Association of county perinatal resources and gestational weight gain in West Virginia, United States.

BACKGROUND: Inappropriate (inadequate or excessive) gestational weight gain (GWG) is of great concern to maternal, fetal and infant health. Different maternal and fetal risk factors are associated with GWG, but little is known about a more distal risk factor: inadequate county-level perinatal resources. Therefore, the study aim was to investigate GWG in women living in counties with below average perinatal resources in comparison with their counterparts living in counties with above average perinatal resources. METHODS: Retrospective study of 406,792,010-2011 West Virginia births in 55 counties. The outcome was GWG and the main predictor was county perinatal resources. Hierarchical linear mixed model was used to investigate the association of county perinatal resources and GWG. RESULTS: County perinatal resources was associated with GWG (p = 0.009), controlling for important covariates. Below average county perinatal resources was not significantly associated with a decrease in mean GWG (M: - 5.29 lbs., 95% CI: - 13.94, 3.35, p = 0.2086), in comparison with counties with above average county perinatal resources. There was significant difference between average, and above average county perinatal resources (M: - 17.20 lbs., 95% CI: - 22.94, - 11.47, p < 0.0001), controlling for smoking during pregnancy and other covariates. CONCLUSIONS: Average county perinatal resources was associated with reduced mean GWG relative to above average county perinatal resources, but not below average county perinatal resources. However, this could be due to the small number of counties with above average resources as the effect was in the hypothesized direction. This highlights one of the challenges in county perinatal resource studies.

Maternal characteristics associated with injury-related infant death in West Virginia, 2010-2014.

Although injury-related deaths have been documented among children and adult populations, insufficient attention has been directed towards injury-related infant deaths. The objective of this retrospective study was to investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia. Birth and infant mortality data for 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston. Relative risk was calculated using log-binomial regression utilizing generalized estimating equations. Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ([Formula: see text] = 7.48, p = .03), and smoking during pregnancy ([Formula: see text], p < .00). Risk of a Black Non-Hispanic infant suffering an injury-related death was 4.0 (95% CL 1.7, 9.3) times that of infants of other races/ethnicities. Risk of an infant dying from an injury-related cause, if the mother smoked during pregnancy, was 2.9 (95% CL 1.6, 5.0) times the risk of such a death if maternal smoking status during pregnancy is unknown or no smoking, controlling for race/ethnicity. This study provides important information to public health stakeholders at both the state and local levels in designing interventions for partial reduction or prevention of injury-related infant mortality in West Virginia.