National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (1)
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- Caregiving (1)
- Case Study (1)
- Children/Adolescents (2)
- Communication (1)
- Comparative Effectiveness (2)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- COVID-19 (1)
- Cultural Competence (1)
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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 23 of 23 Research Studies DisplayedViswanathan 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
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
Balk 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
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
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
Venkataramani M, Ogunwole SM, Caulfield LE
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
The purpose of this study was to determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration. Findings showed moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. Further, findings showed low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration.
AHRQ-funded; 75Q80120D00003.
Citation: Venkataramani M, Ogunwole SM, Caulfield LE .
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
pediatric pediatrics food.
Keywords: Newborns/Infants, Children/Adolescents, Women, Maternal Care, Outcomes, Nutrition
Hunte R, Klawetter S, Paul S
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
The purpose of this qualitative study was to examine how Black women’s health, pregnancy and parenting are impacted by racism, and how the relationship between Black women’s health, pregnancy and parenting and racism-related stress are affected by a culturally-specific perinatal care program. The researchers conducted focus groups and utilized a Black Feminist approach to center the perspectives and lived experiences of Black women. Four themes surfaced in the analysis, including: 1) The widespread reach of structural racism, 2) Trust and healing facilitated through shared identities, 3) Racism directly impacts mental health, and 4) Advocacy at all levels is a vital service. The researchers concluded that structural racism has chronic and toxic effects on Black women’s physical and mental health, and Black perinatal care should include: culturally-specific approaches, advocacy, mental health support with specific attention to racism-related stress, and examination of implicit biases.
AHRQ-funded; HS026370.
Citation: Hunte R, Klawetter S, Paul S .
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
Matern Child Health J 2022 Apr;26(4):933-40. doi: 10.1007/s10995-021-03283-4..
Keywords: Racial and Ethnic Minorities, Women, Maternal Care, Pregnancy, Newborns/Infants, Cultural Competence
Barrero-Castillero A, Beam KS, Bernardini LB
COVID-19: neonatal-perinatal perspectives.
This review provides a comprehensive overview of neonatal-perinatal perspectives of COVID-19, ranging from the basic science of infection and recommendations for care of pregnant women and neonates to important psychosocial, ethical, and racial/ethnic topics emerging as a result of both the pandemic and the response of the healthcare community to the care of infected individuals.
AHRQ-funded; HS000063.
Citation: Barrero-Castillero A, Beam KS, Bernardini LB .
COVID-19: neonatal-perinatal perspectives.
J Perinatol 2021 May;41(5):940-51. doi: 10.1038/s41372-020-00874-x..
Keywords: COVID-19, Newborns/Infants, Infectious Diseases, Pregnancy, Women
Berger BO, Wolfson C, Reid LD
AHRQ Author: Reid LD
Adverse birth outcomes among women of advanced maternal age with and without health conditions in Maryland.
This study examined the association between advanced maternal age (AMA) and adverse birth outcomes among women with and without preexisting and pregnancy-related health conditions. Data for singleton births from the population-based Maryland Pregnancy Risk Assessment Monitoring System 2004-2015 were used to compare women aged 20-34 years and 35 years and older. Findings indicated that AMA is associated with adverse birth outcomes among women with and without health conditions compared with younger women with similar health status. Recommendations included improved screening and management of health conditions during pregnancy for older women, regardless of parity.
AHRQ-authored.
Citation: Berger BO, Wolfson C, Reid LD .
Adverse birth outcomes among women of advanced maternal age with and without health conditions in Maryland.
Womens Health Issues 2021 Jan-Feb;31(1):40-48. doi: 10.1016/j.whi.2020.08.008..
Keywords: Pregnancy, Newborns/Infants, Outcomes, Women, Risk
Leifheit KM, Schwartz GL, Pollack CE
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
This study measured the association of severe housing insecurity with adverse birth and infant outcomes. Data was analyzed from 3248 mother-infant dyads enrolled in the Fragile Families and Child Wellbeing Study. This prospective cohort study represented births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness. Adverse outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. There were statistically significant associations found between severe housing insecurity during pregnancy and low birth weight and/or preterm births. Housing insecurity and infant fair or poor health and poor temperament were not found to have statistically significant associations. Population attributable fraction (PAF) estimates suggested that up to 3% of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women.
AHRQ-funded; HS000046.
Citation: Leifheit KM, Schwartz GL, Pollack CE .
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
Int J Environ Res Public Health 2020 Nov 21;17(22):8659. doi: 10.3390/ijerph17228659..
Keywords: Pregnancy, Labor and Delivery, Vulnerable Populations, Outcomes, Adverse Events, Women, Low-Income, Newborns/Infants
Schafer R, Phillippi JC
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. This article used a case study approach to discuss evidence-based, patient-centered care for group B streptococcal bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
AHRQ-funded; HS024733.
Citation: Schafer R, Phillippi JC .
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
J Midwifery Womens Health 2020 May;65(3):376-81. doi: 10.1111/jmwh.13085..
Keywords: Infectious Diseases, Pregnancy, Women, Patient-Centered Healthcare, Evidence-Based Practice, Newborns/Infants, Sepsis, Case Study
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Campbell KH, Illuzzi JL, Lee HC
Optimal maternal and neonatal outcomes and associated hospital characteristics.
The goal of this study was to examine hospital variation in both maternal and neonatal morbidities and to identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. The authors found that hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance.
AHRQ-funded; HS023801.
Citation: Campbell KH, Illuzzi JL, Lee HC .
Optimal maternal and neonatal outcomes and associated hospital characteristics.
Birth 2019 Jun;46(2):289-99. doi: 10.1111/birt.12400.
.
.
Keywords: Hospitals, Newborns/Infants, Outcomes, Pregnancy, Provider Performance, Quality of Care, Women
Vanderlaan J, Rochat R, Williams B
Associations between hospital maternal service level and delivery outcomes.
This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. The investigators concluded that for the group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Rochat R, Williams B .
Associations between hospital maternal service level and delivery outcomes.
Womens Health Issues 2019 May - Jun;29(3):252-58. doi: 10.1016/j.whi.2019.02.004..
Keywords: Maternal Care, Labor and Delivery, Pregnancy, Women, Outcomes, Hospitals, Quality of Care, Newborns/Infants, Mortality
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S .
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communication, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
Mehra R, Shebi FM, Cunningham SD
Area-level deprivation and preterm birth: results from a national, commercially-insured population.
This research studied the association between area-level deprivation and preterm birth. A retrospective cohort study was conducted using data obtained from the Health Care Cost Institute that uses national, commercial health claims data from 2011. The highest quartile of area-level deprivation experienced the highest number of preterm birth (24.9%) as opposed to the lowest quarter (9.6%). This was true even among commercially-insured women.
AHRQ-funded; HS017589; HS022242.
Citation: Mehra R, Shebi FM, Cunningham SD .
Area-level deprivation and preterm birth: results from a national, commercially-insured population.
BMC Public Health 2019 Feb 27;19(1):236. doi: 10.1186/s12889-019-6533-7..
Keywords: Health Insurance, Newborns/Infants, Pregnancy, Social Determinants of Health, Women
Connor KA, Duran G, Faiz-Nassar M
Feasibility of implementing group well baby/well woman dyad care at federally qualified health centers.
The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing Centering Parenting (CP) in federally qualified health centers (FQHCs) in Baltimore. The investigators concluded that perceptions regarding facilitators and barriers to CP implementation in FQHCs were similar to existing group well-child care literature; however the benefit of emphasis on maternal wellness was a unique finding. The investigators suggested that a maternal wellness integration might make CP a particularly desirable model for implementation at FQHCs, but potential systems barriers must be addressed.
AHRQ-funded; HS017596.
Citation: Connor KA, Duran G, Faiz-Nassar M .
Feasibility of implementing group well baby/well woman dyad care at federally qualified health centers.
Acad Pediatr 2018 Jul;18(5):510-15. doi: 10.1016/j.acap.2017.09.011..
Keywords: Caregiving, Children/Adolescents, Education: Patient and Caregiver, Health Promotion, Healthcare Delivery, Maternal Care, Newborns/Infants, Pregnancy, Women
Glazer KB, Eliot MN, Danilack VA
Residential green space and birth outcomes in a coastal setting.
The objective of this study was to evaluate associations between green and blue space and birth outcomes in a coastal area of the northeastern US. Findings from this study did not support the hypothesis that residential green space was associated with reduced risk of preterm birth or higher birthweight after adjustment for individual and contextual socioeconomic factors, but variation in results with incremental adjustment raised questions about the optimal degree of control for confounding by markers of SES. The investigators found that living near a freshwater body was associated with higher birthweight.
AHRQ-funded; HS025013.
Citation: Glazer KB, Eliot MN, Danilack VA .
Residential green space and birth outcomes in a coastal setting.
Environ Res 2018 May;163:97-107. doi: 10.1016/j.envres.2018.01.006..
Keywords: Pregnancy, Newborns/Infants, Outcomes, Adverse Events, Women
Jou J, Kozhimannil KB, Abraham JM
Paid maternity leave in the United States: associations with maternal and infant health.
Using data from Listening to Mothers III, a national survey of women ages 18-45 who gave birth in 2011-2012, the investigators conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. They concluded that Practice Paid maternity leave significantly predicted lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management.
AHRQ-funded; HS023950.
Citation: Jou J, Kozhimannil KB, Abraham JM .
Paid maternity leave in the United States: associations with maternal and infant health.
Matern Child Health J 2018 Feb;22(2):216-25. doi: 10.1007/s10995-017-2393-x..
Keywords: Maternal Care, Newborns/Infants, Policy, Pregnancy, Women
Phillippi JC, Danhausen K, Alliman J
Neonatal outcomes in the birth center setting: a systematic review.
This systematic review examined the effects of the birth center setting on neonatal mortality in economically developed countries. The criteria for inclusion included being in English, published after 1980 and in countries with similar guidelines to the American Association of Birth Centers Standards. The only measure used was neonatal mortality and results did not find any difference between using a birth center as opposed to a traditional hospital setting. The literature was not found to have many good quality studies, and further research is recommended.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Danhausen K, Alliman J .
Neonatal outcomes in the birth center setting: a systematic review.
J Midwifery Womens Health 2018 Jan;63(1):68-89. doi: 10.1111/jmwh.12701..
Keywords: Evidence-Based Practice, Labor and Delivery, Mortality, Newborns/Infants, Outcomes, Pregnancy, Women
Witt WP, Mandell KC, Wisk LE
Infant birthweight in the US: the role of preconception stressful life events and substance use.
The purpose of this study was to determine the relationships among preconception stressful life events (PSLEs), women's alcohol and tobacco use before and during pregnancy, and infant birthweight. It concluded that PSLEs and women's tobacco use before and during pregnancy are independent risk factors for having a lower birthweight baby.
AHRQ-funded; HS000063; HS000083.
Citation: Witt WP, Mandell KC, Wisk LE .
Infant birthweight in the US: the role of preconception stressful life events and substance use.
Arch Womens Ment Health 2016 Jun;19(3):529-42. doi: 10.1007/s00737-015-0595-z.
.
.
Keywords: Newborns/Infants, Pregnancy, Stress, Substance Abuse, Women
Cheng ER, Park H, Wisk LE
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
The authors suggested a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight, and subsequent offspring health. Infant and toddler health outcomes were assessed at 9 and 24 months, including overall health status, special healthcare needs, and severe health conditions. The analysis suggested a chains-of-risk model in which women's exposure to PSLEs increased the risk for giving birth to a very low birth weight infant, adversely affecting infant and toddler health.
AHRQ-funded; HS000063; HS00083.
Citation: Cheng ER, Park H, Wisk LE .
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
J Epidemiol Community Health 2016 Mar;70(3):245-52. doi: 10.1136/jech-2015-205848.
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Keywords: Maternal Care, Women, Labor and Delivery, Newborns/Infants, Newborns/Infants
Camelo Castillo W, Boggess K, Sturmer T
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
The purpose of this study was to estimate the risks of adverse pregnancy outcomes among women receiving glyburide compared with insulin for the treatment of gestational diabetes mellitus (GDM) in a US population-based cohort. It found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury, and large for gestational age in women with GDM.
AHRQ-funded; HS017950.
Citation: Camelo Castillo W, Boggess K, Sturmer T .
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
JAMA Pediatr 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74..
Keywords: Adverse Drug Events (ADE), Adverse Events, Comparative Effectiveness, Diabetes, Labor and Delivery, Maternal Care, Medication, Newborns/Infants, Outcomes, Pregnancy, Women