Zelalem T. Haile

Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge

Background: Exclusive breastfeeding is recommended in the first 6 months of life, especially for infants born to women with a history of gestational diabetes mellitus (GDM). Yet, women with a history of GDM face challenges with exclusive breastfeeding in the early postpartum period, a critical period for setting up longer term breastfeeding success. Minimal research has been published on associated risk factors for not exclusively breastfeeding. Objective: The purpose of this study was to examine the association between GDM and exclusive breastfeeding at hospital discharge. Methods: We conducted a cross-sectional analysis including 2038 women who participated in the population-based Infant Feeding Practices Study II between May 2005 and June 2007. Results: Gestational diabetes mellitus prevalence was 5.8%. The crude prevalence of exclusive breastfeeding at hospital discharge was 62.2% among women with GDM compared to 75.4% of women without GDM (P < .01). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding were lower among women with GDM compared to women without diabetes (odds ratio = 0.59; 95% confidence interval, 0.39-0.92). Furthermore, women who had gestational weight gain (GWG) below the Institute of Medicine guidelines had lower odds of exclusive breastfeeding compared to women who had normal GWG (odds ratio = 0.62; 95% confidence interval, 0.45-0.85). Conclusion: Women with GDM history and women with inadequate GWG may need additional education to promote exclusive breastfeeding during maternal hospital stay. It is important for health care providers to assess both factors when providing education on exclusive breastfeeding and to support these women’s breastfeeding efforts in the early postpartum period to maximize potential for longer term breastfeeding success.

Association between oral contraceptive use and markers of iron deficiency in a cross-sectional study of Tanzanian women.

To analyze the associations between oral contraceptive (OC) use and markers of iron deficiency, objectively measured using hemoglobin and soluble transferrin receptor.

Influence of gestational diabetes mellitus on fatty acid concentrations in human colostrum

OBJECTIVE The aim of this study was to examine differences in fatty acid concentrations in colostrum of women with and without gestational diabetes mellitus (GDM). The effect of GDM on fatty acid composition of colostrum is not fully understood, although rates of GDM are increasing globally. METHODS A prospective case-control study was conducted of postpartum women with and without GDM. Gas chromatographic analysis was conducted to examine differences in colostral fatty acids of the colostrum samples of 29 women with and 34 without GDM. RESULTS Analyses of the fatty acid composition revealed significantly higher concentrations of four essential ω-6 polyunsaturated fatty acids-γ-linolenic, eicosatrienoic, arachidonic, and docosatetraenoic-in the colostrum of GDM women compared with non-GDM women. Timing of collection influenced saturated medium chain fatty acid and monounsaturated fatty acid levels. CONCLUSIONS Differences in concentrations of ω-6 fatty acids but not in dietary linoleic fatty acid or ω-3 fatty acids suggest that altered concentrations are attributed to changes in specific endogenous metabolic pathways. Implications of higher concentrations of ω-6 fatty acids in the colostrum of women with GDM have yet to be determined. Timing of colostrum collection is critical in determining colostral fatty acid and metabolite concentrations.

Factors that can influence feelings towards and interactions with people living with HIV/AIDS in rural Central Kenya.

Background In Kenya, HIV incidence and prevalence have declined. HIV rates are lower in rural areas than in urban areas. However, HIV infection is reported higher in men in rural areas (4.5%) compared to those in urban areas (3.7%). Objectives This study examined HIV knowledge, feelings, and interactions towards HIV-infected from 302 participants in rural Central Kenya. Methods Chi square tests and multivariable logistic regression analyzed variables of interest. Results Most participants exhibited positive feelings in their interaction with people living with HIV and AIDS (PLWHA). Association between HIV knowledge and socio-demographic characteristics revealed that the proportion of participants with a correct response differed by gender, age, level of education, and marital status (p < 0.05). Compared to those with inadequate knowledge of HIV/AIDS, participants with adequate HIV/AIDS knowledge were nearly three times as likely to disagree that PLWHA should be legally separated from others to protect public health (adjusted odds ratio: aOR (95% CI) (2.76 (1.12, 6.80). Conclusions HIV stigma continues to impact HIV prevention strategies particularly in rural Central Kenya. Culturally, appropriate interventions addressing HIV knowledge among those with lower levels of education, single, older, and male are warranted. Review of HIV policies separating high-risk populations from the general population is needed to reduce stigma.

Correlates of women's knowledge of mother-to-child transmission of HIV and its prevention in Tanzania: a population-based study

Studies that explored womens knowledge on mother-to-child transmission (MTCT) of HIV and its prevention (PMTCT) in the general population are currently lacking. This paper examined factors associated with having adequate knowledge of MTCT of HIV and PMTCT among a nationally representative sample of women in Tanzania. We conducted a cross-sectional analysis including 10,299 women from the 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The outcome of interest was the presence of adequate knowledge on MTCT and PMTCT of HIV. We used multivariable logistic regression to identify factors associated with having adequate knowledge on MTCT and PMTCT of HIV. Results revealed that the overall prevalence of having adequate knowledge on MTCT and PMTCT of HIV was low (46%). We found a statistically significant difference in the proportions of having adequate knowledge between HIV-negative and HIV-positive women (45% vs. 56%; p < .0001), although knowledge of the transplacental route of transmission did not differ by HIV serostatus. Overall, having adequate knowledge on MTCT and PMTCT of HIV was positively associated with experiencing at least one pregnancy, having some education, having higher household wealth, residing in urban area, being exposed to HIV education, having tested for HIV, knowing a place to get HIV test, and having comprehensive knowledge on HIV and AIDS. Among HIV-seropositive women, experiencing at least one pregnancy and having comprehensive knowledge on HIV and AIDS were strongly associated with having adequate knowledge on MTCT and PMTCT of HIV (Adjusted odds ratio: aOR 2.78, 95% CI 1.21, 6.37 and aOR 1.71, 95% CI 1.15, 2.73, respectively). Further efforts are needed to enhance HIV/AIDS education among women of childbearing age and strengthen PMTCT services in Tanzania.

Gestational weight gain and unplanned or emergency cesarean delivery in the United States

BACKGROUND In the United States, the rates of cesarean delivery are well above the World Health Organization recommended target. Although obesity is a widely established risk factor for cesarean delivery, there is limited population-based research that examines the relationship between gestational weight gain and cesarean delivery. OBJECTIVE To determine the association between gestational weight gain and unplanned or emergency cesarean delivery. METHODS We examined 2107 mothers from the Infant Feeding Practices Study II 2005-2007. The Institute of Medicines current guidelines were used to define categories of gestational weight gain: inadequate (less than the recommended guideline), adequate (within the recommended guideline) and excessive (above the recommended guideline). FINDINGS Approximately 49.3% and 13.6% of the participants had excessive weight gain and unplanned or emergency cesarean delivery, respectively. A Greater proportion of women with excessive weight gain had an unplanned or emergency cesarean delivery followed by women with adequate and inadequate weight gain, respectively (17.8%, 10.0%, 8.8%; p<0.001). In the multivariable model, compared to women with adequate weight gain, the odds of unplanned or emergency cesarean delivery were higher among women with excessive weight gain (OR 1.56, 95% CI 1.07-2.27, p=0.020). DISCUSSION Women with excessive gestational weight gain are more likely to experience an unplanned or emergency cesarean delivery, which increases the risk for poor maternal-infant health outcomes. CONCLUSION It is critical to identify populations at increased risk of unplanned or emergency cesarean delivery and provide preconception and prenatal counseling to achieve and maintain the recommended weight gain for optimal maternal-infant health outcomes.

Association Between Risky Sexual Behavior and Cervical Cancer Screening Among Women in Kenya: A Population-Based Study

Women residing in Eastern Africa are disproportionately affected by cervical cancer. Previous studies have identified risky sexual behavior as a major risk factor for cervical cancer. However, population-based studies examining the relationship between sexual behavior and cervical cancer screening are currently lacking. This descriptive cross-sectional study utilized nationally representative secondary data from the 2014 Kenya Demographic and Health Survey (n = 6104) to examine the association between risky sexual behavior and cervical cancer screening among sexually active women. Both descriptive and inferential statistical methods were utilized. Overall, 20.2% of the study sample reported having cervical cancer examination. Approximately 13.1% of the participants reported involvement in risky sexual behavior. Significantly lower proportion of women engaged in risky sexual behavior reported having cervical cancer examination (14.5 vs. 21.0%; p = 0.001). In the multivariable model, we found a significant interaction between risky sexual behavior and marital status on cervical cancer examination. Among women who were married/living together, risky sexual behavior was negatively associated with cervical cancer examination after adjusting for potential confounders (Prevalence Ratio, 95% CI) (0.42; 0.24–0.74; p = 0.002). The prevalence of having visual inspection with VIA or VILI were lower among women who were involved in risky sexual behavior (0.39; 0.18–0.87; p = 0.022). However, we were unable to detect any significant association between risky sexual behavior and having Papanicolaou test. With increasing incidence of cervical cancer in resource-limited settings, it is critical to identify populations at increased risk of infection and provide effective screening and follow-up services.

The moderating role of race/ethnicity on associations between insurance status and HPV vaccination among women in the USA

To evaluate associations between insurance status and HPV vaccination.

Association of Youth Characteristics and Recent Utilization of Dental Services in the United States

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersens theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youths utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates

BACKGROUND AND OBJECTIVE Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. METHODS Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. RESULTS The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. CONCLUSIONS Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.