Increasing Prenatal Care Compliance in At-Risk Black Women: Findings from a RCT of Patient Navigation and Behavioral Incentives.

BACKGROUND: In the USA, infant mortality remains a major public health concern, particularly for Black women and their infants who continue to experience disproportionately high mortality rates. Prenatal care is a key determinant of infant health, with inadequate prenatal care increasing risk for prematurity, stillbirth, neonatal loss, and infant death. The aim of the present study was to determine if concurrent delivery of patient navigation and behavioral incentives to at-risk Black pregnant women could improve prenatal care attendance and associated maternal and infant outcomes. METHODS: Participants were 150 Black pregnant women recruited at first prenatal visit and screening at risk for adverse maternal and infant outcomes. Women were randomized to either the patient navigation + behavioral incentives intervention (PNBI) or assessment + standard care control (ASC) group. All were followed throughout pregnancy and 12-week postpartum. Group comparisons were made using intention-to-treat and per-protocol sensitivity analyses. RESULTS: While no group differences were found in prenatal care visits, the average number of visits for both groups (9.3 for PNBI and 8.9 for ASC) approached the American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. There were also no group differences in maternal and infant outcomes. Both intention-to-treat and per-protocol sensitivity analyses, however, consistently found PNBI women attended more postpartum visits than ASC controls (p = 0.002). CONCLUSIONS: Given ACOG's redefining of the postpartum period as the fourth trimester, study findings suggest PNBI may facilitate prevention and intervention efforts to more successfully reduce health disparities in outcomes for both mother and infant.

Pre-Pregnancy Intimate Partner Violence and Short Interbirth Interval: The Role of Insurance Status.

Short interbirth interval (IBI) has serious adverse health consequences, yet has an estimated prevalence of 35% in the United States. Similarly, intimate partner violence (IPV) around time of pregnancy, experienced by approximately 5% of women, is associated with increased risk of poor pregnancy outcomes. IPV might compromise women's decision-making, contributing to unintended pregnancy and short IBI. This study examines the relationship between pre-pregnancy IPV and short IBI, and whether insurance status moderates this relationship among multiparous women who responded to the 2009-2011 Pregnancy Risk Assessment Monitoring System survey (N = 13,675). Pre-pregnancy IPV (yes; no), insurance status (Private insurance; Medicaid/public insurance; no insurance), and short IBI (yes; no) were examined. Insurance status was identified as an effect modifier (p = .03), and maternal age, maternal and paternal education, marital status, and drinking alcohol were identified as potential confounders. Multiple logistic regression analysis stratified by insurance status provided adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CI). Overall, 4.6% of women reported IPV before pregnancy, and 48% had a short IBI. When stratified by insurance status, the odds of short IBI was about 3 times higher among women with no insurance and women on Medicaid/public insurance who reported IPV compared to women who did not report IPV (aOR = 3.36, 95% CI = [1.02, 8.02], and aOR = 2.50, 95% CI = [1.04, 5.92], respectively). There was no observed significant difference in the likelihood of short IBI by experience of IPV among privately insured women. Findings from this study strengthen the evidence that women who experience IPV before pregnancy are significantly more likely to have short IBI compared to women who do not experience pre-pregnancy IPV. Furthermore, the odds of short IBI is highest among women experiencing pre-pregnancy IPV who are uninsured or on Medicaid/public insurance.

Female genital mutilation and contraceptive use: findings from the 2014 Egypt demographic health survey.

OBJECTIVES: Female genital mutilation (FGM) includes procedures that remove partial or total external female genitalia, or causes other injury to female genital organs with no medical reason. Physical and psychological trauma associated with FGM may interfere with a woman's ability and intent to utilize contraception. Our study examines the association between FGM and utilization of contraception methods among sexually active reproductive-aged women in Egypt. METHODS: Data from the 2014 Egypt Demographic and Health Survey were analyzed (n = 20,055). Multinomial logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals. RESULTS: Our study found that FGM was performed on over 90% of Egyptian women and almost half (45%) of women did not use contraception. Women with FGM had significantly lower odds (OR = 0.6) of using barrier/natural contraceptive methods (e.g., condoms) than intrauterine devices (IUDs). However, women with FGM were more likely to use hormonal methods (OR = 1.2) than IUDs compared to those who had not experienced FGM. CONCLUSIONS: In order to promote women's health and support use of effective contraception methods, a large reduction in FGM practice is essential.

Intimate Partner Violence Around the Time of Pregnancy and Utilization of WIC Services.

OBJECTIVES: Intimate partner violence (IPV) around the time of pregnancy is a risk factor for adverse pregnancy and birth outcomes. The supplemental nutrition program for women, infants, and children (WIC), available to low income pregnant women, may provide an opportunity to identify victims of IPV and refer them to services. This cross-sectional study aims to determine whether WIC participants are more likely than non-WIC participants to have reported IPV before or during pregnancy in the United States. METHODS: The 2004-2011 National Pregnancy Risk Assessment Monitoring System (PRAMS) survey (n = 319,689) was analyzed in 2015. Self-reported WIC participation, pre-pregnancy IPV, and IPV during pregnancy were examined. The associations between IPV and WIC participation were analyzed using multiple logistic regression and adjusted odds ratios with corresponding 95% confidence intervals were calculated. Subpopulation analysis was conducted, stratified by race/ethnicity. RESULTS: Nearly half of the study sample received WIC (48.1%), approximately 4% of women reported physical abuse 12 months before their most recent pregnancy, and 3% reported abuse during pregnancy. After adjusting for confounders, women who reported IPV before and during pregnancy had significantly higher odds of WIC utilization compared to women who did not report IPV. However, when stratified by race, the association was only significant for non-Hispanic White women (pre-pregnancy AOR 1.47, 95% CI [1.17, 1.85]; during pregnancy AOR 1.47, 95% CI [1.14, 1.88]). CONCLUSIONS FOR PRACTICE: There is an association between IPV before and during pregnancy and utilization of WIC. Public health professionals and policy makers should be aware of this association and use this opportunity to screen and address the needs of WIC recipients.

Marital Status Disruptions and Internalizing Disorders of Children.

Marital disruption (i.e., separation or divorce) impacts an estimated 40-50% of married couples. Previous research has shown that marital disruption results in negative health outcomes for children and adolescents. Our study aims to investigate the relationship between marital disruptions and internalizing disorders of children in a prospective cohort. Comparisons between marital status groups at each time point showed a significant difference in CBCL score between children in married and unmarried families at 3 years of age, with children in unmarried families having a 0.10 higher standardized CBCL score (95% CI: 0.09-0.12; p<.0001). Differences in CBCL score by marital status were not significant at 5 and 9 years after adjusting for confounders. Parental marital status is associated with an increased CBCL internalizing behavior score at 3 years of age, but the association disappears at later time points.

Importance of Familial Opinions on Breastfeeding Practices: Differences Between Father, Mother, and Mother-in-Law.

Background: Multiple types of individuals compose a mother's social support network. Women may value opinions of individuals' within their support network differently. Our study examined the relationship between breastfeeding opinions from individuals within the social support network and breastfeeding initiation and duration. Materials and Methods: Data from the Infant Feeding Practices Survey II were analyzed. The importance of individuals' opinions on a mother's breastfeeding decision was investigated for the baby's father, the participant's mother and mother-in-law, the infant's pediatrician, and the participant's obstetrician. The main outcomes were breastfeeding initiation (yes; no) and breastfeeding duration (weeks). Logistic regression provided the odds of never breastfeeding, while Cox proportional hazard models were used to assess the risk of breastfeeding cessation. Results: Women who stated that the father's opinion was not at all important were more likely to never breastfeed and prematurely cease breastfeeding compared to women who stated that the father's opinion was very important for their breastfeeding decisions. Conversely, women had lower odds of never breastfeeding and a decreased risk of breastfeeding cessation if they reported that the mother-in-law's opinion was not at all important or not very important compared to women who reported that the mother-in-law was very important. No statistically significant relationship was found between the participant's mother and breastfeeding initiation and cessation. Conclusion: This study found a hierarchical association between individuals in a social support network and breastfeeding initiation and duration. Inverse relationships were found between the importance of fathers' and mother-in-laws' opinions. Interventions aimed at increasing breastfeeding initiation, and duration rates should include a wider range of individuals within a social support network.

Effectiveness of shortened time interval to postpartum visit in improving postpartum attendance: Design and rationale for a randomized controlled trial.

BACKGROUND/AIMS: Recent evidence suggests that there are numerous benefits to scheduling postpartum visits as early as 3 weeks post-delivery. However, findings are not conclusive due to methodological limitations. This report discusses the unique aspects of a randomized controlled trial's (RCT) design, intervention, and strategies to maintain participant retention. METHODS: This study was a four-year, prospective, open-label RCT conducted at the Virginia Commonwealth University Medical Center. Women who recently delivered a healthy, full-term baby vaginally, were randomized to receive a 3-4 or 6-8 weeks postpartum appointment and were followed for 18 months. RESULTS: A total of 364 women participated in this study. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3-4 weeks group: 88.0%; 6-8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3-4 (70.5%) and 6-8 (90.0%) week postpartum groups. CONCLUSION: The study design offered unique features which ensured excellent participant completion and adherence rates, despite the presence of hard-to-track women who typically do not return for their postpartum visits.

Spatial Analysis of the Impact of a School-Level Youth Violence Prevention Program on Violent Crime Incidents in the Community.

This study investigated the effect of a school-based violence prevention program on community rates of violence for youth aged 10 to 18 in three urban communities with high rates of crime and poverty. We evaluated the impact of the Olweus Bully Prevention Program (OBPP) combined with a family intervention using a multiple baseline design in which we randomized the order and timing of intervention activities across three schools. Outcomes were police reports of violent crime incidents involving offenders aged 10 to 18 years (N = 2859 incidents) across a 6-year period. We used Bayesian hierarchical regression modeling to estimate the reduction of youth violence in the census blocks of the intervention middle school zones. Models controlled for percent female head-of-household, median household income, and percent renter-occupied housing units. Block groups within the attendance zones of schools receiving the intervention had a reduced risk of violence compared with those that did not (relative risk = 0.83, 95% credible interval = 0.71, 0.99). Our findings suggest that the school-level intervention was associated with a significant reduction in community-level youth violence. Public health professionals, program planners, and policy-makers should be aware of the potential community-wide benefit of school-level interventions.

Interracial couples and breastfeeding initiation in the United States.

In the past decade, the prevalence of interracial couples has steadily increased. Recent reports state that nearly one in five marriages are between spouses of different races. Interracial couples receive less social support and are more likely to separate. As a result, children born to these couples may be at an increased risk of poor health outcomes. This study aims to investigate the relationship between interracial couples and breastfeeding initiation. Data from the 2014 Vital Statistics Natality Birth database were analyzed. Data were restricted to singleton births and infants with no congenital malformations. Racial composition of parents was categorized as non-Hispanic (NH) white, NH black; Hispanic; NH white/NH black; NH white/Hispanic; and NH black/Hispanic. Breastfeeding initiation (yes; no) was categorized according to information from the child's birth certificate file. Multiple logistic regression was used to generate crude and adjusted odds ratios and 99% confidence intervals. After adjusting for confounders, all interracial couples with at least one Hispanic parent had increased odds of breastfeeding initiation. Interracial white and black parents had 18% lower odds of breastfeeding initiation. The lowest odds of breastfeeding initiation were observed among intraracial black parents, who had 43% lower odds of breastfeeding initiation compared to intraracial white parents. Breastfeeding non-initiation continues to pose the greatest risk for infants with at least one black parent. Nurses, midwives, physicians, and other medical staff should discuss potential barriers that may be unique to interracial couples and provide additional breastfeeding education and support.

Workplace support and breastfeeding duration: The mediating effect of breastfeeding intention and self-efficacy.

BACKGROUND: Given the large proportion of mothers in the United States work force, understanding the implications of workplace support on breastfeeding outcomes is an important public health priority. The current study investigates if (a) workplace support directly influences the working mothers' breastfeeding intention, self-efficacy, and duration, and (b) workplace support indirectly influences breastfeeding duration through the mediating effect of breastfeeding intention and self-efficacy. METHODS: Data from the longitudinal Infant Feeding Practices Survey II were analyzed. The main predictor variable, workplace support, was based on a Likert scale from "not at all supportive" to "very supportive." Both mediators, exclusive breastfeeding intention and self-efficacy, were dichotomized (yes; no) while the study outcome, breastfeeding duration, was continuous. Structural equation modeling was used to obtain direct and indirect effects of breastfeeding intention and confidence in attaining breastfeeding goals. RESULTS: After adjusting for confounders, there was a statistically significant direct effect between self-efficacy, breastfeeding intention, and breastfeeding duration. A statistically significant indirect effect of workplace support on breastfeeding duration through self-efficacy in attaining breastfeeding goals was also observed. The mediation ratios of the indirect effects showed that self-efficacy in attaining breastfeeding goals accounted for 40.8% (P-value=0.032) of the total effect; however, all other mediation ratios did not show statistical significance. CONCLUSIONS: Self-efficacy is an important predictor for breastfeeding duration. Workplaces may help bolster women's self-efficacy by providing environments that are supportive to breastfeeding working mothers. Future research is needed to identify breastfeeding policies that boost self-efficacy.

Prepregnancy Depression and Breastfeeding Duration: A Look at Maternal Age.

BACKGROUND: In the United States, major depressive disorder affects one in five women aged 20-40 years. During these childbearing years, depression can negatively impact maternal behaviors that are crucial for infant growth and development. This study examined the relationship between prepregnancy depression and breastfeeding duration by maternal age. METHODS: Data from Phase 7 (2012-2013) of the Pregnancy Risk Assessment Monitoring System (N=62,483) were analyzed. Prepregnancy depression was dichotomized while breastfeeding duration was categorized as never breastfed, breastfed 8 weeks or less, and breastfed more than 8 weeks. Maternal age was a significant effect modifier; therefore, results were stratified by maternal age. Multinomial logistic regression was used to obtain odds ratios and 95% confidence intervals (CI). RESULTS: For women aged 20-24, 25-29, and 30-34 years with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were significantly higher than in women with no history of prepregnancy depression. Notably, among women aged 25-29 with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were 93% (adjusted odds ratio (AOR) = 1.93, 95% CI =1.57-2.37) and 65% (AOR = 1.65, 95% CI = 1.37-1.99) higher compared to women with no history of prepregnancy depression, respectively. CONCLUSIONS: Having a history of poor mental health before pregnancy may increase the likelihood of premature breastfeeding cessation. A woman's mental health status before pregnancy should be considered in reproductive and prenatal care models. Efforts should be made to understand challenges women of specific age groups face when trying to breastfeed.

Discordance in Couples Pregnancy Intentions and Breastfeeding Duration: Results from the National Survey of Family Growth 2011-2013.

BACKGROUND: Parental disagreement in pregnancy intention elevates the risk of adverse health events for mother and child. However, research surrounding parental pregnancy intention discrepancies and breastfeeding duration is limited. This study aims to examine the relationship between couple's discordant pregnancy intention and breastfeeding duration. METHODS: Data from the 2011-2013 National Survey of Family Growth was analyzed. Parental pregnancy intention was categorized as "intended by both parents," "unintended by both parents," "father intended and mother unintended," and "father unintended and mother intended." Breastfeeding duration was categorized as "never breastfed," "breastfed less than six months," and "breastfed at least six months." Multinomial logistic regression, odds ratios, and 95% confidence intervals were calculated. RESULTS: Couples with a concordant unintended pregnancy were more likely to have a child who was never breastfed or breastfed less than six months compared to couples with a concordant intended pregnancy. Similarly, couples with a discordant pregnancy were more likely to have a child who was never breastfed or breastfed less than six months. CONCLUSIONS: Findings from this study show a relationship between couples' pregnancy intentions and subsequent breastfeeding behaviors. Healthcare professionals should be cognizant of parents' differing opinions surrounding pregnancy intention and the implications on breastfeeding outcomes.

Short interpregnancy interval and adverse birth outcomes in women of advanced age: a population-based study.

PURPOSE: Short interpregnancy interval (IPI) has been linked with adverse birth outcomes. However, the association in advanced age women needs further investigation. This study aims to examine the association between short IPI and adverse birth outcomes including preterm birth, post-term birth, low birth weight, and macrosomia, in a population of advanced age U.S. women. METHODS: The 2016 U.S. public-use natality data was analyzed. Analysis was restricted to women with second-order singleton live births who were ≥35 years at first live birth (n = 46,684). Multinomial logistic regression analysis was used to examine the association between short IPI and adverse birth outcomes. RESULTS: Short IPI in advanced age women was significantly associated with higher odds of extremely preterm birth (0-5 months IPI: adjusted odds ratio [AOR] = 2.43, 95% confidence interval [CI] = 1.07-5.52; 6-11 months IPI: AOR = 2.17, 95% CI = 1.09-4.31), very preterm birth (0-5 months IPI: AOR = 1.63, 95% CI = 1.04-2.56), and extremely low birth weight (0-5 months IPI: AOR = 2.43, 95% CI = 1.28-4.60) in the second delivery. An inverse relationship between short IPI and post-term birth was observed and no significant association between short IPI and macrosomia was found. CONCLUSIONS: Short IPI in advanced age women increases the odds of adverse birth outcomes in the second delivery.

Disparities in Risk Factors and Birth Outcomes Among American Indians in North Dakota.

Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007-2009 to 2010-2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions.

The Associations Between Mental Health Status, Hypertension, and Hospital Inpatient Visits in Women in the United States.

BACKGROUND: Poor mental health status is more prevalent in women and may be related to poor hypertension outcomes and increased hospital inpatient visits. This study aims to find the association between mental health status and hypertension in women and the combined effect of mental health status and hypertension on hospital inpatient visits in women in the United States. METHODS: The household component of 2014 Medical Expenditure Panel Surveys (MEPS) was analyzed (N = 9,137). Kessler (K6) scale for mental health status (poor, good/excellent), hypertension (yes, no), and hospital inpatient visits (yes, no) were examined. A combined effect variable for mental health status and hypertension was created. Multiple logistic regression analysis was conducted and adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were calculated. RESULTS: After adjusting for confounders, women who reported poor mental health had significantly higher odds of hypertension compared to women who reported good/excellent mental health (AOR = 1.39, 95% CI = 1.16, 1.68). Further, women who reported hypertension coupled with poor mental health had higher odds of having hospital inpatient visits compared to women who reported no hypertension coupled with good/excellent mental health in the adjusted analysis (AOR = 3.03, 95% CI = 1.96, 4.69). CONCLUSIONS: There is a significant association between mental health status and hypertension in women. Further, poor mental health status coupled with hypertension leads to increase hospital inpatient visits for women. It is important that health professionals focus on utilizing available screening tools to assess mental health status of women for early detection and to manage the disorder.

Association between Breastfeeding Duration and Type of Birth Attendant.

INTRODUCTION: Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. METHODS: Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics' national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. RESULTS: Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. CONCLUSIONS: Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population.

Association Between Intimate Partner Violence and Breastfeeding Duration: Results From the 2004-2014 Pregnancy Risk Assessment Monitoring System.

BACKGROUND: Intimate partner violence is a major public health problem that disproportionately affects women. Current literature investigating the relationship between intimate partner violence and breastfeeding is inconsistent. Research aim: This study aims to investigate the relationship between physical intimate partner violence that occurs in the preconception or prenatal period and any breastfeeding duration. METHODS: Data from the retrospective, cross-sectional 2004-2014 Pregnancy Risk Assessment Monitoring System were analyzed ( N = 195,264). The outcome, breastfeeding duration, was categorized as never breastfed, breastfed 8 weeks or less, and breastfeed more than 8 weeks. Multinomial logistic regression was used to obtain crude and adjusted odds ratios and 95% confidence intervals. RESULTS: Approximately 6% ( n = 11,766) of survey respondents reported preconception and/or prenatal intimate partner violence, and 36.3% ( n = 67,667) of women reported never breastfeeding. The odds of discontinuing breastfeeding before 8 weeks were 18% higher among women who reported experiencing abuse 12 months before pregnancy compared with women who did not report intimate partner violence (adjusted odds ratio = 1.18; 95% confidence interval [1.01, 1.37]). All other estimates showed an overlapping 95% confidence interval. CONCLUSION: Breastfeeding is essential in improving maternal and child health; however, women in abusive relationships may face additional barriers to breastfeeding. Further research is needed to better understand the impact of violence on breastfeeding behaviors to inform healthcare practices and interventions.

Disparities in Self-Reported Prenatal Counseling: Does Immigrant Status Matter?

Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression. Counseling topics included diet, smoking, drinking, medication use, breastfeeding, baby development and early labor. In additional analyses, we separately examined these relationships among Hispanic, Mexican and Non-Hispanic (NH) Asian women. Neither immigrant status nor self-reported English proficiency was associated with prenatal counseling. However, we found that being interviewed in a language other than English language by ECLS-B surveyors was positively associated with counseling on smoking (OR, 2.599; 95% CI, 1.229-5.495) and fetal development (OR, 2.408; 95% CI, 1.052-5.507) among Asian women. Race/ethnicity was positively associated with counseling, particularly among NH black and Hispanic women. There is little evidence of systematic overall differences in self-reported prenatal counseling between U.S.-born and immigrant mothers. Future research should investigate disparities in pregnancy-related knowledge among racial/ethnic subgroups.

Correlates of Postpartum Visits Among Medicaid Recipients: An Analysis Using Claims Data from a Managed Care Organization.

BACKGROUND: The postpartum care visit (PPCV) plays an important role in ensuring the well-being of mother and infant. This study sought to assess correlates of PPCV attendance among women who are at high risk of nonattendance. MATERIALS AND METHODS: This study used deidentified medical claims data from Virginia Premier-a nonprofit Managed Care Organization that provides health insurance for Medicaid beneficiaries. The association between various correlates and PPCV attendance was examined using multiple logistic regression analyses. RESULTS: Of the 25,692 women in the study, more than half (50.5%) did not attend a postpartum visit. Racial/ethnic minorities and women receiving the majority of their care at hospitals, Health Departments, or Federally Qualified Health Centers were more likely to attend their postpartum visit. Women who smoked and those who did not attend prenatal care had reduced odds of postpartum visit attendance. Age, education, and delivery method were not found to be significantly associated with PPCV attendance. CONCLUSIONS: Our results highlight factors associated with attendance of PPCVs in low income populations. The continued disparity in postpartum care utilization compels additional efforts to improve access to health services across socioeconomic and demographic boundaries.

Racial Differences and the Role of Marital Status in the Association Between Intimate Partner Violence and Unintended Pregnancy.

More than half of all pregnancies in the U.S. are unintended which may lead to poor health outcomes. Racial and ethnic differences underlying the association between IPV and unintended pregnancy are inconsistent. This study examines the association between IPV and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Data from the national 2009/11 Pregnancy Risk Assessment Monitoring System consisting of women who recently delivered a live birth baby were analyzed (n=108,220). A dichotomous variable was created to indicate whether women experienced IPV in the 12 months leading to their most recent pregnancy (yes; no). The outcome, pregnancy intention, was dichotomized as intended or unintended. Subpopulation analysis was conducted stratified by race/ethnicity and marital status. Adjusted odds ratios and 95% confidence intervals were generated using multiple logistic regression models. The odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history. Among unmarried non-Hispanic other women, abused women were significantly less likely to report unintended pregnancy than the non-abused. No significant differences were observed for Hispanic or non-Hispanic Black women. There are significant racial and ethnic differences in the association between IPV and unintended pregnancy. Additionally, the association differed by marital status. Public health professionals and health care providers should be aware of these differences.