Association between the number of visits during prenatal care and the occurrence of low birth weight in the United States

BackgroundLow birth weight (LBW) is one of the major child and infant health issues in the United States, standing as one of the main causes of child and infant mortality. While the importance of prenatal visits regarding pregnancy outcomes is recognized, its relationship with birth weight is still a matter of debate.ObjectivesThis study examines the relationship between the number of prenatal visits and low birth weight among children born in the United States in 2017.Study designData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals.ResultsData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals. ConclusionThis study reveals that the number of prenatal visits has an inverse relationship with low birth weight, even when confounding and other factors are accounted for. These findings are compatible with the notion that the more a woman goes for prenatal visits, the more likely it is to detect risks of negative pregnancy outcomes.

Use of open-text responses to recode categorical survey data on postpartum contraception use among women in the United States: A mixed-methods inquiry of Pregnancy Risk Assessment Monitoring System data

Background Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses. Methods and findings We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term “pregnancy prevention.” Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores. Conclusions In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data.

Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination During Pregnancy, Pregnancy Risk Assessment Monitoring System, 2019

Background Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines is recommended for pregnant women to protect themselves and their infants from adverse health outcomes. Objectives To estimate the prevalence of maternal influenza and Tdap vaccination and determine factors associated with receipt of these vaccines. Methods We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System, from 43 jurisdictions. We estimated the overall prevalence of women reporting receipt of a healthcare provider offer or recommendation for influenza vaccine (n=44,528), and influenza vaccine during the 12 months before delivery (n=44,213). We also estimated Tdap vaccine receipt during pregnancy from the 21 jurisdictions (n=22,972). Maternal influenza and Tdap vaccination were examined by selected maternal characteristics and by jurisdiction. Results Overall, 86.4% of women reported being offered or recommended an influenza vaccination, and 60.8% of women reported receiving an influenza vaccination in the 12 months prior to their delivery, ranging from 36.0% in Puerto Rico to 82.1% in Rhode Island. Tdap receipt during pregnancy was 73.7%, ranging from 52.2% in Mississippi to 85.1% in Vermont. Prevalence of influenza vaccination was lower among women aged 18–24 years (52.2%), who are non-Hispanic black (44.5%), with a high school diploma or less education (51.3%), with no prenatal insurance (43.2%), having no (42.0%) prenatal care, with ≥3 previous live births (49.3%) and not offered or recommended the influenza vaccine by a healthcare provider (20.0%). Tdap vaccination also varied by all characteristics examined and was lower among similar groups of women observed to have lower influenza vaccination uptake. Conclusion In 2019, influenza and Tdap vaccination were suboptimal among women with a recent live birth. It is important that U.S. jurisdictions provide equitable access to these vaccines during pregnancy. These results may also inform efforts for vaccination for other infectious diseases among pregnant women.

Prevalence of Prenatal HIV Screening in Massachusetts: Examining Patterns in Prenatal HIV Screening Using the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2016

Prenatal HIV screening is critical to eliminate mother-to-child (MTC) HIV transmission. Although Massachusetts (MA) has near-zero MTC transmission rates, recent trends in statewide prenatal HIV testing are unknown. This study examined variations in prenatal HIV screening across race/ethnicity, socioeconomic status, and prenatal care settings in MA, in the period following national and state-level changes in guidance encouraging routine prenatal HIV testing. According to the MA Pregnancy Risk Assessment Monitoring System (PRAMS) data, 68.3% of pregnant women in MA were screened for HIV between 2007 and 2016. There were significant differences in prenatal screening rates across race/ethnicity, with 83.38% of Black non-Hispanic (NH), 85.5% of Hispanic women, and 62.4% of White NH women reporting being tested for HIV at some point during their pregnancy ( P <.0001). Multivariate regression found that differences in screening were explained by race/ethnicity, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) status, prenatal care site, type of insurance, nativity, and marital status. Annual rates of prenatal HIV screening did not change significantly in MA from 2007 to 2016 ( P = .27). The results of the analysis revealed that prenatal HIV screening rates differ based on race/ethnicity, with higher rates in Black NH and Hispanic women when compared to White NH women. The racial disparities in prenatal HIV screening and lack of universal screening in MA raises questions about the effectiveness of the state's approach.

Klasifikasi Resiko Kehamilan Menggunakan Ensemble Learning berbasis Classification Tree

In health science there is a technique to determine the level of risk of pregnancy, namely the Poedji Rochyati score technique. In this evaluation technique, the level of pregnancy risk is calculated from the values ​​of 22 parameters obtained from pregnant women. Under certain conditions, some parameter values ​​are unknown. This causes the level of risk of pregnancy can not be calculated. For that we need a way to predict pregnancy risk status in cases of incomplete attribute values. There are several studies that try to overcome this problem. The research "classification of pregnancy risk using cost sensitive learning" [3] applies cost sensitive learning to the process of classifying the level of pregnancy risk. In this study, the best classification accuracy achieved was 73% and the best value was 77.9%. To increase the accuracy and recall of predicting pregnancy risk status, in this study several improvements were proposed. 1) Using ensemble learning based on classification tree 2) using the SVMattributeEvaluator evaluator to optimize the feature subset selection stage. In the trials conducted using the classification tree-based ensemble learning method and the SVMattributeEvaluator at the feature subset selection stage, the best value for accuracy was up to 76% and the best value for recall was up to 89.5%

Association of Voluntary Legal Paternity and Breastfeeding Duration and Exclusivity in a Sample of Mothers in NewYork State, United States

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinical) included subsequently. The backward elimination method was used to determine the set of covariates to adjust in the model. Results: Of the 1,753 mothers initiating breastfeeding, 1,364 had VLP and 389 had no-VLP established. Mothers of infants with a no-VLP were more likely to be Black (29.49%), Hispanic (17.74%), have lower income (80.21%), have lower-education levels (44.73%) and were more likely to be <30 years old (61.7%), and had higher levels (14.4%) of reported traumatic stress before and during the most recent pregnancy. Among mothers initiating breastfeeding, those with no-VLP had a higher risk of breastfeeding cessation at 13 weeks (OR: 2.06; 95% CI, 1.25-3.42) after adjusting for maternal resilience, social support, hospital breastfeeding support, pre-pregnancy BMI, paternal age, and paternal education; and higher risk of breastfeeding cessation at 13 weeks (OR:1.46; 1.01-2.09). Conclusion and Implications for Translation: Voluntary legal establishment of paternity is associated with maternal breastfeeding outcomes. Screening of mothers may include legal paternity status as a further indication of the need for additional breastfeeding support, especially among socio-economically disadvantaged populations. Copyright © 2021 Alio et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.