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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 185 Research Studies DisplayedBalk EM, Danilack VA, Bhuma MR
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
This systematic review’s objective was to assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found five randomized controlled trials and five nonrandomized comparative studies that compared reduced routine antenatal visit schedules with traditional schedules. The studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was also insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Bhuma MR .
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):8-18. doi: 10.1097/aog.0000000000005193..
Keywords: Maternal Care, Newborns/Infants, Women, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Evidence-Based Practice
Stierman EK, O'Brien BT, Stagg J
AHRQ Author: Fabiyi CA, Chew E, Harding B, Mistry KB
Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas.
The objective of this study was to describe perinatal quality improvement activities, specifically the implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units. Researchers conducted a survey of AIM-enrolled hospitals in Oklahoma and Texas and gathered data on obstetric unit organization and QI processes. Their findings showed that adoption of QI processes varied and also highlighted the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units. The researchers concluded that this has implications for implementing future perinatal QI initiatives.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Stierman EK, O'Brien BT, Stagg J .
Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas.
Qual Manag Health Care 2023 Jul-Sep; 32(3):177-88. doi: 10.1097/qmh.0000000000000407..
Keywords: Quality Improvement, Teams, Communication, Maternal Care, Quality of Care
Balk EM, Danilack VA, Cao W
Televisits compared with in-person visits for routine antenatal care: a systematic review.
This systematic review’s objective was to compare benefits and harms of televisits and in-person visits in people receiving routine antenatal visit care. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found two randomized controlled trials, four nonrandomized comparative studies, and one survey that compared visit types between 2004 and 2020, three of which were conducted during the COVID-19 pandemic. The studies found low-strength evidence that hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn or preterm births. However, the COVID-19 pandemic confounded the association between the use of hybrid visits and preterm birth. The authors also found there is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Cao W .
Televisits compared with in-person visits for routine antenatal care: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):19-29. doi: 10.1097/aog.0000000000005194..
Keywords: Telehealth, Health Information Technology (HIT), Maternal Care, Women
Blebu BE, Liu PY, Harrington M
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
The purpose of this mixed methods design study was to integrate the perspectives of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership developed for the purpose of addressing social and structural determinants in pregnancy. The researchers utilized in-depth interviews and social network analysis to incorporate the perspectives of healthcare clinicians and staff with the views of community-based partner organizations to identify implementation factors related to cross-sector partnerships. The study identified 7 implementation variables related to 3 themes: strengths of a network approach to cross-sector collaboration, relationship-centered care, and barriers and facilitators of cross-sector partnerships. The study results highlighted establishing relationships between healthcare staff, patients, and community-based partner organizations.
AHRQ-funded; HS026407.
Citation: Blebu BE, Liu PY, Harrington M .
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
Front Public Health 2023 Jun 16; 11:1106740. doi: 10.3389/fpubh.2023.1106740..
Keywords: Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Maternal Care, Women, Implementation
Stroumsa D, Moniz MH, Crissman H
Pregnancy outcomes in a US cohort of transgender people.
This letter summarized a study which assessed severe parental morbidity, cesarean deliveries, and preterm births among trans people compared with cisgender people. Data on deliveries was taken the Truven MarketScan Medicaid and commercial databases separately. Results indicated that trans individuals had similar rates of severe parental morbidity as cisgender people. Rates of cesarean delivery were significantly lower among trans people. No significant difference were found in preterm birth rates.
AHRQ-funded; HS025465.
Citation: Stroumsa D, Moniz MH, Crissman H .
Pregnancy outcomes in a US cohort of transgender people.
JAMA 2023 Jun 6; 329(21):1879-81. doi: 10.1001/jama.2023.7688..
Keywords: Maternal Care, Outcomes
Venkatesh KK, Grobman WA, Wu J
Association of a large-for-gestational-age infant and maternal prediabetes mellitus and diabetes mellitus 10 to 14 years after delivery in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study.
Hypothesizing that having a large-for-gestational-age (LGA) infant even without gestational diabetes mellitus (GDM) may be a precursor to postpartum dysglycemia, researchers estimated the association of having had an LGA infant with developing maternal prediabetes mellitus and type 2 diabetes mellitus after delivery among individuals without GDM. They conducted a secondary analysis of the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS). Their findings suggested that having an LGA infant was associated with a higher risk of prediabetes mellitus or diabetes mellitus by 10 to 14 years
after delivery.
after delivery.
AHRQ-funded; HS028822.
Citation: Venkatesh KK, Grobman WA, Wu J .
Association of a large-for-gestational-age infant and maternal prediabetes mellitus and diabetes mellitus 10 to 14 years after delivery in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study.
Am J Obstet Gynecol 2023 Jun; 228(6):756-58.e3. doi: 10.1016/j.ajog.2023.02.017..
Keywords: Newborns/Infants, Maternal Care, Women, Diabetes
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
McGowan M, D'Amico M, Kang M
A survey of patient-centered practices in perinatal quality collaboratives.
This research brief shows the results of a web-based survey of US perinatal quality collaborative (PQC) leaders to explore patient-centered practices for quality improvement (QI) initiatives. The survey consisted of multiple-choice questions including procedures for soliciting community input through community advisory boards, (CABs), social media, surveys, and town halls and measures to capture individual patient experiences, including patient-reported outcomes (PROs) and patient-reported experience measures (PREMs). Over one third (35%) of the 40 PQCs responded with over half reporting an active CAB, with the most common participants including community members. CAB recruitment was most often performed by existing PQC members or leaders. Only half of CABs offered their members compensation. Four organizations used no patient-centered strategies, and only two collected PREMs. In total 12 out of 14 respondents provided at least one free survey response. The respondents highlighted how patient engagement is a powerful tool for shaping diverse aspects of PQCs, from “birth equity” to “how to engage community and patients.”
AHRQ-funded; HS025465.
Citation: McGowan M, D'Amico M, Kang M .
A survey of patient-centered practices in perinatal quality collaboratives.
Int J Gynaecol Obstet 2023 May; 161(2):670-71. doi: 10.1002/ijgo.14636..
Keywords: Patient-Centered Healthcare, Maternal Care, Quality of Care
Field C, Lynch CD, Fareed N
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
The role of community walkability in influencing glycemic regulation in expectant individuals with pre-existing diabetes is yet to be established. The purpose of this study was to explore the relationship between the walkability of a neighborhood at the community level and glycemic control, as indicated by hemoglobin A1c (A1C), in pregnant individuals with pregestational diabetes. The researchers conducted a retrospective examination of expectant individuals with pregestational diabetes who participated in a combined prenatal and diabetic care program from 2012 to 2016. The determinant of interest was community walkability, determined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which includes intersection concentration (design), closeness to transit stops (distance), and a combination of job and household varieties (diversity). Participants from the most walkable neighborhoods were contrasted with those from less walkable neighborhoods as per the National Environmental Protection Agency's definition. The outcomes were glycemic control, including A1C, measured both in early and late pregnancy, and the average change in A1C throughout pregnancy. The study found that out of 417 expectant individuals, 10% resided in the most walkable areas. All 417 participants had an A1C assessment in early pregnancy, and 376 had another A1C assessment in late pregnancy. Pregnant individuals living in the most walkable areas were more likely to have an A1C <6.0% in early pregnancy, and an A1C <6.5% in late pregnancy compared with those in less walkable areas. The change in A1C across pregnancy was not related to walkability. The study concluded that individuals with pre-existing diabetes residing in more walkable areas demonstrated better glycemic control during both early and late pregnancy.
AHRQ-funded; HS028822.
Citation: Field C, Lynch CD, Fareed N .
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
Am J Obstet Gynecol MFM 2023 May; 5(5):100898. doi: 10.1016/j.ajogmf.2023.100898..
Keywords: Diabetes, Maternal Care, Social Determinants of Health, Women
Simpson KR, Spetz J, Gay CL
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
The objective of this study was to estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Registered nurses were enrolled in a cross-sectional survey; hospital characteristics were obtained from the 2018 American Hospital Association Annual Survey. The findings indicated that, overall, nurses reported strong adherence to staffing guidelines within their hospitals. Higher birth volume, teaching status, higher percentage of Medicaid-paid births, and presence of a neonatal intensive care unit were all associated with lower mean adherence scores.
AHRQ-funded; HS025715.
Citation: Simpson KR, Spetz J, Gay CL .
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
Nurs Outlook 2023 May; 71(3):101960. doi: 10.1016/j.outlook.2023.101960..
Keywords: Hospitals, Maternal Care, Provider: Nurse, Workforce, Vulnerable Populations
Quinlan TAG, Lindrooth RC, Guiahi M
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
In addition to providing a global payment for maternity care, an increasing number of state Medicaid programs pay for immediate postpartum long-acting reversible contraception (LARC). The purpose of this study was to examine postpartum LARC utilization by race and ethnicity and overall among respondents with Medicaid-paid births during 2012-2018 in eight states that implemented immediate postpartum LARC payment and eight states without immediate postpartum LARC payment. The study found that the policy resulted in a 2.1-percentage-point increase in postpartum LARC use overall. Further analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. The researchers concluded that additional research is required to determine whether the increase was related with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices utilize a patient-centered approach that reinforces reproductive autonomy and equity.
AHRQ-funded; HS028762.
Citation: Quinlan TAG, Lindrooth RC, Guiahi M .
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
Health Aff 2023 May; 42(5):665-73. doi: 10.1377/hlthaff.2022.01178..
Keywords: Medicaid, Maternal Care, Women, Access to Care, Policy
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Zhong J, Simpson KR, Spetz J
Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRNs Survey.
The objective of this study was to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. Nurse respondents were recruited via email distribution of an electronic survey; hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. The results suggested that improving safety climate through means such as better teamwork and communication may improve nursing care quality during labor and birth through decreasing missed nursing care. Strategies to reduce missed care may also conversely improve the safety climate.
AHRQ-funded; HS025715.
Citation: Zhong J, Simpson KR, Spetz J .
Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRNs Survey.
J Patient Saf 2023 Apr 1;19(3):166-72. doi: 10.1097/pts.0000000000001106.
Keywords: Maternal Care, Pregnancy, Labor and Delivery, Nursing, Patient Safety, Provider: Nurse
Lucchini M, Rayport Y, Valeri L
Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study.
This study’s aim was to assess the prevalence and severity of sleep-disordered breathing (SDB) across racial/ethnic groups in 3702 pregnant people at 6 to 15 and 22 to 31 weeks gestational age; examine whether BMI modifies the association between race/ethnicity and SDB; and investigate whether interventions to reduce weight might reduce racial/ethnic disparities in SDB. The study cohort consisted of comprised 61.2% non-Hispanic White (nHW), 11.9% non-Hispanic Black (nHB), 18.5% Hispanic, and 3.7% Asian persons. SDB prevalence was higher for nHB compared with nHW pregnant people at 6 to 15 weeks, whereas at 21 to 32 weeks, Asian pregnant people had a higher SDB prevalence than nHW. The severity of SDB differed across racial/ethnic groups in early pregnancy, with nHB pregnant people having a higher apnea-hypopnea index (AHI) compared with nHW. Having overweight/obesity was associated with a higher AHI.
AHRQ-funded; HS024274.
Citation: Lucchini M, Rayport Y, Valeri L .
Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study.
Obesity 2023 Apr;31(4):923-33. doi: 10.1002/oby.23697.
Keywords: Racial and Ethnic Minorities, Sleep Problems, Women, Maternal Care
de Assis V, Shields AD, Johansson A
Resuscitation of traumatic maternal cardiac arrest: a case report and summary of recommendations from Obstetric Life Support.
The authors in this report highlight critical techniques in the resuscitation of reproductive-age women with traumatic cardiac arrest using recommendations from Obstetric Life Support™ (OBLS™). In this report they examined a case of a morbidly obese female presenting to the Emergency Department (ED) with ongoing CPR and massive hemorrhage from two gunshot wounds to the chest. The report summarizes critical techniques addressing Maternal Cardiac Arrest recommended in OBLS™ courses. Including 1) expanding the FAST exam to assess for pregnancy status, 2) estimating gestational age by fundal height or point-of-care ultrasound, 3) performing a RCD via midline vertical incision at 4 min if pregnancy is suspected to be ≥20 weeks' gestation (fundal height at or above the umbilicus, femoral length of ≥30 mm or biparietal diameter of ≥45 mm), and 4) execution of ECPR for refractory cardiac arrest.
AHRQ-funded; HS026169.
Citation: de Assis V, Shields AD, Johansson A .
Resuscitation of traumatic maternal cardiac arrest: a case report and summary of recommendations from Obstetric Life Support.
Trauma Case Rep 2023 Apr; 44:100800. doi: 10.1016/j.tcr.2023.100800..
Keywords: Maternal Care, Cardiovascular Conditions, Women, Guidelines
Garrett SB, Walia A, Miller F
Antibias efforts in United States maternity care: a scoping review of the publicly funded health equity intervention pipeline.
Clin Obstet Gynecol 2023 Mar 1; 66(1):110-23. doi: 10.1097/grf.0000000000000761.
AHRQ-funded; HS022241.
Citation: Garrett SB, Walia A, Miller F .
Antibias efforts in United States maternity care: a scoping review of the publicly funded health equity intervention pipeline.
Clin Obstet Gynecol 2023 Mar 1; 66(1):110-23. doi: 10.1097/grf.0000000000000761..
Keywords: Maternal Care, Women, Training, Evidence-Based Practice
Kozhimannil KB, Lewis VA, Interrante JD
Screening for and experiences of intimate partner violence in the United States before, during, and after pregnancy, 2016-2019.
The objective of this study was to measure rates of intimate partner violence (IPV) screening during the perinatal period among people experiencing physical violence in the US. Data from the Pregnancy Risk Assessment Monitoring System was used to describe the incidence of physical IPV before or during pregnancy. The results indicated that nearly half of those reporting physical IPV were not screened before or after pregnancy. The authors concluded that public health efforts to improve maternal health must address universal screening for IPV as well as access to care.
AHRQ-funded; HS027640.
Citation: Kozhimannil KB, Lewis VA, Interrante JD .
Screening for and experiences of intimate partner violence in the United States before, during, and after pregnancy, 2016-2019.
Am J Public Health 2023 Mar; 113(3):297-305. doi: 10.2105/ajph.2022.307195..
Keywords: Screening, Domestic Violence, Pregnancy, Women, Maternal Care
Steenland MW, Trivedi AN
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
This study examined the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum. This cohort study used data comparing persons with Medicaid and commercially financed childbirth using Arkansas' All-Payer Claims Database (2013-2016). A total of 60,990 births were included, with 72% of births paid for by Medicaid and 28% paid by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point increase in the likelihood, or a relative change of 110%, in this outcome. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points and the number of days with antidepressant supply in the later postpartum period by 14.1 days.
AHRQ-funded; HS027464.
Citation: Steenland MW, Trivedi AN .
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
JAMA Health Forum 2023 Feb; 4(2):e225603. doi: 10.1001/jamahealthforum.2022.5603..
Keywords: Depression, Behavioral Health, Medicaid, Maternal Care, Women, Access to Care
Konnyu KJ, Danilack VA, Adam GP
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
This study systematically reviewed patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care. This review is a subset of a larger review on both the qualitative experiences and quantitative benefits and harms of reduced prenatal care visit schedules and televisits for routine prenatal care that was produced by the Brown Evidence-based Practice Center for AHRQ. The authors synthesized barriers and facilitators to the implementation of reduced care visits or of televisits into 1 of 14 domains defined by the Theoretical Domains Framework (TDF) and a Best Fit Framework approach and summarized themes within TDF domains. They assessed their confidence in the summary statements using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) tool. They found four studies that addressed the number of scheduled routine prenatal visits, and five studies that addressed televisits. These studies found that health care professionals believed fewer routine visits may be more convenient for patients and may increase clinic capacity to provide additional care for patients with high-risk pregnancies. But both patients and clinicians had concerns about potential lesser care with fewer visits, including concerns about quality of care and challenges with implementing new delivery-of-care models.
AHRQ-funded; 290201500002I.
Citation: Konnyu KJ, Danilack VA, Adam GP .
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
Obstet Gynecol 2023 Feb;141(2):299-323. doi: 10.1097/aog.0000000000005046.
Keywords: Maternal Care, Pregnancy, Women, Telehealth, Health Information Technology (HIT)
Egan KA, Lo BK, Haneuse S
Associations of maternal consumption of sugary beverages in pregnancy with infant weight status.
Researchers studied mother-infant dyads from a prospective cohort study in order to examine links between maternal consumption of 100% juice and sugar-sweetened beverages in the third trimester of pregnancy with infant weight status at 6 and 12 months. 100% juice consumption was found to be associated with higher infant weight-for-length at 6 months and higher odds of rapid infant weight gain from birth to 6 months and birth to 12 months. 100% juice consumption was not associated with weight-for-length at 12 months and sugar-sweetened beverage consumption was not associated with any of the outcome measures.
AHRQ-funded; HS022242.
Citation: Egan KA, Lo BK, Haneuse S .
Associations of maternal consumption of sugary beverages in pregnancy with infant weight status.
Acad Pediatr 2023 Jan-Feb; 23(1):109-16. doi: 10.1016/j.acap.2022.05.007..
Keywords: Pregnancy, Nutrition, Newborns/Infants, Maternal Care, Women
Steenland MW, Wherry LR
Medicaid expansion led to reductions in postpartum hospitalizations.
The purpose of this study was to assess whether the Medicaid expansions of the Affordable Care Act (ACA) affected rates of postpartum hospitalization. The researchers compared states that did and did not expand Medicaid under the ACA as they related to changes in hospitalizations among birthing people with a Medicaid-financed delivery. The study found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions, and evidence of a lesser decrease in hospitalizations between 61 days and 6 months postpartum. The researchers concluded that Medicaid coverage expansion under the ACA resulted in improved postpartum health for low-income birthing people.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wherry LR .
Medicaid expansion led to reductions in postpartum hospitalizations.
Health Aff 2023 Jan; 42(1):18-25. doi: 10.1377/hlthaff.2022.00819..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Hospitalization, Maternal Care, Women, Health Insurance, Access to Care
Auty SG, Daw JR, Wallace J
State-level variation in supplemental maternity kick payments in Medicaid managed care.
The purpose of the cross-sectional study described in this research letter was to assesses the prevalence and magnitude of state-level delivery event–triggered kick payments to Medicaid managed care (MMC) plans for covering pregnant patients and the association of such payments with delivery costs. MMC kick payment rates were compared with average state Medicaid fee-for-service (FFS) payments for delivery hospitalizations and state kick payment rates compared with the Medicaid-Medicare fee index. The authors found “substantial and potentially unwarranted” state variation in delivery kick payment rates within MMC. They noted that if kick payment rates are set too low, plans may attempt to avoid pregnant enrollees by limiting coverage of certain services or restricting maternity care clinicians in their networks, with consequences for Black and Indigenous maternity patients.
AHRQ-funded; HS028754.
Citation: Auty SG, Daw JR, Wallace J .
State-level variation in supplemental maternity kick payments in Medicaid managed care.
JAMA Intern Med 2023 Jan; 183(1):80-82. doi: 10.1001/jamainternmed.2022.5146..
Keywords: Care Management, Health Insurance, Access to Care, Payment, Maternal Care
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
Jensen JL, Sweeney A, Gill C
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
This study evaluated patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services. This mixed-methods study included a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members, and semistructured interviews at a tertiary academic medical center in the southeastern United States. The chart review included examination of patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Access to an interpreter or clinician certified in medical Spanish was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported on long and unpredictable wait times to access interpreters. Temporary solutions included relying on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. These deviations from national standards may put postpartum families at risk for harm.
AHRQ-funded; HS027260.
Citation: Jensen JL, Sweeney A, Gill C .
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
Nurs Womens Health 2022 Dec;26(6):429-38. doi: 10.1016/j.nwh.2022.09.002.
Keywords: Maternal Care, Cultural Competence, Clinician-Patient Communication, Communication
Eliason EL, Daw JR
Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.
The purpose of this study was to evaluate the relationship between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access. The researchers utilized 2012-2019 National Center for Health Statistics natality files of all live births in adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming, with outcomes of first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care. The study found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with an increase in first-trimester prenatal care, driven by earlier month of first prenatal care visit. The researchers concluded that in individuals with lower education, presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care.
AHRQ-funded; HS000011.
Citation: Eliason EL, Daw JR .
Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.
Health Serv Res 2022 Dec;57(6):1288-94. doi: 10.1111/1475-6773.14035..
Keywords: Pregnancy, Maternal Care, Access to Care, Medicaid, Women