HIV-INFECTED WOMEN AND INFANTS

The utilization of health care by HIV-seropositive pregnant women and their infants was studied in an indigent urban population. Ninety HIV-seropositive women delivered 99 HIV-exposed infants at the Johns Hopkins Hospital from August 1, 1988, to April 1, 1991. Repeat pregnancies occurred in 17 (18.9%) women during the study period. Completion of the primary immunization series by age nine months was the criteria for infant adherence to medical care. Of all infants, 72.9% achieved adequate immunization status by nine months. However, only 41 (45.6%) women reported ever seeking HIV-related health care. Factors associated with maternal adherence with HIV-related health care included HIV status of her infant, maternal drug use, and incarceration. Number of living children, maternal age, educational level, marital status, and repeat pregnancy were not associated with mothers seeking HIV-related health care. Despite low adherence to HIV-related health care in this sample of HIV-seropositive women, the majority of their infants did receive adequate immunizations, one proxy measure of adequate infant health care.     

The Association of Inadequate and Intensive Prenatal Care With Maternal,Fetal, and Infant Outcomes: A Population-Based Study in Manitoba,Canada

ObjectiveLittle is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba.MethodsThis retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours.ResultsThe distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.ConclusionInadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.     

A systematic,multidisciplinary approach to address the reproductive needs of HIV-seropositive women

Nearly 130,000 American women are human immunodeficiency virus (HIV) seropositive. The present study sought to establish a comprehensive programme to address their fertility needs in order to minimize infectious, medical and reproductive risks to prospective patients. Forty women, aged 27–42 years, were evaluated. HIV was diagnosed 7.2 ± 0.7 years prior to their seeking care, and most women (n = 38) were on highly active antiretroviral therapy. Their prenatal CD4 counts were 712.2 ± 56 cells/mm³ (range 327–1881) and HIV-1 concentrations were undetectable in all cases prior to initiating treatment. HIV-seropositive women were statistically identical to their age-matched HIV-seronegative counterparts with respect to the IVF clinical outcome parameters measured. Throughout the pregnancies, maternal HIV-1 RNA concentrations remained undetectable and CD4 counts were stable. All infants, tested at birth and at 3 and 6 months of age, remained HIV negative. This is the first report of an institutional paradigm in the USA dedicated to evaluate and treat HIV-seropositive women. Using a multidisciplinary approach to care, HIV-seropositive women may be successfully managed in a programme of assisted reproduction.     

A study of out-of-wedlock pregnancies: outcome and utilization of maternal/child health services

The characteristics of unwed pregnant women, their utilization of maternal and child health services and the infant mortality among these out-of-wedlock births were investigated. During the study period, 5% of all pregnancies (48 of 855) were of this nature. Utilization of antenatal services was poor among unwed pregnant women, compared to those who were married. However, they used the child care services satisfactorily, as observed by the well-baby-clinic visits and acceptance of immunization. The infant mortality was 125 per 1000 live births, more than double the rate among infants born to married women. Either immediately after child birth or within one year after delivery, 50% of the unwed mothers started living with the putative fathers.     

Determinants of periodontal health in pregnant women and association with infants' anthropometric status: a prospective cohort study from Eastern Uganda

ABSTRACT: BACKGROUND: Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in sub Saharan Africa and has been linked to poor periodontal health during pregnancy. This study investigated predisposing and enabling factors as determinants of oral health indicators in pregnancy as well as the association between periodontal problems at 7 months gestational age and the infants' anthropometric status METHOD: A community --based prospective cohort study was conducted in Mbale, Eastern Uganda between 2006 and 2008. Upon recruitment, 713 pregnant women completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices. A total of 593 women were followed up with anthropometric assessments of their infants 3 weeks after delivery. Multiple logistic regression analyses were used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) was used to investigate the relationship between periodontal problems and the child's anthropometric status in terms of wasting, underweight and stunting RESULTS: A total of 67.0% of women presented with periodontal problems, 12.1% with poor oral hygiene, 29.8% with recent dental visit and 65.0% with periodontal symptoms. Of the infants, 2.0% were wasted, 6.9% were underweight and 10.0% were stunted. The odds ratio of having CPI > 0 increased with increased maternal age and single marital status, and was lower in primiparous women and those who used mosquito bed nets. Mean wasting scores discriminated between mothers with CPI = 0 and CPI > 0 as well as between mothers with good and poor OHI-S scores CONCLUSIONS: Socio-demographic factors and information about oral health were associated with oral health indicators in pregnant women. Second, the height- for- age status at 3 weeks postpartum was worse in infants of mothers having periodontal problems and poor oral hygiene during pregnancy. Efforts to prevent oral diseases during pregnancy should be part of the local state and national health policy agenda in Uganda.     

Methamphetamine use in pregnancy,child protection,and removal of infants: Tertiary centre experience from Western Australia

AbstractThe aim of this study is to explore factors that determine infant removal by Child Protective Services and placement in out of home care, for methamphetamine-using women receiving pregnancy care with Western Australia Women and Newborn Drug and Alcohol Service.MethodA prospective cohort study of 112 methamphetamine-using women attending Women and Newborn Drug and Alcohol Service for pregnancy care from 2015 to 2018 was undertaken. Maternal methamphetamine use was assessed during each trimester of pregnancy using a standardised assessment tool. Drug use was by maternal self-report. Involvement of Western Australia's Department for Child Protection and Family Support and removal from maternal care were recorded. Infant development was formally assessed at 12 months with Griffiths Mental Development Scales. The comparison was made between three groups: those women who had no involvement with Child Protection, those for whom Child Protection was involved but the child remained in maternal care and those women who had their infants removed from their care. A comparison between Aboriginal and non-Aboriginal women was also undertaken.ResultsOf the 110 infants born to 112 women, 33 (30.3%) of infants were removed from maternal custody after delivery. Overall 60 (53.5%) of women had Child Protection involvement. Aboriginal women were overrepresented in our population 59 (52.7%) and 24 out of the 33 infants were Aboriginal were removed and placed into out of home care. Infants were removed from women with a high level of risk factors associated with MA use including those who were homeless, in prison, unemployed or continued high use of MA, mental health issues. Aboriginal infants were at increased risk of removal. Children removed from maternal care had a trend towards poorer developmental attainment at around 12 months compared to those who remained with their mother. Infants who were removed by the Child protection had lower general quotients (p = 0.132) than infants who had no involvement or some involvement.ConclusionInfants removed from maternal care were more likely to be from women with high use, adverse social factors and born to mothers who identified as being Aboriginal. Resources are required that work intensively with families to reduce the number of infants being removed from maternal care to overcome the risks and challenges of addiction.Implications for practiceResources that provide long term support and community-based models that offer a comprehensive range of maternal-child services and in-home-support would be more effective in keeping families together.     

Influenza and tetanus, diphtheria, and acellular pertussis vaccinations during pregnancy

Vaccinations in pregnancy are an important aspect of prenatal care and of improving not only maternal health but also neonatal outcomes. Only 2 vaccines are specifically recommended during pregnancy: influenza and tetanus, diphtheria, and acellular pertussis (Tdap). Because influenza illness disproportionately affects pregnant women compared with other populations, annual prevention of influenza illness is recommended for all women who will be pregnant during influenza season (October to May). Influenza vaccination has been recently reported to also result in decreased febrile respiratory illnesses in the newborn, likely through passive antibody transfer. Pertussis infection rates are rising in the United States as vaccine-induced immunity wanes, with the mortality burden primarily seen in infants aged <6 months. Pertussis immunization with Tdap is now recommended for all pregnant women during the late second (>20 weeks) or third trimester with the intent to both protect the pregnant woman and provide passive antibody to the infant before vaccination at 2 months of age. Provider support for these recommendations regarding both annual influenza vaccination and postpartum Tdap vaccination during pregnancy is critical to ensuring vaccine delivery and improving both maternal and fetal health. The article reviews the epidemiology and clinical aspects of influenza and pertussis infection with particular attention to pregnancy and recommendations for vaccination in these women. TARGET AUDIENCE: Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians LEARNING OBJECTIVES: After completing this CME activity, obstetricians and gynecologists should be better able to analyze how influenza infection disproportionally affects pregnant women. Assess how influenza vaccination improves maternal and likely neonatal outcomes. Evaluate pertussis infection and immunity in adults, and counsel pregnant women as to the benefits of Tdap vaccination, particularly for the infant.     

Early mother–infant interaction: associations with the close relationships and mental health of the mother

The present study examined the association between a woman's close relationships and mental health and the quality of her maternal behaviour in early mother–infant interaction. A total of 131 mothers and their infants participated in the study. The quality of the mother's childhood relationship with her own mother and her marital relationship were investigated in a semi‐structured interview and, as a part of the interview, the Structured Clinical Interview for DSM‐IV (SCID) was used to assess her mental health. Mother–infant interaction was videotaped at 8–11 weeks of the infant's age, and scored using the Global Rating Scale for Mother–Infant Interaction. The mother's childhood relationship with her mother was significantly related to her own interactive and affective behaviour with her infant. A poor, disengaged marital relationship was also associated with poorer interactive behaviour but only among mothers with mental health problems. Thus the mother's close relationships had an effect on maternal behaviour; however, maternal perinatal psychopathology per se was not related to maternal behaviour at 2 months of the infant's age.     

Association between low maternal low-density lipoprotein cholesterol levels in the second trimester and delivery of small for gestational age infants at term: a case-control study of the national center for child health and development birth cohort

Maternal malnutrition during pregnancy can lead to a small for gestational age (SGA) status among infants. In the present study, we compared the lipid levels during the second trimester in women who delivered SGA infants at term with those in women who delivered appropriate for gestational age infants at term, to examine whether abnormalities in maternal lipid levels could be a risk factor for the delivery of an SGA infant. We enrolled pregnant women who gave birth at the National Center for Child Health and Development (NCCHD), their infants, and who volunteered in a Birth cohort study at the NCCHD. We analyzed a total of 843 blood samples obtained from the women during the second trimester. Moreover, we used multi-regression analysis to assess the relationship between low-density lipoprotein cholesterol (LDL-C) levels during the second trimester and the risk of delivering an SGA infant. The adjusted odds ratio (OR) for LDL-C levels was 0.99 (95% CI, 0.98–0.99). These results indicate that a low LDL-C level during the second trimester was associated with an increased risk of delivering an SGA infant at term. The finding would not only help predict future SGA infant birth, but can also help prevent SGA infant birth.     

Perinatal addiction: outcome and management.

The care of the pregnant drug-dependent woman and her newborn infant has become a major and controversial health problem requiring specific approaches to this high-risk mother and neonate. A comprehensive approach to the care of 278 pregnant drug-dependent women and their infants at the Philadelphia General Hospital has significantly reduced maternal and infant morbidity heretofore associated with pregnancies complicated by opiate addiction. Most significantly, the incidence of low birth weight has been reduced to below 20 per cent, and a decrease in severe withdrawal in infants born to mothers in the comprehensive care program has occurred. We propose that application of this approach to women whose pregnancies are complicated by drug dependency is a significant factor in successful management.     

Fetal health assessment in pregnancies complicated by sickle hemoglobinopathies

The contraction stress test (CST) and nonstress test (NST) are used as fetal health assessments. Severe sickle hemoglobinopathies in the parturient have been shown to place the fetus significantly at risk. This study correlates these fetal health assessment tests with outcome data in 58 pregnancies occurring in women with sickle cell disease. There were 30 patients with homozygous sickle cell anemia (HbS-S), 19 with hemoglobin S-C disease (HbS-C), and nine with hemoglobin S-thalassemia (HbS-Thal). All received prophylactic partial exchange transfusions as part of their antepartal care. At 34 weeks' gestation, NSTs followed by CSTs were begun in each patient. A total of 255 tests were performed. Of these, 19 NSTs and 24 CSTs were unsatisfactory or questionably abnormal and were repeated. There were no nonreactive NSTs, and no patient demonstrated a positive CST. The neonatal outcome revealed one infant who was small for gestational age and two infants who were of low birth weight but appropriate for gestational age. All infants survived and were normal. These data suggest that the fetal reactivity and placental reserve among these parturients with severe sickle hemoglobinopathies were uncompromised, as these tests have been shown to be relatively sensitive assessments of fetal well-being in other maternal disorders.     

The impact of maternal HIV status on infant feeding patterns in Nakuru, Kenya.

The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P < .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (> mean birth weight, P < .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. J Hum Lact . 24(1):34-41.     

Joys and challenges of motherhood for Australian young women of preterm and full-term infants: an Interpretative Phenomenological Analysis

Objective: This study aimed to further our understanding of the daily experience of being a young mother for Australian young women who have preterm infants. Background: Both preterm birth and adolescent childbearing are associated with increased risk of poor maternal and infant health outcomes. However, little research has explored how having a preterm infant influences the experience of being a mother for young women or whether it differs from having a full-term infant. Methods: This Interpretative Phenomenological Analysis study analysed interviews with 14 young women (15–19 years; 10 preterm and 4 full-term) who were interviewed 3 times over the first 12 months of parenting. Results: Preterm birth did not detract from the joys associated with becoming a mother, which was central to all mother’s stories. Instead, preterm birth exacerbated challenges faced by all young women, such as transportation difficulties and negative judgement from others. Unique challenges included lack of embodied interaction with their infants and navigating the hospital system. Young women frame the experience of being a mother in terms of immediacy and daily demands. Conclusion: This research further challenges the view that early motherhood is detrimental to young women, by demonstrating how the polemics of enjoyment and challenge coexist in the experience of mothering on a day-to-day basis. Using global categories such as age or birth status to assess risk may not be appropriate as they do not provide nuanced criteria for establishing which mothers need assistance.     

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence‐based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow‐up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.     

The relationship between facility delivery and infant immunization in Ethiopia

Objective

To determine whether facility delivery is related to compliance with recommended infant immunizations, particularly those that occur weeks or months after delivery.

Methods

In a retrospective analysis, multivariate logistic regression was used to assess data from the 2011 Ethiopia Demographic and Health Survey (EDHS) to determine the strongest correlates of facility delivery. These correlates were then used, along with facility delivery itself, to determine the relationship between facility delivery and infant immunization.

Results

In total, 3334 women delivered a newborn 12–24 months before the 2011 EDHS: 90.2% (3007) delivered at home, and 9.8% (327) delivered in a facility. Education, wealth status, urban residence, and number of children under 5 years living in the household were the factors most strongly associated with facility delivery. When facility delivery and its strongest correlates were entered into multivariate logistic regression models with infant immunizations as the outcome, facility delivery was significantly associated with increased likelihood of DPT-HepB-Hib, polio, and measles vaccination, and increased likelihood of being fully immunized (all P < 0.01). Facility delivery was the strongest single factor associated with infants being immunized, doubling the odds of full immunization.

Conclusion

The impact of facility delivery on health outcomes transcends the immediate delivery and postpartum period.     

Intertwined disparities: Applying the maternal-infant dyad lens to advance perinatal health equity

Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.