Timing Of Prenatal Care Research Articles

Closing the gap? Results-based financing and socioeconomic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilisation of health services. This study leverages the staggered rollout of the program as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilising pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF program is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally, the program is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritising expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022.

To identify trends in stillbirth rates attributed to congenital syphilis in the United States by describing congenital syphilis-related stillbirths and comparing characteristics of pregnant people who had congenital syphilis-related stillbirths with those of people who had preterm and full-term liveborn neonates with congenital syphilis. Cases of congenital syphilis reported to the Centers for Disease Control and Prevention during 2016-2022 were analyzed and categorized as stillbirth, preterm live birth (before 37 weeks of gestation), or term live birth (37 weeks or later). Cases with unknown vital status or gestational age were excluded. Frequencies were calculated by pregnancy outcome, including pregnant person demographics; receipt of prenatal care; syphilis stage and titer; and timing of prenatal care, testing, and treatment. Overall, 13,393 congenital syphilis cases with vital status and gestational age were reported; of these, 853 (6.4%) were stillbirths. The number of congenital syphilis-related stillbirths increased each year (from 44 to 231); the proportion of congenital syphilis cases resulting in stillbirth ranged from 5.2% to 7.5%. Median gestational age at delivery for stillborn fetuses was 30 weeks (interquartile range 26-33 weeks). People with congenital syphilis-related stillbirths were more likely to have titers at or above 1:32 (78.9% vs 45.5%; P<.001) and to have received no prenatal care (58.4% vs 33.1%; P<.001) than people with liveborn neonates with congenital syphilis. The risk of stillbirth was twice as high in persons with secondary syphilis compared with those with primary syphilis (11.5% vs 5.7%, risk ratio 2.00; 95% CI, 1.27-3.13). Across all congenital syphilis cases, 34.2% of people did not have a syphilis test at their first prenatal visit. Stillbirths occurred in more than 1 in 20 pregnancies complicated by congenital syphilis. Risk factors for stillbirth included high titers, secondary stage, and lack of prenatal care. If the prevalence of congenital syphilis continues to rise, there will be a corresponding increase in the overall stillbirth rate nationally.

Impact of maternal social vulnerability and timing of prenatal care on outcome of prenatally detected congenital heart disease.

Early prenatal detection of congenital heart disease (CHD) allows mothers to plan for their pregnancy and delivery; however, the effect of certain sociodemographic and fetal factors on prenatal care has not been investigated thoroughly. This study evaluated the impact of maternal and fetal characteristics on the timing of prenatal diagnosis of CHD and fetal and postnatal outcomes. This retrospective multicenter cohort study included women with a fetal echocardiographic diagnosis of CHD between 2010 and 2019. Women were grouped into quartiles of social vulnerability (quartiles 1-4; low-high) using the 2014 social vulnerability index (SVI) provided by the Centers for Disease Control and Prevention. A fetal disease severity score (range, 1-7) was calculated based on a combination of CHD severity (mild = 1; moderate = 2; severe, two ventricles = 3; severe, single ventricle = 4 points) and prenatally diagnosed genetic abnormality, non-cardiac abnormality and fetal hydrops (1 point each). Late diagnosis was defined as a fetal echocardiographic diagnosis of CHD after 24 weeks' gestation. Univariate and multivariable regression analyses were used to identify factors associated with late diagnosis, termination of pregnancy (TOP), postnatal death, prenatal-postnatal discordance in CHD diagnosis and severity and, for liveborn infants, to identify which prenatal variables were associated with postnatal death or heart transplant. Among 441 pregnancies included, 94 (21%) had a late diagnosis of CHD. Late diagnosis was more common in the most socially vulnerable quartile, 38% of women in this group having diagnosis > 24 weeks, compared with 14-18% in the other three quartile groups. Late diagnosis was also associated with Catholic or other Christian religion vs non-denominational or other religion and with a lower fetal disease severity score. There were 93 (21%) TOP and 26 (6%) in-utero fetal demises. Factors associated with TOP included early diagnosis and greater fetal disease severity. Compared with the other quartiles, the most socially vulnerable quartile had a higher incidence of in-utero fetal demise and a lower incidence of TOP. Among the 322 liveborn infants, 49 (15%) died or underwent heart transplant during the follow-up period (range, 0-16 months). Factors associated with postnatal death or heart transplant included longer delay between obstetric ultrasound examination at which CHD was first suspected and fetal echocardiogram at which CHD was confirmed and greater fetal disease severity. High social vulnerability, Catholic or other Christian religion and low fetal disease severity are associated with late prenatal CHD diagnosis. Delays in CHD diagnosis are associated with fewer TOPs and worse postnatal outcome. Therefore, efforts to expedite fetal echocardiography following abnormal obstetric screening, particularly for at-risk women (e.g. those with high SVI), have the potential to impact pregnancy and postnatal outcome among the prenatally diagnosed CHD population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Sexual violence against women in the Western Amazon.

ABSTRACTOBJECTIVE:To characterize sexual violence cases suffered by women notified by the Sistema de Informação de Agravos de Notificação (Information System for Notifiable Diseases) in the city of Rio Branco (AC - Brazil) from 2011 to 2016.METHODS:Descriptive study based on information from the Notifiable Diseases Information System. The study population consisted on women victims of sexual violence reported in the city of Rio Branco (AC), from 2011 to 2016.RESULTS:The results show a higher number of notifications during 2012, especially among single, brown, and aged between 10 and 14 years victims; usually they have 5 to 8 years of schooling. Normally violence occurred in residences and by a single aggressor, male and non-alcoholic.DISCUSSION:The large number of notifications of pregnant women aged 10 to 14 years corresponds to the compulsory notification of rape of a vulnerable person, identified at the time of prenatal care or childbirth.CONCLUSION:We confirm the susceptibility to sexual violence of young women in Rio Branco, raising the issue of child marriage and teenage pregnancy.

Indicators of prenatal care received by Family Health Strategy users in cities of the State of Paraíba

Introduction: Prenatal care benefits maternal and neonatal health. Objective: To evaluate indicators of prenatal care of users from Family Health Strategy in cities of the State of Paraíba, Brazil, and to investigate differences according to the social context and the health team. Methods: Cross-sectional study based on the questionnaire application to 897 individuals. Multivariate logistic regression was performed to verify the association between social characteristics and type of health team with indicators of the prenatal care (time of beginning, number of consultations for gestational age at delivery, use of ferrous sulfate, vaccination against tetanus before or during the gestation), treated as dependent variables. Results: Among interviewees, 81.0% began prenatal care in the first quarter of pregnancy and 83.0% had at least six consultations. Ferrous sulfate use and tetanus immunization were reported by respectively 94.9% and 88.8% of the interviewed women. Participants living with a partner, with higher socioeconomic level, and not participating in the Bolsa Família Program were more likely to have adequate beginning time of prenatal care, number of consultations and supplementation with ferrous sulfate. Beginning of prenatal care in the first quarter and having at least six consultations were associated with low food insecurity, while maternal work outside the home, high social support, family functionality and attendance by teams from Programa Mais Médicos favored the prenatal beginning time. Conclusion: The study showed satisfactory indicators of prenatal care, influenced by the socioeconomic characteristics and the social support of the pregnant woman.

Letramento em saúde no pré-natal relacionado aos métodos não farmacológicos para alívio da dor no trabalho de parto

The aim was to know and investigate the level of health literacy of pregnant women, as well as to describe and discuss non-pharmacological methods for pain relief during labor and how the transmission of these guidelines by health professionals occurs. It is a qualitative method, with the participation of 10 postpartum women, about Grande Vitória in Espírito Santo, in September 2020. The interview addressed issues of sociodemographic profiles, literacy in non-pharmacological methods in prenatal care and what was the source of this reported knowledge. Of these, the majority obtained information from friends and the others from relatives, the internet, the pregnant woman's booklet and a minority from nurses and doctors. For this, the pillars of the methods were: shower bath, immersion bath, massage, exercises without or with a Swiss ball, breathing and movements in general. It is concluded that health education at the time of prenatal care is an indispensable factor for the promotion of humanized childbirth, mainly due to the occurrence in the reproduction of obstetric violence. Therefore, it is the health professional's role to promote the autonomy and empowerment of the puerperal woman, making her have control of her body.

Child Support Enforcement and Infants Health Outcomes

This paper explores the potential externality of enforcements in child support policies on infants’ health outcomes. Exploiting the variations in child support policies across states and over the year and using the universe of birth records in the US (1975-2004), I document that the policies were effective in improving birth outcomes. Infants born to single mothers in states that fully adopt child support policies have on average 38 grams higher birth weight and 99 basis points lower likelihood of being born with low birth weight. These effects hold for a wide range of health outcomes. The marginal impacts are larger for mothers in states above-median changes in child support policies and for mothers who reside in poorer states. The results suggest that a higher quantity of prenatal care and better timing of prenatal care could be possible mechanisms of impact. This study contributes to the existing literature by providing the first evidence of health externality of child support policies for infants’ health outcomes.

Psychosocial status and prenatal care of unintended pregnancies among low-income women

BackgroundNearly half of all pregnancies in the United States are reported as unintended and rates are highest among women of low socioeconomic status. The purpose of this study was to examine the associations between unintended pregnancies and maternal mental health and timing of prenatal care among low-income women.MethodsIn this cross-sectional study, 870 women, whom were participating in the First 1000 Days program in three community health centers in the Boston area, were enrolled at their first prenatal visit from August 2016 – September 2017. We assessed pregnancy intention by self-report using the Pregnancy Risk Assessment Monitoring System. We used self-reported survey information and electronic health record data to assess the following outcomes: current stress, current depression, and timing of initial prenatal visit. We used multivariable logistic regression models to examine associations and adjusted for sociodemographic factors.ResultsWomen were a mean (SD) age of 29.3 (6.1), and 39.2% reported that their pregnancy was unintended. 50.6% of women were Hispanic, 28.4% were White, 10.1% were Black, and 10.9% were other races. 78.9% of women reported an annual household income <$50,000. Overall, 26.7% of women reported current stress, 8.2% reported current depression, and 18.3% of women initiated prenatal care after their first trimester. In multivariable analyses, women with unintended pregnancies had higher odds of experiencing current stress (OR: 1.72; 95% CI: 1.22, 2.41), current depression (OR: 1.83; 95% CI: 1.04, 3.20), and initiation of prenatal care post-first trimester (OR: 1.84; 95% CI: 1.23, 2.74).ConclusionsUnintended pregnancies were associated with current stress and depression, and delayed prenatal care in this sample of low-income women suggesting the importance of identifying high-risk women and tailoring interventions to support women’s needs.Trial registrationClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).

Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study.

ObjectivesTo investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID‐19 outbreak.DesignCross‐sectional study.SettingTwo cities in China––Wuhan (epicentre) and Chongqing (a less affected city).PopulationA total of 1947 pregnant women.MethodsWe collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID‐19 (using a self‐constructed five‐point scale). The Self‐Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision‐making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis.Main outcome measuresAnxiety status and its influencing factors. Obstetric decision‐making.ResultsDifferences were observed between cities in some background characteristics and women's attitudes towards COVID‐19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city‐based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding.ConclusionsThe outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision‐making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.Tweetable abstractThe COVID‐19 outbreak increased pregnant women's anxiety and affected their decision‐making.

Is Sleep Deprivation Associated With Adverse Pregnancy Outcomes? [22M

INTRODUCTION: The purpose of this study was to evaluate the association between measures of sleep deprivation (SD) and adverse pregnancy outcomes. METHODS: A screening questionnaire which included novel items intended to assess sleep deprivation, was administered at the time of prenatal care; this was a secondary analysis of participants enrolled (2010-2012). SD was defined as a 3 hour or more difference between weekday and weekend self-reported sleep duration. This analysis received an IRB exemption. RESULTS: Of 1172 women, 17.41% (n=204) had SD. Women with SD were more likely to have large for gestational age (LGA) babies (6.5% vs. 2.99%, P=.015) and babies admitted to the neonatal intensive care unit (NICU) (21.1% vs. 15.4%, P=.048). Women who reported falling asleep while driving were more likely to have gestational hypertension (gHTN) (18.6% vs. 9.3%, P=.030), preeclampsia (PreE) (27.1% vs. 13.8%, P=.010), PreE with severe features (18.8% vs. 8.68%, P=.017) and to experience adverse composite obstetric outcomes (64.7% vs. 50%, P=.040). Women who reported napping were more likely to have PreE with severe features (11.1% vs. 7.59%, P=.049), preterm birth (PTB) (16.6% vs. 9.71%, P=.001), and NICU admission (20.9% vs. 14.4%, P=.005). Women who reported napping more than 3x/week were more likely to have gHTN (12.0% vs. 8.12%, P=.024), PTB (16.0% vs. 10.3%, P=.003), and adverse composite obstetric outcomes (54.0% vs. 48.3%, P=.047). CONCLUSION: Sleep deprivation, falling asleep while driving, and napping are associated with various adverse obstetric outcomes and composite obstetric outcomes. Further research into the effects of sleep deprivation during pregnancy is warranted.

658: Is shift work or self-reported short sleep duration during pregnancy associated with adverse pregnancy outcomes?

Shift work has been associated with adverse pregnancy outcomes such as preterm delivery, hypertensive disorders of pregnancy, and infants of small for gestational age. The purpose of this study was to evaluate the association between shift work, sleep duration, and adverse pregnancy outcomes. Secondary analysis of a prospective study of participants enrolled in an OSA screening study (2010 – 2012). A screening questionnaire with standard OSA questions as well as novel items about shift work and nocturnal sleep duration was administered at the time of prenatal care. Short sleep duration (SSD) was defined as less than 7 hours. Prolonged sleep duration (PSD) was defined as greater than 9 hours. Normal sleep duration (NSD) was defined as 7-9 hours. In a cohort of 1163 women, 12.2% (n=142) reported shift work at the time of screening. Women who reported shift work were more likely than women who reported no shift work to have preeclampsia (PreE) (27.0% vs. 12.7%, p< 0.001), PreE with severe features (16.1% vs. 8.2%, p=0.003), A2 gestational diabetes mellitus (GDM) (21.9% vs. 14.1%, p=0.016), and adverse composite obstetric outcomes (CoOB) (58.9% vs 49.3%, p=0.033). 5.07% (n=61) of women reported SSD and 37.71% (n=454) of women reported PSD. Women who reported SSD were more likely than women who reported NSD or PSD to have GDM (31.1% vs. 24.9% and 13.9%, respectively, p< 0.001) and A2 GDM (29.55 vs. 17.7% and 10.1%, respectively, p< 0.001). Women who reported PSD were less likely to experience adverse CoOB than women who reported NSD or SSD (43.8% vs. 54.1% and 57.4%, respectively, p=0.002). Shift work is associated with PreE with and without severe features, A2 GDM, and adverse CoOB. Short sleep duration is associated with GDM and A2 GDM. Prolonged sleep duration is associated with lower adverse CoOB. This is in contrast to recent findings. Further research on sleep disturbance in pregnancy is warranted.

Racial Differences in Stillbirth Risk Factors in Women Who Experienced Stillbirth During 2016

Non-Hispanic Black women experience twice the risk of stillbirth compared with non-Hispanic White women. In 2005, researchers found several stillbirth risk factors were more prevalent in Black women than White women: younger than 20 years old, low education level, obesity, smoking, hypertension, diabetes, late prenatal care, and previous cesarean. It is not known whether these disparities remain. The purpose of this study was to explore whether the stillbirth risk-factor disparity between White and Black women has changed since 2005. The study used secondary data analysis. The National Center for Health Statistics’ 2016 fetal death data file was obtained and analyzed. The sample included White and Black women who experienced stillbirths in the United States in 2016. Non-U.S. residents, fetal deaths before 20 weeks, and multiple births were excluded. A random sample of 315 Black and White women who experienced stillbirths (from the 2016 fetal death data file) was analyzed and descriptive variables were calculated. Black women were compared with White women for each of the risk factors of interest. Age was evaluated using a t test. Education level, obesity, smoking, hypertension, diabetes, timing of prenatal care, and history of previous cesarean were compared using a chi-square test. Age, hypertension, diabetes, timing of prenatal care, and previous cesareans did not differ significantly between Black and White women, but education, obesity, and smoking did. Black women were more likely to possess less than a high school education (14.7% vs. 8.8%, p < .05). They were also less likely to possess an undergraduate degree or higher (11.6% vs 25%, p < .05). Black women were more likely to be obese (44% vs. 29%, p < .05) and less likely to report smoking during the pregnancy (16.3% vs. 19.0%, p < .05). The previously described racial disparity in stillbirth risk factors has changed since 2005. Among women bereaved by stillbirth, only obesity, education level, and smoking still differ between Black and White women. For smoking, the direction of the disparity has changed; White mothers are now more likely to smoke than Black mothers. These findings may help nurses identify women who are at risk of stillbirth and may benefit from preventative measures.

A case control study of risk factors and neonatal outcomes of preterm birth

ObjectiveThe aim is to examine risk factors and neonatal outcomes of preterm birth and to provide basis in preventing preterm birth. Materials and methodswe carried out our study on 1328 term controls and 1328 preterm birth cases. By using multivariable logistic regression procedures we estimated odds ratio (OR) of potential preterm birth risk factors. T-test and chi-square test were used to estimate differences between groups. ResultsMaternal age, prior history of pregnancy and abortion, prenatal care, complications of pregnancy (includes hypertension, intrahepatic cholestasis of pregnancy (ICP), fetal growth restriction (FGR), premature rupture of the membranes (PROM), placenta previa, abnormal presentation, abnormal S/D ratio et al.) were significantly associated with preterm birth. Several factors emerged as being statistically significant risk factors for preterm birth, such as prior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation. The time of prenatal care was shown to be a protective factor. Additionally, we observed evidence suggested that male babies are known to have a significant higher risk of preterm birth than female babies. ConclusionPrior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation were covariates identified in this study as risk factors for preterm birth. Preterm birth is an important reason of neonatal poor prognosis and death.

Inadequate prenatal care use and breastfeeding practices in Canada: a national survey of women.

BackgroundPrevious studies have demonstrated that prenatal care (PNC) has an effect on women’s breastfeeding practices. This study aims to examine the influence of adequacy of PNC initiation and services use on breastfeeding practices in Canada.MethodsData for this secondary analysis was drawn from the Maternity Experiences Survey (MES), a cross sectional, nationally representative study that investigated the peri-and post-natal experiences of mothers, aged 15 and above, with singleton live births between 2005 and 2006 in the Canadian provinces and territories. Adequacy of PNC initiation and services use were measured by the Adequacy of Prenatal Care Utilization Index. The main outcomes were mother’s intent to breastfeed, initiate breastfeeding, exclusively breastfeed, and terminate breastfeeding at 6 months. Multivariate logistic regression analysis assessed the adequacy of PNC initiation and service use on breastfeeding practices, while adjusting for socioeconomic, demographic, maternal, pregnancy and delivery related variables. Bootstrapping was performed to account for the complex sampling design.ResultsAround 75.0 % of women intended to only breastfeed their child, with 90.0 % initiating breastfeeding, while 6 month termination and exclusive breastfeeding rates were at 52.0 % and 14.3 %, respectively. Regression analysis showed no association between adequate PNC initiation or services use, and any breastfeeding practice. Mothers with either a family doctor or a midwife as PNC provider were significantly more likely to have better breastfeeding practices compared to an obstetrician.ConclusionsIn Canada, provider type impacts a mother’s breastfeeding decision and behavior rather than quantity and timing of PNC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0889-9) contains supplementary material, which is available to authorized users.

Mining care trajectories using health administrative information systems: the use of state sequence analysis to assess disparities in prenatal care consumption.

BackgroundPregnant women are a vulnerable population. Although regular follow-ups are recommended during pregnancy, not all pregnant women seek care. This pilot study wanted to assess whether the integration of data from administrative health information systems and socio-economic features allows identifying disparities in prenatal care trajectories.MethodsPrenatal care trajectories were extracted from the permanent sample of the French health insurance information system linked to the hospital discharge information system. The records of 2518 women who gave birth without complications in France in 2009 were analyzed. State sequence data analysis was performed to identify homogeneous groups of prenatal care trajectories. Socio-economic data were used to characterize their living environment.ResultsWe identified three groups of homogeneous prenatal care trajectories: (i) women with relatively high prenatal care consumption (~11 %), (ii) women with no prenatal care (~21 %), and (iii) women with an intermediate level of prenatal care (~66 %). Analysis of the socio-economic data demonstrated the association between disparities in prenatal care trajectories and the women’s living environment. Women with relatively high care consumption generally lived in socio-economically privileged areas (better education levels, employment status and housing conditions) compared with women with few or no prenatal care.ConclusionsAlthough ecological, our approach demonstrates that data from health administrative information systems could be used to describe prenatal care. However, more individual variables and an improvement of the data quality are needed to efficiently monitor the content and timing of prenatal care. Moreover, state sequence analysis, which was used in this context for the first time, proves to be an interesting approach to explore care trajectories. Finally, the integration of heterogeneous sources of data, including contextual information, might help identifying areas that require health promotion actions toward vulnerable populations, such as pregnant women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0857-5) contains supplementary material, which is available to authorized users.

Beginning and duration of pregnancy in automated health care databases: review of estimation methods and validation results.

To describe methods reported in the literature to estimate the beginning or duration of pregnancy in automated health care data, and to present results of validation exercises where available. Papers reporting methods for determining the beginning or duration of pregnancy were identified based on Pubmed searches, by consulting investigators with expertise in the field and by reviewing conference abstracts and reference lists of relevant papers. From each paper or abstract, we extracted information to characterize the study population, data sources, and estimation algorithm. We then grouped these studies into categories reflecting their general methodological approach. Methods were classified into 5 categories: (i) methods that assign a uniform duration for all pregnancies, (ii) methods that assign pregnancy duration based on preterm-delivery or health care related codes, or codes for other pregnancy outcomes, (iii) methods based on the timing of prenatal care, (iv) methods based on birth weight, and (v) methods that combine elements from 2 and 3. Validation studies evaluating these methods used varied approaches, with results generally reporting on the mistiming of the start of pregnancy, incorrect estimation of the duration of pregnancy, or misclassification of drug exposure during pregnancy or early pregnancy. In the absence of accurate information on the beginning or duration of pregnancy, several methods of varying complexity are available to estimate them. Validation studies have been performed for many of them and can serve as a guide for method selection for a particular study.

Adverse Outcomes Among Asian Indian Singleton Births in New Jersey, 2008-2011.

The study determined the incidence of low birth weight (LBW), small for gestational age (SGA), preterm birth, and perinatal morbidity among Asian Indians (AI) in New Jersey (NJ), as well as identified predictors of SGA. We analyzed birth records for singletons born to mothers identified as AI and non-Hispanic white from 2008 to 2011, obtained from the NJ Department of Health. For AI, rates of LBW and SGA were elevated, rates of preterm birth were similar, and neonatal intensive care unit admission was lower, compared to whites. Factors associated with SGA in AI included nulliparity, anemia, hypertension, placental abruption, and lack of prenatal care. Maternal education, marital status, substance abuse, and timing of prenatal care were associated with SGA in whites, but not in AI. SGA incidence was higher among AI despite preterm rates similar to whites. Anemia was associated with SGA uniquely among AI.

Early Life Factors and Risk of Childhood Rhabdomyosarcoma

Although little is known about etiology of childhood rhabdomyosarcoma (RMS), early life factors are suspected in the etiology. We explored this hypothesis using linked data from the California Cancer Registry and the California birth rolls. Incident cases were 359 children <6-year-old (218 embryonal, 81 alveolar, 60 others) diagnosed in 1988–2008. Controls (205, 173), frequency matched on birth year (1986–2007), were randomly selected from the birth rolls. We examined association of birth characteristics such as birth weight, size for gestational age, and timing of prenatal care with all-type RMS, embryonal, and alveolar subtypes. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression. In contrast to a previous study, we observed statistically non-significant association for embryonal subtype among high birth weight (4000–5250 g) children for term births [OR (95% CI): 1.28 (0.85, 1.92)] and all births adjusted for gestational age [OR (95% CI): 1.21 (0.81, 1.81)]. On the other hand, statistically significant 1.7-fold increased risk of alveolar subtype (95% CI: 1.02, 2.87) was observed among children with late or no prenatal care and a 1.3-fold increased risk of all RMS subtypes among children of fathers ≥35 years old at child birth (95% CI: 1.00, 1.75), independent of all covariates. Our finding of positive association on male sex for all RMS types is consistent with previous studies. While we did not find a convincingly positive association between high birth weight and RMS, our findings on prenatal care supports the hypothesis that prenatal environment modifies risk for childhood RMS.

Missed Opportunities for Preventing Congenital Syphilis Infection in New York City

To describe health care providers' missed opportunities for preventing and treating congenital syphilis in New York City. Review of congenital syphilis cases reported to the New York City Department of Health and Mental Hygiene from January 1, 2000 to December 31, 2009. Receipt and timing of prenatal care, serologic testing, and treatment of mothers and newborns were reviewed. Missed opportunities were defined as receipt of prenatal care plus one of the following: 1) lack of documented treatment for syphilis infection diagnosed before pregnancy; 2) absence of serologic testing during pregnancy; 3) late maternal treatment; 4) maternal treatment with a nonpenicillin regimen; or 5) lack of maternal treatment. In total, 195 newborns with congenital syphilis were born to 190 mothers with 191 pregnancies. Overall, 80% (95% confidence interval [CI] 74-86%, 152 of 190) of all mothers received prenatal care; 63% (95% CI 56-71%, 96 of 152) of these had one or more missed opportunities for prevention. Twelve mothers received inadequate treatment or no treatment during the case pregnancy for documented syphilis infection before pregnancy, and 42 mothers without previous syphilis diagnosis did not have serologic testing during the case pregnancy. Of 103 mothers with syphilis diagnosed before 30 weeks of gestation, 12 received late penicillin therapy, 27 received no therapy, and 3 received inappropriate (nonpenicillin) therapy. Seventeen percent (95% CI 12-22%, 33 of 193) of liveborn newborns received no treatment during their hospitalization. Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians. III.

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

THE U.S. INFANT mortality rate remains unacceptably high, with large disparities found by race. Increasingly, research has demonstrated that interventions must go beyond ensuring access to care and prenatal focus to address the preconception health of women. Critical fetal development occurs in the earliest weeks after conception, often before a woman is aware of her pregnancy. The Maternal Child Health Bureau’s life course initiatives and the Centers for Disease Control’s preconception health initiatives are placing infant mortality and child health in a life course context, that is, uniting the reproductive health and pediatric longitudinal perspectives. In the recent report “Clinical Preventive Services forWomen”, the Institute ofMedicine recommended annual well-women visits incorporating preconception care, and Healthy People 2020 includes a section of objectives on preconception health and behaviors. With growing scientific recognition that early antecedents of child and adult health start prenatally and even preconceptionally, women’s health is key. Pediatric clinicians have been leaders in the efforts to reduce infant mortality and in family-centered care, but how can pediatrics further contribute? A golden opportunity exists to serve as preconception care (PCC) clinicians for preconceptional adolescents and interconceptional mothers seen in practice.