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Low-income women of color are disproportionately more likely to contract HIV, struggle with treatment adherence, and have compromised health as a result of HIV infections in comparison to White and more affluent women. The current study is a secondary analysis aimed at examining the association between stress, symptoms of depression, trauma exposure, healthcare engagement, and adherence self-efficacy, among low-income women of color with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Structural equation modeling is used to identify latent mental health symptoms that may influence one another, as well as outcomes involving treatment engagement. Participants contributing to this dataset (n = 134) were low income, women of color (primarily African American) living with HIV or AIDS, receiving care at a major medical center in the northeastern United States. Findings indicate significant indirect associations between perceived stress and the outcome of medical appointment attendance. Significant mediators of this indirect relationship include depressive symptoms, parenting stress, and adherence self-efficacy. Implications for health and behavioral health practice and policy interventions are drawn. Areas in need of future research are identified. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White). Methods: We analyzed 2000–2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women. Results: Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18–45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38–0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16–2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19–2.66) compared to US-born White children in adjusted models. Discussion: MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts. Significance: What is already known on this subject?: National studies have evaluated maternal and perinatal health among minoritized groups; however, none have presented results among Middle Eastern and North African (MENA) women and children. The few studies that have evaluated MENA maternal and child health (MCH) outcomes have provided only state and local estimates. What this study adds?: This study provides nationally representative baseline data on the maternal and perinatal health of foreign-born MENA women and children. This is the first study to examine oral health among pregnant MENA women compared to US- and foreign-born pregnant White women. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the "off-hour effect" on maternal and neonatal adverse events in a large cohort representing U.S. population. Study Design A secondary analysis of the Consortium on Safe Labor (CSL) dataset with 208,695 women and 229,385 deliveries was performed. The study included the deliveries of ≥23 gestational weeks from 19 hospitals in the United States from 2002 to 2008. Babies with congenital anomalies were excluded from neonatal outcomes. We compared maternal and neonatal outcomes of patients delivered during weekdays versus off hours (nights and weekends). The primary outcomes of the study were composite maternal and composite neonatal adverse events. The secondary outcomes were delivery type and individual maternal and neonatal adverse events including maternal death and perinatal mortality rate. Associations between off hours and all the outcomes were analyzed in bivariable and multivariable analyses. The same analyses were performed in strata by indication for admission (spontaneous labor or induction of labor). Results Composite maternal adverse events (6.19 vs. 6.06%, p = 0.41) and maternal death (0.01 vs. 0.01%, p = 0.19) were not significantly different between off hours and weekday groups. In contrast, composite neonatal adverse events (6.91 vs. 5.84%, p < 0.001) and perinatal mortality rate (1.03 vs. 0.77%, p < 0.001) were higher in the off-hour group. After adjusting for confounding variables, only the composite neonatal outcome continued to be associated with off hours (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI]: 1.04–1.16). Stratified analyses showed that the off-hour effect for the neonatal composite outcome was not present in those presenting in spontaneous labor (6.1 vs. 5.9%, p = 0.40). Conclusion Off-hour delivery was not associated with severe maternal morbidity and was only modestly associated with severe neonatal morbidity. This association was observed in women undergoing induction, not in those presenting in spontaneous labor. These data draw into question the existence of a clinically meaningful and correctable "off-hour effect" in obstetrics. Key Points The presence of a significant off-hour effect in obstetrics is still questionable. If the off-hour effect exists, it seems that not to be related with staffing issues. There is not a big difference for adverse events at off hours in spontaneously laboring patients. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. Methods: We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. Results: The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. Conclusion: The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception. [ABSTRACT FROM AUTHOR]

Objectives: The COVID pandemic has had widespread impacts on maternal mental health. This research aims to examine the relationship between psychosocial stressors and symptoms of depression and anxiety and the extent to which emotional support or resilient coping moderates the relationship between psychosocial stressors and maternal mental health during the first wave of the COVID pandemic. Methods: This analysis includes data collected in October and November 2020 from a geographically and sociodemographically diverse sample of 776 mothers in the U.S. with children ≤ 18 years of age. Log binomial models were used to estimate the association between moderate or severe symptoms of anxiety and depression and psychosocial stressors. Results: Symptoms of moderate or severe anxiety and depression were reported by 37.5% and 37.6% of participants, respectively. Moderate (aRR 2.76 [95% CI 1.87, 4.07]) and high (aRR 4.95 [95% CI 3.40, 7.20]) levels of perceived stress were associated with greater risk of moderate or severe anxiety symptoms. Moderate and high levels of parental burnout were also associated with greater prevalence of moderate or severe anxiety symptoms in multivariable models. Results were similar when examining the relationship among stress, parental burnout, and depressive symptoms. Neither resilient coping nor social support modified the relationship between psychosocial stressors and mental health. Conclusions for Practice: Evidence-based strategies to reduce stress and parental burnout and improve the mental health of mothers are urgently needed. Strategies focused on bolstering coping and social support may be insufficient to improve maternal mental health during acute public health emergencies. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation's worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool's initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals. [ABSTRACT FROM AUTHOR]

Increasing hospital and labor & delivery (L&D) closures have led to declining access to hospital obstetric care in rural areas across the country. These closures increase the burden on women and families living in rural communities, who often must drive long distances for prenatal visits and delivery. The lack of maternal health care in rural America can also result in several adverse maternal and infant outcomes including premature birth, low birth weight, out of hospital births, maternal and infant morbidity and mortality, and increased risk of postpartum depression. The reasons for these closures are multifactorial, and include, workforce shortages, financial viability, low volume of patients, concerns over maintaining the knowledge base and skill sets of the obstetrical health care team required to provide high quality and safe care, as well as medical-legal concerns. The problems of providing and accessing quality maternal and obstetrical care in rural America have not happened overnight, Likewise, the solutions to these problems will also not occur overnight and must also address the multifactorial nature of the problem. However, there are several opportunities to improve access to maternal health care in rural communities. Programs, policies, and funding need to be designed and provided to make these opportunities a reality. [ABSTRACT FROM AUTHOR]

There is great evidence to support improved maternal and neonatal outcomes when a patient delivers in a center that is suited to the needs of both the birthing person and the fetus. As rural centers have closed, access remains challenging. This manuscript examines The Emergency Medical Treatment and Labor Act, Emergency Medical Services (EMS) challenges, needs of rural hospitals including education, and elaborates further upon the need to expand maternal transport in rural areas to improve outcomes in the future. [ABSTRACT FROM AUTHOR]

This report presents the rates of maternal syphilis among pregnant women and congenital syphilis among newborns in the Military Health System (MHS) beneficiary population from 2012 to 2022. Medical encounter data from military hospitals and clinics as well as civilian health care facilities were obtained from the Defense Medical Surveillance System (DMSS) to determine pregnancies, live births, and confirmed diagnoses of maternal and congenital syphilis. The rate of maternal syphilis in female MHS beneficiaries increased by 233% between 2012 (n=123, 66.0 per 100,000 births) and 2022 (n=169, 219.8 per 100,000 births), while the rate of congenital syphilis in newborn MHS beneficiaries increased by 355% (n=9 to n=32, 6.8 to 30.8 per 100,000 live births). Pregnant active component service members generally evinced higher rates of maternal syphilis than pregnant non-service member MHS beneficiaries during the reporting period. Additionally, the positive predictive value of maternal syphilis cases in the MHS was found to be low (59%). Future studies could focus on potential misclassification of maternal syphilis cases as well as syphilis screening compliance and treatment during pregnancy for all pregnant MHS beneficiaries. The rate of diagnosed maternal syphilis among pregnant female active component service members exceeded previously reported rates of syphilis among all female active component service members annually between 2015 and 2022, likely due to increased screening.

Epidemiological studies have suggested that breastfeeding is associated with child weight status. However, the length of breastfeeding in relation to child weight remains poorly understood. Therefore, this study investigated the association between age stopped breastfeeding and child weight status by sociodemographic characteristics. This cross-sectional analysis utilized a nationally representative sample of 3248 U.S. children ages 2–6 years from 2009 to 2018, from parents interviewed as part of the National Health and Nutrition Examination Survey. Child body weight and height were measured during physical examination. Information on age stopped breastfeeding and other demographic characteristics were assessed using questionnaires. Multivariable logistic regression models were performed to examine the association between age stopped breastfeeding and child weight status, adjusting for potential confounders. Children breastfed for ≤ 11 months had an increased odds of being overweight and obese with the strongest association observed among those classified as obese (OR=2.12; 95%CI 1.23, 3.64) compared with children breastfed for > 11–24 months. The association between breastfeeding and child weight status was observed by racial/ethnic groups. Non-Hispanic white and Black children breastfed for ≤ 11 months had an associated increased likelihood of being overweight than their counterparts breastfed for > 11–24 months. Among Hispanic children, we observed elevated odds of being obese when breastfed for ≤ 11 months (OR=1.98; 95%CI 1.00, 3.91) than those breastfed for > 11–24 months. Child weight status was associated with age stopped breastfeeding, where likelihood of being overweight and obese were greatest among children breastfed for ≤ 11 months. [ABSTRACT FROM AUTHOR]

Ample research links mothers' postpartum depression (PPD) to adverse interactions with their infants. However, most studies relied on general population samples, whereas a substantial number of women are at elevated depression risk. The purpose of this study was to describe mothers' interactions with their 6- and 12-month-old infants among women at elevated risk, although with a range of symptom severity. We also identified higher-order factors that best characterized the interactions and tested longitudinal consistency of these factors from 6 to 12 months of infant age. We leveraged data from eight projects across the United States (n = 647), using standardized depression measures and an adaptation of the NICHD Mother-Infant Interaction Scales. Overall, these depression-vulnerable mothers showed high levels of sensitivity and positive regard and low levels of intrusiveness, detachment, and negative regard with their infants. Factor analyses of maternal behaviors identified two overarching factors—"positive engagement" and "negative intrusiveness" that were comparable at 6 and 12 months of infant age. Mothers' ability to regulate depressed mood was a key behavior that defined "positive engagement" in factor loadings. An exceptionally strong loading of intrusiveness on the second factor suggested its central importance for women at elevated depression risk. Mothers with severe depressive symptoms had significantly more "negative intrusiveness" and less "positive engagement" with their 6-month-old infants than women with moderate or fewer depressive symptoms, suggesting a potential tipping point at which symptoms may interfere with the quality of care. Results provide the foundation for further research into predictors and moderators of women's interactions with their infant among women at elevated risk for PPD. They also indicate a need for evidence-based interventions that can support more severely depressed women in providing optimal care. [ABSTRACT FROM AUTHOR]

Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD., Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app's intended audience., Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid., Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features., Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps., (©Natalie Perme, Endia Reid, Macdonald Chinwenwa Eluagu, John Thompson, Courtney Hebert, Steven Gabbe, Christine Marie Swoboda. Originally published in JMIR Formative Research (https://formative.jmir.org), 08.11.2024.)

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small- N study to explore the associations between stress and psychological symptoms during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms (Beck Anxiety and Depression Index, respectively), as well as stressful life experiences prior to-versus during the pandemic (Social Readjustment Rating Scale). Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers' experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers' mental health. [ABSTRACT FROM AUTHOR]

In response to the crisis of racist disparities in maternal mortality, many activists are pushing for increased access to birth doulas for Black women. As states and municipalities respond by incorporating doulas into hospital settings with increasingly common requirements for doula certification, it is more important than ever to investigate the role of doulas, and how that role might change under the medical model of birth within US hospitals. Will activism for doulas turn into arguments for the "right" to a doula? Without the full privileges of citizenship—will the most marginalized women be left out of that right despite their health and safety being at the origins of the activist struggle? To investigate these questions, we can look to the history of midwives in the United States, and examine how the midwifery model of childbirth changed as activists fought for increased access to midwives to improve birth outcomes. [ABSTRACT FROM AUTHOR]

This scoping review critically assessed evidence regarding mental disorders among mothers involved with the criminal justice system (CJS) and provided pooled prevalence rates of mental disorders. In total, 27 studies were included in the review, with 23 studies from the United States of America and 26 focused on incarcerated mothers. The findings supported the evidence on substantial burden of mental disorders, among CJS-involved mothers. Several factors contributing to mental disorders were identified, including history of abuse/incarceration/mental illness, a greater number of pregnancies, child-rearing responsibilities, less contact with children, and poor social support, which were organised using a socioecological model. However, significant gaps in the current evidence base were apparent, including inconsistencies in methodologies and outcomes assessed and a lack of large, longitudinal studies. The study highlights the importance of high-quality longitudinal research to extend knowledge around causal pathways between different risk or protective factors and mental disorders among CJS-involved mothers., (© 2024. The Author(s).)

Background: Over a third of reproductive-age women in the USA are obese, and the prevalence of cardiovascular disease (CVD) is rising in premenopausal women. Cardiac hypertrophy is an independent predictor of CVD. In contrast to pregnancy, where transiently increased left ventricular (LV) mass is not associated with cardiac damage, obesity-mediated cardiac hypertrophy is pathological. There is a paucity of data describing the effect of obesity during pregnancy on maternal cardiovascular health. The purpose of this study was to determine the long-term effect of obesity during pregnancy on cardiac function and structure in mice. Methods: Female C57BL/6 J mice were fed a high-fat (HF) or a low-fat (LF) diet for 20 weeks. After 4 weeks, LF- and HF-fed female mice were either crossed with males to become pregnant or remained non-pregnant controls. Following delivery, pups were euthanized, and females maintained on respective diets. After 20 weeks of diet feeding, cardiac function was quantified by echocardiography, and plasma leptin and adiponectin concentrations quantified in LF- and HF-fed postpartum and nulliparous females. mRNA abundance of genes regulating cardiac hypertrophy and remodeling was quantified from left ventricles using the NanoString nCounter Analysis System. Cardiac fibrosis was assessed from picrosirius red staining of left ventricles. Results: HF-fed postpartum mice had markedly greater weight gain and fat mass expansion with obesity, associated with significantly increased LV mass, cardiac output, and stroke volume compared with HF-fed nulliparous mice. Plasma leptin, but not adiponectin, concentrations were correlated with LV mass in HF-fed females. HF feeding increased LV posterior wall thickness; however, LV chamber diameter was only increased in HF-fed postpartum females. Despite the marked increase in LV mass in HF-fed postpartum mice, mRNA abundance of genes regulating fibrosis and interstitial collagen content was similar between HF-fed nulliparous and postpartum mice. In contrast, only HF-fed postpartum mice exhibited altered expression of genes regulating the extracellular matrix. Conclusions: These results suggest that the combined effects of pregnancy and obesity augment cardiac hypertrophy and promote remodeling. The rising prevalence of CVD in premenopausal women may be attributed to an increased prevalence of women entering pregnancy with an overweight or obese BMI. [ABSTRACT FROM AUTHOR]

Social connectedness and mental health have been associated with infant birth weight, and both were compromised by the COVID-19 pandemic. We sought to examine whether changes in maternal prenatal social contact due to the COVID-19 pandemic were associated with infant birth weight and if maternal prenatal mental health mediated this association. A longitudinal study of mothers and their infants born during the first wave of the COVID-19 pandemic. The sample consisted of 282 United States-based mother-infant dyads. Depressive symptoms were measured with the Beck Depression Inventory-II, anxiety was measured with the State Anxiety Inventory, and stress was measured using the Perceived Stress Scale 14. We also asked participants about pandemic-related changes in social contact across various domains. Adjusted birth weight was calculated from birth records or participant-report when birth records were unavailable. Decreases in social contact during the pandemic were associated with lower adjusted infant birth weight (B = 76.82, SE = 35.82, p =.035). This association was mediated by maternal prenatal depressive symptoms [Effect = 15.06, 95 % CI (0.19, 35.58)] but not by prenatal anxiety [95 % CI (−0.02, 32.38)] or stress [95 % CI (−0.31, 26.19)]. These findings highlight concerns for both mothers and infants in the wake of the COVID-19 pandemic, since birth weight can have long-term health implications and the social restructuring occasioned by the pandemic may lead to lasting changes in social behavior. • Longitudinal study of pregnancy during the COVID-19 pandemic verses pre-pandemic • Decreases in prenatal social contact are associated with lower infant birth weight. • Prenatal depression mediated association between social contact and birth weight. • Reduced social contact during COVID-19 may impact maternal and infant health. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal changes occur during pregnancy; one-half of pregnant women experienced low back pain and/or pelvic pain during pregnancy. Prescription opioid use for Medicaid enrolled pregnant women has increased dramatically due to severe low back pain/pelvic pain., Objectives: This study aimed to explore the prevalence of low back pain/pelvic pain and related risk factors among a broader population., Design: This is a retrospective cohort study., Methods: This study utilized de-identified Medicaid claims data provided by the South Carolina Revenue and Fiscal Affairs Office, including individuals who gave birth between 2016 and 2021 during pregnancy. Low back pain/pelvic pain and a group of musculoskeletal risk factors were identified with International Classification of Diseases v10. Comparisons were made for the prevalence of low back pain and pelvic pain between those with pregnancy-related musculoskeletal risk and those without., Results: Among 167,396 pregnancies, 65.6% were affected by musculoskeletal risk factors. The overall prevalence of low back pain was 15.6%, and of pregnancy-related pelvic pain was 25.2%. The overall prevalence for either low back pain or pelvic pain was 33.3% (increased from 29.5% in 2016 to 35.3% in 2021), with 24.6% being pregnancy-induced. Pregnancies with musculoskeletal risk factors were more likely to be diagnosed with low back pain (20.7% versus 5.7%, p  < 0.001) or pelvic pain (35.3% versus 6.0%, p  < 0.001) than those without., Conclusion: This study found a very high prevalence of musculoskeletal risk and a high prevalence of low back pain or pelvic pain, with an increasing trend, among South Carolina pregnancies enrolled in Medicaid during the period 2016-2021. Most of the diagnosed low back pain or pelvic pain were pregnancy induced. Musculoskeletal risk factors were associated with low back pain or pelvic pain.

Pregnant women are an important at-risk population to consider during public health emergencies. These women, like nonpregnant adults, may be faced with the risk of acquiring life-threatening infections during outbreaks or bioterrorism (BT) events and, in some cases, can experience increased severity of infection and higher morbidity compared with nonpregnant adults. Yersinia pestis , the bacterium that causes plague, is a highly pathogenic organism. There are 4 million births annually in the United States, and thus the unique needs of pregnant women and their infants should be considered in pre-event planning for a plague outbreak or BT event. [ABSTRACT FROM AUTHOR]

In the United States, the risk of death during and up to a year after pregnancy from pregnancy-related causes increased from ∼10 deaths per 100,000 live births in the early 1990s to 17 deaths per 100,000 live births in 2013. While vital statistics-based surveillance systems are useful for monitoring trends and disparities, state and local maternal mortality review committees (MMRCs) are best positioned to both comprehensively assess deaths to women during pregnancy and the year after the end of pregnancy, and identify opportunities for prevention. Although the number of committees that exist has increased over the last several years, both newly formed and long-established committees struggle to achieve and sustain progress toward reviewing and preventing deaths. We describe the key elements of a MMRC; review a logic model that represents the general inputs, activities, and outcomes of a fully functional MMRC; and describe Building U.S. Capacity to Review and Prevent Maternal Deaths, a recent multisector initiative working to remove barriers to fully functional MMRCs. Increased standardization of review committee processes allows for better data to understand the multiple factors that contribute to maternal deaths and facilitates the collaboration that is necessary to eliminate preventable maternal deaths in the United States. [ABSTRACT FROM AUTHOR]

Background: Maternal chorioamnionitis (MC) is one of the major risk factors for early-onset neonatal sepsis. Kaiser sepsis risk calculator (SRC) is a validated risk assessment tool for such newborns. The National Institute of Child Health and Human Development (NICHD) workshop on MC has proposed a risk assessment algorithm. The objective of the study was to compare the reduction in antibiotic use in newborns treated with SRC and NICHD algorithm and determine the antibiotic use correlation between them., Methodology: A retrospective chart review was performed on newborns born at ≥ 37 weeks to mothers with MC during the years 2018-2020. The same cohort of newborns was evaluated using SRC and NICHD algorithm to determine whether treatment with antibiotics could have been avoided in some patients. The data were analyzed using a t-test, Chi-square test, and ANOVA., Results: During the study period, 101 newborns were born to mothers with chorioamnionitis and received antibiotics. When the newborns were assessed using the SRC, only 16/101 (15.84%) would have received treatment. When NICHD algorithm was applied to the same cohort 71/101 (70.30%) newborns would have received treatment. The two approaches agreed in their assessment for treatment or observation only in 44/101 (43.56%) of the cases. The NICHD treatment group had a higher incidence of chorioamnionitis as seen in placental pathology (94.37% vs. 75.00% for Kaiser, p-0.015). The SRC treatment group however had newborns with significantly lower Apgar score at 1 min (8.21 vs 6.63, p-0.006) and 5-minute (8.69 vs 8.00, p-0.019) and had significantly higher supplemental oxygen requirements at admission (62.50% vs. 21.13%, p < 0.001)., Conclusion: Both SRC and NICHD algorithms expose fewer newborns to antibiotics; however, they differ in the number of newborns that would require antibiotics. Ventilation assistance and lower Apgar scores were associated with higher probability of antibiotic administration., Competing Interests: Conflict of interest The authors have no conflict or funding to declare., (Copyright © 2023 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of competing interest No competing interests for all authors.

Purpose: Perinatal substance use is a clinical and public health concern. The purpose of the study was to understand the perspectives and experiences of perinatal healthcare providers serving pregnant people who receive Medicaid and are living with a substance use disorder., Design and Methods: We conducted a secondary data analysis of the responses from perinatal healthcare providers who completed a survey to assess the state of Alabama's capability to effectively identify and treat individuals with substance use disorder. We analyzed short answer responses using consensus coding., Findings: Nine-hundred and ninety-five Medicaid providers completed the survey, 36 of the respondents identified that they were employed in an obstetric practice. Health insurance limitations, a lack of time and resources, and limited treatment options were the primary barriers indicated in the participants' responses., Conclusions: Structural and health system barriers negatively impact the capacity of perinatal healthcare providers in Alabama to serve pregnant people who receive Medicaid and are living with a substance use disorder., Clinical Relevance: Perinatal healthcare providers need educational opportunities, training, and up-to-date resources to provide supportive, comprehensive care programming for perinatal populations with substance use disorders., (© 2023 Sigma Theta Tau International.)

Objective: To evaluate the feasibility of using electronic health records (EHRs) and wearable data to describe patterns of longitudinal change in day-level heart rate before, during, and after pregnancy and how these patterns differ by age and body mass index., Design: Descriptive secondary analysis feasibility study using data from the National Institutes of Health All of Us Research Program., Setting: United States., Participants: Women (N = 89) who had a birth or length of gestation code in the EHR and at least 60 days of Fitbit heart rate data during pregnancy., Methods: We estimated pregnancy-related episodes using EHR codes. Time consisted of five 3-month periods: before pregnancy, first trimester, second trimester, third trimester, and after birth. We analyzed data using descriptive statistics and locally estimated scatterplot smoothing., Results: An average of 330 days (SD = 112) of Fitbit heart rate data (29,392 days) were available from participants. During pregnancy, distinct peaks in heart rate occurred during the first trimester (6% increase) and third trimester (15% increase)., Conclusion: Future researchers can examine whether longitudinal timing and patterns of heart rate from wearable devices could be leveraged to detect health problems early in pregnancy., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

A better understanding of why women die during pregnancy, childbirth, or postpartum offers valuable insight into strategies aimed at preventing maternal deaths and arresting the progression in the severity of a complication. The rate of severe maternal morbidity and maternal mortality in the United States has been trending upward in recent years and has garnered national attention with concentration on bolstering reviews of maternal deaths and implementing patient safety initiatives. The obstetric nurse is in a unique position to improve maternal outcomes through the anticipation, recognition, and communication of the early warning signs of impending deterioration in maternal condition. Presented in the context of the conceptual model of Stephen Covey's Circle of Influence, the professional nurse can proactively influence maternal outcomes directly, with actions defined by the scope of professional nursing practice or indirectly through professional interactions with others. Advancing one's education, knowledge, and technical skills broadens the influential capacity. [ABSTRACT FROM AUTHOR]

Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW; <2,500 g) and preterm delivery (<37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, comparing prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p < 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight ( p = 0.08). Postnatal homelessness was not associated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a marker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide housing and health care to homeless women during pregnancy may result in improved birth outcomes. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity and mortality are increasing in the United States with continued healthcare disparities among Non-Hispanic Black women. However, there is sparse data on the disparities of severe maternal morbidity and mortality by race/ethnicity as it relates to community type., Objective: To determine whether residing in rural communities increases the racial/ethnic disparities in severe maternal morbidity and mortality., Design: This study is a cross-sectional analysis of women admitted for delivery from 2015 to 2020. A total of 204,140 adults who self-identified as women, were admitted for delivery, who resided in Maryland, and were between the ages 15 and 54 were included in our analysis. Community type was defined as either rural or urban., Methods: A multivariable logistic regression, which included an interaction term between race/ethnicity and community type, was used to assess the effect of community type on the relationship between race/ethnicity and severe maternal morbidity and mortality. Data were obtained from the Maryland Health Service Cost Review Commission database. The primary outcome was a composite, binary variable of severe maternal morbidity and mortality. Exposures of interest were residence in either rural or urban counties in Maryland and race/ethnicity., Results: Our study found that after adjusting for confounders, odds of severe maternal morbidity and mortality were 65% higher in Non-Hispanic Black women (odds ratio 1.65, 95% confidence interval: 1.46-1.88, p  < 0.001) and 54% higher in Non-Hispanic Asian women (odds ratio 1.54, 95% confidence interval: 1.24-1.90, p  < 0.001) compared to Non-Hispanic White women. The interaction term used to determine whether community type modified the relationship between race/ethnicity and severe maternal morbidity and mortality was not statistically significant for any race/ethnicity (Non-Hispanic Black women, p  = 0.60; Non-Hispanic Asian women, p  = 0.91; Hispanic women, p  = 0.15; Other/Unknown race/ethnicity, p  = 0.54)., Conclusion: Although our study confirmed the known disparities in maternal outcomes by race/ethnicity, we found that residing in rural communities did not increase racial/ethnic disparities.

In this cross-sectional descriptive study, women using the Ovia pregnancy app expressed receiving adequately safe maternal care during the COVID-19 pandemic, but voiced concerns related to obtaining infant supplies and prenatal education. [ABSTRACT FROM AUTHOR]

This article presents an analysis of literature on paternal and maternal development and resilience through the experience of having a child diagnosed, treated, and possibly die from cancer. The methods and analysis of findings from research conducted in this area are assessed, as are the data's relevance and implications for practice. The review required an in-depth search of relevant health-care databases using appropriate search terms. Findings were then culled and analysed based on the inclusion and exclusion criteria, and two papers were deemed appropriate for selection. Four contrasting themes emerged from each article. It was generally acknowledged that mothers and fathers enduring such an experience stated that changes occurred in their lives. The mothers felt a need to become tougher for their child and family, and the fathers recognized a need to focus quickly on what needed to be done to treat their child's illness. However, analytically the differences in each paper are vast. The research was conducted in Japan and the United States, where contrasting cultural and societal beliefs and influences are apparent, therefore inadvertently affecting the research findings. Furthermore, a gap in research in this area has been detected, and much more research specifically focused on this subject is required if the children's nurse is to provide evidence-based holistic care in this area on a continual basis. [ABSTRACT FROM AUTHOR]

Existing literature has documented the associations between marital status and maternal depression within the first year postpartum. Using data that is representative of urban non-marital births in the United States with a large over-sample of non-marital births, we investigate the association of maternal depression with not only marital status but also relationship quality with the father of the baby. Quality is independently associated with maternal depression after controlling for marital status and other variables that have been documented as risk factors for maternal depression. In addition, relationship quality explains away the associations between marital status and maternal depression. After controlling for relationship quality, single women were no more likely to be depressed compared to married or cohabiting women. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the possible association between maternal smoking during pregnancy and offspring outcomes of birth weight, pre-term birth, remediation, low scholastic achievement, regular smoking, attention deficit hyperactivity disorder and conduct problems while controlling for similar behaviors in parents. Methods: Using telephone interviews, data were collected, in 2001 and 2004, as a part of two United States offspring-of-twins projects. Fathers, who were twins participating in the Vietnam Era Twin Registry, their female spouse and their offspring were interviewed — information on 1,342 unique pregnancies in mothers with a history of regular smoking was utilized for these analyses. The association between maternal smoking during pregnancy and birth weight, pre-term birth, remediation, low scholastic achievement, regular smoking, attention deficit hyperactivity disorder and conduct disorder while controlling for similar behaviors in parents, was examined using regression. Results: Maternal smoking during pregnancy was associated with decreased birth weight, low scholastic achievement, regular smoking and attention deficit hyperactivity disorder. However, the association between maternal smoking during pregnancy and offspring attention deficit hyperactivity disorder was explained by maternal attention deficit hyperactivity disorder. Maternal smoking during pregnancy was also associated with earlier age of offspring initiation of smoking and onset of regular smoking. Conclusions: Maternal smoking during pregnancy may influence certain offspring outcomes via mechanisms that are independent from genetic risk attributable to comorbid conditions. Assisting expecting mothers with their smoking cessation efforts will likely provide widespread health benefits to both mother and offspring. [Copyright &y& Elsevier]

The objective of this research was to partition phenotypic variation in calf gain from birth to weaning, and milk production measured, by the weigh-suckle-weigh method, and udder score of cows into genetic and nongenetic components. Data were from the Line 1 Hereford population maintained by USDA-ARS at Miles City, MT, and included observations of pre- weaning gain (n = 6,835) from 2,172 dams, milk production (n = 692) from 403 cows, and udder score (n = 1,686) from 622 cows. Data were analyzed using a Gibbs sampler for multiple-trait animal models. Results are reported as means ± SD derived from the posterior distributions of parameter estimates. Mean estimates of the phenotypic variance of preweaning gain, milk production, and udder score were 476.3 kg2, 8.88 kg2, and 1.89 (1 to 9 scale), respectively. Estimates of phenotypic correlations between preweaning gain and milk production, preweaning gain and udder score, and milk production and udder score were 0.37 ± 0.04, -0.07 ± 0.04, and -0.09 ± 0.05, respectively. Estimates of heritability for direct and maternal preweaning gain, milk production, and udder score were 0.13 ± 0.03, 0.25 ± 0.04, 0.25 ± 0.06, and 0.23 ± 0.05, respectively. Genetic correlations of milk production with maternal preweaning gain and udder score were estimated as 0.80 ± 0.08 and -0.36 ± 0.16, respectively. Posterior distributions of the other genetic correlations all contained 0.00 within the respective 90% probability density posterior intervals. Estimates of repeatability of maternal preweaning gain, milk production, and udder score were 0.43 ± 0.03, 0.39 ± 0.05, and 0.34 ± 0.03, respectively. Breeding value for maternal gain from birth to weaning was highly predictive of breeding value for milk production. Direct measurement of milk production to use in genetic improvement may not be justified because it is difficult to measure, and selection based on the breeding value for maternal preweaning gain may be nearly as effective in changing milk production as direct selection. A potentially undesirable consequence of selection to increase milk production is the degradation of udder quality. However, this correlation is not so strong as to preclude simultaneous improvement of milk production and udder quality using appropriate predicted breeding values for each trait. [ABSTRACT FROM AUTHOR]

In 2001, the U.S. Environmental Protection Agency (EPA) adopted a revised reference dose (RfD) for methyl mercury (MeHg) of 0.1 μg/kg/day. The RfD is based on neurologic developmental effects measured in children associated with exposure in uztero to MeHg from the maternal diet. The RfD derivation proceeded from a point of departure based on measured concentration of mercury in fetal cord blood (micrograms per liter). The RID, however, is a maternal dose (micro- grams per kilogram per day). Reconstruction of the maternal dose corresponding to this cord blood concentration, including the variability around this estimate, is a critical step in the RID derivation. The dose reconstruction employed by the U.S. EPA using the one-compartment phar-macokinetic model contains two areas of significant uncertainty: It does not directly account for the influence of the ratio of cord blood:maternal blood Hg concentration, and it does not resolve uncertainty regarding the most appropriate central tendency estimates for pregnancy and third- trimester-specific model parameters. A probabilistic reassessment of this dose reconstruction was undertaken to address these areas of uncertainty and generally to reconsider the specification of model input parameters. On the basis of a thorough review of the literature and recalculation of the one-compartment model including sensitivity analyses, I estimated that the 95th and 99th percentiles (i.e., the lower 5th and 1st percentiles) of the maternal intake dose corresponding to a fetal cord blood Hg concentration of 58μg/L are 0.3 and 0.2 μg/kg/day, respectively. For the 99th percentile, this is half the value previously estimated by the U.S. EPA. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship of depressive symptoms to psychosocial and lifestyle variables in postpartum women. Design: The Mothers' Overweight Management Study (MOMS) was a randomized, weight-gain prevention trial. Baseline data are presented on the Beck Depression Inventory (BDI), Perceived Stress Scale, Social Support Questionnaire, smoking status, body weight, waist circumference, and step counts. Subjects/Setting: The study was conducted at the Special Supplemental Feeding Program for Women, Infants, and Children (WIC). Women (N = 151) had to be over the age of 18 years and have a child under two years of age to participate. Results:Fifty-one percent of the women (mean age = 27 years; mean of 30 weeks postpartum) reported depressive symptoms (27% mild, 21 % moderate, and 3% severe). Overall, stress scores were high (Mean = 27.2) and activity levels low (Mean steps = 5984). Mean body mass index was 30.2. Neither body weight nor steps walked were related to depressive symptoms in the bivariate or regression analyses. However, stress and social support were related to symptoms. Women without symptoms reported significantly less stress than the mild and moderate! severe symptom groups (Means = 23.4, 29.6, and 32.7, respectively, p < .001). Mean social support satisfaction was significantly higher for non-depressed women compared to women in the moderate/severe symptom range (Means = 5.9 and 4.7 respectively, p < .00 1). Stress and current smoking status explained 46% of the variance in depressive symptoms. Conclusions: These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives : Ectopic pregnancy is a common condition with significant health consequences; complications are a major cause of maternal mortality in the United States. Accurate ascertainment of the number of ectopic pregnancies occurring in the United States has been dramatically affected by changing medical practices, causing estimates based on hospital data to be falsely low. This study was performed to identify nationally representative data on ectopic pregnancies and determine overlap of these data, to calculate the annual weighted number of ectopic pregnancies and confidence intervals for these estimates, and to determine barriers to estimation of ectopic pregnancy incidence. Methods : To assess whether a national estimate of the incidence of ectopic pregnancy could be calculated, we analyzed 1992–99 data from the six nationally representative data sets that include information on ectopic pregnancy. We examined relevant data in each data set and assessed whether any combination of data sets could be used to estimate ectopic pregnancy incidence. We calculated weighted estimates and 95% confidence intervals for hospitalizations, outpatient surgeries, outpatient medical procedures, and physician visits for and self-reports of ectopic pregnancy. Results : Small sample sizes severely limited calculation of estimates of ectopic pregnancy. Data needed for assessing multiple counting was not available consistently. The likelihood of multiple counting of cases was substantial when data set counts were combined. Conclusions : A reliable incidence rate for ectopic pregnancy in the United States could not be estimated from existing nationally representative data sources. Major advances in diagnosis and treatment of ectopic pregnancy have affected surveillance in two ways: inpatient hospital treatment of ectopic pregnancy has decreased, and multiple health care visits for a single ectopic pregnancy have increased. Alternate means of surveillance are needed to improve understanding of risk factors and trends for ectopic pregnancy, and we recommend examination of the databases of public and private insurance systems and managed care systems. Similar alternate means of surveillance may be needed for other health conditions with comparable changes in management of care. [ABSTRACT FROM AUTHOR]

Objective : To evaluate the association between maternal depressive symptoms and child behavior problems in a nationally representative sample of U.S. mothers of normal birthweight babies. Methods : We analyzed data from the 1988 National Maternal and Infant Health Survey (NMIHS) and a 1991 follow-up survey. Depressive symptoms were measured at both surveys using the CES-D, and child behavior problems were assessed by maternal self-report at follow-up. Results : Approximately 28% of the 5303 mothers reported depressive symptoms at a mean of 17 months after delivery, as did 20% at 36 months. In multivariate analyses, women with depressive symptoms at either or both surveys were significantly more likely than women without depressive symptoms to report that their children had frequent temper tantrums or difficulty getting along with other children, and were difficult to manage, unhappy, or fearful. Compared to women without depressive symptoms, the risks of reporting three out of the five child behavior problems for women with depressive symptoms were OR = 1.6 (CI = 1.1–2.1), 1988 only; OR = 2.3 (CI = 1.6;3.3), 1991 only; and OR = 3.6 (2.6–5.0), both 1988 and 1991. Conclusions : Study findings indicate that a substantial proportion of mothers of young children in the United States experience depressive symptoms and that their children are at significantly increased risk of maternally reported behavior problems. Our results suggest that efforts to identify and treat depression in new mothers should be increased and that mothers whose children are found to have behavior problems should be assessed for depression. [ABSTRACT FROM AUTHOR]

Objectives: To describe the process of developing and implementing experiential learning through translational research teams that engage diverse undergraduate and graduate students., Methods: After a college redesign, translational research teams were developed to foster multidisciplinary research and better integrate students with faculty research, community, and clinical activities. Three primary approaches were used to engage undergraduate and graduate students in the maternal and child health translational research team (MCH TrT). These included an undergraduate experiential learning course; participation in translational research team meetings and events; and mentorship activities including graduate student theses and supplementary projects., Results: Since 2019, a total of 56 students have engaged with the MCH translational research team. The majority (64%) of students engaging in translational research were undergraduates. Racial and ethnic diversity was evident with 16% Latinx, 14% Black/African American, 12% Asian, 10% two or more races, and 4% Native American or Native Hawaiian. A large proportion (42%) of students indicated that they were first-generation college students, while 24% indicated they had a disability. Five themes emerged from student feedback about their involvement in the experiential learning course: the value of translational research, development of research skills, collaboration, practice development, and value for community partners., Conclusions for Practice: Through an MCH translational research team, we have established a pathway to enhance diversity among the MCH workforce which will increase recruitment and retention of underrepresented groups, and ultimately improve MCH research and practice., (© 2022. The Author(s).)

Background: Pregnant women who have substance use disorders (SUDs) are at increased risk of preterm birth, fetal mortality, and inadequate prenatal care and have higher rates of childhood trauma than their counterparts without SUDs. Doulas have been utilized with other vulnerable populations who experience trauma to increase perinatal healthcare utilization, provide emotional support, and improve birth outcomes. The objective of the current study was to examine, in women with opioid use disorder (OUD), perceptions of working with a doula in the perinatal period., Methods: Eligible participants were ≥ 18 years old, in OUD treatment, and were pregnant or recently delivered (child ≤ 3 months of age). Semi-structured interviews were used to collect tacit data on the woman's experience working with a doula during the perinatal period. All one-hour interviews were conducted over the phone and transcribed verbatim by a HIPAA compliant transcription service. Transcripts were reviewed independently by 4 coders using open coding procedures, constant comparative method of grounded theory, and inductive thematic analysis. Demographic data and history of childhood trauma information (Adverse Childhood Experiences Tool) were collected with a phone survey prior to the interview., Results: Participants' (N = 23) were 32.5 years of age (4.1 SD), with the majority Caucasian (71.4%), Non-Hispanic (71.4%) and Medicaid recipients (100%). Participants reported a mean of 5.61 (SD=2.93) adverse childhood experiences, indicating a significant trauma burden. Major themes uncovered in the interview transcripts revealed emotional and OUD recovery support provided by the doula and increased maternal health literacy and self-advocacy. The presence of a doula during labor/delivery reduced maternal perceptions of stigma they perceived from their healthcare providers., Conclusion: Doula engagement was associated with perceptions of increased emotional support, health literacy and self-advocacy in maternal health among women with OUD, which is significant given this population's trauma histories. This preliminary research has significant implications for improving the health of the mother child dyad affected by maternal OUD., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Pregnant women are among the groups most affected by the United States opioid epidemic., Objectives: To determine latent classes of maternal comorbidities, examine their relationship to opioid use disorder (OUD), and how they can predict hospital discharge status among hospitalized pregnant women with and without OUD., Study Design: This is a cross-sectional study., Setting: Hospitals in North Carolina., Methods: A latent class analysis (LCA) was performed using 929,085 hospital discharge records from the 2000-2014 State Inpatient Databases for North Carolina. We defined OUD status and 24 maternal comorbid conditions based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and Clinical Classification Software codes, respectively. Discharge status was categorized as home, institution, or died. Binary and multinomial logistic regression models were constructed adjusting for demographic and hospital characteristics., Results: LCA of maternal comorbid conditions resulted in 591,745 records belonging to Class 1 (birth complications) and 337,340 records belonging to Class 2 (pre-existing and pregnancy-related morbidities). Class 2 records less frequently belonged to patients with OUD than those without OUD, and more frequently to younger, Black/Hispanic/other race or ethnicity, and patients with a higher socioeconomic status who resided in large metropolitan areas. Non-Medicare primary payers were more likely among Class 2 records. Irrespective of OUD status, patients belonging to Class 2 were less likely to be discharged to an institution or be deceased, controlling for confounders., Limitations: Administrative database; data clustering; misclassification bias; confounding bias; temporality; data-driven approach; generalizability., Conclusions: Hospitalized pregnant women may be classified based on comorbid conditions into 2 latent classes ("birth complications" and "pre-existing and pregnancy-related morbidities"), with the former exhibiting greater OUD frequency than the latter. These findings can inform health care needs of populations with a high-risk for OUD.

Background: Bibliometric analysis can analyze development trends and predict research hotspots. We used these analyses to better understand the pregnancy-related implications of thyroid diseases., Methods: Publications on thyroid diseases during pregnancy from 1926 to hitherto were retrieved based on the Web of Science database. The publications and references, the institutions and countries, the journals, the keywords and citations were analyzed by utilizing VOSviewer, CiteSpace and Cit- NetExplorer., Results: A total of 3310 publications were retrieved and were cited 87913 times. The United States took the dominant position in outputs and collaborations. Harvard University had the most articles 86, which also had the highest h-index 30. Thyroid ranked first with 201 publications and Journal of Clinical Endocrinology Metabolism had the highest h-index 67. Among the 49 burst keywords, "antibody" had the longest burst period from 1991 to 2012, "thyroxine" had the strongest burst strength 16.7026, "hypothyroxinemia" appeared most recently in 2018. The most frequent keyword was "pregnancy" which occurred 1324 times. All the top 98 frequent keywords were clustered into 4 clusters. The citation network visualization was grouped into 8 groups., Conclusion: The research focus of thyroid diseases in pregnancy ranged from clinical thyroid dysfunction to milder thyroid dysfunction. Guidelines published by the American Thyroid Association enacted a crucial purpose in the treatment and development of thyroid diseases during pregnancy. Some randomized controlled studies of unresolved problems and long-term follow-up of offspring may be the direction of future research. In the meantime, bibliometric methods can help scholars choose journals, track research hotspots, and identify the direction or focus of future research., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Pertussis and seasonal influenza are responsible for significant maternal, neonatal, and infant morbidity and mortality, but vaccine coverage rates (VCR) for both pertussis (administered as a tetanus, diphtheria, acellular pertussis [Tdap] vaccination) and seasonal influenza in pregnancy remain generally low. Only a small number of countries, including Spain, the United Kingdom (UK), and the United States (US), have high Tdap and seasonal influenza VCRs in pregnancy. The purpose of this study was to identify the key factors that contributed to the high VCRs observed in these countries., Methods: The experience from both Tdap and seasonal influenza vaccination programmes during pregnancy were documented in Spain, the UK, and the US using a three-step approach. A literature review yielded 157 publications, and a further 117 documents were selected through desk research. A published five-pillar VCR framework for influenza was amended to evaluate the specific contributing factors leading to high Tdap and seasonal influenza VCRs among pregnant women., Results: The analysis identified components that contributed to higher VCR in pregnant women across three different healthcare systems in Spain, UK, and US. The combination of several key interventions in each country led to a rapid increase in VCR that reached near-optimal levels (i.e. 75% for seasonal influenza) within a few years. As well as inclusion in national immunisation programme and vaccine reimbursement, key components that were identified included the mobilisation of health authorities, prenatal care Healthcare Professionals (HCP) and scientific societies, the inclusion of vaccination in antenatal medical guidance, the provision of educational material to HCPs, and a strong disease awareness driven by recent pertussis outbreaks in each country., Conclusions: Although there is no simple, universal solution to improving sub-optimal VCRs, the list of components identified in this study from three countries with high-performing Tdap and seasonal influenza vaccination programmes provides a basis for public health and medical stakeholders in other countries to define strategies to successfully implement national vaccination programmes for pregnant women., (© 2021. The Author(s).)

Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants' weight and health. This study aims to examine cross-sectional associations between infants' LCS exposure via maternal DB intake during lactation and infants' health outcomes. Six hundred and eighty-two mother-infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005-2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants' LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants' LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants' LCS exposure and BMI-for-age or risk of overweight, infants' LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05-7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.

Retinol (vitamin A) is essential, so the objective of this Institutional Review Board approved study is to evaluate retinol placental concentration, intrauterine transfer, and neonatal status at time of term delivery between cases of maternal retinol adequacy, insufficiency, and deficiency in a United States population. Birth information and biological samples were collected for mother–infant dyads (n = 260). Maternal and umbilical cord blood retinol concentrations (n = 260) were analyzed by HPLC and categorized: deficient (≤0.7 umol/L), insufficient (>0.7–1.05 umol/L), adequate (>1.05 umol/L). Intrauterine transfer rate was calculated: (umbilical cord blood retinol concentration/maternal retinol concentration) × 100. Non-parametric statistics used include Spearman's correlations, Mann–Whitney U, and Kruskal–Wallis tests. p-values <0.05 were statistically significant. Only 51.2% of mothers were retinol adequate, with 38.4% insufficient, 10.4% deficient. Only 1.5% of infants were retinol adequate. Placental concentrations (n = 73) differed between adequate vs. deficient mothers (median 0.13 vs. 0.10 μg/g; p = 0.003). Umbilical cord blood concentrations were similar between deficient, insufficient, and adequate mothers (0.61 vs. 0.55 vs. 0.57 μmol/L; p = 0.35). Intrauterine transfer increased with maternal deficiency (103.4%) and insufficiency (61.2%) compared to adequacy (43.1%), p < 0.0001. Results indicate that intrauterine transfer rate is augmented in cases of maternal retinol inadequacy, leading to similar concentrations in umbilical cord blood at term delivery. [ABSTRACT FROM AUTHOR]

Multisectoral investments over the past decade have accelerated the growth of Maternal Mortality Review Committee (MMRC) programs across the United States. The U.S. Centers for Disease Control and Prevention (CDC) launched the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Initiative in 2019. Under ERASE MM, CDC directly funds 24 U.S. jurisdictions supporting MMRCs in 25 states. With increased investment in programs nationally, the CDC has designed a performance management framework to identify areas for improvement or sustained achievement and standardize measurement of key process benchmarks across programs. This article presents a report on the baseline measures collected through this performance management approach and suggests key partnerships required to continue to accelerate progress toward the elimination of preventable maternal mortality in the United States.

Background: Research on prenatal cannabis use and adverse infant outcomes is inconsistent, and findings vary by frequency of use or cigarette use. We assess (1) the prevalence of high frequency (≥once/week), low frequency (

Introduction: In 2016, March of Dimes (MOD) launched its Prematurity Collaborative to engage a broad cross section of national experts to address persistent and widening racial disparities in preterm birth by achieving equity and demonstrated improvements in preterm birth. African-American and Native American women continue to have disproportionate rates of preterm birth and maternal death. As part of the Collaborative, MOD created the Health Equity Workgroup whose task was the creation of a scientific consensus statement articulating core values and a call to action to achieve equity in preterm birth utilizing health equity and social determinants of health frameworks., Methods: Health Equity Workgroup members engaged in-person and virtually to discuss key determinant contributors and resolutions for disparate maternal and birth outcomes. Workgroup members then drafted the Birth Equity Consensus Statement that contained value statements and a call to action. The birth equity consensus statement was presented at professional conferences to seek broader support. This article highlights the background and context towards arriving at the core values and call to action, which are the two major components of the consensus statement and presents the core values and call to action themselves., Results: The result was the creation of a birth equity consensus statement that highlights risks and protections of social determinants based on the prevailing science, and identifies promising solutions for reducing preterm birth and eliminating racial disparities., Conclusion: The birth equity consensus statement provides a mandate, guiding the work of March of Dimes and the broader MCH community, for equity-based research, practice, and policy advocacy at local, state, and federal levels., Significance: This field report adds to the current knowledge base on racial and ethnic disparities in birth and maternal health outcomes. Research has documented the science behind eliminating health disparities. Scientists and practitioners should continue to explore in practice how the social determinants of birth and maternal health, which manifest historically and contemporarily, can be addressed.

Background: The prevalence of preterm birth and low birth weight has been increasing slightly in recent years. A few studies have suggested that psychosocial stress during pregnancy may increase risk for these adverse birth outcomes. To extend those observations, we analyzed various major life event stressors separately and cumulatively as potential risk factors for preterm birth and low birth weight using granular categories of each outcome in a large, population-based study. Additionally, we assessed if greater social support buffered any effects., Methods: Data were from a nested prevalence study of 4395 women in the National Birth Defects Prevention Study who delivered live-born non-malformed infants (controls) between 2006 and 2011. Participants completed a standardized, computer-assisted interview between 6 weeks and 24 months after delivery that included questions on stress and social support from 3 months before pregnancy to the 3rd month of pregnancy. Cumulative stress and support indices were also calculated. Preterm birth was divided into "early preterm" (< 32 weeks), "late preterm" (32-36 weeks) and "term." Low birthweight was divided into "very low birth weight" (< 1500 g), "low birth weight" (1500-2499 g) and "normal birth weight" (≥2500 g). Relative risks and 95% confidence intervals (95% CI) were calculated using Poisson regression., Results: For women reporting relationship difficulties, there was a suggestive risk of early preterm birth (RR: 1.9, 95%CI: 0.9-3.9) and very low birthweight (RR: 2.0, 95%CI: 0.9-4.4). For women reporting that they or someone close to them were victims of abuse, violence, or crime, there was an increased risk of low birthweight (RR: 1.8, 95%CI: 1.1-2.7) and late preterm birth (RR: 1.5, 95%CI: 1.0-2.2). There were no strong associations observed between social support questions and the various outcomes., Conclusions: Our results add some support to prior evidence that certain stressors may be associated with increase selected adverse birth outcomes risk. We did not find strong evidence that social support buffered the observed risks in our study.

Objective: Examine the associations of maternal thyroid hormones, maternal dietary information, and newborn T 4 levels with cognitive outcomes in mid-childhood., Methods: We studied 921 children born 1999-2003 at gestational age ≥ 34 weeks, who were participants in Project Viva, a prospective pre-birth cohort study in Massachusetts. We examined maternal dietary information, maternal thyroid hormone levels, and neonatal levels of T 4 . Research staff performed cognitive testing in mid-childhood (median age 7.7 years)., Results: We included 514 women with measured first trimester thyroid hormone concentrations (mean 10.2 weeks); 15% of women had a thyroid stimulating hormone (TSH) level ≥ 2.5 mU/L, and 71% were college graduates. Newborn T 4 was collected from 375 infants (mean 17.6 μg/dl; SD 4.0), on day 2 (mean 1.9 days; SD 0.7) as part of the newborn screening program. Mean (SD) verbal and nonverbal IQ, memory, and motor scores of children were 113.2 (14.3), 107.1 (16.7), 17.1 (4.4), and 92.5 (16.6) points, respectively. In multivariable analysis, first trimester maternal thyroid function (total T 3 , total T 4 , free T 4 , thyroid stimulating hormone (TSH) or total thyroid peroxidase (TPO) antibody levels) or newborn T 4 were not associated with any of the cognitive outcomes in mid-childhood after adjustment for sociodemographic and perinatal variables., Conclusions for Practice: Maternal or neonatal thyroid hormone levels were not associated with cognitive outcomes in mid-childhood in this population with generally normal thyroid function. As we studied a highly educated cohort residing in an iodine-sufficient area, findings may not be generalizable.

Background: Despite significant research, the reasons for racial health disparities among adverse birth outcomes (ABO) remain largely unknown. The bulk of research into racial health disparities among ABO in the United States has concentrated on the risk of race and ethnic groups relative to the specific sub-population of non-Hispanic white women and their children. The objective of this study was to estimate the racial and ethnic risks among a set of neonatal and maternal health disparities while minimizing bias attributable to how the baseline risk was established., Methods: All birth records were obtained from the United States Natality database for the years 2014 to 2017. A Bayesian modeling approach was used to estimate the risk disparity for disorders by race. The estimation of the race-specific risks used a sum-to-zero constraint for the race regression coefficients., Results: Estimating racial health disparities relative to the overall population rate yielded novel results and identified perinatal health disparities for all the race groups studied., Conclusions: Unbiased risk estimates for racial disparities among ABO are now available for stimulating and initiating more complex causal modeling that can lead to understanding how racial health disparities for ABO are mediated and how they can be prevented.