Search

Objectives: To investigate whether adverse childhood experiences are associated with miscarriage. Methods: The Gulf Resilience on Women's Health Consortium recruited from clinics and community organizations in Southern Louisiana, 2011–2016. Data from 1511 reproductive-aged women with at least one pregnancy were analyzed. Adverse childhood experiences including abuse, neglect, and family dysfunction, as a child (< age 12), and as an adolescent (12–17), were assessed. Outcome measures were self-reported miscarriage at first pregnancy and at any pregnancy, analyzed with logistic regression with adjustment for maternal age at pregnancy, race, BMI, education, marital and smoking status. Results: Women reporting four or more adversities as a child and as a teen had higher odds of experiencing miscarriage at first pregnancy (AORchild 1.71, 95% CI 1.00–2.90; AORteen 1.73, 95% CI 1.05–2.87) and miscarriage at any pregnancy (AORchild 1.74, 95% CI 1.16–2.62; ORteen 1.65, 95% CI 1.10–2.45) compared to those with no adverse childhood experiences. Similar patterns of association were seen for other ACE sub-categories. Conclusions: Childhood adversities were associated with miscarriage. Further research is needed on the pathways which created this association, including psychological, behavioral, and physiological mechanisms and factors which can mitigate the effects of these outcomes. [ABSTRACT FROM AUTHOR]

The health and well-being of pregnant women during and after natural disasters remains an international concern. In this mixed methods study we described pregnant women's mental health, psychosocial concerns and sources of stress living in New Orleans during long term recovery from Hurricane Katrina. Our survey of 402 pregnant women indicated poor social support was associated with higher levels of depression symptomology, post-traumatic stress disorder, anxiety, and stress. Women were interviewed and described seven common areas of worry. We concluded that pregnant women living in post-disaster communities have stressful lives years after the event, needing innovative models of care to build resilience. [ABSTRACT FROM AUTHOR]

Objectives To clarify the effectiveness of perinatal social support interventions in reducing postpartum depression among minority, low-income women. Methods The Transdisciplinary Research Consortium for Gulf Resilience on Women’s Health supported a community-based participatory research project to improve perinatal health among low-income, first-time pregnant women living in a vulnerable Gulf Coast region. Community health workers (CHWs) were partnered with recruited women, and used a mix of mobile technology and home visits to develop a supportive relationship during the perinatal period. Results Women enrolled in the CHW-led intervention had lower (F: 2.38, p = 0.04) average postpartum depression scores (EPDS) 6 months postpartum than a comparison population. The difference, however, was not seen among women in the intervention group who reported relatively poor relationships with their CHWs. Conclusions for Practice Results reinforce the evidence that perinatal social support can affect postpartum depression outcomes. CHWs are increasingly utilized by public programs to reach at-risk populations. We discuss the potential efficacy of CHW programs, but also, the need to pair outreach with effective monitoring and evaluation of the relationship development between CHW and clients. [ABSTRACT FROM AUTHOR]

Both intimate partner violence and neighborhood crime have been associated with worse mental health outcomes, but less is known about cumulative effects. This association was studied in a sample of pregnant women who were enrolled in a study of disaster exposure, prenatal care, and mental and physical health outcomes between 2010 and 2012. Women were interviewed about their exposure to intimate partner violence and perceptions of neighborhood safety, crime, and disorder. Main study outcomes included symptoms of poor mental health; including depression, pregnancy-specific anxiety (PA), and posttraumatic stress disorder (PTSD). Logistic regression was used to examine predictors of mental health with adjustment for confounders. Women who experienced high levels of intimate partner violence and perceived neighborhood violence had increased odds of probable depression in individual models. Weighted high cumulative (intimate partner and neighborhood) experiences of violence were also associated with increased odds of having probable depression when compared with those with low violence. Weighed high cumulative violence was also associated with increased odds of PTSD. This study provides additional evidence that cumulative exposure to violence is associated with poorer mental health in pregnant women. [ABSTRACT FROM AUTHOR]

Anxiety in pregnancy has been associated with adverse birth outcomes. Relatively few studies have investigated how acculturation affects mental health in pregnancy among Latinas. The goal of this study was to determine if acculturation was associated with anxiety over the course of pregnancy in a sample of predominantly Puerto Rican women. Women were recruited in pregnancy for participation in Proyecto Buena Salud, a prospective cohort study of Latina women ( n = 1412). Acculturation was measured via the Psychological Acculturation Scale (PAS), language preference and generation in the USA. Anxiety was measured using the State-Trait Anxiety Instrument. Linear and logistic multivariable regressions were used to investigate associations. After adjustment, women with bicultural identification had significantly lower trait anxiety scores in early pregnancy ( β = −3.62, SE = 1.1, p < 0.001) than low acculturated women. Women with higher levels of acculturation as indicated by English-language preference ( β = 1.41, SE = 0.7, p = 0.04) and second or third generation in the USA had significantly higher trait anxiety scores in early pregnancy ( β = 1.83, SE = 0.6, p < 0.01). Bicultural psychological acculturation was associated with lower trait anxiety in early pregnancy, while English-language preference and higher generation in the USA were associated with higher trait anxiety in early pregnancy. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. METHODS Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants after Wave I and before age 20, were still in secondary school while pregnant, and had complete data (N = 402) were included. Mothers reported infants' birthweight and gestational age. School administrators reported whether family planning counseling, diagnostic screening (including sexually transmitted diseases [ STDs]), STD treatment, and prenatal/postpartum health care were provided on-site at school at Wave I. Multilevel models adjusted for individual and school characteristics were conducted. RESULTS Few schools offered reproductive health care services on-site. In multilevel analyses, availability of family planning counseling (Est. β = 0.21, 95% confidence interval [ CI] 0.04-0.38 p < 0.05) and prenatal/postpartum health care (Est. β = 0.21, 95% CI 0.02-0.40 p < 0.05) were significantly associated with increased infant birthweight. No services examined were significantly associated with increased gestational age. CONCLUSIONS Some school-based reproductive health services may improve subsequent birth outcomes among adolescent mothers. Future analyses should examine the mechanisms by which services impact birth outcomes. [ABSTRACT FROM AUTHOR]

Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = −0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = −0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population. [ABSTRACT FROM AUTHOR]

Objectives: To examine how the recovery following Hurricane Katrina affected pregnancy outcomes. Methods: 308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders. Results: Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = −158 g) and between injury and gestational age (adjusted beta = −0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: −112 g, p = 0.08; gestational age: −3.2 days, p = 0.02; birth length: −0.65 cm, p = 0.06). Conclusions: Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome. [ABSTRACT FROM AUTHOR]

Assess the amount of agreement between the classification of stress from the Perceived Stress Scale (PSS) and the Assessment of Stress portion of the Prenatal Psychosocial Profile (PPP) among pregnant women. A secondary data analysis on a cross-sectional study of 301 pregnant women from the New Orleans and Baton Rouge areas who were exposed to Hurricane Katrina was conducted. Women with complete data (219) were analyzed. Women scoring in the third tertile of each instrument were compared. The kappa statistic was used to assess agreement between instruments. Additional comparisons were made with three instruments that measure other important psychosocial constructs that could be related to stress: the Edinburgh Depression Scale (EDS) and the Assessments of Support (partner and other support) and Self-Esteem from the PPP. No significant difference was found between the two tests. The PSS and the PPP were both statistically significantly correlated to each other (ρ = 0.71, p < 0.01). Thirty-five women were classified discordantly resulting in a Kappa Coefficient of 0.61 (95 % CI 0.50-0.72, p < 0.01). No significant differences were found between these two instruments in correlation with the EDS (PPP, r = 0.76; PSS, r = 0.72; p < 0.01 for each), partner support (PPP, r = −0.47; PSS r = −0.46; p < 0.01 for each), other support (PPP, r = −0.31; PSS r = −0.32; p < 0.01 for each) and self-esteem (PPP, r = −0.41; PSS, r = −0.52; p < 0.01 for each), respectively. Given the similarities between the PSS and PPP, researchers are encouraged to choose and administer one instrument to participants, or to use the instruments in combination as an external reliability check. [ABSTRACT FROM AUTHOR]

Background: High impact experiences following a natural disaster have been shown to influence later psychopathology. Individual-level factors such as age may also contribute to a disaster's impact on mental health, though it is unclear whether young age confers a protective effect or represents a period of increased risk as compared to adulthood. Objective: The present study evaluated the influence of adolescent age and hurricane experiences on mental health in the years following multiple hurricanes in the New Orleans region. Methods: 794 women, currently aged 18-45, participating in a cohort study of lifetime adversity and reproductive health completed a survey about hurricane experience and current mental health. Joint associations between disaster experience and age at the time of disaster on depression and post-traumatic stress disorder (PTSD) were evaluated. Results: Compared to women who were adults at the time of the disaster, being in early adolescence resulted in reduced depression and PTSD up to 9-years post-disaster, controlling for hurricane experiences, time since disaster, and income. A similar effect was not observed among older adolescents. Increased endorsement of feeling one's life was in danger and experiencing illness or injury resulted in increased odds of depression, while danger was associated with increased odds of PTSD. Conclusions: Younger age at the time of a natural disaster may confer a protective effect on mental health outcomes post-disaster, even when disaster experiences are considered, potentially representing the importance of parental support and cognitive development on disaster effects. [ABSTRACT FROM AUTHOR]

Aims To examine the relationship between personality, pregnancy and birth outcomes in adolescents. Background Personality has been shown to be a strong predictor of many health outcomes. Adolescents who become pregnant have worse birth outcomes than adults. Design Cross-sectional study using data from the National Longitudinal Study of Adolescent Health (baseline, 1994-1995; follow-up, 2007-2008). Methods The study sample was 6529 girls, 820 of whom reported on pregnancy outcomes for a teenage birth. Personality data were taken from the Mini International Personality Item Pool personality tool, which measures the five-factor personality traits of neuroticism, conscientiousness, intellect/imagination, extraversion and agreeableness. Logistic regression was used to predict teen pregnancy and linear regression was used to predict birth weight and gestational age with adjustment for confounders and stratification by race. Results Agreeableness and intellect/imagination were associated with a reduced likelihood of becoming pregnant as an adolescent, while neuroticism, conscientiousness and extraversion were all associated with an increased likelihood of becoming pregnant. Higher neuroticism was associated with lower birth weight and gestational age among Black girls, but not non-Black. Conscientiousness was associated with lower gestational age among non-Black girls. No relationships were found with extraversion or agreeableness and birth outcomes. Receiving late or no prenatal care was associated with higher intellect/imagination. Conclusions Personality is understudied with respect to pregnancy and birth outcomes compared with other health outcomes. Such research could help professionals and clinicians design and target programmes that best fit the characteristics of the population most likely to need them, such as those with high neuroticism. [ABSTRACT FROM AUTHOR]

To study the relationship between neighborhood demographic characteristics (disadvantage, racial concentration) and the birthweight of infants born to adolescent mothers, potentially as mediated by smoking, prenatal care use, or perceptions of neighborhood safety. Data from Waves I and IV of the National Longitudinal Survey of Adolescent Health were analyzed. Birthweight (continuous) and low birthweight (<2.5 kg) of singleton infants born to non-Hispanic Black and non-Hispanic White adolescent mothers (<20 years) after Wave I were examined as outcomes. Neighborhood demographic characteristics included Census Block Group socioeconomic disadvantage and Black racial concentration. Possible mediators (smoking during pregnancy, early initiation of prenatal care, and perceptions of safety) were also examined. Controls for adolescent baseline age, age at pregnancy, body mass index (BMI) and parental education were included. Analyses were run stratified on race. Baseline continuous birthweight, BMI and neighborhood demographics varied significantly between non-Hispanic Black and White adolescent mothers, with Black adolescent mothers evidencing lower birthweight and higher BMI, neighborhood disadvantage and Black racial concentration. In multivariable analyses among Black adolescent mothers, Black racial concentration was positively associated with birthweight, and negatively associated with low birthweight; no mediators were supported. Neighborhood disadvantage and Black racial concentration were unassociated with birthweight outcomes among White adolescent mothers. Infants born to Black adolescent mothers evidenced higher birthweight with increasing Black neighborhood concentration. Further exploration of mechanisms by which Black racial concentration may positively impact birthweight is warranted. [ABSTRACT FROM AUTHOR]

There is growing interest in the application of propensity scores (PS) in epidemiologic studies, especially within the field of reproductive epidemiology. This retrospective cohort study assesses the impact of a short interpregnancy interval (IPI) on preterm birth and compares the results of the conventional logistic regression analysis with analyses utilizing a PS. The study included 96,378 singleton infants from Louisiana birth certificate data (1995-2007). Five regression models designed for methods comparison are presented. Ten percent (10.17 %) of all births were preterm; 26.83 % of births were from a short IPI. The PS-adjusted model produced a more conservative estimate of the exposure variable compared to the conventional logistic regression method (β-coefficient: 0.21 vs. 0.43), as well as a smaller standard error (0.024 vs. 0.028), odds ratio and 95 % confidence intervals [1.15 (1.09, 1.20) vs. 1.23 (1.17, 1.30)]. The inclusion of more covariate and interaction terms in the PS did not change the estimates of the exposure variable. This analysis indicates that PS-adjusted regression may be appropriate for validation of conventional methods in a large dataset with a fairly common outcome. PS's may be beneficial in producing more precise estimates, especially for models with many confounders and effect modifiers and where conventional adjustment with logistic regression is unsatisfactory. Short intervals between pregnancies are associated with preterm birth in this population, according to either technique. Birth spacing is an issue that women have some control over. Educational interventions, including birth control, should be applied during prenatal visits and following delivery. [ABSTRACT FROM AUTHOR]