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PubMed2002

Achieving optimal maternal and infant health outcomes for Medicaid patients, with application for commercial populations.

Maternity management, the cornerstone of Medicaid programs, will support the nation's ability to achieve public health goals related to maternal and infant health. The authors' present data showing how organizations that combine practical solutions garnered from both public and commercially funded programs have the greatest potential for developing successful maternity management programs.

Female↗
PubMed1991

Psychosocial predictors of maternal and infant health among adolescent mothers.

Past work suggests that stressful life events and social support are significantly associated with a broad range of child health outcomes. Such associations have remained, however, generally modest in magnitude, suggesting that stress and support may be only proxy measures for a deeper, more central aspect of childhood psychosocial experience. One aspect of young people's lives that could plausibly mediate the effects of stress and social support on health is the sense of stability and "permanence" in ongoing life experience. We developed a standardized psychometric instrument for measuring a "sense of permanence" and employed the measure in a prospective 1-year study of health outcomes among 89 adolescent mothers and their infants. Psychosocial and demographic factors were significantly predictive of maternal, but not infant, health outcomes, and the sense of permanence appeared to operate as a "final common pathway" in the influence of psychosocial variables on health and illness end points. Results of the study underscore the importance of continuity and stability in childhood and suggest that changes in an individual's sense of permanence may underlie the previously documented health effects of stressful life events and social support.

Adolescent↗
PubMed1994

Drinking-water quality, sanitation, and breast-feeding: their interactive effects on infant health.

The promotion of proper infant feeding practices and the improvement of environmental sanitation have been two important strategies in the effort to reduce diarrhoeal morbidity among infants. Breast-feeding protects infants by decreasing their exposure to water- and foodborne pathogens and by improving their resistance to infection; good sanitation isolates faecal material from the human environment, reducing exposures to enteric pathogens. Taken together, breast-feeding and good sanitation form a set of sequential barriers that protect infants from diarrhoeal pathogens. As a result, breast-feeding may be most important if the sanitation barrier is not in place. This issue is explored using data from a prospective study of 2355 urban Filipino infants during the first 6 months of life. Longitudinal multivariate analyses are used to estimate the effects of full breast-feeding and mixed feeding on diarrhoeal disease at different levels of sanitation. Breast-feeding provides significant protection against diarrhoeal disease for infants in all environments. Administration of even small portions of contaminated water supplements to fully breast-fed infants nearly doubles their risk of diarrhoea. Mixed-fed and weaned infants consume much greater quantities of supplemental liquids, and as a result, the protective effect of full breast-feeding is greatest when drinking-water is contaminated. Similarly, full breast-feeding has stronger protective effects among infants living in crowded, highly contaminated settings.

Adult↗
PubMedDate not supplied

Pregnancy and infant health: progress toward the 1990 objectives.

Assuring all infants a healthy start in life and enhancing the health of their mothers are goals of the Public Health Service's health promotion and disease prevention initiative. The 13 priority objectives selected for the pregnancy and infant health area of the initiative focus on lowering infant, neonatal, and perinatal mortality rates, reducing the number of low-birth-weight infants, improving the health care of pregnant women and infants through regionalized perinatal care systems and comprehensive primary care services, encouraging early prenatal care and healthy lifestyles in pregnancy, and targeting the factors and populations associated with health risk. Although considerable progress has been made in this century in lowering the infant mortality rate, infants continue to die at a higher rate than members of any other age category under 60 years, and black infants die at almost twice the rate of white infants. To lower these high mortality rates, the private, public, and voluntary sectors have cooperated in new approaches to perinatal and infant health that have already produced some encouraging results. Recent data, for example, indicate that the priority objective of universal screening of newborns for treatable metabolic disorders has already been achieved and that the target for neonatal and infant mortality rates could be reached earlier than 1990. Substantial challenges, however, lie ahead if the current racial and ethnic differentials evident in the rates for prenatal care registration, low-birth-weight babies, and maternal and infant mortality are to be eliminated.

Female↗
PubMed1993

Infant health care utilization predicted by pattern of prenatal care.

STUDY OBJECTIVE: The objective of this study was to examine the relationship between patterns of prenatal care and subsequent infant health care use in a sample of inner-city women and their infants. In testing this relationship we controlled for several sociodemographic, economic, and psychological factors. DESIGN: This case-control study examined medical records of 148 infants born to mothers previously enrolled in a 9-month study of prenatal care and use or nonuse of illicit drugs. Cases (N = 62) were defined as infants born to women who first registered for prenatal care after 28 weeks' gestation or completed fewer than four prenatal visits. Controls (N = 86) were all other infants matched by date of birth. Data on maternal health and sociodemographic factors were obtained from a maternal interview and medical record review. Maternal drug use was defined as the use of illicit drugs at any time during the pregnancy based on maternal interview and/or a positive maternal or neonatal urine toxicology screen obtained within 48 hours of delivery. RESULTS: Infants of case mothers had significantly lower birth weight and gestational age, increased number of protective service referrals, and lower completion rate of three or more health supervision visits by 9 months of age. Multiple logistic regression analysis revealed that adequate prenatal care was significantly associated with adequate use of infant health care independent of maternal drug use, educational level, marital status, and number of previous living children. CONCLUSIONS: Patterns of infant health care use can be predicted before birth based on the mother's pattern of prenatal care use.

Adult↗
PubMed1997

Effect of maternal depression on premature infant health during initial hospitalization.

This study evaluates the effect of maternal depression on neonatal health status in premature infants during their initial hospitalization. Infants younger than 34 weeks' gestation born to nondrug abusing mothers were enrolled in the study. Thirty-one mother-infant pairs were identified. Maternal depression was evaluated by the Center for Epidemiologic Studies-Depression Scale (CES-D). Scores > or = 16 defined maternal depression. Initial infant physiologic health status was determined by the Score for Neonatal Acute Physiology (SNAP). In-hospital health status was assessed by the following variables: days receiving supplemental oxygen, days on mechanical ventilation (VENT), and days not on enteral feeding (NPO). Health status variables evaluated for long-term outcome included bronchopulmonary dysplasia at 28 days (BPD), BPD at 34 weeks' postmenstrual age (BPD-34), and intraventricular hemorrhage (IVH). Seventeen (55%) of 31 mothers manifested depression on the CES-D. No epidemiologic differences were found between this group and the nondepressed mothers. No differences in gestation or birth weight was detected between the preterm infants of depressed versus nondepressed mothers. The CES-D scores correlated significantly with SNAP (r = .36, P < .02). Infants of depressed mothers experienced significantly worse outcomes in the occurrence of BPD (P = .015), BPD-34 (P = .049), and IVH (P = .055). This study confirms that maternal depression occurs frequently in mothers of preterm infants and adversely affects the presenting neonatal health status of their babies during the initial hospitalization. Maternal depression was related to the severity of the initial neonatal illness and was significantly related to IVH and BPD. These factors may have long-term consequences for subsequent growth, neurodevelopment, and recurrence of related health problems.

Bronchopulmonary Dysplasia↗
PubMed1994

Use of perinatal and infant health services by Mexican-American Medicaid enrollees.

OBJECTIVES: Lack of health insurance and a regular source of medical care are barriers affecting use of health services by Mexican Americans. We studied perinatal and infant health service use by Mexican-American women and non-Hispanic white women and their infants enrolled in Arizona's Medicaid program and explored characteristics associated with use of health services. DESIGN: A descriptive comparative study that used data collected from office records, birth certificates, and household interviews. SETTING: Participants resided in the state's most populous county and were enrolled in the Arizona Health Care Cost Containment System, a health maintenance organization-oriented Medicaid demonstration project. SUBJECTS: Random sample of 308 Mexican-American mother-infant dyads and 312 non-Hispanic white mother-infant dyads. The women were enrolled before the sixth month of pregnancy and for 60 days post partum; their infants were continuously enrolled throughout their first year. OUTCOME MEASURES: Timing and number of prenatal visits and a modified Kessner Index, postpartum visits, number and purpose of office visits during the infants' first year, and immunizations received. RESULTS: Mexican Americans averaged fewer prenatal visits than non-Hispanic whites (8.6 vs 10.2 visits) and were less likely to have "adequate" care (41.1% vs 52.8%). Both groups of mothers are well below the 68% of women nationally who receive adequate prenatal care. Controlling for important socioeconomic status and cultural characteristics, ethnicity had a strong independent effect on the number of prenatal visits and adequacy of prenatal care. Mexican-American infants made fewer visits (8.2 vs 9.8) and completed fewer age-appropriate immunizations than non-Hispanic whites. CONCLUSIONS: Health insurance and a regular source of care are insufficient conditions for ensuring adequate use of maternal and child health services by Mexican-American Medicaid enrollees. Factors associated with their less frequent use of these preventive health services include higher numbers of children, transportation problems, and less assistance from their support system.

Acculturation↗
PubMed1994

Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program.

OBJECTIVE: To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years. DESIGN: Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (< or = 2000 g) and heavier (2001 to 2500 g). SETTING: Eight socioeconomically heterogeneous clinical sites. PARTICIPANTS: Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum. INTERVENTION: The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance. MAIN OUTCOME MEASURES: Cognitive development, behavioral competence, and health status. RESULTS: At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher; P = .03) and higher verbal IQ scores (4.2 points higher; P = .02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum. CONCLUSION: The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum.

Child Behavior↗
PubMed1988

AMRA's role in the 1988 National Maternal and Infant Health Survey.

The American Medical Record Association (AMRA) has worked closely with the National Center for Health Statistics (NCHS) in planning the 1988 National Maternal and Infant Health Survey (NMIHS). AMRA has endorsed the NMIHS and encourages the participation of hospital medical record departments.

Female↗
PubMed1997

Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey.

OBJECTIVES: This analysis uses nationally representative data from the 1988 National Maternal and Infant Health Survey to explore the factors, including employment, associated with breast-feeding initiation and duration. METHODS: Multiple logistic regression was used to model the determinants of breast-feeding initiation among 9087 US women. Multiple linear regression was used to model the duration of breast-feeding among women who breast-fed. RESULTS: Fifty-three percent of mothers initiated breast-feeding in 1988, and the decision to breast-feed was not associated with maternal employment. However, among breast-feeders, returning to work within a year of delivery was associated with a shorter duration of breast-feeding when other factors were controlled. Among employed mothers, the duration of maternity leave was positively associated with the duration of breast-feeding. CONCLUSIONS: The low rates of breast-feeding initiation in the United States are not attributable to maternal participation in the labor force. However, returning to work is associated with earlier weaning among women who breast-feed.

Adult↗
PubMed1993

Identifying at-risk children for early intervention services: lessons from the Infant Health and Development Program.

A U.S. law mandates early intervention services for infants and young children who have, or are at risk for, developmental problems. Participating states must develop definitions for identifying infants and young children at risk for developmental problems. To assess the sensitivity, specificity, and positive predictive value of some commonly identified risk factors, we examined the definitions proposed by five states. Data on risk factors and 36-month developmental outcomes were obtained from follow-up participants in the Infant Health and Development Program, a multisite, collaborative prospective intervention program involving 985 low birth weight preterm infants. Few individual risk factors proposed by these states were associated with poor developmental outcomes. Characteristics with positive predictive values greater than 30% were highly specific but tended to involve few cases. Risk factors with positive predictive values greater than 50%, such as hypothyroidism, occurred infrequently (< 6%) in this sample. When state definitions for at-risk children were examined in composite, each definition yielded a positive predictive value of 25% to 35%, with poor specificities ranging from 12% to 40%. These data on low birth weight infants have implications for the design and funding of population-based early intervention programs, and suggest that more careful clinical and longitudinal research is necessary before appropriate definitions can be promulgated for identifying children in need of early intervention services.

Child, Preschool↗
PubMedDate not supplied

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Child Health Services↗
PubMed2001

Iodine in human milk: perspectives for infant health.

Iodine is essential for normal growth, mental development, and survival of infants. The main source of iodine for breastfeeding infants is the iodine found in human milk. Despite the importance of iodine for infant health, there have been limited studies addressing human milk iodine concentrations. The newly recommended Adequate Intake of iodine for infants is 110 microg/day for infants 0-6 months and 130 microg/day for infants 7-12 months. Further studies of human milk iodine are needed to ensure that iodine prophylaxis is providing sufficient iodine for mothers and infants worldwide.

Diet↗
PubMedDate not supplied

The urban American Indian oversample in the 1988 National Maternal and Infant Health Survey.

Although more than two-thirds of American Indians and Alaska Natives (AI) live outside reservations and Tribal lands, few data sets describe social and maternal-child health risk factors among urban AI. The Indian Health Service sponsored a special effort to survey mothers of AI infants as part of the 1988 National Maternal and Infant Health Survey (NMIHS), a comprehensive national study conducted by the National Center for Health Statistics, Centers for Disease Control. The authors analyzed questionnaires completed by mothers residing in selected locations served by urban Indian health programs and compared the data with those for women of other races residing in metropolitan areas. After adjusting the sample for non participating States, the response rate in the Urban Indian Over sample was 60.8 percent (763 of 1,254). More than 45 percent of AI and black respondents, compared with 15 percent of white respondents, reported an annual household income of less than $10,000. About half of AI and black women, compared with nearly three-quarters of white women, reported having insurance or health maintenance organization coverage during pregnancy. Despite having a similarly low rate of health insurance coverage and low household income, AI respondents were far less likely than black respondents to have Medicaid coverage. A higher proportion of AI women than of black or white women reported difficulties in obtaining prenatal care, and AI women were less likely to obtain prenatal care. AI women were also less likely than white women to obtain prenatal care in the first trimester. Although a similar proportion of Al and white women reported that they consumed alcohol during the year before pregnancy, a higher proportion of Al drinkers than of white drinkers reported consuming one or more drinks weekly after finding out they were pregnant. The proportion of unwanted pregnancies was higher among Al women than among white women, but lower than among black women. Al and black women had a higher prevalence of depressive symptoms than did white women.The data suggest that urban Al mothers experience a disproportionate burden of economic, social, and behavioral risk factors for adverse pregnancy outcome.In spite of some data limitations, the Urban Indian Over sample of the NMIHS provides important information about social and health risk factors among urban Al mothers.

Adult↗
PubMed1998

Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia.

STUDY OBJECTIVES: The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period. DESIGN: A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42. SETTING: The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia. PARTICIPANTS: A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42. MAIN RESULTS: At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01). CONCLUSIONS: There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care.

Adolescent↗
PubMed1999

Assessing the effects of welfare reform policies on reproductive and infant health.

OBJECTIVES: The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. METHODS: The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. RESULTS: State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions. CONCLUSIONS: Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.

Family Planning Services↗
PubMedDate not supplied

Mothers' stress and close relationships: correlates with infant health status.

This descriptive follow-up study focuses on changes in maternal stress and close relationships over the infant's first year and explores the association of these maternal variables with infant health status. After initial interviews at 1 month, mothers of 43 infants completed a follow-up questionnaire when their infants were 13 months old. Women tended to select their husbands or mothers as their closest relations, and 9 women noted that their closest person at 13 months was a different person than at 1 month. Infant hospitalization, but not risk status or major illness in the infant, was significantly related to maternal stress and relationship change. The association among infant hospitalization, greater maternal stress, and less closeness in relationships support the importance of focusing on the whole family in the hospital setting.

Adult↗