Maternal and Child Health Library

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December 11, 2009

Correction: A supplement to the December 2009 issue of Pediatrics focuses on epidemiologic and public health issues at the national and state levels affecting children with special health care needs. The supplement, sponsored by the Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB), presents findings from the 2005-2006 National Survey of Children with Special Health Care Needs, a survey funded and developed by MCHB with the Centers for Disease Control and Prevention's National Center for Health Statistics. The survey is available at http://www.cdc.gov/nchs/slaits/cshcn.htm. The supplement's table of contents and abstracts are available at http://pediatrics.aappublications.org/content/vol124/Supplement_4. A limited number of paper copies of the journal supplement will be available from the HRSA Information Center at http://www.ask.hrsa.gov or by phone at 1-888-Ask-HRSA, or from Steph Toomer at stoomer@hrsa.gov.

1. Journal Focuses on Strategies to Advance Children's Oral Health and Access to Oral Health Services
2. Review Examines Safety of Influenza Vaccination During Pregnancy
3. Authors Explore Women's Beliefs About the Definition of "Full Term" and the Safety of Delivery at Various Gestational Ages
4. Article Analyzes Adolescents' Use of Mental Health Services After School-Based Suicide Screening
5. Study Identifies Risk Factors for Antenatal Depression Among African American Women

1. JOURNAL FOCUSES ON STRATEGIES TO ADVANCE CHILDREN'S ORAL HEALTH AND ACCESS TO ORAL HEALTH SERVICES

The November-December 2009 issue of Academic Pediatrics, Special Issue on Children's Oral Health, contains the background papers prepared for the American Academy of Pediatric's (AAP's) National Summit on Children's Oral Health held in November 2008 in Chicago, Illinois. The issue, produced by AAP with support from Proctor and Gamble, includes commentaries on children's oral health as a pediatric health priority, progress in children's oral health since Oral Health in America: A Report of the Surgeon General was published in 2000, and scientific investments and improvements in oral health. Articles in the special issue address the following topics: science and surveillance, access and barriers to care, the oral health work force, and policy achievements and challenges. Highlights of the 2008 AAP Periodic Survey of Pediatricians' Office Practices in Oral Health are included. The full-text journal content and the summit agenda, list of speakers and attendees, and additional background information are available from the AAP Web site at http://www.aap.org/commpeds/dochs/oralhealth/summit/index.cfm.

2. REVIEW EXAMINES SAFETY OF INFLUENZA VACCINATION DURING PREGNANCY

"Inactivated influenza vaccine can be safely and effectively administered during any trimester of pregnancy," state the authors of a review published in the December 2009 issue of the American Journal of Obstetrics and Gynecology. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends routine influenza vaccination for all women who are or will be pregnant during the influenza season. Physicians and other health professionals play a crucial role in the decision-making process with regard to influenza vaccination. They can explore the determinants of vaccine refusal and alleviate fears by addressing real and perceived concerns about immunizations during pregnancy. The article reviews the evidentiary basis for the recommendation of vaccination of all women who will be pregnant during the influenza season and safety data of influenza vaccination during pregnancy.

The review is based on data from 11 studies on safety outcomes of influenza immunization during pregnancy. The authors explored the evolution of U.S. immunization recommendations, risks of influenza infection in pregnancy, safety of inactivated influenza vaccine for the pregnant woman, benefits of influenza vaccination for the neonate, safety of maternal influenza vaccination for the fetus, and influenza vaccination and thimerosal.

The authors found that

• No study to date has demonstrated an increased risk of either maternal complications or untoward fetal outcomes associated with inactivated influenza vaccination.
• No scientific evidence exists that thimerosal-containing vaccines are a cause of adverse events among children born to women who received influenza vaccine during pregnancy.
• Immunization of the mother reduces one potential source of viral exposure to the infant, and immunization of other family members reduces other potential sources.

Health professionals "should anticipate questions that expecting mothers may have regarding vaccine safety . . . [and] encourage the vaccination of pregnant women against both the pandemic influenza A (H1N1) virus, as well as seasonal influenza," conclude the authors.

Tamma PD, Ault KA, del Rio C, et al. 2009. Safety of influenza vaccination during pregnancy. American Journal of Obstetrics and Gynecology 201():547-552. Abstract available at http://www.ajog.org/article/S0002-9378%2809%2901108-9/abstract.

Readers: More information is available from the following MCH Library resource:

- Immunizations: Resource Brief at http://www.mchlibrary.info/guides/immunization.html

3. AUTHORS EXPLORE WOMEN'S BELIEFS ABOUT THE DEFINITION OF "FULL TERM" AND THE SAFETY OF DELIVERY AT VARIOUS GESTATIONAL AGES

"Pregnant women carry varying definitions of 'full term' and hold different opinions regarding the safety of delivery at various gestational ages," write the authors of an article published in the December 2009 issue of Obstetrics and Gynecology. The rate and absolute number of late preterm births (34-36 weeks of gestation) and early term births (37-38 weeks of gestation) are increasing. Births after induction of labor and cesarean delivery before labor appear responsible for much of the increase in preterm and early term births. However, the reasons for the choice of timing of these deliveries have not been well studied. When choosing when to deliver, women’s perceptions of the gestational age that defines preterm and whether prematurity poses health risks are likely to be important factors. In a recent survey commissioned by United Healthcare (a national health benefits provider) to estimate women’s attitudes related to cesarean and induced delivery, several questions were asked related to women’s beliefs about the definition of "full term" and the safety of delivery at various gestational ages. The article presents survey findings on women's understanding of the definition of "full term" and the gestational age at which it is safe to deliver during an otherwise healthy pregnancy.

First-time mothers ages 21-45 were selected at random from a national database of women who had given birth within the past 18 months. (Those who had a medical condition that would put them at high risk for a cesarean delivery were excluded from the study.) The survey explored the relationship between respondents' perceptions of the gestational age at which a birth becomes full term and the earliest gestational age at which they believed an infant can be delivered safely. The analysis also assessed whether participants' responses to the question on the gestational age they considered "full term" and "safe to deliver" varied by their sociodemographic characteristics.

The authors found that

• Six hundred and fifty women completed the survey.
• When asked "at what gestational age do you believe the baby is considered full term?" (with possible responses ranging from 34 to 40 weeks of gestation), 24.1 percent of the respondents chose 34-36 weeks, 50.8 percent chose 37-38 weeks, and 25.2 percent chose 39-40 weeks.
• Compared with women ages 21-29, women ages 30-39 were more likely to choose 34-36 weeks of gestation as the definition of "full term," as were single women compared with married women. Compared with women employed outside the home, those not employed outside the home were less likely to choose 34-36 weeks of gestation as the definition of "full term."
• When asked "what is the earliest point in the pregnancy that it is safe to deliver the baby, should there be no other medical complications requiring early delivery?" (also with the range of choices from 34-40 weeks of gestation), more than half of the women selected 34-36 weeks of gestation as their response. In contrast, fewer than one in four selected either 37 weeks or 38 weeks. Fewer than 10 percent chose 39-40 weeks
• Compared with white women, Asian women were less likely to choose 34-36 weeks of gestation, as were women with a high school education or a college education compared with women with a graduate education.
• The gestational age at which the women had delivered their infant significantly correlated with the gestational age at which they considered their infant full term and the gestational age at which they considered it safe to deliver. However, the association between the variables was relatively weak.
• There was a significant correlation between the gestational age at which women considered their infant full term and the earliest gestational age that they considered it safe to deliver, showing a moderately strong relationship.

"With the trend of an increased patient role in medical decision-making, ensuring that women understand the implications of the timing of delivery may be an important component of interventions to reduce the number of elective or semi-elective late preterm and early term deliveries," conclude the authors.

Goldenberg RL, McClure EM, Bhattacharya A, et al. 2009. Women's perceptions regarding the safety of births at various gestational ages. Obstetrics and Gynecology 114(6):1254-1258. Abstract available at http://journals.lww.com/greenjournal/Abstract/2009/12000/Women_s_Perceptions_Regarding_the_Safety_of_Births.15.aspx.

Readers: More information is available from the following MCH Library resource:

- Preconception and Pregnancy: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_pregnancy.html

4. ARTICLE ANALYZES ADOLESCENTS' USE OF MENTAL HEALTH SERVICES AFTER SCHOOL-BASED SUICIDE SCREENING

"Screening seems to be effective in enhancing the likelihood that students at risk for suicidal behavior will get into treatment," write the authors of an article published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Screening is an important component of adolescent suicide prevention. However, although research has supported suicide screening programs' ability to identify at-risk adolescents, a systematic assessment of whether these adolescents actually accessed services after being identified by the screen has not been reported. The study described in this article sought to examine service use follow-through by adolescents who screened as at risk for suicidal behavior and to identify barriers that adolescents and parents perceived as preventing them from following up on referrals.

At-risk adolescents were identified during a two-stage screening program conducted from fall 2002 through spring 2004 involving 2,342 adolescents (ages 13-19) enrolled in grades 9-12 in six high schools in New York State. A total of 317 adolescents were identified as being at risk. These students were followed approximately 2 years after the initial screen to assess service use during the intervening period and identify barriers that may have interfered with seeking treatment.

The authors found that

* At the time of the screen, 227 (71.6 percent) at-risk adolescents were not receiving any type of mental health services. Of these, researchers made referrals for 118 (51.9 percent) adolescents who were not currently receiving any mental health services, gave a list of local mental health professionals without a specific referral to 35, and gave no specific referral or health professional list to 74. (For the last group, the researchers determined that no treatment or further evaluation was needed, or the parent did not need or want assistance.)

* The follow-up participation rate was 70.3 percent (n=223). The rate did not differ significantly by referral recommendation (68.0 percent, 75.7 percent, and 71.4 percent) for those who received a referral, list, or no referral, respectively, but did differ significantly by the adolescents' treatment status at the time of the screen (66.5 percent and 80 percent for those who had not previously been in treatment and those who had been, respectively).

* Among the 78 students in the follow-up sample who were not receiving any mental health services at the time of the screen and received a referral, 69.2 percent (n=54) sought a new mental health service after the screen.

* Both adolescents and their parents reported perceptions about mental problems, specifically relating to the need for treatment, as the primary reason for not seeking services.

The authors conclude that "systematic planning is needed to ensure that screening and referral services are coordinated so as to facilitate access for youths into timely treatment." Furthermore, they add, "future efforts will be needed to enhance the engagement of parents and youths and address their perceptions about mental health problems."

Gould MS, Marrocco FA, Hoagwood K, et al. 2009. Service use by at-risk youths after school-based suicide screening. Journal of the American Academy of Child and Adolescent Psychiatry 48(12):1193-1201 Abstract available at http://journals.lww.com/jaacap/Abstract/2009/12000/Service_Use_by_At_Risk_Youths_After_School_Based.9.aspx.

Readers: More information is available from the following MCH Library resource:

- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html

- School Health: Resource Brief at http://mchlibrary.info/guides/schoolhealth.html

5. STUDY IDENTIFIES RISK FACTORS FOR ANTENATAL DEPRESSION AMONG AFRICAN AMERICAN WOMEN

"Our findings indicate that African American women's risk for depression increases with age," state the authors of an article published in the November 2009 issue of the Journal of Women's Health. Depression is the most common mental health problem identified during pregnancy and following delivery. Most research addresses postpartum depression; however, there is increasing evidence that antenatal depression impacts maternal health and birth outcomes. African American women are among those with the highest rates of antenatal and postpartum depression. Disadvantaged populations have been found to be more vulnerable to depression. Identifying pregnancy-related depression early is important in preventing postpartum depression and improving birth outcome. The article identifies factors associated with the risk for major antenatal depression among African American women with low incomes.

Data were collected during the period 2002-2007 through services provided by the Central Hillsborough Healthy Start program, a community-campus partnership to narrow racial disparities in maternal and infant health outcomes in urban neighborhoods in Tampa, Florida, where the black infant mortality and morbidity rates are more than double white rates. Florida's universal screening of pregnant women and infants was used to identify women at risk of poor outcomes. Screening included administration of the Edinburgh Postnatal Depression Scale (EPDS) during prenatal visits. The aggregate sum of EPDS scores from participating women was used to determine the prevalence of depressive symptomatology consistent with risk for antenatal depression. The analysis determined differences in sociodemographic characteristics between women with EPDS scores compatible with risk of major depression vs. those with lower scores.

The authors found that

• Of the 546 women in the study, 137 had EPDS scores consistent with risk for major depression (25.0 percent).
• Prenatal screening score and maternal age were significantly associated with elevated risk for major antenatal depression. The strongest association was with maternal age, which demonstrated an increase in risk for major antenatal depression in a dose-effect pattern.
• Compared with adolescents, the risk of major antenatal depression was more than doubled among women ages 25-29 and almost quintupled by the time African American women reached age 30 and beyond.
• The observed trend between maternal age and possible antenatal depression appeared to be biphasic, with age 30 being a critical point in time when the risk of antenatal depression became more pronounced and maintained a much greater level of risk there and beyond.

"Maternal age is a fairly good predictor of risk for major antenatal depression," conclude the authors. They add, "healthcare providers need to be aware of the increased risk of pregnancy-related depression in older African American women in order to better provide effective prenatal screenings and eventual optimal management for this population."

Luke S, Salihu HM, Alio AP, et al. 2009. Risk factors for major antenatal depression among low-income African American women. Journal of Women's Health 18(11):1841-1846. Abstract available at http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.1261.

Readers: More information is available from the following MCH Library resource:

- Depression During and After Pregnancy: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_postpartum.html

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