Search

The field of relationship science has called for more research on the impact of relationship education on child outcomes, yet studies in this area remain sparse, particularly regarding maternal and infant health at birth. Research on group prenatal care demonstrates that individual-oriented group interventions have a positive impact on infant birth outcomes, suggesting the need to consider the impacts of other forms of group programming for women. The current study examined the impact of MotherWise, an individual-oriented relationship education and brief case management/coaching program for minority and low-income pregnant women, on birth outcomes. The study sample included 136 women who enrolled in a larger randomized controlled trial of MotherWise during early pregnancy. Although statistical power was limited due to the sample size and the effects were not outright significant at p 0.05, results indicated that the effects of MotherWise on birth outcomes were small to moderate in size (0.23 for birthweight, 0.46 for preterm birth) and suggest important avenues for future tests of relationship education programs and their impacts on maternal and infant health. The current study suggests that relationship education during pregnancy could directly impact women's and infant's health.关系科学领域呼吁有更多的研究来针对关系教育对儿童结果的影响。这一领域的研究仍然很少，特别是在产妇和婴儿出生时的健康方面。关于群体产前护理的研究表明，面向个人的群体干预措施对婴儿出生结果具有积极影响，这表明需要考虑其他形式的群体方案对妇女的影响。本研究调查了MotherWise对分娩结果的影响，这是一项针对少数族裔和低收入孕妇的以个人为导向的关系教育和简单案例管理/指导项目。该研究的样本包括了136名妇女，她们在早期怀孕期间参加了MotherWise的一项更大的随机对照试验。虽然由于样本量的原因，统计能力有限，且在p.05时的影响并不完全显著。结果表明，MotherWise对出生结果的影响在样本量上是小到中等的（出生体重为23，早产为46)，并为未来的关系教育项目测试及其对母婴健康的影响提出了重要的途径。本研究表明，怀孕期间的关系教育可以直接影响妇女和婴儿的健康。.

Objective. Perinatal outcomes in the United States are poor among Hispanics, the country's fastest-growing population. Hispanics experience higher rates of obesity, diabetes, gestational diabetes, preterm birth, and pregnancy-related hypertension, as well as 20% of infant deaths. StartSmarttm, an mHealth app, screens for risk and protective factors. This project translated and culturally adapted StartSmarttm for Spanish-speaking pregnant women. Methods. Using the Beaton process for translation and cultural adaptation, we completed a six-stage process. Stage I: Translation into Spanish, Stage II: Synthesis of the translations, Stage III: Back-translation, Stage IV: Expert committee review, Stage V: Pretesting with Spanish-speaking pregnant women, Stage VI: Appraisal of process. Results. StartSmarttm was acceptable and feasible for use during prenatal visits. Participants reported ease of use and understanding the material. No issues regarding literacy were identified, and participants provided helpful feedback for refining StartSmarttm for Spanish-speaking women. Conclusions. The Beaton process ensures culturally appropriate translation.

To determine if concordance of contraceptive preference and uptake differ between postpartum recipients of emergency versus full scope Medicaid.We performed a historical cohort study of patients who delivered at a safety-net hospital in Denver, Colorado in 2016. In our public system, all patients had access to immediate postpartum tubal ligation and all forms of reversible contraception in outpatient clinics. We used data from electronic health records to compare contraceptive preferences and uptake between patients with full scope and emergency Medicaid at hospital discharge and by 12 weeks postpartum. We then compared contraceptive concordance (use of the same method as desired during delivery admission) between the groups at time of postpartum discharge and by 12 weeks postpartum.We examined 693 women; 349 (50.1%) had emergency Medicaid and 344 (49.9%) had full scope Medicaid. The mean age at delivery was 27.9 years, and most patients were Hispanic (74%). Women with emergency Medicaid were less likely to receive their desired method of postpartum contraception before hospital discharge (53.6% vs. 66.9%; p .01). One-half of the patients with emergency Medicaid who did not receive their desired method of immediate postpartum contraception were unable to obtain it based on insurance ineligibility. By 12 weeks postpartum, the rates of concordance did not differ by insurance status: 52.4% of patients with emergency Medicaid and 55.2% of patients with full scope Medicaid received their desired method of contraception (p = .46).Emergency Medicaid recipients, largely recent and/or unauthorized immigrants, have high demand for highly effective postpartum contraceptives. Although emergency Medicaid recipients initially had lower rates of receipt of their desired contraceptive during the hospital stay compared with those with full scope Medicaid, they ultimately had similar concordance rates by 12 weeks postpartum. We suspect this finding was in part due to free access to all methods of contraception in our outpatient clinics during the postpartum course. Systemic barriers should be reduced to ensure better access to postpartum contraceptives for all patients, regardless of insurance coverage, to improve reproductive equity.

Objective Substance use disorders often coexist with depression. The objective of this study was to establish whether pregnant women who report depressive symptomatology were more likely to report use of alcohol, tobacco, and marijuana during pregnancy. Study Design This was a secondary analysis of prospectively collected data from the Maternal-Fetal Medicine Units Network Preterm Prediction Study. Self-reported history of alcohol, tobacco, and marijuana use was compared between pregnant women with and without depressive symptomatology with adjustment for demographic factors. Results After adjustment for demographic factors, women with depressive symptomatology were more likely to report: any alcohol use (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.1–1.8), >1 drink per week (OR: 1.3, 95% CI: 1.0–1.8), and >1 drink per day (OR: 2.2, 95% CI: 1.5–3.4). Women with depressive symptomatology were also more likely to report use of marijuana (OR: 1.8, 95% CI: 1.2–2.6) and cigarettes (OR: 1.4, 95% CI: 1.1–1.7). Conclusion Depressive symptomatology was associated with an increase in self-reported the use of alcohol, tobacco, and marijuana during pregnancy. These data reveal the importance of targeted screening of pregnant women with depressive symptomatology for substance use.

IntroductionPerinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15–20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal–child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health.MethodsA multidisciplinary team of physicians, behavioral health providers, public health, and administrators was assembled at Denver Health, an integrated hospital and community health care system that serves as the safety net hospital to the city and county of Denver, CO. This team was brought together to create a universal screen-to-treat process for PMAD’s in perinatal clinics and to adapt the existing Integrated Behavioral Health (IBH) model into a program better suited to the health system’s obstetric population. Universal prenatal and postnatal depression screening was implemented at the obstetric intake visit, a third trimester prenatal care visit, and at the postpartum visit across the clinical system. At the same time, IBH services were implemented across our health system’s perinatal care system in a stepwise fashion. This included our women’s care clinics as well as the family medicine and pediatric clinics. These efforts occurred in tandem to support all patients and staff enabling a specially trained behavioral health provider (psychologists and L.C.S.W.’s) to respond immediately to any positive screen during or after pregnancy.ResultsIn August 2014 behavioral health providers were integrated into the women’s care clinics. In January 2015 universal screening for PMADs was implemented throughout the perinatal care system. Screening has improved from 0% of women screened at the obstetric care intake visit in August 2014 to >75% of women screened in August 2016. IBH coverage by a licensed psychologist or licensed clinical social worker exists in 100% of perinatal clinics as of January 2016. As well, in order to gain sustainability, the ability to bill same day visits as well as to bill, and be reimbursed for screening and assessment visits, continues to improve and provide for a model that is self-sustaining for the future.ConclusionImplementation of a universal screening process for PMADs alongside the development of an IBH model in perinatal care has led to the creation of a program that is feasible and has the capacity to serve as a national model for improving perinatal mental health in vulnerable populations.

Synovial sarcoma is the most common nonrhabdomyosarcomatous soft tissue sarcoma in children and adolescents and is characterized by a reciprocal t(X;18)(p11;q11) which results in the fusion of the SYT gene on chromosome 18q11 to either of two closely related genes, SSX1 (Xp11.23) or SSX2 (Xp11.21). Detection of this translocation or its resultant gene fusion by molecular methods is helpful in the pathologic diagnosis of synovial sarcoma, especially in poorly differentiated tumors. This study was designed to evaluate the utility of a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay to detect and distinguish SYT-SSX1 and SYT-SSX2 fusions in fresh and archival specimens of synovial sarcoma in pediatric patients seen at St. Jude Children's Research Hospital. In addition, the clinico-pathologic features of the tumors with SYT-SSX1 vs. SYT-SSX2 fusions were compared. The 25 patients studied had a median age of 13 years 9 months (range 5 to 19 years). Estimates of survival and event-free survival at 5 years were 78.7 ± 10.5% and 56.2 ± 13.2%, respectively. Seventeen (68%) tumors were monophasic, eight (32%) were biphasic. Seven tumors contained poorly differentiated areas. Positive results for either SYT-SSX1 or SYT-SSX2 were obtained in 21/25 (84%) cases. Three cases did not have a detectable gene fusion and one had no amplifiable RNA. SYT-SSX1 transcripts were found in 18/24 (75%) of the tumors while SYT-SSX2 transcripts were identified in 3/24 (12.5%). All of the poorly differentiated tumors and seven out of eight tumors from patients who developed lung metastases had an SYT-SSX1 fusion transcript. Real-time PCR is useful in detecting and distinguishing SYT-SSX1 from SYT-SSX2 gene fusions in synovial sarcoma. Valuable aspects of this methodology are the applicability to both frozen and formalin-fixed samples, decreased labor costs, and the rapidity of results. In addition, distinguishing SYT-SSX1 from SYT-SSX2 fusions with these methods allow for prospective collection of information that may clarify issues of prognostic relevance.

Objective To determine the predictive value of an embryonic heart rate (EHR) for a live birth in women with and without a history of recurrent pregnancy loss (RPL). Design Prospective cohort study with concurrent controls. Setting A subspecialty clinic for couples with RPL. Patient(s) Three hundred pregnant women who previously had been diagnosed with RPL, followed prospectively compared with 300 age-, race-, and gestational age–matched pregnant control women. Intervention(s) Transvaginal sonography between 6 to 8 weeks of gestation. Main outcome measure(s) The EHR was determined between 6 and 8 weeks of gestation by transvaginal sonography. Obstetrical history and current pregnancy outcome were evaluated. Result(s) Data were analyzed by using the two-tailed t test and Fisher's exact test. In women with RPL, an EHR predicted a successful live birth in 246 (82%) of 300, compared with 294 (98%) of 300 in control women. The mean (± SD) EHR from successful pregnancies in the control group (143.2 ± 20.8 beats per minute) was significantly higher than the mean in women with a history of RPL (131.4 ± 22.9 beats per minute). Conclusion(s) An EHR in women with RPL is associated with a live birth rate of 82% and is significantly lower than EHR in controls. Clinicians should use this information to counsel patients with RPL.