Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant

The interrelationships among parenting stress and quality of life of the caregiver and preschool child with very low birth weight

This study examined the interrelationships of quality of life (QOL) of primary caregivers and their preschool children with very low birth weight (VLBW) and parenting stress. Primary caregivers of 118 VLBW and 170 non-VLBW children completed questionnaires. Structural equation modeling suggested that the QOL of the primary caregivers was directly related to parenting stress, and that parenting stress was directly related to the children's QOL. The aforementioned relationship did not differ between VLBW and non-VLBW groups. Targeting the QOL and parenting skills of the primary caregiver could also improve the QOL of the preschooler.

Quality of life of caregivers of very low-birthweight infants

BACKGROUND

The health and developmental outcomes of very low-birthweight infants are unpredictable over the first year of life. This uncertainty may have meaningful consequences for parents' quality of life. The objective of this study was to explore the quality of life of caregivers of these infants.

METHODS

Primary caregivers of very low-birthweight infants, 12 to 18 months old, who had been cared for in an inner-city hospital were enrolled in the study. Primary caregivers of full-term infants of the same age served as a comparison group. During a telephone survey, participants answered questions about their quality of life, mental and physical health, living arrangements, and child's health.

RESULTS

Eighty-three caregivers of very low-birthweight infants and 84 caregivers of full-term infants were enrolled in the study. Demographic characteristics of the caregivers were similar between the groups. Forty-five percent of caregivers of very low-birthweight infants reported that their child had an ongoing medical problem compared with 23 percent of caregivers of full-term infants. Both groups of caregivers reported significant physical and mental health problems. Caregivers of very low-birthweight infants reported higher quality of life than did caregivers of full-term infants, but the difference did not reach statistical significance.

CONCLUSIONS

Although very low-birthweight infants had poorer health and required significantly more health care resources than full-term infants, caregivers' quality of life did not differ between the two groups. Caregivers of both groups of infants reported substantial mental and physical health problems but perceived good quality of life. These data will aid parents, physicians, and policy makers as they struggle to make decisions concerning care of high-risk, costly, very low-birthweight infants.

Health status and health service utilization of infants and mothers during the first year after neonatal intensive care

PURPOSE

To describe the self-reported health status of mothers and maternal report of their infants' health problems at 3, 6, and 12 months after the infant's discharge from the neonatal intensive care unit (NICU) and to describe the self-reported utilization of health resources and services during the first year of the infants' life.

SUBJECTS

One hundred fifty-two mothers of 165 infants who were admitted to the NICU.

DESIGN

Descriptive longitudinal study that was part of a larger project that investigated changes in family function during the first year after the birth of an infant requiring neonatal intensive care.

METHODS

Mothers were asked to complete the study questionnaires at 3, 6, and 12 months after the infants' discharge from the NICU.

MAIN OUTCOME MEASURES

Maternal health status (1 question from the Short Form-12 Health Survey); health service utilization of mothers and their infants (components of the Health and Social Service Utilization Questionnaire adapted for postpartum women and their newborn infants); and mother's report of infant's health problems and infant's re-hospitalization(s) (form developed for current study).

PRINCIPAL RESULTS

The majority of mothers described their current health to be excellent or very good (73%, 64%, and 73%, at 3, 6, and 12 months, respectively). Approximately half of the mothers indicated that their infants had a variety of health problems during each of the 3 time periods after NICU discharge. Use of health services was reported by the largest proportion of mothers in the 3 months after discharge, with physicians being the most heavily used group at each of the 3 time periods (72%, 36%, and 45% at 3, 6, and 12 months, respectively). According to maternal report, few infants were readmitted to hospital at any time period (14%, 6%, and 10% at 3, 6, and 12 months, respectively).

CONCLUSIONS

Few mothers of high-risk infants in the current study reported poor health. About half of the sample reported their infants to have health problems during the first year of life. Mothers reported use of more health services during the first 3 months following their child's discharge than during the latter part of the first year. Mothers also reported using more health services for their infants in this time period compared with the later time periods. By maternal report, few infants were rehospitalized in any time period.

The co-occurrence of smoking and a major depressive episode among mothers 15 months after delivery

OBJECTIVE

To examine the association between maternal smoking 15 months after delivery and the occurrence of a major depressive episode in the prior 12 months.

METHODS

Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study. In 20 U.S. cities, 4898 mothers were surveyed at delivery in the years 1998 to 2000. In a survey 15 months later, 4353 (89%) of the mothers reported their smoking behavior and symptoms of a major depressive episode during the prior 12 months.

RESULTS

At the follow-up survey, 26.6% of mothers reported that they were current smokers and 13.6% reported that they had symptoms of a major depressive episode during the prior 12 months. After adjusting for sociodemographic characteristics, the prevalence (95% confidence interval) of a major depressive episode was higher among smokers than nonsmokers: 17.7% (15.7%, 19.8%) vs. 12.1% (10.9%, 13.3%). Smoking was also more common among mothers with a major depressive episode than in those without one: 34.0% (30.6%, 37.4%) vs. 25.5% (24.1%, 26.8%).

CONCLUSION

Smoking and depression often co-occur among mothers with infants. This suggests that these conditions should not be diagnosed or treated in isolation from each other and that the care of mothers and children should be integrated.

Depressive Symptoms and Indicators of Maternal Health Status during Pregnancy

OBJECTIVES

Depressive symptoms are common among women, especially those who are of childbearing age or are pregnant. Prior studies have suggested that an increased burden of depressive symptoms is associated with diminished health and functional status, but these studies were primarily of middle-aged and older adults. In the current study, we investigated the relationship between depressive symptoms and health and functional status among pregnant women.

METHODS

Women were enrolled in the study at their first prenatal visit to hospital-based clinics and administered an interview that contained the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms and several questions to measure overall health status, limitations in performing moderate activities, and limitations in climbing stairs.

RESULTS

The sample included 1163 women. Women with higher levels of depressive symptoms, using cutoff points on the CES-D of either > or =16 (clinically significant) or > or =23 (major depression), had approximately twice the risk of poorer self-reported health and functional status than those with lower scores after adjustment for age, marital status, smoking, education, insurance, trimester, and race.

CONCLUSIONS

These results suggest that an increased burden of depressive symptoms during pregnancy is associated with diminished health status and may offer an explanation for the reported association between depressive symptoms and preterm birth.

Changes in the health status of women during and after pregnancy

OBJECTIVE

To characterize the changes in health status experienced by a multi-ethnic cohort of women during and after pregnancy.

DESIGN

Observational cohort.

SETTING/PARTICIPANTS

Pregnant women from 1 of 6 sites in the San Francisco area (N=1,809).

MEASUREMENTS AND MAIN RESULTS

Women who agreed to participate were asked to complete a series of telephone surveys that ascertained health status as well as demographic and medical factors. Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third trimester (0-100 scale, where 100 represents better health), and improved during the postpartum period (mean score, 90.7). The prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2% during the third trimester, and then declined to 14.2% during the postpartum period. Insufficient money for food or housing and lack of exercise were associated with poor health status before, during, and after pregnancy.

CONCLUSIONS

Women experience substantial changes in health status during and after pregnancy. These data should guide the expectations of women, their health care providers, and public policy.

Integrated perinatal health framework. A multiple determinants model with a life span approach

BACKGROUND

Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health.

METHODS

To propose a new framework that integrates a "life span" approach with a multiple determinants model.

RESULTS

We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring.

CONCLUSIONS

Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.

Women's health after pregnancy and child outcomes at age 3 years: a prospective cohort study

OBJECTIVES

This study examined the persistence and comorbidity of women's physical and mental health conditions after pregnancy and the association of these conditions with child outcomes.

METHODS

A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age approximately 3 years).

RESULTS

Women's poor physical health and smoking had strong, graded associations with children's physical health and behavior problems, whereas women's depressive symptoms were associated with children's delayed language and behavior problems.

CONCLUSIONS

Substantial persistence and comorbidity of women's health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women's health outside the context of pregnancy.

An intersection of women's and perinatal health: the role of chronic conditions

This paper has three objectives: 1) to review data on the prevalence of chronic disease among women of reproductive age; 2) to establish that chronic diseases are an important influence on perinatal health; and 3) to emphasize opportunities where women's health and perinatal health can intersect. This involves broadening strategies aimed at improving perinatal health to emphasize a woman's overall health, regardless of childbearing status or plans, and using perinatal health care as a bridge to ongoing care for women. These issues are discussed in the context of a continuum often used to organize perinatal health interventions.

Learning needs as perceived by women less than or equal to 16 weeks pregnant

In April 1997, 120 women < or = 16 weeks gestation responded to a survey conducted by the Middlesex-London Health Unit, which identified learning needs of women in their first trimester of pregnancy. This survey was part of a larger community initiative to plan, develop and implement first trimester "Prenatal Health Fairs" in London, Ontario. A listing of topics identified by women as most salient to their learning needs is included. There was a strong emergence of the need to include environmental health issues in the first trimester curriculum. The ranking of topics was unrelated to age, education and employment status with the exception that employed women were more likely to rank coping with discomforts of pregnancy, reasons for regular prenatal care and physical changes of pregnancy as important. Specific information related to reasons for attending a health fair, best times, locations and methods of advertising is addressed.

Learning needs as perceived by women less than or equal to 16 weeks pregnant

In April 1997, 120 women < or = 16 weeks gestation responded to a survey conducted by the Middlesex-London Health Unit, which identified learning needs of women in their first trimester of pregnancy. This survey was part of a larger community initiative to plan, develop and implement first trimester "Prenatal Health Fairs" in London, Ontario. A listing of topics identified by women as most salient to their learning needs is included. There was a strong emergence of the need to include environmental health issues in the first trimester curriculum. The ranking of topics was unrelated to age, education and employment status with the exception that employed women were more likely to rank coping with discomforts of pregnancy, reasons for regular prenatal care and physical changes of pregnancy as important. Specific information related to reasons for attending a health fair, best times, locations and methods of advertising is addressed.

Infants entering foster care compared to other infants using birth status indicators

OBJECTIVE

Infants comprise nearly one fourth of all entries to foster care. Linkage of administrative birth and placement data can provide information about these infants that may otherwise be unavailable or difficult to obtain.

METHOD

Statewide birth records and foster care placement histories were linked via probability matching. Logit regression was used to compare 26,460 maltreated infants who entered foster care between 1989 and 1994 with a random sample of 68,401 other infants born during that time frame.

RESULTS

Infants in care were more than twice as likely to have single parents and be born with low birthweight, and twice as likely to have been born with a birth abnormality as other infants, controlling for other factors. The largest difference was in the eightfold increased likelihood for mothers of infants in care to have had no prenatal care. Infants in care were nearly three times as likely to be born into larger families (third or greater live births to the mother). Mothers of infants in care were more than twice as likely to be African American compared to White than mothers of other infants, while Hispanic and Other ethnic groups were underrepresented in the group of infants in care. Foreign born mothers, especially Hispanic women, were much less likely to have infants in care than they were to have children in the other group.

CONCLUSIONS

Administrative datasets, while often limited in the number of variables they include and scope of their information, can be a valuable tool when used to understand demographics and frame questions for future research. Infants who enter foster care differ in substantial ways from other children. These findings have important implications for future research aimed toward targeting of child welfare services and supports.