Tobacco Use and Cessation Among Pregnant Alaska Natives from Western Alaska Enrolled in the WIC Program, 2001–2002

Objectives This study examined the rate of tobacco use (cigarette smoking and smokeless tobacco [ST]) at three time points: during the 3 months before pregnancy, during pregnancy, and at 6 weeks postpartum among Alaska Native women residing in the Y-K Delta region of Western Alaska. Methods A retrospective, non-randomized observational cohort design was utilized. The sample consisted of 832 Alaska Natives (mean maternal age = 26.2 years, average length of gestation = 3.8 months) seen at their first prenatal visit and enrolled in the women, infant, and children (WIC) program at the Yukon-Kuskokwim Delta Regional Hospital in Bethel, Alaska, during a 2-year-period (2001–2002). Tobacco use was assessed using an interview format at the first prenatal and at the 6-week postpartum visits. Results The rates of any tobacco use were 48% (95% CI 45%, 52%) 3 months before pregnancy, 79% (95% CI 76%, 82%) during pregnancy, and 70% (95% CI 67%, 74%) at 6 weeks postpartum. The proportion of women using ST changed significantly (P < 0.001) over the three time points (14%, 60%, and 61%, respectively) as well as the proportion of women who smoked cigarettes (P < 0.001) (40%, 42%, and 19%, respectively). Conclusions This study documents the high rate of tobacco use, particularly ST use, during pregnancy among Alaska Native women. Development of tobacco use prevention and cessation interventions during pregnancy for Alaska Native women is warranted.     

Racial/Ethnic Differences in Sleep Disorders and Reporting of Trouble Sleeping Among Women of Childbearing Age in the United States

Objectives Whether racial/ethnic differences in prevalence/reporting of sleep disorders exist in pregnant women/women of child-bearing age is unknown. Study objectives were to estimate prevalence of sleep disorders and to examine racial/ethnic differences in sleep disorders, reporting of sleep issues, and amount of sleep among women of child-bearing age (15–44 years) in the US. Methods Through a secondary analysis of the National Health and Nutrition Examination Survey 2005–2010 (3175 non-pregnant, 432 pregnant women in main analysis), prevalence of sleep disorders, reporting of sleep disorders to a physician/health professional, and amount of sleep were estimated overall, by pregnancy status, and by race/ethnicity stratified by pregnancy status. Racial/ethnic differences in reporting of trouble sleeping by pregnancy status were examined using univariate and multivariate logistic regression. Results Prevalence of diagnosed sleep disorders among women of childbearing age was 4.9 % [3.9 % pregnant; 5.1 % non-pregnant (p < 0.01)]. Significantly fewer pregnant and non-pregnant minority women reported adequate sleep (7–8 h) than non-Hispanic white (white) women (p < 0.05). Among non-pregnant women, odds of report of trouble sleeping were significantly higher for white compared to black (aOR 0.47 [95 % CI 0.36, 0.61]) or Mexican-American women (aOR 0.29 [95 % CI 0.21, 0.41]); non-pregnant minority women were also significantly less likely to report trouble sleeping than white women when controlling for amount of sleep. Among pregnant women, these same trends were found. Discussion Compared to white women, minority women, despite reporting less adequate sleep, are less likely to report trouble sleeping, providing evidence of an important health disparity.     

Pregnancy Intention and Post-partum Depressive Affect in Louisiana Pregnancy Risk Assessment Monitoring System

Background Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner’s pregnancy intentions and reported post-partum depressive symptoms (PPDs). Methods Using Louisiana pregnancy risk assessment monitoring system, 2000–2003, a secondary cross-sectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design. Results In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23–2.53). Furthermore, the association between husbands/partners’ who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02–1.69); while among Black women, neither parent’s pregnancy intention were associated with mild or severe PPDs. Conclusions This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.     

Maternal Sociodemographic Characteristics,Experiences and Health Behaviors Associated with Postpartum Care Utilization: Evidence from Maryland PRAMS Dataset, 2012–2013

Objectives Postpartum visits are increasingly recognized as a window of opportunity for health care providers to counsel new mothers and promote healthy behaviors, including increasing contraceptive use and screening for postpartum depression. In Maryland, there is a lack of research on postpartum visit (PPV) attendance and the specific risk factors associated with not receiving postpartum care. In this study, we estimated the proportion of mothers in Maryland who attended a PPV and assessed maternal sociodemographic characteristics and health behaviors associated with PPV non-attendance. Methods Data were analyzed from the 2012 and 2013 Maryland Pregnancy Risk Assessment Monitoring System (n?=?2204). Bivariate and multivariable logistic regression were performed to examine the association between covariates and PPV non-attendance. Results Overall, 89.6% of women reported PPV attendance. Bivariate analyses between maternal sociodemographic and health behavior characteristics and PPV non-attendance indicated that being unmarried (OR 3.03, 95% CI 2.12–4.31), experiencing infant loss (OR 7.17, 95% CI 2.57–19.97), working during pregnancy (OR 0.44, 95% CI 0.31–0.63) and not receiving dental care (OR 2.03, 95% CI 1.43–2.88) as significant risk factors for PPV non-attendance. After controlling for known and theoretical confounders, experiencing an infant loss (aOR 5.18, 95% CI 1.54–17.4), not receiving dental care (aOR 1.54, 95% CI 1.06–2.26) and working during pregnancy (aOR 0.61, 95% CI 0.41–0.93) emerged as strong predictors of PPV non-attendance. Conclusions for Practice Mothers who recently experienced an infant death were at greatest risk for not attending a PPV, suggesting the need to establish comprehensive support networks, including grief counseling and additional service reminders for mothers who experienced an infant death.     

Partner Involvement During Pregnancy and Maternal Health Behaviors

Objectives Healthcare provider focus often rests solely on a pregnant woman, while a woman’s partner may prove to be an ally in a pregnant woman’s health behaviors. The objective of this study is to assess the role of partner support and other demographic factors affecting alcohol and drug use in pregnancy. Methods This cross-sectional cohort study at Thomas Jefferson University Hospital evaluated pregnant women and their partners and obtained sociodemographic information, medical history, tobacco and alcohol use, and results from the Norbeck Social Support Questionnaire (NSSQ). Inclusion criteria were pregnant women 18–44 years old, and English fluency. Subjects without support persons were excluded. Results 198 women were evaluated. Women who reported having a partner were less likely to smoke and drink, as 2.8 % of partnered women smoked and 26 % drank, compared with 12.2 % non-partnered women smoked (p = 0.01), and 42 % drank alcohol (p = 0.07). Significant factors positively influencing the NSSQ included being married, increased household income, and higher education (p < 0.001). On multivariate regression, having a partner and higher income level were the most important predictors of the Social Support Score (p < 0.05). Conclusions for Practice Having a partner during pregnancy is an important factor in alcohol and drug use. Patients with a reliable partner were less likely to smoke cigarettes and drink alcohol in pregnancy. Increased income and relationship status are other important factors for the support of pregnant women.     

Does Preconception Health Differ by Nativity?: Findings from the Los Angeles Mommy and Baby (LAMB) Study

Objectives To compare certain preconception health (PCH) behaviors and conditions among US-born (USB) and foreign-born (FB) mothers in Los Angeles County (LAC), regardless of race/ethnicity, and to determine if any identified differences vary among Asian/Pacific Islanders (API’s) and Hispanics. Methods Data are from the 2012 Los Angeles Mommy and Baby study (n = 6252). PCH behaviors included tobacco use, multivitamin use, unintended pregnancy, and contraception use. PCH conditions comprised being overweight/obese, diabetes, asthma, hypertension, gum disease, and anemia. The relationship between nativity and each PCH behavior/condition was assessed using multivariable logistic regression models. Results USB women were more likely than FB women to smoke (AOR 2.12, 95 % CI 1.49–3.00), be overweight/obese (AOR 1.57, 95 % CI 1.30–1.90), and have asthma (AOR 2.04, 95 % CI 1.35–3.09) prior to pregnancy. They were less likely than FB women to use contraception before pregnancy (AOR 0.59, 95 % CI 0.49–0.72). USB Hispanics and API’s were more likely than their FB counterparts to be overweight/obese (AOR 1.57, 95 % CI 1.23–2.01 and AOR 2.37, 95 % CI 1.58–3.56, respectively) and less likely to use contraception (AOR 0.58, 95 % CI 0.45–0.74 and AOR 0.46, 95 % CI 0.30–0.71, respectively). USB Hispanic mothers were more likely than their FB counterparts to smoke (AOR 2.47, 95 % CI 1.46–4.17), not take multivitamins (AOR 1.30, 95 % CI 1.02–1.66), and have asthma (AOR 2.35, 95 % CI 1.32–4.21) before pregnancy. Conclusions US nativity is linked to negative PCH among LAC women, with many of these associations persisting among Hispanics and API’s. As PCH profoundly impacts maternal and child health across the lifecourse, culturally-appropriate interventions that maintain positive behaviors among FB reproductive-aged women and encourage positive behaviors among USB women should be pursued.     

Women’s Autonomy and Skilled Attendance During Pregnancy and Delivery in Nepal

Objectives This study aims to explore the association between women’s autonomy and skilled attendance during pregnancy and delivery in Nepal. Methods We adopt data from the Nepal Demographic and Health Survey (NDHS, 2011). We include only married women who gave birth in the 5 years preceding the survey (N = 4148). Women’s autonomy was assessed on the basis of four indicators of decision making: healthcare, visiting friends or relatives, household purchases and spending earned money. Each indicator was dichotomized (yes/no) and then summarized into a single variable to measure overall autonomy. Next, we measured health attendance (skilled vs. unskilled) during antenatal and delivery care. The association between women’s autonomy and skilled attendance was analysed using a logistic regression model. Results Most women had a medium (40 %) and high (35 %) level of overall autonomy. The proportion of women accessing skilled providers during antenatal and delivery care was 51 and 36 %. Women with autonomy in healthcare, visiting friends or relatives, making household purchases and spending money earned were associated with a higher likelihood of receiving care from skilled providers during antenatal care and delivery. An elevated probability of access to skilled attendance during antenatal (aOR 1.33; 95 % CI 1.10–1.59) and delivery care (aOR 1.38; 95 % CI 1.12–1.70) was reported among women with higher levels of overall autonomy. Conclusion Women’s autonomy was significantly associated with the maternal health care utilization by skilled attendants. This study will provide insights for policy makers to develop strategies in improving maternal health.     

Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005–2010

Objective The purpose of this study was to examine the association between prenatal smoking and small for gestational age (SGA) infants among adolescent women in West Virginia, taking into account sociodemographic and health-related factors. Methods Secondary data analysis was conducted using the 2005–2010 West Virginia Pregnancy Risk Assessment and Monitoring Systems weighted dataset. The study population using complete case analysis procedure consisted of 886 adolescent women ages 19 and younger who delivered a live singleton infant in West Virginia. Results The prevalence of smoking among adolescents during the last 3 months of pregnancy was 67 %. Nearly a quarter (22.0 %) of the adolescents gave birth to SGA infants. Results from the logistic regression analysis showed that after controlling for sociodemographic and health-related variables, adolescents who smoked during the last 3 months of pregnancy were more likely to have SGA infants than those who did not smoke during the last 3 months of pregnancy (OR = 1.86, 95 % CI 1.06–3.27, P = 0.0307). Conclusion This study highlights the importance of recognizing that prenatal smoking is an issue among West Virginia adolescents and the need for evidence-based, culturally, and developmentally appropriate interventions for this Appalachian population.     

Gestational Weight Gain,Body Mass Index,and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population

Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46–10.00; p_trend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00–8.71, p_trend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34–2.27) and 1.86 odds of preeclampsia (95 % CI 1.37–2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.     

Maternal Alcohol Consumption During the Perinatal and Early Parenting Period: A Longitudinal Analysis

Objectives Despite potential health risks for women and children, one in five women report alcohol use during pregnancy and a significant proportion of those who quit during pregnancy return to drinking post-delivery. This study seeks to understand the longitudinal patterns of alcohol consumption before, during pregnancy and post-delivery, and the role of maternal characteristics for purposes of informing prevention design. Methods General growth mixture models were used to describe the average developmental patterns of maternal weekly drinking quantity at six time points, from preconception through child entering kindergarten, as well as heterogeneity in these patterns among 9100 mothers from the Early Childhood Longitudinal Study representing the 2001 US national birth cohort. Results Four distinct classes of mothers were defined by their longitudinal alcohol consumption patterns: Low Probability Drinkers (50.3 %), Escalating Risk Drinkers (12.0 %), Escalating Low Risk Drinkers (27.4 %), and Early Parenting Quitters (10.2 %). Heterogeneous covariate associations were observed. For example, mothers who gave birth after age 36 were twice as likely to be Escalating Risk Drinkers and Escalating Low Risk Drinkers (vs Low Probability Drinkers), but not more likely to be Early Parenting Quitters, when compared to mothers who gave birth between the ages of 26 and 35. Conclusions for practice There is significant heterogeneity in maternal longitudinal alcohol use patterns during the perinatal period. Baseline maternal characteristics and behavior associated with these heterogeneous patterns provide valuable tools to identify potential risky drinkers during this critical time period and may be synthesized to tailor pre- and postnatal clinical counseling protocols.     

Small-for-Gestational-Age Births are Associated with Maternal Relationship Status: A Population-Wide Analysis

Objectives To examine the association between maternal relationship status during pregnancy and infant birth outcomes. Methods Observational study of the National Longitudinal Survey of Youth 1979, a nationally representative sample of 12,686 men and women between the ages of 14 and 21. We used data from surveys of women reporting childbirth between 1979 and 2004. Relationship status was defined as relationship with an opposite-sex partner in the child’s birth year. Relationship stability was defined as the consistency in relationship status in the 1 year before, of, and after the child’s birth. Childbirth outcome included small-for-gestational age (SGA) infant. We applied random effects logistic regression models to assess the association between relationship status and stability and childbirth outcome—adjusting for maternal race, infant sex, history of miscarriage, employment, maternal age, multiparity, cohort-entry year, household poverty status, and tobacco use. Results The study included 4439 women with 8348 live births. In fully adjusted models, term SGA infants were more commonly born to partnered women (AOR 1.81; 95 % CI 1.20–2.73) and unmarried women (AOR 1.82; CI 1.34–2.47; LRT p value 0.0001), compared to married women. SGA infants were also more commonly born in unstable relationships (AOR 1.72; 95 % CI 1.14–2.63; LRT p value 0.01) compared to stable relationships. Conclusions for Practice Maternal relationship status and stability during pregnancy is independently associated with risk of SGA infant birth.     

Attachment to Conventional Institutions and Adolescent Rapid Repeat Pregnancy: A Longitudinal National Study Among Adolescents in the United States

Introduction There is limited research on rapid repeat pregnancies (RRP) among adolescents, especially using nationally representative samples. We examine distal factors—school, family, peers, and public/private religious ties—and their associations with RRP among adolescent mothers. Methods Guided by social development theory, we conducted multivariate logistic regression analyses, adjusted for sociodemographic characteristics, to examine associations between RRP and attachment to school, family, peers, and religion among 1158 female respondents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who reported at least one live birth before age 20. Results Attachments to conventional institutions were associated with lower likelihood of RRP. Adolescent mothers who had a stronger relationship with their parents had reduced odds of RRP (adjusted odds ratio [aOR] 0.83, 95 % CI 0.71–0.99). Increased odds of RRP were associated with anticipating fewer negative social consequences of sex (aOR 1.18, 95 % CI 1.02–1.35), never praying (versus praying daily; aOR 1.47, 95 % CI 1.10–1.96), and never participating in church-related youth activities (versus participating once a week; 1.04, 95 % CI 1.01–1.07). Discussion After an adolescent birth, social support from family, peers, and the community can benefit young mothers. Private aspects of religiosity may be especially important. Understanding the processes by which these distal factors are linked to the likelihood of RRP is needed to create multifaceted intervention programs that provide diverse methods of support customized to specific circumstances of adolescent mothers.     

Obese Mothers have Lower Odds of Experiencing Pro-breastfeeding Hospital Practices than Mothers of Normal Weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2008

Objectives This study examines the extent to which a mother’s pre-pregnancy body mass index (BMI) category is associated with her exposure to pro-breastfeeding hospital practices. Methods Data from the 2004–2008 CDC PRAMS were analyzed for three states (Illinois, Maine, and Vermont) that had administered an optional survey question about hospital pro-breastfeeding practices. Results Of 19,145 mothers surveyed, 19 % were obese (pre-pregnancy BMI ≥ 30). Obese mothers had lower odds than mothers of normal weight of initiating breastfeeding [70 vs. 79 % (unweighted), p < 0.0001]. Compared with women of normal weight, obese mothers had lower odds of being exposed to pro-breastfeeding hospital practices during the birth hospitalization. Specifically, obese mothers had higher odds of using a pacifier in the hospital [odds ratio (OR) 1.31, 95 % confidence interval (CI) (1.17–1.48), p < 0.0001] and lower odds of: a staff member providing them with information about breastfeeding [OR 0.71, 95 % CI (0.57–0.89), p = 0.002], a staff member helping them breastfeed [OR 0.69, 95 % CI (0.61–0.78), p < 0.0001], breastfeeding in the first hour after delivery [OR 0.55, 95 % CI (0.49–0.62), p < 0.0001], being given a telephone number for breastfeeding help [OR 0.65, 95 % CI (0.57–0.74), p < 0.0001], rooming in [OR 0.84, 95 % CI (0.73–0.97), p = 0.02], and being instructed to breastfeed on demand [OR 0.66, 95 % CI (0.58–0.75), p < 0.0001]. Adjusting for multiple covariates, all associations except rooming in remained significant. Conclusions Obesity stigma may be a determinant of breastfeeding outcomes for obese mothers. Breastfeeding support should be improved for this at-risk population.     

Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State,Nigeria: A Multilevel Model

Objectives Pregnancy carries a high risk for millions of women and varies by urban–rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the “Risk Approach” strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban–rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban–rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15–24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09–0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.     

Risk Factors Associated with Very Low Birth Weight in a Large Urban Area,Stratified by Adequacy of Prenatal Care

Objectives This study examined risk and protective factors associated with very low birth weight (VLBW) for babies born to women receiving adequate or inadequate prenatal care. Methods Birth records from St. Louis City and County from 2000 to 2009 were used (n = 152,590). Data was categorized across risk factors and stratified by adequacy of prenatal care (PNC). Multivariate logistic regression and population attributable risk (PAR) was used to explore risk factors for VLBW infants. Results Women receiving inadequate prenatal care had a higher prevalence of delivering a VLBW infant than those receiving adequate PNC (4.11 vs. 1.44 %, p < .0001). The distribution of risk factors differed between adequate and inadequate PNC regarding Black race (36.4 vs. 79.0 %, p < .0001), age under 20 (13.0 vs. 33.6 %, p < .0001), <13 years of education (35.9 vs. 77.9 %, p < .0001), Medicaid status (35.7 vs. 74.9, p < .0001), primiparity (41.6 vs. 31.4 %, p < .0001), smoking (9.7 vs. 24.5 %, p < .0001), and diabetes (4.0 vs. 2.4 %, p < .0001), respectively. Black race, advanced maternal age, primiparity and gestational hypertension were significant predictors of VLBW, regardless of adequate or inadequate PNC. Among women with inadequate PNC, Medicaid was protective against (aOR 0.671, 95 % CI 0.563–0.803; PAR ?32.6 %) and smoking a risk factor for (aOR 1.23, 95 % CI 1.01, 1.49; PAR 40.1 %) VLBW. When prematurity was added to the adjusted models, the largest PAR shifts to education (44.3 %) among women with inadequate PNC. Conclusions Community actions around broader issues of racism and social determinants of health are needed to prevent VLBW in a large urban area.     

Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies

Physical activity has been inconsistently associated with risk of gestational diabetes mellitus in epidemiological studies, and questions remain about the strength and shape of the dose–response relationship between the two. We therefore conducted a systematic review and meta-analysis of cohort studies and randomized trials on physical activity and gestational diabetes mellitus. PubMed, Embase and Ovid databases were searched for cohort studies, and randomized controlled trials of physical activity and risk of gestational diabetes mellitus, up to August 5th 2015. Summary relative risks (RRs) were estimated using a random effects model. Twenty-five studies (26 publications) were included. For total physical activity the summary RR for high versus low activity was 0.62 (95 % CI 0.41–0.94, I² = 0 %, n = 4) before pregnancy, and 0.66 (95 % CI 0.36–1.21, I² = 0 %, n = 3) during pregnancy. For leisure-time physical activity the respective summary RRs for high versus low activity was 0.78 (95 % CI 0.61–1.00, I² = 47 %, n = 8) before pregnancy, and it was 0.80 (95 % CI 0.64–1.00, I² = 17 %, n = 17) during pregnancy. The summary RR for pre-pregnancy activity was 0.70 (95 % CI 0.49–1.01, I² = 72.6 %, n = 3) per increment of 5 h/week and for activity during pregnancy was 0.98 (95 % CI 0.87–1.09, I² = 0 %, n = 3) per 5 h/week. There was evidence of a nonlinear association between physical activity before pregnancy and the risk of gestational diabetes mellitus, p_nonlinearity = 0.005, with a slightly steeper association at lower levels of activity although further reductions in risk were observed up to 10 h/week. There was also evidence of nonlinearity for physical activity in early pregnancy, p_nonlinearity = 0.008, with no further reduction in risk above 8 h/week. There was some indication of inverse associations between walking (before and during pregnancy) and vigorous activity (before pregnancy) and the risk of gestational diabetes mellitus. This meta-analysis suggests that there is a significant inverse association between physical activity before pregnancy and in early pregnancy and the risk of gestational diabetes mellitus. Further studies are needed to clarify the association between specific types and intensities of activity and gestational diabetes mellitus.     

Associations Between Peer Counseling and Breastfeeding Initiation and Duration: An Analysis of Minnesota Participants in the Special Supplemental Nutrition Program for Women,Infants, and Children (WIC)

Background Peer counseling (PC) has been associated with increased breastfeeding initiation and duration, but few analyses have examined the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) model for peer counseling or the continuation of breastfeeding from birth through 12 months postpartum. Objectives Identify associations between Minnesota WIC Peer Breastfeeding Support Program services and breastfeeding initiation and continuation. Methods Retrospective analysis of observational data from the Minnesota WIC program’s administrative database of women who gave birth in 2012 and accepted a PC program referral prenatally (n?=?2219). Multivariate logistic regression and Cox regression models examined associations between peer services and breastfeeding initiation and continuation of any breastfeeding. Results Among women who accepted referral into a PC program, odds of initiation were significantly higher among those who received peer services (Odds Ratio (OR): 1.66; 95% CI 1.19–2.32), after adjusting for confounders. Women who received peer services had a significantly lower hazard of breastfeeding discontinuation from birth through 12 months postpartum than women who did not receive services. (Hazard Ratio (HR) month one: 0.45; 95% CI 0.33–0.61; months two through twelve: 0.33; 95% CI 0.18–0.60). The effect of peer counseling did not differ significantly by race and ethnicity, taking into account mother’s country of origin. Conclusion for practice Receipt of peer services was positively associated with breastfeeding initiation and continued breastfeeding from birth through 12 months postpartum. Making peer services available to more women, especially in communities with low initiation and duration, could improve maternal and child health in Minnesota.     

Is Long-Acting Reversible Contraceptive Use Increasing? Assessing Trends Among U.S. College Women, 2008–2013

Objective To assess LARC use trends among college women (18–24 years) and identify groups that have increased LARC use. Methods Data were extracted from the National College Health Assessment-II (NCHA-II) fall 2008–2013 surveys. Logistic regression statistics were used to assess LARC use. Results Although LARC use increased from 2008 to 2013 (aOR?=?2.62; 95% CI 2.23–3.07), less than half of the sample (44%) reported using contraception at last vaginal sex. Only 2.5% of college women in this study reported using a LARC method; of LARC users, 90% reported using an intrauterine device. Nearly all sociodemographic factors were significantly associated with increases in LARC use including: age, sexual orientation, and insurance status. Conclusions LARC use significantly increased among college women. However, less effective methods such as condoms and short-acting reversible contraceptives are used more frequently. Promoting LARC use for women who desire to effectively prevent pregnancy can reduce unintended pregnancy and improve health outcomes for women while in college. Future work should examine the importance of individual and lifestyle factors that influence college women’s decision to choose a LARC method and seek to eliminate barriers to college women choosing a contraceptive method they believe works best for them.