Maternal social deprivation and preterm birth: The PreCARE cohort study.

BACKGROUND: Maternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association. OBJECTIVE: To assess the association between maternal social deprivation and PTB (overall and by phenotype). METHODS: We analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log-binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies. RESULTS: In all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes. CONCLUSIONS: In the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype.

Risk of adverse infant outcomes associated with maternal mental health and substance use disorders.

PURPOSE: This study aimed to evaluate the association of mental health and substance use disorders on the risk of adverse infant outcomes overall and by race/ethnicity and payer. METHODS: We used birth certificates (2017-2022; n = 125,071) linked with state-wide insurance claims (2016-2022; n = 7,583,488) to assess the risk of an adverse infant outcome (i.e., prematurity [< 37 weeks gestation] or low birthweight [< 2,500 g]) associated with "any mental health" or "any substance use" disorder overall, by race/ethnicity, and by payer using diagnoses during the 9 months of pregnancy. We additionally evaluated seven specific mental health conditions and four specific substance use disorders. RESULTS: The rate of having an adverse infant outcome was 13.4%. Approximately 21.5% of birthing individuals had a mental health condition, and 8.7% had a substance use disorder. We found increased adjusted risk of an adverse infant outcome associated with having a mental health condition overall (aRR: 1.28; 95%CI: 1.23-1.32) and for all racial/ethnic groups and payers. We additionally found increased risk associated with substance use disorder overall (aRR: 1.32; 95%CI: 1.25-1.40) and for White, Black, privately-covered, and Medicaid-covered individuals. There was increased risk associated with six of seven mental health and three of four substance use disorders. CONCLUSIONS: Given the risk of adverse infant outcomes associated with mental health and substance use disorders across racial/ethnic groups and payers, our findings highlight the critical importance of policies and clinical guidelines that support early identification and treatment of a broad spectrum of mental health and substance use disorders throughout the perinatal period.

Pregnancy outcomes of forced migrants in the Netherlands: A national registry-based study.

Background: The rise of global forced migration urges healthcare systems to respond to the needs of forced migrants (FM) during pregnancy and childbirth. Yet, comprehensive data on the health outcomes of pregnant FM in destination countries remain scarce. This study aimed to describe the characteristics and maternal and perinatal outcomes of pregnancy in this specific migrant population on a national scale in the Netherlands and to explore differences from other populations. Methods: The Dutch perinatal registry was linked to national migration data to analyze pregnancy outcomes in FM (2014-2019), using non-migrants (NM) and resident migrants (RM) as reference populations. We reported outcome rates (% [95 % CI]) for a range of primary and secondary pregnancy outcomes. Primary outcomes included perinatal mortality, small for gestational age infants (SGA), preterm birth, and emergency cesarean section (CS), for which we also calculated the crude relative risk (RR [95 % CI]) of FM compared to NM and RM. In addition, we conducted binary logistic regression analyses on primary outcomes to report adjusted odds ratios (aORs [95 % CIs]) while controlling for multiple births, maternal age and parity. Findings: Compared to the NM group, the FM group had increased risks of perinatal mortality (RR 1.50 [95 % CI 1.20-1.88]), SGA (1.65 [1.59-1.71], and emergency CS (1.19 [1.13-1.25]). Compared to RM, FM still had elevated risks of SGA (1.17 [1.13-1.22]). In contrast, the risk of preterm birth was lower in FM than in NM (0.81 [0.76-0.86]) and RM (0.83 [0.77-0.88]). These differences were confirmed in the adjusted analysis. Differences in secondary outcomes included higher rates of late antenatal care in FM (29.4 % [28.5-30.3]) than in NM (6.7 % [6.6-6.9]) and RM (15.5 % [15.1-15.9]). Rates of planned CS were similarly elevated (14.3 % [95 % CI 13.7-14.8] versus 7.·8 % [7.7-7.8] and 9.6 % [9.5-9.7]), while FM had lower rates of postpartum hemorrhage (3.9 % [3.6-4.2]) versus 6.8 % [6.8-6.9] and 5.7 % [5.6-5.9]). Conclusion: This first Dutch registry-based study demonstrated increased risks of multiple, though not all, adverse pregnancy outcomes in forced migrants. Our results emphasize the imperative to further unravel and address migration-related disparities, dismantle structural barriers to health among forced migrants, and improve the inclusivity of data systems. Collaborative policy, clinical practice, and research efforts are essential to ensure equitable care for every individual, regardless of migration status.

Patient Perspectives on AI for Mental Health Care: Cross-Sectional Survey Study.

BACKGROUND: The application of artificial intelligence (AI) to health and health care is rapidly increasing. Several studies have assessed the attitudes of health professionals, but far fewer studies have explored the perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues, including those related to radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health care solutions, but broader perspectives toward AI for mental health care have been underexplored. OBJECTIVE: This study aims to understand public perceptions regarding potential benefits of AI, concerns about AI, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health care. METHODS: We conducted a 1-time cross-sectional survey with a nationally representative sample of 500 US-based adults. Participants provided structured responses on their perceived benefits, concerns, comfort, and values regarding AI for mental health care. They could also add free-text responses to elaborate on their concerns and values. RESULTS: A plurality of participants (245/497, 49.3%) believed AI may be beneficial for mental health care, but this perspective differed based on sociodemographic variables (all P<.05). Specifically, Black participants (odds ratio [OR] 1.76, 95% CI 1.03-3.05) and those with lower health literacy (OR 2.16, 95% CI 1.29-3.78) perceived AI to be more beneficial, and women (OR 0.68, 95% CI 0.46-0.99) perceived AI to be less beneficial. Participants endorsed concerns about accuracy, possible unintended consequences such as misdiagnosis, the confidentiality of their information, and the loss of connection with their health professional when AI is used for mental health care. A majority of participants (80.4%, 402/500) valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked who was responsible for the misdiagnosis of mental health conditions using AI, 81.6% (408/500) of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of patients' information. CONCLUSIONS: Future work involving the use of AI for mental health care should investigate strategies for conveying the level of AI's accuracy, factors that drive patients' mental health risks, and how data are used confidentially so that patients can determine with their health professionals when AI may be beneficial. It will also be important in a mental health care context to ensure the patient-health professional relationship is preserved when AI is used.

Public Maternal Health Dashboards in the United States: Descriptive Assessment.

BACKGROUND: Data dashboards have become more widely used for the public communication of health-related data, including in maternal health. OBJECTIVE: We aimed to evaluate the content and features of existing publicly available maternal health dashboards in the United States. METHODS: Through systematic searches, we identified 80 publicly available, interactive dashboards presenting US maternal health data. We abstracted and descriptively analyzed the technical features and content of identified dashboards across four areas: (1) scope and origins, (2) technical capabilities, (3) data sources and indicators, and (4) disaggregation capabilities. Where present, we abstracted and qualitatively analyzed dashboard text describing the purpose and intended audience. RESULTS: Most reviewed dashboards reported state-level data (58/80, 72%) and were hosted on a state health department website (48/80, 60%). Most dashboards reported data from only 1 (33/80, 41%) or 2 (23/80, 29%) data sources. Key indicators, such as the maternal mortality rate (10/80, 12%) and severe maternal morbidity rate (12/80, 15%), were absent from most dashboards. Included dashboards used a range of data visualizations, and most allowed some disaggregation by time (65/80, 81%), geography (65/80, 81%), and race or ethnicity (55/80, 69%). Among dashboards that identified their audience (30/80, 38%), legislators or policy makers and public health agencies or organizations were the most common audiences. CONCLUSIONS: While maternal health dashboards have proliferated, their designs and features are not standard. This assessment of maternal health dashboards in the United States found substantial variation among dashboards, including inconsistent data sources, health indicators, and disaggregation capabilities. Opportunities to strengthen dashboards include integrating a greater number of data sources, increasing disaggregation capabilities, and considering end-user needs in dashboard design.

Listening to the Perspectives of Black Women on Perinatal Health Disparities: Reversing the Tide and Improving Outcomes.

INTRODUCTION: Pregnancy-related health in the USA fares worse than similarly resourced countries and the gap continues to widen. This trend however is disproportionately experienced by women of color. We have come to understand that this is due to the systems and structures that perpetuate racism. Despite our awareness of this, the voices of the community impacted by these systems have been largely left out of research. The authors aimed to utilize participatory research methods within a qualitative design to ask Black pregnant and parenting women about their lived experiences of pregnancy and perinatal health services. METHODS: Over three focus groups, the authors gathered information from 12 participants. Participants were Black women currently pregnant or pregnant in the last year, ages 22-37 years old. Participants shared their experiences and views on racial disparities within perinatal health care. Our analytic goal was to explore the questions: "What are Black women talking about in relation to perinatal health"; "Where do Black women get information about perinatal health disparities?"; and "How do Black women feel when they hear or talk about perinatal health risks?". RESULTS: In general, participants felt that the burden to understand their pregnancy risks and options was theirs alone to carry. This resulted in their utilization of and reliance on the internet, social supports, and holistic providers such as doulas for information about how to reduce their risk for maternal morbidity and mortality. DISCUSSION: Results demonstrate patients' receptivity to frank conversation about perinatal health disparities, and their willingness to partner with their providers to reduce risks in pregnancy. While interventions to reduce perinatal health risks must be systemic, they cannot move forward without including the voices of and partnering with the community they hope to positively impact.

Exclusive breastfeeding rates upon hospital discharge at a tertiary center prior to and during the COVID-19 pandemic.

This study aimed to describe exclusive breastfeeding (EBF) rates at discharge at Sunnybrook Health Sciences Centre and explore factors that contributed to changes in breastfeeding rates during the COVID-19 pandemic. 4762 patient charts were reviewed, 2000 from the pre-pandemic period, and 2762 from the lockdown period. Data was collected on EBF status at discharge, on maternal health history, and on infant characteristics. EBF rates fell from 75.8% to 73.85% from the pre-COVID to COVID period. During the pandemic, EBF was positively associated with BMI < 30, spontaneous conception, and infants at risk of low blood sugar. Non-spontaneous conception was associated with lower EBF.

Knowledge of pregnancy care behaviors, complications, and urgent maternal warning signs up to one year postpartum among Georgia residents.

OBJECTIVES: Maternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum. METHODS: In 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions. RESULTS: Participants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p < 0.001). CONCLUSIONS: This research identified important gaps in maternal health knowledge among adults living in the State of Georgia, highlighting specific opportunities for intervention and offering evidence-based information that can help improve health literacy for better maternal outcomes.

[Epidemiology and risk factors for preterm births in north-western Algeria]. / Épidémiologie et facteurs de risque de la prématurité dans le nord-ouest algérien.

Introduction: preterm births continue to be the main cause of infant and child mortality as well as sensory-motor disabilities and neurodevelopmental difficulties worldwide. The rate of preterm births has been rising, in particular in Algeria. The purpose of this study is to determine the frequency of preterm births in the Oran Wilaya and to identify risk factors. Methods: we used data from a multicentre cross-sectional study carried out in all Public Maternity Hospitals in the Oran Wilaya (13). The study included parturient women who had given birth to a live and/or stillborn child (with birthweights ≥500 g), whose gestational age was greater than or equal to 24-36 weeks of amenorrhoea. Mothers´ demographic, medical and socio-behavioural factors were recorded. Logistic regression was used to study predictors of prematurity. Results: preterm birth rate was 9.9% (45/452). The average age of patients was 30.4±6 years; multiple pregnancies accounted for 2.2% of births. Factors related to prematurity were the risk of premature labour (aOR=4.68; 95% CI: 2.27-9.64), the lack of clinical monitoring of pregnancy (OR=2.83; CI 95%: 1.83-6.05) and gestational hypertension (aOR = 3.69, 95% CI: 1.83-8.8). Conclusion: the rate of preterm births is in line with the rate observed in neighbouring countries. The study identified predictive factors, some of which are already targeted by the national perinatal program. However, it is essential to continue to lead efforts to improve the monitoring and management of pregnancies and premature births at all levels of care.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study.

PURPOSE: International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))? METHODS: In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data. RESULTS: During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status. CONCLUSION: Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

Building Cross-sectoral Collaborations to Address Perinatal Health Inequities: Insights From the Dutch Healthy Pregnancy 4 All-3 Program.

BACKGROUND: Addressing perinatal health inequities is the joint responsibility of professionals working for local governments, the medical, social, and public health sector. Cross-sectoral collaboration between these professionals is challenging. For such collaborations to succeed, a transition, ie, a fundamental shift in the dominant structure, culture, and practices at the systems level, is necessary. We investigated facilitators and barriers for cross-sectoral collaborations, when addressing perinatal health inequities in the Netherlands. Additionally, we studied how cross-sectoral collaborations can be facilitated by action research. METHODS: We used interview and questionnaire data of the Healthy Pregnancy 4 All-3 (HP4All-3) program, which resulted from action research in six Dutch municipalities. All interviews were coded using open codes related to facilitators and barriers for cross-sectoral collaboration and categorized into three subgroups: structural, cultural, or practical. The answers to the questionnaire were analyzed and summarized quantitatively. RESULTS: We conducted 53 interviews with a total of 81 professionals. The most important ingredients for cross-sectoral collaborations mentioned by the interviewees were: (1) structural: having a solid network with a clear overview of professionals working in the different sectors, (2) cultural: having a joint vision/goal, and (3) practical: short lines of communication and timely sharing of information. A total of 85 professionals filled in (parts of) the questionnaire. Two-thirds to over 80 percent replied that the HP4All-3 program had an added value in building cross-sectoral collaborations. CONCLUSION: Our research shows that cross-sectoral collaborations in the context of perinatal health are hampered by structural, cultural, and practical barriers. Analyzing facilitators and barriers at these three levels helps to identify bottlenecks in cross-sectoral collaboration. Action researchers can be of great advantage in facilitating collaboration, as they can offer an open setting for reflection and instigate a sense of urgency for building collaborations.

Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study.

BACKGROUND: Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. OBJECTIVE: This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. METHODS: In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. RESULTS: The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique's land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique's land area, including Maputo, could access timely CMPHS. CONCLUSIONS: The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.

Perinatal Health Outcomes Among Women on Community Supervision: A Scoping Review.

The purpose of this scoping review is to review the extant literature regarding perinatal health outcomes for women on community supervision in the United States. PubMed, CINAHL, Scopus, PsycINFO, and Public Health were searched for peer-reviewed articles published in the United States from January 1, 1970, to March 7, 2023. After removal of duplicates and review of 1,412 article titles and abstracts, 19 articles were retrieved for full-text review; this yielded 4 studies for inclusion. Studies range in size from 10 to 292 participants (N = 405) and only two reported geographic locations. Three studies comprised probation or parole and two studies included court-mandated treatment for substance use. All studies examined outcomes during the postpartum period, such as mood disorder or substance use severity. No studies evaluated the health of women during pregnancy and/or childbirth. To enhance health equity and reduce maternal morbidity and mortality among women on community supervision, more inclusive research that examines health outcomes during the perinatal period is needed. Furthermore, there must be interventions that address the social determinants of health, racial and systemic discrimination, socioeconomic barriers, and violence that are often experienced among women with criminal justice system involvement.

Male twinning after the 2008 Obama election: A test of symbolic empowerment.

On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003-October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health.

Racial Differences in Psychosocial Resources and Mental and Physical Health Outcomes during Pregnancy: A structural equation modeling approach.

Objectives: Poor prenatal health is of particular concern among minoritized individuals who may experience adverse social determinants of health contributing to the intergenerational transmission of health disparities. The purpose of this study was to investigate associations between psychosocial resources, and mental and physical health among a prenatal sample, and to explore if these relationships vary by race. Methods: English-speaking pregnant individuals living in the United States were recruited using Centiment (n=340). Participants completed a 121-item cross-sectional survey. We conducted a single- and multi-group structural equation model to test hypothesized relationships, and then investigated differences by pregnant White individuals versus Black, Indigenous, and People of Color (BIPOC). Results: Our final single-group model exhibited good model fit (χ2 (43) = 99.07, p<.01, CFI = 0.97, SRMR = 0.04, and RMSEA = 0. 06 (0.05 - 0.08)). After controlling for demographic characteristics and social determinants of health, higher levels of mindfulness were statistically significantly related to lower anxiety and depression scores (both p<.01). Higher levels of social supports were statistically significantly related to lower anxiety scores. Scale measurement invariance was confirmed for the multi-group model and the structural model was statistically significantly different between pregnant White individuals and BIPOC in this sample (Δ χ2 (27) = 116.71, p <.01). Conclusions: Identification of core components of psychosocial resource interventions, consideration of upstream structural determinants, mindfulness and valued-living (MVL)-based strategies, cultural adaptation, and an emphasis on resilience rather than psychopathology may result in improved prenatal health among pregnant individuals traditionally underrepresented in research.

An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities.

AIM(S): To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities. DESIGN: Discussion paper. METHODS: We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health. DATA SOURCES: We conducted a systematic review of literature published from 2001 to 2024 in four databases. RESULTS: Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes. CONCLUSION: The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women. IMPLICATIONS FOR NURSING: Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps. IMPACT: The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.

An Integrated Approach to Address Perinatal Mental Health Within an Obstetrics Practice.

Outpatient perinatal care providers (one certified nurse-midwife, one nurse practitioner, and one physician assistant) at a high-volume, suburban health system in southeastern Pennsylvania developed and implemented a care model to identify and care for patients at risk for perinatal and postpartum mental health conditions. The program, Women Adjusting to Various Emotional States (WAVES), was created to bring the most up-to-date, evidence-based treatment recommendations to patients while addressing the increased demand placed on the health care system by pregnant and postpartum patients in need of psychiatric services. WAVES is a specialized program offered for anyone who is pregnant or up to one year postpartum who is struggling with mental health symptoms or concerns. Perinatal mood and anxiety disorders have become one of the most prevalent pregnancy ailments, yet mental health is not always addressed during routine prenatal care visits. Common obstacles to patients obtaining mental health care during pregnancy include lack of access, clinician gaps in knowledge, and stigma surrounding diagnoses. WAVES offers a method to empower perinatal providers with the education and tools to address this need. The model outlines how to appropriately assess, diagnose, manage, or refer patients for mental health services. Patient feedback has been overwhelmingly positive, and this novel care model shows great promise for the future of perinatal care. The development of integrated programs like WAVES may be a valuable resource to help combat the perinatal mental health epidemic.

Augmenting Telepostpartum Care With Vision-Based Detection of Breastfeeding-Related Conditions: Algorithm Development and Validation.

BACKGROUND: Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead many mothers to discontinue breastfeeding. For instance, nipple damage and mastitis affect 80% and 20% of US mothers, respectively. Lactation consultants (LCs) help mothers with breastfeeding, providing in-person, remote, and hybrid lactation support. LCs guide, encourage, and find ways for mothers to have a better experience breastfeeding. Current telehealth services help mothers seek LCs for breastfeeding support, where images help them identify and address many issues. Due to the disproportional ratio of LCs and mothers in need, these professionals are often overloaded and burned out. OBJECTIVE: This study aims to investigate the effectiveness of 5 distinct convolutional neural networks in detecting healthy lactating breasts and 6 breastfeeding-related issues by only using red, green, and blue images. Our goal was to assess the applicability of this algorithm as an auxiliary resource for LCs to identify painful breast conditions quickly, better manage their patients through triage, respond promptly to patient needs, and enhance the overall experience and care for breastfeeding mothers. METHODS: We evaluated the potential for 5 classification models to detect breastfeeding-related conditions using 1078 breast and nipple images gathered from web-based and physical educational resources. We used the convolutional neural networks Resnet50, Visual Geometry Group model with 16 layers (VGG16), InceptionV3, EfficientNetV2, and DenseNet169 to classify the images across 7 classes: healthy, abscess, mastitis, nipple blebs, dermatosis, engorgement, and nipple damage by improper feeding or misuse of breast pumps. We also evaluated the models' ability to distinguish between healthy and unhealthy images. We present an analysis of the classification challenges, identifying image traits that may confound the detection model. RESULTS: The best model achieves an average area under the receiver operating characteristic curve of 0.93 for all conditions after data augmentation for multiclass classification. For binary classification, we achieved, with the best model, an average area under the curve of 0.96 for all conditions after data augmentation. Several factors contributed to the misclassification of images, including similar visual features in the conditions that precede other conditions (such as the mastitis spectrum disorder), partially covered breasts or nipples, and images depicting multiple conditions in the same breast. CONCLUSIONS: This vision-based automated detection technique offers an opportunity to enhance postpartum care for mothers and can potentially help alleviate the workload of LCs by expediting decision-making processes.

The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco.

INTRODUCTION: Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. METHODS: Community engagement (PRECEDE phases 1-2) informed the "Pregnancy Village" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring "one-stop-shop" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys. RESULTS: The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement. CONCLUSION: Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.