Dataset Information

Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017.

ABSTRACT: Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002 to 2017 (N?=?13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, marital status, education level, income) and clinical (trimester, substance use, alcohol use disorder, major depression). Where associations differed by pregnancy stage (trimester 1 vs. trimesters 2 and 3), association was evaluated by stage. Overall, higher risk for any and binge drinking was observed among those with other substance use (aORs 2.9-25.9), alcohol use disorder (aORs 4.5-7.5), depression (aORs?=?1.6), and unmarried women (aORs 1.6-3.2). For any drinking, overall, higher risk was observed in adolescents (aOR?=?1.5) and those with higher education (aOR?=?1.4), while lower risk was observed in those with lower income (aORs?=?0.7). For binge drinking, associations differed by pregnancy stage. In trimester 1, lower risk was observed in middle ages (aOR?=?0.4). In trimesters 2/3, higher risk was observed in Blacks (aOR?=?3.3) and those with lower income (aORs 3.5-3.9), while lower risk was observed in those with higher education (aOR?=?0.3). To prevent severe prenatal harm, health care providers should focus on women at higher risk for binge drinking during pregnancy: women with tobacco or drug use, alcohol use disorder, or depression, and women who are unmarried, Black, or of lower socioeconomic status.

SUBMITTER: Shmulewitz D

PROVIDER: S-EPMC6561097 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017.

Shmulewitz Dvora D Hasin Deborah S DS

Preventive medicine 20190501

Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002 to 2017 (N = 13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, ...[more]

PMID: 31054285

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Project description:ImportanceSince 1994, the US Department of Health and Human Services has published treatment guidelines for pregnant women living with HIV. Understanding how well prescribing patterns correspond with treatment guidelines could inform health policy and influence future clinical practice.ObjectivesTo compare antiretroviral prescribing practices over time among pregnant women living with HIV with Department of Health and Human Services treatment guidelines and identify factors associated with receiving recommended regimens.Design, setting, and participantsA prospective cohort study of 1582 pregnant women living with HIV were enrolled in the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring of ART (antiretroviral therapy) Toxicities study between January 1, 2008, and June 30, 2017. The study was conducted at 18 academic research hospitals in the United States.ExposuresAntiretroviral medications (ARVs) prescribed during pregnancy.Main outcomes and measuresProportion of regimens prescribed to pregnant women living with HIV qualifying as preferred or alternative according to Department of Health and Human Services guidelines, stratified by timing of initiation.ResultsOf 1867 pregnancies (among 1582 pregnant women living with HIV with a mean [SD] age of 28.6 [6.1] years at conception), 1264 (67.7%) occurred among women self-identified as black, 480 (25.7%) self-identified as white, and 123 (6.6%) self-identified as other or unreported race/ethnicity. Antiretroviral medications were initiated prior to conception for 790 women (42.3%), resumed during pregnancy for 625 women (33.5%), and initiated during pregnancy for 452 women (24.2%). Only 925 pregnancies (49.5%) were associated with prescribed ARVs designated as preferred or alternative, while 492 (26.4%) involved ARVs with insufficient evidence for use during pregnancy and 136 (7.3%) involved ARVs that were not recommended during pregnancy. A higher proportion of treatment-naive pregnant women initiating ARVs were prescribed preferred or alternative ARVs compared with those resuming ARVs or those treated with ARVs before conception (316 of 452 [69.9%] vs 325 of 625 [52.0%] vs 284 of 790 [35.9%]; P?<?.001). A total of 91 of 452 women (20.1%) initiating ARVs during pregnancy were prescribed ARVs with insufficient evidence for use during pregnancy or not recommended during pregnancy. Among women resuming ARVs, those with a viral load greater than 1000 copies/mL early in pregnancy had higher odds of being prescribed guideline-recommended ARVs (adjusted odds ratio, 2.03 [95% CI, 1.33-3.10]) compared with those with a viral load of 400 copies/mL or less.Conclusions and relevanceThis study suggests that US ARV prescribing practices for pregnant women living with HIV do not align well with national guidelines. This finding is particularly concerning when treatment is initiated during pregnancy. Further research is needed to understand disparities between prescribing practices and evidence-based guideline recommendations.

Project description:Describe the longitudinal national epidemiology of tracheostomies performed in acute care hospitals and describe the annual rate of tracheostomy performed for patients with respiratory failure with invasive mechanical ventilation.DesignSerial cross-sectional study.SettingThe 2002-2014 and 2016-2017 Healthcare Utilization Project's National Inpatient Sample datasets.PatientsDischarges greater than or equal to 18 years old, excluding those with head and neck cancer or transferred from another hospital. We used diagnostic and procedure codes from the International Classification of Diseases, 9th and 10th revisions to define cases of respiratory failure, invasive mechanical ventilation, and tracheostomy.InterventionsNone.Measurements and main resultsThere were an estimated 80,612 tracheostomies performed in 2002, a peak of 89,545 tracheostomies in 2008, and a nadir of 58,840 tracheostomies in 2017. The annual occurrence rate was 37.5 (95% CI, 34.7-40.4) tracheostomies per 100,000 U.S. adults in 2002, with a peak of 39.7 (95% CI, 36.5-42.9) in 2003, and with a nadir of 28.4 (95% CI, 27.2-29.6) in 2017. Specifically, among the subgroup of hospital discharges with respiratory failure with invasive mechanical ventilation, an annual average of 9.6% received tracheostomy in the hospital. This changed over the study period from 10.4% in 2002, with a peak of 10.9% in 2004, and with a nadir of 7.4% in 2017. Among respiratory failure with invasive mechanical ventilation discharges with tracheostomy, the annual proportion of patients 50-59 and 60-69 years old increased, whereas patients from 70 to 79 and greater than or equal to 80 years old decreased. The mean hospital length of stay decreased, and in-hospital mortality decreased, whereas discharge to intermediate care facilities increased.ConclusionsOver the study period, there were decreases in the annual total case volume and adult occurrence rate of tracheostomy as well as decreases in the rate of tracheostomy among the subgroup with respiratory failure with invasive mechanical ventilation. There is some evidence of changing patterns of patient selection for in-hospital tracheostomy among those with respiratory failure with invasive mechanical ventilation with decreasing proportions of patients with advanced age.

Project description:CONTEXT:Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking. OBJECTIVE:To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States. DESIGN:National survey. SETTING:Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. PARTICIPANTS:A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status. MAIN OUTCOME MEASURES:Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking. RESULTS:Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status. CONCLUSIONS:Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.

Dataset Information

Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017.

Publications

Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017.

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