Preterm birth among Pacific Islanders in the United States and the US-affiliated Pacific Islands: A systematic review and meta-analysis.

OBJECTIVE: To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US-Affiliated Pacific Islands. METHODS: Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US-Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders. RESULTS: Fourteen of the 3183 screened articles were included in meta-analyses. Random-effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%-13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%-23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR = 1.40, 95% CI: 1.28-1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre-pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth. CONCLUSIONS: Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup-specific outcomes to address perinatal health disparities.

Conceptions of pregnancy health and motivations for healthful behavior change among women in American Samoa.

BACKGROUND: American Samoan women are particularly at risk of obesity-related non-communicable disease (NCD), requiring efficacious interventions to protect their health and that of their infants. Prior studies have identified pregnancy as an ideal time for behavior change interventions related to NCD. AIM: This study aimed to understand American Samoan women's conceptions of health during pregnancy, their motivations for pregnancy behavior change, and the role of their family in both enabling and preventing these changes. METHODS: Eighteen women (2-19 weeks post-partum) completed semi-structured interviews that explored their experiences of pregnancy-related behavior change and social support. A thematic analysis identified prominent themes. A stages of change framework was used to describe the sample's readiness for behavior change. FINDINGS: Participants expressed a Westernized conception of health during pregnancy that focused on eating a balanced diet and exercising regularly; behaviors that would usually be stigmatized outside of pregnancy. Many were in the contemplative/pre-contemplative stages of change, although some reported initiating healthful behaviors in pregnancy. Participants overwhelmingly described external motivations for adopting healthy behaviors, most notably the perceived benefit to their baby. During pregnancy, women reported protective treatment from their families as a result of communal ownership over the baby that is potentially limiting for women's agency over their health. CONCLUSIONS: This study confirmed pregnancy as an opportune moment for health behavior intervention, especially within the context of Samoan culture. Future efforts should capitalize on external motivations for behavior change but also encourage the development of internal motivators to sustain changes initiated in pregnancy post-partum.

Predictors of prenatal care satisfaction among pregnant women in American Samoa.

BACKGROUND: Pregnant women in American Samoa have a high risk of complications due to overweight and obesity. Prenatal care can mitigate the risk, however many women do not seek adequate care during pregnancy. Low utilization of prenatal care may stem from low levels of satisfaction with services offered. Our objective was to identify predictors of prenatal care satisfaction in American Samoa. METHODS: A structured survey was distributed to 165 pregnant women receiving prenatal care at the Lyndon B Johnson Tropical Medical Center, Pago Pago. Women self-reported demographic characteristics, pregnancy history, and satisfaction with prenatal care. Domains of satisfaction were extracted using principal components analysis. Scores were summed across each domain. Linear regression was used to examine associations between maternal characteristics and the summed scores within individual domains and for overall satisfaction. RESULT: Three domains of satisfaction were identified: satisfaction with clinic services, clinic accessibility, and physician interactions. Waiting ≥ 2 h to see the doctor negatively impacted satisfaction with clinic services, clinic accessibility, and overall satisfaction. Living > 20 min from the clinic was associated with lower clinic accessibility, physician interactions, and overall satisfaction. Women who were employed/on maternity leave had lower scores for physician interactions compared with unemployed women/students. Women who did not attend all their appointments had lower overall satisfaction scores. CONCLUSIONS: Satisfaction with clinic services, clinic accessibility and physician interactions are important contributors to prenatal care satisfaction. To improve patient satisfaction prenatal care clinics should focus on making it easier for women to reach clinics, improving waiting times, and increasing time with providers.

Mothers' attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa.

BACKGROUND: In American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration. AIMS: (1) To examine American Samoan mothers' feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding. METHODS: Eighteen semi-structured interviews were conducted with American Samoan mothers at 16-32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data. FINDINGS: Intention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous "back-up option" where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design. CONCLUSION: This study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.