Yee, Lynn M.

Abstract Introduction The Hunger Vital Sign (HVS) is a two‐item, validated food insecurity screener recommended by the American Academy of Pediatrics. Given its brevity, HVS could be useful in assessing food insecurity in pregnant populations, for whom high‐quality nutrition and food access is essential. However, the HVS has not been evaluated in obstetric settings. Thus, we aimed to evaluate the performance of the HVS compared to the gold standard, the 18‐item US Household Food Security Survey Module (HFSSM) among low‐income, urban pregnant people. Methods We conducted a prospective study at a multi‐hospital tertiary health system (September 2023 to April 2024) in the United States. English‐ or Spanish‐speaking individuals from zip codes in which ≥10% of households were under the federal poverty line or who had publicly funded antenatal care completed a 20‐min self‐administered survey, which included the HFSSM and HVS. Food insecurity was defined as marginal, low, or very low food insecurity on the HFSSM; the prevalence of food insecurity was assessed and evaluated by participant characteristics. A positive screen on the HVS was defined as a “often true” or “sometimes true” to either item. Descriptive statistics were performed to characterize the performance of the HVS compared to the HFSSM. Results Of 713 potentially eligible participants based on medical record review, 192 (27%) completed an eligibility screener and were found to be eligible. Of these, 171 (89%) completed the survey. Nearly half (41%) of participants ( n = 70; of whom 74% received publicly funded care) screened positive for food insecurity on the HFSSM. HVS sensitivity was 83%, while specificity was 96%. The positive predictive value of the HVS was 94% and negative predictive value was 89%. Conclusion The two‐item HVS had relatively high accuracy for detecting food insecurity in this low‐income, urban obstetric population. Incorporating this brief screener into prenatal care may enable efficient, clinically useful food insecurity detection and intervention to address this need.

Abstract Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians' perspectives on postpartum pain management differed by clinician roles. This is a qualitative study at a large, tertiary, and academic medical center. From November 2021 to June 2022, obstetric clinicians, including attending physicians, trainee physicians, and advanced practice providers (APPs), were recruited to complete in-depth interviews regarding their clinical experience managing postpartum pain using a semi-structured interview guide. Participants were asked to reflect both on their own role and that of the other clinician types. Purposive sampling was used to enroll a cohort representative of the institutional workforce in terms of clinician type and demographics. Data were analyzed using the constant comparative method. Of 46 participants, 47.8% (n = 22) were attending physicians, and 91% (n = 42) were female. Emergent themes were both self-reflected and externally directed. Data demonstrated that postpartum pain management differs by clinician type and level of experience. Themes related to the role of attending physicians included responsibilities as teachers for trainees, supervisory roles, and perceptions that attendings have greater comfort with prescribing opioids. Themes related to the role of trainee physicians included the impact of patient load on trainees' management, limitations of morning rounds, familiarity with emerging data, and perceptions of hesitancy to prescribe opioids. Themes related to the role of APPs included less reliance on opioids for postpartum pain management and emphasis on nonpharmacological approaches. Perspectives on postpartum pain management vary by clinician role. Consideration of these differences and the interplay between roles is essential when examining opioid prescribing patterns and developing interventions to improve postpartum pain management.

Introduction Given the rising incidence and importance of treatment adherence for gestational diabetes (GDM), this study aimed to examine patient perspectives on social support's role in gestational diabetes (GDM) management during pregnancy and early postpartum. Methods This is an analysis of qualitative data collected during a feasibility randomized controlled trial of postpartum patient navigation for individuals with GDM. Participants completed semistructured interviews at 4 to 12 weeks postpartum on their experiences with GDM as well as facilitators and barriers to its management, including social support. Data were analyzed using the constant comparative method. Results Of 38 participants, 55% reported a family member or friend with a history of GDM, type 1, or type 2 diabetes mellitus. The analysis identified 4 themes: (1) communal support, (2) indirect GDM support (ie, removing logistical barriers to care), (3) direct GDM support, and (4) barriers of social support (eg, stigma), which impeded disease understanding. Participants identified communal support as a catalyst for lifestyle change and a source for advice and emotional support. Indirect support included transportation, childcare, and work accommodations. Direct support included providing healthy food, giving insulin shots, or providing accountability. Discussion Harnessing social support may be a key strategy to activate and sustain lifestyle and self‐management skills in GDM and should be considered in intervention development.

Abstract Postpartum pain management practices have significant variation and are known to be influenced by nonclinical factors. We aimed to examine factors that contribute to clinicians' assessment and management of postpartum pain, including the role of opioids. We conducted a qualitative study of obstetric clinicians providing postpartum care at a single, large, tertiary care center (November 2021–June 2022). Attending and trainee OB/GYN physicians and advanced practice providers (APPs) completed in-depth interviews using a semistructured interview guide. Purposive sampling was employed to ensure a representative sample of each clinician type was included. Participants were asked about factors that influence postpartum pain management. Data were analyzed using the constant comparative method. Of 46 participants, 48% were attending physicians, 32% trainee physicians, and 20% APPs. The analysis demonstrated three key themes related to postpartum assessment and management: influencing factors (knowledge or experiences that influence practice), objective findings, and the role of counseling. While clinicians reported guidelines and patient satisfaction as major influencing factors, several also shared the inherent conflict that may arise between them. Objective findings, specifically the impact of pain on patients achieving functional goals, also influenced clinician decision-making. Conversely, many participants reported the limited utility of the numeric pain scale as an objective metric. Additionally, the role of counseling in shared decision-making and providing anticipatory guidance was emphasized. Finally, clinicians had a range of opinions on the role of opioids in pain management, but many spoke to the value of opioids as second-line treatment and the impact of the opioid epidemic on prescribing practices. The factors that influence clinicians' assessment and management of postpartum pain are occasionally in conflict. Furthermore, objective measures, such as the numeric pain scale, have significant limitations.