Critical Congenital Heart Disease Newborn Screening Implementation: Lessons Learned.

Introduction The purpose of this article is to present the collective experiences of six federally-funded critical congenital heart disease (CCHD) newborn screening implementation projects to assist federal and state policy makers and public health to implement CCHD screening. Methods A qualitative assessment and summary from six demonstration project grantees and other state representatives involved in the implementation of CCHD screening programs are presented in the following areas: legislation, provider and family education, screening algorithms and interpretation, data collection and quality improvement, telemedicine, home and rural births, and neonatal intensive care unit populations. Results The most common challenges to implementation include: lack of uniform legislative and statutory mandates for screening programs, lack of funding/resources, difficulty in screening algorithm interpretation, limited availability of pediatric echocardiography, and integrating data collection and reporting with existing newborn screening systems. Identified solutions include: programs should consider integrating third party insurers and other partners early in the legislative/statutory process; development of visual tools and language modification to assist in the interpretation of algorithms, training programs for adult sonographers to perform neonatal echocardiography, building upon existing newborn screening systems, and using automated data transfer mechanisms. Discussion Continued and expanded surveillance, research, prevention and education efforts are needed to inform screening programs, with an aim to reduce morbidity, mortality and other adverse consequences for individuals and families affected by CCHD.

Role of Marital Status in the Association between Prepregnancy Body Mass Index and Breastfeeding Duration.

BACKGROUND: In the United States, breastfeeding rates fail to meet national guidelines. Given the rising prevalence of obesity and births to unmarried women, this study explores if the association between prepregnancy body mass index (BMI) and breastfeeding duration differs by marital status. METHODS: Data from the 2009-2011 Pregnancy Assessment Monitoring System were analyzed. The sample included women who had live singleton births in the United States and who reported information to calculate BMI and breastfeeding duration (n = 93,106). Breastfeeding duration was categorized as never breastfed, breastfed for 8 weeks or less, and breastfed for more than 8 weeks. BMI was categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 (kg/m(2)), or obese (30.0 + kg/m(2)). Marital status was categorized as married or not married. There was a significant interaction between marital status and prepregnancy BMI (p = .028). Data were stratified by marital status and multinomial logistic regression was conducted adjusting for confounding factors. RESULTS: Approximately one-half of women were of normal weight before pregnancy (50.4%); 24.1% were overweight, 21.2% were obese, and 4.3% were underweight. Among married women, the odds of never breastfeeding and breastfeeding for 8 weeks or less was greater among overweight (adjusted odds ratio [AOR], 1.23 [95% confidence interval {CI}, 1.10-1.38]; AOR, 1.36 [95% CI, 1.24-1.49]) and obese women (AOR, 1.72 [95% CI, 1.53-1.93]; AOR, 1.95 [95% CI, 1.77-2.15]) compared with normal weight women who breastfed for more than 8 weeks. In contrast, among unmarried women, no association was observed among overweight women and the association was attenuated among obese women (AOR, 1.38 [95% CI, 1.21-1.58]; AOR, 1.43 [95% CI, 1.27-1.62]). CONCLUSION: Providers and public health practitioners should be aware of the influence of marital status in the association between prepregnancy BMI and breastfeeding duration. The role of obesity and marital status should be considered in designing breastfeeding promotion interventions.

Prepregnancy obesity and breastfeeding noninitiation in the United States: an examination of racial and ethnic differences.

BACKGROUND: Prepregnancy overweight/obesity can adversely affect breastfeeding initiation, but studies examining this association among different racial/ethnic groups of U.S. women are limited. This study used a large, nationally representative sample to assess racial/ethnic differences in breastfeeding noninitiation among U.S. women of different body mass index (BMI) classifications. MATERIALS AND METHODS: This study analyzed data from the Pregnancy Risk Assessment Monitoring System, including 95,141 women who delivered a live, singleton baby from 2009 to 2011 and provided BMI and breastfeeding information. Prepregnancy BMI was categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Breastfeeding initiation was reported as having ever breastfed after delivery (yes or no). Adjusted models, which included only potential confounders resulting in a 10% or greater change in estimate, generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for breastfeeding noninitiation. Analysis was stratified by race/ethnicity. RESULTS: Compared with normal weight non-Hispanic white women, the odds of breastfeeding noninitiation were 17% and 25% higher among overweight (AOR=1.17, 95% CI=1.07-1.29) and obese (AOR=1.25, 95% CI=1.14-1.36) non-Hispanic white women, respectively. Among non-Hispanic black women, the odds of breastfeeding noninitiation were 29% higher only in obese women compared with normal weight non-Hispanic black women. No association was observed among Hispanic women or women of other races. CONCLUSIONS: Prepregnancy BMI is a significant predictor for breastfeeding noninitiation for non-Hispanic white and non-Hispanic black women. Further exploration of the differences underlying the association between prepregnancy BMI and breastfeeding behaviors among racial subpopulations of women in the United States is warranted.