Maternal and Child Health Commons^™

Familial Sex Trafficking In East Tennessee, Mary K. Brannock

Electronic Theses and Dissertations

This dissertation was completed in partial fulfillment of the Doctor of Public Health program at East Tennessee State University. The dissertation follows the Manuscript Format which includes three manuscripts, these manuscripts regard familial sex trafficking and are as follows, a scoping review, an empirical study on regional familial sex trafficking, and a policy implications paper on criminal record relief for survivors of familial sex trafficking.

The scoping review includes eight peer reviewed studies on familial sex trafficking and a summary of grey literature. Thematic analysis was used to map the existing literature onto the Three Ps of human trafficking: Prevention, …

Patient Understanding Of Fetal Sex Versus Gender In The Context Of Routine Cell-Free Dna Screening, Mindy Kolodziejski

Dissertations and Theses (Open Access)

Non-invasive prenatal testing (NIPT) is the current standard of care to screen for fetal aneuploidy using cell-free DNA (cfDNA). NIPT screens for sex chromosome aneuploidies (SCAs) and in doing so, can predict fetal chromosomal sex. Despite sex and gender being distinct concepts, many patients refer to NIPT as “the gender test” and elect testing in order to find out predicted fetal sex and assume gender. Our study aimed to evaluate and describe patient understanding of sex and gender in the context of receiving routine prenatal genetics education (PGE) on NIPT. A survey was developed with the goal of assessing patient …

Challenges Beyond Addiction: Maternal Experiences With Postpartum Substance Use Disorder Recovery And Perspectives Of Reproductive Healthcare Providers, Leah Holcomb

All Dissertations

Substance use disorders (SUD) impact millions of pregnant and postpartum people in the United States. With the increasing rates of perinatal substance use and the risk of overdose and death during the postpartum period, understanding overall functioning and the needs of postpartum persons is critical for informing interventions to reduce the impact of substance use within the perinatal period. The goal of this research is to explore the needs of postpartum people navigating SUD recovery.

This dissertation investigates postpartum maternal functioning within the context of early SUD recovery, as well as the comfort of reproductive healthcare providers (RHPs) to care …

Obstacles To Optimal Antenatal Corticosteroid Administration To Eligible Patients, Kara M Rood, Lynda G Ugwu, William A Grobman, Jennifer L Bailit, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Alan T N Tita, George R Saade, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa

Faculty, Staff and Student Publications

Background

Administration of antenatal corticosteroids (ANCS) is recommended for individuals expected to deliver between 24 and 34 weeks of gestation. Properly timed administration of ANCS achieves maximal benefit. However, more than 50% of individuals receive ANCS outside the recommended window.

Objective

To examine maternal and hospital factors associated with suboptimal receipt of ANCS among individuals who deliver between 24–34 weeks gestation.

Study Design

Secondary analysis of the Assessment of Perinatal Excellence (APEX), an observational study of births to 115,502 individuals at 25 hospitals in the US from March 2008–February 2011. Data from 3123 individuals who gave birth to a non-anomalous …

Maternal Diabetes And Intrapartum Fetal Electrocardiogram, Beth A Plunkett, Steven J Weiner, George R Saade, Michael A Belfort, Sean C Blackwell, John M Thorp, Alan T N Tita, Russell S Miller, David S Mckenna, Edward K S Chien, Dwight J Rouse, Yasser Y El-Sayed, Yoram Sorokin, Steve N Caritis, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal-Fetal Medicine Units (Mfmu) Network

Faculty, Staff and Student Publications

Objective:

Fetal electrocardiogram (ECG) ST-changes are associated with fetal cardiac hypoxia. Our objective was to evaluate ST-changes by maternal diabetic status and stage of labor.

Methods:

Secondary analysis of a multi-centered randomized-controlled trial in which laboring patients with singleton gestations underwent fetal ECG scalp electrode placement and were randomly assigned to masked or unmasked ST-segment readings. Our primary outcome was the frequency of fetal ECG tracings with ST-changes by stage of labor. ECG tracings were categorized into mutually exclusive groups (ST-depression, ST-elevation without ST-depression or no ST-changes). We compared participants with pre-gestational diabetes mellitus (DM), gestational DM (GDM), and no …

A Mixed-Methods Study To Investigate Feasibility And Acceptability Of An Early Warning Score For Preterm Infants In Neonatal Units In Kenya: Results Of The News-K Study, Eleanor Mitchell, Jalemba Aluvaala, Lucy Bradshaw, Jane Daniels, Caren Emadau, Bernadine Muthumbi, Helen Nabwera, Ednah Ojee, Jacqueline Opira, Phoebe Pallotti

Centre of Excellence in Women and Child Health

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants’ vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.

Socioecological Factors Associated With The Timing Of Prenatal Care Initiation In Kentucky And Beyond: An Exploratory Study., Melissa B. Eggen

Electronic Theses and Dissertations

Objectives: Early prenatal care is initiated in the first twelve weeks of pregnancy and is a known contributor to improved short- and long-term outcomes for women and infants. Despite its known benefits, many women do not initiate early prenatal care. The purpose of this dissertation was to explore the socioecological factors associated with the timing of prenatal care initiation in the United States and in Kentucky. Methods: Chapter Two of this dissertation used a scoping review methodology to identify barriers and facilitators related to first-trimester prenatal care initiation among women in the United States. Chapter Three of this dissertation used …

Stillbirth Mortality By Robson Ten-Group Classification System: A Cross-Sectional Registry Of 80 663 Births From 16 Hospital In Sub-Saharan Africa, Claudia Hanson, Kristi Annerstedt, Maria Alsina, Muzdalfat Abeid, Hussein Kidanto, Helle Alvesson, Andrea Pembe, Peter Waiswa, Jean-Paul Dossou, Effie Chipeta

Centre of Excellence in Women and Child Health

Objective To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends.

Design Cross-sectional study.

Setting Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda.

Population All women aged 13–49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022.

Methods We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality.

Main outcome measures Stillbirth mortality, defined as antepartum and intrapartum stillbirths.

Results We included 80 663 babies born to 78 085 women; …

Investigating The Influence Of Prenatal Metals Exposures On Childhood Mitochondrial Biomarkers, Z'Dhanne Williams

Molloy Multidisciplinary Undergraduate Research Conference

Note: Z'Dhanne is a current Molloy student and conducted this research while studying at Columbia University - Mailman School of Public Health

Abstract

Background and Purpose: Mitochondrial health plays a vital role in the development of chronic health conditions, including neurodegenerative and cardiovascular diseases. Mitochondria have the unique ability to independently control replication of mitochondrial DNA (mtDNA) depending on conditions of cellular stress, including oxidative stress. Exposure to environmental metals affects a variety of health outcomes via oxidative stress pathways. Our objective was to determine the association between prenatal exposure to metals on two biomarkers of mtDNA in child blood: …

Prognostic Values Of Serum Lactate-To-Bicarbonate Ratio And Lactate For Predicting 28-Day In-Hospital Mortality In Children With Dengue Shock Syndrome, Thanh Nguyen Tat, Nhu Vo Hoang-Thien, Dat Nguyen Tat, Phuc Hoang Nguyen, Lien Thi Ho, Duong Hung Doan, Dung Tuan Phan, Yen Nguyen-Hoang Duong, Truc Huynh Nguyen, Tuyet Kim Nguyen, Ha Thi-Thu Dinh, Thuy Thi-Diem Dinh, Anh Thi-Mai Pham, Viet Do Chau, Tung Huu Trinh, Luan Vo Thanh

Faculty, Staff and Student Publications

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of …

Reproductive Justice In Mississippi: A Call For Reform And Acknowledgement, Andie Udziela

Honors Theses

In this thesis, I apply the values of the Reproductive Justice Movement to reproductive healthcare resources in Mississippi to advocate for reproductive policy reform. I begin by navigating the historic racial discrimination in gynecology and how it manifested in Mississippi. Dr Sim’s abusive experimentation on Anarcha, Betsy, and Lucy depict how Anti-Black racism took root in gynecology and obstetrics and was later expanded on by the eugenic goals of white supremacy and the feminist movement through Margaret Sanger and the Mississippi Appendectomy. Then I discuss the current availability of reproductive care in Mississippi to low-income individuals to emphasize socioeconomic and …

The Mental Health Impact Of Aortic Dissection, Elaine Symanski, Kristina W Whitworth, Hector Mendez-Figueroa, Kjersti M Aagaard, Iman Moussa, Juan Alvarez, Adrien Chardon Fabian, Kurunthachalam Kannan, Cheryl L Walker, Cristian Coarfa, Melissa A Suter, Hamisu M Salihu

Faculty, Staff and Student Publications

INTRODUCTION: The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S.

METHODS: The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset …

Improving Patients’ Perception Of Provider Trust And Communication With Birth Plans, Christelle Reeves, Nicole Tenzel, Timothy Kremer

North Texas GME Research Forum 2024

Objective: Birth plans are an effective tool for a pregnant person to express their desires and expectations for labor and postpartum. Shortcomings of birth plans can be found whenever there is a lapse in communication between provider and patient. In the management of labor and emergent situations, it has been observed by patients that obstetric providers can communicate in authoritarian and dismissive manners. In response to this, birth plans were developed to serve as a guide in these scenarios. Birth plans allow a pregnant person to design a thoughtful plan of action with their healthcare provider before giving birth, rather …

Protocols For Postpartum Hemorrhage, Nicole A. Mitchell, Wilbur Greene, Samantha Claxton, Lydia Lester

Student Scholar Showcase

The purpose of this study was to examine the relationship between the protocols for postpartum hemorrhage and lack of implementation, how race may play a role in care, the different effect on maternal lives; physically and mentally, and more effective treatment options. Many women all over the world struggle with postpartum hemorrhaging as it is a life-threatening complication that can follow giving birth. There are standard protocols set in place for different facilities that relay how the healthcare professionals should act in that situation. The PICOT question, “In child-bearing women, how do protocols for postpartum hemorrhage compared with a lack …

Preparatory Program For Women During Pregnancy/Postpartum And Transitioning Back To Work Or School, Bria Runnels, Rebecca King

Spring 2024 Virtual OTD Capstone Symposium

Despite the importance of maternal health during the prenatal, postnatal, and parenting stages, there is a lack of research on the role of occupational therapists (OTs) in addressing the occupational challenges faced by women during this transitional phase. This dissertation aims to develop a program that raises awareness of the role of occupational therapy in maternal health and promotes occupational therapists as part of an interdisciplinary team within the scope of maternal health care. By adapting co-occupation for mothers, occupational therapists can play an important role in individualizing occupations for enhanced transitioning and overall quality of life. The study highlights …

‘Joining The Dots: Linking Prenatal Drug Exposure To Childhood And Adolescence’ – Research Protocol Of A Population Cohort Study, Kate Lawler, Mithilesh Dronavalli, Andrew Page, Evelyn Lee, Hannah Uebel, Barbara Bajuk, Lucinda Burns, Michelle Dickson, Charles Green, Lauren Dicair, John Eastwood, Ju Lee Oei

Faculty, Staff and Student Publications

INTRODUCTION: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The

METHODS AND ANALYSIS: Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal …

Pharmacologic Management Of Postpartum Hemorrhage In An Urban Hospital, Jessica Summer Martin Bsn, Rn, Alison Brubaker Doyle Bsn, Rn, Lacey Camille Ballard Bsn, Rn, Stephanie Marie Maupin Bsn, Rn, Kate Fouquier Phd, Aprn, Cnm, Facnm

Doctor of Nursing Practice Projects

This retrospective chart review examined female patients (N=25) who had a postpartum hemorrhage. Electronic medical records from Regional One Health were queried for ICD-10 072 related codes from January 1, 2021-October 31, 2023. Of those, a maximum of 25 charts were identified and the information was deidentified. All data was de-identified, coded, encrypted, housed, and locked securely. Selected records that met the above criteria were then queried for the following: Baseline demographics, gravida, para, amount of blood loss, pharmacological and non-pharmacological interventions, and timing of tranexamic acid (TXA) administration. Data was imported into MS Excel and statistical analysis was conducted …

Neonatal Outcomes In The Surgical Management Of Placenta Accreta Spectrum Disorders: A Retrospective Single-Center Observational Study From 468 Vietnamese Pregnancies Beyond 28 Weeks Of Gestation, Phuc Nhon Nguyen, Anh Dinh Bao Vuong, Xuan Trang Thi Pham

Faculty, Staff and Student Publications

BACKGROUND: Placenta accreta spectrum disorders (PASDs) increase the mortality rate for mothers and newborns over a decade. Thus, the purpose of the study is to evaluate the neonatal outcomes in emergency cesarean section (CS) and planned surgery as well as in Cesarean hysterectomy and the modified one-step conservative uterine surgery (MOSCUS). The secondary aim is to reveal the factors relating to poor neonatal outcomes.

METHODS: This was a single-center retrospective study conducted between 2019 and 2020 at Tu Du Hospital, in the southern region of Vietnam. A total of 497 pregnant women involved in PASDs beyond 28 weeks of gestation …

Impact Of Fads Genotype On Polyunsaturated Fatty Acid Content In Human Milk Extracellular Vesicles: A Genetic Association Study, John J. Miklavcic, Natalie Paterson, Jennifer Hahn-Holbrook, Laura M. Glynn

Food Science Faculty Articles and Research

Background

Extracellular vesicles in human milk are critical in supporting newborn growth and development. Bioavailability of dietary extracellular vesicles may depend on the composition of membrane lipids. Single-nucleotide polymorphisms (SNPs) in the fatty acid desaturase gene cluster impact the content of long-chain polyunsaturated fatty acids in human milk phospholipids. This study investigated the relation between variation in FADS1 and FADS2 with the content of polyunsaturated fatty acids in extracellular vesicles from human milk.

Methods

Milk was obtained from a cohort of mothers (N = 70) at 2–4 weeks of lactation. SNPs in the FADS gene locus were determined using …

Voices, Stories And Experiences Of Black Women Phase Ii: Community Engagement Activity Report Informing The Establishment Of A Trenton-Based Maternal & Infant Health Innovation Center, John S. Watson Institute For Urban Policy And Research, Tirzah Spencer, Phd, Mph, Barbara George Johnson

Center for Urban Policy Research

As an extension of our 2022 study Voices, Stories and Experiences of Black Women (Phase 1), the John S. Watson Institute for Urban Policy and Research at Kean University’s Maternal and Child Health Equity Team was asked to share information about the planned Maternal and Infant Health Innovation Center (MIHIC) with Trenton residents as a part of Nurture NJ’s community engagement efforts. The Team implemented the following community engagement activities: Communication: Community engagement through social media outreach and in-person outreach were used as approaches to inform Trenton residents about the MIHIC. Dissemination of Findings: Community cafés were designed to share …