Browsing by Subject "postpartum"
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Item Birthing Minnesota: The Associations of Structural Racism and Neighborhood Characteristics with the Health of Minnesota’s Birthing Population, Pregnancy through Postpartum(2021-12) Mentzer, KariStructural racism in Minnesota communities may be associated with adverse birth outcomes such as preterm birth, low birthweight, severe maternal morbidity, and death for birthing people. This dissertation provides a comprehensive report on the birthing outcomes of Minnesota people who gave birth 2011-2019 including the rates of prenatal risks (e.g. inadequate prenatal care, diabetes, and hypertension), adverse pregnancy outcomes (e.g. premature birth, low birthweight, fetal death), maternal morbidity (e.g. transfusion, unplanned hysterectomy, admission to ICU), and death (e.g. pregnancy-related, pregnancy-associated, all-cause after the first year). The relationship between structural racism in Minnesota and the health outcomes experienced by birthing people, specifically Black and American Indian people, during the perinatal period and in the years following childbirth is examined using the Index of Concentration at the Extremes (ICE) in a treatment effects model. In areas with the highest exposure to structural racism (according to ICE measures), neighborhood characteristics (e.g. access to healthy food, presence of green spaces, available quality education) may be associated with better than expected outcomes when the quality and number of resources are high. A logistic model was used to detail the association of increasing neighborhood resources to birth outcomes for individuals exposed to high levels of structural racism.Item Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital(University of Minnesota, College of Pharmacy, 2014) Schatz, Kristina; Chapman, Jennifer; Chang, JongwhaPurpose: To describe a pharmacist’s counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking. Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted. Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p<0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p<0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, & 65%) to want counseling compared with the age range of 12-17 years (all p<0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours. Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.Item Prenatal depressive symptoms and social support: An examination of their role in prenatal care adequacy, birth outcomes, and risk for postpartum depressive symptoms among low-income urban women(2016-05) Sidebottom, AbbeyBackground. Decreasing the prevalence of inadequate prenatal care, poor birth outcomes, and postpartum depression are public health priorities. Objectives. To examine, in a low-income, racially diverse, urban clinic-based sample the associations of: 1) Social support and depressive symptoms with prenatal care adequacy. 2) Social support and depressive symptoms with poor birth outcomes. 3) Prenatal and postpartum depressive symptoms, as well as their magnitude, and correlates of occurrence. Methods. The study sample was women who received prenatal care at five community health centers from 2005-2009. Maternal data from prenatal and postpartum risk screening tools were linked to data from their infants’ birth certificates. We examined the associations of social support and prenatal depressive symptoms with late and less than adequate prenatal care (Paper 1, n = 2,341) and preterm birth, low birthweight, and small size for gestational age (Paper 2, n = 2,868). We also characterized depressive symptoms in the prenatal and postpartum periods (Paper 3, n = 594). For all papers, multivariable analyses included personal, social, behavioral, and environmental risk factors associated with maternal and infant health. Results. Lack of social support was associated with inadequate prenatal care. Women with poor partner support and depressive symptoms were at the highest risk for starting care late. Neither prenatal depressive symptoms nor social support were independently associated with birth outcomes. There was an association between prenatal and postpartum depressive symptoms. Over half of women with postpartum symptoms had elevated symptoms prenatally. Variability in risk markers suggest unique risk factors are associated with experiencing depressive symptoms in either or both time periods. Conclusions. This study assessed understudied psychosocial risks with public health priority outcomes in a sample of women served by the public health system. Findings support efforts to increase screening for prenatal depression to better identify those at risk of postpartum depression.