Maternal and Child Health Journal

Cigarette smoking is a serious global public health issue, and is particularly harmful to the maternal and child population. The study aimed to determine if there was an association between smoking cessation intervention during pregnancy and postpartum smoking relapse, and to define a time trend of postpartum smoking relapse after delivery. Data from the 2004–2008 pregnancy risk assessment monitoring systems of Colorado, Maine, Ohio, and Washington were analyzed. Logistic regression was used to define the association between smoking cessation intervention and postpartum smoking relapse, and to identify trend of postpartum smoking relapse. Analyses were done using SAS-Callable SUDAAN v.10.0 and Mplus v.6.0. Among the 2,938 women in the study the relapse rate was 48 %. It was 45 % among those without intervention, 58 % among those who received only counseling, and 57 % among those who received both counseling with treatment and/or referral. The rate was 42, 61, and 67 % among women whose infants were at 2–3, 4–5, and 6 months or more, respectively. Adjusted logistic regression models showed a trend of increased smoking relapse, but did not indicate an association between smoking cessation intervention and smoking relapse. Rates of smoking relapse were high and increased by time after delivery. Smoking cessation intervention during pregnancy may not be successful at preventing postpartum smoking relapse.

Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children. Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced. Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced. Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child’s development.

This paper provides an overview of the origins, purpose, and methods of the Perinatal Periods of Risk (PPOR) approach to community-based planning for action to improve maternal and infant health outcomes. PPOR includes a new analytic framework that enables urban communities to better understand and address fetal and infant mortality. This article serves as the core reference for accompanying specific PPOR methods and practice articles. PPOR is based on core principles of full community engagement and equity and follows a six stage community-based planning process. In Stage 1, communities are mobilized and engaged, related planning efforts aligned, and community and analytic readiness assessed. In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested. Stage 3 produces action plans for targeted prevention strategies. Stages 4 and 5 include implementation, monitoring, and evaluation. Stage 6 fosters political will to sustain efforts. PPOR can be used in local maternal child health (MCH) practice for improving perinatal outcomes. MCH programs can use PPOR to integrate health assessments, initiate planning, identify significant gaps, target more in-depth inquiry, and suggest clear interventions for lowering feto-infant mortality. PPOR enables greater cooperation in improving MCH through more effective data use, strengthened data capacity, and greater shared understanding of complex infant mortality issues. PPOR offers local health departments and their community partners a comprehensive approach to address the health of women and infants in their jurisdictions.

Objective: This paper examines risk factors for twin preterm birth in 1981–82 and 1996–97 in the United States in order to see if they have changed over time. Methods: We studied all U.S. twin births for the years examined (N = 346,567). Since the gestational age distributions for twins differs from singletons, the risk of preterm birth was examined at <33, 33–34, and 35–36 weeks. Logistic regression was used to examine the contributions of sociodemographic and obstetric factors at each period. Results: While the <33 week twin preterm rate rose 7% from 1981–82 to 1996–97, the 33–34-week rate rose 31%, and the 35–36-week rate rose 51%. Women with less education, teenagers, unmarried women, primiparas, and blacks were more likely to deliver preterm across all three preterm birth levels. However, the effect of these low socioeconomic status markers diminished over the study period. Additionally, the odds of preterm birth among blacks increased with earlier gestational ages. Women who had intensive prenatal care utilization as compared with less than adequate utilization were more likely to deliver preterm (35–36 weeks) in 1996–97 (odds ratio (OR) = 2.05) compared with 1981–82 (OR = 1.44). Smaller increases were noted for <33 and 33–34 weeks. Conclusions: Obstetric factors appear to be playing a greater role in the rise of twin preterm births at 35–36 weeks gestation. Temporal sociodemographic changes do not explain the rise in the preterm rate. Changing clinical practices may be having unintended consequences on the public health goals of reducing preterm and low birthweight rates in the United States.

This study explored the developmental trajectories of postpartum weight from 0.5 to 3 years after childbirth, and aimed to determine the associations between postpartum weight trajectories and prepregnancy body mass index and adequacy of gestational weight gain (GWG). Data from the Norwegian Mother and Child Cohort study were used, following 49,528 mothers 0.5, 1.5, and 3 years after childbirth. Analyses were performed using latent growth mixture modeling. Three groups of developmental trajectories of postpartum weight were found, with most women (85.9 %) having a low level of weight retention initially and slight gain over 3 years, whereas 5.6 % of women started at a high postpartum weight retention (on average 7.56 kg) at 0.5 years but followed by a marked weight loss over time (2.63 kg per year on average), and the third trajectory represented women (8.5 %) who had high weight retention high initially (on average 4.67 kg at 0.5 years) and increasing weight over time (1.43 kg per year on average). Prepregnancy overweight and obesity and excessive GWG significantly predicted a high postpartum weight trend. Women had substantial variability in postpartum weight development—both initially after birth and in their weight trajectories over time. Early preventive interventions may be designed to assist women with prepregnancy overweight and obesity and excessive GWG, which helps to reduce the increasing trend for postpartum weight.

To provide pregnant and puerperal women experiencing problems with receiving health care in Diyarbakir, Turkey, with an education program and counseling to help them attain appropriate health behaviors and to support receiving health care through a community based distribution model. This article is a descriptive report of a qualitative community based distribution project conducted in cooperation with the Women’s Research and Implementation Centre (WRIC) of Diyarbakir Metropolitan Municipality (DMM) and Turkish Family Health and Planning Foundation. The study was carried out between March 2007 and April 2008 in six districts of Diyarbakir, a region with a population of 37,000 people of low socio-economic status and who immigrated from the surrounding villages. A total of 6,029 families were visited and 1,119 pregnant and puerperal women were contacted, provided with education and counseling and referred to primary health care clinics at home visits. Seven women living in the region were selected and educated so that they could offer peer education and educational material was prepared for the target group. The pregnant and puerperal women living in the study area were recorded and referred to primary health care clinics. They were visited four times during pregnancy and three times during puerperium and were provided an education program and counseling. Data were collected from the records made during monitoring the women and focus group discussions with women, peer trainers and health care staff. They were found to acquire appropriate health behaviors, 36.2 % women started to receive health care from primary health care clinics for the first time and 86.9 % of the deliveries were performed at health centers. The pregnant and puerperal women were satisfied with home visits, felt special and put the information about self-care into practice. The number of the women receiving iron supplements and vaccine against tetanus and receiving regular care increased.