An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers

Health Characteristics and Birth Outcomes for "Starting Out Right," a Teen Pregnancy Program

PURPOSE

To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, "Starting Out Right" (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation.

DESCRIPTION

The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate.

ASSESSMENT

Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began.

CONCLUSION

These results suggest that participation in SOR was associated (p ≤ 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p ≤ 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens.

Who goes back to school after birth? Factors associated with postpartum school return among adolescent mothers in the Eastern Cape, South Africa

Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high . This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare.

Post-Pregnancy Factors Predicting Teen Mothers' Educational Attainment by Age 30 in Two National Cohorts

Women who begin childbearing as teenagers attain lower levels of education than women who delay childbearing until age 20 and later. Little is known about post-pregnancy factors that predict educational attainment among teen mothers. The current study examined whether teen mothers' environment and experiences 2 years after their first birth contribute to their educational outcomes by age 30, net of selection factors associated with teenage childbearing. Data were from two cohorts, the National Longitudinal Surveys of Youth 1979 (N = 241) and 1997 (N = 378). Multinomial logistic regression modeling was used to assess associations of post-pregnancy factors with teen mothers' educational attainment. Having child care was associated with increased odds of attaining a high school diploma and of attending college in both cohorts. Providing regular and subsidized child care for teen mothers is an opportunity to support teen mothers in achieving higher levels of educational attainment.

How effects on health equity are assessed in systematic reviews of interventions

BACKGROUND

Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions.  OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness.

SEARCH METHODS

We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies.

SELECTION CRITERIA

We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment).

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.  MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility.

AUTHORS' CONCLUSIONS

There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.

Bodies of concern? A qualitative exploration of eating, moving and embodiment in young mothers

In some countries, including the United Kingdom, young mothers' pregnant and postnatal bodies remain an area of concern for policy and practice, with interventions developed to support improved health behaviours including diet and physical activity. This article explores what young women themselves think and feel about eating and moving during and after pregnancy. Semi-structured interviews with 11 young mothers were conducted within two voluntary organisations. Data were analysed using thematic analysis with the theoretical lens of embodiment, which provided an understanding of how young women's eating and moving habits related to how they felt about their bodies in the world. Four themes situated in different experiences of being and having a body were identified: pregnant body, emotional body, social body and surveilled body. Stress and low mood impacted eating habits as young women responded to complex circumstances and perceived judgement about their lives. Food choices were influenced by financial constraints and shaped by the spaces and places in which young women lived. Whilst young women were busy moving in their day-to-day lives, they rarely had the resources to take part in other physical activity. Holistic approaches that focus on how women feel about their lives and bodies and ask them where they need support are required from professionals. Interventions that address the structural influences on poor diet and inequalities in physical activity participation are necessary to underpin this. Approaches that over-focus on the achievement of individual health behaviours may fail to improve long-term health and risk reinforcing young women's disadvantage.

A Systematic Review of Programs to Promote Aspects of Teen Parents' Self-sufficiency: Supporting Educational Outcomes and Healthy Birth Spacing

Introduction

Expectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children’s healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents’ self-sufficiency by promoting their educational outcomes and healthy birth spacing.

Methods

We conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review’s eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies’ findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence.

Results

We identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs.

Discussion

Effective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens’ education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness.

Electronic supplementary material

The online version of this article (10.1007/s10995-019-02854-w) contains supplementary material, which is available to authorized users.

Social networking sites: Can midwives and nurses working with adolescent mothers harness their potential value?

AIM

This paper aims to discuss social networking sites as potentially salutogenic, culturally relevant extensions to maternity care provision for adolescent mothers.

BACKGROUND

Studies report that online networking may enhance social capital, a concept linked to enhanced well-being, particularly for marginalized individuals. Improving outcomes for adolescent mothers is an ongoing global strategy; thus, this paper has relevance for all professionals involved in their care.

DESIGN

This is a discussion paper.

DATA SOURCES

This paper draws on the authors' research and is supported by literature and theory. Key terms and Boolean operators were used to identifiy English-language papers published in January 1995 to January 2019 in nine databases and Google Scholar databases.

IMPLICATIONS FOR NURSING

Despite limited evidence specific to adolescent mothers, contextual studies suggest that social networking sites may enhance well-being. Nurses and midwives need to understand adolescent mothers' use of online networks to aid development of innovative, health-enhancing care strategies using adolescent-familiar modalities.

CONCLUSION

This paper highlights the need for further research regarding the value of professional engagement in online networks to enhance an adolescent's transition to motherhood.

Perinatal epidemiology: Issues, challenges, and potential solutions

Perinatal epidemiology research is concerned with identifying the effects of events during pregnancy on pregnancy outcomes that include maternal, fetal, and neonatal health outcomes. Randomized trials in perinatal research face many challenges, including randomization difficulties, ethical considerations, and inadequate statistical power due to the small number of subjects eligible for participation. For these reasons, most epidemiological studies conducted in this research field are observational and include different types of bias. This review describes the key methodological difficulties in the design and analysis of randomized and observational studies in perinatal epidemiology, and provides potential corrective approaches.

Healthcare professionals' views on supporting young mothers with eating and moving during and after pregnancy: An interview study using the COM-B framework

Young mothers under the age of 20 often have poor nutrition and low levels of physical activity, adversely affecting outcomes for themselves and their babies. The aim of this qualitative study was to explore the experiences of healthcare professionals in supporting young women around eating and moving during and after pregnancy. Seventeen semi-structured interviews were conducted with midwives, family nurse practitioners and health visitors involved in the care of pregnant and post-natal mothers under the age of 20 in England and Wales. Data were analysed using thematic analysis and coded within the theoretical framework of the COM-B model to three areas of capability, motivation and opportunity. For capability, participants were broadly divided between those who had specialist knowledge and training in communication skills to support health behaviours in this population and professionals reliant on tacit knowledge. For opportunity, having enough time was seen as critical because young women's difficult social contexts meant supporting improved health behaviours required relationships of trust to be built. For motivation, participants reported that supporting young women with eating and moving was part of their role. However, the decision to prioritise this support sometimes related to perceived need based on BMI and this was complicated as young women were still growing. Motivation was additionally connected to professionals' own body experiences and health behaviours. Moving habits were less frequently discussed than eating as professionals described how young women tended to walk a lot in their daily lives or found that young women were not interested. Results suggest that to support eating and moving behaviours with young women, professionals need to be trained in communication techniques, enabled with the time to hold space for young women and be able to reflect on their own attitudes and beliefs to support a rounded model of health and wellbeing.

Building Community Support Using a Modified World Café Method for Pregnant and Parenting Teenagers in Forsyth County, North Carolina

STUDY OBJECTIVE

To identify community priorities, foster awareness of existing supports, and recognize barriers and opportunities to enhance support services for pregnant and parenting teens (PPTs).

DESIGN AND SETTING

A modified World Café event incorporated parallel, rotating focus groups with semistructured, case-based discussions of salient issues. The event was organized and took place in Forsyth County, North Carolina.

PARTICIPANTS

Seventy-eight local health and social service professionals and 15 PPT representatives.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Qualitative coding was used to thematically analyze transcript data. Quantitative data pre-/post-event comparisons were made using Fisher exact test.

RESULTS

Key community-based support services for PPTs were identified. Qualitative analysis yielded 10 key codes regarding barriers and opportunities to enhance community-based support services, resulting in 4 themes. Themes included maximizing access and efficient delivery of high-quality health care, engaging a 3-generation approach to meet the current and future needs of at-risk families, focusing efforts to meet the unique needs of each teen and his/her family, and emphasizing teen self-advocacy. Pre/post survey responses were overwhelmingly positive regarding use of the modified World Café format for discussion and network building.

CONCLUSION

The modified World Café Method offered a platform to collaboratively identify challenges and opportunities and to develop networks to improve health and well-being of PPTs. Engaging multiple stakeholders in meaningful dialogue might foster multidisciplinary, cross-sector collaboration that mitigates risk and enhances resilience among PPTs and their children.