1
|
de Waal N, Lodder P, Nyklíček I, Hulsbosch LP, van den Heuvel MI, van der Gucht K, de Caluwé E, Pop VJM, Boekhorst MGBM. Trait mindfulness during pregnancy and maternal-infant bonding: Longitudinal associations with infant temperament and social-emotional development. Early Hum Dev 2024; 196:106082. [PMID: 39116724 DOI: 10.1016/j.earlhumdev.2024.106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
Maternal love and caregiving are pillars for optimal child development and may affect infant outcomes from pregnancy onwards. The present study aimed to examine whether maternal trait mindfulness during pregnancy and pre- and postnatal maternal-infant bonding were associated with maternal perceptions of infant temperament and social-emotional development. In total, 408 Dutch women (Mage = 31.33, SD = 3.59) participated in a prospective perinatal cohort study and completed questionnaires on trait mindfulness, prenatal bonding, postnatal bonding, infant temperament, and infant social-emotional development at 20 and 28 weeks of gestation, and 10 weeks, 6 and 12 months postpartum, respectively. Path analyses demonstrated that higher levels of the trait mindfulness facet non-judging (i.e., refraining from judgments about own feelings and thoughts) were associated with more pre- and postnatal maternal bonding and fewer social-emotional problems as perceived by the mother. Adopting an accepting and non-judgmental attitude may promote positive feelings of bonding and benefit the infant in terms of having fewer social-emotional problems in the first year of life. Mindfulness interventions may be offered to pregnant women in order to enhance maternal bonding and improve infant outcomes after birth.
Collapse
Affiliation(s)
- Noor de Waal
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Ivan Nyklíček
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Lianne P Hulsbosch
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands; Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
| | | | - Katleen van der Gucht
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
| | - Elien de Caluwé
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
| | - Victor J M Pop
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Myrthe G B M Boekhorst
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
2
|
Sharp M, Ward LG, Pomerantz M, Bourjeily G, Guthrie KM, Salmoirago-Blotcher E, Desmarattes A, Bublitz MH. Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38976481 DOI: 10.1089/jicm.2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Aim: In this secondary analysis of a pilot randomized controlled trial (RCT), we sought to examine whether mindfulness training (MT) is associated with change in interoceptive awareness in pregnant people at risk for hypertension using quantitative and qualitative methods. Interoceptive awareness is the perception, regulation, and integration of bodily sensations. Interoceptive awareness increases following MT and has been proposed as a psychosomatic process underlying hypertension outside of pregnancy. Methods: Twenty-nine participants (mean age 32 ± 4 years; 67% White) with a history of hypertensive disorders of pregnancy (HDP) were enrolled at 16 weeks' gestation (SD = 3) for a RCT assessing the feasibility and acceptability of an 8-week phone-delivered MT intervention. Fifteen participants were randomized to MT, whereas 14 were randomized to usual prenatal care. Before and after the intervention, all participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA) measure and participated an individual interview, which queried for mind-body changes noticed across the study period. Results: Adjusting for baseline interoceptive awareness and gestational age, participants randomized to MT reported less worry about physical sensations on the MAIA after the intervention compared to those randomized to usual care. Qualitative data corroborated these results; MT participants described improved awareness of body and breath sensations, ability to notice blood pressure changes, non-judgmental observation of thoughts, and improved responses to interpersonal challenges. Conclusions: MT may improve the ability to notice body sensations that arise in pregnancy in a way that promotes healthy responding rather than worry. Results provide support for interoceptive awareness as a potential mechanism through which mindfulness may modulate blood pressure and potentially reduce the prevalence of HDP. Clinical Trial Registration: ClinicalTrials.gov (NCT03679117).
Collapse
Affiliation(s)
- Meghan Sharp
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - L G Ward
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Madison Pomerantz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ghada Bourjeily
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Elena Salmoirago-Blotcher
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island, USA
| | - Amanda Desmarattes
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Margaret H Bublitz
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
3
|
Huynh T, Kerr ML, Kim CN, Fourianalistyawati E, Chang VYR, Duncan LG. Parental Reflective Capacities: A Scoping Review of Mindful Parenting and Parental Reflective Functioning. Mindfulness (N Y) 2024; 15:1531-1602. [PMID: 39328292 PMCID: PMC11426413 DOI: 10.1007/s12671-024-02379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 09/28/2024]
Abstract
Objectives Two key parental reflective capacities-mindful parenting (MP) and parental reflective functioning (PRF) - have been shown to promote healthy parent-child relationships through parents' increased sensitivity and responsiveness to their children's needs in spite of parenting stressors. Despite the theoretical overlap between these two constructs, researchers have continued to examine them independently. Therefore, the purpose of this scoping review was to review the overlapping and distinctive outcomes and correlates in the empirical MP and PRF literatures. Method A comprehensive literature search across the MP and PRF literature for studies published from 2005 through early 2020 (pre-COVID-19 pandemic) was conducted. Results A review of 301 articles (n = 180 MP and n = 121 PRF) revealed overlapping study outcomes and correlates, including improvement in parent and child well-being, parenting behaviors, and attachment. Both MP and PRF literatures suggest MP and PRF are amenable to intervention-induced changes, although mostly documented in White mothers, which results may not be generalizable to diverse populations. Conclusions Researchers should consider the impact MP and PRF have on positive family relationships. Results suggest that scholars should consider investigating and intervening on MP and PRF simultaneously. Specifically, results identified MP and PRF convergent associations and perhaps synergistic impacts on positive parenting behaviors. Limitations and future directions are discussed. Preregistration This review was not preregistered.
Collapse
Affiliation(s)
- Tuyen Huynh
- Department of Psychology, University of South Carolina, Barnwell College Room 517, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Margaret L Kerr
- Human Development and Family Studies, University of Wisconsin-Madison, 4109 Nancy Nicholas Hall, 1300 Linden Drive, Madison, Wisconsin 53706, USA
| | - Christina N Kim
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Endang Fourianalistyawati
- Faculty of Psychology, Universitas YARSI, Menara YARSI, Kav. 13, Jl. Letjend. Suprapto. Cempaka Putih, Jakarta Pusat, DKI, Jakarta 10510, Indonesia
| | | | - Larissa G Duncan
- Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, Wisconsin 53706, USA
| |
Collapse
|
4
|
Kundarti FI, Kiswati, Komalyna INT. Mindfullness based intervention reduce anxiety in labor. GACETA SANITARIA 2024; 38:102359. [PMID: 38330537 DOI: 10.1016/j.gaceta.2024.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To determine the effectiveness of mindfulness interventions on anxiety through a systematic review. METHOD Systematic review by searching articles through the PubMed, ProQuest, Science Direct, Wiley Library, Sage Journal, and Cochrane Library databases with publication years January 2012 to January 2022 RESULTS: Eleven articles met the inclusion criteria covering several countries, including Canada 1 article, Egypt 1 article, Taiwan 1 article, Amsterdam 2 articles, Iran 1 article, Austria 1 article, San Francisco 1 article, Germany 1 article, Sweden 1 article, China 1 article, and Spain 1 article. CONCLUSIONS Management of anxiety about childbirth is important for pregnant women. Mindfulness interventions are effective for reducing anxiety about labor and increasing comfort during labor. Mindfulness intervention mechanisms have the potential to reduce anxiety by increasing skills to regulate emotions.
Collapse
Affiliation(s)
- Finta Isti Kundarti
- Department of Midwifery, Health Polytechnic Ministry of Health Malang, Malang, Indonesia.
| | - Kiswati
- Department of Midwifery, Health Polytechnic Ministry of Health Malang, Malang, Indonesia
| | - I Nengah Tanu Komalyna
- Department of Nutrition, Health Polytechnic Ministry of Health Malang, Malang, Indonesia
| |
Collapse
|
5
|
Wang X, Xu H, Liu X, Yan J, Chen C, Li Y. Evaluating the effect of psychoeducational interventions on prenatal attachment and anxiety/depression in pregnant women and partners: A systematic review and meta-analysis. J Affect Disord 2023; 342:33-44. [PMID: 37689313 DOI: 10.1016/j.jad.2023.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Evidence about effective psychoeducational interventions to improve prenatal attachment, anxiety and depression has been increasing, but it lacks a complete synthesis of the results. The aim of this study is to evaluate the effect of psychoeducational intervention on prenatal attachment and anxiety/depression in pregnant women and their partners. METHODS Ten databases were systematically searched to identify randomized controlled trials (RCTs) on the effectiveness of psychoeducational interventions on prenatal attachment from inception to March 2023, then manually screened to include studies of anxiety or depression. Two researchers assessed the methodological quality of the included studies using the Cochrane risk-of-bias tool and meta-analysis was performed using RevMan 5.4 software. RESULTS Ten RCTs with a total of 700 pregnant women and 399 partners were included. Prenatal attachment scores after the intervention (standardized mean difference = 1.10, 95 % CI 0.65 to 1.55, P <.00001) was significantly increased and anxiety scores (standardized mean difference = -0.99, 95 % CI -1.18 to -0.80, P <.00001) was significantly lower. The subgroup analysis showed that the different prenatal attachment assessment tools were the source of heterogeneity in the combined results. The sensitivity analysis results showed reliable pooled results except for the studies using the self-made anxiety scale. CONCLUSION This review suggests that psychoeducational interventions can effectively enhance prenatal attachment, reduce anxiety and depression, providing reference for the promotion of evidence-based practice of psychoeducational interventions in perinatal pregnant women and their partners.
Collapse
Affiliation(s)
- Xiaoying Wang
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Han Xu
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Xuejie Liu
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Jingwen Yan
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Caifeng Chen
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Yuhong Li
- College of Nursing, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
6
|
Skovbjerg S, Sumbundu A, Kolls M, Kjærbye-Thygesen A, Fjorback LO. The effect of an adapted Mindfulness-Based Stress Reduction program on mental health, maternal bonding and birth outcomes in psychosocially vulnerable pregnant women: a study protocol for a randomized controlled trial in a Danish hospital-based outpatient setting. BMC Complement Med Ther 2023; 23:364. [PMID: 37838672 PMCID: PMC10576273 DOI: 10.1186/s12906-023-04194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Stress and mental disorders in pregnancy can adversely affect the developing fetus. Women with a preconception history of mental disorders or of psychosocial vulnerabilities are at increased risk of experiencing perinatal stress or mental health problems. Mindfulness-Based-Stress-Reduction (MBSR) is an acceptable intervention for pregnant women and has a growing evidence-base with meta-analyses consistently pointing to reductions in symptoms of stress, anxiety and depression. This study protocol aim to address the need for a wider array of evidence-based and non-pharmacological options during pregnancy to reduce stress and improve mental health in a psychosocially highly vulnerable group of women. METHODS Pregnant women with a preconception history of mental disorders or psychosocial vulnerabilities (n = 240) will be recruited from an obstetric ambulatory clinic at Copenhagen University Hospital, Hvidovre, Denmark. Recruitment for the study began in March 2022 and will continue until the desired number of participants is reached. Consenting pregnant women will be randomized to one of two study arms, an adapted MBSR program as add on to usual care or usual care alone. The primary outcome is mental wellbeing at nine months post-randomization. Secondary and exploratory outcomes include stress, anxiety, depression, and maternal antenatal attachment, experience of childbirth, delivery and mode of delivery. Mindfulness and self-compassion are examined as possible mediators of the effect on outcomes. DISCUSSION Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to improve mental health and wellbeing during pregnancy, reduce stress and support the transition to parenthood. Mindfulness-Based Stress Reduction does not target a particular group, and results from the study is thus of potential relevance for pregnant women in general as a means of reducing stress and improving perinatal mental health and wellbeing. TRIAL REGISTRATION ClinicalTrials.gov: NCT05300646 . Registered March 29, 2022.
Collapse
Affiliation(s)
- S Skovbjerg
- Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - A Sumbundu
- Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M Kolls
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - A Kjærbye-Thygesen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - L O Fjorback
- Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Shan T, Tian X. The effects of mindfulness upbringing perception on social entrepreneurship orientation: A moderated mediation model of prosocial motivation and perceived pressure from external stakeholders. Front Psychol 2022; 13:968484. [PMID: 36312148 PMCID: PMC9606459 DOI: 10.3389/fpsyg.2022.968484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Driven by economic and social benefits, social enterprises create new development models that combine wealth creation, social welfare provision, and environmental improvement through innovative approaches. The social entrepreneurship orientation reflects the behavioral tendency to transplant entrepreneurship orientation into the field of social value creation. It is a strategy to balance and integrate economic interests and social interests, which has a significant impact on social entrepreneurship performance. The purpose of this study is to explore the internal mechanism of the impact of social entrepreneurs’ mindfulness upbringing perception on social entrepreneur orientation. To reveal the internal mechanism, we propose a moderated and mediation model of prosocial motivation and perceived pressure from external stakeholders. In this study, random sampling was conducted among social start-ups in China. In order to improve the accuracy of the scale, a pre-survey was conducted before the formal survey. The data analysis results of the pre-survey showed that the scale in this study was suitable for the Chinese context and had good external validity. Through using survey data from social entrepreneurs in China, hierarchical regression analysis and bootstrapping model are adapted to test and verify mediation and moderation effects. The results show that mindfulness upbringing perception indeed positively influences social entrepreneurship orientation directly and partly through the mediating effect of prosocial motivation. Moreover, findings suggest the perceived pressure from external stakeholders negatively moderates not only the relationship between prosocial motivation and social entrepreneurship orientation but also the overall mediation model. This indicates that social entrepreneurs with low perceived pressure from external stakeholders will improve their social entrepreneurship orientation rapidly when their prosocial level is high. Based on these findings, we conclude that social entrepreneurship orientation may be achieved more effectively through the complex process of mindfulness upbringing perception, prosocial motivation, and perceived pressure from external stakeholders. Finally, the study proposes the theoretical and practical implications and suggestions for follow-up research.
Collapse
|
8
|
Yuen WS, Lo HC, Wong WN, Ngai FW. The effectiveness of psychoeducation interventions on prenatal attachment: A systematic review. Midwifery 2021; 104:103184. [PMID: 34753018 DOI: 10.1016/j.midw.2021.103184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/30/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Positive prenatal attachment facilitates parental role adaptation and psychological adjustment during pregnancy, which is a significant predictor of postpartum attachment. The objective of this systematic review was to examine the effect of psychoeducation interventions on prenatal attachment of pregnant women and their partners. DESIGN Systematic literature searches of randomized controlled trials (RCTs) were conducted from January 2000 to January 2021, using databases: CINAHL, Embase, Medline, PsycInfo, PubMed, Web of Science and Cochrane Central Register of Controlled Trial and through hand-searching. Studies were independently selected by two reviewers, who also assessed the methodological quality of the included studies using the Cochrane Risk of Bias Tool. Narrative synthesis was conducted due to the significant clinical and methodological heterogeneity. SETTING/PARTICIPANTS Fifteen studies met the eligibility criteria for this review, among which 11 studies focused on pregnant women and four studies on their partners. FINDINGS The psychoeducation interventions in the included studies showed consistent favorable effects on prenatal attachment. Nine out of the 11 included studies showed statistical significant effects on maternal fetal attachment. Three out of the four studies reported significant effects favoring paternal fetal attachment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The preliminary evidence suggests that psychoeducation interventions have potential favorable effects on maternal fetal attachment and can enhance paternal fetal attachment. However, more studies are needed for investigating the effects of psychoeducation on paternal fetal attachment and for enhancing the validity of the evidence. Our review recommends that healthcare professionals to include psychoeducation as a part of their prenatal care for promoting prenatal attachment. Common characteristics of the interventions could act as references when designing psychoeducation programs for enhancing prenatal attachment.
Collapse
Affiliation(s)
- Wing Shan Yuen
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Hiu Ching Lo
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Wing Nga Wong
- Undergraduate student, School of Nursing, The Hong Kong Polytechnic University
| | - Fei Wan Ngai
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University.
| |
Collapse
|
9
|
Babbar S, Oyarzabal AJ, Oyarzabal EA. Meditation and Mindfulness in Pregnancy and Postpartum: A Review of the Evidence. Clin Obstet Gynecol 2021; 64:661-682. [PMID: 34162788 DOI: 10.1097/grf.0000000000000640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Given their growing popularity, mindfulness practices including meditation are actively being studied in clinical trials to assess their efficacy at improving health outcomes during pregnancy and the postpartum period. We conducted a literature review to compile these studies and assessed their findings. There is sufficient evidence to support the practice of mindfulness practices in pregnancy to reduce anxiety, depression, and stress during pregnancy, which may continue to have beneficial effects through the postpartum period. There is limited evidence on the benefits of mindfulness and meditation for other aspects of pregnancy. However, due to the low-risk nature of these techniques, all women should be encouraged to engage in mindfulness practices during pregnancy.
Collapse
Affiliation(s)
- Shilpa Babbar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Esteban A Oyarzabal
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|