Abstract
First trimester bacterial vaginosis (BV) and vaginal microbiomes of pregnant women in New Orleans: Establishing clinical relevance
Kerri Wizner, MPH1, Kaaren Kargbo-Reffell, BS2 and Emily W. Harville, PhD2
(1)Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, (2)Tulane University, New Orleans, LA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Research focus on human microbiomes has documented associations between bacterial vaginosis (BV) and negative pregnancy outcomes. The NHANES estimates BV prevalence in U.S. women ages 14–49 to be 21.2 million (29.2%) with higher rates in pregnant women and minorities. The dynamic vaginal microbiome during pregnancy is not well cataloged but is essential to exploring what should be considered clinically relevant. This study collected vaginal swabs from 69 non-HIV, first trimester pregnant, adult women living in New Orleans, Louisiana. 52 (75.4%) identified as African-American, 44 (63.8%) had at least some high school education, and 52 (80%) had at least one prior pregnancy. Swabs were analyzed using Nugent scoring (a common clinical diagnostic for BV). Initial results found that 46.4% (11.6% intermediate and 34.8% strong) of participants had a Nugent score indicative of BV. Of the 69 participants, 8 (11.6%) had pre-term deliveries; 5 (62.5%) of the pre-term mothers had clinical BV in their first trimester, all of which were considered strong cases of BV. 17.9% of participants tested positive for yeast, an important cofactor in vaginal microbiomes; of those, 75.0% did not have BV. DNA profiling using 16s DNA extractions of this cohort will provide a better picture of what microbes may be considered abnormal and of clinical relevance. This is an important step towards targeted clinical care for pregnant women with BV to improve pregnancy outcomes.
Basic medical science applied in public health Clinical medicine applied in public health Public health biology Public health or related research
Abstract
Tested Tools to Support Hospitals Achieving the Ten Steps to Successful Breastfeeding
Kathy Parry, MPH, IBCLC, LMBT1 and Catherine Sullivan, MPH, RD, LDN, IBCLC, FAND2
(1)Ms., Chapel Hill, NC, (2)University of North Carolina at Chapel Hill, Chapel Hill, NC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The new Lancet Series on breastfeeding reveals that through universal breastfeeding, US$300 billion could be saved in addition to the lives of over 800,000 children. The Baby Friendly Hospital Initiative and its Ten Steps to Successful Breastfeeding (Ten Steps) serve this goal, and were recently endorsed in the ACOG Committee on Obstetric Practice Opinion. Hospitals working toward implementing the Ten Steps need support. This study tested materials designed for Step 3.
Methods
Participating mothers received a voluntary pre- and post-questionniare before and after education with the materials. Feeding intentions were measured using the Infant Feeding Intention (IFI) Scale. Recognition of infant feeding cues, knowledge of optimal maternity care practices, and formula feeding comfort were assessed for positive change.
Results
99% of participants (n=416) found the session acceptable on each of 5 measures. Session participation resulted in a significant increase in participants' IFI Scale scores (p < 0.0001). Participation significantly increased identification of early infant feeding cues (p < 0.0001), and knowledge improvement on maternity care practices: skin-to-skin (p < 0.0001), rooming-in (p < 0.0001) and identification of supplementation risks (p < 0.0001). Formula feeding comfort decreased after participation (p < 0.0001).
Conclusions
Prenatal education with these tools increase IFI Scale scores and thus have potential to improve breastfeeding rates while reducing comfort with the idea of formula feeding, which has been shown to explain much of the disparity among black mothers' intention to breastfeed. These free materials, along with other resources, may help support hospitals to achieve the Ten Steps.
Administer health education strategies, interventions and programs Diversity and culture Implementation of health education strategies, interventions and programs
Abstract
Maternal complications during pregnancy and adverse perinatal outcomes in rural Bangladesh
Rasheda Khanam, MBBS, MPH, PhD1, Saifuddin Ahmed2, Andreea Creanga, MD, PhD3 and Abdullah H. Baqui, DrPH, MPH, MBBS3
(1)Johns Hopkins University, Baltimore, MD, (2)Hohns Hopkins University, Baltimore, MD, (3)Johns Hopkins University School of Public Health, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Despite impressive declines in maternal mortality globally, rates of maternal complications during pregnancy remain high contributing to the high rates of perinatal deaths. This study examines patterns of maternal complications during pregnancy and risk of perinatal deaths associated with these complications.
Methods: We used survey data from 6,285 women on self-reported maternal complications, care seeking and pregnancy outcomes in Sylhet district, Bangladesh. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths), three binary exposure variables (antepartum hemorrhage, probable infection, and probable pregnancy-induced hypertension) and conducted multivaraible Poisson regression to estimate risk ratios and population attributable fractions for adverse perinatal outcomes associated with pregnancy complications.
Results: We identified 356 perinatal deaths; 195 stillbirths and 161 early neonatal deaths. Antepartum hemorrhage was associated with the highest risks of deaths (perinatal deaths: RR=3.5, 95% CI, 2.4; 5.0; stillbirths: RR=3.7, 95% CI 2.3; 5.9; early neonatal deaths: RR=3.2, 95% CI 1.8; 5.5). Pregnancy-induced hypertension was a risk factor for stillbirths (RR=1.8, 95% CI 1.3; 2.5) while probable infection was significantly associated with early neonatal deaths (RR=1.5, 95% CI 1.1-2.3). Population attributable fractions of perinatal mortality associated with antepartum hemorrhage and pregnancy-induced hypertension were 7% and 10% respectively, mostly due to increased risk of stillbirths (8% for antepartum hemorrhage and 15% for probable pregnancy-induced hypertension).
Conclusions: Identifying maternal complications during pregnancy and ensuring access to adequate antenatal and obstetric care is key to reducing adverse perinatal outcomes in a setting where most deliveries occur at home.
Advocacy for health and health education Assessment of individual and community needs for health education
Abstract
Growth Trajectories of Infants Born to Obese Low-income African American Women
Caitlin Murphy1, Susan Gross, PhD, MPH, RD, LDN2, Marycatherine Augustyn, PhD2, Janice Henderson, MD, MA3, Patricia Waddy1 and David Paige, MD MPH1
(1)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, (3)Johns Hopkins University, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Infants born to obese mothers are at an increased risk of being large for gestational age (LGA). Infants who gain weight rapidly during the first few months or years of life may be at increased risk for obesity and related adverse health outcomes across the lifespan. The objective was to examine the growth trajectories of infants born to obese women.
Methods: The data was from a randomized clinical trial of obese postpartum women who received Johns Hopkins WIC Program services and prenatal care from the Johns Hopkins Nutrition in Pregnancy Clinic. Women were recruited prenatally. Infant weight for length (wt/lt) was assessed at birth and 6 months. Wt/lt percentile (%tile) was categorized as small <=5%tile, normal 15-85%tile, and large >=85%tile.
Results: 53 African-American women participated. At birth 24.5% of infants' wt/lt =<15%tile and 45.3% wt/lt =>85%tile. At 6 months, 7.5% of infants' wt/lt=<15%tile and 52.8% wt/lt =>85%tile. 35.8% of infants were >=85%tile at birth and at 6 months. 17.0% of infants were born in the small or normal range and reached the 85%tile by 6 months.
Conclusions: Maternal obesity may contribute to abnormal infant growth trajectories. Interventions targeting obese pregnant women could impact growth in infancy and improve health outcomes across the life course.
Chronic disease management and prevention Public health or related research
Abstract
Severe Maternal Morbidity Among Pregnancy-Related Discharges in Mississippi, 2010-2012
Charlene Collier, MD, MPH, MHS, FACOG1, Manuela Staneva, MPH1, James Martin Jr., MD, FACOG, FRCOG2 and Lei Zhang, PhD, MSc, MBA1
(1)Mississippi State Department of Health, Jackson, MS, (2)University of Mississippi Medical Center, Jackson, MS
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Severe maternal morbidity, often called near-miss events, are over 100 times more common than maternal mortality. The purpose of this study was to identify the prevalence of severe maternal morbidity (SMM) diagnoses and associated patient characteristics among pregnancy related discharges, utilizing Mississippi's hospital discharge data for 2010 through 2012.
Methods: We identified severe maternal morbidity diagnoses among all pregnancy related discharges using ICD-9-CM diagnostic and CPT procedural codes. Deaths were analyzed separately. We further identified if SMM events were related to early pregnancy complications (abortions, ectopic, molar), delivery discharges, postpartum discharges and other/antepartum hospitalizations. We evaluated patient race, residence, hospital charges and length of stay.
Findings: There were 2,911 discharges with SMM diagnoses from 2010-12 in MS, reflecting a rate of 246 events per 10,000 pregnancy related discharges. The number of hospitalizations with at least one SMM diagnoses was 952 in 2010, 992 in 2011 and 967 in 2012. During this time there were 26 maternal deaths, 23 of which had an associated SMM diagnoses. Blood transfusion was the leading SMM diagnoses identified among 1,677 discharges. The greatest number of SMM diagnoses occurred during delivery hospitalizations (1,815, 62.3%), followed by post-partum hospitalizations (516, 17.7%) then other/antepartum hospitalizations (362, 12.4%). Compared to women without SMM, women with SMM diagnoses were more likely to be African-American (55.4% vs. 43.6%, p = 0.001) and non-metro county residents (58.9% vs. 55.3%, p = 0.001). The mean charges ($30.874.3 vs. $13,818.6, p = 0.001) and length of stay (4.3 days vs. 2.6 days, p = 0.001) were higher for SMM-related discharges.
Conclusion: In Mississippi, severe maternal morbidity events are increasingly common, costly and disproportionately affecting African-American women. SMM diagnoses occur across all stages of pregnancy, indicating a need for targeted safety initiatives to improve pregnancy outcomes.
Clinical medicine applied in public health Epidemiology Provision of health care to the public
Abstract
Prenatal Care Provider Perceptions of Gestational Weight Gain Counseling and Tracking During the Perinatal Period
Samantha Pinzl, MPH, CHES1, Anders Cedergren, PhD, CHES2, Emily Whitney, PhD, MCHES3, Keely Rees, PhD, MCHES4 and Brenda Rooney, PhD, MPH5
(1)Marathon County Health Department, Wausau, WI, (2)University of Wisconsin-La Crosse, La Crosse, WI, (3)University of Wisconsin - La Crosse, La Crosse, WI, (4)University of Wisconsin La Crosse, La Crosse, WI, (5)Gundersen Health System, La Crosse, WI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Research indicates a link between excessive gestational weight gain and adverse health risk factors for the mother and unborn child that can affect health decades post-delivery (Birdsong et. al, 2014). The obesity rate in women of reproductive years doubled over the past 20 years (Macleod et al., 2012). Almost 60% of the four million women who give birth annually begin pregnancy either overweight or obese (Stotland et al., 2010). This study provides insight on the knowledge and awareness prenatal care providers have on the 2009 Institute of Medicine guidelines for gestational weight gain, as well as the attitudes, beliefs, and practices regarding gestational weight gain counseling and tracking methods at a Midwestern healthcare system. Patient-Provider Communication Theory and Social Capital Theory were used to identify barriers for prenatal care providers in gestational weight gain counseling. Electronic surveys were administered to 63 prenatal care providers at a Midwestern healthcare system and regional clinics. Data were analyzed using Statistical Analysis System (SAS) software to determine correlations between provider demographics and knowledge of the 2009 Institute of Medicine gestational weight gain guidelines and barriers to effective gestational weight gain counseling. Significant correlations to knowledge of the guidelines included type of provider and number of pregnancies managed per year. The greatest barriers to effective gestational weight gain counseling were lack of patient compliance, lack of pateints' willingness to listen, and time constraints. Based on the findings of this research, interventions can be targeted at certain types of prenatal care providers or those who manage fewer pregnancies per year. An intervention incorporating a public health educator or nurse educator trained in motivational interviewing may provide a way to increase patient compliance and reduce time constraints during the providers' appointments.
Chronic disease management and prevention Other professions or practice related to public health Provision of health care to the public Public health or related education Public health or related organizational policy, standards, or other guidelines
Abstract
Interpregnancy interval and adverse birth outcomes in women of advanced age: A population–based study
Timothy Ihongbe, MBBS, MPH, PhD1, Sylvia Rozario, PhD, MPH, MBBS2, Jordyn Wallenborn, MPH1 and Saba Masho, MD, MPH, DrPH1
(1)Virginia Commonwealth University, Richmond, VA, (2)Virginia Commonwealth University, School of Humanities and Sciences, Richmond, VA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Delayed childbearing is a growing trend in the US. Rates of first births to women 35-39 years increased from 2.1 to 11.0 per 1000 live births between 1970 and 2012. This study aims to examine the association between interpregnancy interval (IPI) and adverse birth outcomes in women of advanced age.
Methods
This study utilized the 2014 public-use natality data. Analysis was restricted to women 35 years and older with second- or higher-order singleton births in 47 states of the US and the District of Columbia (N=396,032) which utilized the 2003 revised birth certificate as of January 1, 2014. IPI was defined as the time interval between a live birth and conception of a subsequent live birth and was categorized into five categories (0-5, 6-11, 12-17, 18-23 and ≥24 months). Birth outcomes examined include gestational age at time of delivery [extremely preterm (<28 weeks), very preterm (28-<32 weeks), moderate-to-late preterm (32-<37 weeks) and post-term (≥42 weeks) births] and birthweight [extremely low birthweight (<1,000g), very low birthweight (<1,500g), low birthweight (<2,500g) and macrosomia (≥4,000g)]. Multinomial logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals for the association.
Results
A U-shaped relationship between IPI and adverse birth outcomes was observed. IPIs of 0-5 and ≥24 months significantly increased the odds of all categories of preterm birth (aOR range=1.27-1.69 and 1.26-1.64, respectively) and low birthweight (aOR range=1.21-1.70 and 1.42-1.82, respectively), and post-term birth (aOR=1.92, 95% CI=1.74-2.12 and aOR=1.08, 95% CI=1.02-1.15, respectively), but reduced the odds of macrosomia (aOR=0.92, 95% CI=0.85-0.99 and aOR=0.87, 95% CI=0.84-0.90, respectively). Decreasing odds of post-term birth were observed as IPI increased from 0-5 to ≥24 months. The odds of preterm birth and low birthweight were not statistically significant for IPIs of 6-11 and 12-17 months.
Conclusions
The risk of adverse birth outcomes increases with both short and long IPIs in women of advanced age. This highlights the need to counsel women of advanced age to wait for at least 12 months after delivery before subsequent conception.
Public health or related research
Abstract
Evaluation of a medical home intervention to prevent rapid repeat pregnancies in teen mothers
Amy Lewin, PsyD1, Stephanie Mitchell, PhD2, Michel Boudreaux, PhD1 and Lee Beers, MD3
(1)University of Maryland, College Park, MD, (2)University of Maryland, (3)Children's National Health System, Washington, DC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Teen childbearing is associated with adverse outcomes for both mothers and children, and teens who have a repeat birth are at risk for additional adverse outcomes. Secondary teen pregnancy prevention has become a public health goal, but no specific intervention has emerged as a standard model. We examined the effect of a primary care medical home intervention on rapid repeat pregnancies in teen mothers.
Methods: We compared teen mothers enrolled in the intervention with a cohort of demographically similar teen mothers enrolled in standard primary care. Data were collected in-person with 150 African American teen mothers at baseline (child age 2 months) and two follow-ups (child age 12 and 24 months).
Results: Intent-to-treat analyses indicated that significantly fewer mothers in the intervention had repeat pregnancies by 24 months (29% vs. 49%; p=0.04). Mothers in the intervention group were more likely to use contraceptives at 12 months (OR=3.18; p=0.02) and at 24 months (OR=2.48; p=0.02) when controlling for baseline use. Bivariate analyses indicated that intervention mothers had steady use of contraception over time, but there was a decline in use among comparison mothers, suggesting that the intervention prevented contraceptive discontinuation. Additional analyses will compare data on program costs to program benefits.
Conclusions: This patient-centered medical home intervention is an innovative and effective model for preventing rapid repeat pregnancies among teen mothers. This model of care can easily be integrated into existing primary care settings in order to best support this vulnerable population of mothers and children.
Implementation of health education strategies, interventions and programs Program planning Public health or related research