1
|
Morris AR, Sellery PE, Truong V, Jeyasingh D, Haddan L, Saxbe DE. Maternal prenatal social contact during the COVID-19 pandemic predicts infant birth weight. Early Hum Dev 2023; 187:105881. [PMID: 37944266 PMCID: PMC10773973 DOI: 10.1016/j.earlhumdev.2023.105881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Social connectedness and mental health have been associated with infant birth weight, and both were compromised by the COVID-19 pandemic. AIMS We sought to examine whether changes in maternal prenatal social contact due to the COVID-19 pandemic were associated with infant birth weight and if maternal prenatal mental health mediated this association. STUDY DESIGN A longitudinal study of mothers and their infants born during the first wave of the COVID-19 pandemic. SUBJECTS The sample consisted of 282 United States-based mother-infant dyads. OUTCOME MEASURES Depressive symptoms were measured with the Beck Depression Inventory-II, anxiety was measured with the State Anxiety Inventory, and stress was measured using the Perceived Stress Scale 14. We also asked participants about pandemic-related changes in social contact across various domains. Adjusted birth weight was calculated from birth records or participant-report when birth records were unavailable. RESULTS Decreases in social contact during the pandemic were associated with lower adjusted infant birth weight (B = 76.82, SE = 35.82, p = .035). This association was mediated by maternal prenatal depressive symptoms [Effect = 15.06, 95 % CI (0.19, 35.58)] but not by prenatal anxiety [95 % CI (-0.02, 32.38)] or stress [95 % CI (-0.31, 26.19)]. CONCLUSION These findings highlight concerns for both mothers and infants in the wake of the COVID-19 pandemic, since birth weight can have long-term health implications and the social restructuring occasioned by the pandemic may lead to lasting changes in social behavior.
Collapse
Affiliation(s)
- Alyssa R Morris
- Department of Psychology, University of Southern California, Los Angeles, CA, United States.
| | - Pia E Sellery
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Van Truong
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Divya Jeyasingh
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Lila Haddan
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
2
|
Hinton L, Dumelow C, Hodgkinson J, Montgomery C, Martin A, Allen C, Tucker K, Green ME, Wilson H, McManus RJ, Chappell LC, Band R. 'Nesting networks': Women's experiences of social network support in high-risk pregnancy. Midwifery 2023; 120:103622. [PMID: 36893551 DOI: 10.1016/j.midw.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING England. PARTICIPANTS Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.
Collapse
Affiliation(s)
- L Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge.
| | - C Dumelow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - J Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - C Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - C Allen
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| | - K Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - H Wilson
- Department of Women and Children's Health, King's College London, London
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - L C Chappell
- Department of Women and Children's Health, King's College London, London
| | - R Band
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| |
Collapse
|
3
|
Scelza BA, Hinde K. Crucial Contributions : A Biocultural Study of Grandmothering During the Perinatal Period. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2020; 30:371-397. [PMID: 31802396 PMCID: PMC6911617 DOI: 10.1007/s12110-019-09356-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.
Collapse
Affiliation(s)
- Brooke A Scelza
- Department of Anthropology, UCLA, Los Angeles, CA, 90095-1553, USA. .,Center for Behavior, Evolution and Culture, UCLA, Los Angeles, CA, 90095-1553, USA.
| | - Katie Hinde
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 85287, USA.,Center for Evolution and Medicine, Arizona State University, Tempe, AZ, 85287, USA
| |
Collapse
|
4
|
Cameron RP, Wells JD, Hobfoll SE. Stress, Social Support and Coping in Pregnancy. J Health Psychol 2016; 1:195-208. [DOI: 10.1177/135910539600100204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The social support literature, despite its focus on women's strengths in relationships, has not fully addressed the social realities of women of diverse ethnic backgrounds and socio economic conditions. Specifically, the emphasis on marital relationships as primary sources of support during pregnancy marginalizes those women for whom these partnerships are unhelpful or unavailable. In addition, women's greater use of social support as a coping strategy is often portrayed in the coping literature as an ineffective approach to stress. Data from two studies of pregnant women are presented to illustrate these points and to present a new model of coping that reframes women's coping as prosocial, active and effective. Our article is designed to challenge researchers to examine the relevance of work on social support and coping to women of varying ethnicities and economic circumstances.
Collapse
|
5
|
Tesdahl E, Gesell SB. Assessing the Impact of De Novo Social Ties within Health Intervention Settings: New Questions for Health Behavior Intervention Research. Clin Transl Sci 2015; 8:676-81. [PMID: 26577514 DOI: 10.1111/cts.12345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Recent developments in the study of health and social networks have focused on linkages between health outcomes and naturally occurring social relations, such as friendship or kinship. Based on findings in this area, a new generation of health behavior intervention programs have been implemented that rely on the formation of new social relations among program participants. However, little is known about the qualities of these de novo social relations. We examined the social networks of 59 participants within a randomized controlled trial of an intervention designed to prevent excessive gestational weight gain. We employed exponential random graph modeling techniques to analyze supportive relationships formed between participants in the intervention arm, to detect unique effects of program participation on the likelihood of forming ties. Program participation had a positive effect on the likelihood of forming supportive social relations, however, in this particular timeframe we did not detect any additional effect of such relations on the health behaviors or outcomes of interest. Our findings raise two critical questions: do short-term group-level programs reliably lead to the formation of new social relations among participants; and do these relations have a unique effect on health outcomes relative to standard methods of health behavior intervention?
Collapse
Affiliation(s)
- Eric Tesdahl
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Sabina B Gesell
- Department of Social Sciences and Health Policy, and The Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
6
|
Modeling costs and benefits of adolescent weight control as a mechanism for reproductive suppression. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2013; 3:299-334. [PMID: 24222442 DOI: 10.1007/bf02734054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/1992] [Accepted: 06/02/1992] [Indexed: 10/22/2022]
Abstract
The "reproductive suppression hypothesis" states that the strong desire of adolescent girls in our culture to control their weight may reflect the operation of an adaptive mechanism by which ancestral women controlled the timing of their sexual maturation and hence first reproduction, in response to cues about the probable success of reproduction in the current situation. We develop a model based on this hypothesis and explore its behavior and evolutionary and psychological implications across a range of parameter values. We use the process of model development to identify assumptions implicit in the reproductive suppression hypothesis and variables that need to be measured in order to investigate it more fully. In addition, because costs were probably associated with weight control, an important part of this analysis is the specification of situations in which the benefits of adaptive adjustment of the maturation schedule could have outweighed the costs of achieving that adjustment by slowing adolescent weight gain.
Collapse
|
7
|
Raman S, Srinivasan K, Kurpad A, Dwarkanath P, Ritchie J, Worth H. 'My mother…my sisters… and my friends': sources of maternal support in the perinatal period in urban India. Midwifery 2013; 30:130-7. [PMID: 23561829 DOI: 10.1016/j.midw.2013.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/13/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to explore the wide-ranging sources of support that the maternal-infant dyad need or expect throughout the perinatal period in urban India. DESIGN qualitative interviews and ethnographic approach. SETTING homes and community settings in greater metropolitan Bangalore, South India. PARTICIPANTS using in-depth interviews of 36 mothers from different socio-cultural and socio-economic backgrounds who had given birth within the past two years in a tertiary hospital, we explored the nature of support, advice and emotional sustenance through pregnancy, childbirth and the early child rearing period available to these women. FINDINGS the overwhelming importance of women's own mothers in practical and emotional terms, the connectedness to 'native' place or 'ooru', the role of the diverse, extensive female network and the more contingent role of the husband emerged as major themes. The family was a major source of support as well as distress. While the support from their own mother was a constant, women used various forms of support throughout the perinatal continuum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE we call for a more nuanced understanding of what women in urban India expect and need in terms of support throughout the perinatal period. Clinicians and policy makers need to understand the various players, their different roles at critical times through the perinatal continuum and be able to identify those who are vulnerable and in need of enhanced support. Although the health sector is not a strong player in the socio-cultural milieu in the perinatal period, their role as facilitators of this support is crucial.
Collapse
Affiliation(s)
- Shanti Raman
- Department of Community Paediatrics, South Western Sydney and Sydney Local Health Districts, Liverpool Hospital, Liverpool, NSW 2170, Australia.
| | | | | | | | | | | |
Collapse
|
8
|
Zlotnick C, Capezza NM, Parker D. An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study. Arch Womens Ment Health 2011; 14:55-65. [PMID: 21153559 PMCID: PMC3042850 DOI: 10.1007/s00737-010-0195-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 11/02/2010] [Indexed: 11/29/2022]
Abstract
This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing depression and posttraumatic stress disorder (PTSD) in a sample of low-income pregnant women with recent intimate partner violence (IPV). Fifty-four women were randomly assigned to the intervention or control group. The intervention consisted of four sessions during pregnancy and one "booster" session within 2 weeks of delivery. Based on principles of Interpersonal Psychotherapy, the intervention was designed to help participants improve their interpersonal relationships, including their social support networks, and master their role transition to motherhood. Assessments were administered at four time points (intake, 5-6 weeks post-intake, 2 weeks postpartum, 3 months postpartum) to assess for depression, PTSD, and IPV. The intervention did not significantly reduce the likelihood of a major depressive episode, PTSD, or IPV during pregnancy or up to 3-month postpartum. However, we found moderate effects for the intervention in reducing symptoms of PTSD and depression during pregnancy and a large effect for PTSD symptoms from pregnancy up to 3 months postpartum. This study suggests some initial support for our intervention. Larger randomized trials are needed to further examine the intervention both during and after pregnancy.
Collapse
Affiliation(s)
- Caron Zlotnick
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | | | | |
Collapse
|
9
|
Baldwin KA. Comparison of Selected Outcomes of CenteringPregnancy Versus Traditional Prenatal Care. J Midwifery Womens Health 2010; 51:266-272. [PMID: 16814221 DOI: 10.1016/j.jmwh.2005.11.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to assess the effect of traditional prenatal care versus a group model of care, CenteringPregnancy, on maternal knowledge of pregnancy, social support, health locus of control, and satisfaction. The CenteringPregnancy model of care gives patients extended time with the provider in a group setting. The study used a two-group, pretest/posttest design of pregnant women who elected either the traditional approach to prenatal care (n = 48) or the Centering approach (n = 50). The results of this study showed statistically significant differences between the groups on posttest in knowledge of pregnancy. For social support and health locus of control, the high scores at pretest contributed to a ceiling effect, which limited the potential for change. Additional research is needed to assess health status outcomes among women electing alternative approaches to prenatal care.
Collapse
|
10
|
Bollini P, Pampallona S, Wanner P, Kupelnick B. Pregnancy outcome of migrant women and integration policy: A systematic review of the international literature. Soc Sci Med 2009; 68:452-61. [PMID: 19042065 DOI: 10.1016/j.socscimed.2008.10.018] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Indexed: 10/21/2022]
|
11
|
Cruz AN. Heterogeneity of Birthweight Outcomes among Latinas in Boston. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2002. [DOI: 10.2190/9gjl-4ryd-e9tj-bawa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examines the increase in poor birth outcomes, particularly low birthweight (LBW) and very low birthweight (VLBW) among Latinas in Boston for 1992–1994 and 1996. The research questions were: 1) What are the factors influencing Latino birth outcomes particularly LBW and VLBW?; and 2) Do these factors occur differently among Latino women from different ethnic backgrounds? Birth certificate data from the Massachusetts Department of Public Health for Latinos in Boston from 1987–1995 were used to examine these questions. The sociodemographic, health access, maternal/biological, substance abuse, and infant risk factors contributing to poor birthweight outcomes among Puerto Ricans, Cubans, Dominicans, Mexicans, Central Americans, South Americans, and other Latino ethnic groups were examined through bivariate and multivariate analyses. Statistically significant differences were observed among the groups. The findings reveal variation in the number and types of variables affecting birthweight among various Latino ethnic groups and inform health and social policies regarding Latino women's reproductive and perinatal health.
Collapse
|
12
|
Hoare K, Wright CM, Wilson P, Weaver LT. Disseminating weaning messages: an intervention trial. Br J Community Nurs 2002; 7:196-200. [PMID: 11979198 DOI: 10.12968/bjcn.2002.7.4.10225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports a non-randomized intervention study conducted in two market towns to find out whether participant-centred health education discussions improve parents' knowledge and actions concerning infant feeding. Following an initial quiz, parents of 8-week-old infants attended a discussion on weaning (intervention) or home safety (control). They were then asked to complete a questionnaire about their knowledge and actions concerning weaning when their infants were 7-9 months old. A total of 61 parents took part in the intervention and 49 in the control. In the post-intervention questionnaire, the intervention group reported using more home-cooked foods and less commercially-prepared foods and knew the optimum time to register their infants with the dentist. These results suggest that participant-centred discussions are an effective way of disseminating public health messages concerning infant feeding.
Collapse
Affiliation(s)
- K Hoare
- Sure Start Bedlington and Scotland Gate, Northumberland
| | | | | | | |
Collapse
|
13
|
Abstract
Fetal growth is an indicator of social inequalities in health that may have a long-term impact persisting into later life. Little is known about the social patterns of birth weight in Hong Kong. This is a study of live-born singletons from 1984 to 1997 in a Hong Kong birth registry. Ordinary least-squares regression and logistic regression are used to analyse birth weight and low birth weight (< 2500 g), respectively. A gradient of birth weight and prevalence of low birth weight is demonstrated according to mothers' educational attainment. In relation to babies of the most educated mothers, babies of the least educated mothers had a mean deficit of 46g in birth weight and an odds ratio of 1.56 of low birth weight (each P<0.05). This social gradient was hidden unless parity was adjusted for. Unexpectedly, migrants from mainland China delivered heavier rather than lighter babies (each P<0.05). Type of living quarters and parental relation were also related to birth weight and low birth weight (each P<0.05). Continuous monitoring of the social patterns of birth weight is recommended.
Collapse
Affiliation(s)
- Y B Cheung
- Clinical Trials Centre, Faculty of Médicine, University of Hong Kong, Pokfulam
| | | |
Collapse
|
14
|
Ritter C, Hobfoll SE, Lavin J, Cameron RP, Hulsizer MR. Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. Health Psychol 2000; 19:576-85. [PMID: 11129361 DOI: 10.1037/0278-6133.19.6.576] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources.
Collapse
Affiliation(s)
- C Ritter
- Department of Sociology, Kent State University, Ohio 44242, USA.
| | | | | | | | | |
Collapse
|
15
|
Cavalli AS, Tanaka T. Maternal leisure-time physical activities are not determinant risk factors of low birthweight babies: A cross-sectional study of 1,714 pregnant women. Environ Health Prev Med 2000; 5:72-80. [PMID: 21432201 DOI: 10.1007/bf02932007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/1999] [Accepted: 02/28/2000] [Indexed: 12/16/2022] Open
Abstract
There is a general recognition of the role of low birthweight (LBW) as a major determinant of infant mortality rates. Since the rate of LBW has been increasing over the past fifteen years in Japan, we decided to ascertain the risk factors related to it, and also to verify whether or not maternal leisure-time physical activities including sports activities, before pregnancy and during gestation, affected the rate of LBW babies. In our study of the 2,682 questionnaires delivered within a year to the Municipal Health Centers of the three cities chosen for this study, 1,714 questionnaires were analyzed. The results in a univariate analysis showed that maternal height, pre-pregnancy weight, length of gestation, smoking, hospitalization before the 37th week of gestation, a history of LBW, and occupational activities were significantly associated with LBW. In logistic regression analyses, mothers of smaller stature, less pre-pregnancy weight, less length of gestation and mothers who were, furthermore, hospitalized before the 37th week of gestation, smoked, had previously delivered a LBW baby or had experienced stressful events during pregnancy were more likely to have LBW babies. The results showed that maternal leisure-time physical activities before and/or during pregnancy had no bearing on the delivery of a LBW baby.
Collapse
Affiliation(s)
- A S Cavalli
- Graduate School of Physical Education, Division of Health Science, Chukyo University, 101 Tokodachi, 470-0348, Kaizu-cho, Toyota, Aichi-ken
| | | |
Collapse
|
16
|
Variables perinatales y desigualdades en salud en un área sanitaria de Cáceres. GACETA SANITARIA 2000. [DOI: 10.1016/s0213-9111(00)71426-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
17
|
Abstract
Stress is thought to be one of the biopsychosocial factors that contribute to adverse pregnancy outcomes, such as preterm labor and low birthweight. Identification of these factors (as in total number), and measurement of their individually perceived importance (severity) could lead to opportunities for intervention, and improved pregnancy outcome. A pilot study of the Daily Hassles Scale, was conducted in order to determine the appropriateness of its use among pregnant women. Daily hassles were thought to be a valid proxy for prenatal stress. Content and construct validity were determined among a sample of four content experts and 30 pregnant women. The Daily Hassles Scale proved to be a reliable (internally consistent) measure of stress (alpha reliability coefficient of 0.90). Further adaptation of the scale to include hassles specific to pregnancy and further testing of its usefulness among diverse multicultural and ethnic populations is warranted.
Collapse
Affiliation(s)
- R J Ruiz
- University of Texas Health Science Center, San Antonio, USA.
| | | |
Collapse
|
18
|
Gaudino JA, Jenkins B, Rochat RW. No fathers' names: a risk factor for infant mortality in the State of Georgia, USA. Soc Sci Med 1999; 48:253-65. [PMID: 10048782 DOI: 10.1016/s0277-9536(98)00342-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Many studies have explored maternal and infant factors as risks for infant mortality, but little attention is given to paternal factors. In Georgia, listing a father's name on the birth certificate is optional for married couples and possible after paternal acknowledgment for unmarried couples. The authors evaluated father's name reporting as a paternity measure and risk for infant mortality. Using the linked 1989-1990 birth and death certificates of singleton Georgia infants to calculate relative risks (RRs), infant mortality rates for 38,943 infants with no father's names listed were compared to rates for 178,100 with father's names listed. Compared with the rate for married women listing names, the death rates were higher for unmarried mothers not listing fathers (relative risk, RR = 2.5; 95% CI 2.3-2.7), unmarried mothers listing fathers (RR = 1.4; 95% CI 1.3-1.6), and married women not listing fathers (RR = 2.3; 95% CI 1.6-3.1). Increased risks remained after stratifying by maternal race, age, adequacy of prenatal care and medical risks; and congenital malformations, birthweight, gestational age, and small-for-gestational age. Using logistic regression to examine for effect modification and to adjust for these factors together, the adjusted relative risks for death varied across different groups without fathers' names, regardless of marital status. For example, it remained statistically higher for infants with no father listed and without effect-modifying conditions such as low birthweight (estimated RR = 2.0; 95% CI 1.6-2.4). Although these findings suggest paternal involvement, as measured by listing fathers' names, is protective against low birthweight and infant mortality, further evaluation is needed.
Collapse
Affiliation(s)
- J A Gaudino
- Pregnancy and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | |
Collapse
|
19
|
Abstract
The purpose of the study was to identify how women described, interpreted, and managed their preterm labor experience. Ten married, middle-class women participated in an in-depth, tape-recorded interview in the hospital after preterm labor was stabilized; periodically over the telephone after discharge from the hospital; and in the hospital, home, or via telephone after birth, for a total of 31 interviews. Using qualitative data analysis techniques, the findings were conceptualized as five recursive stages: becoming aware that something was wrong and feeling unbalanced, making sense of the experience as they sought to understand why preterm labor occurred, trying different strategies to re-create a balance in their lives, addressing other life stressors that threatened restoring balance, and emerging from the preterm labor experience with added growth. An increased understanding of the preterm labor experience from the women's perspective can be helpful to health care professionals and others who support women during pregnancy.
Collapse
Affiliation(s)
- M A Coster-Schulz
- Department of Mental Health, William S. Hall Psychiatric Institute, South Carolina, USA
| | | |
Collapse
|
20
|
Abstract
This study presents a structural equation model describing the influence of stressful life experiences on low birth weight. Data were gathered prospectively in two waves from 5295 inner-city women as part of a city-wide preterm birth prevention project. Using interviews and the medical record, over 200 measures were gathered on each mother and her infant, where each measure was included because of its relevance documented in the risk factor literature. Seventeen of these measures reflected real life stressful experiences and through measurement modeling, eleven of these measures were chosen to represent three underlying measures of stress: economic stress, family stress, and the lack of social support. This study incorporates these psychosocial stressors into a full structural equation model to show their influence on addictive behavior and low birth weight. The full model emerged from tests of alternative causal conceptualizations of how these stressors influence each other and low birth weight--whether their influence on low birth weight in simple and direct, or whether their influence is mediated by addictive behaviors. The model was tested on the first wave, a sample of 3205, and cross-validated on the second wave, a sample of 2090. The model shows that economic stress influences both social support and family stress, but has no direct influence on low birth weight: that social support, or its absence, influences addictive behavior, but has no direct influence on low birth weight, and that family stress influences addictive behavior, and consistent with 30 years of research on humans, has no direct influence on low birth weight. Finally, the mother's history of medical risks shows an independent influence on low birth weight, while her age does not. Age, however, shows a strong influence on addictive behavior. The study demonstrates how structural equation modeling can be used to create and test alternative conceptualizations of how stress affects low birth weight. There are strong implications for planners of prenatal care programs.
Collapse
Affiliation(s)
- T J Sheehan
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, USA
| |
Collapse
|
21
|
Abstract
This paper describes the psychological and psychosocial aspects of prenatal care, which are believed to be of particular importance for medical/psychological practice. The emotional changes that "normally" take place during pregnancy are surveyed and evidence is provided linking these changes with potential adverse effect on pregnancy and labour. The salience of anxiety and life stresses in pregnancy research is highlighted as well as their intricate inverse relationship with social support. Antenatal classes are offered as an example of social support provision. The different kinds of such classes and evaluation of their effectiveness are briefly presented, as well as a number of controlled trials of enhanced support during pregnancy. Finally, the effect provision of prenatal care has on women as well as their role in their own care are raised. The need is stressed for further sophisticated longitudinal and multivariate research exploring further the causative links between quality of prenatal care, pregnancy outcome, and subsequent child development.
Collapse
Affiliation(s)
- T Dragonas
- Department of Early Childhood Education, University of Athens, Greece
| | | |
Collapse
|
22
|
Roberts EM. Neighborhood social environments and the distribution of low birthweight in Chicago. Am J Public Health 1997; 87:597-603. [PMID: 9146438 PMCID: PMC1380839 DOI: 10.2105/ajph.87.4.597] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined the socioeconomic precursors of disparities in maternal health by measuring the associations of nine neighborhood-level indicators of social phenomena with low infant birthweight. METHODS Vital records and census data for the Chicago metropolitan area in 1990 were merged (n = 112,327); a logistic regression model predicting low birthweight was estimated by backward elimination. RESULTS With individual-level variables held constant, six neighborhood-level indicators predicted low birthweight, together contributing to a variation in rate of 5.5%. Community economic hardship and housing costs were positively associated with low birthweight, while community socioeconomic status, crowded housing, and high percentages of young and African-American residents were negatively associated with low birthweight. CONCLUSIONS Maternal health inequalities should be explored in the context of historical segregation, social stratification, the dynamics of social support, and resource sharing among communities. Several community characteristics associated with poverty are negatively associated with low birthweight. The traditional focus on individual risk factors for low birthweight limits our understanding.
Collapse
Affiliation(s)
- E M Roberts
- Medical Scholars Program, University of Illinois at Urbana-Champaign 61801, USA
| |
Collapse
|
23
|
Ogden J, Mtandabari T. Examination stress and changes in mood and health related behaviours. Psychol Health 1997. [DOI: 10.1080/08870449708407406] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
24
|
Abstract
We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth retardation. Included in the review are all reports on the direct effects of stressors or psychological distress; the indirect effects of stressors or distress through health behaviours such as smoking; and the direct and buffering effects of social support. Although an important stimulus for recent stress research has been the attempt to explain racial and social class differences in birth outcome, the recent data show that stressful life events during pregnancy, though more common in disadvantaged groups, do not increase the risk of preterm birth. In contrast, intimate social support from a partner or family member appears to improve fetal growth, even for women with little life stress. Questions unanswered by the research to date are whether elevated levels of depressive symptoms affect pregnancy outcome, either directly or by encouraging negative health behaviours, and whether chronic (vs. acute) stressors are harmful. Additional research is also needed to determine whether psychosocial factors interact with specific clinical conditions to promote adverse pregnancy outcomes. Focusing on intimate support and how it benefits pregnancy outcome could lead to the design of more effective interventions.
Collapse
Affiliation(s)
- S Hoffman
- Division of Epidemiology, Columbia University School of Public Health, New York, USA
| | | |
Collapse
|
25
|
Sherraden MS, Barrera RE. Prenatal care experiences and birth weight among Mexican immigrant women. J Med Syst 1996; 20:329-50. [PMID: 9001998 DOI: 10.1007/bf02257044] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
National studies indicate that Mexican immigrant women tend to have more positive birth outcomes than other groups, despite receiving relatively low levels of medical prenatal care. Our study-based on in-depth interviews with immigrant women who had recently given birth in Chicago-examines women's experiences seeking prenatal care. Qualitative findings contribute to understanding why many of these women received less than optimal care during pregnancy. The study also offers modest evidence that, despite overall positive birth outcomes and low levels of prenatal care, adequate prenatal care may make a difference in birth outcomes in this group. Suggestions are made concerning ways to improve access to adequate care, paying particular attention to the impact of migration and communication in prenatal care.
Collapse
Affiliation(s)
- M S Sherraden
- Department of Social Work and Research Associate, University of Missouri-St. Louis 63121, USA
| | | |
Collapse
|
26
|
Paarlberg KM, Vingerhoets AJ, Passchier J, Dekker GA, Van Geijn HP. Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J Psychosom Res 1995; 39:563-95. [PMID: 7490693 DOI: 10.1016/0022-3999(95)00018-6] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This review focuses on the research concerning the relation between psychosocial factors and pregnancy outcome. The following four outcome measures are dealt with: (1) birth weight, (2) preeclampsia, (3) preterm labour, and (4) intrapartum complications. The most consistent finding concerns the association between maternal exposure to taxing situations and preterm delivery. Three possible pathways are hypothesized: (1) an indirect influence via unhealthy coping and life style behaviour, (2) a direct influence via stress-dependent hormones, and (3) an additional direct influence via psycho-immunological factors. Intervention studies aimed at improving pregnancy outcome show fairly mixed results. It is recommended that studies on the relationship between psychosocial factors and pregnancy outcome should employ a prospective design with due attention to chronic stressors, should include appropriate biochemical assessments, and multivariate techniques are applied.
Collapse
Affiliation(s)
- K M Paarlberg
- Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
27
|
Callister LC. Beliefs and perceptions of childbearing women choosing different primary health care providers. Clin Nurs Res 1995; 4:168-80. [PMID: 7757024 DOI: 10.1177/105477389500400204] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The beliefs and perceptions of 60 low-risk childbearing women (n = 60) who had either nurse midwives or obstetricians as health care providers are identified in this descriptive phenomenological study. Interviews were conducted following childbirth, and participants completed the Utah Test for the Childbearing Year, which measures beliefs and perceptions about childbearing. There were no significant demographic differences, or significant differences in fear of childbirth, between groups of women having different providers. Mothers with physician caregivers had significantly higher rates of epidural anesthesia for pain management, higher levels of reliance on others, and less active participation in childbirth care decisions. Mothers with certified nurse midwives as caregivers participated more actively in childbirth care decisions and emphasized the quality of the birth experience. In this sample, differences in the beliefs and perceptions of women choosing different health care providers are identified. The importance of a philosophical fit with care providers and availability of options that are congruent with the individualized needs of childbearing women is evident from the study findings.
Collapse
|
28
|
Stamp GE, Crowther CA. Women's views of their postnatal care by midwives at an Adelaide Women's Hospital. Midwifery 1994; 10:148-56. [PMID: 7815954 DOI: 10.1016/0266-6138(94)90045-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE to determine the characteristics of a sample of women giving birth in one hospital in South Australia and these women's perceptions of the usefulness of the advice and care that they were given during the puerperium DESIGN survey using questionnaires, incorporating Lipsett's (1984) questions, administered before the women left hospital and at six weeks postdelivery. SETTING one hospital in South Australia. PARTICIPANTS a sample of convenience of 235 women completed the hospital questionnaire and 222 (95%) returned the six weeks postpartum questionnaire. FINDINGS the women's ages ranged from 17-44 years, 86% were living in a stable relationship and 42% were primiparous. Most women (74%) made comments on the helpfulness of midwives. The midwife provided emotional support (57%), answered questions (32%) and gave information (30%). However, midwives' attitudes were perceived as insensitive (18%) and judgemental (9%). Midwives gave conflicting advice (10%) and 40% of the women made one or more comments about midwife unhelpfulness. Sixteen per cent of the women made no comment on the helpfulness of the midwife. IMPLICATIONS FOR PRACTICE contact with midwives in the early postnatal period is an ideal time for helpful advice and support to be given but midwives are not always perceived as fulfilling this part of their role. There is a need to address the issue of conflicting advice.
Collapse
|
29
|
Norwood SL. First Steps: participants and outcomes of a maternity support services program. J Obstet Gynecol Neonatal Nurs 1994; 23:467-74. [PMID: 7965250 DOI: 10.1111/j.1552-6909.1994.tb01906.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To describe characteristics and pregnancy outcomes of participants in a maternity support program and to compare these characteristics and outcomes with those for women who were eligible for, but did not participate in, the program. DESIGN Descriptive, ex post facto. SETTING An inland northwest city. PARTICIPANTS Two hundred twenty postpartum patients who received Medicaid during their pregnancy. MAIN OUTCOME MEASURE Quantitative data were obtained from a structured interview that gathered demographic information. Subjects also completed the Social Support Apgar, an investigator-designed instrument. RESULTS Demographic characteristics and overall pregnancy outcomes were similar for program participants and nonparticipants; however, more program participants than nonparticipants quit smoking during their pregnancy. CONCLUSIONS Findings are consistent with results documented by other researchers on the effectiveness of similar programs in different locales. The findings support the need for continued efforts to better define appropriate target populations, interventions, and expectations for these programs.
Collapse
Affiliation(s)
- S L Norwood
- Department of Nursing at Gonzaga University, Spokane, WA
| |
Collapse
|
30
|
Reading R, Raybould S, Jarvis S. Deprivation, low birth weight, and children's height: a comparison between rural and urban areas. BMJ (CLINICAL RESEARCH ED.) 1993; 307:1458-62. [PMID: 8281087 PMCID: PMC1679497 DOI: 10.1136/bmj.307.6917.1458] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To compare proportions of low birthweight babies and mean heights of schoolchildren between rural and urban areas at different levels of social deprivation. DESIGN Cross sectional population based study classifying cases by Townsend material deprivation index of enumeration district of residence and by rural areas, small towns, and large towns. SETTING Northumberland Health District. SUBJECTS 18,930 singleton infants delivered alive during January 1985 to September 1990 and resident in Northumberland in October 1990; 9055 children aged 5 to 8 1/2 years attending Northumberland schools in the winter of 1989-90. MAIN OUTCOME MEASURES Odds ratios for birth weight less than 2800 g; difference in mean height measured by standard deviation (SD) score. RESULTS Between the most deprived and most affluent 20% of enumeration districts the odds ratio for low birth weight adjusted for rural or urban setting was 1.71 (95% confidence interval 1.51 to 1.93) and the difference in mean height -0.232 SD score (-0.290 to -0.174). Between large towns and rural areas the odds ratio for low birth weight adjusted for deprivation was 1.37 (1.23 to 1.53) and the difference in mean height -0.162 SD score (-0.214 to -0.110). Results for small towns were intermediate between large towns and rural areas. CONCLUSIONS Inequalities in birth weight and height exist in all rural and urban settings between deprived and affluent areas. In addition, there is substantial disadvantage to living in urban areas compared with rural areas which results from social or environmental factors unrelated to current levels of deprivation.
Collapse
|
31
|
Degen HM, Myers BJ, Williams-Petersen MG, Knisely JS, Schnoll SS. Social support and anxiety in pregnant drug abusers and nonusers: unexpected findings of few differences. Drug Alcohol Depend 1993; 32:37-44. [PMID: 8486083 DOI: 10.1016/0376-8716(93)90020-q] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Drug-abusing (n = 25) and nonusing (n = 55) pregnant women from a publicly supported prenatal clinic were tested for level of social support and of pregnancy anxiety during the last half of pregnancy. Differences found between the groups were fewer than expected. Drug abusers did not differ from nonusers in overall level of social support or in Appraisal, Belonging, or Tangible subscales. Abusers were found to report lower levels of self esteem; lower self esteem was predicted by drug abuse, having more children and lower socioeconomic status. Drug abusers did not differ from nonusers in their overall feelings of pregnancy anxiety, but they did indicate higher fears for themselves and for the baby, and there was a tendency for higher depression and withdrawal.
Collapse
Affiliation(s)
- H M Degen
- Department of Psychology, Virginia Commonwealth University, Richmond 23284-2018
| | | | | | | | | |
Collapse
|
32
|
Abstract
This study used a naturalistic approach to describe the childbearing woman's views of her preterm labor and delivery experience. Specifically, the aim was to identify how women describe, interpret, and manage preterm labor and subsequent preterm or term delivery. The views of 20 women who were hospitalized for preterm labor (before 37 weeks) were documented with semistructured, tape-recorded, in-depth interviews during their hospitalization for preterm labor and after delivery. Qualitative data analysis focused on the process of becoming a preterm labor patient and on living with a diagnosis of preterm labor. Women either waited for a period of time before seeking care or sought care immediately for the symptoms they were experiencing. Women interpreted the experience by identifying causes of preterm labor and by worrying about the outcome for the baby. Managing preterm labor required extensive, moderate, or limited changes in their lives. Women who delivered at term appeared to have more tangible help than those who delivered preterm. A better understanding of women's preterm labor experiences will provide clues to nurses on how to improve the care they provide.
Collapse
|
33
|
|
34
|
Oakley A. Measuring the effectiveness of psychosocial interventions in pregnancy. Int J Technol Assess Health Care 1992; 8 Suppl 1:129-38. [PMID: 1428631 DOI: 10.1017/s0266462300013027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Questions about the effectiveness of psychosocial interventions in pregnancy are important in any overall evaluation of antenatal care. This article reviews the evidence as to the positive benefit on a range of pregnancy outcomes provided by 35 published and unpublished randomized controlled trials of psychosocial interventions.
Collapse
|
35
|
Bryce RL, Stanley FJ, Garner JB. Randomized controlled trial of antenatal social support to prevent preterm birth. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:1001-8. [PMID: 1751431 DOI: 10.1111/j.1471-0528.1991.tb15338.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To test the effect of a programme of additional antenatal social support on the occurrence of preterm birth (a birth from 20 to 36 weeks gestation) in women at risk of preterm birth. DESIGN A prospective randomized controlled trial. The design was one of randomization before consent for a new treatment. SETTING Three public hospital antenatal clinics in Perth and the offices of 87 obstetricians and general practitioners in Western Australia. SUBJECTS 1970 pregnant women with poor obstetric histories entered the trial; 983 of these were randomly allocated to the programme group and 987 to the control group. INTERVENTIONS Normal antenatal care was provided for both groups. In addition, members of the programme group were offered an intervention aimed at providing expressive (emotional) social support, consisting of antenatal home visits and telephone calls by midwives. Of the women allocated to the programme group, 24 refused consent and 69 were not traced before completion of their pregnancies, the remaining 890 women (90.5%) agreed to enter the programme, and each received at least one intervention. MAIN OUTCOME MEASURES Gestational age at completion of the pregnancy. A pregnancy ending before 20 weeks was labelled a miscarriage. RESULTS There were 126/981 (12.8%) preterm births in the programme group and 147/986 (14.9%) in the control group. The outcome data for two women in the programme group and one in the control group could not be found. The unadjusted odds ratio for preterm birth in the programme was 0.84 (95% CI 0.65-1.09). The observed relative reduction in preterm births associated with the programme was 13.8% (95% CI -8.2% to +31.5%) and the trial had a 60% power to exclude a true relative reduction of 25%. CONCLUSIONS The results of this trial and those of other controlled clinical trials provide little evidence for the effectiveness of social support interventions in the prevention of preterm birth in women with poor obstetric histories.
Collapse
Affiliation(s)
- R L Bryce
- Department of Obstetrics & Gynaecology, Flinders Medical Centre, Bedford Park, South Australia
| | | | | |
Collapse
|
36
|
Merkatz RB, Merkatz IR. The contributions of the nurse and the machine in home uterine activity monitoring systems. Am J Obstet Gynecol 1991; 164:1159-62. [PMID: 2035556 DOI: 10.1016/0002-9378(91)90676-i] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The relative contributions of home tokodynamometry and daily nursing telephone contact to the success of preterm birth prevention programs remains a subject of debate. Because investigators have obtained conflicting data, a reinterpretation of published results was undertaken by proposing a dynamic interface between the nurse and the machine. Experience gained from the technology and the development of nursing expertise with assessment of patient symptoms are presented as interdependent factors, both of which are critical to a therapeutic nurse-patient relationship. It is proposed that this combined interactive expertise increases sensitivity to the early recognition of preterm labor. The nurse's role in providing social support to high-risk pregnant women is then identified as a potential additional independent contributing factor to reported observed reductions in preterm births. Discussion focuses on future research, public policy issues, and the need for expanding nurse-patient interactions into the home.
Collapse
Affiliation(s)
- R B Merkatz
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461
| | | |
Collapse
|
37
|
Mutale T, Creed F, Maresh M, Hunt L. Life events and low birthweight--analysis by infants preterm and small for gestational age. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:166-72. [PMID: 2004053 DOI: 10.1111/j.1471-0528.1991.tb13363.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Social stress was assessed in 92 women with low-birthweight babies and 92 controls using the detailed LEDS measure of life events and severe chronic difficulties. The low-birthweight group was divided into preterm delivery (n = 40), small for gestational age (SGA) (n = 40) and mixed groups. Multivariate analysis was performed using a binomial-logit model to examine whether social factors were independently and significantly associated with low birthweight once the effect of demographic factors, obstetric factors and smoking/drinking were taken into account. Comparison of preterm births with controls indicated that three factors were significantly associated: a previous low-birthweight baby, severe life event/difficulty and bleeding during pregnancy. For SGA babies the factors were: previous low-birthweight baby, low social support and smoking. By using a reliable measure of life events and adequate numbers of low-birthweight babies, this study overcame the potential inaccuracies of previous studies and indicates a more specific relation between social stress and low birthweight.
Collapse
Affiliation(s)
- T Mutale
- Department of Psychiatry, Manchester Royal Infirmary
| | | | | | | |
Collapse
|
38
|
Abstract
In the past decade the prevention and management of prematurity have begun to be addressed with more appropriate designs. A few strategies--very few--can now be recommended. A few, some widely implemented, can be abandoned. The risks and benefits of most interventions still require clarification.
Collapse
|
39
|
Abstract
Both observational studies and nonrandomized controlled trials have found the presence of support during pregnancy to be associated with superior outcomes in terms of preventing abortion, extending the length of gestation, and reducing interventions in labor. However, randomized controlled trials of supportive interventions in pregnancy have not demonstrated any physical benefits from the interventions. It is also unlikely there are any significant adverse effects. Psychological benefits do appear to result from supportive interventions, including better enjoyment of the pregnancy and better postnatal status.
Collapse
Affiliation(s)
- R L Bryce
- Flinders Medical Centre, South Australia
| |
Collapse
|
40
|
Abstract
The purpose of this paper is to review the literature on psychosocial factors in pregnancy outcome and to present a model which attempts to integrate the findings theoretically. There are four sections. The first presents published data on the incidence of early childhood mortality and low birth weight. Changes over time and differences between countries are noted and attention is drawn to the marked inequalities between occupational groups in the British data. The second section reviews the evidence that a variety of psychosocial risk factors influence pregnancy outcome, notably social, emotional, cognitive and behavioural factors. The third section develops the theme of inequalities and examines theories which have been advanced to account for the differences in adult mortality. We argue that material deprivation goes some way towards explaining inequalities in pregnancy outcome, but that any proper account will have to explain the links between inputs and outcomes--the processes and mechanisms by which material deprivation is translated into observable mortality and morbidity. In the concluding section, we argue that some of the principal links are the psychosocial risk factors described in the second section, and we present a model which traces the pathways of mediation.
Collapse
|
41
|
Pagel MD, Smilkstein G, Regen H, Montano D. Psychosocial influences on new born outcomes: a controlled prospective study. Soc Sci Med 1990; 30:597-604. [PMID: 2309138 DOI: 10.1016/0277-9536(90)90158-o] [Citation(s) in RCA: 129] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper reports the results of a prospective investigation of 100 women during their pregnancies to test the hypothesis that social and psychological factors influence pregnancy outcome after controlling for demographic, biomedical, and lifestyle variables. Subjects completed questionnaires that assessed family social supports, life events, and anxiety. In addition, data were collected on general biomedical and pregnancy risk, lifestyle practices including smoking and drinking, as well as demographic information. Four infant outcomes, birthweight, gestational age, and 1 and 5 min Apgar scores, were studied via hierarchical multiple regression analyses for their relationship to the social and psychological variables, after controlling for all other sets of variables. The results of these analyses showed that life events stress accounted for significant variation in birthweight, and social supports and anxiety were associated with the two pediatric Apgar scores. Gestational age bore a simple relationship to anxiety, with higher anxiety predictive of lower gestational age. Further analyses revealed that women with either low social supports or high anxiety were, on the average, younger, more often single, of lower education level, had less income, smoked more, and had higher general biomedical risk than women with adequate social supports or lower anxiety. This suggests the multiple ways in which social and psychological risk factors may be related to pregnancy outcome and emphasizes the need for well controlled studies in this area.
Collapse
Affiliation(s)
- M D Pagel
- Department of Family Practice, University of Washington, Seattle 98195
| | | | | | | |
Collapse
|
42
|
Power FL, Gillies PA, Madeley RJ, Abbott M. Research in an antenatal clinic--the experience of the Nottingham Mothers' Stop Smoking Project. Midwifery 1989; 5:106-12. [PMID: 2586327 DOI: 10.1016/s0266-6138(89)80024-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Nottingham Mothers' Stop Smoking Project was extremely successful in helping women to stop smoking during pregnancy and in reinforcing non-smoking behaviour. This paper describes the experience of undertaking the action research project in the antenatal clinic from the points of view of the researchers, women and midwifery staff. The article outlines the practical problems encountered in attempting to adhere to a research protocol. The implementation of the project involving friendly encouragement, a carbon monoxide monitor and the offer of self-help groups is described within the context of the busy antenatal clinic setting. Pregnant women's experience of the project and the views of midwifery staff are also presented. The feasibility of incorporating such projects into everyday activity is discussed.
Collapse
|
43
|
Gale R, Seidman DS, Dollberg S, Armon Y, Stevenson DK. Is teenage pregnancy a neonatal risk factor? JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1989; 10:404-8. [PMID: 2808085 DOI: 10.1016/0197-0070(89)90219-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Maternal characteristics and neonatal outcome of 421 primiparas aged 15-19 years who delivered at Bikur Cholim Hospital in Jerusalem were examined. The study group included 190 teenage mothers from the Mea Shearim community who marry young and who receive extensive social and economic support. The control group included 231 teenage mothers from other areas of Jerusalem, characterized by a predominantly low social class, Oriental ethnic origin, and a high rate of out-of-wedlock births (28.6%). The Mea Shearim mothers had a significantly lower incidence of low birth weight (less than 2500 g) infants compared to the control group (6.3% vs. 14.7%, p less than 0.01). The differences could not be explained by maternal age distribution, ethnicity, smoking, or marital status. These results suggest that in a community that provides extensive social and economic support and good access to free prenatal care of high standard, teenage pregnancy is not a neonatal risk factor.
Collapse
Affiliation(s)
- R Gale
- Department of Neonatology, Bikur Cholim Hospital, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
44
|
Elliott PM, Tattersall MH, Coppleson M, Russell P, Coates AS, Solomon HJ. Changing character of cervical cancer in young women. BMJ (CLINICAL RESEARCH ED.) 1989; 298:1451. [PMID: 2502289 PMCID: PMC1836582 DOI: 10.1136/bmj.298.6685.1451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
45
|
Milford CA. Hypoxaemia and adenoidectomy. BMJ (CLINICAL RESEARCH ED.) 1989; 298:1451. [PMID: 2502290 PMCID: PMC1836589 DOI: 10.1136/bmj.298.6685.1451-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
46
|
Jennett B. Life sustaining technology: making the decisions. West J Med 1989. [DOI: 10.1136/bmj.298.6685.1450-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
47
|
Dowling P. Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress. West J Med 1989. [DOI: 10.1136/bmj.298.6685.1451-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Spencer B, Thomas H, Morris J. A randomized controlled trial of the provision of a social support service during pregnancy: the South Manchester Family Worker Project. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1989; 96:281-8. [PMID: 2653416 DOI: 10.1111/j.1471-0528.1989.tb02387.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A pilot scheme was introduced in Manchester to provide additional social support to pregnant women at above average risk of giving birth to a low-birthweight baby. The help of lay workers, known as family workers, was made available to eligible women. The effect on infant birthweight of offering the help of a family worker was assessed by a randomized controlled trial. No significant differences were observed between the experimental and control group, but on a number of grounds the interpretation of this finding is not straightforward, and further research is recommended.
Collapse
Affiliation(s)
- B Spencer
- Department of Epidemiology and Social Oncology, University of Manchester, Christie Hospital and Holt Radium Institute, Kinnaird Road, Withington
| | | | | |
Collapse
|
49
|
Lumley J. The prevention of preterm birth: unresolved problems and work in progress. AUSTRALIAN PAEDIATRIC JOURNAL 1988; 24:101-11. [PMID: 3293559 DOI: 10.1111/j.1440-1754.1988.tb00298.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J Lumley
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
50
|
Blondel B, Zuber MC. Marital status and cohabitation during pregnancy: relationship with social conditions, antenatal care and pregnancy outcome in France. Paediatr Perinat Epidemiol 1988; 2:125-37. [PMID: 3237493 DOI: 10.1111/j.1365-3016.1988.tb00192.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A survey of a representative sample of 5508 births in France in 1981 permitted the study of social characteristics of pregnant women, the medical care they received during their pregnancy and their pregnancy outcome, as a function of their marital status and whether or not they lived with the father of the child. Unmarried women living with the father (n = 412) like unmarried women living alone (n = 171), were more often younger, having their first baby and had a lower educational level than did married women living with the father (n = 4590). However, among the unmarried women, those living alone were in a more unfavourable position than those living with the father; in particular, they were more often less than 20 years old, had the minimum educational level required and were unemployed. Both groups of unmarried women had a higher preterm delivery rate than did married women, even after taking other risk factors into account in a logistic regression. The odds ratios (95% confidence interval) for pre-term delivery among unmarried mothers living without the father was 1.9 (1.0-3.4) and that for the unmarried cohabiting with the father was 1.6 (1.0-2.4). Thus, to fully appreciate the perinatal risks and medical needs during pregnancy, both the marital and cohabitational status of the women should be considered.
Collapse
Affiliation(s)
- B Blondel
- Unité de Recherches Epidémiologiques, INSERM, Villejuif, France
| | | |
Collapse
|