RESUMO
BACKGROUND: Rates of breastfeeding are lower among minority and underserved populations in the United States. Our study objective was to assess pregnant persons attitudes and barriers to breastfeeding among a cohort at high risk for not breastfeeding. METHODS: We disseminated the Iowa Infant Feeding Attitude Scale (IIFAS) to 100 pregnant persons at least 18 years of age attending a prenatal visit in a low-resource, academic practice in south-central Louisiana (Woman's Hospital). The IIFAS, as well as questions collecting information on breastfeeding experience and sociodemographic characteristics, were administered via interview. Medical records were reviewed to investigate associations between attitudes about breastfeeding in pregnancy and patient's feeding choices during the delivery hospital stay. Fisher exact tests and Wilcoxon rank-sum tests were used to assess associations between categorical and continuous variables respectively. RESULTS: Of the 98 participants who completed the study, 8% were Hispanic, 63% were Black, 95% were Medicaid eligible, and 50% were unemployed. 59% (n = 58) went on to breastfeed/combination breast-formula feed (called "Any-Breastfeeding Group") during the delivery stay. Total IIFAS score during pregnancy was significantly higher among those who went on to breastfeed during delivery hospital stay (Any-Breastfeeding Group vs. Formula-Feeding-Only Group: 58.9 ± 5.5 vs. 53.7 ± 6.2 respectively, p < 0.001). In the group that went on to only formula feed (Formula-Feeding-Only Group), only 4% agreed breastfeeding was more convenient when surveyed during pregnancy, compared to 45% of the Any-Breastfeeding Group. 60% of Formula-Feeding-Only Group agreed formula is as healthy as breast milk. CONCLUSION: The three major themes that coincided with favorability toward breastfeeding in the study, and can be addressed during prenatal counseling, are: mother-infant bonding, convenience, and health benefits. By identifying attitudes and barriers to breastfeeding for patients during pregnancy who went on to not breastfeed, directed educational opportunities can be developed to address these specific attitudes to ultimately increase breastfeeding initiation and continuation.
Assuntos
Aleitamento Materno , Cognição , Feminino , Humanos , Lactente , Gravidez , Escolaridade , Nível de Saúde , Leite Humano , Estados Unidos , Estudos ProspectivosRESUMO
We present a simulation study and application that shows inclusion of binary proxy variables related to binary unmeasured confounders improves the estimate of a related treatment effect in binary logistic regression. The simulation study included 60,000 randomly generated parameter scenarios of sample size 10,000 across six different simulation structures. We assessed bias by comparing the probability of finding the expected treatment effect relative to the modeled treatment effect with and without the proxy variable. Inclusion of a proxy variable in the logistic regression model significantly reduced the bias of the treatment or exposure effect when compared to logistic regression without the proxy variable. Including proxy variables in the logistic regression model improves the estimation of the treatment effect at weak, moderate, and strong association with unmeasured confounders and the outcome, treatment, or proxy variables. Comparative advantages held for weakly and strongly collapsible situations, as the number of unmeasured confounders increased, and as the number of proxy variables adjusted for increased.
Assuntos
Modelos Logísticos , Humanos , Fatores de Confusão Epidemiológicos , Simulação por Computador , Viés , Tamanho da AmostraRESUMO
BACKGROUND: The study aim was to describe the incidence of depression, anxiety, perinatal-post-traumatic stress disorder (PTSD), and their co-occurrences in the early postpartum period in a low-resource OB/GYN clinic serving majority Medicaid-eligible persons. We hypothesized that postpartum persons screening positive for depression will have an increased risk of a positive screen for anxiety and perinatal PTSD. METHODS: A retrospective study of postpartum persons receiving care in Baton Rouge, Louisiana was conducted using responses abstracted from the electronic medical record (EMR) of the Patient Health Questionnaire-9 (PHQ9), Generalized Anxiety Disorder-7 (GAD7), and Perinatal Post Traumatic Stress Disorder Questionnaire-II (PPQII). Categorical distributions were compared using Fisher exact tests, while t-tests were used to compare continuous covariates. Multivariable logistic regression was used to predict anxiety (GAD7) and perinatal PTSD (PPQII) scores while adjusting for potential confounders, as well as to predict continuous PPQII and GAD7 based on continuous PHQ9 scores. RESULTS: There were 613 birthing persons 4-12 weeks postpartum that completed mental health screening (PHQ9, GAD7, and PPQII) between November 2020 and June 2022 as part of routine postpartum care in the clinic. The incidence of screening positive for symptoms of depression (PHQ9 > 4) was 25.4% (n = 156), while the incidence of positive screening for symptoms of anxiety (GAD7 > 4) and perinatal PTSD (PPQII [Formula: see text] 19) were 23.0% (n = 141) and 5.1% (n = 31) respectively. Postpartum patients with mild anxiety or more (i.e. GAD7 > 4) had 26 times higher odds of screening positive for symptoms of depression (PHQ9 > 4) (adjusted odds ratio [aOR] 26.3; 95% confidence interval [CI] 15.29-46.92; p < 0.001). Postpartum persons with a PPQII score indicating symptoms of perinatal PTSD (PPQII [Formula: see text] 19) had 44 times higher odds of screening positive for symptoms of depression (PHQ > 4) (aOR 44.14; 95%CI 5.07-5856.17; p < 0.001). CONCLUSIONS: Depression, anxiety, and perinatal PTSD are each independent risk factors for each other. To comply with the American College of Obstetricians and Gynecologists (ACOG) recommendations, providers should universally screen postpartum persons with validated screening tools for mood disturbances. However, if a complete full mood assessment is not feasible, this study provides evidence to support screening patients for depression, and if the patient screens positive, prompt additional screening for anxiety and perinatal PTSD.
Assuntos
Ansiedade , Depressão Pós-Parto , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Gravidez , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtornos de Ansiedade , Depressão/epidemiologia , Depressão Pós-Parto/diagnóstico , Período Pós-Parto/psicologia , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , ComorbidadeRESUMO
BACKGROUND: Postpartum hemorrhage (PPH) is the most common cause of maternal mortality worldwide. Predicting PPH remains difficult, and risk factors vary among populations. We aimed to determine prevalence, risk factors, and causes for PPH in our obstetric population in South-Central Louisiana. METHODS: We conducted a retrospective cohort study utilizing medical records for deliveries between October 2015 and September 2020 at Woman's Hospital, a tertiary hospital in South-Central Louisiana. PPH was defined by the current American College of Obstetricians and Gynecologists' (ACOG) criteria as cumulative blood loss greater than or equal to 1000 mL within 24 h after the birth process regardless of route of delivery. Logistic regression assessed the association of PPH and possible risk factors: anemia at the time of delivery, race, parity, delivery mode, body mass index, age, and health insurance. An additional logistic regression also investigated risk factors within our cohort for severe maternal morbidity among patients who experienced PPH including the same covariates. RESULTS: A total of 30,674 deliveries were included in our cohort, among which PPH occurred in 12.3% (n = 3773). Patients experiencing PPH were more likely to be of Black race, Medicaid-eligible, deliver via cesarean section, and have lower hemoglobin and hematocrit at time of delivery compared to patients without PPH (all p < .001). Anemia at delivery (aOR = 1.28; 95%CI = 1.154-1.419), cesarean delivery (aOR = 8.796; 95%CI = 7.731-10.007), BMI > 40kg/m2 (aOR = 1.363; 95%CI = 1.186-1.567), and Black race (aOR = 1.233; 95%CI = 1.099-1.383) were the strongest predictors of PPH. Among cesarean cases (n = 10,888), Black race and BMI > 40 kg/m2 were the strongest predictors for PPH. Among patients who experienced PPH, anemia was associated with a higher likelihood of experiencing a severe maternal morbidity event (aOR = 2.587; 95%CI = 1.990-3.364). CONCLUSION: Consistent with literature in the United States, Black race, increased BMI, cesarean delivery, and anemia were associated with risk of PPH. Anemia at delivery increased the risk for severe maternal morbidity among patients experiencing PPH.
Assuntos
Anemia , Hemorragia Pós-Parto , Humanos , Gravidez , Feminino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Cesárea/efeitos adversos , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Risco , Anemia/epidemiologia , Anemia/complicaçõesRESUMO
BACKGROUND: There are conflicting reports of postoperative efficacy of negative pressure wound therapy in patients with obesity after cesarean delivery. METHODS: Retrospective cohort study for patients with obesity and negative pressure wound therapy or abdominal dressing after cesarean delivery between April 1, 2014 and January 31, 2018. Postoperative surgical site infection was defined from medical record charting or positive wound culture and confirmed by the hospital's Infection Prevention team. Multivariable logistic regression model for surgical site infection was conducted including additional potential confounding variables. Mantel-Haenszel tests were conducted to stratify by body mass index class and operative time, and we performed quasi-Poisson regression to determine which factors were associated with an increased operative time. RESULTS: We included 4,391 Black or White patients with obesity, 696 (15.9%) underwent negative pressure wound therapy and 3,695 (84.1%) abdominal dressing after cesarean delivery. Incidence of surgical site infection after negative pressure wound therapy and abdominal dressing were 6.1% and 3.4%, respectively (2-sample test of proportions P < .001). The multivariable logistic regression (covariates: race, diabetes, body mass index category, insurance, scheduled/emergency, artificial rupture, previous c-section, operative time, age, closure type) found negative pressure wound therapy dressing was associated with an increased risk of surgical site infection (adjusted odds ratio 1.54; 95% confidence interval, 1.01-2.34), as did a Mantel-Haenszel test which was stratified by body mass index (odds ratio 1.62; 95% confidence interval, 1.08-2.43) and a Mantel-Haenszel test stratified by operative time (odds ratio 1.85; 95% confidence interval, 1.28-2.65). Negative pressure wound therapy dressing also led to an increase in operative time in the Quasi-Poisson regression, which was the primary predictor of infection. CONCLUSION: Negative pressure wound therapy was associated with an increased the risk of postoperative surgical site infection after cesarean delivery in our obstetric patients with obesity. Future prospective studies are needed to determine a dressing type and other intervention to decrease postoperative cesarean surgical site infection in women with obesity.
Assuntos
Bandagens , Cesárea/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Obesidade/complicações , Infecção da Ferida Cirúrgica/etiologia , Adulto , Feminino , Humanos , Razão de Chances , Duração da Cirurgia , Gravidez , Complicações na Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: To compare the efficacy of single-dose letrozole (25 mg) with a 5-day course (5 mg/day) for ovulation induction (OI). DESIGN: Retrospective cohort study. SETTING: Hospital. PATIENTS: Patients undergoing first round of OI and intrauterine insemination with letrozole from January 2015 through December 2017. INTERVENTIONS: Patients received letrozole as either a single 25 mg dose for 1 day (1D) versus 5 mg daily for 5 days (5D). A secondary analysis was performed on patients also receiving gonadotropins (GND). MAIN OUTCOME MEASURES: Pregnancy rate (PR) determined by positive human chorionic GND. RESULTS: There were 847 patients included in the study, 302 in the 1D group and 284 in the 5D group; 261 patients had concurrent GND administration, 162 1D+GND and 99 5D+GND. There was no difference in smoking status, primary versus secondary infertility, or total motile sperm concentration. Comparing 1D with 5D, there was a statistically significant, although not clinically relevant, difference in both age and body mass index (31 vs. 31.8 years; 26.2 vs. 27.4, respectively). Similarly, comparing 1D+GND with 5D+GND, there was statistically significant difference in body mass index (27.19 vs. 29.1). Secondary outcomes included live birth rate (LBR), multiple gestation rate (MG), and miscarriage rate (SAB). There were no differences between 1D and 5D in the primary outcome of PR (14.2% vs. 11.6%), LBR (9.6% vs. 7%), MG (16.2% vs. 13.8%), or SAB (16.22% vs. 13.8%). In looking at the GND groups alone, there was no difference in PR (18.3% vs. 23.8%), LBR (11.72% vs. 17.86%), MG (8.7% vs. 5.56%), or SAB (13.64% vs. 5.56%). There was a significant difference in cycle cancellation rate in the 1D versus 5D groups (3.9% vs. 9.6%); however, this was not seen in the 1D+GND versus 5D+GND groups. CONCLUSIONS: A single-dose protocol with letrozole in an OI/intrauterine insemination cycle may be considered an alternative to standard 5D dosing protocols with the potential for improved compliance and similar reproductive outcomes.