Objective To examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes (GDM) and maternal and perinatal outcomes. Study Design A secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were randomized to treatment versus usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal mortality. Other outcomes examined included the frequency of large for gestational age (LGA), birth weight, neonatal intensive care unit admission (NICU), gestational hypertension / preeclampsia and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26 weeks, 27 weeks, 28 weeks, 29 weeks, ≥30 weeks) and treatment group (treated vs. routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared to those who initiated treatment at a later GA (p-value for interaction with the primary outcome is 0.44). Similarly, there was no evidence that other outcomes were significantly improved by earlier initiation of GDM treatment (LGA p=0.76; NICU admission p=0.8; cesarean delivery p=0.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (p=0.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.
INTRODUCTION: Perinatal depression affects one in seven women, and is associated with significant morbidity. Limited data suggest depression rates to be twice as high among low-income, minority women. This study aimed to identify associations between race/ethnicity and perinatal depression in a medically and psychosocially at-risk population. METHODS: Study data were collected from interviews conducted from December 2013 through August 2016 by Community Health Workers as part of the initial obstetric assessment. Depression was scored on the Center for Epidemiologic Studies Depression (CES-D) Scale, with depression defined as a score of greater than 16 for clinical symptoms. Race and ethnicity were self-reported. Chi-square analyses were performed. RESULTS: A total of 3,214 women were included in the study. Analyses revealed that a larger proportion of African American women (26.2%) met criteria for depression than their White (20.1%), Asian (5.2%) and Mixed Race counterparts (2.6%; chi-square less than .01, P greater than .001). Analyses involving ethnicity revealed that women who identified as Hispanic/Latina (27.1%) were less likely than non-Hispanic women (38.5%) to meet CES-D depression criteria (chi-square=44, P less than .001). CONCLUSION: Race and ethnicity were significantly associated with perinatal depression. A higher proportion was seen among African American women, while a lower proportion seen among Hispanic/Latinas. Implications for practice include increasing mental health support and a referral network to access during pregnancy and postpartum. Future research might include examination of protective factors for depressive symptoms in pregnant women of different ethnic/racial backgrounds. Screening tools for other mental health conditions may account for other ethnic/racial differences.
IntroductionTraditional perinatal care alone cannot address the social and structural determinants that drive disparities in adverse birth outcomes. Despite the wide acceptance of partnerships between healthcare systems and social service agencies to address this challenge, there needs to be more research on the implementation factors that facilitate (or hinder) cross-sector partnerships, particularly from the perspective of community-based organizations. This study aimed to integrate the views of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership designed to address social and structural determinants in pregnancy.MethodsWe used a mixed methods design (in-depth interviews and social network analysis) to integrate the perspectives of healthcare clinicians and staff with those of community-based partner organizations to identify implementation factors related to cross-sector partnerships.ResultsWe identified seven implementation factors related to three overarching themes: relationship-centered care, barriers and facilitators of cross-sector partnerships, and strengths of a network approach to cross-sector collaboration. Findings emphasized establishing relationships between healthcare staff, patients, and community-based partner organizations.ConclusionThis study provides practical insights for healthcare organizations, policymakers, and community organizations that aim to improve access to social services among historically marginalized perinatal populations.
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