Mothers In California Research Articles

The Supplemental Nutrition Program for Women, Infants, and Children and Birth Outcomes Among Hispanic Mothers in California: A Sibling Control Design.

Participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy appears to reduce risks of preterm birth and low birthweight. Many pregnant women who receive WIC benefits, however, also participate in Medicaid (Medi-Cal in California). This co-participation raises the question of whether WIC per se confers these perinatal health benefits. We use a unique, sibling-linked dataset of California births to estimate birth outcomes relating to program receipt (i.e., No WIC or Medi-Cal; WIC alone; Medi-Cal alone; and WIC and Medi-Cal). We also contribute to the literature by focusing on Hispanic mothers who represent the largest fraction of births in California, as well as the highest proportion of WIC recipients in the state. We specifically assessed the relation of differential program receipt on preterm birth (< 37weeks) and low birthweight (< 2500g). We restrict our analytic sample to births between 2007 and 2015 (n = 942,274). Our sibling-control results show lower odds of low birthweight (OR: 0.82, 95% CI: 0.77, 0.87) and preterm birth (OR: 0.87, 95% CI: 0.83, 0.90) when Hispanic mothers receive WIC benefits during pregnancy compared to when the mothers do not receive WIC benefits. While births associated with receipt of both WIC and Medi-Cal also exhibit lower odds of preterm birth (OR: 0.86, 95% CI: 0.79, 0.92), the protective findings do not extend to low birthweight. Our results extend previous work in other states and should stimulate additional research on whether participation in multiple means-tested programs reduce racial/ethnic disparities in adverse birth outcomes.

Neonatal per- and polyfluoroalkyl substance exposure in relation to retinoblastoma

BackgroundNeonatal per- and polyfluoroalkyl substance (PFAS) exposure can disrupt hormonal homeostasis and induce neuro- and immunotoxicity in children. In this exploratory study, we investigated associations between PFAS levels in neonatal dried blood spots and retinoblastoma risk. Materials and methodsThis study included 501 retinoblastoma cases born from 1983 to 2011 and 899 controls frequency-matched by birth year (20:1 matching ratio), born to 755 US-born and 366 Mexico-born mothers in California. Perfluorooctanesulfonic acid (PFOS), perflurooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) feature intensities were identified from neonatal blood spots from California newborn Genetic Disease Screening Program. Using logistic regression, we assessed whether an interquartile range (IQR) increase of PFAS levels or having above-mean levels of PFAS in blood affects retinoblastoma risk overall or its subtypes (i.e., unilateral, bilateral). We assessed children of US-born and Mexico-born mothers, separately. Results and DiscussionAmong all children, above-mean PFOS levels at birth increased the odds of retinoblastoma overall by 29% (95% Confidence Interval (CI): 1.00, 1.67) and unilateral retinoblastoma by 42% (95% CI: 1.03, 1.97). For children of Mexico-born mothers, we estimated the highest odds of retinoblastoma overall (adjusted odds ratio (aOR): 1.67; 95% CI: 1.06, 2.66) and bilateral retinoblastoma (aOR: 2.06; 95% CI: 1.12, 3.92) with above-mean PFOS levels. Among children of US-born mothers, higher PFOS levels increased the odds of unilateral retinoblastoma by 15% (95% CI: 0.99, 1.35) for each IQR increase and by 71% among children with above-mean PFOS levels (95% CI: 1.04, 2.90). In addition, for children of US-born mothers, PFOA increased the odds of retinoblastoma overall (aOR: 1.41; 95% CI: 1.00, 2.02 for above-mean levels, aOR: 1.06; 95% CI: 0.98, 1.16 per IQR increase). PFNA was not associated with retinoblastoma risk. ConclusionsOur results suggested that PFOS and PFOA might contribute to retinoblastoma risk in children born in California.

Association between maternity care practitioner type and postpartum depression screening.

Postpartum depression (PPD) is increasingly common in the United States and poses a significant threat to maternal and neonatal health. Universal screening for postpartum depression is recommended by numerous organizations, including the American College of Obstetricians and Gynecologists, but is not achieved in practice. A cross-sectional, weighted, state-representative study of California residents who gave birth in 2016 using the Listening to Mothers in California 2018 data set. Primary exposure was type of maternity care professional providing care during pregnancy, and the primary outcome was PPD screening. The secondary exposure was self-reported depression or anxiety during pregnancy, and the secondary outcome was attending a postpartum office visit. Bivariate analyses were conducted using Rao-Scott chi-square tests, and multivariate analyses were conducted using logistic regression. Compared to participants cared for by obstetricians, participants cared for by midwives had 2.6 times the odds of reporting being screened for PPD after controlling for covariates (95% CI = 1.5, 4.4). Receiving care from any other practitioner type compared with an obstetrician was not associated with a different rate of postpartum depression screening. Reporting depression or anxiety during pregnancy was associated with 0.7 times the odds (95% CI = 0.5, 1.0) of returning for postpartum care after controlling for covariates. Being cared for by a midwife during pregnancy increases the likelihood of being screened for postpartum depression. In addition, even perfectly implemented universal screening will miss a vulnerable sector of the population that is at high risk for postpartum depression and is less likely to return for postpartum care.

California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours.

Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign. Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours. CalFresh Healthy Living (California's SNAP-Ed). Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated. Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7). The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

Influence of technical and maternal-infant factors on the measurement and expression of extracellular miRNA in human milk.

Breast milk contains thousands of bioactive compounds including extracellular vesicle microRNAs (EV-miRNAs), which may regulate pathways such as infant immune system development and metabolism. We examined the associations between the expression of EV-miRNAs and laboratory variables (i.e., batch effects, sample characteristics), sequencing quality indicators, and maternal-infant characteristics. The study included 109 Latino mother-infant dyads from the Southern California Mother's Milk Study. Mothers were age 28.0 ± 5.6 and 23-46 days postpartum. We used principal components analysis to evaluate whether EV-miRNA expression was associated with factors of interest. Then, we used linear models to estimate relationships between these factors and specific EV-miRNA counts and analyzed functional pathways associated with those EV-miRNAs. Finally, we explored which maternal-infant characteristics predicted sequencing quality indicators. Sequencing quality indicators, predominant breastfeeding, and breastfeedings/day were associated with EV-miRNA principal components. Maternal body mass index and breast milk collection timing predicted proportion of unmapped reads. Expression of 2 EV-miRNAs were associated with days postpartum, 23 EV-miRNAs were associated with breast milk collection time, 23 EV-miRNAs were associated with predominant breastfeeding, and 38 EV-miRNAs were associated with breastfeedings/day. These EV-miRNAs were associated with pathways including Hippo signaling pathway and ECM-receptor interaction, among others. This study identifies several important factors that may contribute to breast milk EV-miRNA expression. Future studies should consider these findings in the design and analysis of breast milk miRNA research.

COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income, Food-Insecure Households

ObjectiveTo examine the dietary behaviors of mothers from very low food security (VLFS) households following the availability of coronavirus disease 2019 (COVID-19) unemployment and Supplemental Nutrition Assistance Program benefits. MethodsDiet and food security status were obtained from 2,584 California mothers during Federal Fiscal Year 2020. Fruits, vegetables, and 100% fruit juice (FV100%FJ), sugar-sweetened beverages, and water intake, and Healthy Eating Index-2015 scores, were compared across 4 groups (before vs after COVID-19 benefits by VLFS vs non-VLFS households) with race/ethnicity and age as covariates. ResultsBefore COVID-19 benefits, VLFS was associated with fewer cups of FV100%FJ (P = 0.010), more fluid ounces of sugar-sweetened beverages (P = 0.004), and poorer diet quality (P = 0.003). After COVID-19 benefits, mothers from VLFS vs non-VLFS households reported similar dietary outcomes. VLFS mothers reported 0.96 (95% confidence interval, 0.53–1.38) more cups of FV100%FJ after COVID-19 benefits. Conclusions and ImplicationsCoronavirus disease 2019 benefits may have reduced dietary inequities among low-income families. Associations between increased Supplemental Nutrition Assistance Program and unemployment benefits and decreased costs associated with the negative health outcomes linked to food insecurity and poor diets would be of value.

Prenatal exposure to ambient air pollution is associated with neurodevelopmental outcomes at 2 years of age

BackgroundHigher prenatal ambient air pollution exposure has been associated with impaired neurodevelopment in preschoolers and school-aged children. The purpose of this study was to explore the relationships between prenatal ambient air pollution exposure and neurodevelopment during infancy.MethodsThis study examined 161 Latino mother-infant pairs from the Southern California Mother’s Milk Study. Exposure assessments included prenatal nitrogen dioxide (NO2) and particulate matter smaller than 2.5 and 10 microns in diameter (PM2.5 and PM10, respectively). The pregnancy period was also examined as three windows, early, mid, and late, which describe the first, middle, and last three months of pregnancy. Infant neurodevelopmental outcomes at 2 years of age were measured using the Bayley-III Scales of Infant and Toddler Development. Multivariable linear models and distributed lag linear models (DLM) were used to examine relationships between prenatal exposures and neurodevelopmental scores, adjusting for socioeconomic status, breastfeeding frequency, time of delivery, pre-pregnancy body mass index, and infant birthweight and sex.ResultsHigher prenatal exposure to PM10 and PM2.5 was negatively associated with composite cognitive score (β = -2.01 [-3.89, -0.13] and β = -1.97 [-3.83, -0.10], respectively). In addition, higher average prenatal exposure to PM10 was negatively associated with composite motor (β = -2.35 [-3.95, -0.74]), scaled motor (β = -0.77 [-1.30, -0.24]), gross motor (β = -0.37 [-0.70, -0.04]), fine motor (β = -0.40 [-0.71, -0.09]), composite language (β = -1.87 [-3.52, -0.22]), scaled language (β = -0.61 [-1.18, -0.05]) and expressive communication scaled scores (β = -0.36 [-0.66, -0.05]). DLMs showed that higher prenatal air pollution exposure during mid and late pregnancy was inversely associated with motor, cognitive, and communication language scores.ConclusionsHigher exposure to air pollutants during pregnancy, particularly in the mid and late prenatal periods, was inversely associated with scaled and composite motor, cognitive, and language scores at 2 years. These results indicate that prenatal ambient air pollution may negatively impact neurodevelopment in early life.

Moving to greener pastures: Health selection into neighborhood green space among a highly mobile and diverse population in California

Global urbanization has sparked substantial environmental, public health, and social science research on the importance of conserving and propagating natural environments. A large subset of this work focuses on the benefits of green space for health. An often-overlooked methodological concern when examining relations between green space and health, however, involves residential self-selection. The selective movement of individuals into greener neighborhoods on the basis of preexisting health and correlated social factors may bias associations, particularly in cross-sectional studies, which predominate existing green space/health research. To quantify the extent of residential self-selection bias, this study used a longitudinal sibling comparison design with repeated individual and neighborhood measures to estimate associations between pre-move health factors, including maternal body mass index (BMI) and infant birthweight, and post-move neighborhood green space in a residentially mobile sample of mothers in California, 2007 to 2015 (n = 288,333). Results show that better health before moving predicted higher levels of neighborhood green space after moving, providing evidence of health selection. Findings also indicate some support for differential health selection into neighborhood green space by race/ethnicity, including that evidence of selection emerges for white and Hispanic, but not Black, mothers. However, weak relations between pre-move individual factors and post-move neighborhood green space across analyses suggest that potential bias due to residential self-selection appears relatively minimal in a large, diverse, and highly mobile sample of families in California. Findings support calls to increase green space in historically marginalized neighborhoods as a means to promote environmental and health equity.

The association of doula support and patient experiences with hospital staff during birth in a sample of California women: An exploratory analysis.

Research suggests that doula support improves birth outcomes, contributing to lower rates of preterm birth, low birthweight, and nonindicated cesarean delivery. Few studies investigate whether doula support is associated with the quality of patient-reported birth experiences in hospital settings. This study uses data from Listening to Mothers in California, a statewide representative survey of women who gave birth in 2016 in Californian hospitals. The analytic sample included 1345 English-speaking participants. We used multivariable logistic regression to test for associations between doula support and self-reported unfair treatment, abuse, and rapport with delivery staff. We also examined associations between these experiences and openness to doula support in a future birth. Models adjusted for maternal sociodemographic characteristics and views about medical intervention in birth. Just over 9% of women had doula support during birth. During their hospital stay, 6.3% reported unfair treatment, 11.5% reported abuse by providers, and 5.7% reported no rapport with delivery room staff. There were no statistically significant relationships between doula support and unfair treatment, abuse, or delivery staff rapport in our models. Participants who reported no rapport with hospital staff were more likely to express openness to doula support in a future birth (AOR: 2.59; 95% CI: 1.15, 5.79). Despite their best efforts, doulas may not be able to mitigate all negative interactions between their clients and hospital staff. These experiences may also influence desires for additional support from doulas in future births. Hospital policies and practices should include doulas as valuable members of the care team to help ensure positive experiences during birth.

Postnatal exposure to ambient air pollutants is associated with the composition of the infant gut microbiota at 6-months of age

ABSTRACT Epidemiological studies in adults have shown that exposure to ambient air pollution (AAP) is associated with the composition of the adult gut microbiome, but these relationships have not been examined in infancy. We aimed to determine if 6-month postnatal AAP exposure was associated with the infant gut microbiota at 6 months of age in a cohort of Latino mother-infant dyads from the Southern California Mother’s Milk Study (n = 103). We estimated particulate matter (PM2.5 and PM10) and nitrogen dioxide (NO2) exposure from birth to 6-months based on residential address histories. We characterized the infant gut microbiota using 16S rRNA amplicon sequencing at 6-months of age. At 6-months, the gut microbiota was dominated by the phyla Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria. Our results show that, after adjusting for important confounders, postnatal AAP exposure was associated with the composition of the gut microbiota. As an example, PM10 exposure was positively associated with Dialister, Dorea, Acinetobacter, and Campylobacter while PM2.5 was positively associated with Actinomyces. Further, exposure to PM10 and PM2.5 was inversely associated with Alistipes and NO2 exposure was positively associated with Actinomyces, Enterococcus, Clostridium, and Eubacterium. Several of these taxa have previously been linked with systemic inflammation, including the genera Dialister and Dorea. This study provides the first evidence of significant associations between exposure to AAP and the composition of the infant gut microbiota, which may have important implications for future infant health and development.

Longitudinal Changes in Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances from Pregnancy to Two Years Postpartum.

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy and lactation is of increasing public health concern, but little is known about longitudinal changes in maternal PFAS concentrations from pregnancy to a few years postpartum. We quantified 11 PFAS in 251 serum samples prospectively collected from 42 Northern California mothers during the first, second, and third trimesters of pregnancy and at 3, 6, and 24 months after delivery over 2009-2017. We fit separate linear mixed models during pregnancy, early postpartum, and late postpartum to estimate percent changes of PFAS for each subperiod. Among five PFAS detected in more than 99% of samples, linear and branched perfluorooctanesulfonate (n- and Sm-PFOS), linear perfluorooctanoate (n-PFOA), and perfluorononanoate (PFNA) concentrations changed -4% to -3% per month during pregnancy. During early postpartum, perfluorohexanesulfonate (PFHxS) and n-PFOA concentrations changed -6% and -5%, respectively, per month, and Sm-PFOS and PFNA concentrations changed -1% per month. During late postpartum, n-PFOS, Sm-PFOS, and PFNA concentrations changed -1% per month. Breastfeeding duration was the primary determinant of n-PFOA and PFNA concentrations during late postpartum, showing negative associations. Our findings might be useful for reconstructing reliable prenatal or early life PFAS exposures for offspring.

Predictors of Maternal Recidivism in the Child Protection System.

Child maltreatment recidivism is typically measured and studied at the individual level. Conditions that give rise to child abuse and neglect, however, typically affect multiple children in a given family. In the current study, we estimated maltreatment recidivism at the maternal level and examined its risk as a function of maternal sociodemographic characteristics that may change over time. Using linked administrative records, we identified a subset of first-time mothers in California whose first child was reported to the child protection system (CPS) between birth and age 5 and who then gave birth to another child (n = 14,715). Following the firstborn child's CPS reporting, nearly half of these mothers (43.3%) were re-reported concerning the non-firstborn children during the first 5years of the child's life. Risk factors consistently documented across births were associated with a heightened risk of maternal CPS recidivism. Our study advances an understanding of the full extent of maltreatment recidivism by broadening the focus from individual children.

Home Food Environments of Mothers in South-Eastern Africa and California-An Illustration of Global Extremes

INTRODUCTION: The type and availability of food in the home is known to directly shape food intake and weight status, but cross-cultural differences remain poorly documented. &#x0D; &#x0D; OBJECTIVE: The purpose of this study was to describe and compare the home food environments of low-income, childbearing women living in a low-income country (Malawi) and a high-income country (United States).&amp;nbsp; &#x0D; &#x0D; METHODS: A home food environment survey was available in 714 mothers in Malawi (mean BMI 19.5, mean age 22.1 years) and 371 in California (mean BMI 31.8, mean age 28.1 years). &#x0D; &#x0D; RESULTS: Mothers in California vs. Malawi had on average (SD) 22.8 (4.4) vs. 1.2 (1.4) different food items in the home. The women in California had an abundance of fruits and vegetables that were virtually absent in the homes of Malawian women. The most prevalent food in the homes in Californian women was rice (in 97% homes) and in Malawian women was corn flour (in 47% of homes). &#x0D; &#x0D; CONCLUSIONS: Given the global extremes in food availability, efforts to address over and under food availabilities in the homes of childbearing women need to move beyond country centric approaches. It is time to consider maternal and child health as a global priority.

Risk of Micronutrient Inadequacy among Hispanic, Lactating Mothers: Preliminary Evidence from the Southern California Mother's Milk Study.

Micronutrients are dietary components important for health and physiological function, and inadequate intake of these nutrients can contribute to poor health outcomes. The risk of inadequate micronutrient intake has been shown to be greater among low-income Hispanics and postpartum and lactating women. Therefore, we aimed to determine the risk of nutrient inadequacies based on preliminary evidence among postpartum, Hispanic women. Risk of micronutrient inadequacy for Hispanic women (29–45 years of age) from the Southern California Mother’s Milk Study (n = 188) was assessed using 24 h dietary recalls at 1 and 6 months postpartum and the estimated average requirement (EAR) fixed cut-point approach. Women were considered at risk of inadequate intake for a nutrient if more than 50% of women were consuming below the EAR. The Chronic Disease Risk Reduction (CDRR) value was also used to assess sodium intake. These women were at risk of inadequate intake for folate and vitamins A, D, and E, with 87.0%, 93.4%, 43.8%, and 95% of women consuming less than the EAR for these nutrients, respectively. Lastly, 71.7% of women consumed excess sodium. Results from this preliminary analysis indicate that Hispanic women are at risk of inadequate intake of important micronutrients for maternal and child health.

Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California.

BackgroundConcern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling.MethodsThis study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4‐item Patient Health Questionnaire (PHQ‐4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression.ResultsWe found non‐Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non‐Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6‐21.7) to report counseling.DiscussionThese findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.

Ambient Air Pollution Exposure is Associated with the Infant Gut Microbiota

BACKGROUND AND AIM: Exposure to ambient air pollutants (AAP) has been linked with the gut microbiome in young adults; however, this relationship has not been studied in infancy. This study aimed to examine the relationships between AAP and the infant gut microbiota. METHODS: This study included 105 infants from the Southern California Mother’s Milk Study. Average exposure to particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2), was examined during the first 6 months of life. The infant gut microbiota was characterized using 16S rRNA sequencing at 6 months. Associations between AAP and the composition of the gut microbiota was examined using a Zero Inflated Poisson Regression (ZIPR), where incidence risk ratios (IRR) and Bonferroni adjusted p-values are reported. Compositionally aware, multinomial models were used to describe associations between AAP and the abundance of each gut microbe, and new methods for visualizing those associations were used to identify an important subset of associated taxa. Based on a directed acyclic graph, models adjusted for sex, breastfeeding frequency, socioeconomic status, birthweight and infant age. RESULTS:Overall, 26, 16 and 22 gut bacterial taxa were associated with exposure to PM10, PM2.5 and NO2, respectively. For example, PM10 and PM2.5 were associated with Enterococcus (IRR=1.08, p0.001) and Actinomyces (IRR=1.46, p0.001) abundances, respectively. Multinomial analysis also revealed that PM10 exposure was associated with the composition of the gut microbiota based on the log-ratio of differentially ranked taxa sub-groups (R2=0.28, p0.001). For example, all microbial genera positively associated with PM10 via ZIPR were also classified as being in the top 35% of differentially ranked taxa positively associated with PM10 exposure. CONCLUSIONS:Early postnatal exposure to AAP was associated with the composition of the infant gut microbiota at 6-months of age. These results suggest that early life exposure to AAP may impact the developing gut microbiome, which may have important implications for infant development. KEYWORDS: Air pollution, Microbiome, Outcomes, Particulate matter, Oxides of nitrogen, Children's environmental health

Perceptions of the HPV Vaccine in Indian Immigrant Mothers

Each year, over 14 millions Americans are infected with human papillomavirus, or HPV. Yet, the 2020 US goal is to vaccinate 80% of all adolescents for HPV is over 25% higher than the actual vaccination rate of teens, which was 54.2% in 2019. In California specifically, Asians were found to have the lowest HPV vaccination rates compared to other ethnic groups. When looking at the major Asian subgroups, the Indian American population has grown by 76% between 2000 and 2010 in Santa Clara County. Yet, no previous studies have been conducted about the Indian immigrant population. Thus, this paper explores the following research question: How do Indian immigrant mothers in Santa Clara County, California perceive vaccinating their daughters for HPV? &#x0D; A phenomenological study using one-on-one virtual interviews was conducted using two question frameworks to structure the interview questions: the Socio-Context framework and Andersen's Behavioral Model of Health Services. Indian immigrant mothers’ were found to significantly prioritize their daughter’s safety. Another notable theme was that there was a strong trust in the overall science of vaccines to keep the daughters safe. Although many mothers believed that the HPV vaccine was a decision solely between the parents and the doctor, some mothers believed that their community would be influenced fairly strongly by the actions of their family and friends regarding vaccinating their children for HPV. Overall, this study examined the HPV vaccine perception in an understudied population, Indian immigrant mothers in California.

Perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content: Evidence from the Listening to Mothers in California survey.

ObjectivePostpartum visits are an important opportunity to address ongoing maternal health. Experiences of discrimination in healthcare can impact healthcare use, including postpartum visits. However, it is unknown whether discrimination is associated with postpartum visit content. This study aimed to examine the relationship between perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content.Research designData were from Listening to Mothers in California, a population-based survey of people with a singleton hospital birth in California in 2016. Adjusted logistic regression models estimated the association between perceived discrimination during the childbirth hospitalization and 1) postpartum visit attendance, and 2) topics addressed at the postpartum visit (birth control, depression and breastfeeding) for those who attended.Results90.6% of women attended a postpartum visit, and 8.6% reported discrimination during the childbirth hospitalization. In adjusted models, any discrimination and insurance-based discrimination were associated with 7 and 10 percentage point (pp) lower predicted probabilities of attending a postpartum visit, respectively. There was a 7pp lower predicted probability of discussing birth control for women who had experienced discrimination (81% vs. 88%), a 15pp lower predicted probability of being asked about depression (64% vs. 79%), and a 9 pp lower predicted probability of being asked about breastfeeding (57% vs. 66%).ConclusionsAmid heightened attention to the importance of postpartum care, there is a need to better understand determinants of postpartum care quality. Our findings highlight the potential consequences of healthcare discrimination in the perinatal period, including lower quality of postpartum care.

Prenatal exposure to ambient air pollutants and early infant growth and adiposity in the Southern California Mother\u2019s Milk Study

BackgroundPrior epidemiological and animal work has linked in utero exposure to ambient air pollutants (AAP) with accelerated postnatal weight gain, which is predictive of increased cardiometabolic risk factors in childhood and adolescence. However, few studies have assessed changes in infant body composition or multiple pollutant exposures. Therefore, the objective of this study was to examine relationships between prenatal residential AAP exposure with infant growth and adiposity.MethodsResidential exposure to AAP (particulate matter < 2.5 and 10 microns in aerodynamic diameter [PM2.5, PM10]; nitrogen dioxide [NO2]; ozone [O3]; oxidative capacity [Oxwt: redox-weighted oxidative potential of O3 and NO2]) was modeled by spatial interpolation of monitoring stations via an inverse distance-squared weighting (IDW2) algorithm for 123 participants from the longitudinal Mother’s Milk Study, an ongoing cohort of Hispanic mother-infant dyads from Southern California. Outcomes included changes in infant growth (weight, length), total subcutaneous fat (TSF; calculated via infant skinfold thickness measures) and fat distribution (umbilical circumference, central to total subcutaneous fat [CTSF]) and were calculated by subtracting 1-month measures from 6-month measures. Multivariable linear regression was performed to examine relationships between prenatal AAP exposure and infant outcomes. Models adjusted for maternal age, pre-pregnancy body mass index, socioeconomic status, infant age, sex, and breastfeeding frequency. Sex interactions were tested, and effects are reported for each standard deviation increase in exposure.ResultsNO2 was associated with greater infant weight gain (β = 0.14, p = 0.02) and TSF (β = 1.69, p = 0.02). PM10 and PM2.5 were associated with change in umbilical circumference (β = 0.73, p = 0.003) and TSF (β = 1.53, p = 0.04), respectively. Associations of Oxwt (pinteractions < 0.10) with infant length change, umbilical circumference, and CTSF were modified by infant sex. Oxwt was associated with attenuated infant length change among males (β = -0.60, p = 0.01), but not females (β = 0.16, p = 0.49); umbilical circumference among females (β = 0.92, p = 0.009), but not males (β = -0.00, p = 0.99); and CTSF among males (β = 0.01, p = 0.03), but not females (β = 0.00, p = 0.51).ConclusionPrenatal AAP exposure was associated with increased weight gain and anthropometric measures from 1-to-6 months of life among Hispanic infants. Sex-specific associations suggest differential consequences of in utero oxidative stress. These results indicate that prenatal AAP exposure may alter infant growth, which has potential to increase childhood obesity risk.

Specific amino acids but not total protein attenuate postpartum weight gain among Hispanic women from Southern California.

There is a high prevalence of obesity and type 2 diabetes in the United States, particularly among Hispanic women, which may be partly explained by failure to lose gestational weight during the postpartum period. Previous work indicates that protein and amino acids may protect against weight gain; therefore, this study examined the impact of dietary protein and amino acid intake on changes in postpartum weight and the percent of women meeting the Estimated Average Requirement (EAR) for these dietary variables among Hispanic women from the Southern California Mother's Milk Study (n = 99). Multivariable linear regression analysis was used to examine the associations between protein and amino acid intake with change in weight after adjusting for maternal age, height, and energy intake. Women's weight increased from prepregnancy to 1‐month and 6‐months postpartum (71.1 ± 14.6 vs. 73.1 ± 13.1 vs. 74.5 ± 14.6 kg, p < .0001). Although dietary protein was not associated with weight change (β = −1.09; p = .13), phenylalanine (β = −1.46; p = .04), tryptophan (β = −1.71; p = .009), valine (β = −1.34; p = .04), isoleucine (β = −1.26; p = .045), and cysteine (β = −1.52; p = .02) intake were inversely associated with weight change. Additionally, fewer women met the EAR values for cysteine (11.1%), phenylalanine (60.6%), and methionine (69.7%), whereas most women met the EAR values for tryptophan (92.9%), valine (96.0%), and isoleucine (94.9%). Study results indicate that several essential and conditionally essential amino acids were associated with postpartum weight loss, with a significant portion of women not meeting recommended intake levels for some of these amino acids. These results highlight the importance of postpartum maternal diet as a potential modifiable risk factor.