The literature presents kinship care in three interrelated ways: as an informal caregiving tradition in some minority communities, especially in the African-American community; as a child welfare service; and as an intergenerational parenting context with distinct family dynamics. Kinship care is defined as the caregiving of dependent children by a relative or close family friend when the biological parents are unavailable, unable, or unwilling to care for the child(ren) (Child Welfare League of American [CWLA], 1994). In the African-American community, kinship has traditional roots in slavery, in which children were taken into the homes of relatives and friends when their biological parents were sold. Contemporarily, the phrase kinship care emerges from the work of Stack (1974), who found that in an AfricanAmerican community, the extended family network is an important social support strategy. Kinship care also has moved from a traditional informal caregiving arrangement in the African-American community to a formal child welfare service. There are two types of kinship care arrangements: informal, which is an agreement among family members, and formal, which is facilitated in the child welfare system. Currently, a subsystem of formal service, kinship foster care, has evolved, in which children live with relatives and are under the jurisdiction of the child welfare system. Foster kinship care is the fastest growing out-of-home living arrangement. It is difficult to assess the prevalence of informal kinship care arrangements, but it is assumed to exceed formal kinship care arrangements.
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【Abstract】 Objective To explore the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain and its subtypes on the risk of preeclampsia. Methods Pregnant women delivered in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Shanxi Medical University from March 2012 to September 2016 were selected as the research subjects. According to the inclusion and exclusion criteria, 9 274 pregnant women were included. 901 preeclampsia pregnant women were selected as the case group, and 8 373 non-preeclampsia pregnant women were selected as the control group. General demographic characteristics, pre-pregnancy weight, height, lifestyle during pregnancy, reproductive history, and disease history of pregnant women were collected, and pre-pregnancy BMI and gestational weight gain were calculated. Unconditional logistic regression was used to analyze the relationship between pre-pregnancy BMI and weight gain during pregnancy and PE and its clinical subtypes. Results Among the 901 preeclampsia after inclusion and exclusion, 401 cases were diagnosed as early-onset PE (EOPE), 500 cases were late-onset PE (LOPE), 178 cases were Mild PE (MPE), and 723 cases were severe PE (SPE). There were statistically significant differences between PE and non-PE pregnant women in terms of maternal age, residence, parity, family history of gestational diabetes and hypertension (P<0.05). After adjusting for the above factors, the logistic regression analysis results showed that pre-pregnancy BMI<18.5 kg/m2 and inadequate gestational weight gain were protective factors for PE (OR=0.74, 95%CI: 0.56-0.98; OR=0.78, 95%CI: 0.62-0.99), while pre-pregnancy BMI≥ 24.0 kg/m2and excessive gestational weight gain were risk factors for PE (OR=1.82, 95%CI: 1.54-2.14; OR=1.82, 95%CI: 1.54-2.15). After subtype analysis on PE, the results showed that pre-pregnancy BMI<18.5 kg/m2 was a protective factor for EOPE and MPE (OR=0.52, 95%CI: 0.32-0.83; OR=0.47, 95%CI: 0.23-0.97), while pre-pregnancy BMI≥24.0 kg/m2 and excessive gestational weight gain were risk factors for clinical subtypes of PE. After stratification according to pre-pregnancy BMI, excessive gestational weight gain was the risk factor for PE (OR=1.86, 95%CI: 1.51-2.30; OR=1.90, 95%CI: 1.39-2.60) in pregnant women 18.5 kg/m2≤BMI<24.0 kg/m2 and ≥ 24.0 kg/m2. Inadequate gestational weight gain (OR=0.55, 95%CI: 0.34-0.89) was a protective factor for PE in pregnant women with pre-pregnancy BMI≥24.0 kg/m2. Excessive gestational weight gain (OR=4.05, 95%CI: 1.20-13.69) was a risk factor for EOPE in pregnant women with pre-pregnancy BMI< 18.5 kg/m2. Excessive gestational weight gain was a risk factor for the clinical subtype of PE in pregnant women 18.5 kg/m2≤BMI<24.0 kg/m2 before pregnancy. Inadequate gestational weight gain was a protective factor for EOPE and MPE (OR=0.39, 95%CI: 0.19-0.80; OR=0.29, 95%CI: 0.11-0.77) in pregnant women with pre-pregnancy BMI≥24.0 kg/m2. Excessive weight gain was a risk factor for EOPE, LOPE and SPE (OR=1.60, 95%CI: 1.06-2.42; OR=2.20, 95%CI: 1.44-3.37; OR=2.28, 95%CI: 1.58-3.29). Conclusions Pre-pregnancy BMI and gestational weight gain affect the risk of preeclampsia and its clinical subtypes. In contrast, the influence of gestational weight gain on preeclampsia varies among different pre-pregnancy BMI groups. Therefore, it is recommended to pay attention to the changes in pre-pregnancy BMI and gestational weight gain simultaneously to reduce preeclampsia. 【Key words】 Pre-pregnancy body mass index; Gestational weight gain; Preeclampsia Fund programs: National Natural Science Foundation of China (81703314, 81803323); Scientific and Technological Innovation Project of Higher Education Institutions in Shanxi Province (2019L0439)
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