The purpose of this study is to examine the association of child mental health conditions and parent mental health status. This study used data from the 2007 National Survey of Children's Health on 80,982 children ages 2-17. The presence of a child mental health condition was defined as a parent-reported diagnosis of at least one of seven child mental health conditions. Parent mental health was assessed via a 5-point scale. Logistic regression was used to assess the association of child mental health conditions and parent mental health status, while examining socioeconomic, parent, family, and community factors as potential effect modifiers and confounders of the association. 11.1% of children had a mental health condition (95% CI = 10.5-11.6). The prevalence of child mental health conditions increased as parent mental health status worsened. Race/ethnicity was the only significant effect modifier of the child-parent mental health association. After adjustment for confounders, the stratum-specific adjusted odds ratios (95% CI) of child mental health conditions related to a one-level decline in parent mental health were: 1.44 (1.35-1.55) for non-Hispanic whites, 1.24 (1.06-1.46) for non-Hispanic blacks, 1.04 (0.81-1.32) for Hispanics from non-immigrant families, 1.21 (0.96-1.93) for Hispanics from immigrant families, and 1.43 (1.21-1.70) for non-Hispanic other race children. The effect of parent mental health status on child mental health conditions was significant only among non-Hispanic children. Parent-focused interventions to prevent or improve child mental health conditions may be best targeted to the sub-populations for whom parent and child mental health are most strongly associated.

Perinatal regionalization, or risk-appropriate care, is an approach that classifies facilities based on capabilities to ensure women and infants receive care at a facility that aligns with their risk. The CDC designed the Levels of Care Assessment Tool (LOCATe) to assist jurisdictions working in risk-appropriate care in assessing a facility’s level of maternal and neonatal care aligned with the most current American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) and American Academy of Pediatrics (AAP) guidelines. LOCATe produces standardized assessments for each hospital that participates and facilitates conversations among stakeholders in risk-appropriate care. This article describes how public health departments implement and use LOCATe in their jurisdictions.

Objectives We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory‐confirmed SARS‐CoV‐2 infection by trimester of infection. Study Design We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes included live birth and pregnancy loss (<20 weeks and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age, birth defects, and neonatal intensive care unit admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for demographics. Results Of 35,200 people included in this analysis, 50.8% of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%; aPR 1.44 95% CI: 1.35–1.54). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. Conclusions There were no signals for increased birth defects among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS‐CoV‐2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0–10.2%), particularly among people with third trimester infection. Consequences of COVID‐19 during pregnancy support recommended COVID‐19 prevention strategies, including vaccination.

IMPORTANCEReducing neonatal mortality is a national health care priority. Understanding the association between neonatal mortality and antenatal transfer of pregnant women to a level III perinatal hospital for delivery of infants who are very preterm (VPT) may help identify opportunities for improvement.OBJECTIVE To assess whether antenatal transfer to a level III hospital is associated with neonatal mortality in infants who are VPT. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study included infants who were born VPT to Illinois residents in Illinois perinatal-network hospitals between January 1, 2015, and December 31, 2016, and followed up for 28 days after birth. Data analysis was conducted from June 2017 to September 2018.EXPOSURES Delivery of an infant who was VPT at a (1) level III hospital after maternal presentation at that hospital (reference group), (2) a level III hospital after antenatal (in utero) transfer from another hospital, or (3) a non-level III hospital. MAIN OUTCOMES AND MEASURES Neonatal mortality. RESULTSThe study included 4817 infants who were VPT (gestational age, 22-31 completed weeks) and were born to Illinois residents in 2015 and 2016. Of those, 3302 infants (68.5%) were born at a level III hospital after maternal presentation at that hospital, 677 (14.1%) were born at a level III hospital after antenatal transfer, and 838 (17.4%) were born at a non-level III hospital. Neonatal mortality for all infants who were VPT included in this study was 573 of 4817 infants (11.9%). The neonatal mortality was 10.7% for the reference group (362 of 3302 infants), 9.8% for the antenatal transfer group (66 of 677 infants), and 17.3% for the non-level III birth group (145 of 838 infants). When adjusted for significant social and medical characteristics, infants born VPT at a level III hospital after antenatal transfer from another facility had a similar risk of neonatal mortality as infants born at a level III hospital (odds ratio, 0.79 [95% CI, 0.56-1.13]) after maternal presentation at the same hospital. Infants born at a non-level III hospital had an increased risk of neonatal mortality compared with infants born at a level III hospital after maternal presentation to the same hospital (odds ratio, 1.52 [95% CI, 1.14-2.02]). CONCLUSIONS AND RELEVANCEThe risk of neonatal mortality was similar for infants who were VPT, whether women initially presented at a level III hospital or were transferred to a level III hospital before delivery. This suggests that the increased risk of mortality associated with delivery at a non-level III hospital may be mitigated by optimizing opportunities for early maternal transfer to a level III hospital.