Description

Maternal and Child Health Journal is the first exclusive forum to advance the scientific and professional knowledge base of the maternal and child health (MCH) field. This quarterly provides peer-reviewed papers addressing the following areas of MCH practice policy and research: MCH epidemiology demography and health status assessment Innovative MCH service initiatives Implementation of MCH programs MCH policy analysis and advocacy MCH professional development. Exploring the full spectrum of the MCH field Maternal and Child Health Journal is an important tool for practitioners as well as academics in public health obstetrics gynecology prenatal medicine pediatrics and neonatology. Sponsors include the Association of Maternal and Child Health Programs (AMCHP) the Association of Teachers of Maternal and Child Health (ATMCH) and CityMatCH.

Publisher details

Springer Verlag

Publications in this journal

• Predictors of Inadequate Prenatal Care in Methamphetamine-Using Mothers in New Zealand and the United States.

  Authors: Min Wu, Linda L Lagasse, Trecia A Wouldes, Amelia M Arria, Tara Wilcox, Chris Derauf, Elana Newman, Rizwan Shah, Lynne M Smith, Charles R Neal, Marilyn A Huestis, Sheri Dellagrotta, Barry M Lester

  Maternal and child health journal.

  This study compared patterns of prenatal care among mothers who used methamphetamine (MA) during pregnancy and non-using mothers in the US and New Zealand (NZ), and evaluated associations amongThis study compared patterns of prenatal care among mothers who used methamphetamine (MA) during pregnancy and non-using mothers in the US and New Zealand (NZ), and evaluated associations among maternal drug use, child protective services (CPS) referral, and inadequate prenatal care in both countries. The sample consisted of 182 mothers in the MA-Exposed and 196 in the Comparison groups in the US, and 107 mothers in the MA-Exposed and 112 in the Comparison groups in NZ. Positive toxicology results and/or maternal report of MA use during pregnancy were used to identify MA use. Information about sociodemographics, prenatal care and prenatal substance use was collected by maternal interview. MA-use during pregnancy is associated with lower socioeconomic status, single marital status, and CPS referral in both NZ and the US. Compared to their non-using counterparts, MA-using mothers in the US had significantly higher rates of inadequate prenatal care. No association was found between inadequate care and MA-use in NZ. In the US, inadequate prenatal care was associated with CPS referral, but not in NZ. Referral to CPS for drug use only composed 40 % of all referrals in the US, but only 15 % of referrals in NZ. In our study population, prenatal MA-use and CPS referral eclipse maternal sociodemographics in explanatory power for inadequate prenatal care. The predominant effect of CPS referral in the US is especially interesting, and should encourage further research on whether the US policy of mandatory reporting discourages drug-using mothers from seeking antenatal care.

• Patterns of Infant Mortality from 1993 to 2007 in Belgrade (Serbia).

  Authors: Tatjana Gazibara, Darija Kisic-Tepavcevic, Jelena Dotlic, Bojana Matejic, Anita Grgurevic, Tatjana Pekmezovic

  Maternal and child health journal.

  The population of the Republic of Serbia has been exposed to radical changes in living standards and employment status and inequalities in utilization of health-care services. Given that infantThe population of the Republic of Serbia has been exposed to radical changes in living standards and employment status and inequalities in utilization of health-care services. Given that infant mortality rates (IMR) reflect general community health, we evaluated the trends and mortality structure of Belgrade's infant population for a 15-year period (1993-2007). Data were collected from published and unpublished materials of the Municipal Institute of Statistics in Belgrade. Records were based on official notifications of live-born infants and death certificates. A linear regression equation was used to estimate mortality trends over time, while an F test was performed to assess the significance of the linear regression coefficient. The average IMR was 11.3 [95 % confidence interval (CI) 9.4, 13.2] per 1,000 live births for both sexes with a higher average rate observed for male infants. Throughout the whole period, a statistically significant declining trend (y = 17.072 - 0.721x, p = 0.001) was noted. The most common causes of death were conditions occurring during the perinatal period, with an average annual mortality rate of 7.7 [95 % CI 6.4, 8.9] per 1,000, arising mainly from respiratory distress of the newborns. Regarding congenital anomalies, deformations of the heart and aortic and mitral valves were most frequently found. A statistically significant inverse correlation was observed between average net salary and IMR for each sex separately (for males r = -0.727, p = 0.002, for females r = -0.721, p = 0.002) and for both sexes jointly (r = -0.759, p = 0.001). A decline in infant mortality in Belgrade has been observed. However, further promotion of health-related activities, as well as continuous surveillance of IMR, is required.

• Interpregnancy Intervals and the Risk for Infant Mortality: A Case Control Study of Arizona Infants 2003-2007.

  Authors: Khaleel S Hussaini, Douglas Ritenour, Dean V Coonrod

  Maternal and child health journal.

  There is well-documented evidence on how interpregnancy interval (IPI) is associated with adverse perinatal outcomes and how short and long IPIs are associated with increased risk for preterm birth,There is well-documented evidence on how interpregnancy interval (IPI) is associated with adverse perinatal outcomes and how short and long IPIs are associated with increased risk for preterm birth, low birth weight, and intra-uterine growth restriction. However, the extremes of IPI on infant mortality are less well documented. The current study builds on the existing evidence on IPI to examine if extremes of IPI are associated with infant mortality, and also examines if IPI is associated with both neonatal and post-neonatal mortality after adjusting for several known confounders. Matched birth and death certificate data for Arizona resident infants was drawn for 2003-2007 cohorts. The analysis was restricted to singleton births among resident mothers with a previous live birth (n = 1,466) and a randomly selected cohort of surviving infants during the same time-frame was used as a comparison group (n = 2,000). Logistic regression models were utilized to assess the odds for infant mortality at monthly interpregnancy intervals (<6, 6-11, 12-17, 18-23, 24-59, ≥60), while adjusting for established predictors of infant mortality (i.e., preterm birth, low birth weight, and small for gestational age), and other potential confounders. Unadjusted analysis showed greater clustering at extreme IPIs of <6 months and ≥60 months for infants that died (32 %) compared to infants that survived (24.7 %). Shorter IPI (i.e., <6 months, 6-11 months, and 12-17 months) compared to 'ideal' IPI (i.e., 18-23 months), were associated with infant mortality even after adjusting for confounders. Short intervals were significantly associated with neonatal, but not post-neonatal deaths. IPI above 23 months were not associated with infant mortality in our analyses. Shorter IPIs (18 months or less) significantly increases the risk for neonatal infant mortality even after controlling for known confounders, and our study adds to the existing evidence on adverse perinatal outcomes. Counseling women of reproductive age on the benefits of spacing pregnancies to at least 18 months addresses one preventable risk for early infant mortality.

• Social Support During the Postpartum Period: Mothers' Views on Needs, Expectations, and Mobilization of Support.

  Authors: Rennie Negron, Anika Martin, Meital Almog, Amy Balbierz, Elizabeth A Howell

  Maternal and child health journal.

  Research has indicated that social support is a major buffer of postpartum depression. Yet little is known concerning women's perceptions on social support during the postpartum period. The objectiveResearch has indicated that social support is a major buffer of postpartum depression. Yet little is known concerning women's perceptions on social support during the postpartum period. The objective of this study was to explore postpartum women's views and experiences with social support following childbirth. Four focus groups were conducted with an ethnically diverse sample of women (n = 33) in a large urban teaching hospital in New York City. Participants had completed participation in a postpartum depression randomized trial and were 6-12 months postpartum. Data transcripts were reviewed and analyzed for themes. The main themes identified in the focus group discussions were mother's major needs and challenges postpartum, social support expectations and providers of support, how mothers mobilize support, and barriers to mobilizing support. Women across all groups identified receipt of instrumental support as essential to their physical and emotional recovery. Support from partners and families was expected and many women believed this support should be provided without asking. Racial/ethnic differences existed in the way women from different groups mobilized support from their support networks. Instrumental support plays a significant role in meeting women's basic needs during the postpartum period. In addition, women's expectations surrounding support can have an impact on their ability to mobilize support among their social networks. The results of this study suggest that identifying support needs and expectations of new mothers is important for mothers' recovery after childbirth. Future postpartum depression prevention efforts should integrate a strong focus on social support.

• Disparate Patterns of Prenatal Care Utilization Stratified by Medical and Psychosocial Risk.

  Authors: Elizabeth E Krans, Matthew M Davis, Christie L Palladino

  Maternal and child health journal.

  To evaluate patterns of prenatal care utilization stratified by medical and psychosocial risk. A retrospective cohort of 786 pregnant women who subsequently delivered live births from 1999 to 2003 atTo evaluate patterns of prenatal care utilization stratified by medical and psychosocial risk. A retrospective cohort of 786 pregnant women who subsequently delivered live births from 1999 to 2003 at the University of Michigan were classified into high medical, high psychosocial, high medical and high psychosocial (dual high risk) and low-risk pregnancies. Chi-square and logistic regression analyses assessed the association between risk and prenatal care utilization using the Kotelchuck Index. Of 786 pregnancies, 202 (25.7 %) were high medical risk, 178 (22.7 %) were high psychosocial risk, 227 (28.9 %) were dual high risk and 179 (22.8 %) were low-risk. Over 31 % of dual high risk and 25 % of high medical risk pregnancies received "adequate plus" prenatal care versus 10 % of high psychosocial risk pregnancies. In multivariate analyses, adjusted for risk, race and insurance, high psychosocial risk pregnancies (OR = 1.69; 95 % CI 1.06-2.72) were significantly more likely to receive inadequate prenatal care than care of greater intensity. Many high psychosocial risk pregnancies do not receive adequate prenatal care.

• Effects of a Medical Home Program for Children with Special Health Care Needs on Parental Perceptions of Care in an Ethnically Diverse Patient Population.

  Authors: Leslie J Hamilton, Carlos F Lerner, Angela P Presson, Thomas S Klitzner

  Maternal and child health journal.

  The Pediatric Medical Home Program at UCLA enrolled 41 patients in a primary care model focused on providing intensive care coordination for medically complex, ethnically diverse children withThe Pediatric Medical Home Program at UCLA enrolled 41 patients in a primary care model focused on providing intensive care coordination for medically complex, ethnically diverse children with special health care needs (CSHCN) in our Pediatric Resident Continuity clinic. We sought to determine the effect of our program on parental satisfaction, and to compare differences in parental satisfaction between English and Spanish speaking patients. The Medical Home Family Index, developed by the Center for Medical Home Improvement, was administered to a total of 22 participating parents, in the family's primary language by a native speaker, at various times after enrollment in the program. Survey data and language effects were analyzed. The 36 standardized mean scores for the 15 Spanish speaking families were significantly higher (8.5 points higher) than the mean scores from the seven English speaking families (p = 0.003). Although no statistically significant differences were noted in individual questions between Spanish and English speakers, a trend towards more positive responses by Spanish speakers was noted in questions regarding physician-patient communication (p = 0.054) and family-centeredness (p = 0.053). Our results suggest that a primary care model focused on providing intensive care coordination produces positive parental perceptions of the organization and delivery of primary care services in a medically complex population of CSHCN. The main finding of the study is that utilizing the AAP's approach to the medical home model, emphasizing family-centered and culturally competent care, can produce higher satisfaction scores in Spanish speaking parents when compared to English speaking parents.

• Changes in Leisure Time Physical Activity During Pregnancy Compared to the Prior Year.

  Authors: Carmen Amezcua-Prieto, Rocío Olmedo-Requena, Eladio Jímenez-Mejías, Francisca Hurtado-Sánchez, Juan Mozas-Moreno, Pablo Lardelli-Claret, José J Jiménez-Moleón

  Maternal and child health journal.

  To quantify changes in leisure time physical activity (LTPA) type, frequency, duration and intensity during the first half of pregnancy as compared with the year prior to pregnancy. A cross sectionalTo quantify changes in leisure time physical activity (LTPA) type, frequency, duration and intensity during the first half of pregnancy as compared with the year prior to pregnancy. A cross sectional study was conducted at the Maternal University Hospital in Granada, Spain. A total of 1,175 healthy pregnant women attending a scheduled visit during the 20-22nd gestational week were enrolled in the study. Information about socio-demographic, obstetric and life-style variables during the previous year and the first half of pregnancy were collected. LTPA was quantified by assigning metabolic equivalents to each activity according to frequency, intensity and duration. The prevalence of women who met the optimal physical activity recommendations before and during pregnancy was calculated, and the McNemar-Bowker symmetry test was used to assess changes in type, frequency, intensity and duration of activities between the two periods. Some sort of LTPA was performed before and during pregnancy by 68.6 % of the pregnant women. Respectively, just 27.5 % and 19.4 % of women fulfilled LTPA recommendations prior to pregnancy and during pregnancy; 12.6 % of the women meeting recommendations prior to pregnancy later did not meet those recommendations during gestation, and 4.5 % showed the reverse trend. A light increase in walking as a LTPA, and a decrease in the rest of the LTPA type activities, were seen during pregnancy. Some 13.4 % of women changed from moderate-the year before- to light LTPA- during pregnancy. Pregnancy involved a decrease in LTPA, not only regarding frequency, but also duration and intensity.

• Prevalence and Associated Factors of Intimate Partner Violence Among Pregnant Women Attending Kisumu District Hospital, Kenya.

  Authors: Lyndah A Makayoto, Jared Omolo, Abel M Kamweya, Valarie S Harder, Joseph Mutai

  Maternal and child health journal.

  To determine prevalence and factors associated with intimate partner violence (IPV) among pregnant women seeking antenatal care. This was a cross-sectional study conducted at Kisumu DistrictTo determine prevalence and factors associated with intimate partner violence (IPV) among pregnant women seeking antenatal care. This was a cross-sectional study conducted at Kisumu District Hospital, Kenya amongst randomly selected pregnant women. A structured questionnaire was used to collect data. Participants self-reported about their own IPV experience (lifetime, 12 months prior to and during index pregnancy) and associated risk factors. Data were analyzed using Epi-info. The mean age of the 300 participants was 23.7 years. One hundred and ten (37 %) of them experienced at least one form of IPV during pregnancy. Psychological violence was the most common (29 %), followed by sexual (12 %), and then physical (10 %). Women who experienced IPV during pregnancy were more likely to have witnessed maternal abuse in childhood (aOR 2.27, 95 % CI = 1.05-4.89), been in a polygamous union (aOR 2.48, 95 % CI = 1.06-5.8), been multiparous (aOR 1.94, 95 % CI = 1.01-3.32) or had a partner who drank alcohol (aOR 2.32, 95 % CI = 1.21-4.45). Having a partner who attained tertiary education was protective against IPV (aOR 0.37, 95 % CI = 0.16-0.83). We found no association between HIV status and IPV. IPV is common among women seeking antenatal care at Kisumu District Hospital. Health care providers should be alerted to the possibility of IPV during pregnancy in women who witnessed maternal abuse in childhood, are multiparous, polygamous, have a partner who drinks alcohol or has low level education. Screening for IPV, support and referral is urgently needed to help reduce the burden experienced by pregnant women and their unborn babies.

• Do Florida Medicaid Providers' Barriers to HPV Vaccination Vary Based on VFC Program Participation?

  Authors: Teri L Malo, Donna Hassani, Stephanie A S Staras, Elizabeth A Shenkman, Anna R Giuliano, Susan T Vadaparampil

  Maternal and child health journal.

  This study aimed to determine if physicians' perceived barriers to human papillomavirus (HPV) vaccination were associated with participation in the federal Vaccines for Children (VFC) program. AThis study aimed to determine if physicians' perceived barriers to human papillomavirus (HPV) vaccination were associated with participation in the federal Vaccines for Children (VFC) program. A sample of 800 Florida Medicaid providers was randomly selected from the Florida Medicaid Master Provider File. A cross-sectional study was conducted using a 27-item survey that included 13 potential barriers to immunizing Medicaid patients against HPV, including concerns about vaccine safety and efficacy, discussing sexuality, vaccinated teens practicing riskier sexual behaviors, cost and reimbursement, ensuring 3-dose series completion, and school attendance requirements associated with HPV vaccination. Pearson χ(2) tests were conducted to investigate differences between each barrier and VFC program participation. Data were analyzed for 449 physicians. Compared to non-VFC providers, VFC providers were significantly less likely to somewhat or strongly agree that the following were barriers to vaccination: the cost of stocking the HPV vaccine (p = 0.0011), lack of adequate reimbursement for HPV vaccination (p < 0.0001), and lack of timely reimbursement for HPV vaccination (p < 0.0001). After adjusting for provider specialty and number of years since completion of residency training, VFC status remained significantly associated with the barrier regarding lack of adequate reimbursement for vaccination such that non-VFC providers had a 2.6-fold (95 % confidence interval, 1.1-5.8) greater odds of somewhat or strongly agreeing that this barrier applied to them. Increasing participation in the VFC program may decrease physicians' cost-related barriers, which may increase the number of children vaccinated on time according to the recommended schedule.

• Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives.

  Authors: Deborah Mindry, Glenn Wagner, Jordan Lake, Amber Smith, Sebastian Linnemayr, Molly Quinn, Risa Hoffman

  Maternal and child health journal.

  Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls toCombination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39 % of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.

• Factors Associated with Collaboration Among Agencies Serving Children with Complex Chronic Conditions.

  Authors: Savithri Nageswaran, Shannon L Golden, Douglas Easterling, T Michael O'Shea, William B Hansen, Edward H Ip

  Maternal and child health journal.

  Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agencyOur objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve children with CCC in Forsyth County, North Carolina about their agencies' collaborations with other agencies. We used social network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies. The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele (aOR: 2.1 and 1.6 for 11-30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment companies, educational programs and family-support services. Collaborative relationships between agencies that serve children with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.

• Prevalence and Correlates of Drinking in Early Pregnancy Among Women who Stopped Drinking on Pregnancy Recognition.

  Authors: S M Parackal, M K Parackal, J A Harraway

  Maternal and child health journal.

  Women of child bearing age that regularly drink alcohol are at risk for drinking in early pregnancy. Evidence indicates a majority of women stop alcohol consumption on pregnancy recognition. However,Women of child bearing age that regularly drink alcohol are at risk for drinking in early pregnancy. Evidence indicates a majority of women stop alcohol consumption on pregnancy recognition. However, there is a dearth of studies reporting on patterns and correlates of drinking in early pregnancy prior to stopping on pregnancy recognition, which the current study aims to address. In 2005, a New Zealand nationwide cross-sectional survey was conducted on a random sample of 1,256 women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Of the 1,256 women who participated, 127 (10 %) were currently pregnant and 425 women (34 %) were previously pregnant. Half of currently pregnant women and 37 % of previously pregnant women reported that they ceased drinking on recognising pregnancy. Women categorised as "risky drinkers" and those aged 16-24 years had higher odds to drink and binge drink in early pregnancy, compared with non-risky drinkers and women of other age categories respectively. A majority of women stop alcohol consumption on pregnancy recognition but prior to this, drink at levels posing a risk for the developing foetus. Women most at risk for drinking and binge drinking in early pregnancy were younger in age and exhibited risky drinking behaviour prior to pregnancy. A targeted intervention to reduce the risk for an alcohol exposed pregnancy is warranted for sexually active younger women in New Zealand and elsewhere.

• Associated Factors for Accelerated Growth in Childhood: A Systematic Review.

  Authors: Maria Aurora Chrestani, Iná S Santos, Bernardo L Horta, Samuel C Dumith, Maria Alice Souza de Oliveira Dode

  Maternal and child health journal.

  Several studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of childrenSeveral studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of children who have suffered some sort of restriction of nutrition or oxygen supply. However, accelerated growth has been observed among children who have an appropriate birth weight for their gestational age (AGA) and with no apparent morbidity. Therefore, this systematic review was carried out on the associated factors of accelerated growth, or catch-up, using the Medline/Pubmed database. Only cohort studies written in Portuguese, English or Spanish, with children between zero and 12 years old who presented accelerated growth or catch-up as the outcome were included. Out of the 2,155 articles found, 9 were selected. There is no uniformity in the operational definition of accelerated growth, or in the concept of catch-up. According to this review, accelerated growth is associated with primiparity, maternal smoking during pregnancy, lower birth weight, and early weaning. The main limitations in the available literature are the high number of follow-up losses and the lack of control for confounding factors. The determinants of accelerated growth still need to be studied further, especially among AGA children.

• First Trimester Exposure to Ambient Air Pollution, Pregnancy Complications and Adverse Birth Outcomes in Allegheny County, PA.

  Authors: Pei-Chen Lee, James M Roberts, Janet M Catov, Evelyn O Talbott, Beate Ritz

  Maternal and child health journal.

  Despite numerous studies of air pollution and adverse birth outcomes, few studies have investigated preeclampsia and gestational hypertension, two pregnancy disorders with serious consequences forDespite numerous studies of air pollution and adverse birth outcomes, few studies have investigated preeclampsia and gestational hypertension, two pregnancy disorders with serious consequences for both mother and infant. Relying on hospital birth records, we conducted a cohort study identifying 34,705 singleton births delivered at Magee-Women's Hospital in Pittsburgh, PA between 1997 and 2002. Particle (<10 μm-PM(10); <2.5 μm-PM(2.5)) and ozone (O(3)) exposure concentrations in the first trimester of pregnancy were estimated using the space-time ordinary Kriging interpolation method. We employed multiple logistic regression estimate associations between first trimester exposures and preeclampsia, gestational hypertension, preterm delivery, and small for gestational age (SGA) infants. PM(2.5) and O(3) exposures were associated with preeclampsia (adjusted OR = 1.15, 95 % CI = 0.96-1.39 per 4.0 μg/m(3) increase in PM(2.5); adjusted OR = 1.12, 95 % CI = 0.89-1.42 per 16.8 ppb increase in O(3)), gestational hypertension (for PM(2.5) OR = 1.11, 95 % CI = 1.00-1.23; for O(3) OR = 1.12, 95 % CI = 0.97-1.29), and preterm delivery (for PM(2.5) ORs = 1.10, 95 % CI = 1.01-1.20; for O(3) ORs = 1.23, 95 % CI = 1.01-1.50). Smaller 5-8 % increases in risk were also observed for PM(10) with gestational hypertension and SGA, but not preeclampsia. Our data suggest that first trimester exposure to particles, mostly PM(2.5), and ozone, may increase the risk of developing preeclampsia and gestational hypertension, as well as preterm delivery and SGA.

• Maternal Age and Low Birth Weight: A Reinterpretation of Their Association Under a Demographic Transition in Southern Brazil.

  Authors: C Homrich da Silva, A R Hernandez, M Agranonik, M Z Goldani

  Maternal and child health journal.

  To evaluate the relationship between changes in fecundity rates and maternal age and the impact of maternal age on low birth weight (LBW) rates in a developed region in southern Brazil. A time seriesTo evaluate the relationship between changes in fecundity rates and maternal age and the impact of maternal age on low birth weight (LBW) rates in a developed region in southern Brazil. A time series study evaluating birth weight and maternal ages through the born alive information system (SINASC) in Porto Alegre from 1996 to 2008. The Chi-square test for trends was used to evaluate the trend of LBW and fecundity rates at each maternal age. Population attributed risk (PAR) was used to calculate the impact of maternal age on LBW rates. The study included 271,100 newborns. There was a significant reduction in fecundity rates in all age groups younger than 34 years, but especially in the groups between 20 and 29 years. Overall LBW increased from 9.3 to 10.7 % (P < 0.001). The PAR for LBW showed a reduction in the group from 17 to 19 years (from 1.7 % in 1996-1999 to 0.1 % in 2004-2008), and an increase in the groups from 35 to 39 years (from 2.0 % in 1996-1999 to 2.3 % in 2004-2008) and above 40 (from 1.1 % in 1996-1999 to 1.5 % in 2004-2008). There was a significant change in fecundity pattern in the last 12 years in southern Brazil. Adolescent mothers were surpassed by mothers over 30 years of age in terms of vulnerability for LBW babies. The results show a change in the maternal age distribution towards older mothers, accompanied by an increasing incidence of LBW. This demographic transition also involved a paradoxical pattern with a remarkable reduction in fecundity rates in intermediate maternal age groups with concomitant increase in their risk for LBW.

• Do Unmet Needs Differ Geographically for Children with Special Health Care Needs?

  Authors: Kimberly G Fulda, Katandria L Johnson, Kristen Hahn, Kristine Lykens

  Maternal and child health journal.

  The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmetThe purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

• Changes in LDL and HDL Subclasses in Normal Pregnancy and Associations with Birth Weight, Birth Length and Head Circumference.

  Authors: Aleksandra Zeljkovic, Jelena Vekic, Slavica Spasic, Zorana Jelic-Ivanovic, Vesna Spasojevic-Kalimanovska, Tamara Gojkovic, Daniela Ardalic, Vesna Mandic-Markovic, Nikola Cerovic, Zeljko Mikovic

  Maternal and child health journal.

  Pregnancy is associated with alterations in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, but the exact pattern of these variations remains controversial. This studyPregnancy is associated with alterations in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, but the exact pattern of these variations remains controversial. This study investigates longitudinal changes of plasma LDL and HDL particles distributions during the course of normal pregnancy, as well as associations of maternal LDL and HDL subclasses distributions before delivery with parameters of newborn size. Blood samples were collected from 41 healthy pregnant women throughout entire pregnancy, before delivery and 7 weeks postpartum. LDL and HDL subclasses were determined by gradient gel electrophoresis, while other biochemical parameters were measured by standard laboratory methods. During gestation LDL size significantly decreased (P < 0.001), due to reduction in relative proportion of LDL I (P < 0.01) and increase of LDL II (P < 0.001) and IIIA (P < 0.05) subclasses. In the same time, HDL size and proportions of HDL 2a particles significantly decreased (P < 0.001), with concomitant increase of HDL 3b and 3c subclasses (P < 0.05). Observed alterations were associated with changes in serum triglyceride levels. Rearrangement in LDL subclasses distribution during gestation was transient, while postpartum HDL subclasses distribution remained shifted toward smaller particles. Higher proportion of LDL IVB in maternal plasma before delivery was an independent predictor of smaller birth weights and lengths, while higher proportions of LDL IVB and HDL 2a subclasses were independent determinants of newborns' smaller head circumferences. Routine gestational and prenatal care in otherwise normal pregnancy could be complemented with evaluation of LDL and HDL particles distribution in order to ensure an adequate size of the newborn.

• Tobacco Use Among Married Women in Nepal: The Role of Women's Empowerment.

  Authors: Shanta Pandey, Yuan Lin

  Maternal and child health journal.

  This study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and HealthThis study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and Health Survey that interviewed 10,793 women and 4,397 men. We analyzed the couple's data or households (N = 2,600) in which both husband and wife were interviewed. We examined the effects of women's empowerment-measured by education, employment, intra-household decisions, and age-on their tobacco use controlling for other individual and household characteristics. Women's empowerment had mixed effects on tobacco use. While women's education was inversely associated with their tobacco use, their age, employment and ability to make intra-household mobility decisions were positively associated with smoking. Women with primary and beyond primary education were 48 and 92 % less likely to smoke compared to women with no education, respectively. Tobacco use among women increased dramatically with age from 8 % in teen years to 42 % in their forties. A 1 year increase in age increased the odds of tobacco use by 6 %. Women whose husbands smoked were twice as likely to smoke. Nepal should not only restrict tobacco use in public places by implementing its Tobacco Control and Regulatory Act of 2010 but also focus on encouraging smoke-free homes by increasing awareness about the health consequences of tobacco use and secondhand smoke among populations most likely to smoke that include nearly all men, employed women, women with low levels of education, women whose spouses smoke and those who are 30 and above in age. Additionally, a long term goal should be to ensure at least 5th grade of education for all girls.

• A Qualitative Study of Factors Affecting Pregnancy Weight Gain in African American Women.

  Authors: Kara Goodrich, Mary Cregger, Sara Wilcox, Jihong Liu

  Maternal and child health journal.

  African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG inAfrican Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8-23 weeks gestation, n = 10), mid to late pregnancy (24-36 weeks, n = 15), and early postpartum (6-12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.

• Early Predictors of Obesity and Cardiovascular Risk Among American Indian Children.

  Authors: Sara M Lindberg, Alexandra K Adams, Ronald J Prince

  Maternal and child health journal.

  American Indian (AI) children have the highest rates of obesity among ethnic groups in the United States, and rates continue to increase. This study was designed to examine the effects of prenatalAmerican Indian (AI) children have the highest rates of obesity among ethnic groups in the United States, and rates continue to increase. This study was designed to examine the effects of prenatal and early postnatal factors on AI children's body mass index (BMI) trajectories, adiposity, and cardiovascular risk markers during early childhood. We screened 471 AI children (ages 5-8) from three Wisconsin tribes. Screenings included anthropometric and body fat measures and non-fasting lipid and glucose via fingerstick blood samples. Tribal records from Women Infants and Children (WIC) programs and clinic charts provided data on children's BMI trajectories, maternal prenatal factors, and the early postnatal feeding environment. Forty-seven percent of children were overweight or obese. Analysis of growth trajectories showed that children's BMI category was largely determined within the 1 year of life. Significant predictors of children's BMI category at age 1 included macrosomia (OR 4.38), excess gestational weight gain (OR 1.64) and early termination of breastfeeding (OR 1.66). Children who were overweight/obese at age 1 had greater odds of being overweight (OR 3.42) or obese (OR 3.36), and having unhealthy levels of body fat (OR 2.95) and LDL cholesterol (OR 1.64) at ages 5-8. Children's BMI category is determined in the early post-natal environment, within the 1 year of life, by factors including excess gestational weight gain and early termination of breastfeeding. In turn, children's BMI category at age 1 predicts the emergence of cardiovascular risk markers in early childhood.

• Characteristics of Sexually Active Teenage Girls Who Would Be Pleased with Becoming Pregnant.

  Authors: Patricia A Cavazos-Rehg, Melissa J Krauss, Edward L Spitznagel, Mario Schootman, Linda B Cottler, Laura Jean Bierut

  Maternal and child health journal.

  To investigate factors associated with favorable pregnancy attitudes among teenage girls. Participants were sexually active teenage girls aged 15-18 years old (n = 965) who took part in the 2002 orTo investigate factors associated with favorable pregnancy attitudes among teenage girls. Participants were sexually active teenage girls aged 15-18 years old (n = 965) who took part in the 2002 or 2006-2010 National Survey of Family Growth (NSFG). Multinomial multivariable logistic regression was used to assess the likelihood of being pleased with a teenage pregnancy. Sixteen percent of sexually active teenage girls (n = 164) would be pleased (11 % a little pleased, 5 % very pleased) if they became pregnant. In a multivariable model, participants who had not yet discussed sexual health topics (i.e., how to say no to sexual intercourse or birth control) or had only discussed birth control with a parent were more likely to be very pleased with a teenage pregnancy than participants who had discussed both topics with a parent. Prior pregnancy, racial/ethnic group status, older age, and having parents with a high school education or less also increased the odds of being pleased with a teenage pregnancy. Being pleased with a teenage pregnancy was correlated with a lack of discussion of sexual health topics with parents, prior pregnancy, and sociodemographic factors (having less educated parents, racial/ethnic group status). Pregnancy prevention efforts can be improved by acknowledging the structural and cultural factors that shape teenage pregnancy attitudes.

• "They Told Me to Come Back": Women's Antenatal Care Booking Experience in Inner-City Johannesburg.

  Authors: Ijeoma Solarin, Vivian Black

  Maternal and child health journal.

  To assess women's experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conductedTo assess women's experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing antenatal care policies are implemented and reinforced and that women are empowered to demand better services.

• Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The 2011 MCH Epidemiology Awards.

  Authors: Charlan D Kroelinger, Jessica Jones

  Maternal and child health journal.

• Multiple Childcare Arrangements and Health Outcomes in Early Childhood.

  Authors: Jen-Hao Chen

  Maternal and child health journal.

  This study examined the associations between multiple childcare arrangements and young children's health problems. This study used three waves of the Early Childhood Longitudinal Study-Birth Cohort,This study examined the associations between multiple childcare arrangements and young children's health problems. This study used three waves of the Early Childhood Longitudinal Study-Birth Cohort, collected from a nationally representative sample of children when they were 9 months old, 2 years old, and 4 years old (N = 7,150). 'Multiple childcare arrangements' was defined and measured by the number of non-parental childcare arrangements that occurred on a regular basis. During each wave of the data collection, the mother reported the number of regular childcare arrangements by three types: relative care, non-relative care, and center-based care. These numbers were summed to calculate the total number of arrangements. The mother also reported the incidence of ear infections, gastrointestinal illnesses, asthma diagnosis, and unintentional injuries of the child. Random effects and fixed effects regression models were used to estimate the association between the number of childcare arrangements and measures of early childhood health problems. Increases in the total number of childcare arrangements were associated with an elevated risk of ear infections, gastrointestinal illnesses, and diagnosed asthma in children. Further analysis indicates that increases in both the number of center-based care and non-relative care (but not relative care) arrangements can lead to a greater chance of health problems in young children. Multiple childcare arrangements are associated with communicable illness and diagnosed asthma in early childhood and appear to be a risk factor for health problems in early childhood.

• Survey of Minnesota Parent Attitudes Regarding School-Based Depression and Suicide Screening and Education.

  Authors: Claudia K Fox, Marla E Eisenberg, Barbara J McMorris, Sandra L Pettingell, Iris W Borowsky

  Maternal and child health journal.

  School-based depression screening and education programs are recommended for addressing the high rates of children's mental illness. The objectives of this study were to (1) identify Minnesota parentSchool-based depression screening and education programs are recommended for addressing the high rates of children's mental illness. The objectives of this study were to (1) identify Minnesota parent attitudes regarding the provision of school-based depression and suicide screening and education and (2) identify predictors of parent support for these school-based programs. A random sample of 1,300 Minnesota households with children ages 5-18 years was surveyed by mail. Chi-square tests and regression analyses were used to detect differences in parent support for depression and suicide screening and education across demographic categories, and parent beliefs and knowledge about depression and suicide. The response rate of eligible households was 43 % (N = 511). Overall, 84-89 % of parents supported school-based depression and suicide screening and education. After adjusting for all variables, parent support for depression screening was associated with greater knowledge [OR 8.48, CI(1.30-55.21)] and fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.12)]. Support for suicide screening was associated with fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.10)]. Support for depression education was associated with fewer stigmatizing beliefs [OR 0.32, CI(0.10-1.00)] and lower educational attainment [OR 0.59, CI(0.40-0.89)]. Support for suicide education was associated with greater knowledge [OR 7.99, CI(1.02-62.68)], fewer stigmatizing beliefs [OR 0.26, CI(0.07-0.92)], and lower educational attainment [OR 0.60, CI(0.38-0.94)]. Parent support for school-based depression and suicide screening and education was high. Parent education to decrease stigmatizing beliefs and increase knowledge about depression and suicide may increase support among the minority of parents who do not endorse such programs.

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