Stressful Life Events Around the Time of Unplanned Pregnancy and Women’s Health: Exploratory Findings from a National Sample

Objective Little is known about how women’s social context of unintended pregnancy, particularly adverse social circumstances, relates to their general health and wellbeing. We explored associations between stressful life events around the time of unintended pregnancy and physical and mental health. Methods Data are drawn from a national probability study of 1078 U.S. women aged 18–55. Our internet-based survey measured 14 different stressful life events occurring at the time of unintended pregnancy (operationalized as an additive index score), chronic disease and mental health conditions, and current health and wellbeing symptoms (standardized perceived health, depression, stress, and discrimination scales). Multivariable regression modeled relationships between stressful life events and health conditions/symptoms while controlling for sociodemographic and reproductive covariates. Results Among ever-pregnant women (N?=?695), stressful life events were associated with all adverse health outcomes/symptoms in unadjusted analyses. In multivariable models, higher stressful life event scores were positively associated with chronic disease (aOR 1.21, CI 1.03–1.41) and mental health (aOR 1.42, CI 1.23–1.64) conditions, higher depression (B 0.37, CI 0.19–0.55), stress (B 0.32, CI 0.22–0.42), and discrimination (B 0.74, CI 0.45–1.04) scores, and negatively associated with ≥?very good perceived health (aOR 0.84, CI 0.73–0.97). Stressful life event effects were strongest for emotional and partner-related sub-scores. Conclusion Women with adverse social circumstances surrounding their unintended pregnancy experienced poorer health. Findings suggest that reproductive health should be considered in the broader context of women’s health and wellbeing and have implications for integrated models of care that address women’s family planning needs, mental and physical health, and social environments.     

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.     

Disparities in Infant Mortality by Race Among Hispanic and Non-Hispanic Infants

Objectives

U.S.-born Hispanic infants have a well-documented health advantage relative to other minority groups. However, little published research has examined racial heterogeneity within the Hispanic population, in relation to health outcomes. The current study aims to explore possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. Methods Data were drawn from 2007 to 2008 NCHS Cohort Linked Live Birth—Infant Death Files, restricted to deliveries of Hispanic black, Hispanic white, non-Hispanic black (NHB) and non-Hispanic white mothers (NHW) (n?=?7,901,858). Adjusted odds ratios for first week mortality, neonatal, postneonatal, and overall infant mortality were calculated for each group, using NHW as the reference group. Results: A distinct health gradient was observed in which NHB infants (n?=?1,250,222) had the highest risk of first week (aOR?2.29, CI 2.21–2.37), neonatal (aOR 2.23, CI 2.17–2.30), postneonatal (aOR 1.74, CI 1.68–1.81), and infant mortality (aOR 2.05, CI 2.00–2.10) compared to NHW infants (n?=?4,578,150). Hispanic black infants (n?=?84,377) also experienced higher risk of first-week (aOR?1.28 (1.12–1.47), neonatal (aOR .27, CI 1.13–1.44), postneonatal (aOR?1.34, CI 1.15–1.56), and infant mortality (aOR 1.30, CI 1.18–1.43) compared to both NHW and Hispanic white infants (n?=?1,989,109). Conclusions for Practice: Risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes. Our findings suggest implications of racial heterogeneity on infant health outcomes, and provide insight into the role of race as a social construct.

     

A Multidimensional Approach to Characterizing Psychosocial Health During Pregnancy

Objectives Domains of psychosocial health have been separately connected to pregnancy outcomes. This study explores the relationship between five domains of psychosocial health and their joint association with prenatal health and pregnancy outcomes. Methods Women from a prospective cohort study in Durham, North Carolina were clustered based on measures of paternal support, perceived stress, social support, depression, and self-efficacy. Clusters were constructed using the K-means algorithm. We examined associations between psychosocial health and maternal health correlates, pregnancy intention, and pregnancy outcomes using Chi square tests and multivariable models. Results Three psychosocial health profiles were identified, with the first (Resilient; n = 509) characterized by low depression and perceived stress and high interpersonal support, paternal support, and self-efficacy. The second profile (Vulnerable; n = 278) was marked by high depression and perceived stress, and low interpersonal support, paternal support, and self-efficacy. The third profile (Moderate, n = 526) fell between the other profiles on all domains. Health correlates, pregnancy intention, and pregnancy outcomes varied significantly across profiles. Women with the vulnerable profile were more likely to have risky health correlates, have an unintended pregnancy, and deliver preterm. Women with the resilient profile had better birth outcomes and fewer deleterious health correlates, preconception and prenatally. Conclusions We posit that vulnerable psychosocial health, deleterious health correlates, and the stress which often accompanies pregnancy may interact to magnify risk during pregnancy. Identifying and intervening with women experiencing vulnerable psychosocial health may improve outcomes for women and their children.     

Factors Associated with Quality of Life Among Mothers Rearing 4- and 18-Month Old Infants in Japan

Objective The purpose of the present study was to investigate factors associated with quality of life (QOL) among mothers raising 4 and 18-month-old infants. Methods A cross-sectional study was conducted using self-report questionnaires. Participants included 400 women who took their infants for health checkups at a city in Aichi Prefecture, Japan (4-month-olds: n?=?197, 18-month-olds: n?=?203). Study variables included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, mother’s lifestyle, support from family, and other factors potentially related to QOL. Results For mothers of 4-month-old infants, total QOL was associated with emotional support from families (OR 6.09, 95% CI 2.13–17.43) and having enough sleep (7 h or more; OR 4.18, 95% CI 1.86–9.36). These mothers had shorter sleeping hours than mothers of 18-month-old infants. QOL of mothers of 18-month-old infants was associated with emotional support from families (OR 3.06, 95% CI 1.14–8.22) and using childrearing support facilities (OR 2.02, 95% CI 1.01–4.01). Conclusion Different factors contributed to mothers’ QOL as a function of infant age. Emotional support from families was associated with better QOL in both mother groups. Differences were that for mothers of 4-month-old infants, enough sleep was relevant to QOL, while in mothers of 18-month-old infants, childcare services helped improving their QOL.     

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.     

Early Childhood Adversity and Pregnancy Outcomes

Objectives To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits. Methods Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators. Results Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age. Conclusions ACEs have an enduring effect on maternal reproductive health, as manifested by mothers’ delivery of offspring that were of reduced birth weight and shorter gestational age.     

Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth?

Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (<?37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997–2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure—controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure—were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32–36 weeks), and 92 very preterm (<?32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13–3.50) and moderately preterm birth (32–36 weeks) (aOR 2.17; 95% CI 1.22–3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.     

Caffeine Intake During Pregnancy in Different Intrauterine Environments and its Association with Infant Anthropometric Measurements at 3 and 6 Months of Age

Objective To investigate the association between maternal caffeine intake during pregnancy and infant anthropometric measurements at age 3 and 6 months. Methods Longitudinal observational study of mother–child pairs stratified into five groups: diabetic women (DM), hypertensive women (HYP), smoking mothers (SMO), mothers of infants small for gestational age (SGA), and controls (CTL). Pairs were recruited from three public hospitals in Porto Alegre, Brazil, from 2011 to 2015, using a convenience sampling strategy. The Food Frequency Questionnaire (FFQ) was administered on postpartum day 7 to evaluate maternal caffeine intake during pregnancy. The anthropometric measurements of interest (weight, length, and skinfold thickness) were assessed at birth and at age 3 and 6 months. Linear regression was used to analyze the interaction between caffeine intake and skinfold thickness. Results Overall, 272 mother–child pairs were investigated (41 DM, 26 HYP, 68 SMO, 25 SGA, and 112 CTL). There were no differences in anthropometric measurements between infants born to mothers who had and had not consumed caffeine during pregnancy (P?>?0.05). Children of mothers in the DM group had the highest adjusted average skinfold thicknesses at 3 months. An interaction between maternal caffeine intake during pregnancy and the sum of skinfolds at age 3 months was found in the DM and CTL groups (P?<?0.05). However, significant differences were not observed at 6 months. Conclusions Maternal caffeine intake influenced infants skinfold thickness measurements at 3 months of age. This parameter was reduced in infants born to mothers with DM and increased in those born to healthy control mothers.     

Influential Factors of Puerto Rican Mother–Child Communication About Sexual Health Topics

Introduction Latina mothers play a central role in raising and socializing their children; however, few studies have examined the cultural, socio-cognitive and neighborhood-related variables influencing the level of communication between Puerto Rican mothers and their children about sexuality and sexual health. This cross-sectional study sought to examine these influences. Methods Puerto Rican mothers with children aged 10–19 years (n = 193) were selected randomly for an ethnographic interview as part of a community participatory action research project in a U.S. urban northeastern community. Results Bivariate analyses found statistically significant associations between the child’s age (p = 0.002), the mother’s past communication about traditional gender role norms of women (marianismo) (p < 0.001), her positive outcome expectations for communications with her child (p < 0.025), and her perceptions of the physical condition (p < 0.001) and sexual health problems (p = 0.047) in the neighborhood. In a multivariate model, all of these variables remained significant except sexual health problems, and mother’s attitudes toward the obligations of children to parents (familismo) emerged as a factor associated with a decrease in the number of sexual health topics that mothers raised with their children. No significant effects were found for mother’s spiritual and religious experience (religiosidad). Discussion Our study highlights the importance of marianismo as a framework within which Puerto Rican mothers communicate sexual health information as well as the need to improve mothers’ confidence discussing sexual health issues with their children. Future public health interventions to promote communication about sexuality and sexual health among Puerto Rican mothers should consider addressing this issue as a part of comprehensive neighborhood improvement projects.     

Mother’s Self-Efficacy Mediates the Relationship Between Household Food Insecurity and Maternal Infant Feeding Styles

Objectives This study was performed to examine the association between household food insecurity, self-efficacy and infant feeding styles in mothers with children under 2 years old in Varamin, Iran. Methods In this cross-sectional study, 423 mothers aged 17–40 years from different areas of Varamin were selected by a multistage sampling methods from October 2013 to February 2014. The questionnaires consisted of three valid instruments, including: Household Food Insecurity Access Scale, Comprehensive Feeding Practices Questionnaire and Mother’s Self-Efficacy Questionnaire. Data were analyzed using Chi-square, t tests, ANOVA, Pearson correlations and multiple linear regressions. Structural equation modeling was also used. Results Mild and moderate–severe food insecurity was observed in 39.5 and 12.8 % of the households respectively. Mean score of mother’s self-efficacy in food secure households was 32.5 ± 3.7; while in mild food insecure and moderate–severe food insecure households were 31.9 ± 3.1 and 28.4 ± 4.0, respectively (P = 0.001). There was a significant negative correlation between household food insecurity and mother’s self-efficacy (r = ?0.297, P < 0.01). Significant correlation was seen between mother’s self-efficacy and the maternal infant feeding styles. Household food insecurity and mother’s self-efficacy had significant relationship with mother-infant feeding styles: control of home food access [β (SE)] = [?0.015(0.004), P = 0.001]; restriction for weight control [β = 0.038(0.013), P = 0.003]; restriction for health [β = 0.019(0.008), P = 0.027] and encouragement [=0.018(0.006), P = 0.001]. The model had sufficient fitness with data of the research (CFI = 0.927, RMSEA = 0.076). Conclusions Our findings suggest that performing interventions in order to enhance mother’s self-efficacy in food insecure households can lead to improve positive maternal feeding behaviors.     

Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care

Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother–baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period.     

When Fathers are Perceived to Share in the Maternal Decision to Breastfeed: Outcomes from the Infant Feeding Practices Study II

Objectives The present study investigates the influence of joint feeding preferences of both the mother and father on initiation and duration of breastfeeding. Methods Data from the Infant Feeding Practices Study II was analyzed. Female participants in a national consumer opinion panel were followed from pregnancy through 1 year postpartum, and were asked about infant feeding practices. We examined the association between maternal prenatal perception of the expectant father’s breastfeeding preferences and breastfeeding outcomes (initiation, duration of exclusive breastfeeding and any breastfeeding) and whether concordance between the parents’ infant feeding preferences influenced breastfeeding. Results Mothers who perceived that the father preferred exclusive breastfeeding (vs. no preference) were more likely to initiate breastfeeding [adjusted odds ratio (aOR)?=?1.9; 95% confidence interval (95% CI) 1.0–3.7], and they had a lower hazard of stopping exclusive and any breastfeeding at any given time [exclusive breastfeeding: adjusted hazard ratio (aHR)?=?0.8; 95% CI 0.6–0.9; any breastfeeding: aHR?=?0.6; 95% CI 0.5–0.7]. When both the mother and the father preferred exclusive breastfeeding, the hazard of breastfeeding cessation at any given time was lowest (exclusive breastfeeding: aHR?=?0.4; 95% CI 0.3–0.5; any breastfeeding: aHR?=?0.4; 95% CI 0.3–0.5). The risk of breastfeeding cessation remained lower even when only the father preferred exclusive breastfeeding. Conclusions for Practice Mothers tend to breastfeed for a longer duration when they perceive that the expectant father prefers exclusive breastfeeding and, even more so, when both parental preferences for exclusive breastfeeding concur. Efforts are needed to involve expectant fathers in breastfeeding decision-making and education to achieve breastfeeding success.     

Pregnancy Outcomes of American Indians: Contrasts Among Regions and with Other Ethnic Groups

Objectives The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth outcomes of American Indians (AIs) with other race/ethnic groups and to compare the maternal risk factors and birth outcomes of AIs by region to assess whether there are geographic variations in the adverse outcomes that might suggest intervention strategies. Study Design This study used the National Center for Health Statistics live birth infant death cohort files from 1995–2001. Singleton live births to U.S. resident mothers were selected. The analyses were limited to non-Hispanic American Indians, including Aleuts and Eskimos (n = 239,494), Non-Hispanic White (n = 15,488,133), and Hispanic births (n = 5,284,978). Results This comparison of birth characteristics and outcomes by ethnic group revealed that AIs have more adverse maternal risk factors (e.g., unmarried and <18 years of age) than Whites and Hispanics. After adjustment for these factors, AIs have higher risks of low birth weight and preterm birth and elevated risks of postneonatal and infant mortality. Their cause-specific rates for perinatal, SIDS, injury and infection are also higher. The regional analysis indicated the South/Northeast have more low birth weight and preterm problems, but the Mid-West has the highest risks of infant mortality among LBW infants gestational age-specific mortality rates, and mortality from SIDS. Conclusions These data show that AIs are not a homogenous group as evinced by distinct regional differences. SIDS is mainly a problem in the Mid-West, suggesting the involvement of environmental factors in that region. Further investigation is needed to examine the current AI perinatal health concerns.     

Infant Health and Future Childhood Adversity

Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child’s ACE exposures at age 5, controlling for factors that preceded the child’s birth, including the mother’s sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents’ criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14–2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07–2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.     

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.     

One Key Question<Superscript>®</Superscript>: First Things First in Reproductive Health

Objectives Preconceptional health care is increasingly recognized as important to promotion of healthy birth outcomes. Preconceptional care offers an opportunity to influence pregnancy timing and intent and mother’s health status prior to conception, all predictors of individual outcomes and of inequality in birth outcomes based on race, ethnicity and class. Methods One Key Question, a promising practice developed in Oregon which is now attracting national interest, provides an entry point into preconceptional care by calling on providers to screen for pregnancy intent in well woman and chronic disease care for women of reproductive age. For women who choose not to become pregnant or are not definitive in their pregnancy intent, One Key Question provides an opportunity for provision of or referral to counseling and contraceptive care. Results Adoption of One Key Question and preconceptional care as standard practices will require important shifts in medical practice challenging the longstanding schism between well woman care generally and reproductive care in particular. Adoption will also require shifts in cultural norms which define the onset of pregnancy as the appropriate starting point for attention to infant health. Conclusions for Practice This commentary reviews the case for preconceptional care, presents the rationale for One Key Question as a strategy for linking primary care to preconceptional and/or contraceptive care for women, outlines what is entailed in implementation of One Key Question in a health care setting, and suggests ways to build community support for preconceptional health.     

Prepregnancy Obesity and Birth Outcomes

Objective To investigate the association between prepregnancy obesity and birth outcomes using fixed effect models comparing siblings from the same mother. Methods A total of 7496 births to 3990 mothers from the National Longitudinal Survey of Youth 1979 survey are examined. Outcomes include macrosomia, gestational length, incidence of low birthweight, preterm birth, large and small for gestational age (LGA, SGA), c-section, infant doctor visits, mother’s and infant’s days in hospital post-partum, whether the mother breastfed, and duration of breastfeeding. Association of outcomes with maternal pre-pregnancy obesity was examined using Ordinary Least Squares (OLS) regression to compare across mothers and fixed effects to compare within families. Results In fixed effect models we find no statistically significant association between most outcomes and prepregnancy obesity with the exception of LGA, SGA, low birth weight, and preterm birth. We find that prepregnancy obesity is associated with a with lower risk of low birthweight, SGA, and preterm birth but controlling for prepregnancy obesity, increases in GWG lead to increased risk of LGA. Conclusions Contrary to previous studies, which have found that maternal obesity increases the risk of c-section, macrosomia, and LGA, while decreasing the probability of breastfeeding, our sibling comparison models reveal no such association. In fact, our results suggest a protective effect of obesity in that women who are obese prepregnancy have longer gestation lengths, and are less likely to give birth to a preterm or low birthweight infant.