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1.
Birth ; 50(1): 161-170, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36537549

RESUMO

BACKGROUND: Nearly 40% of pregnant women in 2016 were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior studies have investigated nutritional behaviors among WIC participants and access to WIC breastfeeding counseling services. However, there are no (few?) nationally representative, large-scale analyses of WIC users and pregnancy behaviors. Thus, the present study aims to examine associations between WIC use and select pregnancy outcomes among Medicaid enrollees. METHODS: We examined pregnancy-related behaviors and outcomes using 2018 U.S. Birth Certificates for Medicaid patients aged 18-45 years (N = 1 159 263). Outcomes included prenatal care (PNC) adequacy, breastfeeding initiation, cigarette use, and gestational weight gain. Standard binary and multinomial logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). RESULTS: After adjustment, WIC users had statistically significant increased odds of adequate PNC (adjusted OR [AOR] = 1.31 [95% CI 1.30, 1.32]), cigarette use (quit smoking during pregnancy 1.09 [1.07, 1.11]; smoked throughout pregnancy 1.16 [1.14, 1.18], and exceeding recommendations of weight gain 1.07 [1.06, 1.08]) compared with non-WIC users. WIC enrollees also experienced decreased odds of breastfeeding initiation (0.85 [0.85, 0.86]) compared with non-WIC users. CONCLUSIONS: The study underscores the value of the WIC program in improving access to PNC. Yet, low-income women remain at risk for smoking during pregnancy and exceeding the recommended amount of weight gain. Breastfeeding initiation is lower than anticipated among WIC participants. Additional studies are needed to investigate WIC program efficacy.


Assuntos
Medicaid , Resultado da Gravidez , Lactente , Estados Unidos , Gravidez , Feminino , Criança , Humanos , Cuidado Pré-Natal , Aleitamento Materno/psicologia , Gestantes
2.
Health Commun ; : 1-8, 2023 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-37559182

RESUMO

Miscarriage is a pervasive and socioemotionally complex pregnancy complication. Evidence suggests that poor clinical management can worsen these experiences. Yet, assessments of healthcare communication during a miscarriage are limited and a systematic review of the literature is needed. This review identified and synthesized original research on miscarriage and healthcare communication in the United States from the past 20 years to identify existing knowledge gaps for future miscarriage research. The following databases were searched: PubMed, PsychINFO, and ERIC Database. Data were charted according to Arksey and O'Malley's Scoping Review Framework. Eleven articles were included in the review and three primary themes emerged: (a) patients overwhelmingly prefer patient-centered care; (b) miscarriage is often overmedicalized, which leads to poor communication; and (c) informed decision-making related to one's miscarriage can improve patient experiences. Several gaps were also identified, including studies seeking physician perspectives on miscarriage communication, evaluation of standard care guidelines, and studies evaluating diverse patients' perspectives. This review highlights the need for patient-centered care that utilizes compassionate and accessible language and promotes informed decision-making. Future research should use quantitative methodologies and longitudinal designs to build upon these findings and improve patient experiences of miscarriage.

3.
South Med J ; 113(6): 285-291, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483638

RESUMO

OBJECTIVE: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System. METHODS: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99). CONCLUSIONS: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Intervalo entre Nascimentos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde , Período Pós-Parto , Fumar/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Modelos Logísticos , Estado Civil/estatística & dados numéricos , Mississippi/epidemiologia , Razão de Chances , Nascimento Prematuro/epidemiologia , Tennessee/epidemiologia , População Branca/estatística & dados numéricos , Adulto Jovem
4.
Health Care Women Int ; 40(2): 196-212, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30849281

RESUMO

Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.


Assuntos
Parto Obstétrico/métodos , Mortalidade Infantil , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , África Ocidental/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Pobreza , Gravidez , Fatores Socioeconômicos , Adulto Jovem
5.
J Pediatr Nurs ; 34: 17-22, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28215447

RESUMO

PURPOSE: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. DESIGN AND METHODS: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. RESULTS: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. CONCLUSIONS: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. PRACTICE IMPLICATIONS: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses.


Assuntos
Atitude do Pessoal de Saúde , Maus-Tratos Infantis/estatística & dados numéricos , Relações Enfermeiro-Paciente/ética , Enfermeiros Pediátricos/ética , Recursos Humanos de Enfermagem Hospitalar/ética , Adulto , Criança , Maus-Tratos Infantis/ética , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Avaliação das Necessidades , Avaliação de Resultados em Cuidados de Saúde , Enfermagem Pediátrica/ética , Enfermagem Pediátrica/métodos , Percepção , Estados Unidos
6.
Health Care Women Int ; 38(3): 207-221, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27797654

RESUMO

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.


Assuntos
Financiamento Governamental , Gastos em Saúde , Letramento em Saúde , Mão de Obra em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , África Ocidental , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Países em Desenvolvimento , Feminino , Pessoal de Saúde , Inquéritos Epidemiológicos , Humanos , Gravidez , Adulto Jovem
7.
Prev Chronic Dis ; 12: E137, 2015 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-26312382

RESUMO

INTRODUCTION: In 2003, Barbados, a developing country with universal health care, launched the Barbados Strategic Plan for Health, a national intervention to promote public health. Teachers, health educators, and clinicians worked to improve children's health, with particular focus on asthma and diabetes. We studied this intervention by using data on preventable hospitalization, an indicator that assesses both the overall effectiveness of public health and access to primary health care. The purpose of this study was to assess the Barbados Strategic Plan for Health by measuring rates of preventable hospitalization among children. Few researchers have studied these hospitalizations for children, and only 1 study has done so in a developing country. METHODS: We calculated annual (2003-2008) population-based rates of preventable hospitalizations from birth through age 19, both summary and disease-specific, for the 5 conditions that define the indicator for children: asthma, diabetes, gastroenteritis, urinary tract infection, and perforated appendix. RESULTS: Across the 6 years, the population rates of preventable hospitalizations increased 115.4% for boys and 67.2% for girls (both P < .001). Asthma accounted for much of the increase. Regression analysis indicated that the average annual increase in asthma hospitalization for boys was 0.45 per 1,000, an average annual increase of 20.6% of the baseline rate. These results suggest generally increasing rates of hospitalization for asthma for boys. There was no evidence of a corresponding rate trend for girls. CONCLUSION: Results suggest an opportunity to improve public health education and access to primary health care. Public health professionals in developing countries can use the approaches of this study to evaluate initiatives to improve child health.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doença Crônica/prevenção & controle , Acessibilidade aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Saúde Pública/métodos , Adolescente , Assistência Ambulatorial/tendências , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/prevenção & controle , Barbados/epidemiologia , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Doença Crônica/epidemiologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Indicadores Básicos de Saúde , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Indicadores de Qualidade em Assistência à Saúde/normas , Análise de Regressão , Risco , Fatores Sexuais , Estados Unidos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Adulto Jovem
8.
J Women Aging ; 27(4): 273-89, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25651165

RESUMO

We evaluated access to primary health care for older women and men in Barbados, a developing country, using a widely accepted access indicator, hospitalization for ambulatory care sensitive conditions. Using 2003-2008 data, we calculated gender-specific total annual population-based rates of these hospitalizations per 1,000 older women and men and individual rates for the six most prevalent conditions. Across the 6 years, these hospitalizations increased 33.6% for women, 30.6% for men (both P < .0001). However, the average rate for diabetes fell 32% for women, 36% for men. Findings suggest an opportunity to improve access to primary health care, particularly for older women.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Barbados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo
9.
Birth ; 41(1): 93-9, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24654641

RESUMO

BACKGROUND: Two-thirds of reproductive-aged women in the United States are overweight or obese and at risk for numerous associated adverse pregnancy outcomes. This study examined whether the amount of weight gained during pregnancy modifies the prepregnancy body mass index (BMI)-cesarean delivery association. METHODS: A total of 2,157 women aged 18-45 who participated in the 2008-2009 North Carolina Pregnancy Risk Assessment Monitoring System had complete information on prepregnancy BMI, maternal weight gain, and mode of delivery on infant birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95 percent confidence intervals (CIs) to model the association between prepregnancy BMI and cesarean delivery, and a stratified analysis was conducted to determine whether maternal weight gain was an effect modifier of the prepregnancy BMI-cesarean delivery association. RESULTS: Obese women had 1.78 times the odds of cesarean delivery as compared with women with a normal BMI (95% CI: 1.44-2.16). When adjusted for race/ethnicity, live birth order, household income, and education, the association increased in magnitude and remained statistically significant (OR = 2.01, 95% CI: 1.63-2.43). In stratified analyses, the obesity-cesarean delivery association persisted and remained statistically significant among all maternal weight gain categories. CONCLUSIONS: Health care practitioners should stress the importance of achieving a healthy prepregnancy weight and gaining an appropriate amount of weight during pregnancy to reduce the risk of cesarean delivery and other adverse pregnancy outcomes.


Assuntos
Cesárea/estatística & dados numéricos , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Aumento de Peso , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Modificador do Efeito Epidemiológico , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Fatores de Risco , Adulto Jovem
10.
J Racial Ethn Health Disparities ; 11(2): 874-884, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36952122

RESUMO

BACKGROUND: Racially and ethnically marginalized US women experience unintended pregnancy at twice the rate of White women. Understanding contraceptive attitudes can help identify women at increased risk of contraceptive non-use and unintended pregnancy. We assessed the contraceptive attitudes of US-born and foreign-born Black women and examined differences by nativity. METHODS: We used an electronic survey, implemented by Lucid LLC, a consumer research firm, to collect cross-sectional data from 657 reproductive-aged women. Analysis was limited to 414 Black women aged 18-44 years. The exposure variable was nativity (US-born or foreign-born), and the outcome variable was cumulative score on the 32-item Contraceptive Attitude Scale (CAS). Analysis included multivariable linear regression, adjusted for confounders. We also estimated separate models, stratified by nativity to identify predictors of contraceptive attitude among US-born Black women and foreign-born Black women, respectively. RESULTS: Three in four participants were US-born (76.6%). The average cumulative CAS score was 118.4 ±20.4 out of 160 indicating favorable contraceptive attitudes. In pooled analysis, foreign-born Black women had significantly lower contraceptive attitude scores compared to US-born women (adjusted regression coefficient (ß)= -6.48, p=0.036). In nativity-stratified analysis, income, education, and perceived control over pregnancy timing were significant predictors of contraceptive attitudes for both US-born and foreign-born women. Other significant predictors of contraceptive attitude among US-born women were older maternal age, multi-parity, and perceived pregnancy risk; whereas, for foreign-born women, other significant predictors included marital status (married/cohabiting), language spoken predominantly at home (French), and perceived ability to have a baby and still achieve life goals (agree, neither agree nor disagree). CONCLUSION: In addressing the contraceptive needs of Black women, it is important to recognize the differences in attitudes towards contraception by nativity and provide culturally sensitive information and education.


Assuntos
Anticoncepção , Anticoncepcionais , Gravidez , Feminino , Humanos , Estados Unidos , Adulto , Estudos Transversais , Gravidez não Planejada , Conhecimentos, Atitudes e Prática em Saúde
11.
Prev Med Rep ; 44: 102785, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39006187

RESUMO

Objective: The Exercise is Medicine® On Campus (EIM-OC) international campaign leverages university resources (e.g., health centers, recreation, and kinesiology departments) to encourage students, faculty, and staff to integrate physical activity into campus culture. This involves evaluating student physical activity levels during health visits and establishing referral systems for exercise prescriptions. EIM-OC allows universities to earn tiered recognition (Gold, Silver, or Bronze) based on their on-campus physical activity promotion and integration. For Gold recognition, schools must incorporate routine physical activity assessments into their health system, ultimately connecting healthcare providers with health/fitness professionals (HFPs, e.g., campus recreation professionals, kinesiology professors). This research worked to uncover pivotal factors driving EIM-OC on-campus collaborations through HFPs' perspectives. Methods: HFPs (n = 11) working full-time at a Gold-level institution (n = 10 in United States) participated. Semi-structured, Zoom-recorded interviews with a generic qualitative research design were completed between June and September 2022. Results: Major thematic findings included the importance of tangible support (e.g., personnel), encounters with both trust and tension cross-campus, positive student development opportunities, and variations in outcome reporting and program evaluation. Faculty and staff emphasized the need for methods to obtain and sustain program funding. Participants also expressed the importance of interdisciplinary collaboration to increase the collective impact of EIM-OC on student health and overall collegiate success. Conclusion: HFPs expanded on their EIM-OC experiences and program sustainment or growth requirements. With increased interdisciplinary collaboration, rigor in outcome reporting, and tangible resources, the collective impact of EIM-OC on student health outcomes and overall collegiate success could be greatly perpetuated.

12.
J Community Health ; 37(1): 15-24, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21547409

RESUMO

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08-1.39), not smoking (PR = 1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.


Assuntos
Negro ou Afro-Americano/psicologia , Hipertensão/etnologia , Cooperação do Paciente/etnologia , Autocuidado/métodos , Autoeficácia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Adulto Jovem
13.
Matern Child Health J ; 16(6): 1232-40, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21750894

RESUMO

The objective of this study is to examine the relationship between a vulnerable child's family composition (family size and primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using 2006-2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424 children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals to examine the relationship between family composition measures and child well-being. Multivariate results were also stratified by orphan status. Vulnerable children who live in household sizes of 4-6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95% CI: 1.13-2.01, OR = 9.02, 95% CI: 4.62-17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19, 95% CI 0.07-0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related to childhood immunization education and intervention programs. The findings also underscore the need for policies which support families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development designed to meet needs of vulnerable children.


Assuntos
Proteção da Criança/estatística & dados numéricos , Crianças Órfãs , Características da Família , Abastecimento de Alimentos , Programas de Imunização/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Cuidadores , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Quênia , Modelos Logísticos , Masculino , Áreas de Pobreza , População Urbana
14.
Matern Child Health J ; 15(4): 497-506, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20428934

RESUMO

This study examined the association between contraceptive method and satisfaction and discontinuation. Few studies have examined these issues in the university setting and how they may potentially impact unintended pregnancy rates. This study examined data from 172 college women aged 18-36 years enrolled in the Study on Contraceptive Knowledge in Students, a cross-sectional study conducted at a large, public university. Logistic regression was used to model the association between current type of contraceptive method used (non-coital dependent vs. coital dependent) and satisfaction as well as previous type of contraceptive method used and discontinuation of that method. Nearly 80% of contracepting women currently used a non-coital dependent method. After adjustment for age, race, and location where contraception was obtained, current non-coital dependent users were significantly more likely to be satisfied with their contraceptive method compared to women using coital dependent methods (OR = 4.73, 95% CI: 1.64, 13.63). After adjustment for age, race, and history of pregnancy, women who used non-coital dependent methods of contraception were 91% less likely to have discontinued their method compared to women who used coital dependent methods (OR = 0.09, 95% CI: 0.04, 0.20). Healthcare workers and public health professionals can counsel women on using contraceptive methods that best suit their needs. By doing so, patient satisfaction and consistent contraceptive use may improve and lead to a decrease in unintended pregnancies.


Assuntos
Comportamento do Consumidor , Anticoncepção/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/classificação , Estudos Transversais , Feminino , Humanos , North Carolina , Adulto Jovem
15.
Womens Health Issues ; 31(1): 49-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32972809

RESUMO

INTRODUCTION: Although previous studies have found a relationship between having a preterm birth and maternal depression, methodologic issues may have limited the generalizability of results. Thus, the purpose of this study was to evaluate the relationship between having a preterm birth and postpartum depressive symptoms using a large, population-based sample of U.S. women. METHODS: This secondary data analysis used 2012-2014 U.S. Pregnancy Risk Assessment Monitoring System data (N = 89,366). Data on the exposure, preterm birth, were obtained from birth certificates. Infants born at 32 to less than 37 weeks' gestation were considered moderate to late preterm, infants born at 28 to less than 32 full weeks' gestation were considered very preterm, and infant born at less than 28 full weeks' gestation were considered extremely preterm. To assess the outcome, two Pregnancy Risk Assessment Monitoring System questions measuring postpartum depressive symptoms were used. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: After adjustment for confounders, the relationship between having a preterm birth and maternal hopelessness was statistically significant for those who had very preterm and extremely preterm births (moderate to late preterm OR, 1.19; 95% CI, 1.00-1.42; very preterm OR, 1.28; 95% CI, 1.04-1.58; extremely preterm OR, 1.81; 95% CI, 1.31-2.49). In addition, after adjustment, findings indicated no association between preterm birth and maternal loss of interest (extremely preterm OR, 0.85 95% CI, 0.60-1.19; very preterm OR, 1.04; 95% CI, 0.86-1.26; preterm OR, 0.95; 95% CI, 0.82-1.10). CONCLUSIONS: Given the statistically significant increased association between having a preterm birth and postpartum depressive symptoms, health professionals may consider implementing comprehensive screening for depression and other mental illnesses among women who give birth prematurely. Findings may also inform future interventions to emphasize the importance of postpartum care among women who have experienced preterm birth.


Assuntos
Nascimento Prematuro , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Saúde Mental , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Medição de Risco
16.
Birth ; 37(3): 202-10, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20887536

RESUMO

BACKGROUND: Hypertensive complications during pregnancy occur in nearly 8 percent of pregnancies and account for 15 percent of all maternal mortalities in the United States. The purpose of this study was to investigate further the association between physical activity and hypertensive complications during pregnancy using data from a population-based surveillance system. METHODS: This study included 3,348 participants from the 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System. Hypertensive complications during pregnancy were assessed using birth certificate data, and physical activity levels before pregnancy and during pregnancy were self-reported on questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders. RESULTS: Although no strong association was found between physical activity before pregnancy and hypertensive complications during pregnancy, a dose-response relationship emerged for the physical activity during pregnancy-hypertensive complications association after adjustment for prepregnancy body mass index (physical activity for 1-4 days per week: OR=0.63, 95% CI: 0.45-0.90; physical activity for 5+ days per week: OR=0.46, 95% CI: 0.20-1.02). When levels of physical activity before and during pregnancy were combined, a statistically significant protective effect was seen only for women who indicated that they were physically active both before and during pregnancy (adjusted OR=0.65, 95% CI: 0.44-0.96). CONCLUSIONS: In this population-based study, physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy. During a healthy pregnancy, health care practitioners may recommend that women engage in physical activity as one way to potentially prevent the development of this critical condition.


Assuntos
Exercício Físico , Hipertensão Induzida pela Gravidez , Vigilância da População , Adolescente , Adulto , Índice de Massa Corporal , Intervalos de Confiança , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Modelos Logísticos , Pessoa de Meia-Idade , Monitorização Fisiológica/estatística & dados numéricos , North Carolina/epidemiologia , Razão de Chances , Gravidez , Medição de Risco/estatística & dados numéricos , Inquéritos e Questionários
17.
Matern Child Health J ; 13(4): 497-504, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18478321

RESUMO

OBJECTIVES: Although nicotine replacement therapies (NRT) may assist with smoking cessation, little is known about the safety of NRT use during pregnancy. Our purpose was two-fold: to determine characteristics of women prescribed or recommended NRT during pregnancy and to investigate whether NRT prescription/recommendation was associated with adverse pregnancy outcomes using data from the 2004 Pregnancy Risk Assessment Monitoring System. METHODS: Smoking and NRT referral was self-reported by 5,716 women. Information on pregnancy outcomes was obtained from birth certificates. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Smokers <35 years of age and of Hispanic, Non-Hispanic Black, and Asian/Pacific Islander race/ethnicity were less likely to be prescribed or recommended NRT during pregnancy. After adjustment for age, marital status, education, and race/ethnicity, women recommended NRT had twice the risk of low birthweight as compared to nonsmokers (OR = 1.95, 95% CI: 1.10, 3.46) while smokers had 1.31 times the risk of low birthweight (95% CI: 0.92, 1.87). Results for preterm birth were similar after adjustment for the same confounding variables (NRT: OR = 2.04, 95% CI: 1.14, 3.63 and smoking: OR = 1.09, 95% CI: 0.74, 1.61). CONCLUSIONS: Risks of low birthweight and preterm birth were highest for women prescribed or recommended NRT. These findings may be related to frequency of maternal smoking. While heavier smokers may be more likely to be recommended NRT, they also may have the most difficulty with cessation. Greater efforts should be made to ensure that these women do successfully cease smoking.


Assuntos
Nicotina/uso terapêutico , Agonistas Nicotínicos/uso terapêutico , Resultado da Gravidez , Tabagismo/tratamento farmacológico , Adolescente , Adulto , Feminino , Humanos , Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Razão de Chances , Gravidez , Prevenção do Hábito de Fumar , Inquéritos e Questionários , Adulto Jovem
18.
J Community Health ; 34(5): 376-82, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19517221

RESUMO

There is growing evidence that environmental tobacco smoke (ETS) exposure may negatively affect birth outcomes, especially birth weight. This study evaluates the effect of residential ETS exposure on the risk of having a low birth weight (LBW) infant and investigates whether there is a dose-response relationship. This retrospective cohort study comprised 2,206 women who participated in the 2004-2005 North Carolina Phase V Pregnancy Risk Assessment Monitoring System. Women self-reported information on ETS exposure and birth weight was obtained from birth certificates. Logistic regression was used to obtain odds ratios and 95% confidence intervals. When adjusted for marital status and income, women exposed to ETS during pregnancy had increased odds of delivering a LBW baby (OR = 1.29, 95% CI: 1.06, 1.57). After adjustment for the same covariates, a weak dose-response relationship between ETS and LBW was found (OR = 1.28, 95% CI: 1.03, 1.60 for women who were exposed to ETS generated by one cigarette smoker; OR = 1.31, 95% CI: 0.96, 1.31 for those who were exposed to ETS generated by two or more cigarette smokers). This study provides evidence of the adverse effect of residential ETS on pregnancy outcomes. The observed relationship emphasizes the health hazard that ETS exposure in the home poses to pregnant women and their unborn babies. Educational anti-tobacco campaigns and quit smoking initiatives should target both mothers and fathers to ensure smoke-free living conditions and a healthy environment for all family members.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Exposição Ambiental/efeitos adversos , Recém-Nascido de Baixo Peso , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Peso ao Nascer/efeitos dos fármacos , Intervalos de Confiança , Feminino , Humanos , Lactente , Bem-Estar do Lactente , Recém-Nascido , Modelos Logísticos , Masculino , North Carolina/epidemiologia , Razão de Chances , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Inquéritos e Questionários
19.
Artigo em Inglês | MEDLINE | ID: mdl-30088860

RESUMO

INTRODUCTION: Most studies evaluating the effect of group prenatal care on maternal and neonatal health outcomes assess the CenteringPregnancy model, which follows a set structure and educational curriculum. Group prenatal visits (GPVs) bring together pregnant patients for visits that include education and a health evaluation. GPVs represent a more flexible method of delivering group prenatal care, compared with CenteringPregnancy. Our study sought to determine whether GPV participation affects maternal and neonatal health outcomes. METHODS: The Myers Park Obstetrics and Gynecology Clinic is located in Charlotte, North Carolina, and serves a racially, ethnically, and socioeconomically diverse population. GPVs were offered at the clinic between July 2014 and July 2015. Retrospective data were collected for women who obtained prenatal care, either GPV or individual care, during that period. Demographic, birth, and postpartum data were extracted from the electronic health record. GPV participants were categorized by the percent of prenatal visits that were GPVs (limited GPV: <30% of visits as GPV; moderate GPV: ≥30% of visits as GPV). Logistic regression models were created to assess the effect of GPV participation on low birth weight, preterm birth, cesarean birth, and postpartum visit attendance. RESULTS: There were 355 study participants (GPV n = 78, individual care n = 277). Among GPV participants, 52.6% were classified as limited GPV, and 47.4% were classified as moderate GPV. The adjusted analysis showed limited-GPV patients had lower odds of postpartum visit attendance, compared with individual-care patients (odds ratio, 0.48; 95% CI, 0.24-0.94). Neither the unadjusted nor adjusted models demonstrated a statistically significant association between GPV participation and low birth weight, preterm birth, or cesarean birth. DISCUSSION: GPVs for prenatal care can be implemented without negative effects on maternal or neonatal health. However, fidelity to a more comprehensive model of group prenatal care may be necessary to achieve health outcome improvements.

20.
J Midwifery Womens Health ; 63(4): 436-445, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29800502

RESUMO

INTRODUCTION: Although the definition of a short interbirth interval has been inconsistent in the literature, Healthy People 2020 recommends that women wait at least 18 months after a live birth before attempting their next pregnancy. In the United States, approximately 33% of pregnancies are conceived within 18 months of a previous birth. Pregnancies that result from short interbirth intervals can pose serious risks. The objective of this study was to determine the association between interbirth interval and understudied pregnancy complications and outcomes, including small for gestational age (SGA) infants, premature rupture of membranes (PROM), preterm PROM (PPROM), placenta previa, and gestational diabetes, using Pregnancy Risk Assessment and Monitoring System data from Mississippi and Tennessee. METHODS: This study collected self-reported information from 2212 women on interbirth interval (≤18 months, ie, short; 19-35 months, ie, intermediate; and ≥36 months, ie, long; referent), PPROM, placenta previa, and gestational diabetes. SGA and PROM data were obtained from birth certificates. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs. RESULTS: After adjustment, there were no strong associations between interbirth interval and PPROM, gestational diabetes, or SGA infants. However, women with shorter intervals had increased odds of PROM (short: OR, 3.54; 95% CI, 1.22-10.23 and intermediate: OR, 4.09; 95% CI, 1.28-13.03) and placenta previa (short: OR, 2.58; 95% CI, 1.10-6.05 and intermediate: OR, 1.69; 95% CI, 0.94-3.05). DISCUSSION: The study's findings provide further support for encouraging women to space their pregnancies appropriately. Moreover, findings underscore the need to provide women with family planning services so that closely spaced pregnancies and unintended pregnancies can be avoided. Additional studies of the role of interbirth interval on these understudied pregnancy complications and outcomes are warranted.


Assuntos
Serviços de Planejamento Familiar , Fertilização , Paridade , Complicações na Gravidez , Resultado da Gravidez , Adolescente , Adulto , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Recém-Nascido , Modelos Logísticos , Placenta Prévia , Gravidez , Nascimento Prematuro , Medição de Risco , Fatores de Risco , Tennessee , Fatores de Tempo , Adulto Jovem
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