Association between Breastfeeding Duration and Type of Birth Attendant

Introduction. Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods. Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics’ national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. Results. Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. Conclusions. Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population

Do Successive Preterm Births Increase the Risk of Postpartum Depressive Symptoms?

Background. Postpartum depression and preterm birth (PTB) are major problems affecting women’s health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS). However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods. Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was used to examine the association between PTB and PDS. Results. The risk of PDS was 55% higher in women with PTB in both deliveries (aRR = 1.55; 95% CI = 1.28–1.88) and 74% higher in women with PTB in the index delivery only (aRR = 1.74; 95% CI = 1.49–2.05), compared to women with term deliveries. Conclusions. Preterm birth is a risk factor for PDS. PTB in women with a prior history of PTB is not associated with an incremental risk of PDS. Routine screening for PDS should be conducted for all women and closer monitoring should be done for high risk women with PTB

Pre-pregnancy obesity and non-adherence to multivitamin use: findings from the National Pregnancy Risk Assessment Monitoring System (2009–2011)

Background Although adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S. non-pregnant women of childbearing age do not use multivitamins every day. Factors influencing consistent multivitamin use are not fully explored. This study aims to investigate the association between pre-pregnancy body mass index (BMI) and multivitamin use before pregnancy using a large, nationally representative sample of women with recent live births. Methods The national 2009–2011 Pregnancy Risk Assessment Monitoring System data were analyzed. The sample included women with recent singleton live births (N = 104,211). The outcome of interest was multivitamin use which was categorized as no multivitamin use, 1–3 times/week, 4–6 times/week, and daily use. Maternal BMI was examined as underweight (\u3c18.50 kg/m2), normal weight (18.50–24.99 kg/m2), overweight (25.00–29.99 kg/m2), and obese (≥30.00 kg/m2). Multinomial logistic regression was conducted, and adjusted odds ratios and 95 % confidence intervals were calculated. Results Compared to women with normal weight, overweight and obese women had significantly increased odds of not taking multivitamins after adjusting for confounding factors. Further, the lack of multivitamin use increased in magnitude with the level of BMI (ORoverweight = 1.2, 95 % CI = 1.1–1.3; ORobese = 1.4, 95 % CI = 1.2–1.5). Conclusions Obese and overweight women were less likely to follow the recommendation for preconception multivitamin use compared to normal weight women. All health care professionals must enhance preconception care with particular attention to overweight and obese women. Preconception counseling may be an opportunity to discuss healthy eating and benefits of daily multivitamin intake before pregnancy

Source of care and variation in long acting reversible contraception use

OBJECTIVE: To examine variation in long acting reversible contraception (LARC) use by source of birth control services. DESIGN: Cross-sectional study. SETTING: Not applicable. PATIENT(S): Sexually active women who received contraceptive services in the past 12 months, who were neither pregnant nor trying to become pregnant and who were not sterilized and nor were their partners sterilized. INTERVENTION(S): Three multinomial logistic regression models assessed the relationship between source of services and LARC use, controlling for covariates. The odds of LARC use were compared with LARC nonuse, high-efficacy use, and low-efficacy use. MAIN OUTCOME MEASURE(S): Reported LARC method use. RESULT(S): There was no statistically significant difference in LARC use between women receiving services from community or public health clinics and women receiving services from private clinics. Women receiving care at a family-planning clinics had lower odds of LARC use versus LARC nonuse (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.10-0.74), versus high-efficacy method use (OR = 0.32; 95% CI, 0.11-0.88) and versus low-efficacy method use (OR = 0.13; 95% CI, 0.02-0.87) compared with those receiving services at private clinics. CONCLUSION(S): Women receiving care from family-planning clinics had lower odds of LARC use compared with those receiving care from a private doctor\u27s office or health maintenance organization facility

Breastfeeding after Gestational Diabetes: Does Perceived Benefits Mediate the Relationship?

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes.The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed (=4,902). Structural equation modeling estimated direct and indirect effects. Results. Perceived benefits of breastfeeding directly influenced breastfeeding duration ( = 0.392, ≤ 0.001). GDM was not directly associated with breastfeeding duration or perceived benefits of breastfeeding. Similarly, GDM did not have an indirect effect on breastfeeding duration through perceived benefits of breastfeeding. Conclusions. Perceived benefits of breastfeeding are an important factor associated with breastfeeding duration. Maternal and child health care professionals should enhance breastfeeding education efforts

Pre-pregnancy BMI and weight gain: where is the tipping point for preterm birth?

Background Obesity in pregnant women is a major problem affecting both the mother and her offspring. Literature on the effect of obesity on preterm birth is inconsistent and few studies have investigated the influence of weight gain during pregnancy. This study examined the effect of maternal pre-pregnancy BMI and weight gain during pregnancy on preterm birth. Methods Data from the Collaborative Perinatal Project (CPP) on 45,824 pregnant women with singleton, live-born infants with no severe congenital anomalies was analyzed. Primary outcome variables included preterm (\u3c 37 weeks of gestation), categorized into spontaneous preterm with and without premature rupture of membrane (PROM) and indicated preterm. Maternal BMI was categorized into underweight (BMI \u3c 18.50), normal weight (BMI =1 8.50 – 24.99), overweight (BMI = 25.00 – 29.99), and obese (BMI ≥ 30.00). Multinomial regression analysis was conducted and OR and 95% CI were calculated. Results The rate of spontaneous preterm birth with PROM among overweight women decreased with increasing weight gain but increased among women who had excessive weight gain. Similarly, a U-shaped rate of spontaneous preterm birth with and without PROM was observed in obese women. Gaining less weight was protective of spontaneous preterm with and without PROM among overweight and obese women compared to normal weight women. Among underweight women, gaining \u3c 7 kg or 9.5-12.7 kg was associated with increased odds of indicated preterm birth. Appreciable differences were also observed in the association between pre-pregnancy BMI, gestational weight gain and the subtypes of preterm births among African Americans and Caucasian Americans. Conclusion Reduced weight gain during pregnancy among overweight and obese women is associated with reduced spontaneous preterm birth with and without PROM. Health care professionals and public health workers should be aware of this risk and adhere to the 2009 IOM guideline that recommended reduced weight gain during pregnancy for obese and overweight women

Racial Disparities in the Association Between Stress and Preterm Birth

Background: High levels of maternal stress have been linked to preterm births. However, findings from previous studies are inconsistent due to the varied use of stress measures. This study examined the effect of maternal stress on preterm birth, using both psychosocial and physiological measures. Methods: This study was conducted among 231 pregnant women enrolled during their first prenatal care visit. Presence of stress was assessed at enrollment using the Perceived Stress Scale (PSS) and Stressful Life Events Inventory (SLEI). Samples of maternal salivary cortisol were obtained during the first trimester and birth outcomes were ascertained at delivery. Multiple logistic regression was conducted to assess the association between stress and preterm birth. Results: The majority of the study participants were Black, not married, less educated and low income. There was an association between cortisol level and preterm birth. Per 1µg/dL increase in cortisol level, the odds of preterm birth increased by 26%. The increase was accentuated in Blacks where a unit increase in cortisol level was associated with higher odds of preterm birth (29%). Conclusions: Stress measures using PSS and SLEI did not reveal a statistically significant association with preterm birth. Health care and public health professionals should be aware of the association between increased cortisol level and preterm birth. Salivary cortisol may be a better predictor of preterm birth than PSS and SLEI

Postpartum Visit Attendance Increases the Use of Modern Contraceptives

Background. Delays in postpartum contraceptive use may increase risk for unintended or rapid repeat pregnancies. The postpartum care visit (PPCV) is a good opportunity for women to discuss family planning options with their health care providers. This study examined the association between PPCV attendance and modern contraceptive use using data from a managed care organization. Methods. Claims and demographic and administrative data came from a nonprofit managed care organization in Virginia (2008–2012). Information on the most recent delivery for mothers with singleton births was analyzed (N = 24,619). Routine PPCV (yes, no) and modern contraceptive use were both dichotomized. Descriptive analyses provided percentages, frequencies, and means. Multiple logistic regression was conducted and ORs and 95% CIs were calculated. Results. More than half of the women did not attend their PPCV (50.8%) and 86.9% had no modern contraceptive use. After controlling for the effects of confounders, women with PPCV were 50% more likely to use modern contraceptive methods than women with no PPCV (OR = 1.50, 95% CI = 1.31, 1.72). Conclusions. These findings highlight the importance of PPCV in improving modern contraceptive use and guide health care policy in the effort of reducing unintended pregnancy rates