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THE INNOVATION Our family medicine clinic launched a bimonthly Early Pregnancy Dating & Risk Assessment Clinic (EPD-RA) on September 1, 2022. Point-of-care ultrasound (POCUS) is utilized to assess the presence [...]

Objectives Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona's Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. Methods We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006-2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. Results Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02-1.50) and adequate (OR 1.08, 95%CI 1.01-1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07-4.60), primipara women (OR 1.64, 95%CI 1.13-2.38), teens (OR 1.58, 95%CI 1.02-2.45), women in rural border counties (OR 1.45, 95%CI 1.05-1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11-1.55), women in rural border counties (OR 1.18, 95%CI 1.05-1.33), primipara women (OR 1.18, 95%CI 1.05-1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27). Conclusions for Practice: A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity., Author(s): Kelly McCue [sup.1] , Samantha Sabo [sup.1] , Patrick Wightman [sup.2] , Matthew Butler [sup.3] , Vern Pilling [sup.4] , Dulce Jiménez [sup.1] , Rebecca Annorbah [sup.1] , Sara [...]

Purpose Trauma is common among those seeking Ob-Gyn care and may have pervasive impact on obstetrical and gynecological health, social functioning, and healthcare engagement. While guidelines exist on the detection and treatment of perinatal mood and anxiety disorders within Ob-Gyn care, the role of Ob-gyn clinicians in identifying and addressing patients' traumatic experiences and related symptoms is less clearly delineated. This manuscript provides an overview of trauma-related symptoms in the context of Ob-Gyn care and practical guidance of clinicians aiming to improve their detection and response to trauma in their clinical practice. Description Posttraumatic stress disorder (PTSD) describes a psychiatric illness which develops as a response to a traumatic event. Women who have experienced trauma are also at increased risk for borderline personality disorder and other psychiatric comorbidities. Postpartum PTSD has particular relevance to obstetrical care. Assessment Screening for trauma in Ob-Gyn care can provide an opportunity to address risk and offer targeted intervention. Several brief evidence-based screening tools are available. Individuals who screen positive require assessment of immediate safety and targeted referrals. Trauma informed care describes an approach to healthcare aimed to enhance physical and emotional safety for patients and clinicians. Conclusion Given the prevalence and the potentially devastating and enduring impact of trauma and trauma-related symptoms, there is a critical need to address trauma within Ob-Gyn care. By recognizing the signs of trauma and initiating or referring to appropriate treatments, Ob-Gyn clinicians have a unique opportunity to better understand their patients and to improve their care., Author(s): Sarah Nagle-Yang [sup.1] , Jyoti Sachdeva [sup.2] , Lulu X. Zhao [sup.3] , Neeta Shenai [sup.4] , Nicole Shirvani [sup.5] , Linda L.M. Worley [sup.6] , Priya Gopalan [sup.4] [...]

Objective To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. Methods We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a [greater than or equal to] 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. Results The intervention group showed a greater decrease in dichotomous EPDS [greater than or equal to] 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). Conclusions In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. Clinical Trial Registry ClinicalTrials.gov NCT02862444., Author(s): Samira Alfayumi-Zeadna [sup.1] [sup.2] , Atif Zeadna [sup.3] , Zuya Azbarga [sup.4] , Lobna Salman [sup.4] , Miron Froimovici [sup.4] , Awad Alkatnany [sup.4] , Itamar Grotto [sup.5] , [...]

Introduction A small but growing body of evidence suggests individualized support services and improved access to contraception can promote healthy birth spacing among adolescent mothers. This study examines the effectiveness of Steps to Success, a 2-year home visiting program in San Angelo, Texas, enhanced with content designed to reduce rapid repeat pregnancy among young mothers, increase fathers' involvement, and support mothers' education and career aspirations. Methods The study used a randomized controlled trial, with 594 young mothers ages 14-20 randomly assigned to either a program group that received Steps to Success or a control group that received an existing home visiting program focused only on parenting and child development. Women in both research groups completed a baseline survey upon enrolling in the study and 1- and 2-year follow-up surveys. Results After 2 years, participants in the Steps to Success and existing home visiting groups had similar rates of repeat pregnancy. However, women in the Steps to Success group were more likely to use long-acting reversible contraceptives (effect size = 0.18, p = 0.066), particularly younger adolescent mothers ages 14-18 (effect size = 0.34, p = 0.010). Steps to Success also decreased the incidence of unprotected sex for younger adolescent mothers (effect size = -0.25, p = 0.035). Steps to Success did not improve outcomes in other domains. Discussion Steps to Success improved some outcomes related to healthy birth spacing among younger adolescent mothers. Communities interested in similar programming may want to consider focusing their services on this age group., Author(s): Dana Rotz [sup.1] , Menbere Shiferaw [sup.2] , Robert G. Wood [sup.3] Author Affiliations: (1) Wayfair, Inc., , 4 Copley Place, 02116, Boston, MA, USA (2) grid.299565.4, 0000 0000 [...]

Objectives This is a pilot study of the Vermont Family Based Approach, an innovative health promotion program designed to address behavioral health prevention in primary care, adapted for perinatal women. We aimed to determine the acceptability of the intervention across socioeconomic strata, and to identify if participation improves perinatal mental health. Methods Recruitment occurred at a general obstetrics practice. Women 12-25 weeks gestation were paired with a wellness coach who administered a wellness assessment and used motivational interviewing to facilitate individualized plans based on evidence-based domains of health promotion. Participants were offered access to free, co-located wellness activities through the peripartum, and referred to behavioral health services if appropriate. Results 93 women consented; 16 Medicaid Insured women (MI) and 30 Privately Insured (PI) were randomized to the intervention. Of all activities, yoga and parenting activities were most appealing, with 58% of women attending. PI (M = 12.30, SD = 11.71) attended significantly more activities than MI (M = 3.81, SD = 12.30; p = .001). Trauma exposure was inversely associated with attendance (p = .004). Randomization to the intervention was not associated with improvements in internalizing symptoms or perceived stress at 12 months postpartum, however, attending three or more wellness activities was associated with a decrease in perceived stress between baseline and 12 months postpartum. Conclusion This program appeared acceptable and engaging to women with private insurance, but less so with Medicaid. The trial failed to demonstrate improvement in internalizing scores, but of those randomized to the intervention, higher engagement was associated with decreased stress one year after giving birth., Author(s): Sarah Guth [sup.1] , Ellen McGinnis [sup.1] , William Copeland [sup.1] , James Hudziak [sup.1] Author Affiliations: (1) grid.59062.38, 0000 0004 1936 7689, Vermont Center for Children, Youth and [...]

Introduction The birth of a second child to an adolescent woman worsens the adverse medical, socioeconomic, educational, and parenting outcomes for the woman and her children. Despite the known high efficacy of long-acting reversible contraception (LARC), many postpartum adolescents use less effective or no contraception. Interconception care (ICC) focuses on modifying maternal risks between pregnancies and promoting healthy birth spacing to improve outcomes for women and children. Research shows that women regularly attend their child's health care visits even if they do not seek care for themselves between pregnancies. These visits present a potential opportunity for providers to educate women on available LARC options. Methods In an adolescent mother-child clinic, demographic and ICC screening data were collected on women presenting for well child visits of children age 0-24 months. These data were analyzed using logistic regression models to identify independent predictors of LARC initiation and repeat pregnancy. Results Mother-child dyads were screened an average of two times in the study period. Participants with only one visit were less likely to initiate LARC. Of the participants, 5.5% became pregnant again, with patients having only one ICC visit being slightly, but not significantly more likely. Hispanic ethnicity and having [greater than or equal to] 2 visits were significant independent predictors of LARC initiation. The only independent predictor of repeat pregnancy was not initiating LARC. Conclusions This study suggests that optimal ICC may rely on consistent and frequent touch points with providers and not solely on the medical management during the interconception period, making it adaptable to a traditional pediatric medical home. Tying the worlds of pediatric and maternal healthcare is pivotal for successful ICC., Author(s): Hana Smith [sup.1] , Jeanelle Sheeder [sup.2] , Amelia Ehmer [sup.3] , Sadie Hasbrouck [sup.3] , Steve Scott [sup.2] , Bethany Ashby [sup.2] [sup.3] Author Affiliations: (1) grid.430503.1, 0000 [...]

Purpose The Hennepin Healthcare Mother-Baby Day Hospital is a partial hospital program for pregnant and postpartum women with moderate to severe psychiatric illness. Based in an urban safety net hospital, the Day Hospital provides trauma-informed, multigenerational, group-based therapy and psychiatric care. This report describes the program and preliminary data regarding maternal mental health and functioning at treatment entry and discharge. Methods Data include information on pregnant and postpartum women who were admitted to the Day Hospital between April 2013 and September 2019 and completed at least 4 days of treatment. We describe patient demographics and changes in mental health and maternal functioning. Results 328 women consented to participation in research, representing 364 unique admissions. Primary diagnoses included major depression (55.6%; n = 202); generalized anxiety (36.4%; n = 132); bipolar spectrum (28%; n = 102); and trauma-related disorders (20.6%; n = 75). Patients reported significant improvements (p < 0.001) in self-report scales assessing depression, anxiety, and maternal functioning. Conclusions A mother-baby day hospital based in an urban safety net hospital is effective in improving mental health and parenting functioning in perinatal women with moderate to severe psychiatric illness. The high acuity and prevalence of comorbid depression, anxiety, bipolar spectrum, and trauma-related disorders support the need for trauma-informed, multigenerational approaches that address perinatal mental health and attachment-based parenting support., Author(s): Helen G. Kim [sup.1] , Nora L. Erickson [sup.1] , Jessica M. Flynn [sup.1] Author Affiliations: (1) Department of Psychiatry, and Redleaf Center for Family Healing, , Hennepin Healthcare, [...]

Introduction This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. Methods Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. Results Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. Discussion Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing., Author(s): Roxanne Mirabal-Beltran [sup.1] [sup.2] , Jean Anderson [sup.2] [sup.5] , Jacinda K. Dariotis [sup.2] [sup.4] , Sarah Finocchario-Kessler [sup.3] Author Affiliations: (1) grid.213910.8, 0000 0001 1955 1644, Department of [...]

Context: Group perinatal care (GPC) offers a 'one stop' approach to clinical care and perinatal education. It has been shown to be associated with high levels of patient satisfaction and improved clinical outcomes. Co-facilitation of GPC (including postpartum care) by midwives (MW) and family medicine residents (FMR) in a family health team (FHT) has not been previously assessed. Objective: To explore the experience of participants in the academic FHT model of GPC. Study design: Descriptive qualitative study using semi-structured telephone interviews with participants who had completed GPC. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by team members. Setting: Academic family health team (FHT), Toronto, Canada. Participants: 18 patients who had participated in GPC at the Mount Sinai Academic FHT who delivered between November 7, 2016 and October 26, 2018. Findings: The major theme was the value of the relationships established and the positive consequences of those relationships. Participants describe relationships with health care providers that were built on comprehensiveness, continuity and credibility. Relationships with other GPC participants were facilitated but also developed organically, continued outside the structure of GPC and persisted well beyond perinatal care. The consequences of these relationships included creating support networks, shared knowledge and experience with their partners, improved self-confidence during the pregnancy and labour journey, decreased anxiety and extended commitment to breastfeeding. Conclusions: Participants in GPC at the Mount Sinai Academic FHT, in essence, became part of a social network for their labour, birth and early parenting journey by developing relationships with their healthcare providers, partners and fellow participants through the group process. This resulted in informational and emotional support which positively affected their experience. In particular, the contributions to self-confidence and decreased anxiety deserve further exploration., Presenters Anne Biringer, MD, CCFP FCFP, Natalie Morson, MD, CCFP, MScCH, Sakina Walji, MD, MPH, Tutsirai Makuwaza, MA, BSc, Susannah Merritt, Registered Midwife, Natalie Tregaskiss, BA, BHSc, BSc, RN, RM, [...]

Purpose This evaluation describes efforts taken by MIECHV administrators and staff during the pandemic using data collected from 60 MIECHV staff surveys and nine statewide weekly focus groups. Description The Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative funds perinatal home visiting for pregnant women and families with infants throughout the state. Florida MIECHV has shown resilience to disasters and times of crises in the past, while generating a culture of adaptation and continuous quality improvement among local implementing agencies. Florida MIECHV responded to the COVID-19 pandemic crisis within the first few days of the first reported case in Florida by providing guidance on virtual home visits and working remotely. Assessment Findings highlight the role of administrative leadership and communication, staff willingness/morale, logistical considerations, and the needs of enrolled families who face hardships during the pandemic such as job loss, limited supplies, food insecurity, technology limitations, and stress. Home visitors support enrolled families by connecting them with resources, providing public health education and delivering evidence-based home visiting curricula virtually. They also recognized the emotional burden surrounding COVID-19 impacts and uncertainties along with achieving work-life balance by caring for their own children. Conclusion This evaluation helped in understanding the impact of the pandemic on this maternal and child health program and fundamentals of transition to virtual home visiting services. Virtual home visiting appears to be feasible and provides an essential connection to supports for families who may not otherwise have the means or knowledge to access them., Author(s): Jennifer Marshall [sup.1] , Laura Kihlström [sup.1] , Acadia Buro [sup.1] , Vidya Chandran [sup.1] , Concha Prieto [sup.1] , Rafaella Stein-Elger [sup.1] , Keryden Koeut-Futch [sup.1] , Allison [...]

Purpose This article uses an evaluation of New Heights, a school-based program for pregnant and parenting teens in the District of Columbia Public Schools, to illustrate how maternal and child health programs can obtain rigorous evaluations at reasonable cost using extant administrative data. The key purpose of the article is to draw out lessons learned about planning and conducting this type of evaluation, including the important role of partnerships between program staff and evaluators. Description This article summarizes the evaluation's research design, data sources, and lessons learned about ingredients contributing to the successful implementation of this study. The evaluation employed a difference-in-differences design to estimate program impacts using administrative data merged across agencies. Assessment Several features of New Heights and its context facilitated an evaluation. First, New Heights leaders could clearly describe program components and how the program was expected to improve specific student education outcomes. These outcomes were easy to measure for program and comparison groups using administrative data, which agencies were willing to provide. Second, buy-in from program staff facilitated study approval, data agreements, and unanticipated opportunities to learn about program implementation. Finally, time spent by evaluators and program staff in conversation about the program's components, context, and data resulted in greater understanding and a more useful evaluation. Conclusion The New Heights evaluation is a concrete example of how a small program with a modest evaluation budget can obtain evidence of impact. Collaborative relationships between researchers and program staff can enable these informative studies to flourish., Author(s): Susan Zief [sup.1] , John Deke [sup.1] , Ruth Neild [sup.1] Author Affiliations: (1) grid.419482.2, 0000 0004 0618 1906, Mathematica Policy Research, , 600 Alexander Park, 08540, Princeton, NJ, [...]

Objectives Nutrition during pregnancy is related with many maternal and child outcomes. To investigate the consumption of ultra-processed foods is one of the newest methods to evaluate food consumption, but these studies in pregnant women are rare. Methods We conducted a non-randomized controlled educational intervention on healthy eating and physical activity during pregnancy in primary health care units of Botucatu, São Paulo, Brazil. The sample comprised two groups of pregnant women with low obstetric risk, an intervention group (n = 181) and a control group (n = 172). The health professionals that assisted the pregnant women from the intervention group were trained to promote five healthy food practices during the prenatal care appointments: consumption of three fruits; two portions of vegetables; two portions of beans, at least 5 days per week; and restriction of soft drinks and industrially processed cookies. All pregnant women answered two 24-h dietary recalls per trimester, one face-to-face, another by telephone. The foods consumed by pregnant women were classified according Nova. The impact of the intervention on the ultra-processed food consumption was evaluated by multilevel linear regression analysis. Results A quarter of the energy consumed by the pregnant women provided from ultra-processed foods. The intervention reduced these percentage of energy between the first and second trimester of pregnancy by 4.6 points (p = 0.015). This effect was not observed in the third trimester of pregnancy. Conclusions for Practice Training health care professionals to promote healthy food practices is a viable and sustainable alternative to reduce ultra-processed foods during pregnancy., Author(s): Caroline de Barros Gomes [sup.1] , Maíra Barreto Malta [sup.2] , Maria Laura da Costa Louzada [sup.3] , Maria Helena D'Aquino Benício [sup.2] , Aluísio J. D. Barros [sup.4] [...]

Objectives Research indicates the beneficial effects of physical activity during pregnancy on maternal health, although controversy still exists regarding its influence on birth outcomes. Little research has been done to objectively measure physical activity during pregnancy in black African women from low-to-middle income countries. The purpose of this study was to examine the association between physical activity and maternal and birth outcomes in this unique population. Methods This observational, longitudinal study assessed total physical activity using a hip-mounted triaxial accelerometer at 14-18 weeks (second trimester, n = 120) and 29-33 weeks (third trimester, n = 90) gestation. Physical activity is expressed as gravity-based acceleration units (mg). Maternal outcomes included both weight and weight gain at 29-33 weeks gestation. Birth outcomes included gestational age, birth weight, ponderal index and Apgar score, measured within 48 h of delivery. Results There was a significant decline in physical activity from the second to the third trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p [less than or equal to] 0.01). Physical activity at 29-33 weeks as well as a change in PA was inversely associated with weight change at 29-33 weeks ([beta] = - 0.24; 95% CI - 0.49; - 0.00; p = 0.05 and [beta] = - 0.36; 95% CI - 0.62; - 0.10; p = 0.01, respectively). No significant associations were found between physical activity and birth outcomes. Conclusions for Practice Physical activity during pregnancy may be an effective method to control gestational weight gain, whilst presenting no adverse risk for fetal development, in women from a low-income urban setting., Author(s): Estelle D. Watson [sup.1] [sup.2] , Søren Brage [sup.3] , Tom White [sup.3] , Kate Westgate [sup.3] , Shane A. Norris [sup.2] , Mireille N. M. Van Poppel [sup.4] [...]

Objective The purpose of this study was to examine the content of the first prenatal visit within an academic medical center clinic and to compare the topics discussed to 2014 American College of Obstetrics and Gynecologists guidelines for the initial prenatal visit. Methods Clinical interactions were audio recorded and transcribed (n = 30). A content analysis was used to identify topics discussed during the initial prenatal visit. Topics discussed were then compared to the 2014 ACOG guidelines for adherence. Coded data was queried though the qualitative software and reviewed for accuracy and content. Results First prenatal visits included a physician, nurse practitioner, nurse midwife, medical assistant, medical students, or a combination of these providers. In general, topics that were covered in most visits and closely adhered to ACOG guidelines included vitamin supplementation, laboratory testing, flu vaccinations, and cervical cancer screening. Topics discussed less often included many components of the physical examination, education about pregnancy, and screening for an identification of psychosocial risk. Least number of topics covered included prenatal screening. Conclusions for Practice While the ACOG guidelines may include many components that are traditional in addition to those based on evidence, the guidelines were not closely followed in this study. Identifying new ways to disseminate information during the time constrained initial prenatal visit are needed to ensure improved patient outcomes., Author(s): J. Dyer [sup.1] , G. Latendresse [sup.1] , E. Cole [sup.1] , J. Coleman [sup.1] , E. Rothwell [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0001 2193 0096, grid.223827.e, College [...]

Background Midwifery continuity of care is the only health system intervention shown to reduce preterm birth (PTB) and improve perinatal survival, but no trial evidence exists for women with identified risk factors for PTB. We aimed to assess feasibility, fidelity, and clinical outcomes of a model of midwifery continuity of care linked with a specialist obstetric clinic for women considered at increased risk for PTB. Methods and findings We conducted a hybrid implementation-effectiveness, randomised, controlled, unblinded, parallel-group pilot trial at an inner-city maternity service in London (UK), in which pregnant women identified at increased risk of PTB were randomly assigned (1:1) to either midwifery continuity of antenatal, intrapartum, and postnatal care (Pilot study Of midwifery Practice in Preterm birth Including women's Experiences [POPPIE] group) or standard care group (maternity care by different midwives working in designated clinical areas). Pregnant women attending for antenatal care at less than 24 weeks' gestation were eligible if they fulfilled one or more of the following criteria: previous cervical surgery, cerclage, premature rupture of membranes, PTB, or late miscarriage; previous short cervix or short cervix this pregnancy; or uterine abnormality and/or current smoker of tobacco. Feasibility outcomes included eligibility, recruitment and attrition rates, and fidelity of the model. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth. We analysed by intention to treat. Between 9 May 2017 and 30 September 2018, 334 women were recruited; 169 women were allocated to the POPPIE group and 165 to the standard group. Mean maternal age was 31 years; 32% of the women were from Black, Asian, and ethnic minority groups; 70% were in employment; and 46% had a university degree. Nearly 70% of women lived in areas of social deprivation. More than a quarter of women had at least one pre-existing medical condition and multiple risk factors for PTB. More than 75% of antenatal and postnatal visits were provided by a named/partner midwife, and a midwife from the POPPIE team was present at 80% of births. The incidence of the primary composite outcome showed no statistically significant difference between groups (POPPIE group 83.3% versus standard group 84.7%; risk ratio 0.98 [95% confidence interval (CI) 0.90 to 1.08]; p = 0.742). Infants in the POPPIE group were significantly more likely to have skin-to-skin contact after birth, to have it for a longer time, and to breastfeed immediately after birth and at hospital discharge. There were no differences in other secondary outcomes. The number of serious adverse events was similar in both groups and unrelated to the intervention (POPPIE group 6 versus standard group 5). Limitations of this study included the limited power and the nonmasking of group allocation; however, study assignment was masked to the statistician and researchers who analysed the data. Conclusions In this study, we found that it is feasible to set up and achieve fidelity of a model of midwifery continuity of care linked with specialist obstetric care for women at increased risk of PTB in an inner-city maternity service in London (UK), but there is no impact on most outcomes for this population group. Larger appropriately powered trials are needed, including in other settings, to evaluate the impact of relational continuity and hypothesised mechanisms of effect based on increased trust and engagement, improved care coordination, and earlier referral on disadvantaged communities, including women with complex social factors and social vulnerability. Trial registration We prospectively registered the pilot trial on the UK Clinical Research Network Portfolio Database (ID number: 31951, 24 April 2017). We registered the trial on the International Standard Randomised Controlled Trial Number (ISRCTN) (Number: 37733900, 21 August 2017) and before trial recruitment was completed (30 September 2018) when informed that prospective registration for a pilot trial was also required in a primary clinical trial registry recognised by WHO and the International Committee of Medical Journal Editors (ICMJE). The protocol as registered and published has remained unchanged, and the analysis conforms to the original plan., Author(s): Cristina Fernandez Turienzo 1,*, Debra Bick 2, Annette L. Briley 3, Mary Bollard 4, Kirstie Coxon 5, Pauline Cross 6, Sergio A. Silverio 1, Claire Singh 1, Paul T. [...]

Purpose Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother-child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways. Description The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities. Assessment Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities. Conclusion With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities., Author(s): Marni Storey-Kuyl[sup.1] , Betty Bekemeier[sup.2] , Elaine Conley[sup.3] Author Affiliations: (1) Washington County Health and Human Services, 155 North First Street MS 5, 97124, Hillsboro, OR, USA (2) Psychosocial [...]

Introduction: For 25 years, Inuit midwives have provided perinatal and newborn care for about 90% of the pregnancies in northwestern Quebec. Patients in this region continue to have high rates of preventable nutritional deficiencies. The objective of this study was to explore the perceptions of professional midwives and students about what makes a healthy pregnancy and a healthy newborn. Methods: We convened, via teleconference, a semistructured focus group with the local midwives and students. The conversation focused on local understanding of a healthy pregnancy and a healthy newborn, and the role of midwives in the communities. Results: Four midwives and 6 students took part in the focus group, representing 80% of local midwives and students. All of the participants were women, and their professional experience ranged from 3 to 25 years. Through inductive thematic analysis, it became apparent that personal experiences and professional training were important determinants of opinions. Midwives believed that the health of women and infants could be improved through better food selection, particularly reliance on traditional nutrient-rich food. They were aware that iron deficiency was a problem and that infants required vitamin D; however, they reported that supplement uptake was poor. Conclusion: Concern was expressed about a decline in traditional beliefs and about unhealthy behaviours. Participants advanced strategies to promote knowledge locally (e.g., visual aids, local radio) to attempt to reduce rates of nutritional deficiencies. Introduction : Pendant 25 ans, les sages-femmes inuites ont prodigue les soins perinataux et neonataux requis pour environ 90 % des grossesses dans le Nord-Ouest du Quebec. Les patientes de cette region continuent de presenter des taux eleves de carences nutritionnelles evitables. L'objectif de cette etude etait d'explorer les perceptions des sages-femmes professionnelles et des etudiantes sur ce qu'elles considerent comme une grossesse saine et un nouveau-ne en bonne sante. Methodes : Nous avons organise un groupe de discussion semi-structure par teleconference avec des sages-femmes et des etudiantes locales. L'entrevue a porte sur leur conception d'une grossesse saine et d'un nouveau-ne en bonne sante et sur le role des sages-femmes dans les communautes. Resultats : Quatre sages-femmes et 6 etudiantes ont participe au groupe de discussion, representant 80 % des sages-femmes et etudiantes locales. Toutes les participantes etaient des femmes et leur experience professionnelle variait de 3 a 25 ans. Une analyse thematique inductive a fait ressortir que les experiences personnelles et la formation professionnelle etaient d'importants determinants des opinions formulees. Les sages-femmes se sont dites d'avis que la sante des femmes et des nouveau-nes pouvait etre amelioree par de meilleurs choix alimentaires, particulierement en ce qui concerne l'alimentation traditionnelle, riche en elements nutritifs. Elles etaient conscientes du fait qu'une carence en fer constitue un probleme et que les nourrissons ont besoin de vitamine D. Elles ont toutefois mentionne que dans les faits, les supplements sont peu utilises. Conclusion : Les participantes ont exprime leur inquietude face au declin des connaissances traditionnelles et face aux comportements malsains. Elles ont propose des strategies pour promouvoir la transmission des connaissances a l'echelle locale (p. ex., aides visuelles, radio locale) pour tenter de remedier aux carences nutritionnelles., INTRODUCTION Midwives of western Nunavik in northern Quebec provide local care for expectant mothers and infants for the first 2 months of life. (1,2) More than 90% of the approximately [...]

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life. J. Nutr. 140: 402-406, 2010. doi: 10.3945/jn.109.114488.

This article reviews key findings about the long-term impact of a nutrition intervention carried out by the Institute of Nutrition of Central America and Panama from 1969 to 1977. Results from follow-up studies in 1988-89 and 2002-04 show substantial impact on adult human capital and economic productivity. The 1988-89 study showed that adult body size and work capacity increased for those provided improved nutrition through age 3 y, whereas the 2002-04 follow-up showed that schooling was increased for women and reading comprehension and intelligence increased in both men and women. Participants were 26-42 y of age at the time of the 2002-04 follow-up, facilitating the assessment of economic productivity. Wages of men increased by 46% in those provided with improved nutrition through age 2 y. Findings for cardiovascular disease risk factors were heterogeneous; however, they suggest that improved nutrition in early life is unlikely to increase cardiovascular disease risk later in life and may indeed lower risk. In conclusion, the substantial improvement in adult human capital and economic productivity resulting from the nutrition intervention provides a powerful argument for promoting improvements in nutrition in pregnant women and young children. J. Nutr. 140:411-414, 2010. doi: 10.3945/jn.109.114504.

Daily telephone monitoring by a nurse may not reduce the rate of preterm labor in pregnant women at risk for early delivery. Researchers enrolled 2,422 women at risk for preterm labor in an educational class, then randomly assigned them to receive weekly or daily nursing calls, or daily uterine activity monitoring. Daily calls and monitoring did not reduce the rate of preterm labor. Women who received daily calls made more unscheduled visits to the obstetrician and were more often prescribed drugs to stop uterine contractions, indicating that premature labor may have been overdiagnosed.