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BackgroundWorkplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health.MethodsUsing an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques.ResultsParticipants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias.ConclusionBlack pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.

BackgroundA disproportionate number of people who are killed by police each year are Black. While much attention rightly remains on victims of police brutality, there is a sparse literature on police brutality and perinatal health outcomes. We aimed to explore how Black pregnant women perceive police brutality affects them during pregnancy and might affect their children.MethodsThis qualitative study involved semi-structured interviews among 24 Black pregnant women in New Haven, Connecticut (January 2017 to August 2018). Interview questions explored neighborhood factors, safety, stressors during pregnancy, and anticipated stressors while parenting. Grounded theory informed the analysis.ResultsParticipants, regardless of socioeconomic status, shared experiences with police and beliefs about anticipated police brutality, as summarized in the following themes: (1) experiences that lead to police distrust - "If this is the way that mommy's treated [by police]"; (2) anticipating police brutality - "I'm always expecting that phone call"; (3) stress and fear during pregnancy - "It's a boy, [I feel] absolutely petrified"; and (4) 'the talk' about avoiding police brutality - "How do you get prepared?" Even participants who reported positive experiences with police anticipated brutality towards their children.ConclusionsInteractions between Black people and police on a personal, familial, community, and societal level influenced how Black pregnant women understand the potential for police brutality towards their children. Anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes. Police brutality must be addressed in all communities to prevent harming the health of birthing people and their children.

BackgroundIntimate partner violence (IPV) during pregnancy is associated with adverse maternal and child health outcomes, including poor mental health. Previous IPV research has largely focused on women's victimization experiences; however, evidence suggests young women may be more likely to engage in bilateral violence (report both victimization and perpetration) or perpetrate IPV (unilateral perpetration) during pregnancy than to report being victimized (unilateral victimization). This study examined prevalence of unilateral victimization, unilateral perpetration, and bilateral violence, and the association between these IPV profiles and mental health outcomes during pregnancy among young, low-income adolescents.MethodsSurvey data were collected from 930 adolescents (14-21 years; 95.4% Black and Latina) from fourteen Community Health Centers and hospitals in New York City during second and third trimester of pregnancy. Multivariable regression models tested the association between IPV profiles and prenatal depression, anxiety, and distress, adjusting for known predictors of psychological morbidity.ResultsThirty-eight percent of adolescents experienced IPV during their third trimester of pregnancy. Of these, 13% were solely victims, 35% were solely perpetrators, and 52% were engaged in bilateral violence. All women with violent IPV profiles had significantly higher odds of having depression and anxiety compared to individuals reporting no IPV. Adolescents experiencing bilateral violence had nearly 4-fold higher odds of depression (OR = 3.52, 95% CI: 2.43, 5.09) and a nearly 5-fold increased likelihood of anxiety (OR = 4.98, 95% CI: 3.29, 7.55). Unilateral victims and unilateral perpetrators were also at risk for adverse mental health outcomes, with risk of depression and anxiety two- to three-fold higher, compared to pregnant adolescents who report no IPV. Prenatal distress was higher among adolescents who experienced bilateral violence (OR = 2.84, 95% CI: 1.94, 4.16) and those who were unilateral victims (OR = 2.21, 95% CI: 1.19, 4.12).ConclusionsAll violent IPV profiles were associated with adverse mental health outcomes among pregnant adolescents, with bilateral violence having the most detrimental associations. Comprehensive IPV screening for both victimization and perpetration experiences during pregnancy is warranted. Clinical and community prevention efforts should target pregnant adolescents and their partners to reduce their vulnerability to violence and its adverse consequences.Trial registrationClinicalTrials.gov, NCT00628771 . Registered 29 February 2008.

Objective: The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre‐pregnancy obesity in American Samoa. Methods: We enrolled n = 80 low‐risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care‐delivered intervention vs. one‐on‐one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Results: Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between‐group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). Conclusions: It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high‐risk setting using a group care‐delivered intervention. [ABSTRACT FROM AUTHOR]

ObjectivesDepressive symptoms are associated with preterm birth among adults. Pregnant adolescents have high rates of depressive symptoms and low rates of treatment; however, few interventions have targeted this vulnerable group. Objectives are to: (a) examine impact of CenteringPregnancy® Plus group prenatal care on perinatal depressive symptoms compared to individual prenatal care; and (b) determine effects of depressive symptoms on gestational age and preterm birth among pregnant adolescents.MethodThis cluster-randomized controlled trial was conducted in 14 community health centers and hospitals in New York City. Clinical sites were randomized to receive standard individual prenatal care (n = 7) or CenteringPregnancy® Plus group prenatal care (n = 7). Pregnant adolescents (ages 14-21, N = 1,135) completed the Center for Epidemiologic Studies Depression Scale during pregnancy (second and third trimesters) and postpartum (6 and 12 months). Gestational age was obtained from medical records, based on ultrasound dating. Intention to treat analyses were used to examine objectives.ResultsAdolescents at clinical sites randomized to CenteringPregnancy® Plus experienced greater reductions in perinatal depressive symptoms compared to those at clinical sites randomized to individual care (p = .003). Increased depressive symptoms from second to third pregnancy trimester were associated with shorter gestational age at delivery and preterm birth (

Pregnancy is a universal experience shaped by sociocultural contexts. News media presents a unique opportunity to analyze public narratives of pregnancy and how it differs across cultures. Our study aims to (1) identify the most prevalent overall themes in news media narratives of pregnancy across 19 English-speaking countries, and (2) compare pregnancy narratives across geographic regions. We used the largest English news media corpus that included over 30 million news articles from more than 7000 news websites across 19 countries, and extracted a one-year data subset (2019; 1.5 billion words). Of the primary search terms 'pregnant' and 'pregnancy', we collated 240,464 descriptors that met criteria of lexical proximity and semantic bonding. Thereafter, we used topic modelling to identify the five most prevalent pregnancy-related themes: (1) complications and risk, (2) crime, (3) celebration, (4) celebrity births, and (5) contraception. Although there were regional differences, themes of complications and risk were most common, comprising 39.6% of all pregnancy narratives in our big-data corpus. The second-most dominant theme was crime (20.8%). Narratives of contraception were more prevalent in Europe, North America, and Oceania (27.2–31.3%) compared to Africa and Asia (11.9–19.6%). Though the vast majority of pregnancies are healthy, themes of complications and risk dominated the news media discourse; unchecked, this may be an avenue for misinformation, stress, and anxiety. In addition, lower prevalence of contraception narratives in Africa and Asia may reflect a gap that requires the attention of policymakers in building culturally-adapted programs to promote family planning and encourage open discussions about sexual health. Results contribute to the academic repository of societal representations of pregnancy through a big-data lens, providing contextual information for future development, implementation and evaluation of localized pregnancy-related campaigns. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of the study was to investigate whether group prenatal care (Centering Pregnancy Plus [CP+]) has an impact on pregnancy weight gain and postpartum weight loss trajectories and to determine whether prenatal depression and distress might moderate these trajectories.Study designThis was a secondary analysis of a cluster-randomized trial of CP+ in 14 Community Health Centers and hospitals in New York City. Participants were pregnant women aged 14-21 years (n = 984). Medical record review and 4 structured interviews were conducted: in the second and third trimesters and 6 and 12 months postpartum. Longitudinal mixed modeling was utilized to evaluate the weight change trajectories in the control and intervention groups. Prenatal distress and depression were also assessed to examine their impact on weight change.ResultsThere were no significant differences between the intervention and control groups in baseline demographics. Thirty-five percent of the participants were overweight or obese, and more than 50% had excessive weight gain by Institute of Medicine standards. CP+ was associated with improved weight trajectories compared with controls (P < .0001): women at clinical sites randomized to group prenatal care gained less weight during pregnancy and lost more weight postpartum. This effect was sustained among women who were categorized as obese based on prepregnancy body mass index (P < .01). Prenatal depression and distress were significantly associated with higher antepartum weight gain and postpartum weight retention. Women with the highest levels of depression and prenatal distress exhibited the greatest positive impact of group prenatal care on weight trajectories during pregnancy and through 12 months postpartum.ConclusionGroup prenatal care has a significant impact on weight gain trajectories in pregnancy and postpartum. The intervention also appeared to mitigate the effects of depression and prenatal distress on antepartum weight gain and postpartum weight retention. Targeted efforts are needed during and after pregnancy to improve weight gain trajectories and overall health.

Objectives Originally developed to assess emergency preparedness, evidence suggests the Social Vulnerability Index (SVI) may also be useful to investigate multilevel environmental and social influences on health risk behaviors and outcomes. This ecological study explores the application of the SVI as a predictor of teen pregnancy rates across counties in the United States (U.S.) and identifies areas with greatest need for community-based interventions. Methods County-level SVI and teen birth rate data were obtained from the Centers for Disease Control and Prevention. Regression analysis was conducted to examine associations between teen birth rates and social vulnerability, geographic region, and the four themes which compromise the index: socioeconomic status, household composition, minority status, and housing. Dot maps of teen birth rates and SVI by quartiles were used to examine spatial distribution across counties. Results Each increase in SVI quartile was associated with an additional 11.5 births per 1000 females ages 15-19. Higher social vulnerability was significantly associated with higher teen birth rates to varying degrees across the U.S., with largest effect sizes observed in East South Central ([beta] = 62.56; SE = 6.28; p < 0.001) and West South Central ([beta] = 66.75; SE = 5.33; p < 0.001) Census divisions. Among index themes, socioeconomic status ([beta] = 25.56; SE = 1.16; p < 0.001), household composition ([beta] = 23.49; SE = 1.00; p < 0.001), and minority/language status ([beta] = 10.99; SE = 0.83; p < 0.001) were positively associated with teen birth. No association was observed with housing/transportation. Conclusions The SVI offers a novel tool for identifying at-risk populations most in need of resources and guiding community-based teen pregnancy interventions across the U.S., Author(s): Chloe W. Yee [sup.1] , Shayna D. Cunningham [sup.2] , Jeannette R. Ickovics [sup.2] Author Affiliations: (Aff1) grid.47100.32, 0000000419368710, Department of Health Policy, Yale School of Public Health, , [...]

Introduction: Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support. Methods: Participants were racially diverse pregnant women (14‐42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms. Results: Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P <.001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P <.001) and worse nutritional intake (P =.044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08‐1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01‐1.08; social support: AOR, 0.93; 95% CI, 0.88‐0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects. Discussion: Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health. [ABSTRACT FROM AUTHOR]

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care., Author(s): Shayna D. Cunningham [sup.1] , Stephanie Grilo [sup.1] , Jessica B. Lewis [sup.1] , Gina Novick [sup.2] , Sharon Schindler Rising [sup.3] , Jonathan N. Tobin [sup.4] [sup.5] [sup.6] [...]

Background: Schools are an important environmental context in children's lives and are part of the complex web of factors that contribute to childhood obesity. Increasingly, attention has been placed on the importance of school climate (connectedness, academic standards, engagement, and student autonomy) as 1 domain of school environment beyond health policies and education that may have implications for student health outcomes. The purpose of this study is to examine the association of school climate with body mass index (BMI) among urban preadolescents. Methods: Health surveys and physical measures were collected among fifth- and sixth-grade students from 12 randomly selected public schools in a small New England city. School climate surveys were completed district-wide by students and teachers. Hierarchical linear modeling was used to test the association between students' BMI and schools' climate scores. Results: After controlling for potentially confounding individual-level characteristics, a 1-unit increase in school climate score (indicating more positive climate) was associated with a 7-point decrease in students' BMI percentile. Conclusions: Positive school climate is associated with lower student BMI percentile. More research is needed to understand the mechanisms behind this relationship and to explore whether interventions promoting positive school climate can effectively prevent and/or reduce obesity.

Experiencing bullying as a victim is associated with negative health and health behavior outcomes, including substance use, among adolescents. However, understandings of protective factors--factors that enhance adolescents' resilience to the negative consequences of bullying--remain limited. The current study investigates whether teacher involvement protects adolescent students from the association between being bullied due to race and smoking initiation. Students were recruited from 12 Kindergarten through 8th grade schools in an urban school district in the Northeast United States. The analytic sample included 769 students who responded to surveys in 5th or 6th grade (2009), and two years later in 7th or 8th grade (2011). Students primarily identified as Latino and/or Black, and 90% were eligible for free or reduced lunch. Fifty-four (7%) students initiated smoking between survey time points. Among students reporting lower teacher involvement, race-based bullying was associated with higher likelihood of smoking initiation (OR = 1.69, p = 0.03). In contrast, among students reporting higher teacher involvement, race-based bullying was not associated with higher likelihood of smoking initiation (OR = 0.95, p = 0.81). Results suggest that teacher involvement may protect students from the association between race-based bullying and smoking initiation. Enhancing teacher involvement among students experiencing race-based bullying in schools may limit smoking initiation.

Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods: Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6?months prior to standardized testing. Results: On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p?