Perinatal Periods of Risk (PPOR) serve as an integrated analytical and community-based approach to improving perinatal outcomes across urban communities. NJ has been conducting regional fetal-infant mortality reviews (FIMR) for several years. A PPOR analysis was conducted to enhance the sampling strategy of FIMR cases reviewed and identify racial/ethnic differences in mortality.

Using Phase I PPOR analytic methods, excess fetal mortality was assessed for fetal-infant deaths from 2018-2021. Using a reference group consisting of White, NH, NJ residents over the age of 20 with 13+ years of education, PPOR results identified the total excess mortality rate was 7.9 deaths (per 1,000) live births among the sample of Black, NH infants compared to 0.65 for White, NH infants and 2.16 for Hispanic infants. The excess fetal-infant mortality rate was highest among Black, NH infants in each PPOR category (maternal health/prematurity, maternal care, newborn care, and infant health) compared to White, NH and Hispanic infants. In the maternal health/prematurity period, the Black, NH excess mortality rate (3.57 per 1,000) was 29.8 times higher compared to the White, NH excess mortality rate (0.12 per 1,000).

These results are consistent with other PPOR studies; however, the varied geographic landscape of NJ presents a unique challenge to identifying preventative care measures statewide (e.g., addressing social/environmental barriers in urban settings, increased access to regional perinatal centers in rural areas with limited public transportation). These results provide a basis to identify community approaches through FIMR reviews to reduce fetal-infant mortality, especially within the Black, NH population.

Background: Healthcare utilization and hospital-switching patterns have not been well-studied among pregnancy-related deaths. Lack of continuity of care has been identified as a contributing factor to pregnancy-related mortality.

Methods: California’s Pregnancy Mortality Surveillance System identified 307 non-COVID pregnancy-related deaths in 2017-2021. We examined patient characteristics associated with higher frequencies of ED visits and multiple hospitals (defined as 2+ visits or hospitals) accessed during or after pregnancy. Data sources included linked vital records with hospital data, coroner and medical records. Quality improvement opportunities (QIOs) were identified from in-depth committee reviews of a subset of deaths (n=58).

Results: Among 307 pregnancy-related deaths, 89 individuals (29%) accessed the ED multiple times during or after pregnancy (range 2-29) and 114 (37%) accessed multiple hospitals (range 2-9). Similar characteristics were significantly associated with having 2+ ED visits or accessing 2+ hospitals, including Black or Hispanic race/ethnicity, public insurance, pre-existing medical conditions, substance use, and mental health conditions. Examples of QIOs identified from in-depth committee review of those with multiple ED visits include creating a registry for higher-risk patients; utilizing health information exchanges to share inter-facility data; providing respectful patient-centered care; documenting reasons for leaving against medical advice; and providing social work and wrap-around referrals for pregnant/postpartum patients with complex issues.

Conclusion: Having frequent ED visits or accessing care at multiple hospitals is associated with complex medical issues but may also represent dissatisfaction with care, mistrust, interpersonal or structural discrimination. Further research should focus on developing system-level approaches to improve maternity care and decrease pregnancy-related mortality.

Background

The American Academy of Pediatrics recommends infants sleep Alone, on their Back, and in an empty Crib (ABCs of Safe Sleep) to reduce the risk of sleep-related infant death. In 2022, more than 90% of new mothers in Franklin County reported being told the ABCs of Safe Sleep by a health care provider, yet only 52% said their baby usually sleeps alone on recommended surfaces. Meanwhile, in 2022 Franklin County recorded the highest number of sleep-related infant deaths in more than a decade.

Methods

Home visiting staff interviewed clients with children under the age of two. Clients were asked: “What sorts of things do you do to keep your baby safe while sleeping?” and “What parts of the ABCs of safe sleep do work for you? What parts don't work for you?” Demographic data were also collected. Data were captured using a REDCap® survey and analyzed using ATLAS.ti.

Results

Staff documented 151 interviews during a 5-week collection period. Of the interviewees, a majority were black (65%) and about a quarter were Hispanic. Most clients reported adhering to the ABCs of Safe Sleep but several respondents cited cultural norms or desire to closely monitor their children as reasons for not following guidance.

Conclusion

These qualitative data help public health program staff understand safe sleep barriers within the community. Results can be used to inform more effective messaging and interventions.

Background

Developed in 1987, the Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of Centers for Disease Control and Prevention and health departments. PRAMS is a population- and jurisdiction-based surveillance system, collecting data on experiences and behaviors among mothers with a live birth before, during, and shortly after pregnancy.

Methods

We examined the impact of several recent enhancements to the PRAMS surveillance system including a new web survey module (WSM) for data collection, new survey revision, new PRAMS social determinants of health (SDOH) supplement, and release of the PRAMS automated research file (ARF). We will assess the WSM effect on response rates and impact of the PRAMS ARF, which has streamlined access to PRAMS data.

Results

The WSM data collection option was implemented in summer 2023 in 94% (47/50) sites to reduce collection burden by sites and increase response rates. Ninety percent (47/52) of current and former PRAMS sites are participating in the ARF, where data are available without requiring research proposal submission. In six weeks of the ARF launch, total ARF data requests exceeded all PRAMS data requests in 2023 (265 versus 186). Mental health and general maternal health were most frequently downloaded standard datasets. COVID-19 maternal experiences (19%), prescription opioid use (19%), and COVID-19 vaccine (17%) were most frequently downloaded supplements, and 68% of requests were from academic institutions. We will discuss the new questionnaire implemented in 2023 and 2022 SDOH supplement results.

Conclusion

Recent enhancements to PRAMS have improved data availability, accessibility, reach, and efficiency.

Background

Cardiovascular disease (CVD) is the leading cause of pregnancy-related (PR) deaths in California. Individual-level risk factors for PR-CVD deaths have been extensively researched, but the impact of community-level characteristics remains less explored. We examined the relationship between census-tract-level community characteristics and PR-CVD mortality.

Methods

The California Pregnancy Mortality Surveillance System identified 106 PR-CVD deaths (2015-2019). Data on live births and community-level maternal characteristics indicators were extracted from California’s vital records. Selected community indicators were obtained from the California Healthy Places Index. Indicators were divided into quartiles to measure community well-being at the census-tract-level, from least healthy (Q1) to most healthy (Q4). Relative risks (RR) and 95% Confidence Intervals (CI) were estimated for each indicator using modified Poisson regression models adjusted for maternal age, race/ethnicity, and nativity.

Results

Birthing persons residing in Q1 communities with highly prevalent obesity had a nearly 5-fold higher risk of PR-CVD mortality compared to those in Q4 communities (RR 4.5, 95% CI 1.6-12.8). Similar disparities were observed among other community characteristics: those in Q1 with highly prevalent diabetes (RR 3.3, 95% CI 1.4-7.7), limited healthcare access (RR 3.3, 95% CI 1.2-8.8), hypertension (RR 2.5, 95% CI 1.2-5.2), and no prenatal care (RR 2.5, 95% CI 1.0-6.2) exhibited significantly higher risks of PR-CVD mortality compared to those in Q4 communities.

Conclusions

Residing in communities with highly prevalent chronic health conditions, limited access to healthcare, or no prenatal care exacerbates the risk of PR-CVD mortality. Community-level interventions are required to improve population health, ultimately reducing PR-CVD mortality.

background: To identify a potential interaction between parity, body mass index (BMI), duration of fertility, and duration of menopause, as independent exposures, in association with osteoporotic fracture (wrist, spine, or hip) in postmenopausal women. methods: In this case-control study (N=233), we analyzed data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models assessed the main effects of parity, BMI, duration of fertility, and duration of menopause, and tested their two-way interaction adjusting for covariates. results: There were 54 women in the osteoporotic fracture group and 179 women in the control group. The mean age at screening was 74.0 years, SD±6.2, the mean parity was 2.4 children, SD±1.3, the mean BMI was 28.4, SD±1.5, the mean duration of fertility was 34.9 years, SD±5.8, and the mean duration of menopause was 19.9 years, SD±10.6. The main effect on postmenopausal osteoporotic fracture was the strongest for every SD increase in year of fertility (aOR 4.56, 95% CI: 4.53, 4.59), followed by every SD increase in BMI (aOR 1.26, 95% CI: 1.26, 1.26). The highest significant synergistic interaction was observed between parity and duration of fertility on the (aOR 20.05, 95% CI: 19.88, 20.03). conclusions: This study demonstrated evidence that the odds of fracture are likely amplified by parity and duration of fertility. Findings from this study will help to improve our understanding of factors contributing to fractures in postmenopausal women with osteoporosis, and inform prevention planning.

Background: Early intervention and individual education plans (IEPs) are key strategies for supporting children with autism spectrum disorder (ASD). The complexity of ASD is compounded by its association with adverse childhood experiences (ACEs), which can delay or impede access to crucial diagnostic and intervention services. This study aims to explore how ASD severity affects the likelihood of receiving special education or early intervention plans, and whether the number of ACEs modifies this association.

Methods: This study used the 2020-2021 National Survey of Children’s Health (NSCH) and included 2,537 children aged 3-17 years old who currently have ASD. Multivariable logistic regression, controlling for demographic and family characteristics and health status, was used to explore the association between autism severity and having an early intervention plan. The analysis was stratified by the number of ACEs to explore their role in the association.

Results: Children with moderate or severe ASD were more likely to have a special education or early intervention plan (aOR: 1.51, 95% CI: 1.06-2.15) than those with mild ASD. When stratifying by ACEs, this association was significant in children who experienced 1 ACE (aOR: 2.14, 95%CI: 1.02-4.49) but not in those with no ACEs (aOR: 1.10, 95%CI: 0.71-1.98). A non-significant association was seen in children with 2 or more ACEs (aOR: 1.81, 95%CI: 0.90-3.63).

Conclusion: Results demonstrate that children with moderate or severe autism were more likely to receive early intervention or special education. This association changed depending on the number of ACEs experiences.

Introduction: Maternal willingness to receive a vaccination plays a crucial role in achieving desired vaccination rates. This study aimed to inform policy regarding hepatitis B vaccination for newborns by examining the willingness and associated factors among postpartum mothers receiving services at Kawempe National Referral Hospital.

Methods: This cross-sectional study enrolled 190 postpartum mothers through systematic sampling. Descriptive statistics were employed to analyze frequencies and proportions. Bivariate and multivariate logistic regressions were conducted to identify factors influencing the acceptance of the hepatitis B birth dose.

Results: The willingness to receive a hepatitis B birth dose was 53.2%. According to the multivariate model, mothers who were willing to receive HBV vaccines birth dose were those who participated in HBV birth dose health education (aOR=30.597; 95% CI: 13.623 to 68.72; p<0.001) and who received family support such as transportation (aOR=1.9; 95% CI: 1.003 to 3.5; p<0.001). Additionally, the factors associated with willingness to vaccinate babies at birth were availability (aOR=0.32; 95% CI: 0.12 to 0.8; p=0.015) and affordability (aOR=0.32; 95% CI: 0.12 to 0.8; p=0.015) of hepatitis B vaccines.

Conclusion: The level of willingness to receive a hepatitis B birth dose is less than desirable. The findings of this study underscore the importance of targeted health education initiatives and family support in promoting maternal willingness to receive the hepatitis B birth dose vaccination. However, challenges related to availability and affordability could hinder the achievement of higher vaccination rates. Addressing these barriers through policy measures will be crucial to enhancing vaccination coverage.

Background: Substance use disorder (SUD) during pregnancy and postpartum is associated with adverse maternal and infant health outcomes. We used statewide hospital discharge data to describe the burden of SUD in Michigan (MI) and examine social factors and comorbidities including selected mental health conditions associated with maternal SUD in MI.

Methods: Data from inpatient birth hospitalizations during 2018-2020 among MI residents were used for this cross-sectional statewide study (n=115,309). SUD was defined using a validated approach with ICD-10-CM codes and excluded alcohol use and tobacco use disorder. Social factors included Medicaid insurance, race/ethnicity, median household income by zip code in quartiles (Q), and rural-urban status. Comorbidities (excluding SUD) were determined from ICD-10-CM codes using a validated measure. Adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Overall SUD prevalence was 2.1% (n=2460). Prevalence was 4.2% among Medicaid deliveries (0.76% in non-Medicaid deliveries) and highest among Native American (4.0%), followed by Black (3.5%), White (2.0%), and Hispanic women (1.9%). In adjusted models, factors associated with increased odds of SUD included Medicaid (OR=4.88, 95%CI:4.38-5.43), lower income (OR for Q4 vs. Q1=2.64, 95%CI:2.06-3.38), number of comorbidities (OR for one comorbidity:2.03, 95%CI:1.85-2.22; ≥two comorbidities: OR=4.2, 3.81-4.60) and depression (OR=3.60, 95%CI:3.21-4.10).

Conclusions: Findings show a higher maternal SUD burden in women of lower socioeconomic status and with co-occurring medical conditions including depression, which further increases risk of maternal and infant adverse health outcomes. Results highlight the importance of careful monitoring and support of postpartum women with SUD.

There is limited knowledge on relationship between adverse birth outcomes and childhood physical activity, and the influence of race on this association. Our objective was to explore the association between adverse birth outcomes (preterm birth and low birth weight) and physical activity (PA) patterns during childhood, stratified by race/ethnicity.

Data were collected through the National Survey of Children’s Health from 2016 to 2019. This cross-sectional study included 131,774 children aged 0-17 years. Exposures comprised of adverse birth outcomes including preterm birth (PTB) and low birth weight (LBW). Outcome was measured as PA defined as number of days the child exercised per week. Multinomial logistic regression was used to explore the associations.

Of 131,774 participants, 10,227 were born LBW (9.12%; 95% CI: 8.77%-9.49%) and 14,058 were PTB (11.35%; 95% CI: 10.94%-11.76%). Children born with LBW were 26% less likely to engage in PA 4-6 days/week (RRR 0.74, 95% CI: 0.68-0.82) compared to normal birthweight born children, while those born preterm were 13% less likely (RRR 0.87, 95% CI: 0.81-0.94) than those with term births. Associations varied by race/ethnicity, with Non-Hispanic White versus Non-Hispanic Black RRRs of 24% vs. 18% for LBW and 16% vs. 1% for PTB, respectively.

Our study found that adverse birth outcomes such as LBW and PTB are associated with decreased levels of childhood PA. Moreover, we found that these associations vary across racial and ethnic groups, suggesting a need for targeted interventions to address disparities in physical activity engagement and ultimately improve birth outcomes in diverse populations.