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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
1 to 25 of 185 Research Studies DisplayedNeerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Sneed NM, Heerman WJ, Shaw PA
Associations between gestational weight gain, gestational diabetes, and childhood obesity incidence.
Excessive maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) have been linked to childhood obesity. This cohort study explored the association between maternal weight gain during pregnancy, GDM, and early childhood obesity. Findings revealed that excessive weight gain during the second and third trimesters increased the risk of childhood obesity by age 6. However, GDM was associated with a lower risk. No significant interaction between GWG and GDM was observed.
AHRQ-funded; HS026122.
Citation: Sneed NM, Heerman WJ, Shaw PA .
Associations between gestational weight gain, gestational diabetes, and childhood obesity incidence.
Matern Child Health J 2024 Feb; 28(2):372-81. doi: 10.1007/s10995-023-03853-8.
Keywords: Maternal Care, Women, Children/Adolescents, Obesity
Moniz MH, Stout MJ, Kolenic GE
Association of childbirth with medical debt.
The purpose of this study was to assess the relationship between childbirth and having medical debt in collections and explored variations by neighborhood socioeconomic status. The study found that among a statewide cohort (n=26,717) of commercially insured pregnant and postpartum adults, having medical debt in collections was more likely among postpartum individuals compared with pregnant individuals and those in lowest-income neighborhoods compared with all others. Postpartum adults in the lowest-income neighborhoods also had the greatest predicted probabilities of having medical debt in collections, followed by pregnant adults in the lowest-income neighborhoods, followed by all other postpartum and pregnant adults.
AHRQ-funded; HS025465; HS028672; HS027788.
Citation: Moniz MH, Stout MJ, Kolenic GE .
Association of childbirth with medical debt.
Obstet Gynecol 2024 Jan; 143(1):11-13. doi: 10.1097/aog.0000000000005381..
Keywords: Maternal Care, Women, Healthcare Costs
Cantor AG, Jungbauer RM, Skelly AC
Respectful maternity care : a systematic review.
The purpose of this systematic review was to collect information on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving pregnant and postpartum maternal and infant health outcomes, and strategies for implementation. Frameworks for RMC were found to be well described but varied in definition. Evidence was lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. Tools to measure RMC demonstrated consistency but lacked a gold standard; the authors conclude that further evaluation was needed before implementation in U.S. settings.
AHRQ-funded; 75Q80120D00006
Citation: Cantor AG, Jungbauer RM, Skelly AC .
Respectful maternity care : a systematic review.
Ann Intern Med 2024 Jan; 177(1):50-64. doi: 10.7326/m23-2676..
Keywords: Maternal Care, Women, Patient-Centered Outcomes Research, Evidence-Based Practice
Fingar KR, Weiss AJ, Roemer M
AHRQ Author: Roemer M, Reid LD
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
This AHRQ-authored paper examined the early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. They compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the HCUP across 43 states and the District of Columbia. Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93) and SMM (OR = 0.88) but increased odds of stillbirth (OR = 1.04). COVID-19 deliveries had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51) and Hispanic (OR = 5.09) pregnant women than for White non-Hispanic (OR = 3.28) women.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Fingar KR, Weiss AJ, Roemer M .
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
Birth 2023 Dec; 50(4):996-1008. doi: 10.1111/birt.12753..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Maternal Care, Women, Outcomes
Danilack VA, Siegel-Reamer L, Lum L
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
This study examined women’s expectations and experiences regarding labor induction. Labor induction patients were recruited in a US tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. From April to September 2018, 26 women were interviewed about expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. A wide range of experiences were described- with characterizations from horrible, frustrating, and terrifying to simple, fast and smooth. The Foley balloon catheter was the most polarizing induction method. Other concerns centered on the health of their baby, and an ideal induction involved fewer interventions.
AHRQ-funded; HS025013.
Citation: Danilack VA, Siegel-Reamer L, Lum L .
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
Birth 2023 Dec; 50(4):959-67. doi: 10.1111/birt.12750..
Keywords: Women, Maternal Care, Hospitals, Patient Experience
Dullabh P, Heaney-Huls KK, Chiao AB
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
This paper describes a pilot intervention of a smartphone app for postpartum monitoring of hypertensive disorders of pregnancy (HDP) that integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the pilot evaluation highlighted the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. Key observations of the implementation team included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls KK, Chiao AB .
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
JAMIA Open 2023 Dec; 6(4):ooad098. doi: 10.1093/jamiaopen/ooad098..
Keywords: Electronic Health Records (EHRs), Maternal Care, Blood Pressure, Telehealth, Health Information Technology (HIT), Women
Schulte A, Biggs MA
Association between facility and clinician characteristics and family planning services provided during U.S. outpatient care visits.
The purpose of this study was to characterize the provision of family planning services in outpatient care settings and evaluate variation by facility and clinician characteristics. The researchers utilized National Ambulatory Medical Care Survey data, to evaluate family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and if the patient was seen by their primary care provider. The sample used for analysis included 53,489 patient visits between 2011 and 2019 with reproductive-age (15-49 years) individuals. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas and at community health centers compared with private physician practices. Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity demonstrated broad variation in which clinicians offered family planning services.
AHRQ-funded; HS022241.
Citation: Schulte A, Biggs MA .
Association between facility and clinician characteristics and family planning services provided during U.S. outpatient care visits.
Womens Health Issues 2023 Nov-Dec; 33(6):573-81. doi: 10.1016/j.whi.2023.06.008..
Keywords: Ambulatory Care and Surgery, Maternal Care, Women, Sexual Health
DiMeo A, Karlage A, Schoenherr K
Cultural brokering in pregnancy care: a critical review.
This study is a literature review of cultural brokering during pregnancy. The authors identified 33 articles in their literature search. They found that cultural brokering is not clearly defined in the current literature. Only a few articles provided information about language concordance between cultural brokers and patients or clinicians, with no articles describing the impact of cultural brokering on health outcomes. Cultural broker facilitating was described as providing information about language concordance between cultural brokers and patients or clinicians. Barriers included misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. They propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system.
AHRQ-funded; HS026370.
Citation: DiMeo A, Karlage A, Schoenherr K .
Cultural brokering in pregnancy care: a critical review.
Int J Gynaecol Obstet 2023 Nov; 163(2):357-66. doi: 10.1002/ijgo.15063..
Keywords: Maternal Care, Women, Clinician-Patient Communication, Cultural Competence
Salinas KE, Bazan M, Rivera L
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
The purpose of this study was to explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers. The researchers conducted focus groups with patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center. A total of seven focus groups with 27 total participants were held. The study identified three key themes regarding preferences in patient experiences and communication when seeking pregnancy care: 1. language discordance and concordance between patients and clinicians exist on a spectrum and are not binary; 2. language-discordant care presents communication challenges, even when interpreters are present; and 3. language discordance can be effectively addressed with positive interpersonal engagements between clinicians and patients.
AHRQ-funded; HS026370.
Citation: Salinas KE, Bazan M, Rivera L .
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
Obstet Gynecol 2023 Nov 1; 142(5):1227-36. doi: 10.1097/aog.0000000000005369..
Keywords: Maternal Care, Women, Communication, Cultural Competence, Racial and Ethnic Minorities
Shields AD, Vidosh J, Thomson BA
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
The purpose of this study was to evaluate the knowledge, skills, and self-efficacy of health care participants completing a simulation-based blended learning training curriculum on managing maternal medical emergencies and maternal cardiac arrest. The study included a formative assessment of the Obstetric Life Support curriculum. The training consisted of self-guided pre-course work and an instructor-led simulation course using a customized low-fidelity simulator. Eighty-five participants consented to participation in the training (out of 88 invited); 77 participants completed the training over eight sessions. The study found that at baseline, less than 50% of participants were able to achieve a passing score on the cognitive assessment. After the course, mean cognitive assessment scores improved by 13 points, from 69.4% at baseline to 82.4% after the course. The researchers observed significant improvements in participant self-efficacy, and 92.6% of participants agreed or strongly agreed that the course met its educational objectives.
AHRQ-funded; HS026169.
Citation: Shields AD, Vidosh J, Thomson BA .
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
Obstet Gynecol 2023 Nov 1; 142(5):1189-98. doi: 10.1097/aog.0000000000005349..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Maternal Care, Simulation, Training, Education: Continuing Medical Education, Women
Vear KR, Esbrook E, Padley E
"Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care.
This study’s objective was to understand what support adolescents and young adults need to access abortion amidst the changing legal landscape. A diverse nationwide sample of individuals aged 14-24 responded to a text message survey in July 2022 about the social and logistical support they would need for safe abortion access. Out of the sample of 638, there was a 78% response rate. Primary sources of social support from parents and friends were named by the respondents for potential abortion decisions. The respondents frequently cited money and transportation as logistical support needs for out-of-state abortion care.
AHRQ-funded; HS026369.
Citation: Vear KR, Esbrook E, Padley E .
"Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care.
Contraception 2023 Oct; 126:110128. doi: 10.1016/j.contraception.2023.110128..
Keywords: Children/Adolescents, Young Adults, Maternal Care, Patient Safety, Access to Care
Beck D, Hall S, Costa DK
Leveraging population health datasets to advance maternal health research.
Researchers reviewed a sample of population health datasets and highlighted recommended changes to the datasets to identify existing gaps in maternal health research and help address maternal morbidity and mortality. Their findings showed insufficient representation of pregnant and postpartum individuals across all datasets. They recommended that pregnant and postpartum individuals should be oversampled in population health data to facilitate rapid policy and program evaluation and that individuals with pregnancies resulting in outcomes other than livebirth be included or asked about their experiences.
AHRQ-funded; HS027640.
Citation: Beck D, Hall S, Costa DK .
Leveraging population health datasets to advance maternal health research.
Matern Child Health J 2023 Oct; 27(10):1683-88. doi: 10.1007/s10995-023-03695-4..
Keywords: Maternal Care, Women, Social Determinants of Health
Truong S, Foley OW, Fallah P
Transcending language barriers in obstetrics and gynecology: a critical dimension for health equity.
This article discusses the issue of language barriers in obstetrics and gynecology. The authors present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. Drivers of language-related inequities at the clinician, health system, and societal level are explored in the proposed framework. They end with actionable recommendations for enhancing equitable care for patients experiencing language barriers.
AHRQ-funded; HS026370.
Citation: Truong S, Foley OW, Fallah P .
Transcending language barriers in obstetrics and gynecology: a critical dimension for health equity.
Obstet Gynecol 2023 Oct 1; 142(4):809-17. doi: 10.1097/aog.0000000000005334..
Keywords: Cultural Competence, Women, Maternal Care, Disparities
Henderson JT, Webber EM, Thomas RG
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy with the purpose of informing the U.S. Preventive Services Task Force. The main outcome was Morbidity or mortality, with measures of health-related quality of life. The review included 6 fair-quality studies comparing changes in prenatal screening practices with routine screening at in-person office visits (usual care). This systematic review did not find evidence that any alternate screening strategies for hypertensive disorders of pregnancy had increased effectiveness over routine blood pressure measurement at in-person prenatal visits. No harms of the different screening strategies were identified.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Thomas RG .
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Sep 19; 330(11):1083-91. doi: 10.1001/jama.2023.4934..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Prevention, Evidence-Based Practice, Guidelines, Maternal Care, Women
Akintunde T, Howard J, Wilson D
Racial and ethnic disparities in long-term contraception use among the birthing population at an academic hospital in the Southeastern United States.
This paper discusses racial and ethnic disparities in long-term contraception among the birthing population at an academic hospital in the Southeastern US. The authors used data from 5011 patients who delivered at a large academic hospital to determine the effect of race/ethnicity and social vulnerability index (SVI) on the odds of undergoing a long-term contraceptive procedure. SVI substantially affects the odds of long-term contraception for non-Hispanic White women and birthing people. In contrast, Hispanic and non-Hispanic Black women and birthing people have significantly higher odds of undergoing a long-term contraceptive procedure. These disparities may be attributed to factors including healthcare providers, organizational and external policies.
AHRQ-funded; HS027680.
Citation: Akintunde T, Howard J, Wilson D .
Racial and ethnic disparities in long-term contraception use among the birthing population at an academic hospital in the Southeastern United States.
Proc Hum Factors Ergon Soc Annu Meet 2023 Sep; 67(1):609-13. doi: 10.1177/21695067231192873..
Keywords: Racial and Ethnic Minorities, Disparities, Maternal Care, Women
Saldanha IJ, Adam GP, Kanaan G
Delivery strategies for postpartum care: a systematic review and meta-analysis.
This systematic review examined the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. The authors searched medical databases from inception to November 16, 2022. They found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). The review found that for general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (moderate strength of evidence). Low strength of evidence was found for location of breastfeeding affecting hospitalization, other unplanned care utilization, or mental health symptoms. Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months but not exclusive breastfeeding (all moderate strength of evidence). Moderate strength of evidence was found for the association of use and nonuse of information technology for breastfeeding care with comparable rates of breastfeeding. Moderate strength of evidence was found for the association of testing reminders for screening or preventive care and greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing.
AHRQ-funded; 75Q80120D00001; 75Q80121F32007.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Delivery strategies for postpartum care: a systematic review and meta-analysis.
Obstet Gynecol 2023 Sep 1; 142(3):529-42. doi: 10.1097/aog.0000000000005293..
Keywords: Maternal Care, Women, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Outcomes Research
MacDougall H, Hanson S, Interrante JD
Rural-urban differences in health care unaffordability during the postpartum period.
The purpose of this cross-sectional study was to explore health care unaffordability for rural and urban residents and by postpartum status. The study found that postpartum people reported statistically significantly higher rates of inability to pay medical bills when compared with non-postpartum people. Rural residents also reported higher rates of inability to pay their medical bills and having problems paying medical bills as compared with urban residents. In adjusted models, the predicted probability of being unable to pay medical bills among postpartum respondents was 12.8%, which was higher than among non-postpartum respondents. Similarly, postpartum respondents had higher predicted probabilities of reporting problems paying medical bills (18.4%) than compared with non-postpartum respondents. IN adjusted models, residency in a rural area was not significantly related with the health care unaffordability outcome measures.
AHRQ-funded; HS000011.
Citation: MacDougall H, Hanson S, Interrante JD .
Rural-urban differences in health care unaffordability during the postpartum period.
Med Care 2023 Sep; 61(9):595-600. doi: 10.1097/mlr.0000000000001888..
Keywords: Rural Health, Urban Health, Rural/Inner-City Residents, Maternal Care, Healthcare Costs, Women, Access to Care
Putnam KE, Biel FM, Hoopes M
Landscape of pregnancy care in US community health centers.
This retrospective cohort study utilized EHR data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) to describe clinic and patient characteristics associated with longitudinal prenatal care delivery in community health centers (CHCs). Results showed that 41% of CHCs provided longitudinal prenatal care, and these CHCs were more likely to be larger, have multidisciplinary teams, and serve higher proportions of nonwhite or non-English speaking patients. Patients who received longitudinal prenatal care at CHCs were racially and ethnically diverse and many had comorbidities. The authors concluded that CHCs provided critical access to care for vulnerable populations and will be important in addressing inequities in maternal morbidity and mortality.
AHRQ-funded; HS025155.
Citation: Putnam KE, Biel FM, Hoopes M .
Landscape of pregnancy care in US community health centers.
J Am Board Fam Med 2023 Aug 9; 36(4):574-82. doi: 10.3122/jabfm.2023.230025R1..
Keywords: Maternal Care, Community-Based Practice, Women, Access to Care
Viswanathan M, Urrutia RP, Hudson KN
Folic acid supplementation to prevent neural tube defects: updated evidence report and systematic review for the US Preventive Services Task Force.
The objective of this evidence review was to evaluate new evidence on the benefits and harms of folic acid supplementation for the prevention of neural tube defects to inform the US Preventive Services Task Force. New evidence from observational studies provided evidence of the benefit of folic acid supplementation and no evidence of harms related to multiple gestation, autism, or maternal cancer. The new evidence was consistent with previously reviewed evidence on benefits and harms.
AHRQ-funded; 75Q80120D00007.
Citation: Viswanathan M, Urrutia RP, Hudson KN .
Folic acid supplementation to prevent neural tube defects: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Aug 1; 330(5):460-66. doi: 10.1001/jama.2023.9864..
Keywords: U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Newborns/Infants, Maternal Care, Women
Steele DW, Adam GP, Saldanha IJ
Postpartum home blood pressure monitoring: a systematic review.
This systematic review’s objective was to assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP-monitoring regimens. The authors included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, they extracted demographics and outcomes to SRDR+. Thirteen studies (3 RCTs, 2 nonrandomized comparative studies, and 8 single-arm studies) met eligibility criteria. Home BP monitoring was not associated with the rate of BP treatment initiation but was associated with reduced unplanned hypertension-related hospital admissions. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. Most patients (ranging from 83.3% to 87.0%) were satisfied with management related to home BP monitoring.
AHRQ-funded; 75Q80120D00001; 75Q80121F32006.
Citation: Steele DW, Adam GP, Saldanha IJ .
Postpartum home blood pressure monitoring: a systematic review.
Obstet Gynecol 2023 Aug 1; 142(2):285-95. doi: 10.1097/aog.0000000000005270..
Keywords: Maternal Care, Blood Pressure, Women, Evidence-Based Practice, Patient-Centered Outcomes Research
Klawetter S, Weikel B, Roybal K
Social determinants of health and parenting self-efficacy among mothers of preterm infants.
The purpose of this prospective cohort study was to utilize a social determinants of health (SDoH) framework to examine the associations between social and environmental factors and parenting self-efficacy (PSE) in mothers of preterm infants hospitalized in neonatal intensive care units (NICUs). The study found that the multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant. Significant predictors of PSE were race/ethnicity, having another child/children, and depression.
AHRQ-funded; HS026370.
Citation: Klawetter S, Weikel B, Roybal K .
Social determinants of health and parenting self-efficacy among mothers of preterm infants.
J Soc Social Work Res 2023 Summer; 14(2):411-29. doi: 10.1086/716303..
Keywords: Social Determinants of Health, Newborns/Infants, Maternal Care, Intensive Care Unit (ICU)
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
AHRQ-funded; HS024733.
Citation: Smith DC, Phillippi JC, Tilden EL .
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Bossick AS, Painter I, Williams EC
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
This study investigated whether greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. It was hypothesized that greater reproductive autonomy would lower the risks of poor maternal and neonatal outcomes. The authors developed a composite index to quantify state legislation, which was used to examine the association with maternal and neonatal outcomes. A Delphi panel was used to inform index development, and restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data was used to conduct a cross-sectional study of all live births in the 50 US states for people ages 15 to 44 from 2016 to 2018 to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. There were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM from 2016 to 2018. The Delphi panel found a summed state measure of 106 laws in 8 categories that could affect reproductive anatomy. In adjusted analyses, states in the most enabling reproductive autonomy quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile.
AHRQ-funded; HS013853.
Citation: Bossick AS, Painter I, Williams EC .
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
Womens Health Issues 2023 Jul-Aug; 33(4):359-66. doi: 10.1016/j.whi.2023.03.008..
Keywords: Maternal Care, Sexual Health, Women, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research
Eliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance