Kratom (Mitragyna speciosa): A Case Review of Use Before and During Pregnancy.

Kratom (Mitragyna speciosa) is a plant-based substance with psychoactive properties similar to opioids but is not currently classified as an opioid. One of its more prevalent uses is to treat opioid dependency and withdrawal symptoms. Opioid use disorder is a leading cause of pregnancy-associated maternal mortality, and pregnant women may be using kratom as a substitute or alternative to opioids. Prevalence of kratom use is increasing rapidly, but scientific evidence specific to therapeutic and adverse effects is lacking overall, and the implications of its use in pregnancy and on the fetus-newborn are limited to a few case reports. Kratom is a legal substance by federal law, although some states have banned its use. The lack of regulation is concerning. Significant illness and associated deaths have been reported with kratom use. Lack of disclosure by people using kratom and limited laboratory testing options are major challenges for health care providers and public health.

Improving access to perinatal mental health services: the value of on-site resources.

BACKGROUND: Perinatal mood disorders have both short- and long-term negative consequences for mothers and their babies. National organizations recommend universal screening for postpartum depression. Little is known, however, about screening and referral among women living in underserved areas with limited access to care. OBJECTIVE: The objective of this report was to evaluate the utilization of mental health services in an urban, inner-city hospital following the implementation of colocated counseling services across 10 county-sponsored clinics that serve a medically underserved population. We further explored antecedents of a positive postpartum depression screen, factors associated with successful referral, and the rate of perinatal mood disorder diagnoses following universal screening. We hypothesized that integrated mental health services would improve referral rates following positive postpartum depression screening compared with historically separated services. STUDY DESIGN: This was a retrospective cohort study of women undergoing universal postpartum depression screening with deliveries from January 2017 to December 2019 who were compared with a historic cohort from the same population from June 2008 to March 2010. The Edinburgh Postnatal Depression Scale was used to evaluate women at their postpartum visit, and a mental health service referral was offered to women with a score of ≥13. The primary outcome was a comparison of completed referrals between cohorts with and without colocated mental health services following a positive postpartum depression screen. Statistical analysis included chi-square tests with a P value of <.05 being considered significant and adjusted multivariate analyses for perinatal outcomes associated with a positive postpartum screen. RESULTS: Between January 2017 to December 2019, 25,425 women completed a postpartum depression screen with 978 (4%) of those recording a positive screen. After implementation of colocated mental health counselors, completed perinatal mental health referrals significantly increased when compared with the historic cohort without colocated services (57%; 560 of 978 vs 22%; 238 of 1106; P<.001). Adverse neonatal outcomes, such as stillbirth (adjusted risk ratio, 9.5; 95% confidence interval, 6.35-14.26) and neonatal demise (adjusted risk ratio, 14.3; 95% confidence interval, 6.67-30.46), were most strongly associated with a positive depression screen. There were 122 (21%) women with a positive screen who were diagnosed with a depressive disorder in the peripartum period. There were no specific features associated with those who did or did not complete referral. One-fifth of women were referred for psychiatric evaluation following an initial evaluation, and the referral rate was associated with higher scores on the depression screen (P<.001). CONCLUSION: Utilization of mental health services following a positive depression screen more than doubled following the implementation of colocated services.

Patient Perspectives on Audio-Only Virtual Prenatal Visits Amidst the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic.

OBJECTIVE: To evaluate patient satisfaction after integration of audio-only virtual visits into a pre-existing prenatal care schedule within a large, county-based system during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS: We implemented audio-only prenatal virtual visits in response to the SARS-CoV-2 pandemic within a large, county-based prenatal care system serving predominantly women with low socioeconomic status and limited resources. Using a four-question telephone survey, we surveyed a cross-section of patients who had opted to participate in virtual visits to assess their level of satisfaction surrounding audio-only visits. In addition, average clinic wait times and attendance rates by visit type were examined. RESULTS: From March 17 to May 31, 2020, more than 4,000 audio-only virtual prenatal visits were completed in our system. After implementation, the percentage of visits conducted through the virtual platform gradually rose, with nearly 25% of weekly prenatal visits being performed through the virtual platform by the month of May. Clinic wait times trended downward after implementation of virtual visits (P<.001). On average, 88% of virtual prenatal visits were completed as scheduled, whereas only 82% of in-person visits were attended (P<.001). Hospital administration attempted to contact 431 patients who had participated in at least one virtual visit to assess patient satisfaction; 283 patients were reached and agreed to participate (65%). Ninety-nine percent of respondents reported that their needs were met during their audio-only virtual visits. The majority of patients preferred a combination of in-person and virtual visits for prenatal care, and patients reported many benefits with virtual visits. CONCLUSION: Audio-only virtual prenatal visits-as a complement to in-person prenatal visits-have specific and distinct advantages compared with video-enabled telehealth in a vulnerable population of women and offer a viable option to increase access to care.

Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change.

INTRODUCTION: Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. METHODS: We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. RESULTS: Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self-assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. DISCUSSION: Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.

Women's Perceptions on the Use of Video Technology in Early Labor: Being Able to See.

INTRODUCTION: Delaying admission to the birth setting until active labor has commenced has known benefits. However, women and their partners often struggle to stay home in early labor. Research on telephone triage during early labor at home has illuminated significant disadvantages with this model of care, contributing to women feeling dissatisfied with the early birth experience. Research conducted with midwives on the potential benefits of using video technology suggests it might be a helpful strategy for early labor support. This study examined women's perspectives on the potential use of this technology. METHODS: Focus groups and individual interviews were conducted with 23 English-speaking women who experienced spontaneous labor within the last year. The recordings were transcribed verbatim. Content analysis was used to interpret women's perceptions. RESULTS: The women identified potential advantages of video technology in early labor connected to the major theme of being able to see, which could enable closer human connections between the intrapartum care provider, the woman, and her partner, as well as better assessments of labor. This human connection was integral to enhancing empathy and building confidence. Concerns about using video calls during early labor at home focused on privacy issues and the need to practice beforehand. Concerns about privacy depended upon having a prior relationship with the intrapartum care provider and women being able to decide if they wanted to use the technology. DISCUSSION: One way of optimizing the experience of staying home in early labor and overall satisfaction with the birth experience may be with video technology, which could offer enhancements over traditional telephone triage.

Exploration of the Vaginal and Gut Microbiome in African American Women by Body Mass Index, Class of Obesity, and Gestational Weight Gain: A Pilot Study.

OBJECTIVE: This study determines the differences in the distal gut and vaginal microbiome in African American (AA) women by prepregnancy body mass index and gestational weight gain (GWG) comparing women with and without obesity and by obesity class. STUDY DESIGN: We prospectively sampled the vaginal and distal gut microbiome in pregnant AA women at two time points during pregnancy. Samples were analyzed using high-throughput sequencing of the V4 region of the 16S ribosomal ribonucleic acid gene. RESULTS: Distinct differences in vaginal and distal gut α-diversity were observed at time point 1 between women with and without obesity by total GWG. Significant differences in distal gut ß-diversity were also found at time point 1 in obese women by GWG. Within the Bacteroides genus, a significant association was observed by total GWG among obese women which was absent in nonobese women. Women with class III obesity who experienced low GWG had the lowest abundance of distal gut Bacteroides and appreciably higher relative abundance of a consortia of vaginal taxa including Atopobium, Gardnerella, Prevotella, and Sneathia. CONCLUSION: These results contribute new evidence showing that GWG in combination with obesity and obesity class is associated with an altered distal gut and vaginal composition early in pregnancy among AA women.

A qualitative study of midwives' perceptions on using video-calling in early labor.

BACKGROUND: Decisions made in early labor influence the outcomes of childbirth for women and infants. Telephone assessment during labor, the current norm in many settings, has been found to be a source of dissatisfaction for women and can present challenges for midwives. The aim of this qualitative study was to explore midwives' views on the potential of video-calling as a method for assessing women in early labor. METHODS: A series of 8 midwife focus groups (n = 45) and interviews (n = 4) in the Midlands region of England and the mid-South and Northeast regions of the United States were completed. Audio recordings were transcribed verbatim and coded using content analysis. Coding diagrams were used to help develop major themes in the data. RESULTS: Midwives were generally positive about the potential of video-calling in early labor and using visual cues to make more accurate assessments and to enhance trust. Some midwives expressed concerns about privacy, both for themselves and for women, and issues of accessibility. They suggested strategies for implementation and further research, such as the need for a private space in birth facilities and training for both staff and service users. CONCLUSIONS: Video-calling was seen as a viable option for assessment of women in early labor with some particular challenges related to implementation. This research focused on midwives' views; the views of women and their families should also be considered. There is a lack of evidence on the clinical and cost effectiveness of video-calling in maternity care and further research is warranted.

The Gut Microbiome, Obesity, and Weight Control in Women's Reproductive Health.

The microbes residing in the human gut, referred to as the microbiome, are intricately linked to energy homeostasis and subsequently obesity. Integral to the origins of obesity, the microbiome is believed to affect not only health of the human gut but also overall health. This microbiome-obesity association is mediated through the process of energy extraction, metabolism, and cross talk between the brain and the gut microbiome. Host exposures, including diet, that potentially modify genetic predisposition to obesity and affect weight management are reviewed. The higher prevalence of obesity among women and recent evidence linking obesity during pregnancy with offspring health make this topic particularly relevant. Current limitations in microbiome research to address obesity and future advances in this field are described. Applications of this science with respect to applied nursing and overall health care in general are included, with emphasis on the reproductive health of women and their offspring.

A method comparison of photovoice and content analysis: research examining challenges and supports of family caregivers.

PURPOSE: The purpose of this manuscript is to compare methods and thematic representations of the challenges and supports of family caregivers identified with photovoice methodology contrasted with content analysis, a more traditional qualitative approach. METHODS: Results from a photovoice study utilizing a participatory action research framework was compared to an analysis of the audio-transcripts from that study utilizing content analysis methodology. RESULTS: Major similarities between the results are identified with some notable differences. Content analysis provides a more in-depth and abstract elucidation of the nature of the challenges and supports of the family caregiver. CONCLUSIONS: The comparison provides evidence to support the trustworthiness of photovoice methodology with limitations identified. The enhanced elaboration of theme and categories with content analysis may have some advantages relevant to the utilization of this knowledge by health care professionals.

Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review.

BACKGROUND: Obesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity. AIM: Conduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity. METHODS: A keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence. FINDINGS: Ten articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5-9kg in women with class I obesity, 1 to less than 5kg for class II obesity and no gestational weight gain for women with class III obesity. CONCLUSIONS: Gestational weight gain guidelines may need modification for severity of obesity.

Stroke and pregnancy: an integrative review with implications for neuroscience nurses.

Stroke in association with pregnancy is an infrequent occurrence, but there is evidence that the incidence is rising. The physiological changes of pregnancy are thought to increase stroke risk, and several conditions specific to pregnancy further increase risk. The provision of optimal care to pregnant and postpartum women who experience stroke requires awareness of how the physiological changes of pregnancy may affect the course of stroke and nursing actions. This article provides an overview of current knowledge about pregnancy-related stroke including underlying pathophysiology, risk factors unique to pregnancy, and treatment issues when stroke is a complication of pregnancy. Implications for the nursing care of women with pregnancy-related stroke and maternal child considerations are discussed.

Incorporating breastfeeding education into prenatal care.

INTRODUCTION: Prenatal breastfeeding education increases breastfeeding initiation, exclusivity, and duration. Current research regarding antenatal breastfeeding education suggests that recurrent, individual, and technology-based education programs are effective in providing women with evidence-based breastfeeding information and guidance. MATERIALS AND METHODS: This project was implemented at an obstetrical practice in the northeast United States. Pregnant women between 32 weeks of gestation and birth, receiving care from certified nurse-midwives, were the targeted population. Three breastfeeding modules were created and offered to women at the 32-, 34-, and 36-week prenatal visit via computer tablets. Women answered questionnaires at the end of each module, serving as a measure for participation and content learning. Women also completed a questionnaire at the 6-week postpartum visit to assess summative perceptions. RESULTS: Twenty-three women participated, and 21 women completed questionnaires at 6 weeks postpartum. All women answered the content questions at the end of the modules correctly. Sixty-seven percent reported prior breastfeeding experience, 95% initiated breastfeeding, 86% were exclusively breastfeeding at 6 weeks postpartum, and 71% of the women planned to exclusively breastfeed for 6 months. Sixty-seven percent reported the modules promoted or affirmed their decision to breastfeed, whereas 5% would have preferred group-based education. Providers documented breastfeeding education 52% of the time. CONCLUSIONS: The results of this project indicate that women successfully learned breastfeeding content via the tablet methodology. The results confirm that prenatal breastfeeding education, in the office setting, is well accepted by women. In order to assess the impact of the program on breastfeeding success, further study is needed.