth Lemoine
- Cedars-Sinai Medical Center, Los Angeles
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Sarosh Rana
- University of Chicago Medical Center, Chicago
| | | | | | - Kim Boggess
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | | | - Jimmy Espinoza
- Baylor College of Medicine and Texas Children's Hospital, Houston
| | | | - Amy Murtha
- University of California at San Francisco, San Francisco
| | | | - Yvonne Gollin
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA
| | | | | | | | | | - Errol R Norwitz
- Tufts Medical Center, Boston
- Newton-Wellesley Hospital, Newton, MA
| | | | | | | | - Anna Gaden
- Cedars-Sinai Medical Center, Los Angeles
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Cooper KM, Colletta A, Asirwatham AM, Moore Simas TA, Devuni D. COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes. World J Gastroenterol 2022; 28:6017-6033. [PMID: 36405386 PMCID: PMC9669825 DOI: 10.3748/wjg.v28.i42.6017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Coronavirus disease 2019 (COVID-19) associated liver injury (COVALI) is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection. Despite profound clinical implications, its pathophysiology is poorly understood. Unfortunately, most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research, including pregnant individuals. This manuscript reviews: Clinical features of COVALI, leading theories of COVALI, and existing literature on COVALI during pregnancy, a topic not widely explored in the literature. Ultimately, we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome, and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.
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Affiliation(s)
- Katherine M. Cooper
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Alessandro Colletta
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Alison M. Asirwatham
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
- Departments of Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Deepika Devuni
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
- Division of Gastroenterology and Hepatology, University of Massachusetts Chan Medical School, Worcester, MA 1605, United States
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Cooper KM, Masters GA, Moore Simas TA, Byatt N. The role of clinician assistants in addressing perinatal depression. J Psychosom Obstet Gynaecol 2022; 43:368-373. [PMID: 34533425 PMCID: PMC10849797 DOI: 10.1080/0167482x.2021.1975676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Upwards of one in seven individuals experience perinatal depression and many individuals cannot access treatment. In response, perinatal depression is increasingly being managed in the obstetric setting. This study aimed to characterize the experiences of clinicians and clinician assistants to inform the extent to which clinician assistants can help address depression in obstetric settings. METHODS This cross-sectional analysis used data from an ongoing cluster randomized control trial: The PRogram In Support of Moms (PRISM). Participants included clinicians (physicians, certified nurse midwives, nurse practitioners) and clinician assistants (medical assistants, nursing assistants). Baseline data regarding practices and attitudes of clinicians and clinician assistants toward addressing depression in the obstetric setting were described. Logistic regressions were used to examine the association of clinician time to complete work and depression management. RESULTS Clinician assistants experienced significantly fewer time constraints than did clinicians. However, having adequate time to complete work was not significantly associated with increased depression management in clinicians. Clinician assistants reported feeling that addressing depression is an important part of their job, despite variation in doing so. CONCLUSION Clinician assistants are interacting with perinatal women extensively and are a vital part of obstetric care workflows. Clinician assistants report that they want to address depression and have time to do so. Thus, clinician assistants may be poised to help address the mental health needs of perinatal individuals.
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Affiliation(s)
| | | | - Tiffany A. Moore Simas
- University of Massachusetts Medical School, Worcester, MA, USA
- UMass Memorial Health, Worcester, MA, USA
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA, USA
- UMass Memorial Health, Worcester, MA, USA
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Mattocks KM, Kroll-Desrosiers A, Moore Simas TA, Bastian LA, Marteeny V, Walker L, Sheahan K, Elwy AR. Examining Pregnant Veterans' Acceptance and Beliefs Regarding the COVID-19 Vaccine. J Gen Intern Med 2022; 37:671-678. [PMID: 36042080 PMCID: PMC9427157 DOI: 10.1007/s11606-022-07588-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pregnant persons have received mixed messages regarding whether or not to receive COVID-19 vaccines as limited data are available regarding vaccine safety for pregnant and lactating persons and breastfeeding infants. OBJECTIVE The aims of this study were to examine pregnant Veteran's acceptance of COVID-19 vaccines, along with perceptions and beliefs regarding vaccine safety and vaccine conspiracy beliefs. DESIGN AND PARTICIPANTS We conducted a cross-sectional survey of pregnant Veterans enrolled in VA care who were taking part in an ongoing cohort study at 15 VA medical centers between January and May 2021. MAIN MEASURES Pregnant Veterans were asked whether they had been offered the COVID-19 vaccine during pregnancy, and whether they chose to accept or refuse it. Additional questions focused on perceptions of COVID-19 vaccine safety and endorsements of vaccine knowledge and conspiracy beliefs. Logistic regression was utilized to examine predictors of acceptance of a vaccine during pregnancy. KEY RESULTS Overall, 72 pregnant Veterans were offered a COVID-19 vaccine during pregnancy; over two-thirds (69%) opted not to receive a vaccine. Reasons for not receiving a vaccine included potential effects on the baby (64%), side effects for oneself (30%), and immunity from a past COVID-19 infection (12%). Those who received a vaccine had significantly greater vaccine knowledge and less belief in vaccine conspiracy theories. Greater knowledge of vaccines in general (aOR: 1.78; 95% CI: 1.2-2.6) and lower beliefs in vaccine conspiracies (aOR: 0.76; 95% CI: 0.6-0.9) were the strongest predictors of acceptance of a COVID-19 vaccine during pregnancy. CONCLUSIONS Our study provides important insights regarding pregnant Veterans' decisions to accept the COVID-19 vaccine, and reasons why they may choose not to accept the vaccine. Given the high endorsement of vaccine conspiracy beliefs, trusted healthcare providers should have ongoing, open discussions about vaccine conspiracy beliefs and provide additional information to dispel these beliefs.
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Affiliation(s)
- Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Birch Building, Room 112, 421 North Main Street, Leeds, MA, 01053, USA. .,University of Massachusetts Medical School, Worcester, MA, USA.
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Birch Building, Room 112, 421 North Main Street, Leeds, MA, 01053, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Birch Building, Room 112, 421 North Main Street, Leeds, MA, 01053, USA
| | - Lorrie Walker
- VA Central Western Massachusetts Healthcare System, Birch Building, Room 112, 421 North Main Street, Leeds, MA, 01053, USA
| | | | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, MA, USA
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Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N. Prevalence of Bipolar Disorder in Perinatal Women: A Systematic Review and Meta-Analysis. J Clin Psychiatry 2022; 83:21r14045. [PMID: 35830616 PMCID: PMC10849873 DOI: 10.4088/jcp.21r14045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To estimate overall prevalence of bipolar disorder (BD) and the prevalence and timing of bipolar-spectrum mood episodes in perinatal women. Data Sources: Databases (PubMed, Scopus, PsycINFO, CINAHL, Cochrane, ClincalTrials.gov) were searched from inception to March 2020. Study Selection: Included studies were original research in English that had (1) populations of perinatal participants (pregnant or within 12 months postpartum), aged ≥ 18 years, and (2) a screening/diagnostic tool for BD. Search terms described the population (eg, perinatal), illness (eg, bipolar disorder), and detection (eg, screen, identify). Data Extraction: Study design data, rates, and timing of positive screens/diagnoses and mood episodes were extracted by 3 independent reviewers. Pooled prevalences were estimated using random-effects meta-analyses. Results: Twenty-two articles were included in qualitative review and 12 in the meta-analysis. In women with no known psychiatric illness preceding the perinatal period, pooled prevalence of BD was 2.6% (95% CI, 1.2%-4.5%) and prevalence of bipolar-spectrum mood episodes (including depressed, hypomanic/manic, mixed) during pregnancy and the postpartum period was 20.1% (95% CI, 16.0%-24.5%). In women with a prior BD diagnosis, 54.9% (95% CI, 39.2%-70.2%) were found to have at least one bipolar-spectrum mood episode occurrence in the perinatal period. Conclusions: Our review suggests that the perinatal period is associated with high rates of bipolar-spectrum mood episodes and that pregnant and postpartum women represent a special risk population. This review may help to inform clinical care recommendations, thus helping to identify those who may have.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Corresponding author: Grace A. Masters, BS, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA 01605 (; ORCID ID: https://orcid.org/0000-0001-6064-3786)
| | - Julie Hugunin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Christine M Ulbricht
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Now with National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jean Y Ko
- Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Masters GA, Xu L, Cooper KM, Moore Simas TA, Brenckle L, Mackie TI, Schaefer AJ, Straus J, Byatt N. Perspectives on addressing bipolar disorder in the obstetric setting. Gen Hosp Psychiatry 2022; 77:130-140. [PMID: 35640435 PMCID: PMC10858616 DOI: 10.1016/j.genhosppsych.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Perinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes. METHODS We conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups. RESULTS Thirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration. CONCLUSIONS Barriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America.
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Katherine M Cooper
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
| | - Linda Brenckle
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Thomas I Mackie
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - Ana J Schaefer
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - John Straus
- Massachusetts Behavioral Health Partnership, Boston, MA, United States of America
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
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Smith LD, Valentine A, Moore Simas TA, Parish SL, Levy A, Mitra M. Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities. J Intellect Dev Disabil 2022; 48:12-22. [PMID: 36969147 PMCID: PMC10036077 DOI: 10.3109/13668250.2022.2086110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. Method We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships. Results The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). Conclusions Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.
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Affiliation(s)
- Lauren D. Smith
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester , MA, USA
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Alanna Levy
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Waring ME, Pagoto SL, Moore Simas TA, Heersping G, Rudin LR, Arcangel K. Feedback on Instagram posts for a gestational weight gain intervention. Transl Behav Med 2022; 12:568-575. [PMID: 35191497 PMCID: PMC9150071 DOI: 10.1093/tbm/ibac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lifestyle interventions can facilitate healthy gestational weight gain but attending in-person meetings can be challenging. High rates of use and the popularity of pregnancy content suggests Instagram as a possible platform for delivering gestational weight gain interventions. We assessed the logistics and acceptability of creating a private Instagram group and to obtain feedback on intervention posts. We conducted a 2-week study with pregnant women with pre-pregnancy overweight or obesity who use Instagram daily. Participants created a private Instagram account and followed other participants and a moderator who shared twice-daily posts about physical activity and healthy eating during pregnancy. Participants provided feedback through a follow-up survey and focus group/interviews. Engagement data was abstracted from Instagram. Participants (N = 11) were on average 26.3 (SD: 7.4) weeks gestation and 54% had obesity pre-pregnancy. All participants followed the moderator's account, 73% followed all other participants, participants engaged with 100% of study posts, 82% felt comfortable sharing in the group, and 73% would participate in a similar group if pregnant in the future. While participants felt the posts were visually attractive and included helpful information, they wanted more personalized content and felt reluctant to post photos they felt were not "Instagram worthy." Moderators should foster an environment in which participants feel comfortable posting unedited, authentic photos of their lives, perhaps by sharing personal photos that are relatable and represent their own imperfect lives. Results will inform further development and testing of an Instagram-delivered gestational weight gain intervention.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Sherry L Pagoto
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Grace Heersping
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Lauren R Rudin
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Kaylei Arcangel
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
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Kovell LC, Maxner B, Shankara S, Lemon SC, Person SD, Moore Simas TA, Turkson-Ocran RA, McManus DD, Juraschek SP. Home Blood Pressure Monitoring in Women of Child-Bearing Age With Hypertension From 2009 to 2014. Am J Hypertens 2022; 35:694-698. [PMID: 35512277 PMCID: PMC9340649 DOI: 10.1093/ajh/hpac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/09/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a leading cause of maternal mortality, and HTN guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. Evidence suggests that HBPM be coupled with a care team to maximize its effectiveness. HBPM use and the prevalence of provider counseling in child-bearing age women with HTN are unknown. METHODS We used data from 3,614 women in the cross-sectional National Health and Nutrition Examination Surveys 2009-2014 to determine HBPM use and provider counseling for women of child-bearing age (20-50 years) with and without HTN. HBPM use and provider counseling were self-reported. We examined rates of HBPM use by race/ethnicity, poverty-income ratio (PIR), education, and insurance. RESULTS Among women of child-bearing age with HTN, the mean (SE) age was 37.0 (0.3) years, the mean (SE) BMI was 35.5 (0.6) kg/m2, and 73% were on BP medication. Of these women with HTN, 49.6% reported HBPM use in the past year and 40.4% received provider counseling. There was no significant difference in HBPM use by race/ethnicity, PIR, or insurance, though higher education was associated with HBPM use. Women with HTN who received provider counseling were more likely to use HBPM (odds ratio = 15.7, 95% confidence interval 9.1-26.9). CONCLUSIONS Nearly half of child-bearing age women with HTN have adopted HBPM, and provider counseling was strongly associated with HBPM use. This highlights a need and opportunity for providers to improve BP management by supporting a popular and valuable monitoring approach among women of child-bearing age with HTN.
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Affiliation(s)
| | - Benjamin Maxner
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sravya Shankara
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Obstetrics and Gynecology, Pediatrics and Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ruth-Alma Turkson-Ocran
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Sachdeva J, Nagle Yang S, Gopalan P, Worley LLM, Mittal L, Shirvani N, Spada M, Albertini E, Shenai N, Moore Simas TA, Byatt N. Ensuring Trauma Informed Care in the Obstetric Setting: A vital role for the Psychiatrist. J Acad Consult Liaison Psychiatry 2022; 63:485-496. [PMID: 35513261 DOI: 10.1016/j.jaclp.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Trauma is highly prevalent, and women are twice as likely as men to develop post-traumatic stress disorder following a traumatic exposure. Consequently, many women entering the perinatal period have trauma histories. In the perinatal period, a trauma history, can negatively impact treatment engagement and adversely affect the experience of pregnancy, postpartum and parenting. A trauma informed care approach can mitigate these effects. OBJECTIVES This review aims to summarize literature that can aid psychiatrists in 1) identifying signs and symptoms of trauma in perinatal women 2) integrating elements of trauma informed care into perinatal mental health care, and 3) offering interventions that can minimize adverse outcomes for perinatal women and their children. METHODS A PubMed search was conducted with keywords including trauma, pregnancy, perinatal, post-traumatic stress disorder (PTSD), postpartum PTSD, trauma informed care. RESULTS Perinatal care, given its somewhat invasive nature, has the potential to traumatize or cause re-traumatization. Trauma related disorders are common and can present or worsen in the perinatal period. Trauma can manifest in multiple forms in this population, including exacerbation of pre-existing PTSD, new onset acute stress disorder in the perinatal period or postpartum PTSD secondary to traumatic childbirth. Unaddressed trauma can adversely affect the experience of pregnancy, postpartum and parenting. Psychiatrists caring for women in the perinatal period, are in an ideal position to screen for trauma and offer appropriate intervention. A trauma informed approach to obstetric care can help clinical teams respond to the unique trauma-related challenges that can arise during obstetric care. Trauma informed care, with its emphasis on establishing a culture of safety, transparency, trustworthiness, collaboration, and mutuality can empower health care providers and systems with powerful tools to respond to trauma and its myriad effects in a strengths-based manner. By applying a trauma-informed lens, psychiatrists can help their obstetric colleagues provide patient-centered compassionate care and treatment. CONCLUSIONS Applying a trauma informed approach to evaluation and treatment of perinatal populations could decrease the toll trauma has on affected women and their children.
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Affiliation(s)
- Jyoti Sachdeva
- Associate Professor of Psychiatry and Obstetrics and Gynecology, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 260 Stetson St. Suite 3200, Cincinnati, OH 45219.
| | - Sarah Nagle Yang
- Associate Professor of Psychiatry, University of Colorado School of Medicine
| | - Priya Gopalan
- Associate Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Linda L M Worley
- Professor of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences
| | - Leena Mittal
- Chief, Division of Women's Mental Health , Brigham and Women's Hospital , Instructor of Psychiatry, Harvard Medical School
| | | | - Meredith Spada
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Neeta Shenai
- Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine
| | - Tiffany A Moore Simas
- Professor of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health
| | - Nancy Byatt
- Professor with Tenure of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Heal
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Ramella L, Schaefer AJ, Rokicki S, Adachi J, Thompson AB, Byatt N, Moore Simas TA, Mackie TI. A national survey on adaptations by perinatal psychiatry access programs to promote perinatal mental healthcare equity. Gen Hosp Psychiatry 2022; 76:49-54. [PMID: 35361495 DOI: 10.1016/j.genhosppsych.2022.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Perinatal Psychiatry Access Programs ("Access Programs") are system-level interventions that aim to build the capacity of perinatal healthcare professionals to address mental health, and thereby improve access to perinatal mental healthcare. Access Programs are widely implemented and positioned to promote health equity in perinatal mental healthcare, but little is known about the adaptations being made to the model in response to calls to promote health equity. METHODS One respondent from each of the 14 Access Programs (n = 14) completed an online survey that queried on adaptations made to promote perinatal mental healthcare equity. RESULTS Twelve of the 14 Access Program team members (86%) indicated implementation of at least one new equity initiative. The average number of initiatives that a single Access Program implemented was 3.5 (range 0-10). Two Access Programs (14%) implemented 8.5 initiatives (range: 7-10), indicating that a small cohort is leading promotion of equity among Access Programs. CONCLUSION Efforts to further expand the capacity and services of Access Programs to address perinatal mental healthcare inequities are needed. These adaptations may provide a robust opportunity for implementation initiatives to promote health equity through a system-level intervention.
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Affiliation(s)
- Leah Ramella
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
| | - Ana J Schaefer
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
| | - Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States of America.
| | - Jamie Adachi
- Maternal-Child Mental Health Program, Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States of America.
| | - Azure B Thompson
- Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America.
| | - Nancy Byatt
- Department of Psychiatry, Obstetrics & Gynecology, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health, 222 Maple Ave - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, Memorial Campus, 119 Belmont Street, Worcester, MA 01605, United States of America.
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
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Waring ME, Pagoto SL, Moore Simas TA, Heersping G, Rudin LR, Arcangel K. Correction to: Feedback on Instagram posts for a gestational weight gain intervention. Transl Behav Med 2022; 12:713. [PMID: 35451021 DOI: 10.1093/tbm/ibac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Sherry L Pagoto
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School/ UMass Memorial Health Care, Worcester, MA, USA
| | - Grace Heersping
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Lauren R Rudin
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
| | - Kaylei Arcangel
- Department of Allied Health Sciences and UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, USA
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Yuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, Griffen A, McIntyre L, Byatt N, Moore Simas TA. The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review. J Womens Health (Larchmt) 2022; 31:787-807. [PMID: 35442804 DOI: 10.1089/jwh.2021.0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Breastfeeding has many positive effects on the health of infants and mothers, however, the effect of breastfeeding on maternal mental health is largely unknown. The goal of this systematic review was to (1) synthesize the existing literature on the effects of breastfeeding on maternal mental health, and (2) inform breastfeeding recommendations. Materials and Methods: A literature search was conducted in electronic databases using search terms related to breastfeeding (e.g., breastfeeding, infant feeding practices) and mental health conditions (e.g., mental illness, anxiety, depression), resulting in 1,110 records. After reviewing article titles and abstracts, 339 articles were advanced to full-text review. Fifty-five articles were included in the final analysis. Results: Thirty-six studies reported significant relationships between breastfeeding and maternal mental health outcomes, namely symptoms of postpartum depression and anxiety: 29 found that breastfeeding is associated with fewer mental health symptoms, one found it was associated with more, and six reported a mixed association between breastfeeding and mental health. Five studies found that breastfeeding challenges were associated with a higher risk of negative mental health symptoms. Conclusions: Overall, breastfeeding was associated with improved maternal mental health outcomes. However, with challenges or a discordance between breastfeeding expectations and actual experience, breastfeeding was associated with negative mental health outcomes. Breastfeeding recommendations should be individualized to take this into account. Further research, specifically examining the breastfeeding experiences of women who experienced mental health conditions, is warranted to help clinicians better personalize breastfeeding and mental health counseling.
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Affiliation(s)
- Megan Yuen
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Olivia J Hall
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Grace A Masters
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Catherine Carr
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine Leung
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adrienne Griffen
- Maternal Mental Health Leadership Alliance, Arlington, Virginia, USA
| | | | - Nancy Byatt
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
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Moore Simas TA, Leung K, Nuss E, Marieni M, Marcus B, Rosal MC, Chasan-Taber L. Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia. Matern Child Health J 2022; 26:1741-1751. [PMID: 35386031 DOI: 10.1007/s10995-022-03429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may reduce a woman's ability to engage in lifestyle changes that could reduce their subsequent diabetes risk. METHODS We conducted a secondary analysis using data from Estudio Parto to evaluate sociodemographic, behavioral, psychosocial, and medical factors associated with perinatal depressive symptoms. Estudio Parto was a randomized controlled trial conducted in Western Massachusetts from 2013 to 17. Eligible participants had pregnancy hyperglycemia. The Edinburgh Postnatal Depression Scale (EPDS) was administered at 24-28 weeks gestation and at 6 weeks, 6 months, and 12 months postpartum. An EPDS cutpoint of 10 or greater defined the presence of depressive symptoms. RESULTS In this sample of Puerto Rican women with pregnancy hyperglycemia, 32% and 27% showed prenatal and postpartum depressive symptoms, respectively. Among participants, 35.5% were diagnosed with GDM, 44.3% with isolated hyperglycemia, and 20.2% with impaired glucose tolerance. In multivariable models, being unmarried (OR 3.87; 95% CI 1.51-9.94), prenatal substance use (smoking or alcohol consumption; OR 2.96; 95% CI 1.41-6.18), and maternal age (1.11 for each year; 95% CI 1.04-1.18) were associated with higher odds of prenatal depressive symptoms. None of the risk factors were associated with subsequent postpartum depression in adjusted analyses. CONCLUSIONS Identifying factors associated with prenatal and postpartum depression in Puerto Rican women with pregnancy hyperglycemia can inform targeted lifestyle interventions in this at-risk group, increase the likely adoption of healthy lifestyle behaviors, and thereby work to address health disparities. CLINICALTRIALS gov NCT01679210; date of registration 08/07/2012.
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Affiliation(s)
- Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katherine Leung
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily Nuss
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Michelle Marieni
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics & Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 401 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA.
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Kovell LC, Meyerovitz CV, Skaritanov E, Ayturk D, Person SD, Kumaraswami T, Juraschek SP, Moore Simas TA. Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018. J Hypertens 2022; 40:776-784. [PMID: 35081582 PMCID: PMC10122757 DOI: 10.1097/hjh.0000000000003077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN. METHODS Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20-50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP ≥130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported. RESULTS Of the 8726 women, 12.4% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraceptive status. In logistic regression models, contraceptive use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001-2006) to 81.4% (2013-2018, P < 0.001). CONCLUSIONS Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.
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Affiliation(s)
- Lara C. Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School
| | | | | | - Didem Ayturk
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
| | - Sharina D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | - Tiffany A. Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester
- Departments of Pediatrics and Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Yang C, Huang SS, Moore Simas TA, Silk H, Savageau JA, Russell SL. The MOHIP-14 PW (Modified Oral Health Impact Profile 14-Item Version for Pregnant Women): A Real-World Study of Its Psychometric Properties and Relationship with Patient-Reported Oral Health. Healthcare (Basel) 2022; 10:healthcare10030461. [PMID: 35326939 PMCID: PMC8951846 DOI: 10.3390/healthcare10030461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The 14-item version of the Oral Health Impact Profile (OHIP-14) has been widely used as a measure for oral health-related quality of life (OHQoL) since its publication in 1997. However, few studies have examined its psychometric properties and relationship with patient-reported oral health in pregnant women. Aim: To offer empirical evidence for appropriate use of the OHIP-14 among pregnant women in research and clinical practice. Objectives: (1) to empirically investigate the psychometric properties of the OHIP-14, (2) to modify it into the MOHIP-14PW (modified OHIP-14 for pregnant women), and (3) to compare their relationships with patient-reported oral health in pregnant women. Methods: In this real-world study (RWS) from suburban New York clinics, we collected OHIP-14 data from 291 pregnant women and assessed its psychometric properties at the item-, dimension-, and measure-level, including confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Accordingly, we modified the OHIP-14 into the MOHIP-14PW. Finally, we compared their correlations with patient-reported oral health scores. Results: All OHIP-14 items had severely skewed distributions, and two had a correlation with the patient-reported oral health < 0.1. All seven pairs of items correlated well (0.47 to 0.62), but the Cronbach’s alphas indicated suboptimal reliability, with two below 0.70. CFA results offered suboptimal support to the original structure, and EFA found a three-dimensional structure best fitted the data. Therefore, we modified the OHIP-14 into the MOHIP-14PW. CFA on the MOHIP-14PW offered stronger supports, and the Cronbach’s alphas increased to 0.92, 0.72, and 0.71. The MOHIP-14PW’s dimensions were more meaningful to pregnant women and had stronger relationships with patient-reported oral health than the OHIP-14; the average correlation coefficients increased by 26% from 0.19 in OHIP-14 to 0.24 in the MOHIP-14PW. Conclusions: The original OHIP-14 required modifications at the item-, dimension-, and measure- level, and the MOHIP-14PW had better psychometric properties, easier interpretation, and stronger correlation with patient-reported oral health in low-income pregnant women. Through an interdisciplinary RWS on a large sample of pregnant women, this study offers concrete empirical evidence for the advantages of the MOHIP-14PW over the original OHIP-14.
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Affiliation(s)
- Chengwu Yang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA 01655, USA;
- Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, MA 01655, USA
- Correspondence: (C.Y.); (S.L.R.)
| | - Shulamite S. Huang
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY 10010, USA;
| | - Tiffany A. Moore Simas
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA 01655, USA;
- Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Hugh Silk
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA 01655, USA; (H.S.); (J.A.S.)
| | - Judith A. Savageau
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA 01655, USA; (H.S.); (J.A.S.)
| | - Stefanie L. Russell
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY 10010, USA;
- Department of Oral Surgery, Bellevue Hospital, New York, NY 10016, USA
- Correspondence: (C.Y.); (S.L.R.)
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Meyerovitz C, Skaritanov E, Ayturk D, Person SD, Kumaraswami T, Juraschek SP, Simas TAM, Kovell L. TRENDS IN CONTRACEPTION USE AMONG WOMEN OF CHILD-BEARING AGE WITH HYPERTENSION IN THE UNITED STATES FROM 2001-2018. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Amir N, Smith L, Valentine AM, Mitra M, Parish SL, Moore Simas TA. Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101262. [PMID: 35031269 PMCID: PMC8983509 DOI: 10.1016/j.dhjo.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs. OBJECTIVE The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content. METHODS This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. RESULTS Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs. CONCLUSION Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Nili Amir
- University of Connecticut Medical School, Department of Obstetrics and Gynecology, 200 Academic Way, Farmington, CT 06032, USA; University of Masachusetts Chan Medical School, 55 Lake Ave North Worcester, MA 01605, USA.
| | - Lauren Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Susan L Parish
- Virginia Commonwealth University, College of Health Professions, 900 E. Leigh Street, Box 980233 Richmond, VA 23298, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School/UMass Memorial Health Care Department of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA 01605, USA
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Mitra M, Akobirshoev I, Valentine A, Brown HK, Moore Simas TA. Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities. Am J Prev Med 2021; 61:872-881. [PMID: 34579985 PMCID: PMC8608722 DOI: 10.1016/j.amepre.2021.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities. METHODS This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis. RESULTS This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29). CONCLUSIONS Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
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Darling EV, Byatt N, Maher EL, Gray TD, Simas TAM, Cordova JV. The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders. J Clin Psychol Med Settings 2021; 29:295-309. [PMID: 34617155 DOI: 10.1007/s10880-021-09819-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples' relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the 'Marriage Checkup', an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.
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Affiliation(s)
- Ellen V Darling
- Department of Psychology, Clark University, Worcester, MA, USA.
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily L Maher
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tatiana D Gray
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, MA, USA
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Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, Byatt N, Madni SA, Goodman D. Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17. Health Aff (Millwood) 2021; 40:1551-1559. [PMID: 34606354 DOI: 10.1377/hlthaff.2021.00615] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.
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Affiliation(s)
- Susanna L Trost
- Susanna L. Trost is an Oak Ridge Institute for Science and Education Fellow in the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Jennifer L Beauregard
- Jennifer L. Beauregard is an epidemiologist in the Division of Reproductive Health, CDC, and a lieutenant in the US Public Health Service, in Rockville, Maryland
| | - Ashley N Smoots
- Ashley N. Smoots is an epidemiologist in the Division of Reproductive Health, CDC
| | - Jean Y Ko
- Jean Y. Ko is the lead for the Maternal Health and Chronic Disease Team, Division of Reproductive Health, CDC, and a commander in the US Public Health Service
| | - Sarah C Haight
- Sarah C. Haight is a graduate research assistant in the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina. She was an epidemiologist in the Division of Reproductive Health, CDC, at the time of writing
| | - Tiffany A Moore Simas
- Tiffany A. Moore Simas is the chair of the Department of Obstetrics and Gynecology and medical director of the Lifeline for Moms Program, University of Massachusetts Medical School/UMass Memorial Health, in Worcester, Massachusetts
| | - Nancy Byatt
- Nancy Byatt is the executive director of the Lifeline for Families Center and Lifeline for Moms Program, Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Health Care
| | - Sabrina A Madni
- Sabrina A. Madni is a statistician with BeVera Solutions in the National Center for Immunization and Respiratory Diseases, CDC. She was an Oak Ridge Institute for Science and Education Fellow in the Division of Reproductive Health, CDC, at the time of writing
| | - David Goodman
- David Goodman is the lead for the Maternal Mortality Prevention Team, Division of Reproductive Health, CDC
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Byatt N, Masters GA, Twyman J, Hunt A, Hamad C, Maslin M, Moore Simas TA. Building Obstetric Provider Capacity to Address Perinatal Depression Through Online Training. J Womens Health (Larchmt) 2021; 30:1386-1394. [PMID: 33835884 PMCID: PMC8590156 DOI: 10.1089/jwh.2020.8843] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Perinatal depression is common, underdiagnosed, and undertreated. Obstetric providers often do not receive training in perinatal depression, despite being the frontline providers for perinatal individuals. The objective of this study was to develop and pilot test an online training module to assess feasibility, efficacy, and acceptance in improving obstetric providers' knowledge, skills, and practices regarding perinatal depression. Materials and Methods: We designed, developed, and implemented an online, asynchronous, interactive educational module that trains obstetric providers to: (1) know the prevalence and impact of perinatal depression; (2) use validated tools for depression screening; (3) assess for depression; and (4) start and/or refer for treatment. Formative evaluation with five providers, iterative module and question refinement, and a pilot test with pre- and post-test knowledge and self-efficacy questions were conducted. Results: Sixteen obstetric providers averaged a 32% improvement in their pre- to post-test scores (p < 0.01). The average pretest score was 49% (range 20%-70%), and the average post-test score was 81% (range 70%-95%). Provider beliefs (p = 0.01), self-efficacy (p < 0.01), and confidence (p < 0.01) in treating perinatal depression were also significantly increased between pre- and post-test. Average Likert scores on overall training satisfaction were very high post-training completion (4.44 out of 5, with 5 being most positive). Conclusions: The module was feasible and effective at improving provider knowledge of perinatal depression, self-rated confidence, and self-efficacy. Improving the knowledge and skills of obstetric providers regarding depression is a critical part of any intervention aimed to close gaps in care and help ensure that patients receive optimal treatment.
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Affiliation(s)
- Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Grace A. Masters
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Anne Hunt
- Hunt Consulting Associates, Logan, Utah, USA
| | | | - Melissa Maslin
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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50
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Kovell LC, Maxner B, Ayturk D, Moore Simas TA, Harrington CM, McManus DD, Gardiner P, Aurigemma GP, Juraschek SP. Dietary Habits and Medications to Control Hypertension Among Women of Child-Bearing Age in the United States from 2001 to 2016. Am J Hypertens 2021; 34:919-928. [PMID: 33693539 DOI: 10.1093/ajh/hpab041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/27/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hypertension (HTN) in pregnancy is a leading cause of maternal morbidity and mortality in the United States. Although the Dietary Approaches to Stop Hypertension (DASH) diet is recommended for all adults with HTN, rates of DASH adherence and antihypertensive medication use in women of child-bearing age are unknown. Our objectives were to determine DASH adherence and antihypertensive medication use in women of child-bearing age. METHODS In the National Health and Nutrition Examination Surveys from 2001 to 2016, we estimated DASH adherence among women of child-bearing age (20-50 years). We derived a DASH score (0-9) based on 9 nutrients, with DASH adherence defined as DASH score ≥4.5. HTN was defined by blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use. DASH scores were compared across BP categories and antihypertensive medication use was categorized. RESULTS Of the 7,782 women, the mean age (SE) was 32.8 (0.2) years, 21.4% were non-Hispanic Black, and 20.3% had HTN. The mean DASH score was 2.11 (0.06) for women with self-reported HTN and 2.40 (0.03) for women with normal BP (P < 0.001). DASH adherence was prevalent in 6.5% of women with self-reported HTN compared with 10.1% of women with normal BP (P < 0.05). Self-reported HTN is predominantly managed with medications (84.8%), while DASH adherence has not improved in these women from 2001 to 2016. Moreover, 39.5% of US women of child-bearing age are taking medications contraindicated in pregnancy. CONCLUSIONS Given the benefits of optimized BP during pregnancy, this study highlights the critical need to improve DASH adherence and guide prescribing among women of child-bearing age.
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Affiliation(s)
- Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Benjamin Maxner
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Didem Ayturk
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Obstetrics and Gynecology, Pediatrics and Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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