Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder (PTSD). This study examined the role of health practitioner support and personal control during birth as predictors of PTS symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms. Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, three-weeks and three-months after the birth. Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (beta = -.41, R2 = 16%) at both three-weeks and three-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms three-months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention. Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer-term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth

The Dependent Coverage Provision Is Good for Mothers, Good for Children, and Good for Taxpayers

Importance The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. Objective To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Design, Setting, and Participants Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. Main Exposures The dependent coverage provision of the ACA, which allowed young adults to stay on their parent’s health insurance until age 26 years. Main Outcomes and Measures Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. Results The study population included 1 379 005 births among women aged 24 to 25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27 to 28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, −1.0%]) compared with the control group (52.4% to 51.1% [difference, −1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, −1.4 percentage points (95% CI, −1.7 to −1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, −0.9%]) compared with the control group (4.9% to 4.3% [difference, −0.5%]), adjusted difference-in-differences, −0.3 percentage points (95% CI, −0.4 to −0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, −0.3%) and from 9.1% to 8.9% in the control group (difference, −0.2%) (adjusted difference-in-differences, −0.2 percentage points (95% CI, −0.3 to −0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. Conclusions and Relevance In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission

Preconception Care of Women on Prescribed Opioids

The landmark 2015 report from the Center for Disease Control (CDC) posited that too many women of reproductive age received prescribed opioids. This is significant because fetal exposure to a known teratogen can have catastrophic outcomes. Furthermore, women are often ambivalent about birth control and many pregnancies are unplanned. Fortunately, women identify interactions with health care providers as acceptable cues for preconception decision making. Data has shown that Medicaid populations are disproportionately prescribed opioids compared to insured populations. However, the CDC defines reproductive status by age only. Therefore, the purpose of this research project was to identify women’s actual risk for pregnancy as defined by presence or absence of menopause, sterilization, or long-acting, reversible birth control (LARC)

Birth Order and Education: Evidence from a Korean Cohort

This paper estimates the effects of birth order on education. This paper is the first to control for the mother’s age at first birth. While previous studies find that earlier-born children are better off, this paper finds no effects.Birth order, education

Maternal serum zinc and copper and infant birth weight

Objective: Trace element deficiencies have been documented to play an important role in determination of the fetal outcome. It has been reported that the pregnant women in developing countries consume diets with a lower density of minerals and vitamins. Zinc and copper are essential trace elements and their deficiency can lead to a variety disorders. We evaluated whether is any association between infant birth weight and maternal serum zinc and copper levels. Methods: This case-control study was carried out at the Obstetrics and Gynecology Department of the Alavi Hospital in Ardabil between August 2008- August 2009. Fifty six women who had delivered low- birth- weight infants (<2500gr) were taken as the case group , and from the mothers who had delivered normal birth weight (≥2500gr) infants 56 were selected at random as the control group. Venous blood sampl were obtaind from the mothers. Serum zinc and copper levels were determined by the Atomic Absorption Spectrophotometer method. Finding: Mean of birth weight in infants, maternal age, body mass index in mothers and socioeconomic or demographic factors did not differ between cases and control groups .Maternal zinc concentration (μg/dl) did not differ between Cases and Controls; 55.84 ± 14.40 μg/dl vs.52.16 ± 8.84 μg/dl respectively. The mean serum copper level of case group was (231/75 ± 38/12 μg/dl) significantly higher (p<0/05) than control group (204/42 ± 31/30 μg/dl). There was a negative correlation between maternal serum copper level and birth weight. Conclusion: Maternal zinc concentration has no effect on neonatal birth weight infants. There was a negative correlation between birth weight and maternal copper concentration. Maternal serum zinc and copper concentration declined as gestation progressed Key word: birth weight; gestational age; copper; zin

Divorce and the birth control pill

This paper explores the role of the birth control pill on divorce. To identify its effect, we use a quasi experiment exploiting the differences in the language of the Comstock anti-obscenity statutes approved in the 1800s and early 1900s in the US. Results suggest that banning the sales of oral contraceptive methods has a negative impact on divorce. These findings are robust to alternative specifications and controls for observed (such as female labour force participation, or changes in the early legal access to the birth control pill) and unobserved state-specific factors, and time-varying factors at the state level. Additional analysis, developed to examine whether the impact of subsequent divorce law reforms on divorce is modified after controlling for the birth control pill effect, shows that, although sales bans matter, the impact of divorce law reforms on divorce rate does not vary.Divorce rate; birth control pill; sales bans; unilateral divorce

Older and Wiser? Birth Order and IQ of Young Men

While recent research finds strong evidence that birth order affects children's outcomes such as education and earnings, the evidence on the effects of birth order on IQ is decidedly mixed. This paper uses a large dataset on the population of Norway that allows us to precisely measure birth order effects on IQ using both cross-sectional and within-family methods. Importantly, irrespective of method, we find a strong and significant effect of birth order on IQ, and our results suggest that earlier born children have higher IQs. Our preferred estimates suggest differences between first-borns and second-borns of about one fifth of a standard deviation or approximately 3 IQ points. Despite these large average effects, birth order only explains about 3% of the within-family variance of IQ. When we control for birth endowments, the estimated birth order effects increase. Thus, our analysis suggests that birth order effects are not biologically determined. Also, there is no evidence that birth order effects occur because later-born children are more affected by family breakdown.