Identifying Risk Factors for Cesarean Delivery in a Predominantly Hispanic Teenage Population: A 5-Year Retrospective Study.

STUDY OBJECTIVE: To identify risk factors for primary nonelective cesarean delivery, in a predominantly Hispanic teen population of an urban tertiary care center. DESIGN: Retrospective descriptive study. SETTING: A tertiary academic center with approximately 3000 deliveries per year. PARTICIPANTS: Our study population comprised all women (ages 13-19 years at time of delivery) who gave birth at our tertiary university hospital between July 2011 and July 2016. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Our main outcome of interest was primary nonelective cesarean delivery. RESULTS: Of the 958 included deliveries, 9.6% (92/958) were delivered via nonelective cesarean section. The population was 89% Hispanic with a mean age of 17.7 years. Age, body mass index at delivery, and neonatal birth weight were significantly associated with delivery via cesarean section. Mothers of neonates with extremes of birth weights (<2500 g, >4000 g) had higher odds of having a cesarean delivery, compared with neonates with normal birth weight (odds ratio, 3.27; 95% confidence interval, 1.90-5.63 and odds ratio, 4.43; 95% confidence interval, 1.33-14.72). CONCLUSION: Among adolescent patients, age, body mass index at delivery, and birth weight of the neonate were found to be risk factors that place the gravid teen at increased risk for cesarean delivery.

Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort.

There is a clear need for effective strategies to address the factors that affect retention, or lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and (1) LTFU or (2) uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly diagnosed HIV-infected women in Kinshasa, DRC.

Low cholesterol is associated with depression among US household population.

OBJECTIVE: Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare. METHODS: We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005-2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. RESULTS: After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74-15.09), 1 (reference) and 2.28 (1.07-4.86) respectively for the men with lower (<169 mg/dL), intermediate (169-221 mg/dL), and upper quartile (≥ 222 mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59-5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66-2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women. LIMITATION: The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS: A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.