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Biomedical subjects

Milton Kotelchuck

Publications and source records attributed to Milton Kotelchuck.

13 recordsLinked to original sources
PubMed2007

Psychosocial predictors of being an underweight infant differ by racial group: a prospective study of Louisiana WIC program participants.

OBJECTIVES: In order to prospectively identify psychosocial predictors of infants being underweight, we followed 3,302 low-income infants. These infants received well-baby care in health departments and were enrolled in the Women, Infants, and Children (WIC) Supplemental Food Program from the newborn period to 12 months of age. METHODS: We linked risk factor data collected from newborn medical history records to anthropometric data from a WIC database. The unadjusted relative risk of being underweight at 12 months of age, defined as weight for recumbent length below the 5th percentile, according to current Centers for Disease Control and Prevention growth charts, for each group was calculated for the study population and for black and white racial groups. Using logistic regression, we calculated odds ratios measuring the effect of the newborn risk factors on underweight status at 12 months of age. RESULTS: There were no psychosocial risk factors that were significantly associated with being underweight simultaneously in both racial groups. Among black infants, those whose mothers had an eighth grade education or lower were at greater risk of being underweight at 12 months of age (OR=3.7, CI=1.5-4.8), as were those whose mothers were married (OR=2.7, CI=1.5-4.8). Among white infants, those whose mothers initiated prenatal care in the third trimester were significantly more likely to have underweight infants at 12 months of age (OR=4.5, CI=1.6-12.4). CONCLUSIONS: Predictors of being underweight at 12 months of age in a low-income population differ by racial group. Further research of public health interventions targeting families of infants with the significant psychosocial risk factors is needed.

Adult↗
PubMed2006

Maternal hypertension as a risk factor for low birth weight infants: comparison of Haitian and African-American women.

BACKGROUND: The rate of low birth weight (LBW) of Black women is more than twice that of White women. This study explores if the rate of LBW differs between Haitian and African-American women with chronic hypertension. METHODS: A retrospective cohort study of all Black women self-identified as African-American (n = 12,258) or Haitian (n = 4320) delivering a singleton infant in Massachusetts between 1996 and 2000. RESULTS: Haitian women were more likely than African-American women to have chronic hypertension (2.7% vs. 2.1%, p = 0.006), but had similar rates of preeclampsia (3.1% vs. 3.3%, p = 0.27). The LBW rate was 10% among African-American women and 8.2% among Haitian women. After adjustment for sociodemographic, medical, and prenatal care characteristics, the greatest risks for delivering a LBW infant for Haitian women were chronic hypertension (OR = 6.8; 95% CI, 4.3, 10.6) and preeclampsia (OR = 3.2; 95% CI, 2.0, 5.1). For African-American women, the greatest risks for LBW infants were a history of delivering a LBW infant (OR = 3.9; 95% CI, 2.8, 5.4) and chronic hypertension (OR = 2.9; 95% CI, 2.1, 4.0). In a combined logistic regression model including interaction terms, chronic hypertension and preeclampsia continued to be associated with the greatest risk of LBW among all women. CONCLUSIONS: Differences in maternal risk factors and rates of LBW (8.2% vs. 10%) exist between Haitian and African-American women delivering infants in Massachusetts. While chronic hypertension and preeclampsia are strong risk factors for LBW for both Haitian and African-American women, unknown factors make these disorders much more potent for Haitian women.

Adult↗
PubMed2006

Birth characteristics associated with early intervention referral, evaluation for eligibility, and program eligibility in the first year of life.

OBJECTIVES: The Individual with Disabilities Education Act mandates Early Intervention (EI) services for infants and toddlers with developmental delay. We assessed the percentage of infants at risk for developmental delay due to characteristics present at birth who were referred to Massachusetts EI within 1 year of birth, evaluated for eligibility, and eligible for services. In addition, we identified birth characteristics that independently predicted 0-1 year program referral, evaluation, and eligibility. METHODS: The Pregnancy to Early Life Longitudinal (PELL) data system linked birth certificate, hospital discharge, and EI program data of 219,037 infants born in Massachusetts, 1998-2000. Multivariate logistic regressions identified independent infant predictors of referral, evaluation, and eligibility. RESULTS: Of 219,037 births, 14,852 (6.8%) were referred to EI within 1 year. Birthweight<1200 g (OR=9.7, 95% CI 3.3-12.9) and birthweight 1200-1499 g (OR=7.4, 95% CI 5.8-9.5) strongly predicted referral. Referral was high (88%) among infants with two or more birth risks. Among referrals, 88% were evaluated for eligibility. The strongest predictor of evaluation was triplet birth (OR=4.3, 95% CI 1.6-11.8). Among infants evaluated, 85% were determined to be eligible. CONCLUSION: EI referral and evaluation are high among infants born at risk for delay in Massachusetts. Some characteristics not included in the state's high-risk definition (e.g. birthweight 1200-1499 g) were identified that predicted referral. Most referrals were eligible for services. Results demonstrate the value to states of using linked population and program data for program evaluation.

Confidence Intervals↗
PubMed2006

Preconception care between pregnancies: the content of internatal care.

For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care.

Domestic Violence↗
PubMed2006

Risk factors for neonatal morbidity and mortality among "healthy," late preterm newborns.

Research about neonatal outcomes among late preterm infants (34 weeks through 36 6/7 weeks of gestation) is limited. Understanding which late preterm infants are at risk for neonatal morbidity or mortality is necessary to improve health outcomes and reduce hospital costs. We conducted a population-based cohort study of "healthy," singleton late preterm infants vaginally delivered in Massachusetts hospitals to Massachusetts residents between 1998 and 2002. We compared the incidence of neonatal morbidity (postdelivery inpatient readmissions, observational stays, or mortality) between "healthy," late preterm infants with and without infant, obstetric, and sociodemographic factors by calculating risk ratios adjusted for confounding. Of the 9552 late preterm, "healthy" infants, 4.8% had an inpatient readmission and 1.3% had an observational stay. Infants with neonatal morbidity were more likely to be firstborn, be breastfed at discharge, have labor and delivery complications, be a recipient of a public payer source at delivery, or have an Asian/Pacific Islander mother. Non-Hispanic blacks had a decreased risk for neonatal morbidity compared to other racial/ethnic groups. Knowledge of risk factors for neonatal morbidity among "healthy" late preterm infants can be used to identify infants needing closer monitoring and earlier follow-up after hospital discharge.

Adolescent↗
PubMed2006

Early discharge among late preterm and term newborns and risk of neonatal morbidity.

Understanding how late preterm infants (34-36 completed weeks' gestation) are affected by discharge policies created for term infants (37-41 completed weeks' gestation) is essential for preventing postdischarge neonatal morbidity among late preterm infants. We analyzed linked birth certificate and hospital discharge data for Massachusetts between 1998 and 2002 to evaluate the risk of neonatal morbidity (defined as hospital readmission, observational stay, or both) between all vaginally delivered, live-born singleton late preterm and term infants. All infants were born at a Massachusetts hospital to a state resident and were discharged home early (<2-night hospital stay). We calculated crude and adjusted risk ratios using a modified Poisson regression and compared the timing and principal discharge diagnoses for those neonates who needed hospital readmission. Of the 1004 late preterm and 24,320 term infants in our study, 4.3% and 2.7% of infants, respectively, were either readmitted or had an observational stay. Late preterm infants were 1.5 times more likely to require hospital-related care and 1.8 times more likely to be readmitted than term infants. Among infants who were breastfed, late preterm infants were 1.8 times more likely than term infants to require hospital-related care and 2.2 times more likely to be readmitted. In contrast, no differences were found between late preterm and term infants who were not breastfed. Jaundice and infection accounted for the majority of readmissions. Our findings suggest that late preterm infants discharged early experience significantly more neonatal morbidity than term infants discharged early; however, this may be true only for breastfed infants. Evidence-based recommendations for appropriate discharge timing and postdischarge follow-up for these late preterm infants are needed to prevent neonatal morbidity.

Adult↗
PubMed2005

Identifying multiple gestation groups using state-level birth and fetal death certificate data.

PURPOSE: Birth and fetal death certificates classify individuals as twins or higher order multiples, but do not identify multiple gestation groups. As a result, multiple gestations are consistently excluded from maternal and child health research studies despite the surge in multiple births since the early 1980s and the health risks associated with them. A standardized methodology for states to identify multiple gestation groups is proposed to allow researchers to account for multiple gestations in analyses, improve the accuracy of the incidence of multiple gestations and further knowledge of the impact of multiple gestations on birth outcomes. METHODS: Using 3 years of Massachusetts birth and fetal death certificate data from 1998 to 2000 (247,959 births and 1358 fetal deaths), we assigned matching multiple gestation group numbers to records with identical combinations of mother's first name, last name, date of birth, and month of delivery. To validate our methodology, we calculated plurality and compared it to plurality reported on the existing birth and fetal death data. RESULTS: This method correctly identified 10,765 records out of 10,795 validated multiple gestation deliveries (99.8%). Our method identified 71 additional multiple gestation deliveries, which were not identified by the birth and fetal death files. This method resulted in only 4 false positives and 51 false negatives over 3 years. CONCLUSIONS: This algorithm provides much needed information on multiple gestation groupings, and as an additional benefit, improves the identification of multiple gestation deliveries. This method has proven easy to use, employs state-level data, and offers numerous new analytic opportunities.

Birth Certificates↗
PubMed2004

Predictors of Urban fathers' involvement in their child's health care.

OBJECTIVE: Fathers make important contributions to many aspects of children's well-being, but relatively few studies have evaluated father involvement in their child's health care. The objective of this study was to explore the extent to which fathers are involved in their children's health care and identify those factors that are associated with greater involvement. METHODS: A convenience sample of 104 English-speaking, urban fathers with children younger than 7 years were recruited to complete an anonymous, structured interview. Fathers self-reported the number of well-child visits (WCVs) that they had ever attended and which factors had influenced their attendance. Bivariate and multivariate analyses were used to identify those factors that predicted greater involvement. RESULTS: Eighty-nine percent of the fathers had attended at least 1 WCV. Fifty-three percent had high involvement, ie, had attended > or =40% of the American Academy of Pediatrics recommended visits for their child's age. In multivariate modeling, factors that were significantly associated with high involvement in attending WCVs included attendance at the child's delivery (odds ratio [OR]: 7.3 [1.7-30.4]), younger child age (OR: 0.96 [0.94-0.99]), older father age (OR: 1.2 [1.2-1.3]), the child's having health insurance (OR: 4.1 [1.3-12.0]), and having >1 child (OR: 0.22 [0.06-0.72]). CONCLUSIONS: The factors identified suggest ways that pediatric providers can support fathers' involvement in their children's health care. Providers should focus on encouraging greater involvement early, especially for younger fathers and those with older children. In addition, support of universal health coverage for children might, in addition to other obvious benefits, enhance a father's engagement with his child's health care.

Adult↗
PubMed2002

A comparison of risk factors for twin preterm birth in the United States between 1981-82 and 1996-97.

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.

Adolescent↗
PubMedDate not supplied

Pregnancy Risk Assessment Monitoring System (PRAMS): possible new roles for a national MCH data system.

The Pregnancy Risk Assessment Monitoring System (PRAMS) was established by the Centers for Disease Control and Prevention (CDC) in 1987 in five states, and today 32 states participate. Using states' vital statistics (birth certificates) as its population-based sampling frame, PRAMS "follows back" a stratified sample of women several months post-partum, surveying them about their own and their infant's prenatal, birth, and post-partum behavior and experiences. It uses a standardized protocol and multiple data collection modalities. PRAMS was initiated in an era of intense state and national interest in infant mortality, racial disparities reduction, and publicly supported prenatal care program expansion-and a lack of state-specific information available to inform local and state program development and assessment. The PRAMS format allows more in-depth inquiry about reproductive health topics than is possible from the more widespread but limited set of information available on birth certificates. PRAMS carries on a long, proud tradition of follow-back studies in the maternal and child health (MCH) field. In the 1920s, the U.S. Children's Bureau conducted the nation's first major in-depth study on infant mortality using a similar follow-back methodology. In each of 10 cities, every woman whose infant had died in the past year was systematically surveyed. The results provided an initial understanding of the nature of infant mortality in the U.S., indicating that infant deaths occurred more often in lower-income than higher-income families, among bottle-fed than breast-fed infants, and among twins than singletons. Beginning in 1964 and every eight years thereafter through 1988, the National Center for Health Statistics (NCHS) conducted intensive national follow-back studies of live births and infant/fetal deaths, which has provided much of our more recent national epidemiologic information about pregnancy and births, especially concerning smoking, prenatal care usage, etc. A similar Department of Education/NCHS national follow-back and longitudinal follow-up study, the Early Childhood Longitudinal Study-Birth Cohort (ECLS-BC) was begun in 2001 and will survey 10,000 mothers and their infants through kindergarten age.

Child↗