Maternal and Child Health Commons^™

Experiences And Satisfaction Of High-Risk Mothers Who Gave Birth In Select Facilities In Legazpi City, Philippines, Maria Stephanie Fay S. Cagayan, Veincent Christian F. Pepito, Rita Mae Ang-Bon, Erlidia F. Llamas-Clark

Ateneo School of Medicine and Public Health Publications

Among the interventions implemented to curb maternal mortality in the Philippines, service delivery networks (SDNs) have been one of the most important. However, due to their recent implementation, frameworks to assess the quality of care they provide have not yet been established. To address this need, we had formulated the Integrated Patient-Centered Health Service Framework and used it to explore the satisfaction of mothers who gave birth in select facilities Legazpi City Philippines. We conducted key-informant interviews with 14 mothers. We found out that they were satisfied with the quality of care during pre-pregnancy, pregnancy, and post-partum; however, the quality …

Maternal Viral Load Monitoring: Coverage And Clinical Action At 4 Kenyan Hospitals., Matthew Sandbulte, Melinda Brown, Catherine Wexler, May Maloba, Brad Gautney, Kathy Goggin, Elizabeth Muchoki, Shadrack Babu, Nicodemus Maosa, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Kenya's guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women.

METHOD: We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result.

RESULTS: Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for …

Socioeconomic Status And Symptoms Of Anxiety And Depression In Pregnant Women, Meagan Mandabach

Honors Theses

Pregnancy is a period of great change in a woman’s body as her baby develops. During this period, women commonly experience symptoms of anxiety (Dennis et al., 2017) and depression (Shidhaye & Giri, 2014). Literature has suggested that socioeconomic status (SES) can contribute to the severity at which pregnant women experience anxiety and depression (Arora & Aeri, 2019; Field et al., 2008; Shagufta & Shams, 2019), and women of low socioeconomic status may be more likely to experience symptoms of anxiety and depression during pregnancy (Field et al., 2008). The present study aimed to assess the relationships between household income …

An Examination Of The Association Between State Medicaid Perinatal Services And Birth Outcomes, Joy Morgan Myers

Honors Theses

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded …

Reflection And Literature Review On Loving Choices Pregnancy Center Internship, Madison Stave

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This honors thesis involves a personal reflection and literature review of a nurse internship at Loving Choices Pregnancy Center in Fayetteville, AR. The purpose of this internship was to provide a learning experience in women’s and obstetrical health. Responsibilities included completing community resource projects and assisting staff and nurses in the Care Center and Pregnancy Clinic. To satisfy honors requirements, five learning objectives were created during the internship. These objectives were all met and reflected upon in the first part of this thesis. The second portion of this thesis involves a literature review of the socioeconomic and health-related risks of …

Description Of The Attitudes, Knowledge And Beliefs On Marijuana In Undergraduate Students Compared To Nursing Undergraduate Students, Maifrak Sobrino

Honors Scholar Theses

Introduction: The use of marijuana has drastically increased over the years. Not only is marijuana being used to treat personal symptoms, but some women use marijuana to manage pregnancy-related symptoms.

Objective: To discover the knowledge, attitudes, and beliefs of marijuana in the undergraduate student population at the University of Connecticut.

Method: A cross sectional study conducted through Qualtrics using a 15-questions survey, including 5-point Likert scale questions and 5 yes/no questions.

Result: Forty-nine non-nursing students completed the survey. Non-nursing students in comparison to the population as a whole agreed that marijuana use was okay (M = 3.959, SD = …

Attitudes, Knowledge And Beliefs On Marijuana Use In Pregnant Women In Undergraduate Nursing Students, Jordyn Witkins

Honors Scholar Theses

Introduction: Due to the decriminalization of marijuana use by states in the United States, marijuana use has drastically increased in the general populations and in women who are pregnant. During prenatal care, nurses provide education about pregnancy and fetal development.

Objective: This study explore the attitudes, knowledge and beliefs of undergraduate nursing students on marijuana use for individuals and during pregnancy.

Method: The study design was cross-sectional survey with 15-question survey using Likert scale and yes/no questions. Nursing students and non-nursing undergraduate students responses were compared.

Results: Sixty-four nursing students (female, n=50) completed the survey. Nursing students in comparison to …

Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Over the past 30 years, medical interventions in pregnancy and childbirth have increased. Some pregnant women seek less invasive and nonpharmacological options to manage discomforts during labor. While exercise during pregnancy is recommended, less is known about exercise, specifically dancing, during labor. While anecdotal evidence is supportive, little is known about the implications of exercise and dance during the first stage of labor for pain reduction and labor progression. Some movements common in dance, such as expanding hip circles that loosen and relax muscles of the pelvic floor, may be beneficial to women during labor. Available evidence suggests that dancing …

Polybrominated Diphenyl Ether (Pbde) And Poly- And Perfluoroalkyl Substance (Pfas) Exposures During Pregnancy And Maternal Depression, Ann M. Vuong, Kimberly Yolton, Joseph M. Braun, Andreas Sjodin, Antonia M. Calafat, Yingying Xu, Kim N. Dietrich, Bruce P. Lanphear, Aimin Chen

Environmental & Global Health Faculty Research

Background: Experimental studies in rodents suggest that polybrominated diphenyl ethers (PBDEs) and poly- and perfluoroalkyl substances (PFAS) may contribute to depressive symptoms. Few studies have examined the impact of these chemicals on depression in adults. Objective: To examine the associations between serum PBDE and PFAS concentrations during pregnancy and repeated measures of depressive symptoms in women assessed from pregnancy to 8 years postpartum. Methods: This study was based on 377 women from the Health Outcomes and Measures of the Environment Study, a birth cohort in Cincinnati, OH (USA). PBDEs (BDE-28, -47, -99, -100, -153, and ∑PBDEs) and PFAS (perfluorooctanoate [PFOA], …

Is Physical Activity During Late Pregnancy Related To Infant Body Composition At Birth?, Brenna Menke

Masters Theses & Specialist Projects

Exercise is typically regarded as having a positive impact on maternal and infant health. However, the relationship between maternal physical activity and infant body composition is unclear. The aim of this project was to determine how a physically active lifestyle during late pregnancy influences infant anthropometrics at birth. Pregnant women (34-39 weeks gestation) with low-risk pregnancies were given the Pregnancy Physical Activity Questionnaire (PPAQ) and an accelerometer to wear on their non-dominant wrist for seven consecutive days. Approximately 24-48 hours after delivery, infant body composition was assessed utilizing air displacement plethysmography at the patients’ bedside. Fifty-five pregnant women participated (age: …

Characterization Of Urinary Concentrations Of Heavy Metals Among Socioeconomically Disadvantaged Black Pregnant Women, Inkyu Han, Kristina W Whitworth, Xueying Zhang, Masoud Afshar, Pamela D Berens, Elaine Symanski

Faculty, Staff and Student Publications

The objective of this study was to characterize exposures to metals using biological samples collected on socioeconomically disadvantaged black pregnant women. We obtained 131 anonymous urine samples provided by black pregnant women visiting a Medicaid-serving prenatal clinic in Houston, TX, from March 27, 2017 to April 11, 2017. We analyzed urine samples for 15 metals including cadmium (Cd), arsenic (As), lead (Pb), and nickel (Ni) and for creatinine and cotinine. We found that median concentrations of zinc (Zn), selenium (Se), and aluminum (Al) among black pregnant women in this study were 1.5 to 3 times higher than levels reported among …

Medicaid Home Visitation And Maternal And Infant Care And Health: A Reassessment Of Program Effectiveness, Cristian Meghea, Zhiying You, Jennifer E. Raffo, Lee Anne Roman

Michigan Journal of Public Health

Introduction: The Maternal Infant Health Program, MIHP, is Michigan's largest home visiting program for Medicaid-eligible pregnant women and infants. Prior quasi-experimental propensity score matched MIHP evaluations were limited by the possibility of selection bias due to the limited available baseline characteristics. The purpose of this study was to assess the effectiveness of MIHP including previously unobserved baseline characteristics to mitigate the possibility of selection bias.

Methods: We analyzed health care and outcomes of mothers and their infants using linked administrative and screening data. All Medicaid pregnant women with a singleton birth in Michigan between 2009 and 2012 who were prenatally …

Prenatal Perception Of Wic Breastfeeding Recommendation Affects First Month Postpartum Breastfeeding Outcomes, Qi Zhang, Lamichhane Rajan, Joanne Guthrie

Community & Environmental Health Faculty Publications

No abstract provided.

The Experience Of Intimate Partner Violence Among Pregnant Women Seeking Treatment For Opioid Use Disorder, Julia Dewey, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Intimate partner violence (IPV) is a major health issue among those with substance use disorder. A history of partner violence is associated with increased health problems and less improvement in treatment. The perinatal period is a time of increased risk of IPV for women, as well as a key opportunity for opioid use disorder treatment intervention. The purpose of this study is to characterize the experience of partner violence and evaluate the typology of sequelae associated with it in a population of pregnant women seeking medication assisted treatment for opioid use disorder.

Methods: The population of interest in this …

Identifying Protective Factors In Response To Discriminatory Experiences Among Pregnant African American Woman, Effie Mathew, Krys Foster, Md

Phase 1

Adverse maternal-fetal health outcomes, such as low birth weight and preterm delivery, are disproportionately more likely among African-Americans than Non-Hispanic Whites. Experiences of discrimination have been hypothesized as a contributing factor to the large discrepancies in maternal-fetal health outcomes. It is well understood that with increased levels of self-reported discrimination, there are lower ratings of physical and mental health, and higher reporting rates of depressive symptoms; this relationship is stronger in women. In addition to this, skin tone has long been a marker for social class and opportunity, but research on skin tone as a risk factor for African Americans …

A Needs Assessment Of Screening Of Non-Communicable Diseases In Prenatal Care At Chuk And Muhima District Hospital, Vaishali Mehta, Ilana Porges, Kaitlin Demarest, Alex Rugamba, Kelly Kaneza, Magnifique Irakoze, Md

Phase 1

Introduction: There has been a recent trend of women experiencing delays in management for high-risk pregnancies in Kigali, Rwanda. Physicians at the University Teaching Hospital of Kigali (CHUK) have observed a high incidence of women receiving obstetric care that were not screened appropriately. This points to an inconsistent screening method for non-communicable diseases (NCDs) prior to delivery and lack of streamlined care. The objective of this study is to assess the need for more robust screening of maternal NCDs.

Methods: This study, between June 2018-19, is a needs-assessment for the screening of NCDs among pregnant women (n=255) at CHUK. It …

Examining The Associations Between Addiction Severity And Prior Adverse Childhood Experiences In Pregnant Women Receiving Treatment For Opioid Addiction, Julia Gong, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Opioid use during pregnancy poses risk to both the mother and fetus, including fetal loss and pre-term birth. Prior research suggests that adverse childhood experiences (ACEs) are a plausible antecedent to opioid abuse. However, there is insufficient understanding of the association between prior ACEs, familial history of substance use, and treatment outcomes in pregnant women receiving treatment for opioid addiction.

Methods: A retrospective chart review will be used to review data from 167 MATER patients who entered treatment between 1997 and 2017. Descriptive statistics will be utilized to characterize the study population. Regression and chi-square analyses will be conducted …

Cost-Effectiveness Of A Mobile Health-Supported Lifestyle Intervention For Pregnant Women With An Elevated Body Mass Index, Elizabeth O'Sullivan, Salwa Rokicki, Maria Kennelly, Kate Ainscough, Fionnuala M. Mcauliffe

Articles

Objective To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care.

Methods We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost‐effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG …

Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial, Kristine Alaniz, Bruce Christiansen, Tingting Sullivan, Lisette Khalil, Michael C. Fiore

Journal of Patient-Centered Research and Reviews

Purpose: Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women.

Methods: Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus …

Neonatal Abstinence Syndrome From Selective Serotonin Reuptake Inhibitor Use During Pregnancy, Elizabeth Kramer, Maria Patnella, Rachel Bulko, Allie Harrison, Hannah Lamb, Manoranjan D'Souza

Pharmacy and Wellness Review

Neonatal abstinence syndrome (NAS) is a concern for infants born to mothers receiving treatment with a selective serotonin reuptake inhibitor (SSRI) throughout the pregnancy. The risk of NAS associated with SSRI use during pregnancy varies with the specific SSRI that is used by the patient during pregnancy. Common symptoms of NAS include premature delivery, gastrointestinal disturbances, irritability, low birth weight, short length and lack of response to various stimuli. Neonates that present with these symptoms can be scored using either the Finnegan or Lipsitz scoring tools. Neonates experiencing NAS can be calmed or treated using nonpharmacologic methods such as swaddling, …

Centeringpregnancy: Perceptions Of Providers And Staff In A Private Ob Practice, Allison F. Mills

Doctoral Dissertations and Projects

Traditional prenatal care has been the stalwart of care in the United States since the 1920s; however, a new model of care is emerging: group-style prenatal care. This model of care has been well-documented within literature as having notable maternal and fetal outcomes, including increased patient satisfaction, decreased preterm birth rates, increased breastfeeding rates, and increased patient compliance, to name only a few. With such remarkable outcomes, it begs the question of why the group prenatal care model is not more widely utilized. This project aimed to determine if increasing the knowledge of healthcare providers in a private obstetrics practice …

Why Doula Services Should Become An Essential Health Benefit In New York State, Jalisha Hanshaw, Amy White

Publications and Research

Doulas are birth workers who assist expecting mothers through pregnancy, birth and postpartum using holistic techniques. Techniques include: prenatal yoga, birth affirmations and induction acupuncture. Doulas are underrated healthcare providers who deserve the same respect as clinical and non-clinical providers. Doulas are well-rounded alternative care providers who focus on mental, emotional, and physical well being of mothers. Also, they know special alternative medical techniques that prevent mothers from maternal mortality among other negative health outcomes. The amount of time and effort doulas perform with expecting mothers are equal or more than the average medical healthcare provider and should be a …

Nutrient And Food Group Intakes Of Low-Income Pregnant Women By Race/Ethnicity, Alla M. Hill, Danielle L. Nunnery Phd, Rdn, Ldn, Alice Ammerman Drph, Jigna M. Dharod Phd

Journal of Health Disparities Research and Practice

In an exploratory study, a convenience sample of 148 pregnant women was recruited from a WIC clinic in the southeast region of the U.S. to: 1) Examine and compare daily nutrient and food group intakes of WIC pregnant women to national guidelines, and; 2) Determine racial/ethnic differences in nutrient and food group intakes among WIC pregnant women. Women were selected for the study if they were: ≥ 18 y, in 2^nd trimester of pregnancy, and if they spoke English or Spanish as a first language. Upon recruitment, participants were interviewed to collect information on their socio-demographics, including race/ethnicity. Additionally, …

A Qualitative Metasynthesis Of Published Research Exploring The Pregnancy And Resettlement Experience Among Refugee Women, Diana M. Kingsbury, Sheryl L. Chatfield

The Qualitative Report

The number of refugees and asylum seekers throughout the world continues to increase, leading to increasing challenges in meeting healthcare needs of these individuals. Women’s antenatal health is of particular concern due to their vulnerability to sexual violence and the substantial proportion of refugees consisting of women and girls of or nearing reproductive age. The purpose of this qualitative metasynthesis was to integrate and interpret findings from previously published research reports in which authors explored aspects of pregnancy among resettled refugee women. Following a systematic search process, we used Dedoose qualitative data analysis software to manage the process of extracting …

A Multicountry Randomized Controlled Trial Of Comprehensive Maternal Nutrition Supplementation Initiated Before Conception: The Women First Trial., K. Michael Hambidge, Jamie E. Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S. Goudar, Sangappa M. Dhaded, Omrana Pasha, Sumera A. Ali, Antoinette Tshefu, Adrien Lokangaka, Richard J. Derman, Robert L. Goldenberg, Carl L. Bose, Melissa Bauserman, Marion Koso-Thomas, Vanessa R. Thorsten, Amaanti Sridhar, Kristen Stolka, Abhik Das, Elizabeth M. Mcclure, Nancy F. Krebs

Global Health Articles

Background: Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited.

Objectives: This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3).

Methods: Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was(DRC), Guatemala, India, and …

Prenatal Risk For Autism Spectrum Disorder (Asd): Fetal Cortisol Exposure Predicts Child Asd Symptoms, Sheena Ram, Mariann A. Howland, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

The etiology of autism spectrum disorder (ASD) is multifactorial, complex, and likely involves interactions among genetic, epigenetic, and environmental factors. With respect to environmental influences, a growing literature implicates intrauterine experiences in the origin of this pervasive developmental disorder. In this prospective longitudinal study, we examined the hypothesis that fetal exposure to maternal cortisol may confer ASD risk. In addition, because ASD is four times more prevalent in males than in females, and because sexually dimorphic responses to intrauterine experiences are commonly observed, we examined whether or not any associations differ by fetal sex. Maternal plasma cortisol was measured at …

Prenatal Risk For Asd: Fetal Cortisol Exposure Predicts Child Autism-Spectrum-Disorder Symptoms, Sheena Ram, Mariann A. Howland, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

The etiology of autism spectrum disorder (ASD) is multifactorial, complex, and likely involves interactions among genetic, epigenetic, and environmental factors. With respect to environmental influences, a growing literature implicates intrauterine experiences in the origin of this pervasive developmental disorder. In this prospective longitudinal study, we examined the hypothesis that fetal exposure to maternal cortisol may confer ASD risk. In addition, because ASD is four times more prevalent in males than in females, and because sexually dimorphic responses to intrauterine experiences are commonly observed, we examined whether or not any associations differ by fetal sex. Maternal plasma cortisol was measured at …

Women Are Being Cut During Childbirth Without Need Or Consent, Molly Cora Enking

Capstones

An episiotomy, a surgical cut used to enlarge the vaginal opening during childbirth, can be extremely painful, hard to recover from and can increase the risk of severe complications. In 2018, episiotomies are rarely necessary, but at some U.S. hospitals they happen much more than they should. And in the course reporting this story, New York City News Service found that it is common for doctors to cut women without the mother’s consent.

https://medium.com/@mollyenking/women-are-being-cut-during-childbirth-without-need-or-consent-7677de7eddae

Failing The Mothers Of New York City, Irene Spezzamonte, Vanessa Swales

Capstones

Between 2015 and 2011, about 4,000 women lost their lives while delivering a baby in the United States. That’s 1,000 lost lives every year.

The causes of these deaths are often preventable and are the mere result of racial discrimination. African-American mothers, for instance, have a three-time higher rate of dying than White mothers. Several investigative investigations have been conducted on the racial disparities and the lack of resources offered nationwide, but, so far, none has focused on the local level. This capstone focuses solely in New York City and the three populations that are being affected the most by …

Association Of Adverse Birth Outcomes With Maternal Exposure To Nitrate In Private Well Drinking Water: An Action Plan For Prevention, Jessyka R. Johnson

Capstone Experience: Master of Public Health

Abstract

Goal: The goal of the capstone project is to collect information required to develop an action plan focusing on minimizing exposure to nitrate in pregnant women, which, if implemented, can either prevent or reduce adverse health outcomes associated with nitrate exposure in utero.

Objective: The capstone project objective is to gain a better understanding of what programs to prevent exposure to nitrate from private well drinking water in pregnant women are already in place throughout the United States; to identify any areas of improvement in these programs; and to utilize this information to create a unique action plan in …