Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study

BackgroundWomen of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers.MethodsA prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5 kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices.ResultsAverage age was 29.61 ± 4.71 years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90 ± 5.18 kg. Mean postpartum weight retention was 3.12 ± 4.76 kg, 33.8% retaining ≥5 kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12 kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12 kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention.ConclusionWomen need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.     

Postpartum weight loss in overweight and obese women using the etonogestrel subdermal implant: a pilot study

ObjectiveTo compare weight loss during the first 6 months postpartum in overweight and obese women using the etonogestrel implant, placed in the immediate postpartum period, with that of controls using nonhormonal contraception, utilizing a pilot design.Study designPilot, prospective cohort study. Analysis groups were divided by body mass index (overweight: 25–29.9 kg/m²; Class I Obesity: 30–34.5 kg/m²; Class II Obesity: 35–39.9 kg/m²) and grouped by use of etonogestrel implant or nonhormonal contraception for all outcomes. Primary outcome was the proportion of women in each group returning to pregravid weight by 6 months postpartum. Secondary outcomes included waist circumference, motivation to lose weight, eating habits, physical activity, feasibility of study procedures and assessment of recruitment potential in the first 6 months postpartum.ResultsA total of 127 women enrolled between June 2014 and August 2015. Fifty-seven chose the etonogestrel implant for immediate postpartum contraception while 70 chose nonhormonal contraceptives. Six months after delivery, about half of women in each group returned to within 1.5 kg of pregravid weight (42% etonogestrel [ENG]-implant vs. 67% nonhormonal methods, p=.19). Retention rates were high with over 75% of total study population providing study data at 6 months. Two nonhormonal contraceptive users conceived in the first 4 months postpartum.ConclusionNo statistical difference in percentage return to pregravid weight was detected between groups, but data suggest that a somewhat lower proportion of implant users lost weight at 6 months. Rapid recruitment, high retention and marked acceptance of immediate ENG implant use demonstrate feasibility for a larger, adequately powered trial.ImplicationsImmediate postpartum insertion of the ENG implant is safe and effective. Study findings suggest modest interference in overweight and obese women's ability to lose gestational weight. If future research demonstrates no statistical difference, increased uptake in immediate implant use should occur in most women, including those who are overweight or obese.     

Healthy excessive weight in Portuguese women 4 years after delivery of a liveborn

ObjectiveTo quantify the prevalence of healthy excessive weight and determinants of metabolic profile, considering women's reproductive life.MethodsWe evaluated 1847 mothers of a birth cohort assembled after delivery and reevaluated 4 years later. A healthy profile was defined as the absence of hypertension, diabetes, dyslipidemia, C-reactive protein < 3 mg/l and being below the second tertile of HOMA-IR. Adjusted odds ratios (OR) and confidence intervals (95% CI) were computed using multinomial logistic regression, taking women with normal BMI as the reference category of the outcome.ResultsFour years after delivery, 47% of women had normal BMI, 33% were overweight and 20% obese. In each BMI class, 61%, 33% and 12% presented a healthy metabolic profile, respectively. Family history of CVD/cardiometabolic risk factors was associated with a higher probability of obesity with a not healthy metabolic profile (OR = 1.39 95% CI: 0.98–1.98). Women who breastfed the enrolled child for > 26 weeks and practiced physical exercise were less likely to be obese and metabolically unhealthy (OR = 0.39 95% CI: 0.23–0.68; OR = 0.48 95% CI: 0.33–0.70, respectively), with no effect on healthy excessive weight.ConclusionsThese results support the existence of a healthy excessive weight phenotype in women after motherhood, influenced by anthropometrics, genetic and lifestyles characteristics.     

Sevrage des nourrissons avant six mois à Marrakech : facteurs associés et prévalence

BackgroundIn Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors.MethodsA cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother–child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early.ResultsBreastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR] = 2.09; 95% confidence interval [CI]: [1.07–4.06]), caesarean delivery (OR = 4.15; 95% CI: [1.74–9.88]) and the fact that the pregnancy was desired (OR = 0.19; 95% CI: [0.05–0.68]).ConclusionWeaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.     

The effect of body mass index (BMI) and gestational weight gain on adverse obstetrical outcomes in pregnancies following assisted reproductive technology as compared to spontaneously conceived pregnancies

ObjectiveTo compare the effect of pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) on adverse obstetrical outcomes among women undergoing assisted reproductive technology (ART) treatments as compared to spontaneously-conceived (SC) pregnancies.MethodsThis prospective cohort study included 1058 pregnant women from two medical centres; 504 women who conceived following ART treatments and 554 who conceived spontaneously. The women were recruited at 8 weeks of gestation and follow-up telephone interviews were conducted 6 weeks after delivery. Obstetrical outcomes included pregnancy hypertension, gestational diabetes (GD), low birth weight (LBW) (<2500 g) and small for gestational age (SGA). Multivariate analyses were used to assess the effect of pre-pregnancy BMI and inappropriate GWG on these obstetrical outcomes adjusted for risk factors.ResultsThe effect of pre-pregnancy BMI and inappropriate GWG on adverse obstetrical outcomes did not differ between ART and SC pregnancies. Pre-pregnancy obesity was found to be associated with increased risk for pregnancy hypertension (OR = 2.16; 95%CI 1.16–4.03), GD (OR = 2.89; 95%CI 1.61–5.17), caesarian section (OR = 1.77; 95%CI 1.10–2.85) and SGA (OR = 1.91; 95%CI 1.05–3.46). GWG below recommendations was associated with increased risk for GD (OR = 1.73; 95%CI 1.06–2.82) and SGA (OR = 1.69; 95%CI 1.17–2.40) while GWG above recommendations was associated with increased risk for pregnancy hypertension (OR = 1.77; 95%CI 1.02–3.06).ConclusionsPre-pregnancy obesity and inappropriate GWG were associated with adverse obstetrical outcomes in both ART and SC pregnancies. Emphasis should be given on the importance of an optimal pre-pregnancy BMI and appropriate GWG during pregnancy.     

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study

ObjectivesTo test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.Study designRetrospective cohort study, Mexico, nationally representative sample of women 12–39 years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.ResultsOur analytic sample included 7022 women (population, N = 9,881,470). Twenty percent of the population was 12–19 years old at last birth, 55% aged 20–29 and 25% 30–39 years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio = 0.52; 95% Confidence Interval (CI) = 0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI = 74–78%) of adolescents (12–19 years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI = 56–62%) who deliver in public facilities.ConclusionBoth adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.ImplicationsAdolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.     

Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact

BackgroundBreast milk volume has never been evaluated when the etonogestrel (ENG) implant was inserted immediately postpartum. Thus, this study evaluated if the immediate postpartum insertion of the ENG implant alters breast milk volume.Study designTwenty-four postpartum women and their newborns (NBs) were randomized into two groups: Implant group (ENG implant inserted within 48 h after delivery) and Control group (absence of contraceptive method). The primary outcome was the amount of breast milk intake by the NBs in the first 6 weeks after delivery. Five and ten grams of deuterium (D₂O) were orally administered to the postpartum women on the day of randomization (day 0) and on the 29th study day, respectively. Saliva samples were collected from the mother–NB pairs prior to each D₂O dose administration and after D₂O ingestion (periodic collection). The amount of breast milk ingested by the NBs was estimated by the amount of deuterium (D₂O) ingested by the NBs through breastfeeding, using mass spectrometry in the saliva samples.ResultsTwenty-four postpartum women and their NB were randomized (12 per group). The median of breast milk intake by NBs following the two D₂O doses were similar between groups {first D₂O dose [Implant: 340 mL/day (240–420 mL/day) vs. Control: 330 mL/day (300–530 mL/day), p=.54]; second D₂O dose [Implant: 845 mL/day (770–980 mL/day) vs. Control: 785 mL/day (680–980 mL/day), p=.63]}. The exclusive breastfeeding rate and NB weight were similar between groups in the first 6 weeks postpartum.ConclusionENG implant insertion immediately postpartum does not alter the volume of breast milk intake by NBs.ImplicationsConsidering the benefits of immediate postpartum initiation of ENG implant on reducing unintended pregnancy and pregnancy recurrence, especially in vulnerable populations, our study adds safety data on breastfeeding effect of this practice.     

State-specific estimates of complete smoke-free home rules among postpartum women, 2010

BackgroundSecondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules.MethodsData were analyzed from 26 states and New York City (n = 37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics.ResultsOverall, 93.6% (95% CI: 93.1–94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), < 20 years of age (87.1%), < $15,000 annual income (87.6%), < 12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%).ConclusionsPrevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes.     

Vegetable protein intake is associated with lower gallbladder disease risk: Findings from the Women's Health Initiative prospective cohort

ObjectiveThis study aimed to measure associations between gallbladder disease and protein intake patterns, separated by quantity and type (vegetable vs. animal), among postmenopausal women.MethodsAnalyses were based on 130,859 postmenopausal women enrolled from 1993 to 1998 at 40 U.S. clinical centers in the Women's Health Initiative clinical trials and observational study. Women were excluded if they reported a history of gallbladder disease prior to baseline. Cox proportional hazards regression models, adjusted for gallbladder disease risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between energy-adjusted protein intake and gallbladder disease.ResultsIn this study sample, 8.1% of postmenopausal women self-reported incident gallbladder disease. In multivariate analysis, women in the highest quintile of energy-adjusted vegetable protein intake (> 24.0 g/d) had a lower risk of gallbladder disease (HR, 0.87; 95% CI, 0.81–0.93) as compared to women in the lowest quintile (< 16.3 g/d) (P_trend < 0.001). Total protein intake was modestly protective against gallbladder disease (P_trend < 0.021). Animal protein intake was not associated with gallbladder disease risk. The protective effect of vegetable protein held stable only for women without history of diabetes (HR, 0.86; 95% CI, 0.80–0.92) and without recent weight loss (HR, 0.88; 95% CI, 0.80–0.97).ConclusionsVegetable protein intake is inversely associated with gallbladder disease risk in our sample of postmenopausal women. In addition to weight management, healthcare providers could emphasize vegetable protein as an additional dietary modality to promote lower risk for gallbladder disease.     

Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: Results of a randomized controlled trial

ObjectiveTo evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease (CVD).MethodsIn a randomized controlled trial performed in the Netherlands between 2007 and 2009, usual care was compared to 6 months of individual counseling using motivational interviewing techniques, delivered face to face and by telephone. Participants aimed at improving energy balance-related behavior or smoking cessation. Linear regression analyses were performed to determine the effects.ResultsBody weight had significantly decreased at 6 (β = ?1.9, 95% CI ?2.6; ?1.2) and 12 months (β = ?1.8, 95%CI ?2.8; ?1.1). The intervention effects were also significant for diastolic blood pressure at 6 months (β = ?1.7, 95% CI ?3.3; ?0.1). Among participants who had aimed at energy balance, the intervention had a significant favorable effect on body weight at 6 (β = ?2.1, 95% CI ?2.9; ?1.3) and 12 months (β = ?2.2, 95% CI ?3.1; ?1.3) and at HDL cholesterol (β=0.05, 95% CI 0.01; 0.10) and HbA1c (β = ?0.06, 95%CI ?0.12; ?0.001) at 12 months, although there was no intervention effect on these variables over time.ConclusionIndividual-based counseling resulted in significant beneficial long-term effects on body weight. This is an important finding for occupational health, considering the rising prevalence of obesity and CVD.     

Unintended pregnancy among active-duty women in the United States military, 2011

ObjectivesTo estimate unintended pregnancy rates among a representative sample of active-duty women in the U.S. military aged 18–44 years in 2011.Study designCross-sectional data came from the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel; 9038 women provided data on unintended pregnancy. Unintended pregnancy rates were calculated for all women and by available background characteristics, including military branch, marital status (married versus unmarried), pay grade (enlisted versus officer) and deployment in the previous 12 months. Multivariable logistic regression testing for associations between unintended pregnancy and subgroups was also performed.ResultsThe unintended pregnancy rate was 72/1000 women. Married women (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11–1.54) and enlisted women (OR 2.71, 95% CI 1.99–3.69) had higher odds of reporting unintended pregnancy compared to their counterparts, as did women in the Navy (OR 1.51, 95% CI 1.19–1.91) and Marine Corps (OR 2.38, 95% CI 1.92–2.95) compared to women in the Air Force. Unintended pregnancy rates did not differ between women who were deployed in the previous 12 months and nondeployed women. Additionally, 10% of women who were deployed for 11–12 months in 2011 reported an unintended pregnancy in the previous year, suggesting that their pregnancies occurred during deployment.ConclusionUnintended pregnancy is higher in the military, including during deployment, compared to the general U.S. population (52/1000 women). All branches need to address the issue in a comprehensive manner including evidence-based provision of contraception and education among servicemembers.ImplicationsUnintended pregnancy is high in the military, including during deployment; further efforts to improve evidence-based provision of contraception and education are needed.     

High-protein diet promotes a moderate postpartum weight loss in a prospective cohort of Brazilian women

ObjectiveWhether a high-protein (HP) diet promotes body weight loss (BWL) when compared with a low-protein (LP) diet is still unclear. Therefore, we evaluated the effects of an HP diet on BWL during postpartum.MethodsA food-frequency questionnaire with 81 items was applied at 6 mo after delivery to evaluate the diet of 430 postpartum women aged 18–45 y. Body weight was measured approximately at 0.5, 2, 6, and 9 mo after delivery. Body weight loss was modeled by comparing an HP diet (≥1.2 g · kg^?1 · d^?1) with an LP diet (<1.2 g · kg^?1 · d^?1) using mixed-effects linear regression models adjusted for energy intake, percentage of body fat at baseline, stature, age, race, smoking, and schooling.ResultsUsual energy intake was higher in the HP than in the LP diet group (2623 versus 1791 kcal, P < 0.0001). Daily mean protein intakes were 1.54 ± 0.32 g · kg^?1 · d^?1 for the HP group and 0.83 ± 0.20 g · kg^?1 · d^?1 for the LP group. A multivariate model showed that women in the HP group lost 316 ± 0.062 g of body weight more per month (P < 0.01) when compared with the LP group.ConclusionA reported higher protein intake may improve moderate postpartum body weight loss. Further studies should evaluate the long-term consequences of an HP diet postpartum.     

Enhancing long-term weight loss maintenance: 2 year results from the Keep It Off randomized controlled trial

ObjectiveThe Keep It Off trial evaluated the efficacy of a phone-based weight loss maintenance intervention among adults who had recently lost weight in Minnesota (2007–2010).Methods419 adults who had recently lost ≥ 10% of their body weight were randomized to the “Guided” or “Self-Directed” intervention. Guided participants received a 10 session workbook, 10 biweekly, eight monthly and six bimonthly phone coaching calls, bimonthly weight graphs and tailored letters based on self-reported weights. Self-Directed participants received the workbook and two calls. Primary outcomes are weight change and maintenance (regain of < 2.5% of baseline body weight).ResultsMixed model repeated-measures analysis examining weight change revealed a significant time by treatment group interaction (p < 0.0085). Guided participants regained significantly less weight than the Self-Directed participants at 12 and 24 months. The odds of 24 month maintenance were 1.37 (95% CI: 0.97–2.03) times greater in the Guided than in the Self-Directed group. When maintenance rates were compared across all follow-ups, there was a consistently higher maintenance rate for Guided participants (HR 1.31, 95% CI: 1.12–1.54).ConclusionsA sustained, supportive phone- and mail-based intervention promotes weight loss maintenance relative to a brief intervention for participants who have recently lost weight.     

Relationships between depression,gender, and unhealthy weight loss practices among overweight or obese college students

IntroductionUnhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students.MethodsStudents (body mass index between 25.0 and 34.9 kg/m²) from three Southern California universities (M_age = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form.ResultsTwenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e^B = 1.14 [confidence interval, CI: 1.08–1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e^B = 1.04 [CI: 0.93–1.16]).ConclusionAmong an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.     

Prostate cancer screening practices and diagnoses in patients age 50 and older,Southeastern Michigan,pre/post 2012

IntroductionStudies investigating the regional impact of the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against the use of prostate specific antigen (PSA) screening for prostate cancer have been limited.MethodsA retrospective cohort study was conducted on men age 50 years and older in Southeastern Michigan pre (n = 3647) and post (n = 3618) USPSTF recommendation. PSA screening, transrectal ultrasound, and prostate biopsy rates were evaluated pre/post using a generalized piecewise linear model with a Poisson distribution, and log link. A knot was placed at year 2011 to estimate pre/post slope coefficients. Generalized estimating equations were used to estimate the marginal probability of a prostate diagnosis as a logistic function of pre and post-period, and comorbidities.ResultsPSA utilization significantly increased (β = 0.28; 95% CI: 0.25, 0.31) during the pre-period, but significantly decreased in the post-period (β = − 0.29; 95% CI: − 0.34, − 0.25). Prostate biopsies decreased pre (β = − 0.16; 95% CI: − 0.25, − 0.08) and did not change post (β = 0.01; 95% CI: − 0.09, 0.12). Transrectal ultrasounds were stable pre (β = 0.16; 95% CI: − 0.03, 0.35) and significantly decreased post (β = − 0.27; 95% CI: − 0.50, − 0.04). Patients in the post-period had a decreased probability of having a diagnosis of prostate cancer (OR: 0.81; 95% CI: 0.74–0.89) compared to the pre-period.ConclusionOur study demonstrates how PSA tests are still being frequently used in Southeastern Michigan. Further research is needed to better understand regional variation in prostate cancer screening practices in the U.S.     

What predicts postpartum pertussis booster vaccination? A controlled intervention trial

Background‘Cocooning’ aims to protect susceptible infants from pertussis via caregiver vaccination. Control trials evaluating educational interventions to promote cocooning are lacking. We evaluated the role of message-framing vs. standard health information in promoting pertussis vaccination.MethodsWe recruited postpartum women from a maternity hospital in Sydney, Australia (November 2010–July 2012). Participants self-completed a pertussis knowledge and attitudes questionnaire. We then assigned pertussis-susceptible (no pertussis vaccine ≤10 years) participants to receive a gain-framed, loss-framed pamphlet or control (Government Pertussis factsheet) using weekly sequential block allocation. Next, participants were offered a pertussis vaccine (dTpa) and completed a post-questionnaire on discharge.ResultsA baseline questionnaire was completed for 96.4% (1433/1486) of postpartum women approached. Missing data was excluded (n = 29). Next, participants (1404) were screened for vaccine status: 324 (23%) reported prior pertussis booster vaccine receipt, leaving 1080 participants requiring vaccination. Among susceptible mothers, 70% (754/1080) were vaccinated post-intervention. Rates were similar between ‘gain’, ‘loss’ or ‘control’ pamphlets (69.1% vs. 71.8% vs. 68.8%; p = 0.62). Intention to be vaccinated (OR 2.46, p < 0.001; 95% CI: 1.69–3.58), perceived vaccine benefits (OR: 1.61, p < 0.001; 95% CI: 1.25–2.15) and having received a vaccine recommendation (OR 1.68; p = 0.025; 95% CI: 1.07–2.65) were independent predictors of vaccine uptake. At discharge, overall pertussis vaccine coverage had increased from 23% to 77% among women screened (1078/1404).ConclusionA cocooning strategy for pertussis vaccination can be highly effective when partially implemented within maternity hospitals, with information accompanied by a funded vaccine. Mothers were highly receptive to vaccination in the postnatal ward: facts about pertussis were as effective as message-framing in promoting a high uptake of 70%. Perceived vaccine benefits, intentions and vaccine recommendation were important predictors of uptake. Our intervention trial increased the existing pertussis vaccine coverage of 23–77%.     

Recent trends in adherence to continuous screening for breast cancer among Medicare beneficiaries

ObjectiveThe aim of this study is to examine recent trends in adherence to continuous screening, especially the rate of subsequent screening mammography following an initial screening before and after the U.S. Preventive Services Task Force (USPSTF) revised its guidelines on breast cancer in November 2009.MethodsWe retrospectively analyzed Medicare fee-for-service claims data to: 1) compare rate of subsequent screening mammography over 27 month periods for 317,150 women screened in either 2004 or 2009; and 2) examine patterns of subsequent screening by age and race.ResultsWhen adjusted for age, race, state of residence, county-level covariates, and clustered on ordering provider, the rate of subsequent screening decreased in 2009 relative to 2004 (OR = 0.75; 95% CI: 0.74–0.76). Adjusted odds ratios are similar for alternative follow-up windows (15 months, 0.71; 24 months, 0.70; 30 months 0.75). The decline was mostly attributable to women 75 and older who are now less likely to return for a subsequent screening. Although USPSTF guidelines call for 24 months, approximately half of women continue screening at 12-month intervals in both cohorts.ConclusionsThe rate of subsequent screening mammography has declined after 2009. Older women seem to follow the revised USPSTF guideline, but confusion by physicians and patients about competing guidelines may be contributing to these findings.     

Association between sociodemographic characteristics and age stopped breastfeeding on early childhood weight status

IntroductionEpidemiological studies have suggested that breastfeeding is associated with child weight status. However, the length of breastfeeding in relation to child weight remains poorly understood. Therefore, this study investigated the association between age stopped breastfeeding and child weight status by sociodemographic characteristics.MethodsThis cross-sectional analysis utilized a nationally representative sample of 3248 U.S. children ages 2–6 years from 2009 to 2018, from parents interviewed as part of the National Health and Nutrition Examination Survey. Child body weight and height were measured during physical examination. Information on age stopped breastfeeding and other demographic characteristics were assessed using questionnaires. Multivariable logistic regression models were performed to examine the association between age stopped breastfeeding and child weight status, adjusting for potential confounders.ResultsChildren breastfed for ≤ 11 months had an increased odds of being overweight and obese with the strongest association observed among those classified as obese (OR=2.12; 95%CI 1.23, 3.64) compared with children breastfed for > 11–24 months. The association between breastfeeding and child weight status was observed by racial/ethnic groups. Non-Hispanic white and Black children breastfed for ≤ 11 months had an associated increased likelihood of being overweight than their counterparts breastfed for > 11–24 months. Among Hispanic children, we observed elevated odds of being obese when breastfed for ≤ 11 months (OR=1.98; 95%CI 1.00, 3.91) than those breastfed for > 11–24 months.ConclusionChild weight status was associated with age stopped breastfeeding, where likelihood of being overweight and obese were greatest among children breastfed for ≤ 11 months.     

Tetanus,diphtheria, and acellular pertussis vaccination during pregnancy and reduced risk of infant acute respiratory infections

BackgroundTo protect infants from pertussis infection, the Advisory Committee on Immunization Practices (ACIP) recommends women receive the tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap) vaccine between 27 and 36 weeks of pregnancy. Here, we assessed the association between timing of maternal Tdap vaccination during pregnancy and acute respiratory infection (ARI) in infants <2 months of age.MethodsThis retrospective cohort study included 99,434 infants born to active duty military women in the Department of Defense Birth and Infant Health Registry from 2006 through 2013. Multivariable log-binomial regression was used to calculate relative risks (RRs) and 95% confidence intervals (CIs) for the association between maternal Tdap vaccination during pregnancy and infant ARI at <2 months of age.ResultsInfants of mothers who received Tdap vaccination during pregnancy vs those who did not were 9% less likely to be diagnosed with an ARI at <2 months of age (RR, 0.91; 95% CI, 0.84–0.99), and the risk was 17% lower if vaccination was received between 27 and 36 weeks of pregnancy (RR, 0.83; 95% CI, 0.74–0.93). Similar results were observed when comparing mothers who received Tdap vaccination prior to pregnancy in addition to Tdap vaccination between 27 and 36 weeks of pregnancy versus mothers who only received vaccination prior to pregnancy (RR, 0.85; 95% CI, 0.74–0.98).ConclusionsMaternal Tdap vaccination between 27 and 36 weeks of pregnancy was consistently protective against infant ARI in the first 2 months of life vs no vaccination during pregnancy, regardless of Tdap vaccination prior to pregnancy. Our findings strongly support current ACIP guidelines recommending Tdap vaccination in late pregnancy for every pregnancy.