Maternal and Child Health Journal

Children born very low birth weight (VLBW) are at an increased risk of delayed development of motor skills. Physical and occupational therapy services may reduce this risk. Among VLBW children, we evaluated whether receipt of physical or occupational therapy services between 9 months and 2 years of age is associated with improved preschool age motor ability. Using data from the Early Childhood Longitudinal Study Birth Cohort we estimated the association between receipt of therapy and the following preschool motor milestones: skipping eight consecutive steps, hopping five times, standing on one leg for 10 seconds, walking backwards six steps on a line, and jumping distance. We used propensity score methods to adjust for differences in baseline characteristics between children who did and did not receive physical or occupational therapy, since children receiving therapy may be at higher risk of impairment. We applied propensity score weights and modeled the estimated effect of therapy on the distance that the child jumped using linear regression. We modeled all other end points using logistic regression. Treated VLBW children were 1.70 times as likely to skip eight steps (RR 1.70, 95 % CI 0.84, 3.44) compared to the untreated group and 30 % more likely to walk six steps backwards (RR 1.30, 95 % CI 0.63, 2.71), although these differences were not statistically significant. We found little effect of therapy on other endpoints. Providing therapy to VLBW children during early childhood may improve select preschool motor skills involving complex motor planning.

We examined the associations of maternal intimate partner violence (IPV) victimization with early initiation and exclusive breastfeeding in eight African countries. For mothers 15–49 years with an infant aged less than 6 months from national Demographic and Health Surveys since 2007 for Ghana (n = 173), Kenya (n = 449), Liberia (n = 313), Malawi (n = 397), Nigeria (n = 2007), Tanzania (n = 549), Zambia (n = 454), and Zimbabwe (n = 480), logistic regression was used to estimate the unadjusted and adjusted associations of lifetime maternal emotional, physical, and sexual IPV victimization with early initiation (less than 1 hour of birth) and exclusive breastfeeding in the prior 24 hours. Maternal lifetime IPV victimization often was adversely associated with optimal breastfeeding practices. Physical IPV in Zimbabwe (aOR 0.40, p = 0.002), sexual IPV in Zambia (aOR 0.42, p = 0.017), and emotional IPV in Kenya (aOR 0.54, p = 0.050) and Tanzania (aOR 0.57, p = 0.088) were associated with lower adjusted odds of early initiation. Sexual IPV in Liberia (aOR 0.09, p = 0.026), Ghana (aOR 0.17, p = 0.033), and Kenya (aOR 0.34, p = 0.085) were associated with lower adjusted odds of exclusive breastfeeding. Atypically, physical IPV in Tanzania (aOR 2.11, p = 0.042) and sexual IPV in Zambia (aOR 2.49, p = 0.025) were associated with higher adjusted odds of early initiation and exclusive breastfeeding, respectively. Across several settings, maternal IPV victimization may adversely influence breastfeeding practices. Longitudinal research of these relationships is warranted. Screening for IPV victimization and breastfeeding counseling in prenatal and postpartum care may mitigate the potential intergenerational effects of IPV.

Objectives: This study examines the prevalence of violence experienced by patients enrolled in the Step by Step program, a combined prenatal care/substance abuse treatment program at the Wake County Health Department in North Carolina. In addition, potential associations between violence and sociodemographic characteristics, substance use, and mental health are investigated. Method: All prenatal care/substance abuse treatment patients who met study eligibility criteria (N = 84) were assessed by health care providers. Descriptive statistics and bivariate analyses were used to compare victims of violence and nonvictims on a wide range of variables. Multiple linear regression analysis estimated the impact of the women's experiences of violence on their levels of mental health symptoms while controlling for confounding factors. Results: Forty-two percent of patients had been victims of both sexual and physical violence, and 30% had been victims of physical violence alone. The combination of sexual and physical violence was significantly less common among African-American women compared with other women. No other significant differences were found between victims and nonvictims in terms of sociodemographics or substance use. Compared with nonvictims, victims of the combination of sexual and physical violence had significantly elevated levels of general psychological distress as well as elevated levels of hostility, depression, anxiety, interpersonal sensitivity, and somatization. However, no significant differences in levels of mental health symptoms were observed among women who had experienced physical violence in the absence of sexual violence. Conclusions: Questions concerning experiences of violence, including sexual victimization, should be incorporated into the clinical history-taking procedures of professionals working within prenatal care/substance abuse treatment programs so that effective interventions that take experiences of violence into account can be put into place for these high-risk women.

Approximately one-third of all births in Australia each year are by culturally and linguistically diverse (CALD) women. CALD women are at an increased risk of adverse pregnancy and birth outcomes including prematurity and low birthweight. Infants born weighing less than 2500 g are susceptible to increased risk of ill health and morbidities such as cognitive defects including cerebral palsy, and neuro-motor functioning. An existing linked administrative dataset, Maternity 1000 was utilized for this study which has identified all children born in Queensland (QLD), Australia, between 1st July 2012 to 30th June 2018 from the QLD Perinatal Data Collection. This has then been linked to the QLD Hospital Admitted Patient Data Collection, QLD Hospital Non-Admitted Patient Data Collection, QLD Emergency Department Data Collection, and Medicare Benefits Schedule and Pharmaceutical Benefits Scheme Claims Records between 1 and 2012 to 30th June 2019. Culturally and linguistically diverse infants born with low birthweight had higher mean and standard deviation of all health events and outcomes; potentially preventable hospitalisations, hospital re-admissions, ED presentations without admissions, and development of chronic diseases compared to non-CALD infants born with low birthweight. Results from this study highlight the disparities in health service use and health events and outcomes associated with low birthweight infants, between both CALD and Australian born women. This study has responded to the knowledge gap of low birthweight on the Australian economy by identifying that there are significant inequalities in access to health services for CALD women in Australia, as well as increased health events and poor birth outcomes for these infants when compared to those of mothers born in Australia. What is already known on this subject? It is known that barriers to care during pregnancy contribute to increased risk of poor birth outcomes such a prematurity, low birthweight, and stillbirth. It is also known that the effects of low birthweight can include costly morbidities, that can extend well into adulthood. What this study adds? First and foremost, this study adds details of poor birth outcomes in Australia for Culturally and Linguistically Diverse women, which previously had limited literature.

Neonatal Abstinence Syndrome (NAS) is one of the primary negative effects of substance use during pregnancy. The exact statistics regarding NAS and substance use during pregnancy are difficult to determine due to underreporting, especially in the context of pregnancy. Similarly, little is known regarding whether the severity of NAS differs based on substance exposure. The purpose of this study was to evaluate the prevalence of NAS and types of substance use during pregnancy, and determine whether the presentation of NAS symptoms differ based on the type of substance. A retrospective chart review was conducted over a one year period at a tertiary care hospital. One hundred thirty-one mother-infant pairs met the inclusion criteria of documented NAS scores using the Modified Finnegan Scoring Tool and substance use during pregnancy. The results identified a high prevalence of NAS (8.7 %) primarily as a result of exposure to illicit opioids and/or to methadone as the treatment for opioid addiction. In addition, more than half the women on methadone maintenance treatment continued to use additional substances primarily opiates. Infants who were exposed to methadone experienced more severe NAS compared to infants not exposed to methadone including higher peak scores, prolonged NAS treatment, and length of stay. Given the severity of symptoms of the methadone exposed infants and the high rate of opioid use with methadone treatment, evidence-based interventions are required to decrease the negative effects of NAS.