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Borra C, González L, Patiño D. Mothers' school starting age and infant health. Health Econ 2024; 33:1153-1191. [PMID: 38341769 DOI: 10.1002/hec.4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024]
Abstract
We study the effects of women's school starting age on the infant health of their offspring. In Spain, children born in December start school a year earlier than those born the following January, despite being essentially the same age. We follow a regression discontinuity design to compare the health at birth of the children of women born in January versus the previous December, using administrative, population-level data. We find small and insignificant effects on average weight at birth, but, compared to the children of December-born mothers, the children of January-born mothers are more likely to have very low birthweight. We then show that January-born women have the same educational attainment and the same partnership dynamics as December-born women. However, they finish school later and are (several months) older when they have their first child. Our results suggest that maternal age is a plausible mechanism behind our estimated impacts of school starting age on infant health.
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Affiliation(s)
- Cristina Borra
- Economics and Economic History, Facultad de Ciencias Económicas y Empresariales, Universidad de Sevilla, Seville, Spain
| | - Libertad González
- Universitat Pompeu Fabra and Barcelona School of Economics, Barcelona, Spain
| | - David Patiño
- Economics and Economic History, Facultad de Ciencias Económicas y Empresariales, Universidad de Sevilla, Seville, Spain
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Zhang M, Qiao H, Yang S, Kwok LY, Zhang H, Zhang W. Human Breast Milk: The Role of Its Microbiota and Metabolites in Infant Health. J Agric Food Chem 2024; 72:10665-10678. [PMID: 38691667 DOI: 10.1021/acs.jafc.3c07690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
This review explores the role of microorganisms and metabolites in human breast milk and their impact on neonatal health. Breast milk serves as both a primary source of nutrition for newborns and contributes to the development and maturation of the digestive, immunological, and neurological systems. It has the potential to reduce the risks of infections, allergies, and asthma. As our understanding of the properties of human milk advances, there is growing interest in incorporating its benefits into personalized infant nutrition strategies, particularly in situations in which breastfeeding is not an option. Future infant formula products are expected to emulate the composition and advantages of human milk, aligning with an evolving understanding of infant nutrition. The long-term health implications of human milk are still under investigation.
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Affiliation(s)
- Meng Zhang
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Hui Qiao
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Shuwei Yang
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Lai-Yu Kwok
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Heping Zhang
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Wenyi Zhang
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Inner Mongolia Agricultural University, Hohhot 010018, China
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China
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De Silva DA, Anderson EA, Kim J, Ting Lee ML, Thoma ME. The Association Between Prenatal Food Insecurity and Breastfeeding Initiation and Exclusive Breastfeeding Duration: A Longitudinal Study Using Oregon PRAMS and PRAMS-2, 2008-2015. Breastfeed Med 2024; 19:368-377. [PMID: 38506260 DOI: 10.1089/bfm.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women. Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used (n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics. Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]). Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.
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Affiliation(s)
- Dane A De Silva
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Elaine A Anderson
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Jinhee Kim
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Mei-Ling Ting Lee
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Marie E Thoma
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
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Al-Shami A, Amirghasemi F, Soleimani A, Khazaee Nejad S, Ong V, Berkmen A, Ainla A, Mousavi MPS. SPOOC (Sensor for Periodic Observation of Choline): An Integrated Lab-on-a-Spoon Platform for At-Home Quantification of Choline in Infant Formula. Small 2024:e2311745. [PMID: 38587168 DOI: 10.1002/smll.202311745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/19/2024] [Indexed: 04/09/2024]
Abstract
Choline is an essential micronutrient for infants' brain development and health. To ensure that infants receive the needed daily dose of choline, the U.S. Food and Drug Administration (FDA) has set requirements for choline levels in commercialized infant formulas. Unfortunately, not all families can access well-regulated formulas, leading to potential inadequacies in choline intake. Economic constraints or difficulties in obtaining formulas, exacerbated by situations like COVID-19, prompt families to stretch formulas. Accurate measurement of choline in infant formulas becomes imperative to guarantee that infants receive the necessary nutritional support. Yet, accessible tools for this purpose are lacking. An innovative integrated sensor for the periodic observation of choline (SPOOC) designed for at-home quantification of choline in infants' formulas and milk powders is reported. This system is composed of a choline potentiometric sensor and ionic-liquid reference electrode developed on laser-induced graphene (LIG) and integrated into a spoon-like device. SPOOC includes a micro-potentiometer that conducts the measurements and transmits results wirelessly to parents' mobile devices. SPOOC demonstrated rapid and accurate assessment of choline levels directly in pre-consuming infant formulas without any sample treatment. This work empowers parents with a user-friendly tool for choline monitoring promoting informed nutritional decision-making in the care of infants.
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Affiliation(s)
- Abdulrahman Al-Shami
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Farbod Amirghasemi
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Ali Soleimani
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Sina Khazaee Nejad
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Victor Ong
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Alara Berkmen
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Alar Ainla
- International Iberian Nanotechnology Laboratory, 4715-330, Braga, Portugal
| | - Maral P S Mousavi
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
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de Souza Sá ÁR, Santos Branco DK. Social fund and infant mortality: Evidence from an anti-poverty policy in Northeast Brazil. Health Econ 2024; 33:674-695. [PMID: 38148733 DOI: 10.1002/hec.4785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/28/2023]
Abstract
This paper evaluates the effects of a social fund that meets the needs of the poor in Northeast Brazil, the Fundos Estaduais de Combate e Erradicação da Pobreza (FECEP). The program could have improved infant health by reducing poverty and improving access to health care, sanitation, food, and housing. Using a difference-in-differences approach robust to heterogeneous treatment effects, we confirm that the program has effectively reduced poverty in treated areas. Furthermore, we document that this poverty reduction is associated with a significant decline in infant mortality. These findings provide consistent evidence that targeted public investments can improve living conditions in vulnerable regions.
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Abe N, Baer RJ, Jelliffe-Pawlowski L, Chambers CD, Bandoli G. Maternal Mental Health Diagnoses and Infant Emergency Department Use, Hospitalizations, and Death. Acad Pediatr 2024; 24:451-460. [PMID: 38103588 DOI: 10.1016/j.acap.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The period surrounding childbirth is a uniquely vulnerable time for women and their mental health. We sought to describe the association between maternal mental health diagnoses in the year prior and after birth and infant Emergency Department (ED) utilization, hospitalization, and death. METHODS We studied mothers who gave singleton live birth in California (2011-2017) and their infants using linked infant birth and death certificates and maternal and infant discharge records. Maternal mental health diagnoses in the year before and after birth were identified using International Classification of Diseases (ICD) codes. We abstracted infant ED visits, hospitalizations, discharge diagnoses, deaths, and causes of death. Log-linear regression was used to compare relative risks of infant outcomes between mothers with and without mental health diagnoses, adjusting for maternal variables. RESULTS Of the 3,067,069 mother-infant pairs, 85,047 (2.8%) mothers had at least one mental health diagnosis in the year before and after birth. Infants of mothers with mental health diagnoses were more likely to visit the ED (aRR 1.2, CI:1.1-1.2), have three or more ED visits (aRR 1.4, CI:1.3-1.4), be hospitalized (aRR 1.1, CI:1.04-1.1), and die (aRR 1.7, CI:1.6-1.8) in the first year of life. These infants were also more likely to be diagnosed with accidental injuries, nonaccidental trauma, and non-specific descriptive diagnosis (fussiness/fatigue/brief resolved unexplained event). CONCLUSION This large administrative cohort study showed associations between maternal mental health diagnoses and infant acute ED visits, hospitalization, and death. This study underscores the urgent need to understand what is driving these findings and how to mitigate this risk.
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Affiliation(s)
- Naomi Abe
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif; Division of Emergency Medicine (N Abe), Rady Children's Hospital San Diego, San Diego, Calif.
| | - Rebecca J Baer
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif
| | - Laura Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics (L Jelliffe-Pawlowski), University of California San Francisco
| | - Christina D Chambers
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif; Herbert Wertheim School of Public Health and Human Longevity Science (CD Chambers), University of California San Diego, La Jolla, Calif
| | - Gretchen Bandoli
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif
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Milne ME, Clowse ME, Zhao C, Goldstein BA, Eudy AM. Impact of preeclampsia on infant and maternal health among women with rheumatic diseases. Lupus 2024; 33:397-402. [PMID: 38413920 DOI: 10.1177/09612033241235870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES We sought to identify the impact of preeclampsia on infant and maternal health among women with rheumatic diseases. METHODS A retrospective single-center cohort study was conducted to describe pregnancy and infant outcomes among women with systemic lupus erythematosus (SLE) with and without preeclampsia as compared to women with other rheumatic diseases with and without preeclampsia. RESULTS We identified 263 singleton deliveries born to 226 individual mothers (mean age 31 years, 35% non-Hispanic Black). Overall, 14% of women had preeclampsia; preeclampsia was more common among women with SLE than other rheumatic diseases (27% vs 8%). Women with preeclampsia had a longer hospital stay post-delivery. Infants born to mothers with preeclampsia were delivered an average of 3.3 weeks earlier than those without preeclampsia, were 4 times more likely to be born preterm, and twice as likely to be admitted to the neonatal intensive care unit. The large majority of women with SLE in this cohort were prescribed hydroxychloroquine and aspirin, with no clear association of these medications with preeclampsia. CONCLUSIONS We found preeclampsia was an important driver of adverse infant and maternal outcomes. While preeclampsia was particularly common among women with SLE in this cohort, the impact of preeclampsia on the infants of all women with rheumatic diseases was similarly severe. In order to improve infant outcomes for women with rheumatic diseases, attention must be paid to preventing, identifying, and managing preeclampsia.
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Affiliation(s)
- Megan E Milne
- Division of Rheumatology & Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Megan Eb Clowse
- Division of Rheumatology & Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Amanda M Eudy
- Division of Rheumatology & Immunology, Duke University School of Medicine, Durham, NC, USA
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Decelles S, Nardocci M, Mildon A, Salameh B, Sebai I, Arasimowicz S, Batal M. Determinants of continued breastfeeding in children aged 12-23 months in three regions of Haiti. Rev Panam Salud Publica 2024; 48:e6. [PMID: 38464872 PMCID: PMC10921905 DOI: 10.26633/rpsp.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 03/12/2024] Open
Abstract
Objectives To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12-23 months. Methods Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016-2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d'Hainault in Haiti. A total of 455 children 12-23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic characteristics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization's recommendation for continued breastfeeding up to 2 years or beyond. Conclusions The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.
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Affiliation(s)
- Stéphane Decelles
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Milena Nardocci
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Alison Mildon
- Independent consultantTorontoCanadaIndependent consultant, Toronto, Canada.
| | - Bana Salameh
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Ines Sebai
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Sabrina Arasimowicz
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Malek Batal
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
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Amano M, Matsumoto H, Honda C, Yoshioka-Maeda K. Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups. Public Health Nurs 2024; 41:298-309. [PMID: 38155369 DOI: 10.1111/phn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months. DESIGN AND SAMPLES This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded. MEASUREMENTS Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup. RESULTS Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months. CONCLUSIONS To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.
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Affiliation(s)
- Moe Amano
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Tokyo, Japan
| | - Hiroshige Matsumoto
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Tokyo, Japan
| | - Chikako Honda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Tokyo, Japan
| | - Kyoko Yoshioka-Maeda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Tokyo, Japan
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du Toit LDV, Mason S, van Reenen M, Rossouw TM, Louw R. Metabolic Alterations in Mothers Living with HIV and Their HIV-Exposed, Uninfected Infants. Viruses 2024; 16:313. [PMID: 38400088 PMCID: PMC10892778 DOI: 10.3390/v16020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
HIV-exposed, uninfected (HEU) children present with suboptimal growth and a greater susceptibility to infection in early life when compared to HIV-unexposed, uninfected (HUU) children. The reasons for these findings are poorly understood. We used a metabolomics approach to investigate the metabolic differences between pregnant women living with HIV (PWLWH) and their HEU infants compared to the uninfected and unexposed controls. Untargeted metabolomic profiling was performed using 1H-NMR spectroscopy on maternal plasma at 28 weeks' gestation and infant plasma at birth, 6/10 weeks, and 6 months. PWLWH were older but, apart from a larger 28 week mid-upper-arm circumference, anthropometrically similar to the controls. At all the time points, HEU infants had a significantly reduced growth compared to HUU infants. PWLWH had lower plasma 3-hydroxybutyric acid, acetoacetic acid, and acetic acid levels. In infants at birth, threonine and myo-inositol levels were lower in the HEU group while formic acid levels were higher. At 6/10 weeks, betaine and tyrosine levels were lower in the HEU group. Finally, at six months, 3-hydroxyisobutyric acid levels were lower while glycine levels were higher in the HEU infants. The NMR analysis has provided preliminary information indicating differences between HEU and HUU infants' plasma metabolites involved in energy utilization, growth, and protection from infection.
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Affiliation(s)
- Louise D. V. du Toit
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa;
- UP Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria 0001, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
| | - Shayne Mason
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2520, South Africa; (S.M.); (M.v.R.); (R.L.)
| | - Mari van Reenen
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2520, South Africa; (S.M.); (M.v.R.); (R.L.)
| | - Theresa M. Rossouw
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa;
- UP Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria 0001, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
| | - Roan Louw
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom 2520, South Africa; (S.M.); (M.v.R.); (R.L.)
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Zensho K, Hirose A, Nakamoto S, Akaike H. Usefulness of echocardiography for papular tuberculid with fever after BCG vaccination. BMJ Case Rep 2024; 17:e259546. [PMID: 38320831 PMCID: PMC10860010 DOI: 10.1136/bcr-2023-259546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
| | - Azusa Hirose
- Dermatology, Kurashiki Medical Center, Kurashiki, Japan
| | - Shu Nakamoto
- Pathology, Kurashiki Medical Center, Kurashiki, Japan
| | - Hiroto Akaike
- Paediatrics, Kurashiki Medical Center, Kurashiki, Japan
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Mee N, Abera M, Kerac M. Acceptability and Feasibility of Maternal Mental Health Assessment When Managing Small, Nutritionally At-Risk Infants Aged < 6 Months: A Key Informant Interview Study. Children (Basel) 2024; 11:209. [PMID: 38397321 PMCID: PMC10887604 DOI: 10.3390/children11020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Maternal mental health (MMH) conditions and infant malnutrition are both major global public health concerns. Despite a well-established link between the two, many nutrition programmes do not routinely consider MMH. New World Health Organization (WHO) malnutrition guidelines do, however, emphasise MMH. To inform guideline rollout, we aimed to assess the feasibility and acceptability of MMH assessments in nutrition programmes in low-resource settings. Ten semi-structured interviews were conducted with international key informants who work on nutrition programmes or MMH research. Interview transcripts were coded using subthemes derived from the key points discussed. The benefits and risks were highlighted. These included ethical dilemmas of asking about MMH if local treatment services are suboptimal. Commonly reported challenges included governance, staff training and finance. Community and programme staff perceptions of MMH were primarily negative across the different settings. Many points were raised for improvements and innovations in practice, but fundamental developments were related to governance, care pathways, advocacy, training, funding and using existing community networks. Future implementation research is needed to understand whether assessment is safe/beneficial (as it is in other settings) to promote MMH screening. Current service providers in low-resource settings can undertake several steps, as recommended in this paper, to improve the care offered to mothers and infants.
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Affiliation(s)
- Natalie Mee
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
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13
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Parisi F, Høifødt RS, Bohne A, Wang CEA, Pfuhl G. Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study. Behav Sci (Basel) 2024; 14:117. [PMID: 38392470 PMCID: PMC10886085 DOI: 10.3390/bs14020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.
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Affiliation(s)
- Francesca Parisi
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | | | - Agnes Bohne
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, 9019 Tromsø, Norway
| | | | - Gerit Pfuhl
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
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14
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Borewicz K, Brück WM. Supplemented Infant Formula and Human Breast Milk Show Similar Patterns in Modulating Infant Microbiota Composition and Function In Vitro. Int J Mol Sci 2024; 25:1806. [PMID: 38339084 PMCID: PMC10855883 DOI: 10.3390/ijms25031806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
The gut microbiota of healthy breastfed infants is often dominated by bifidobacteria. In an effort to mimic the microbiota of breastfed infants, modern formulas are fortified with bioactive and bifidogenic ingredients. These ingredients promote the optimal health and development of infants as well as the development of the infant microbiota. Here, we used INFOGEST and an in vitro batch fermentation model to investigate the gut health-promoting effects of a commercial infant formula supplemented with a blend containing docosahexaenoic acid (DHA) (20 mg/100 kcal), polydextrose and galactooligosaccharides (PDX/GOS) (4 g/L, 1:1 ratio), milk fat globule membrane (MFGM) (5 g/L), lactoferrin (0.6 g/L), and Bifidobacterium animalis subsp. lactis, BB-12 (BB-12) (106 CFU/g). Using fecal inoculates from three healthy infants, we assessed microbiota changes, the bifidogenic effect, and the short-chain fatty acid (SCFA) production of the supplemented test formula and compared those with data obtained from an unsupplemented base formula and from the breast milk control. Our results show that even after INFOGEST digestion of the formula, the supplemented formula can still maintain its bioactivity and modulate infants' microbiota composition, promote faster bifidobacterial growth, and stimulate production of SCFAs. Thus, it may be concluded that the test formula containing a bioactive blend promotes infant gut microbiota and SCFA profile to something similar, but not identical to those of breastfed infants.
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Affiliation(s)
- Klaudyna Borewicz
- Mead Johnson B.V., Middenkampweg 2, 6545 CJ Nijmegen, The Netherlands;
| | - Wolfram Manuel Brück
- Institute for Life Technologies, University of Applied Sciences Western Switzerland Valais-Wallis, 1950 Sion, Switzerland
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15
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Vu H. I wish I were born in another time: Unintended consequences of immigration enforcement on birth outcomes. Health Econ 2024; 33:345-362. [PMID: 37910628 DOI: 10.1002/hec.4775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/14/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
This paper studies the effects of Secure Communities (SC), a wide-ranging immigration enforcement program, on infant health outcomes in the United States. Using administrative birth certificate data together with event study and triple-differences designs, I find that SC increases the incidence of very low birth weight by 21% for infants of foreign-born Hispanic mothers, who were most likely to be affected by immigration enforcement. There is suggestive evidence that the results are consistent with (i) changes in maternal stress induced by deportation fear and (ii) inadequate prenatal nutrition. A back-of-the-envelope calculation suggests that this unintended social cost of immigration enforcement ranges from $872 million to $1.59 billion annually.
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Affiliation(s)
- Hoa Vu
- School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
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16
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Xu D, Zhou S, Liu Y, Scott AL, Yang J, Wan F. Complement in breast milk modifies offspring gut microbiota to promote infant health. Cell 2024; 187:750-763.e20. [PMID: 38242132 PMCID: PMC10872564 DOI: 10.1016/j.cell.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/03/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
Breastfeeding offers demonstrable benefits to newborns and infants by providing nourishment and immune protection and by shaping the gut commensal microbiota. Although it has been appreciated for decades that breast milk contains complement components, the physiological relevance of complement in breast milk remains undefined. Here, we demonstrate that weanling mice fostered by complement-deficient dams rapidly succumb when exposed to murine pathogen Citrobacter rodentium (CR), whereas pups fostered on complement-containing milk from wild-type dams can tolerate CR challenge. The complement components in breast milk were shown to directly lyse specific members of gram-positive gut commensal microbiota via a C1-dependent, antibody-independent mechanism, resulting in the deposition of the membrane attack complex and subsequent bacterial lysis. By selectively eliminating members of the commensal gut community, complement components from breast milk shape neonate and infant gut microbial composition to be protective against environmental pathogens such as CR.
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Affiliation(s)
- Dongqing Xu
- Department of Biochemistry and Molecular Biology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Siyu Zhou
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Yue Liu
- Department of Biochemistry and Molecular Biology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Scott
- Department of Biochemistry and Molecular Biology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jian Yang
- NHC Key Laboratory of Systems Biology of Pathogens, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Fengyi Wan
- Department of Biochemistry and Molecular Biology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
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17
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Jawad D, Wen LM, Rissel C, Baur L, Mihrshahi S, Taki S. Barriers and enablers to accessing child health resources and services: Findings from qualitative interviews with Arabic and Mongolian immigrant mothers in Australia. Womens Health (Lond) 2024; 20:17455057241242674. [PMID: 38561970 PMCID: PMC10989050 DOI: 10.1177/17455057241242674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/10/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Over the past two decades, there has been an increase of immigrants in Australia. Despite this, the availability of culturally responsive resources and services that cater to their needs remains insufficient. OBJECTIVE The aim of this study was to explore the resources used and trusted by Mongolian- and Arabic-speaking migrant mothers in Australia for child health information and examine how they navigate and overcome challenges they encounter accessing this information. DESIGN Semi-structured telephone interview. METHODS A theory informed semi-structured 60-min telephone interview was conducted in Arabic and Mongolian with 20 Arabic- and 20 Mongolian-speaking migrant mothers of children younger than 2 years or currently pregnant and living in Australia. Data were analysed thematically using the framework method. RESULTS The reliance on digital platforms such as google emerged as a common trend among both groups of mothers when seeking child health information. Notably, there were differences in resources selection, with Mongolian mothers showing a preference for Australian-based websites, while Arabic-speaking mothers tended to opt for culturally familiar resources. There were various barriers that hindered their access to health services and resources, including language barriers, cost, and limited knowledge or familiarity with their existence. Negative encounters with healthcare professionals contributed to a perception among many mothers that they were unhelpful. Both groups of mothers employed a cross-checking approach across multiple websites to verify trustworthiness of information. Acculturation was shown only among the Mongolian-speaking mothers who adapted their cultural practices in line with their country of residence. CONCLUSION The findings of this study highlight the importance of addressing the needs of migrant mothers in accessing child health information. Health professionals, government agencies, and researchers have an opportunity to provide culturally responsive support by fostering a culturally inclusive approach to developing and promoting equitable access to services and resources, ultimately enhancing the wellbeing of migrant families.
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Affiliation(s)
- Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- College of Medicine and Public Health, Rural and Remote Health SA and NT, Flinders University, Darwin, Bedford Park, SA, Australia
| | - Louise Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, NSW, Australia
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18
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Sprague A, Earle A, Moreno G, Raub A, Waisath W, Heymann J. National Policies on Parental Leave and Breastfeeding Breaks: Racial, Ethnic, Gender, and Age Disparities in Access and Implications for Infant and Child Health. Public Health Rep 2024; 139:39-47. [PMID: 36734210 PMCID: PMC10905754 DOI: 10.1177/00333549231151661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Parental leave and breastfeeding breaks influence the ability to initiate and continue breastfeeding. We investigated how eligibility criteria in the Family and Medical Leave Act (FMLA) and Affordable Care Act (ACA) affect access to unpaid parental leave and breastfeeding breaks and assessed affordability and alternative policy models. METHODS We used family income data to assess the affordability of unpaid leave by race and ethnicity. We used 2017-2018 US Current Population Survey data to determine the percentage of private sector workers aged 18-44 years who met the minimum hour (1250 hours of work during a 12-month period), tenure (12 months), and firm size (≥50 employees) requirements of FMLA and ACA. We analyzed eligibility by gender, race and ethnicity, and age. We also examined parental leave and breastfeeding break policies in 193 countries. RESULTS Most Latinx (66.9%), Black (60.2%), and White (55.3%) workers were ineligible and/or unlikely to be able to afford to take unpaid FMLA leave. Of 69 534 workers, more women (16.9%) than men (10.3%) did not meet the minimum hour requirement. Minimum tenure excluded 23.7% of all workers and 42.2% of women aged 18-24 years. Minimum firm size excluded 30.3% of all workers and 37.7% of Latinx workers. Of 27 520 women, 28.8% (including 32.9% of Latina women) were excluded from ACA breastfeeding breaks because of firm size. Nearly all other countries guaranteed mothers paid leave regardless of firm size or minimum hours and guaranteed ≥6 months of paid leave or breastfeeding breaks. CONCLUSIONS Adopting a comprehensive, inclusive paid parental leave policy and closing gaps in breastfeeding break legislation would remove work-related barriers to breastfeeding; reduce racial, ethnic, and gender inequities; and align US national policies with global norms.
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Affiliation(s)
- Aleta Sprague
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alison Earle
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gonzalo Moreno
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy Raub
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Willetta Waisath
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, University of California, Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, Luskin School of Public Affairs, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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19
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Nadimpalli ML, Rojas Salvatierra L, Chakraborty S, Swarthout JM, Cabrera LZ, Pickering AJ, Calderon M, Saito M, Gilman RH, Pajuelo MJ. Effects of breastfeeding on children's gut colonization with multidrug-resistant Enterobacterales in peri-urban Lima, Peru. Gut Microbes 2024; 16:2309681. [PMID: 38300753 PMCID: PMC10841006 DOI: 10.1080/19490976.2024.2309681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
Children living in low-resource settings are frequently gut-colonized with multidrug-resistant bacteria. We explored whether breastfeeding may protect against children's incident gut colonization with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-Ec) and Klebsiella, Enterobacter, or Citrobacter spp. (ESBL-KEC). We screened 937 monthly stool samples collected from 112 children aged 1-16 months during a 2016-19 prospective cohort study of enteric infections in peri-urban Lima. We used 52,816 daily surveys to examine how exposures to breastfeeding in the 30 days prior to a stool sample were associated with children's risks of incident gut-colonization, controlling for antibiotic use and other covariates. We sequenced 78 ESBL-Ec from 47 children to explore their diversity. Gut-colonization with ESBL-Ec was increasingly prevalent as children aged, approaching 75% by 16 months, while ESBL-KEC prevalence fluctuated between 18% and 36%. Through 6 months of age, exclusively providing human milk in the 30 days prior to a stool sample did not reduce children's risk of incident gut-colonization with ESBL-Ec or ESBL-KEC. From 6 to 16 months of age, every 3 additional days of breastfeeding in the prior 30 days was associated with 6% lower risk of incident ESBL-Ec gut-colonization (95% CI: 0.90, 0.98, p = .003). No effects were observed on incident ESBL-KEC colonization. We detected highly diverse ESBL-Ec among children and few differences between children who were predominantly breastfed (mean age: 4.1 months) versus older children (10.8 months). Continued breastfeeding after 6 months conferred protection against children's incident gut colonization with ESBL-Ec in this setting. Policies supporting continued breastfeeding should be considered in efforts to combat antibiotic resistance.
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Affiliation(s)
- Maya L. Nadimpalli
- Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA, USA
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
| | - Luismarcelo Rojas Salvatierra
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenna M. Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Lilia Z. Cabrera
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Amy J. Pickering
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Blum Center for Developing Economies, University of California, Berkeley, CA, USA
| | - Maritza Calderon
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Robert H. Gilman
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica J. Pajuelo
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Sailaukhanuly Y, Azat S, Kunarbekova M, Tovassarov A, Toshtay K, Tauanov Z, Carlsen L, Berndtsson R. Health Risk Assessment of Nitrate in Drinking Water with Potential Source Identification: A Case Study in Almaty, Kazakhstan. Int J Environ Res Public Health 2023; 21:55. [PMID: 38248520 PMCID: PMC10815420 DOI: 10.3390/ijerph21010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
Infant mortality in Kazakhstan is six times higher compared with the EU. There are several reasons for this, but a partial reason might be that less than 30% of Kazakhstan's population has access to safe water and sanitation and more than 57% uses polluted groundwater from wells that do not comply with international standards. For example, nitrate pollution in surface and groundwater continues to increase due to intensified agriculture and the discharge of untreated wastewater, causing concerns regarding environmental and human health. For this reason, drinking water samples were collected from the water supply distribution network in eight districts of Almaty, Kazakhstan, and water quality constituents, including nitrate, were analyzed. In several districts, the nitrate concentration was above the WHO and Kazakhstan's maximum permissible limits for drinking water. The spatial distribution of high nitrate concentration in drinking water was shown to be strongly correlated with areas that are supplied with groundwater, whereas areas with lower nitrate levels are supplied with surface water sources. Based on source identification, it was shown that groundwater is likely polluted by mainly domestic wastewater. The health risk for infants, children, teenagers, and adults was assessed based on chronic daily intake, and the hazard quotient (HQ) of nitrate intake from drinking water was determined. The non-carcinogenic risks increased in the following manner: adult < teenager < child < infant. For infants and children, the HQ was greater than the acceptable level and higher than that of other age groups, thus pointing to infants and children as the most vulnerable age group due to drinking water intake in the study area. Different water management options are suggested to improve the health situation of the population now drinking nitrate-polluted groundwater.
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Affiliation(s)
- Yerbolat Sailaukhanuly
- Laboratory of Engineering Profile, Satbayev University, 22a Satpaev Str., Almaty 050013, Kazakhstan; (S.A.); (M.K.)
- Central Asian Institute for Ecological Research, 300/26 Dostyk Ave., Almaty 050012, Kazakhstan;
| | - Seitkhan Azat
- Laboratory of Engineering Profile, Satbayev University, 22a Satpaev Str., Almaty 050013, Kazakhstan; (S.A.); (M.K.)
| | - Makhabbat Kunarbekova
- Laboratory of Engineering Profile, Satbayev University, 22a Satpaev Str., Almaty 050013, Kazakhstan; (S.A.); (M.K.)
| | - Adylkhan Tovassarov
- Central Asian Institute for Ecological Research, 300/26 Dostyk Ave., Almaty 050012, Kazakhstan;
| | - Kainaubek Toshtay
- Faculty of Chemistry and Chemical Technology, Al-Farabi Kazakh National University, 71 Al-Farabi Ave., Almaty 050040, Kazakhstan; (K.T.); (Z.T.)
| | - Zhandos Tauanov
- Faculty of Chemistry and Chemical Technology, Al-Farabi Kazakh National University, 71 Al-Farabi Ave., Almaty 050040, Kazakhstan; (K.T.); (Z.T.)
| | - Lars Carlsen
- Awareness Center, Linkøpingvej 35, Trekroner, DK-4000 Roskilde, Denmark;
| | - Ronny Berndtsson
- Division of Water Resources Engineering & Centre for Advanced Middle Eastern Studies, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden
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Gregory EF, Cronholm PF, Levine LD, Beidas RS, DeMarco MP, O'Sullivan AL, Lorch SA, Maddox AI, Wu K, Fiks AG. Integrating Care for Mother-Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility. Womens Health Rep (New Rochelle) 2023; 4:642-650. [PMID: 38155873 PMCID: PMC10754422 DOI: 10.1089/whr.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/30/2023]
Abstract
Objective There are gaps in receipt of maternal preventive services in the interconception period. Yet mother-infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results We interviewed 24 physicians, nurses, midwives, and social workers (March-November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.
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Affiliation(s)
- Emily F. Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa D. Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mario P. DeMarco
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann L. O'Sullivan
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, PA
| | - Scott A. Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I. Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G. Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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22
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van de Kamp E, Ma J, Monangi N, Tsui FR, Jani SG, Kim JH, Kahn RS, Wang CJ. Addressing Health-Related Social Needs and Mental Health Needs in the Neonatal Intensive Care Unit: Exploring Challenges and the Potential of Technology. Int J Environ Res Public Health 2023; 20:7161. [PMID: 38131713 PMCID: PMC10742453 DOI: 10.3390/ijerph20247161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Unaddressed health-related social needs (HRSNs) and parental mental health needs in an infant's environment can negatively affect their health outcomes. This study examines the challenges and potential technological solutions for addressing these needs in the neonatal intensive care unit (NICU) setting and beyond. In all, 22 semistructured interviews were conducted with members of the NICU care team and other relevant stakeholders, based on an interpretive description approach. The participants were selected from three safety net hospitals in the U.S. with level IV NICUs. The challenges identified include navigating the multitude of burdens families in the NICU experience, resource constraints within and beyond the health system, a lack of streamlined or consistent processes, no closed-loop referrals to track status and outcomes, and gaps in support postdischarge. Opportunities for leveraging technology to facilitate screening and referral include automating screening, initiating risk-based referrals, using remote check-ins, facilitating resource navigation, tracking referrals, and providing language support. However, technological implementations should avoid perpetuating disparities and consider potential privacy or data-sharing concerns. Although advances in technological health tools alone cannot address all the challenges, they have the potential to offer dynamic tools to support the healthcare setting in identifying and addressing the unique needs and circumstances of each family in the NICU.
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Affiliation(s)
- Eline van de Kamp
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Jasmin Ma
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
| | - Nagendra Monangi
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (N.M.); (J.H.K.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Fuchiang Rich Tsui
- Tsui Laboratory, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA;
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shilpa G. Jani
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
| | - Jae H. Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (N.M.); (J.H.K.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Robert S. Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- Michael Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - C. Jason Wang
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
- Department of Pediatrics and Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
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Torche F, Nobles J. Vaccination, immunity, and the changing impact of COVID-19 on infant health. Proc Natl Acad Sci U S A 2023; 120:e2311573120. [PMID: 38011548 DOI: 10.1073/pnas.2311573120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023] Open
Abstract
In utero exposure to COVID-19 infection may lead to large intergenerational health effects. The impact of infection exposure has likely evolved since the onset of the pandemic as new variants emerge, immunity from prior infection increases, vaccines become available, and vaccine hesitancy persists, such that when infection is experienced is as important as whether it is experienced. We examine the changing impact of COVID-19 infection on preterm birth and the moderating role of vaccination. We offer the first plausibly causal estimate of the impact of maternal COVID-19 infection by using population data with no selectivity, universal information on maternal COVID-19 infection, and linked sibling data. We then assess change in this impact from 2020 to 2023 and evaluate the protective role of COVID-19 vaccination on infant health. We find a substantial adverse effect of prenatal COVID-19 infection on the probability of preterm birth. The impact was large during the first 2 y of the pandemic but had fully disappeared by 2022. The harmful impact of COVID-19 infection disappeared almost a year earlier in zip codes with high vaccination rates, suggesting that vaccines might have prevented thousands of preterm births. The findings highlight the need to monitor the changing consequences of emerging infectious diseases over time and the importance of mitigation strategies to reduce the burden of infection on vulnerable populations.
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Affiliation(s)
- Florencia Torche
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Jenna Nobles
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI 53706
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De Natale A, Hall S, McFadyen A, Minnis H, Blane DN. 'Breaking the cycle': a qualitative study exploring general practitioners' views of infant mental health. BJGP Open 2023; 7:BJGPO.2023.0009. [PMID: 37263743 DOI: 10.3399/bjgpo.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Infants living in areas of socioeconomic deprivation are more likely to have adverse childhood experiences (ACEs), which are associated with infant mental health (IMH) problems and poor physical and mental health outcomes throughout the life course. As part of the development of IMH services in Scotland, studies are being conducted to explore various stakeholders' perspectives. AIM To understand the views and experiences of GPs working in socioeconomically deprived areas in relation to IMH. DESIGN & SETTING Qualitative study with GPs working in deprived urban communities in Scotland, UK. METHOD Semi-structured interviews were conducted with 12 GPs from 11 practices. Transcribed interviews were thematically analysed, following the Braun and Clarke framework, using NVivo (version 12) software. RESULTS The following three overarching themes are presented: (1) Deep End GPs' inherent understanding of IMH, owing to their placement in deprived communities and their under-recognised role in current IMH provision; (2) Factors influencing how communities might perceive IMH, including the potential associations of IMH with parental blame or judgement in areas of socioeconomic deprivation; and (3) Using previous experience to visualise future IMH service delivery, particularly improving on current shortcomings of connectivity and accessibility of services, to develop successful new services. CONCLUSION GPs in areas of socioeconomic deprivation have a deep understanding of the issues affecting IMH, although do not necessarily relate to the term 'IMH'. New community-based IMH services are much needed, particularly in deprived areas. However, the pre-existing role of primary care must be recognised, supported, and integrated into new services, alongside training to increase IMH awareness among GPs and other primary healthcare professionals (HCPs).
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Affiliation(s)
- Anna De Natale
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Anne McFadyen
- Infant Mental Health Clinical Adviser, Scottish Government Perinatal and Infant Mental Health Advisory Group, Edinburgh, UK
| | - Helen Minnis
- Mental Health & Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David N Blane
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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25
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Uusimäki K, Schneider L, Lubeka C, Kimiwye J, Mutanen M. Mothers' knowledge and practices on breastfeeding and complementary feeding in an urban slum area and rural area in Kenya: A cross-sectional interview study. J Child Health Care 2023; 27:612-627. [PMID: 35428403 PMCID: PMC10676620 DOI: 10.1177/13674935221083451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal breastfeeding and complementary feeding knowledge is an important determinant of childrens' long-term health and development. This study aims to account for associations between knowledge and practices in Kenya and report the food consumption of children from birth to 18 months. In 2015 mother-child pairs were recruited from Mother-and-Child Health Centers; 415 in an urban slum in Nairobi and 364 in rural Machakos. Knowledge and practice scores were calculated from questionnaire variables and 24-h food frequency questionnaire. The associations of knowledge and practices were studied with regression analysis. Breastfeeding knowledge (Nairobi 6.3/9, Machakos 5.9/9) and practices (Nairobi 7.5/8, Machakos 7.2/8) were good in both areas. Complementary feeding knowledge was not as good (Nairobi 7.5/14, Machakos 7.1/14). Minimum meal frequency was reached by almost 80% of the children but dietary diversity was low (Nairobi 2.7 [SD 1.4], Machakos 2.4. [SD 1.3]). Only 27% of children in Nairobi and 13% in Machakos were fed a minimum acceptable diet. The complementary feeding knowledge score was associated only with minimum dietary diversity in Nairobi (OR: 1.29; 95% CI: 1.105-1.514). Infant and young child feeding knowledge and practices were on a similar level in both areas. Future interventions should focus on improving dietary diversity.
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Affiliation(s)
- Kerttu Uusimäki
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Lauriina Schneider
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Crippina Lubeka
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Judith Kimiwye
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Marja Mutanen
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
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26
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Evans M, Graif C, Matthews SA. The Role of Infant Health Problems in Constraining Interneighborhood Mobility: Implications for Citywide Employment Networks. J Health Soc Behav 2023; 64:555-577. [PMID: 37272013 PMCID: PMC10683334 DOI: 10.1177/00221465231172176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Infant health problems are a persistent concern across the United States, disproportionally affecting socioeconomically vulnerable communities. We investigate how inequalities in infant health contribute to differences in interneighborhood commuting mobility and shape neighborhoods' embeddedness in the citywide structure of employment networks in Chicago over a 14-year period. We use the Census Bureau's Longitudinal Employer-Household Dynamics' Origin-Destination Employment Statistics to analyze commuting networks between 2002 and 2015. Results from longitudinal network analyses indicate two main patterns. First, after the Great Recession, a community's infant health problems began to significantly predict isolation from the citywide employment network. Second, pairwise dissimilarity in infant health problems predicts a lower likelihood of mobility ties between communities throughout the entire study period. The findings suggest that infant health problems present a fundamental barrier for communities in equally accessing the full range of jobs and opportunities across the city-compounding existing inequalities.
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Affiliation(s)
- Megan Evans
- Pennsylvania State University, University Park, PA, USA
| | - Corina Graif
- Pennsylvania State University, University Park, PA, USA
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27
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Sofaer S, Glazer KB, Balbierz A, Kheyfets A, Zeitlin J, Howell EA. Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality. J Pediatr X 2023; 10:100094. [PMID: 38186750 PMCID: PMC10769867 DOI: 10.1016/j.ympdx.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.
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Affiliation(s)
| | - Kimberly B. Glazer
- Department of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Balbierz
- New York University Grossman School of Medicine, New York, NY
| | - Anna Kheyfets
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, Inrae, Paris, France
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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28
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van der Mijle AE, Woestenberg PJ, Kosse LJ, van Puijenbroek EP. The Dutch Pregnancy Drug Register: Suitable to Study Paternal Drug Exposures? Int J Environ Res Public Health 2023; 20:7107. [PMID: 38063537 PMCID: PMC10706075 DOI: 10.3390/ijerph20237107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
Paternal medication use around the time of conception is common, but information about its effects on pregnancy outcome and the health of the child is generally limited. The aim of this study is to examine the feasibility of studying paternal exposure in the Dutch Pregnancy Drug Register by using immunosuppressants as a proof of concept. In 113 of 15,959 pregnancies, long-term paternal immunosuppressant use was reported 3 months before conception. In total, 134 immunosuppressants were used. Pregnancy outcome was known for 54 cases and was in accordance with previous findings. Two spontaneous abortions, two premature births, six small for gestational age babies, and two major congenital malformations were reported. Time to pregnancy (TTP) was known for 9548 pregnancies, including 89 with paternal immunosuppressant use. TTP analysis did not show a difference in pregnancies with paternal immunosuppressant use compared to the control group. Moreover, the number of fertility treatments in the paternal immunosuppressant group was similar to the control group. In our opinion, it is feasible to use the Dutch Pregnancy Drug Register to study the effects of paternal exposure on pregnancy outcome. However, to study the potential effects on fertility, more information is needed, particularly since the beginning of pregnancy attempts.
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Affiliation(s)
- Annerose E. van der Mijle
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands; (P.J.W.); (L.J.K.); (E.P.v.P.)
| | - Petra J. Woestenberg
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands; (P.J.W.); (L.J.K.); (E.P.v.P.)
| | - Leanne J. Kosse
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands; (P.J.W.); (L.J.K.); (E.P.v.P.)
| | - Eugène P. van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands; (P.J.W.); (L.J.K.); (E.P.v.P.)
- Groningen Research Institute of Pharmacy, PharmacoTherapy—Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands
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29
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Zivin K, Zhang X, Tilea A, Clark SJ, Hall SV. Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012-2021. Healthcare (Basel) 2023; 11:2921. [PMID: 37998413 PMCID: PMC10671817 DOI: 10.3390/healthcare11222921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders.
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Affiliation(s)
- Kara Zivin
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Anca Tilea
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Sarah J. Clark
- Ambulatory Care Program, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Stephanie V. Hall
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, MI 48109, USA
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30
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Claiborne A, Jevtovic F, May LE. A narrative review of exercise dose during pregnancy. Birth Defects Res 2023; 115:1581-1597. [PMID: 37735993 DOI: 10.1002/bdr2.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
The current recommendations for prenatal exercise dose align with those from the American College of Sports Medicine; 150 min of moderate intensity every week of pregnancy. However, recent works suggest there may be a dose-dependent beneficial effect for mother and offspring; maternal and offspring health outcomes respond differently to low, medium, and high doses of prenatal exercise. It is, therefore, our aim to summarize the published evidence (years 1950-2023) for five metrics of prenatal exercise training commonly reported, that is, "FITT-V": Frequency (number of sessions), Intensity (metabolic equivalents "METs"), Time (duration of sessions), Type (exercise mode), Volume (exercise MET*mins). The target audience includes clinicians and health care professionals, as well as exercise professionals and physiologists. Data suggest that moderate exercise frequency (3-4 times weekly) appears safe and efficacious for mother and offspring, while there is contradictory evidence for the safety and further benefit of increased frequency beyond 5 sessions per week. Moderate (3-6 METs) and vigorous (>6 METs) intensity prenatal exercise have been shown to promote maternal and offspring health, while little research has been performed on low-intensity (<3 METs) exercise. Exercise sessions lasting less than 1 hr are safe for mother and fetus, while longer-duration exercise should be carefully considered and monitored. Taken together, aerobic, resistance, or a combination of exercise types is well tolerated at medium-to-high volumes and offers a variety of type-specific benefits. Still, research is needed to define (1) the "minimum" effective dose of exercise for mother and offspring health, as well as (2) the maximum tolerable dose from which more benefits may be seen. Additionally, there is a lack of randomized controlled trials addressing exercise doses during the three trimesters of pregnancy. Further, the protocols adopted in research studies should be more standardized and tested for efficacy in different populations of gravid women.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Filip Jevtovic
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Linda E May
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
- Department of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
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31
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Nazaruk D, Palacios AM, Chopak-Foss J, Mayo-Gamble TL, Marshall NA. Parental Knowledge and Perceptions on Prevention of Sudden Unexpected Infant Death and Infant Care. Children (Basel) 2023; 10:1550. [PMID: 37761510 PMCID: PMC10529227 DOI: 10.3390/children10091550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
(1) Background: The study's purpose was to explore the knowledge, perceptions, and confidence of mothers about infant care to reduce the risk of sudden unexpected infant death. (2) Methods: A purposeful sampling method was used to recruit 15 first-time mothers from Georgia with infants under 1 year of age. The researchers utilized the Socio-ecological model to report the results. Participants also provided recommendations on how to improve infant care and reduce the risk of SUID. (3) Results: The confidence level of infant care among most participants was low but increased over time. Mothers' knowledge level about the prevention of SUID was high, but poor emotional health could hurt their parental abilities. Most participants recognized medical providers as the main source of reliable information. However, a lack of emotional and physical support was reported by mothers. (4) Conclusions: Results suggested that a more holistic approach to infant care is needed. The healthcare system and communities should provide more physical, social, and mental support to first-time mothers, a consolidated approach to care before and after birth, and easy access to services at all stages of the process to reduce the risk of SUID.
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Affiliation(s)
- Dziyana Nazaruk
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Sothern University, 11935 Abercorn Street, Savannah, GA 31419, USA
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Yelverton CA, Killeen SL, Feehily C, Moore RL, Callaghan SL, Geraghty AA, Byrne DF, Walsh CJ, Lawton EM, Murphy EF, Van Sinderen D, Cotter PD, McAuliffe FM. Maternal breastfeeding is associated with offspring microbiome diversity; a secondary analysis of the MicrobeMom randomized control trial. Front Microbiol 2023; 14:1154114. [PMID: 37720155 PMCID: PMC10502216 DOI: 10.3389/fmicb.2023.1154114] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Background Microbial dysbiosis in infancy can influence long-term health outcomes such as childhood obesity. The aim of this study is to explore relationships among maternal well-being during pregnancy, breastfeeding, and the infant gut microbiome. Methods This is a secondary analysis of healthy pregnant women from the MicrobeMom study, a double-blind randomized control trial of maternal probiotic supplementation (Bifidobacterium breve 702258) versus placebo antenatally and up to 3 months postpartum. Maternal well-being was assessed using the WHO-5 well-being index at 16 weeks' and 34 weeks' gestation. Breastfeeding practices were recorded at discharge from hospital and at 1 month postpartum. Infant stool samples were obtained at 1 month of age. Next generation shotgun sequencing determined infant microbial diversity. Independent sample t-tests and Mann-Whitney U tests informed adjusted regression analysis, which was adjusted for delivery mode, antibiotics during delivery, maternal age and body mass index (BMI), and probiotic vs. control study group. Results Women (n = 118) with at least one measure of well-being were on average 33 years (SD 3.93) of age and 25.09 kg/m2 (SD 3.28) BMI. Exclusive breastfeeding was initiated by 65% (n = 74). Any breastfeeding was continued by 69% (n = 81) after 1 month. In early and late pregnancy, 87% (n = 97/111) and 94% (n = 107/114) had high well-being scores. Well-being was not associated with infant microbial diversity at 1 month. In adjusted analysis, exclusive breastfeeding at discharge from hospital was associated with infant microbial beta diversity (PC2; 0.254, 95% CI 0.006, 0.038). At 1 month postpartum, any breastfeeding was associated with infant microbial alpha diversity (Shannon index; -0.241, 95% CI -0.498, -0.060) and observed species; (-0.325, 95% CI -0.307, -0.060), and infant microbial beta diversity (PC2; 0.319, 95% CI 0.013, 0.045). Exclusive breastfeeding at 1 month postpartum was associated with infant alpha diversity (Shannon index -0.364, 95% CI -0.573, -0.194; Simpson index 0.339, 95% CI 0.027, 0.091), and infant's number of observed microbial species (-0.271, 95% CI -0.172, -0.037). Conclusion Breastfeeding practices at 1 month postpartum were associated with lower microbial diversity and observed species in infants at 1 month postpartum, which is potentially beneficial to allow greater abundance of Bifidobacterium. Clinical trial registration ISRCTN53023014.
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Affiliation(s)
- Cara A. Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Conor Feehily
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Rebecca L. Moore
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Shauna L. Callaghan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A. Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - David F. Byrne
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Calum J. Walsh
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Elaine M. Lawton
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | | | - Douwe Van Sinderen
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
| | - Paul D. Cotter
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Haramati S, Firsow A, Navarro DA, Shechter R. Novel At-Home Mother's Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment. JMIR Pediatr Parent 2023; 6:e43837. [PMID: 37464893 PMCID: PMC10481223 DOI: 10.2196/43837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. OBJECTIVE The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. METHODS System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth-dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. RESULTS Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system's results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth-dependent progress in individual mothers. CONCLUSIONS This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals.
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Libon J, Ng C, Bailey A, Hareendranathan A, Joseph R, Dulai S. Remote diagnostic imaging using artificial intelligence for diagnosing hip dysplasia in infants: Results from a mixed-methods feasibility pilot study. Paediatr Child Health 2023; 28:285-290. [PMID: 37484038 PMCID: PMC10362962 DOI: 10.1093/pch/pxad013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/22/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives Infant hip dysplasia or Developmental Dysplasia of the Hip (DDH) occurs in 1-2% of births worldwide and leads to hip arthritis if untreated. We sought to evaluate the feasibility of implementing an artificial intelligence-enhanced portable ultrasound tool for infant hip dysplasia (DDH) screening in primary care, through determining its effectiveness in practice and evaluating patient and provider feedback. Methods A US-FDA-cleared artificial intelligence (AI) screening device for DDH (MEDO-Hip) was added to routine well-child visits from age 6 to 10 weeks. A total of 306 infants were screened during a 1-year pilot study within three family medicine clinics in Alberta, Canada. Patient and provider satisfaction were quantified using the System Usability Survey (SUS), while provider perceptions were further investigated through semi-structured interviews. Results Provider and user surveys commonly identified best features of the tool as immediate diagnosis, offering reassurance/knowledge and avoiding travel, and noted technical glitches most frequently as a barrier. A total of 369 scans of 306 infants were performed from Feb 1, 2021 until Mar 31, 2022. Eighty percent of hips scanned were normal on initial scans, 14% of scans required a follow-up study in the primary care clinic, and DDH cases were identified and treated at the expected 2% rate (6 infants). Conclusions It is feasible to implement a point-of-care ultrasound AI screening tool in primary care to screen for infants with DDH. Beyond improved screening and detection, this innovation was well accepted by patients and fee-for-service providers with a culture and history of innovation.
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Affiliation(s)
- Jackie Libon
- Correspondence: Jackie Libon, Health Cities, Economic Development Agency 10405 Jasper Ave #1200, Edmonton, Alberta T5J 3N4, e-mail:
| | | | - Allan Bailey
- Department of Family Medicine, University of Alberta, Edmonton, Alberta
| | | | | | - Sukhdeep Dulai
- Department of Surgery, University of Alberta, Edmonton, Alberta
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Richard RM, Maziashvili G, Tran M, Ramos I, Laxman AS, Didbaridze N. Breast Milk Conferred Immunity to Infants Against COVID-19. Cureus 2023; 15:e42075. [PMID: 37602015 PMCID: PMC10434728 DOI: 10.7759/cureus.42075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has notably impacted healthcare systems and everyday life worldwide. Regulatory authorities have approved the emergency use of SARS-CoV-2 vaccines due to the rapid spread of the virus. However, during vaccination testing, pregnant and breastfeeding women were initially excluded, leading to a lack of evidence-based recommendations. When taking the COVID-19 pandemic into account, breastfeeding has emerged as a potential defense mechanism against this infection due to its numerous benefits for newborns. Human breast milk contains immunoglobulins (IgA, IgG, and IgM), lactoferrin, and various cells that play an inevitable role in the newborn's protection against respiratory infections and immune system development. Various studies have highlighted that the onset and severity of respiratory infections in infants can be reduced through breastfeeding, and the effects are noticeable during the first six months of life and that breast milk also has the potential to enhance mucosal immunity and promote a diverse microbiome, reducing the risk of asthma, allergies, and enteric diseases through the provision of specific antibodies and immunological factors. Researchers have indicated that breastfeeding mothers who contracted and recovered from COVID-19 or received vaccination passed protective antibodies to their infants through breast milk. Although rare cases of detection of SARS-CoV-2 RNA in breast milk have been reported, the virus has not been cultured from these samples, suggesting a low risk of transmission to the breastfed baby. However, further research is essential to understand the extent of protection provided by breast milk against COVID-19 and the potential effect of distinct phases of lactation. Nonetheless, the current evidence supports the benefits and safety of breastfeeding during the pandemic. With appropriate safety measures, promoting breastfeeding can contribute to the overall health and well-being of infants during the phase of COVID-19.
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Affiliation(s)
- Riya Mary Richard
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, GEO
| | | | - Mai Tran
- Faculty of Medicine, Washington University of Health and Science, San Pedro, BLZ
| | - Isabel Ramos
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras, Tegucigalpa, HND
| | | | - Nino Didbaridze
- Department of Immunology, Tbilisi State Medical University, Tbilisi, GEO
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Benítez-Páez A. Editorial: Contribution of the maternal microbiome to offspring health. Front Nutr 2023; 10:1229447. [PMID: 37404860 PMCID: PMC10316016 DOI: 10.3389/fnut.2023.1229447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
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Abstract
Osteopontin (OPN) is a multifunctional protein found in all vertebrates. OPN is expressed in many different cell types, and is consequently found in most tissues and physiological secretions. OPN is involved in a multitude of biological processes, such as activation and regulation of the immune system; biomineralization; tissue-transformative processes, including growth and development of the gut and brain; interaction with bacteria; and many more. OPN is found in the highest concentrations in milk, where it is believed to initiate and regulate developmental, immunological and physiological processes in infants who consume milk. Processes for the isolation of bovine OPN for use in infant formula have been developed, and in recent years, many studies have investigated the effects of the intake of milk OPN. The purpose of this article is to review and compare existing knowledge about the structure and function of milk OPN, with a particular focus on the effects of milk OPN on human health and disease.
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Affiliation(s)
- Esben S Sørensen
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus, Denmark
| | - Brian Christensen
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus, Denmark
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Igarashi Y, Horiuchi S, Mwilike B. Effectiveness of an Early Skin-to-Skin Contact Program for Pregnant Women with Cesarean Section: A Quasi-Experimental Trial. Int J Environ Res Public Health 2023; 20:ijerph20105772. [PMID: 37239500 DOI: 10.3390/ijerph20105772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aimed to clarify the effectiveness of early skin-to-skin contact (SSC) after a cesarean section (CS) program. METHODS An "early SSC after CS" program was implemented at a tertiary care hospital in Tanzania. A non-equivalent group design was used. A questionnaire was used to collect data on exclusive breastfeeding, breastfeeding intention, Birth Satisfaction Scale-Revised Indicator (BSS-RI) score, perioperative pain with a visual analogue scale, and infant hospitalization for infectious diseases and diarrhea at 2-3 days postpartum. Follow-up surveys were conducted until 4 months postpartum regarding exclusive breastfeeding, breastfeeding intention, and hospitalization of the infants. RESULTS This study involved 172 parturient women who underwent CS, with 86 in the intervention group and 86 in the control group. The exclusive breastfeeding rates at 4 months postpartum were 57 (76.0%) in the intervention group and 58 (76.3%) in the control group, with no significant difference. The BSS-RI score was higher in the intervention group (7.91, range 4-12, SD 2.42) than in the control group (7.18, range 3-12, SD 2.02) (p = 0.007) for women who underwent emergency CS. The survival probability for infants hospitalized owing to infectious diseases, and diarrhea was significantly higher in the intervention group (98.5%) than in the control group (88.3%) (χ2 = 5.231, p = 0.022) for multiparas. CONCLUSION The early SSC after CS program showed a positive effect on the birth satisfaction of women undergoing emergency CS. It also reduced the incidence of infants hospitalized owing to infectious diseases and diarrhea for multiparas.
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Affiliation(s)
- Yumiko Igarashi
- Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Tokyo 104-0044, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Tokyo 104-0044, Japan
| | - Beatrice Mwilike
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65004, Tanzania
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Pomeranz JL, Chu X, Groza O, Cohodes M, Harris JL. Breastmilk or infant formula? Content analysis of infant feeding advice on breastmilk substitute manufacturer websites. Public Health Nutr 2023; 26:934-942. [PMID: 34517933 PMCID: PMC10346044 DOI: 10.1017/s1368980021003451] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate messages about infant feeding on breastmilk substitute (BMS) manufacturer websites directed at US caregivers and compare information and portrayals of breast-feeding/breastmilk with that of infant formula (IF) feeding. DESIGN We conducted a content analysis of US BMS companies' websites. A codebook was created through an iterative process to identify messages and images about breast-feeding/breastmilk and IF feeding, including benefits or issues associated with each, and direct-to-consumer marketing practices that could discourage breast-feeding. SETTING Data were collected in 2019-2020 and analysed in 2020-2021 for US websites of five IF manufacturers. PARTICIPANTS The websites of Similac, Enfamil and Gerber, which collectively represent approximately 98 % of the US IF market, and two US organic brands, Earth's Best and Happy Baby. RESULTS Websites contained more messages about breast-feeding/breastmilk than IF but were significantly more likely to mention benefits to baby of IF (44 %) than breast-feeding/breastmilk (<26 %), including significantly more statements that IF provides brain, neural and gastrointestinal benefits; 40 % of breast-feeding/breastmilk content was dedicated to breast-feeding problems (e.g. sore nipples). Twice as many screenshots compared IF brands favourably to breastmilk than as superior to other brands. Certain companies displayed images indicating ease of IF feeding and difficulty of breast-feeding. CONCLUSIONS Substantial messaging on BMS manufacturer websites encouraged IF feeding and discouraged breast-feeding. Health professionals should discourage their patients from visiting these websites and the US government should regulate misleading claims. Companies should refrain from providing breast-feeding advice and align their US marketing with the International Code of Marketing of Breast-milk Substitutes.
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Affiliation(s)
| | - Xiangying Chu
- School of Global Public Health, New York University, New York, NY, USA
| | - Oana Groza
- School of Global Public Health, New York University, New York, NY, USA
| | - Madeline Cohodes
- School of Global Public Health, New York University, New York, NY, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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Bertrand K, Kelly A, Chambers CD. The Prevalence of Nonserious Events in a Cohort of Breastfed Infants. Breastfeed Med 2023; 18:43-47. [PMID: 36454186 PMCID: PMC9889008 DOI: 10.1089/bfm.2022.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: Data on baseline rates of nonserious events in breastfed infants in the general population are sparse. This results in difficulty determining if there is an increase in infant nonserious events potentially due to prescription medication exposure through human milk. In this study, we determined the prevalence of nonserious events in infants consuming human milk whose mothers reported no exposure to any prescription medications, tobacco, or recreational drugs in the previous 14 days. Materials and Methods: Between August 2014 and December 2019, 487 breastfeeding mothers without any recent exposure to prescription medications, tobacco, or recreational drugs enrolled in the Human Milk Research Biorepository at the University of California, San Diego. Participants completed a semistructured telephone interview with trained research staff and provided information on maternal and child health, breastfeeding habits, recent medication, and lifestyle exposures, and completed a standard checklist of infant adverse reactions. Results: We found 131 (44.1%) participants reported one or more infant nonserious adverse events in the past 14 days at the time of their study interview. The most commonly reported nonserious events were rash (12.1%), irritability (9.4%), constipation (7.8%), poor sleep (7.1%), and fever (6.3%). Conclusions: These baseline frequencies provide a benchmark for rates of recent nonserious events in breastfed infants in the general population. These data can be used as a reference point for studies that examine adverse events in breastfed infants following maternal use of prescription medications or exposures due to other lifestyle habits such as tobacco or other substances. Clinical Trial Registration Number: NCT05553743.
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Affiliation(s)
- Kerri Bertrand
- Division of Environmental Science and Health, Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Ann Kelly
- Division of Environmental Science and Health, Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Christina D. Chambers
- Division of Environmental Science and Health, Department of Pediatrics, University of California, San Diego, San Diego, California, USA
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
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Frutos AM, Balmaseda A, Vydiswaran N, Patel M, Ojeda S, Brouwer A, Tutino R, Cai S, Bakker K, Sanchez N, Lopez R, Kuan G, Gordon A. Burden and seasonality of primary and secondary symptomatic common cold coronavirus infections in Nicaraguan children. Influenza Other Respir Viruses 2023; 17:e13078. [PMID: 36494188 PMCID: PMC9835451 DOI: 10.1111/irv.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The current SARS-CoV-2 pandemic highlights the need for an increased understanding of coronavirus epidemiology. In a pediatric cohort in Nicaragua, we evaluate the seasonality and burden of common cold coronavirus (ccCoV) infection and evaluate likelihood of symptoms in reinfections. METHODS Children presenting with symptoms of respiratory illness were tested for each of the four ccCoVs (NL63, 229E, OC43, and HKU1). Annual blood samples collected before ccCoV infection were tested for antibodies against each ccCoV. Seasonality was evaluated using wavelet and generalized additive model (GAM) analyses, and age-period effects were investigated using a Poisson model. We also evaluate the risk of symptom presentation between primary and secondary infections. RESULTS In our cohort of 2576 children from 2011 to 2016, we observed 595 ccCoV infections and 107 cases of ccCoV-associated lower respiratory infection (LRI). The overall incidence rate was 61.1 per 1000 person years (95% confidence interval (CI): 56.3, 66.2). Children under two had the highest incidence of ccCoV infections and associated LRI. ccCoV incidence rapidly decreases until about age 6. Each ccCoV circulated throughout the year and demonstrated annual periodicity. Peaks of NL63 typically occurred 3 months before 229E peaks and 6 months after OC43 peaks. Approximately 69% of symptomatic ccCoV infections were secondary infections. There was slightly lower risk (rate ratio (RR): 0.90, 95% CI: 0.83, 0.97) of LRI between secondary and primary ccCoV infections among participants under the age of 5. CONCLUSIONS ccCoV spreads annually among children with the greatest burden among ages 0-1. Reinfection is common; prior infection is associated with slight protection against LRI among the youngest children.
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Affiliation(s)
- Aaron M. Frutos
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Angel Balmaseda
- Health Center Sócrates Flores VivasMinistry of HealthManaguaNicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnósticoy ReferenciaMinistry of HealthManaguaNicaragua
| | - Nivea Vydiswaran
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Mayuri Patel
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | | | - Andrew Brouwer
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Rebecca Tutino
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Shuwei Cai
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Kevin Bakker
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | | | - Roger Lopez
- Laboratorio Nacional de Virología, Centro Nacional de Diagnósticoy ReferenciaMinistry of HealthManaguaNicaragua
- Sustainable Sciences InstituteManaguaNicaragua
| | - Guillermina Kuan
- Health Center Sócrates Flores VivasMinistry of HealthManaguaNicaragua
- Sustainable Sciences InstituteManaguaNicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
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Morimoto D, Washio Y, Sato T, Okamura T, Watanabe H, Yoshimoto J, Tsukahara H. Prediction model for nonopiate-induced neonatal abstinence syndrome. Pediatr Int 2023; 65:e15435. [PMID: 36478019 DOI: 10.1111/ped.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neonatal abstinence syndrome (NAS) induced by opiate use is common worldwide. Psychiatric drugs are a more common cause of NAS in Japan but infants of mothers taking psychiatric medications do not always develop NAS. The purpose of this study was to develop a practical model for predicting the onset of nonopiate-induced NAS, using variables available at birth. METHODS In this diagnostic study, prediction models were developed using multivariable logistic regression with retrospective data collected at our hospital between 2010 and 2019. The NAS diagnosis was based on the Isobe score, and maternal medications were converted to dose equivalents. RESULTS A total of 164 maternal and infant dyads met the inclusion criteria; 91 were included in the analysis, of whom 29 infants (32%) were diagnosed with NAS. Final models were created with and without the drug indices. The model without the drug indices consisted of neonatal head circumference in z-scores and Apgar scores at 5 min < 9, and the model with the drug indices included these, as well as antipsychotics and hypnotics indices. The C-statistics were 0.747 (95% CI: 0.638-0.856), and 0.795 (95% CI: 0.683-0.907), respectively, indicating that the models possessed good predictive accuracy for NAS onset. CONCLUSIONS This study developed models that predicted nonopiate-induced NAS accurately. They may be further improved through the use of drug indices.
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Affiliation(s)
- Daisaku Morimoto
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Washio
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takeshi Sato
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoka Okamura
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirokazu Watanabe
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junko Yoshimoto
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Yeung CHT, Houle SKD, Anderson PO, Best BM, Dubinsky S, Edginton AN. Addressing maternal medication use during breastfeeding using clinical resources and a novel physiologically based pharmacokinetic model-derived metric: A qualitative study. Front Pediatr 2023; 11:1147566. [PMID: 37077336 PMCID: PMC10106747 DOI: 10.3389/fped.2023.1147566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
Introduction Breastfeeding has major benefits to the maternal-infant dyad and yet healthcare providers have expressed uncertainty about advocating breastfeeding when mothers are taking medications. The tendency for some providers to be more cautious in their advising approach is likely a consequence of limited, unfamiliar, and unreliable existing information on medication use during lactation. A novel risk metric termed the Upper Area Under the Curve Ratio (UAR) was developed to overcome existing resource shortcomings. However, the perception and use of the UAR in practice by providers is not known. The aim of this study was to understand existing resource use and potential UAR use in practice, their advantages and disadvantages, and areas of improvement for the UAR. Methods Healthcare providers mainly practicing in California with experience advising on medication use during lactation were recruited. One-on-one semi-structured interviews that included questions on current practices when advising medication use during breastfeeding, and approaches to a given a scenario with and without information about the UAR were conducted. The Framework Method was applied for data analysis to construct themes and codes. Results Twenty-eight providers representing multiple professions and disciplines were interviewed. Six main themes emerged: (1) Current Practice Approaches, (2) Advantages of Existing Resources, (3) Disadvantages of Existing Resources, (4) Advantages of the UAR, (5) Disadvantages of the UAR, and (6) Strategies to Improve the UAR. Overall, 108 codes were identified that illustrated theme topics ranging from a general lack of metric use to the realities of advising. A workflow describing current practice approaches connected all other themes. Almost all disadvantages of existing resources could be overcome by advantages of other resources and the UAR. Several improvements to the UAR were identified to address its shortcomings. Conclusion Through interviews with providers who use resources to advise on medication use during breastfeeding, an improved understanding of current practice approaches and accessed resources was ascertained. Ultimately, it was found that the UAR would confer multiple benefits over existing resources, and improvements of the UAR were identified. Future work should focus on implementing the suggested recommendations to ensure optimal uptake of the UAR to improve advising practices.
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Affiliation(s)
- Cindy Hoi Ting Yeung
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Sherilyn K. D. Houle
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Philip O. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| | - Brookie M. Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| | - Samuel Dubinsky
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Andrea N. Edginton
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
- Correspondence: Andrea N. Edginton
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Obeng C, Jackson F, Nsiah-Asamoah C, Amissah-Essel S, Obeng-Gyasi B, Perry CA, Gonzalez Casanova I. Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women. Int J Environ Res Public Health 2022; 19:ijerph192416560. [PMID: 36554441 PMCID: PMC9779609 DOI: 10.3390/ijerph192416560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 06/13/2023]
Abstract
Human milk has the best impact on childhood survival. In Ghana, it is estimated that 43% of women exclusively breastfeed for 0-5 months and only 42% of breastfeeding mothers continue through 20-23 months. Although the Ghanaian government has implemented policies to facilitate exclusive breastfeeding, substantial gaps to achieve optimal newborn health and wellbeing remain. The purpose of this study was to evaluate breastfeeding prevalence and human milk sharing practices among Ghanaian women. Qualitative responses were received from Ghanaian females (n = 1050). In our sample, 81% indicated they breastfed their children and 8% reported ever sharing breastmilk with another mother. Reasons for sharing milk included (i) insufficient breastmilk production of the recipient mother, and (ii) mother's unavailability prompting women to offer their milk to a crying baby. About 60% of our sample reported that they were not concerned about sharing their milk. Findings present a strong indicator for milk donation towards the establishment of a human milk bank in Ghana. Health promotion efforts should aim at increasing education about the risks involved in milk sharing as well as the benefits of human milk donation through formal and safer channels such as a Human Milk Bank.
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Affiliation(s)
- Cecilia Obeng
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Frederica Jackson
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Christiana Nsiah-Asamoah
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast TF0494, Ghana
| | - Salome Amissah-Essel
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast TF0494, Ghana
| | - Barnabas Obeng-Gyasi
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Cydne A. Perry
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Ines Gonzalez Casanova
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
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Harris DL, Weston PJ, Harding JE. Feeding Patterns of Healthy Term Newborns in the First 5 Days-The Glucose in Well Babies Study (GLOW). J Hum Lact 2022; 38:661-669. [PMID: 35383475 DOI: 10.1177/08903344221087605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The feeding patterns of healthy newborns have been poorly described. RESEARCH AIM To determine the feeding patterns of healthy term newborns soon after birth, and if these differed with sex, gestation, and mode of birth. METHODS This study was a prospective, longitudinal observational cohort study. Term, appropriately grown newborns (N = 66) were fed according to maternal choice and details were recorded. Data were analyzed using generalized Poisson regression for feeding frequencies, and mixed model regression of log-transformed data for durations. RESULTS The participants completing the study had a M = 3589 g (SD = 348 g) birthweight, with a gestation age of M = 40.1 (1.2) weeks. All participants were breastfed; 23 (35%) also received expressed human milk and 10 (15%) received formula. Participants had fewer feeding sessions on Day 1, (M = 7.3 [1.9] sessions/day) increasing to (M = 9.4 [2.4] sessions/day) by Day 3, then reducing to (M = 9.0 [2.2] sessions/day) on Day 5, p < .001. The overall duration of breastfeeding sessions varied widely (Mdn = 29 [range = 1-447] min). Feed frequency but not duration was higher in males than females (M = 8.9, SE = 0.2 vs. 8.1, 02, sessions/day, p = .03), in newborns born ≥ 40 weeks' gestation (M = 8.9, SE = 0.3 vs. 8.2, 02, sessions/day, p = .04), and in newborns born by Caesarean section (M = 9.4, SE = 0.3 vs. 8.4, 02, sessions/day, for vaginal birth, p = .003). CONCLUSION Feeding patterns of healthy term newborns vary widely, but frequency increases during the first 3 days, and is greater in males, newborns born late term, and born by Caesarean section. CLINICAL TRIAL REGISTRATION The Australian and New Zealand Clinical Trials Registry Ref: ACTRN12615000986572. The study protocol is available online: http://hdl.handle.net/2292/32066.
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Affiliation(s)
- Deborah L Harris
- Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Philip J Weston
- Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Pommeret-de Villepin B, Barasinski C, Rigourd V. Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S56-S73. [PMID: 36480673 DOI: 10.1111/jmwh.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.
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Affiliation(s)
- Brune Pommeret-de Villepin
- Service gynécologie-obstétrique, Centre hospitalier de Tourcoing, 155 rue du Président-René-Coty, Tourcoing, 59200, France
| | - Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Axe TGI-DecisipH, Clermont-Ferrand, F-63000, France
| | - Virginie Rigourd
- Pédiatre en néonatalogie médecin responsable du lactarium régional d'Ile de France Hopital, Necker Enfants malades, Paris, France
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Pulvera R, Collin DF, Hamad R. The effect of the 2009 WIC revision on maternal and child health: A quasi-experimental study. Paediatr Perinat Epidemiol 2022; 36:851-860. [PMID: 35871753 PMCID: PMC9588600 DOI: 10.1111/ppe.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest U.S. nutrition program for low-income pregnant women. It was revised in 2009, with the goal of improving nutritional content of food packages, enhancing nutrition education, and strengthening breast feeding support. Few studies have assessed the effects of this revision on perinatal health. OBJECTIVES To investigate the impact of the revised WIC program on maternal and child health in a large, multi-state data set. METHODS We conducted a quasi-experimental difference-in-differences analysis, comparing the pre/post changes among WIC recipients to changes among non-recipients. We adjusted for key sociodemographic covariates in multivariable linear models. We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for 18 states from 2004 to 2017. RESULTS The main analysis included 331,946 mother-infant dyads. WIC recipients were more likely to be younger, Black or Hispanic/Latina, unmarried, and of greater parity. The revised WIC program was associated with reduced likelihood of more-than-recommended GWG (-1.29% points, 95% confidence interval [CI] -2.03, -0.56) and increased likelihood of ever breast fed (1.18% points, 95% CI 0.28, 2.08). We also identified heterogeneous effects on GWG, with more pronounced associations among women 35 and older. There were no associations with foetal growth. CONCLUSIONS The revised WIC program was associated with improvements in women's gestational weight gain and infant breast feeding.
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Affiliation(s)
- Richard Pulvera
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Daniel F. Collin
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, California, USA
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Dinour LM, Pole A. Evaluation of Breastfeeding App Features: Content Analysis Study. JMIR Pediatr Parent 2022; 5:e37581. [PMID: 36287596 PMCID: PMC9647452 DOI: 10.2196/37581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. OBJECTIVE This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. METHODS Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. RESULTS On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. CONCLUSIONS Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users.
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Affiliation(s)
- Lauren M Dinour
- Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, Montclair, NJ, United States
| | - Antoinette Pole
- Department of Political Science and Law, College of Humanities and Social Sciences, Montclair State University, Montclair, NJ, United States
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Witczak A, Pohoryło A, Aftyka A, Pokorska-Niewiada K, Witczak G. Changes in Polychlorinated Biphenyl Residues in Milk during Lactation: Levels of Contamination, Influencing Factors, and Infant Risk Assessment. Int J Mol Sci 2022; 23. [PMID: 36361507 DOI: 10.3390/ijms232112717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/27/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
Given the importance of breastfeeding infants, the contamination of human milk is a significant public concern. The aim of this study was to assess the contamination of human milk with dioxin-like PCBs (dl-PCBs) and non-dioxin-like PCBs (ndl-PCBs) in relation to the duration of lactation and other influencing factors, especially the frequency of the consumption of selected foods during pregnancy. Based on this, the health risk to infants was assessed and compared to the tolerable daily intake (TDI). PCB determinations were performed using gas chromatography/mass spectrometry. The ∑ndl-PCB content ranged from 0.008 to 0.897 ng/g w.w., at an average of 0.552 ng/g wet weight, which was 55% of the maximum level according to the EU guidelines for foods for infants and young children. The toxic equivalent (TEQ) was in the range of 0.033-5.67 pg-TEQ/g w.w. The content of non-ortho, mono-ortho, and ndl-PCBs in human milk decreased the longer lactation continued. Moreover, when pregnant women smoked tobacco, this correlated significantly with increases in the concentrations of PCB congeners 156, 118, and 189 in human milk. The human milk contents of PCB congeners 77, 81, 186, 118, and 189 were strongly positively correlated with the amount of fish consumed. The content of stable congeners PCB 135 and PCB 153 increased with age.
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Beck DC, Tabb KM, Tilea A, Hall SV, Vance A, Patrick SW, Schroeder A, Zivin K. The Association between NICU Admission and Mental Health Diagnoses among Commercially Insured Postpartum Women in the US, 2010-2018. Children (Basel) 2022; 9. [PMID: 36291486 DOI: 10.3390/children9101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses (aOR: 1.19, 95% CI: 1.14%−1.24%) and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%−1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73−0.08), Hispanic (aOR = 0.69, 0.67−0.72), and Asian (aOR: 0.32, 0.30−0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.
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