Asking About Childhood Adversity in the Prenatal Care Setting: Cross-Sectional Associations with Maternal Health and Mental Health Outcomes.

OBJECTIVES: Adverse childhood experiences (ACEs) are associated with poor physical and mental health outcomes in pregnancy, prompting many care agencies to ask about ACEs as part of routine care. However, limited research has been conducted in the clinical setting to demonstrate associations between ACEs and maternal health (i.e., pregnancy complications and birth outcomes) and mental health in pregnancy (i.e., depression, anxiety, and substance use). The aims of the current study were to: (1) examine the prevalence of ACEs reported by patients attending a maternity clinic for medically low-risk patients, and (2) evaluate whether these reports were associated with prenatal health and mental health. METHODS: Participants included pregnant women (n = 338) receiving prenatal care at a low-risk outpatient medical clinical from June 2017 to December 2018. Total ACE scores, pregnancy complications (e.g., gestational hypertension, preeclampsia), birth outcomes (e.g., Apgar scores, preterm birth), and mental health outcomes (i.e., anxiety, depression, and substance use) were extracted from electronic medical records. RESULTS: The majority of women (67.8%) reported experiencing no ACEs, 16.0% reported one ACE, 10.1% reported two ACEs, and 6.2% reported three or more ACEs. ACEs were associated with increased odds of prenatal depression, anxiety, and substance use in a dose-response fashion, but not pregnancy health or birth outcomes. CONCLUSIONS FOR PRACTICE: Prevalence rates of maternal ACEs obtained in the prenatal care setting were low compared to the general population. While ACEs were positively associated with maternal mental health and substance use in pregnancy, they were not associated with pregnancy complications.

Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study.

BACKGROUND: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospective file review, the current study evaluated whether differences in pregnancy health and infant birth outcomes were observed from before to after the implementation of a TIC approach in a low-risk maternity clinic, serving women of low medical risk. METHODS: Demographic and health data were extracted from the medical records of 601 women (n = 338 TIC care, n = 263 pre-TIC initiative) who received prenatal care at a low-risk maternity clinic. Cumulative risk scores for maternal pregnancy health and infant birth outcomes were completed by health professionals. RESULTS: Using independent chi-squared tests, the proportion of women without pregnancy health risks did not differ for women from before to after the implementation of TIC, χ2 (2, 601) = 3.75, p = 0.15. Infants of mothers who received TIC were less likely to have a health risk at birth, χ2 (2, 519) = 6.17, p = 0.046. CONCLUSION: A TIC approach conveyed modest benefits for infant outcomes, but not maternal health in pregnancy. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk.

Does screening for maternal ACEs in prenatal care predict pregnancy health risk above and beyond demographic and routine mental health screening?

BACKGROUND: Adverse childhood experiences (ACEs), including abuse, neglect, and/or household dysfunction, are associated with physical and mental health difficulties in pregnancy and the postpartum period. These associations have prompted the adoption of screening for ACEs in prenatal care settings; however, little is known about whether asking about ACEs in the prenatal care context is additive to other forms of routine prenatal demographic and mental health screening. OBJECTIVE: To identify whether ACEs are predictive of cumulative pregnancy health risk and identify whether ACEs predict maternal health risks in pregnancy above and beyond screening for financial stress, depression, and anxiety. PARTICIPANTS AND SETTING: The electronic medical records of three hundred and thirty-eight patients who accessed prenatal care at a low-risk primary care maternity clinic were included. METHODS: Women retrospectively self-reported their ACEs during their second prenatal primary care visit (~20 weeks' gestation) and reported financial stress as well as their depressive and anxious symptoms using the PHQ-2 and GAD-2. Health risk factors and complications were documented by healthcare providers in the files at birth. Approximately 32% of patients reported at least one ACE. RESULTS: Regression analyses revealed that after accounting for financial stress, neither depression nor anxiety predicted cumulative health risk in the antenatal period. ACEs significantly predicted cumulative health risk (B = 0.14, p = .02) and an additional 1.7% of variance in the outcome. However, the model only accounted for 5.0% of the variance in cumulative health risk. CONCLUSIONS: The total health risk predicted by demographic and ACEs screening is modest in this low-risk sample. Additional research on the implications of broader trauma-informed approaches is needed to evaluate their impact.

Swarm-cell differentiation in Salmonella enterica serovar typhimurium results in elevated resistance to multiple antibiotics.

Although a wealth of knowledge exists about the molecular and biochemical mechanisms governing the swimming motility of Salmonella enterica serovar Typhimurium, its surface swarming behavior has not been extensively characterized. When inoculated onto a semisolid agar medium supplemented with appropriate nutrients, serovar Typhimurium undergoes a morphological differentiation whereby single cells hyperflagellate and elongate into nonseptate, multinucleate swarm cells. Swarm migration is a collective behavior of groups of cells. We have isolated a MudJ insertion mutant of serovar Typhimurium 14028 that failed to swarm under any conditions. The site of the MudJ insertion was determined to be in the pmrK locus within the pmrHFIJKLM operon, which was previously demonstrated to confer resistance to cationic antimicrobial peptides. beta-Galactosidase assays, using the pmrK::lacZ transcriptional fusion, showed increased expression of the pmr operon in swarm cells compared to that in vegetative cells. In concurrence with the expression data, swarm cells exhibited greater tolerance to polymyxin. To compare the profiles of vegetative and swarm-cell resistance to other antibiotics, E-test strips representing a wide range of antibiotic classes were used. Swarm cells exhibited elevated resistance to a variety of antibiotics, including those that target the cell envelope, protein translation, DNA replication, and transcription. These observations, in addition to the dramatic morphological changes associated with the swarming phenotype, provide an intriguing model for examining global differences between the physiological states of vegetative and swarm cells of serovar Typhimurium.