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Al Ahbabi S, Mubarak G, Al Khaldi S, Bin Mousa A, Mohammad Baynouna Al Ketbi L. Prevalence of Postpartum Depression among Mothers in the Emirates of Abu Dhabi. Matern Child Health J 2024:10.1007/s10995-024-03931-5. [PMID: 38951298 DOI: 10.1007/s10995-024-03931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Postpartum depression (PPD) is a common mental health condition that affects women in a silent and covert way and is not clearly visible to the community or to health care providers. Untreated PPD has significant and long-term consequences on the mother and their child. This study aims to assess the risk of postpartum depression among women in the Emirate of Abu Dhabi and its determinants. METHOD This is a questionnaire-based cross-sectional study conducted at primary healthcare centers in the Emirate of Abu Dhabi. The target population is women visiting the well-child vaccination clinics for their infants' vaccination. The questionnaire used consisted of socio-demographic characteristics, important histories such as obstetric, medical, and social histories, and the Edinburgh Post Partum depression scale EPPS. EPPS is a validated tool used to evaluate the probability of postpartum depression. RESULTS The probability of postpartum depression for women visiting the well child care clinics in the Emirate of Abu Dhabi during the study period was 35%, One-third. 10% had high risk, 7% had moderate risk, and 18% had mild risk. Using logistic and linear regression, there was an association identified between postpartum depression risk and the presence of weight concern and employment status OR 5.499(2.618-11.548) and OR 0.483 (0.246-0.951), respectively (P < 0.005). From the total sample, 3.7% responded quite often or sometimes to the question of having the intention to harm themselves. CONCLUSION EPDS is recommended to be used routinely to screen women in the postnatal period. This high prevalence of risk of postpartum depression in the UAE (One in three women) calls for a well-prepared healthcare system and community. Healthcare providers need to be prepared with better knowledge, practice, and management strategies to care for these women, for early identification and management. Further studies should be undertaken to achieve effective strategies to reduce the incidence of this condition.
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Affiliation(s)
- Salma Al Ahbabi
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Ghada Mubarak
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Sharifa Al Khaldi
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Ali Bin Mousa
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
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Niebrzydowska-Tatus M, Pełech A, Rekowska AK, Satora M, Masiarz A, Kabała Z, Kimber-Trojnar Ż, Trojnar M. Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain. J Clin Med 2024; 13:1461. [PMID: 38592297 PMCID: PMC10932422 DOI: 10.3390/jcm13051461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.
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Affiliation(s)
| | - Aleksandra Pełech
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Anna K. Rekowska
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Małgorzata Satora
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Angelika Masiarz
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Zuzanna Kabała
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Żaneta Kimber-Trojnar
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Marcin Trojnar
- Department of Internal Diseases, Medical University of Lublin, 20-059 Lublin, Poland;
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Papadopoulou SK, Pavlidou E, Dakanalis A, Antasouras G, Vorvolakos T, Mentzelou M, Serdari A, Pandi AL, Spanoudaki M, Alexatou O, Aggelakou EP, Giaginis C. Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence. Nutrients 2023; 15:3853. [PMID: 37686885 PMCID: PMC10490519 DOI: 10.3390/nu15173853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
Postpartum depression, with a prevalence ranging between 14% and 25% worldwide, has been considered an urgent health concern that negatively affects both mothers' and their infants' health. Postpartum depression may negatively affect maternal sociodemographic and anthropometric parameters and lifestyle factors. Nutrition has recently been identified as a crucial factor for the management and co-treatment of postpartum depression. This survey aims to determine the possible association of postpartum depression with mothers' socio-demographic and anthropometric characteristics, perinatal outcomes, breastfeeding practices, and Mediterranean diet (MD) adherence. METHODS This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data. RESULTS Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors. CONCLUSIONS This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.
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Affiliation(s)
- Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Health Sciences, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Aspasia Serdari
- Department of Psychiatry and Child Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Aimilia-Lynn Pandi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Exakousti-Petroula Aggelakou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
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Wu CH, Gau ML, Cheng SF, Chen TL, Wu CJ. Excessive gestational weight gain and emotional eating are positively associated with postpartum depressive symptoms among taiwanese women. BMC Womens Health 2023; 23:464. [PMID: 37658388 PMCID: PMC10474696 DOI: 10.1186/s12905-023-02625-4] [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: 06/09/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain and emotional eating may be associated with postpartum depression symptoms. This study was designed to identify how gestational weight gain and eating behaviors are related to postpartum depression (PPD) symptoms among women in Taiwan. METHODS A cross-sectional study was conducted from March 2022 to October 2022 with 318 postpartum women recruited in Taipei, Taiwan. Gestational weight gain (GWG) for the total pregnancy period was recorded as inadequate, adequate, or excessive, based on the 2009 Institute of Medicine recommendations (IOM), accounting for pre-pregnancy body mass index category. Eating behavior at one month postpartum was measured on a 16-item 5-point Likert scale with three subscales: uncontrolled, restrained, and emotional. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale with a cutoff score of 13. RESULTS The prevalence of postpartum depression symptoms (Edinburgh Postnatal Depression Scale ≥ 13) was 23.9% at one month postpartum. Logistic regression analysis revealed that excessive gestational weight gain and emotional eating were positively associated with postpartum depression symptoms at that time. CONCLUSION Evidence presented here suggests that emotional eating and excessive GWG are associated with PPD symptoms in a Taiwanese population. In addition, it should be a public health priority to ensure a particular focus on mental health during the postpartum period. Healthcare providers should discourage pregnant women from unhealthy eating habits by targeting appropriate GWG and focusing on demand eating to reduce PPD in the postpartum period.
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Affiliation(s)
- Chia-Hsun Wu
- Obstetrician and gynecologist, Department of Obstetrics and Gynecology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women's Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Rd, Peitou District, 11219, Taipei, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tzu-Ling Chen
- Department of Nurse-Midwifery and Women's Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Rd, Peitou District, 11219, Taipei, Taiwan.
| | - Chih-Jung Wu
- School of Nursing, China Medical University, Taichung, Taiwan
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Howard K, Maples JM, Tinius RA. Modifiable Maternal Factors and Their Relationship to Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912393. [PMID: 36231692 PMCID: PMC9564437 DOI: 10.3390/ijerph191912393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 05/07/2023]
Abstract
The purpose of the study was to examine how modifiable maternal factors (body mass index (BMI), household income, fatigue, sleep, breastfeeding status, diet, and physical activity) relate to postpartum depression (PPD) at 6 and 12 months postpartum. Participants (n = 26) participated in two study visits (6 and 12 months postpartum) where vitals, weight, body composition (skinfold anthropometrics), and physical activity levels (Actigraph GTX9 accelerometer) were assessed. Validated instruments (BRUMS-32, Subjective Exercise Experience Scale, Pittsburg Sleep Quality index, NIH breastfeeding survey, NIH Dietary History Questionnaire, and Edinburg Postnatal Depression Scale) assessed lifestyle and demographic factors of interest. PPD at six months was correlated to PPD at 12 months (r = 0.926, p < 0.001). At six months postpartum, PPD was positively correlated to BMI (r = 0.473, p = 0.020) and fatigue (r = 0.701, p < 0.001), and negatively correlated to household income (r = -0.442, p = 0.035). Mothers who were breastfeeding had lower PPD scores (breastfeeding 3.9 ± 3.5 vs. not breastfeeding 7.6 ± 4.8, p = 0.048). At 12 months, PPD was positively correlated to sleep scores (where a higher score indicates poorer sleep quality) (r = 0.752, p < 0.001) and fatigue (r = 0.680, p = 0.004). When analyzed collectively via regression analyses, household income and fatigue appeared to be the strongest predictors of PPD at six months postpartum.
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Affiliation(s)
- Kathryn Howard
- Biology Department, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Jill M. Maples
- The Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37996, USA
| | - Rachel A. Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY 42101, USA
- Correspondence:
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Chen F, Wang P, Wang J, Liao Z, Zong X, Chen Y, Lai J, Zhang T, Liu G, Xie X. Analysis and Comparison of Early Childhood Nutritional Outcomes Among Offspring of Chinese Women Under the Chinese 2021 and US 2009 Gestational Weight Gain Guidelines. JAMA Netw Open 2022; 5:e2233250. [PMID: 36149650 PMCID: PMC9508653 DOI: 10.1001/jamanetworkopen.2022.33250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE In 2009, the US National Academy of Medicine (NAM) released revised gestational weight gain (GWG) guidelines, which were established primarily for White North American women and may be unsuitable for Asian women. In 2021, the Chinese Nutrition Society (CNS) released its GWG guidelines, but their applicability requires re-examination. OBJECTIVE To compare the differences between the CNS and NAM recommendations for GWG in association with health outcomes in the offspring of Chinese women. DESIGN, SETTING, AND PARTICIPANTS In this bidirectional cohort study, children in China were recruited at age 3 years from 2017 to 2018, with 2 follow-up visits over the next 2 years (between September 2017 and September 2020). Information during pregnancy was retrieved from medical records. Data analysis was performed from October 2021 to January 2022. MAIN OUTCOMES AND MEASURES GWG was classified as insufficient, appropriate, or excessive according to the CNS and NAM guidelines separately. Children's height, weight, fat mass, fat-free mass, and percentage of body fat were measured at each visit. Body mass index, fat mass index, fat-free mass index, weighted κ score, risk ratio values, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS A total of 3822 children (1996 boys and 1826 girls; mean [SD] age, 3.79 [0.30] years) were enrolled; after exclusions, 3170 term singleton children were recruited and were followed at 4 and 5 years of age. According to the CNS guidelines, the prevalence rates were 14.1% for insufficient GWG, 48.1% for appropriate GWG, and 37.9% for excessive GWG, whereas the rates according to NAM guidelines were 39.7% for insufficient GWG, 37.2% for appropriate GWG, and 23.1% for excessive GWG. The weighted κ value for the classification agreement between the 2 guidelines was 0.530 (95% CI, 0.510-0.550). For the appropriate GWG group, the rates for low nutritional levels did not differ between the 2 guidelines, but the rates for high nutritional levels were significantly lower under CNS guidelines than under NAM guidelines. When the sensitivity, specificity, PPV, and NPV with respect to the mothers who maintained appropriate GWG were used to estimate the nonhigh nutritional status of their offspring, generally higher values based on the CNS guidelines were found compared with those based on the NAM recommendations. CONCLUSIONS AND RELEVANCE These findings suggest that the GWG recommendations promulgated by the NAM are higher than the CNS guidelines, with the latter more suitable for Chinese women.
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Affiliation(s)
| | - Peng Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Jing Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Zijun Liao
- Capital Institute of Pediatrics, Beijing, China
| | - Xinnan Zong
- Capital Institute of Pediatrics, Beijing, China
| | - Yiren Chen
- Capital Institute of Pediatrics, Beijing, China
| | - Jianqiang Lai
- National Institute of Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Ting Zhang
- Capital Institute of Pediatrics, Beijing, China
| | - Gongshu Liu
- Tianjin Women’s and Children’s Health Center, Tianjin, China
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Shen X, Lin S, Li H, Amaerjiang N, Shu W, Li M, Xiao H, Segura-Pérez S, Pérez-Escamilla R, Fan X, Hu Y. Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms. Nutrients 2022; 14:2959. [PMID: 35889915 PMCID: PMC9324203 DOI: 10.3390/nu14142959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03−2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30−3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47−0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34−0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29−0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85−25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80−30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.
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Affiliation(s)
- Xinran Shen
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Shunna Lin
- Department of Pediatrics, Tianhe District Maternal and Child Hospital of Guangzhou, Guangzhou 510620, China;
| | - Hui Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Nubiya Amaerjiang
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Wen Shu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Menglong Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Huidi Xiao
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Sofia Segura-Pérez
- Chief Program Officer, Hispanic Health Council, 175 Main St., Hartford, CT 06106, USA;
| | | | - Xin Fan
- Department of Pediatrics, Women and Children’s Hospital of Chongqing Medical University, No. 120, Longshan Road, Yubei District, Chongqin 400042, China
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
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