OBJECTIVE:We estimated postpartum hospital readmissions trends among women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PDM; i.e., diabetes present before pregnancy), and neither. METHODS:Using the National Readmissions Database, we identified women aged 15-44 years who had a live birth or stillbirth between January 1 and June 30 annually, from 2016 through 2022. Births by diabetes status (GDM, PDM, and no diabetes diagnosis) were grouped to obtain the 1) rates of postpartum rehospitalization for all causes, severe maternal morbidity (SMM), diabetes-related diagnoses, and mental health-related diagnoses, 2) repeated admissions, and 3) the leading causes of readmission. Joinpoint regression was used to assess trends in outcomes for 30, 60, and 180 days postpartum. RESULTS:From 2016 to 2022, rates of all-cause postpartum readmissions increased significantly among women with GDM and women without diabetes by 30 days (annual percent change [APC], 2.78 for both), whereas rates of SMM postpartum readmissions decreased significantly among women with GDM by 30 days (APC, -7.44), 60 days (APC, -7.12), and 180 days (APC, -6.37), among women with PDM by 60 days (APC, -7.05), and among women with no diabetes by 30 days (APC, -5.83), 60 days (APC, -5.68), and 180 days (APC, -4.45). Postpartum diabetes-related readmission rates decreased for all periods among women with GDM and without diabetes (APC p values < .05) and by 180 days among women with PDM (APC, -7.03). Repeated diabetes-related admissions decreased at 60 and 180 days postpartum (APC p values < .05) among women with PDM. Hypertensive disorders were among the top three reasons for readmissions, regardless of diabetes status. CONCLUSION:Although all-cause readmissions increased by 30 days among women with GDM and without diabetes, postpartum SMM and diabetes-related readmissions decreased overall among women with GDM, PDM, and neither. Hypertensive disorders as a top reason for readmission suggests the need to monitor these disorders among women with GDM and PDM at birth.
PURPOSE:We aimed to understand the experiences of miscarriage grief among childbearing people and their perception of helpful and nonhelpful elements of peer support groups. METHODS:English-speaking participants, over the age of 18, who personally experienced a miscarriage in the last 10 years were eligible to complete a one-time Qualtrics survey. An international online sample was recruited through social media sites, support groups, and other networks serving childbearing people. A total of 1,709 individuals from the United States and 32 other countries consented to participate. Of those who indicated peer support involvement (n = 115), approximately 95% (n = 109) shared their personal experiences with peer support. Researchers used SPSS to analyze quantitative data and Dedoose to complete an iterative thematic analysis of qualitative responses. RESULTS:Participants perceived peer support to have both helpful and nonhelpful components. Those who found it helpful had a range of reactions that were grouped into the following major themes: receiving authentic empathy, camaraderie, finding a safe space, learning coping tools and strategies, processing a shared experience, and seeking or providing advice. Those who found the groups unhelpful commented on thematic elements such as the fit and format of the group (i.e., virtual, facilitator type, and structure) and the group feeling overwhelming, uncomfortable, or not specific enough to their needs. CONCLUSIONS:This study's findings suggest that, although perceptions of peer support groups vary depending on format and other elements, such as fit and structure, there are many potentially helpful attributes of these groups to support processing miscarriage grief in a safe space. Health care providers and others caring for those experiencing a pregnancy loss should offer peer support options for individuals who wish to explore them.
BACKGROUND:Black women in the United States continue to experience disproportionate rates of severe maternal morbidity and mortality and frequently report disrespectful perinatal care. Although prior research has documented discriminatory encounters within perinatal care, less is known about how Black women anticipate and prepare for potential poor treatment before and during pregnancy. We aimed to better understand how Black women's anticipation of racism shapes their engagement with care during the perinatal period. METHODS:This qualitative secondary analysis draws on in-depth interviews with 93 Black, English-speaking women across four urban areas of New Jersey who gave birth within the previous 24 months. Data analysis utilized a thematic analysis approach within a community-based participatory research framework. RESULTS:Two major themes were identified: 1) fear of negative outcomes, including acute awareness of the Black maternal health crisis, and resulting vigilance and anxiety, and 2) fear of poor treatment by health care providers, characterized by expectations of being labeled, ignored, or dismissed, which led to anticipatory self-regulation. CONCLUSIONS:These findings bring attention to the phenomenon where some Black women in our study entered perinatal care expecting harm, a reality that creates a profound psychological burden and may undermine the patient-provider relationship before it even begins. This reality also places Black women in a double-bind, wherein they balance the vigilance needed to protect themselves with modifying their behavior to avoid stereotypes. Efforts to improve perinatal health must address clinical disparities in outcomes and the systemic conditions that make anticipatory fear a rational and necessary coping strategy.
BACKGROUND:The DRAMES register (Décès en Relation avec l'Abus de Médicaments Et de Substances) is a French database of drug-related deaths reported by forensic toxicology experts. This study evaluated sex differences in the substances involved in deaths, with the aim of improving public policy on prevention and care for women with substance use disorders. METHODS:We assessed 6,068 drug-related deaths that occurred from January 1, 2010, to December 31, 2023, in France (1,120 women [18.5%] with a mean age of 38 ± 11 years and 4,948 men [81.5%] with a mean age of 38 ± 10 years). Individual demographic characteristics and medical history, forensic autopsy findings, and toxicology reports were evaluated. RESULTS:The proportion of deaths related to polydrug use was higher in women than in men (39.4% vs. 28.4%; p < .001). Female sex was significantly associated with mortality from taking antidepressants (p < .001), antipsychotics (p < .001), benzodiazepines and z-drugs (p < .001), codeine (p = .002), other anxiolytics and hypnotics (p = .029), pholcodine (p = .005), and tramadol (p < .001), all of which are legal prescription medicines in France. Male sex was significantly associated with mortality from taking amphetamine-type stimulants (p = .044), buprenorphine (p = .042), cannabis (p < .001), gamma-hydroxybutyrate (p = .002), heroin (p < .001), and new psychoactive substances (p < .001). Apart from buprenorphine, all of these drugs are illegal in France. CONCLUSION:The observed differences in causes of death between women and men, specifically more polydrug related-deaths (especially with pharmaceuticals), highlight the need to address female-specific concerns. Further studies and resources are needed to develop programs dedicated to women with substance use disorders.
OBJECTIVES:We sought to assess current and former intrauterine device (IUD) users' interest in and experiences with IUD self-removal and to examine associations between participant characteristics, past experiences with removal, and future interest in self-removal. STUDY DESIGN:We conducted a cross-sectional follow-up survey of HER Salt Lake participants who had ever used an IUD and consented to follow-up. Participants completed an electronic survey assessing interest in receiving self-removal information, past self-removal attempts and outcomes, and experiences with provider removal. We used descriptive statistics and χ2 tests to explore self-removal interest and experiences, and differences in interest by characteristics and past removal experiences. RESULTS:More than one-half of the 621 participants (57%) expressed an interest in IUD self-removal. Among current IUD users, 49% reported willingness to try self-removal. One in 10 participants had attempted self-removal; 68% were successful and most (61%) reported no problems. Among those who attempted self-removal, the most commonly reported problems were experiencing more pain than they felt comfortable with (21%) and being unable to feel their IUD strings (9%). Participants who faced prior barriers to provider removal, including cost, scheduling delays, discomfort with care, or distrust of the health care system, were more likely to express interest in self-removal (p < .05). Those interested were also more often nulliparous, current IUD users, those not married or cohabitating with their partners, and those who did not identify as heterosexual. CONCLUSION:In our sample, interest in self-removal was high, and most participants who had attempted self-removal did so successfully and without problems. Providing accessible information about self-removal in preferred formats may help to reduce barriers to IUD discontinuation and support reproductive autonomy.
BACKGROUND:It is well documented that single chronic conditions increase the risk of adverse pregnancy outcomes, but less is known about the impact of multiple chronic conditions in pregnancy. We assessed the association between multimorbidity and adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, intrapartum hemorrhage, placental abruption, prolonged length of hospital stay, stillbirth, preterm birth, and low birthweight. METHODS:We conducted a retrospective cohort study of 6,455 births using medical record data at a safety-net hospital (2015-2019). Multimorbidity was defined as having at least two diagnosis codes before or during pregnancy. Pregnancy outcomes were ascertained using clinical data and diagnosis codes. Log-binomial regression models using generalized estimating equations were fit to assess the association between multimorbidity and each outcome. We additionally stratified results by body mass index (BMI; <30 and ≥30 kg/m2) and describe the prevalence of adverse pregnancy outcomes by multimorbidity across racial and ethnic subgroups. RESULTS:Multimorbidity affected more than one in three births (35.2%) and was associated with greater risks of hypertensive disorders of pregnancy (adjusted risk ratio [aRR], 1.26; 95% confidence interval [CI], 1.12, 1.41), preterm birth (aRR, 1.68; 95% CI, 1.47, 1.93), low birthweight (aRR, 1.61; 95% CI, 1.24, 2.09), stillbirth (RR, 1.84; 95% CI, 0.94, 3.60), placental abruption (aRR, 1.90; 95% CI, 1.00, 3.60), and prolonged hospital stay for cesarean (aRR, 1.40; 95% CI, 1.11, 1.77) and vaginal (aRR, 1.26; 95% CI, 1.07, 1.48) births, compared with individuals without multimorbidity. Further, greater risks of hypertensive disorders of pregnancy (aRR, 1.64; 95% CI, 1.37, 1.96) and gestational diabetes (aRR, 2.58; 95% CI, 1.86, 3.59) were found among those with multimorbidity and a co-occurring BMI of ≥30 kg/m2 compared with those with multimorbidity with a BMI of <30 kg/m2. Most adverse pregnancy outcomes were more frequent among patients with multimorbidity who identified as non-Hispanic Black and Hispanic/Latine and less frequent among white patients with multimorbidity. CONCLUSION:The high prevalence of multimorbidity and its association with adverse pregnancy outcomes highlight the importance of collaborative approaches for preconception and pregnancy care to optimize perinatal health.
BACKGROUND:Knowledge of state-level abortion policies may impact an individual's ability to obtain abortion care. We assessed knowledge and opinions about state abortion policies among young adults in North Carolina following the implementation of new abortion restrictions. METHODS:This was a cross-sectional online survey of individuals ages 18-24 living in North Carolina, recruited via social media from July to October 2024. The primary outcome was high knowledge of state abortion policy (6 or more correct answers on 11 policy knowledge questions). We generated descriptive statistics and evaluated the associations between respondent characteristics and high knowledge. RESULTS:Of 217 participants, 80% were cis women and 49% were current students. Overall, 79% identified abortion as legal in North Carolina, but only 45% had high abortion policy knowledge. More than one-half identified exceptions allowing abortion after 12 weeks in cases of threat to maternal life (62% correct) or rape (52% correct); fewer had knowledge of waiting periods (45% correct), ultrasound examination requirements (43% correct), or exceptions for life-limiting fetal anomalies (47% correct). Individuals reporting household use of public nutrition benefits were more likely to have high knowledge compared with those not receiving nutrition benefits (adjusted odds ratio, 2.18; 95% confidence interval [1.10, 4.35]). High policy knowledge was not associated with personal views about abortion morality or opinions about state abortion law, but was associated with knowledge about abortion safety (p = .002). More than one-half of the participants (60%) believed abortion is extremely or somewhat difficult to obtain in North Carolina, and 62% disapproved of the new restrictions. CONCLUSION:Young adults in this study sample had limited knowledge about the specifics of state abortion policy, highlighting a need to educate the public about policies impacting reproductive health care.
BACKGROUND:Comorbidity is common with migraine. To inform services to support maternal well-being, we identified comorbidity patterns among pregnant individuals with a history of seeking health care for migraine before pregnancy. METHODS:In a population-based cohort of pregnancies in 2007-2022 in Ontario, Canada, to individuals with migraine-related health care encounters in the 5 years before conception, we used latent class analysis to identify subgroups using 33 comorbidities. Classes were chosen using statistical fit indices, parsimony, and clinical interpretability. We compared the sociodemographic and reproductive health-related characteristics of the classes using standardized differences. RESULTS:Of 174,164 pregnant individuals with migraine, 67.2% had one or more comorbidities. The most prevalent comorbidities were mood/anxiety disorders (41.4%), low back pain (16.9%), obesity (12.1%), and asthma (10.6%). Three distinct subgroups characterized comorbidity patterns: class 1, the "mood/anxiety disorder comorbidity," included 81.2% of the cohort; class 2, the "mood/anxiety disorder and low back pain comorbidity" cohort included 8.3%' and class 3, the "multiple mental health comorbidity" cohort included 10.6%. Compared with class 1, at conception individuals in the "multiple mental health comorbidity" group were more likely to be aged 13 to 24 years (37.9% vs. 18.9%; standardized difference, 0.43), reside in neighborhoods in the lowest income quintile (29.7% vs. 22.1%, 0.17), be Canadian born or a long-term resident (87.0% vs. 74.4%, 0.32), and be nulliparous (53.2% vs. 47.5%, 0.11). Those in the "mood/anxiety disorder and low back pain comorbidity" group were more likely to be 35 to 44 years of age (31.9% vs. 20.6%, 0.26) or 45 to 54 years of age (2.1% vs. 0.6%, 0.14), more likely to reside in neighborhoods in the lowest income quintile (26.6% vs. 22.1%, 0.11), and less likely to be nulliparous (38.6% vs. 47.5%, 0.18). Findings were similar in a sensitivity analysis including only comorbidities with a prevalence of 1% or greater. Using physical conditions as indicators only, we also identified three latent classes: "low back pain comorbidity" (4.3%), "obesity comorbidity" (2.8%), and "no physical comorbidity" (92.9%). CONCLUSION:Comorbidity affects two-thirds of pregnant individuals with a history of seeking health care for migraine. Identified patterns of comorbidity suggest subgroups who may benefit from tailored perinatal support related to mental health and chronic pain.
PURPOSE:Positive childbirth experiences (CBEs) impact maternal and child well-being, but many women, particularly those of low socioeconomic status, report negative or traumatic births. This mixed-methods longitudinal study investigated whether and how psychological capital-a psychological construct composed of hope, self-efficacy, resilience, and optimism-moderates the associations between birth complications, birth trauma, and perceived own capacity, a critical indicator of positive CBEs. METHODS:Mixed-methods data were extracted from a prospective longitudinal perinatal cohort study of birthing individuals experiencing at least one indicator of socioeconomic disadvantage. The quantitative data are from 141 individuals during pregnancy (third trimester) and the postpartum period (6 weeks postpartum); 16 of these individuals participated in an interview at 6 weeks postpartum to share their perceptions of their birth experiences. Quantitative data were analyzed using hierarchical linear regression modeling; postpartum interviews were analyzed using thematic and sentiment analysis. RESULTS:Hierarchical linear regression revealed that psychological capital during pregnancy was positively and significantly associated with perceived own capacity related to subjective CBEs, after adjusting for birth complications, birth trauma, and sociodemographic characteristics (p < .01). Interview participants who reported positive CBEs displayed self-efficacy, hope, and optimism. Mixed-methods integration further indicated that self-efficacy and optimism were associated with positive CBEs, even among those who experienced birth complications. CONCLUSIONS:Public health efforts should consider targeting strengths-based strategies to bolster psychological resources during pregnancy, such as evidence-based psychological capital interventions, to promote more positive CBEs. Future work is necessary to understand how to adapt and tailor interventions to better support perinatal individuals experiencing socioeconomic disadvantage through the childbirth process.
INTRODUCTION:Congressional legislation mandated research on intimate partner violence (IPV) among veterans. We convened a panel addressing veteran-related IPV to arrive at evidence-based recommendations. METHODS:A panel composed of community, decision-maker, health service provider, and research representatives addressed veteran-related IPV prevalence, risk factors, consequences, and interventions. The panel process followed a modified Delphi approach centered around 2 days of virtual moderated discussions and pre- and post-panel surveys. RESULTS:Panelists stressed that definitions must include examples beyond physical violence to adequately communicate the scope of IPV for veterans. They highlighted that prevalence varies due to sampling strategies that should be communicated together with estimates. Panelists identified additional risk factors particularly salient to and sometimes unique to veterans such as post-traumatic stress disorder and suicidality, and deployment-related stress on relationships due to prolonged separation. There was no strong agreement on the consequences of IPV unique to veterans. However, there was universal agreement that the guiding principles of VA's National IPV Assistance Program (emphasizing a person-centered, veteran-centric, recovery-oriented, and trauma-informed approach) are critical for program integrity and growth. Recommendations included providing screening skills training and education for all health care staff; establishing a "no wrong door" policy for veterans seeking help; screening for IPV among veterans who are expressing suicidality, post-traumatic stress disorder symptoms, substance abuse, or sleeping problems; engaging in safety planning around homicide risk; and reinforcing the need for screening, staffing, clinical services, staff education, and training. CONCLUSIONS:Panel results can help clinicians, policy makers, and researchers better address IPV in veterans.
BACKGROUND:Prematurity, or birth before 37 weeks of gestation, is associated with increased multisystem health risks for infants and poor mental health outcomes for mothers. Black mothers experience higher likelihoods of preterm birth compared with other racialized groups. Black mothers, however, are a heterogeneous social group who differ on factors such as racialized identity, ethnicity, and nativity, and ignoring these interconnected factors can lead to an incomplete assessment of within-racial group differences in preterm birth risk. Our study applies intersectionality's intracategorical methodological approach to explore heterogeneity in preterm birth risk among Black mothers. METHODS:Using birth certificate data from the 2023 U.S. National Vital Statistics System (N = 552,708), binary logistic regression models were used to analyze whether the likelihood of preterm birth for Black mothers differed across categories of racialized identity (single-race vs. multiracial), and nativity (U.S. born vs. foreign-born). RESULTS:Results revealed multiracial (adjusted odds ratio [aOR] 0.82; 95% confidence interval [CI], 0.80-0.85), Hispanic (aOR, 0.90; 95% CI, 0.87-0.93), and foreign-born (aOR, 0.65; 95% CI, 0.63-0.66) Black mothers had lower odds of preterm birth compared with their single-race, non-Hispanic, and U.S.-born counterparts, respectively. When all aspects of social location were measured conjointly, single-race, non-Hispanic, U.S.-born Black mothers had the highest percentage of preterm births (12.4%), whereas multiracial, Hispanic, foreign-born Black mothers had the lowest percentage of preterm births (8.2%). CONCLUSIONS:Our study contributes to research on preterm birth disparities and broader conversations surrounding the importance of utilizing intersectional frameworks to articulate within-racial group differences in Black maternal outcomes.
BACKGROUND:RhD immune globulin (RhIg) administration in cases of first-trimester bleeding events has historically been recommended to prevent RhD sensitization based on expert opinion and indirect evidence. Emerging evidence has shown that this practice does not improve fetal outcomes, and many medical organizations no longer recommend RhIg administration in the first trimester. We aimed to quantify RhIg uptake by RhD-negative patients at less than 12 weeks gestation receiving abortion care in a clinic system switching from an opt-out to an opt-in policy for RhIg administration. Secondarily, we aimed to analyze characteristics associated with receiving RhIg. METHODS:In this retrospective cohort study, we compared RhIg administration in all RhD-negative patients accessing abortion care at less than 12 weeks gestation from August 15, 2021, to August 14, 2022 (pre), and August 15, 2022, to August 15, 2023 (post), in an abortion care clinic system. We compared characteristics to determine differences in those receiving RhIg versus not. RhD-negative patients at greater than 12 weeks gestation were utilized as a comparison. RhIg continues to be recommended to all patients at greater than 12 weeks gestation. RESULTS:A total of 1,497 RhD-negative patients underwent an abortion at less than 12 weeks gestation, 691 (46.2%) in the pre period and 806 (53.8%) in the post period. The rates of RhIg uptake were 76.1% pre versus 10.4% post (p < .01). In the first 6 months, 88.8% received RhIg and monthly uptake decreased as the official policy change approached. Factors associated with receiving RhIg in the post period were higher gestational age and being Hispanic or Latine. In the comparison group, there was 88.6% uptake in the pre period and 71.4% in the post period. CONCLUSION:The rate of RhIg uptake significantly decreased after the policy change, with evidence of an anticipatory effect before the official change. When RhIg was routinely recommended, 23.9% of patients at less than 12 weeks gestation did not receive it. After the policy change to opt-in administration, 10.4% of patients still received RhIg. Further studies on patient risk tolerance surrounding RhIg are warranted.
BACKGROUND:Perinatal mental health conditions are more prevalent, yet less commonly treated, among people of color compared with white women. METHODS:We conducted an interrupted time series analysis using 2014-2022 Michigan Medicaid claims data to assess the impact of Michigan Medicaid's 2018 requirement to screen for postpartum depression during well-child visits on racial/ethnic differences in maternal mental health diagnosis and treatment outcomes. RESULTS:The sample included 254,890 women and was composed of 137,769 white, 81,257 Black, and 16,358 Hispanic women. Compared with white women, the 2018 policy introduction led to a greater level change in rates of postpartum depression diagnosis for Hispanic women (adjusted odds ratio [aOR] 1.26; 95% confidence interval [CI] [1.03, 1.54]) and a greater level change in rates of medication for those with depression or anxiety among Black (aOR 1.13; 95% CI [1.04, 1.23]) and Hispanic women (aOR 1.23; 95% CI [1.06, 1.44])-reducing but not eliminating inequities in diagnosis and treatment of depression and anxiety. Black women saw a decline in diagnosis (aOR .91; 95% CI [.85, .98]) and treatment (aOR .91; 95% CI [.85, .98]) for substance use disorder compared with white women. After the policy introduction, Black and Hispanic women experienced larger trend increases in all outcomes, moderately reducing inequities. Sensitivity analyses changing the interruption date to 2017 showed stronger differences in trend changes for most outcomes. CONCLUSIONS:Although inequities in diagnoses and treatment for those with postpartum depression or anxiety between 2014 and 2022 modestly improved, Michigan's 2018 Medicaid policy did not eliminate inequities in maternal mental health conditions. Policymakers at the federal and state levels should consider additional ways to improve treatment of perinatal mental health conditions among Black and Hispanic women.
Background Primary care after pregnancy allows for cardiovascular risk factor modification amidst rising rates of cardiometabolic complications in pregnancy. However, postpartum primary care utilization is understudied, with few national studies among the privately insured. In response to updated professional guidelines and expanded insurance access, we conducted a nationally representative, multipayer study among privately and publicly insured individuals with cardiometabolic complications to explore primary care utilization after pregnancy. Methods Using Medical Expenditure Panel Survey (MEPS) data from 2016 to 2022, we conducted a retrospective cohort study examining primary care and other health care utilization (obstetrics/gynecology [OB/GYN], emergency room [ER], hospitalizations) after pregnancy among individuals with hypertension, pregestational diabetes, or gestational diabetes, which we collectively defined as “medically complicated pregnancy.” We used multivariable regression models to test for differences among individuals with medically complicated and uncomplicated pregnancy. Results Among 696 postpartum individuals, 13% had a medically complicated pregnancy. In the 1 year after pregnancy, 33.3% had one or more primary care visits and 58.2% had any OB/GYN visits. Individuals with medically complicated pregnancies had a significantly higher number of ER visits by .2 visit (95% confidence interval [.1, .3]); there were no other significant differences in primary care or other health care utilization in the postpartum year. Conclusion Primary care utilization in the year after pregnancy remains suboptimal, even among individuals with medically complicated pregnancy. These findings highlight a key missed opportunity after pregnancy for cardiovascular risk factor modification and underscore the need for interventions aimed at improving postpartum transitions to primary care.
BACKGROUND:People with disabilities experience intimate partner violence (IPV) at two to three times the rate of those without disabilities yet are routinely underscreened and underserved within perinatal health care settings. Health care providers play a critical role in IPV identification and intervention, but limited training, systemic bias, and ableism may hinder effective, equitable care. OBJECTIVE:We explored health care providers' experiences, perceptions, and challenges in screening and intervening for IPV among people with disabilities during the perinatal period. METHODS:Semistructured interviews were conducted with 44 nurses, midwives, physicians, and doulas providing perinatal care to people with disabilities across diverse clinical settings in the United States. Interviews were transcribed verbatim and analyzed using inductive content analysis to identify recurrent themes related to IPV screening practices, knowledge gaps, and attitudes toward disability. RESULTS:Analysis revealed three interrelated themes: 1) lack of awareness and training regarding disability-related abuse; 2) implicit bias and ableist assumptions shaping health care provider perceptions; and 3) discomfort, avoidance, and missed opportunities for IPV inquiry. Participants described uncertainty, time pressures, and systemic barriers that limited effective screening. They also identified ableism as operating across interpersonal and structural levels, including colleagues' devaluing of disabled patients and institutional care environments that remain difficult to navigate, which collectively hindered trauma-informed, disability-inclusive care. CONCLUSIONS:Discomfort, inadequate preparation, and ableist beliefs among health care providers undermine equitable IPV screening for people with disabilities. Integrating trauma-informed and disability-inclusive approaches into education, policy, and practice will be critical to enhancing identification, trust, and safety in perinatal settings.
BACKGROUND:Rural residents face higher rates of obstetric complications, yet are more likely to lose insurance after childbirth, limiting access to essential postpartum care. This study examined whether continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) differentially impacted postpartum insurance coverage in rural versus urban populations. METHODS:Using data from the 2017-2022 American Community Survey, we evaluated how state-level variation in pregnancy-related Medicaid eligibility during the PHE influenced coverage among rural and urban residents in the postpartum period. RESULTS:Medicaid coverage increased significantly for both rural and urban populations. Adjusting for sociodemographic factors and COVID-19 disease burden, rural mothers experienced a 6.4 percentage-point (pp) greater gain in Medicaid coverage per 100-pp increase in the state's pregnancy-related eligibility threshold (95% confidence interval [CI] [1.6, 11.2] pp). Overall postpartum insurance coverage also rose in both groups, although the increase was not significantly larger among rural mothers (3.2-pp greater gain; 95% CI [-0.4, 6.8]). CONCLUSION:These findings suggest that recently adopted postpartum Medicaid extensions may yield larger increases in Medicaid coverage in rural communities, an important consideration for policymakers seeking to mitigate the impact of impending Medicaid budget constraints on rural populations.
PURPOSE:Pregnant individuals hospitalized for obstetric complications experience perinatal depression at rates nearly double those in the general population. ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) is a brief, evidence-based intervention grounded in interpersonal therapy principles. Although effective in outpatient settings for preventing postpartum depression, its use in inpatient antenatal settings is untested. The objective of this study was to assess the feasibility, participant acceptability, and preliminary efficacy of delivering ROSE to hospitalized antepartum patients using a mixed-methods experimental design. BASIC PROCEDURES:A single-center mixed-methods experimental study (randomized controlled trial with embedded qualitative data collection) was conducted from July 2021 to March 2022. Participants admitted for prolonged antenatal hospitalization were randomized 1:1 to ROSE (four antenatal sessions and one postpartum session) or treatment as usual. Quantitative outcomes included enrollment, intervention completion, and follow-up rates, as well as acceptability via the Client Satisfaction Questionnaire-8. Semi-structured interviews explored participant experiences and were thematically analyzed and integrated with quantitative results. MAIN FINDINGS:Of 85 individuals screened, 45 were randomized (ROSE n = 23; control n = 22). Enrollment (77.6%), retention (87.5%), and follow-up (92.0%) exceeded a priori feasibility thresholds. High acceptability scores aligned with qualitative themes describing the intervention as a helpful distraction, source of emotional support, and tool for developing coping and communication strategies. Preliminary findings also suggested reduced depression severity in the ROSE group at 6 weeks postpartum. PRINCIPAL CONCLUSIONS:ROSE is feasible, and patients find it to be acceptable for use during inpatient antenatal care. Mixed-methods findings support further testing in larger, implementation-focused studies. (Clinical trial identification number: NCT05225025, A Pilot Trial of the Reach Out, Stay Strong, Essentials for Mothers of Newborns (ROSE) Postpartum Depression Prevention Intervention in Pregnant Patients Admitted to Strong Hospital, https://clinicaltrials.gov/study/NCT05225025, approved February 2, 2022.).
