Father Involvement and Psychological Well-Being of Pregnant Women

Spillover effects on the relationship with the partner of a mentalization-based intervention for pregnant women

The birth of a child has been associated with a decline in couple satisfaction, which has implications for the child's social-emotional development. This study investigated the potential spillover effect on pregnant women's perceptions of their relationships with their partners of the Supporting the Transition to and Engagement in Parenthood (STEP) program, a brief trauma-informed mentalization-based prenatal group intervention. Participants (94% White) were recruited in prenatal clinics and through online advertisements in Quebec, Canada. Both quantitative and qualitative data were collected from participants assigned to the STEP program (n = 42) and those receiving treatment-as-usual (TAU; n = 125). Women participating in STEP reported significant improvements in their relationships with their partners compared to those assigned to TAU. More precisely, they reported higher couple satisfaction, enhanced communication, and increased interest in their partners' emotional experience. The qualitative analysis further substantiated these results, with participants reporting having involved their partners in their pregnancy, shared their insights about themselves with their partners and gained fresh perspectives on their relationships. Participants in STEP also expressed sharing program materials with their partners and considered that such interventions should be extended to expecting fathers. This study underscores the potential of mentalization-based interventions to indirectly contribute to couple relationships, which may have positive implications for parenting and the infant.

A Mixed Methods Approach to Understand Mother-Father Relationship and Perceived Stress Among Black Pregnant Women

BACKGROUND

Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress.

PURPOSE

To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women.

METHODS

Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone.

RESULTS

Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered.

CONCLUSIONS

These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women.

IMPLICATIONS

Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy.

Applying the WHO INSPIRE Framework to Ending Violence Against Pregnant Women and Unborn Children: A Case Study in Vietnam

This article adapted the INSPIRE framework, developed by the World Health Organization to prevent violence against children, to the systematic analysis of city-level healthcare services for pregnant women who experienced intimate partner violence. A mixed-methods study conducted in-depth interviews with 22 health and social care professionals and 140 pregnant women in Vietnam. The women were more likely to report limited system-level support for partners regarding violence and mental health, while the professionals perceived more weaknesses in policies and management of services. Traditional values tend to isolate abused women from receiving social services. The INSPIRE framework is innovative and could be applied in other contexts.

Childbirth Self-Efficacy and Its Associated Factors among Pregnant Women in Arba Minch Town, Southern Ethiopia, 2023: A Cross-Sectional Study

Background

Childbirth self-efficacy is a pregnant women's perception of their ability to cope with labor stress. Low childbirth self-efficacy is linked to pain intolerance and poor labor progression, which increase the possibility of operative delivery. However, Ethiopia has limited data. So, the aim of this study was to assess childbirth self-efficacy and its factors among pregnant women attending antenatal care in public health facilities in Arba Minch town, Southern Ethiopia, in 2023.

Objective

To assess childbirth self-efficacy and associated factors among pregnant women attending antenatal care in public health facilities in Arba Minch town, Southern Ethiopia, in 2023.

Methods

An institution-based cross-sectional study was carried out among 416 women from January 1 to January 30, 2023. A systematic random sampling technique was employed. Data were collected by KoboToolbox through face-to-face interviews using a structured and pretested questionnaire. Modified short-form childbirth self-efficacy inventory was used to score self-efficacy. The Statistical Package for Social Sciences, version 27, was used for data management and analysis. Descriptive statistics were calculated for each variable, and a logistic model was used. Statistical significance was determined at a p value of less than 0.05 and 95% confidence level.

Results

A total of 416 pregnant women participated in the study. Two hundred twenty-eight (54.8%) of the pregnant women had low childbirth self-efficacy. Age group in ≤24 years (AOR = 3.80, 95% CI: 1.82-8), primigravida (AOR = 1.51, 95% CI: 1.10-2.86), unplanned pregnancy (AOR = 1.67, 95% CI: 1.02-2.70), poor social support (AOR = 2.17, 95% CI: 1.09-4.30), having anxiety (AOR = 1.30, 95% CI: 1.10-3.64), having poor knowledge of childbirth (AOR = 2.21, 95% CI: 2.09-5.39), and severe fear of childbirth (AOR = 6.40, 95% CI: 2.60-9.80) were statistically significant with low childbirth self-efficacy.

Conclusions

The magnitude of low childbirth self-efficacy was high in the study area. Being primigravida, unplanned pregnancy, age ≤ 24 years, severe fear of childbirth, anxiety, poor social support, and poor knowledge were significantly associated with low childbirth self-efficacy. Therefore, giving special attention to these factors during antenatal care would be important.

Expectant fathers' health behaviors, infant care intentions, and social-emotional wellbeing in the perinatal period: A latent class analysis and comparison to mothers

While parental behaviors during the 'first thousand days' are critical for child health, little is known about fathers during this time. We examined prenatal patterns of health behaviors, social-emotional wellbeing, and infant care intentions among expectant fathers, both overall and compared to expectant mothers. Among 227 mother-father dyads enrolling in a randomized controlled trial of a perinatal obesity prevention program in Boston, Massachusetts (July 2020-July 2022), participants independently completed baseline surveys addressing (1) health behaviors, (2) social emotional wellbeing, and (3) infant care intentions. We compared paternal and maternal responses to survey items within each of these domains. Further, we conducted a latent class analysis of paternal responses and examined their associations with sociodemographic characteristics. Compared to expectant mothers, fathers were more likely to report increased body mass index, less fruit intake, decreased sleep, increased physical activity, and no recent primary care visit. Latent class analysis revealed four distinct groups of paternal health behaviors and infant care intentions: (1) more health behaviors with less infant care; (2) less health behaviors with less infant care; (3) less health behaviors with more infant care; and (4) more health behaviors with more infant care. Fathers with increased health behaviors were more likely to have higher education and income. Fathers with decreased health behaviors were more likely to endorse food insecurity, housing insecurity, and social isolation. Our findings identify potential areas for targeting expectant fathers in health promotion initiatives and suggest that social needs may impact the capacity to adopt healthy lifestyle behaviors.

Mother-Father Relationship and Depressive Symptoms Among Pregnant Black Women

BACKGROUND

Black women report higher levels of depressive symptoms during pregnancy than white women. A supportive relationship with the father of the baby may be protective and decrease depressive symptoms.

OBJECTIVE

We sought to examine the association between mother-father relationship and depressive symptoms among pregnant black women.

METHODS

Using a cross-sectional design, we conducted a secondary data analysis from a subsample of 405 pregnant black women who participated in the Biosocial Impact on Black Births study, a prospective cohort study. Participants completed questionnaires at 19- to 29-week gestation, including 6 measures of their relationship with the father of the baby: (1) contact, (2) involvement, (3) overall relationship, (4) change in relationship from prior to pregnancy to during pregnancy, (5) support, and (6) conflict. Latent class analysis was used to identify and classify the relationship construct. The Center for Epidemiologic Studies-Depression (CES-D) scale was used, with scores ≥23 considered high levels of depressive symptoms. Data were analyzed with logistic regression.

RESULTS

Following adjustment for maternal sociodemographic characteristics, comorbid conditions, and health behaviors, women in a conflictual relationship had higher odds of having depressive symptom scores ≥23 (adjusted odds ratio: 3.50, 95% confidence interval: 2.00, 6.12) than those having no relationship (adjusted odds ratio: 2.81, 95% confidence interval: 1.43, 5.52), when compared with those with a good relationship.

CONCLUSIONS

These findings suggest that having either a conflictual or no relationship with the father of the baby during pregnancy increases the odds for higher maternal depressive symptoms (CES-D scores ≥ 23) among pregnant black women.

Fathers Matter: Black Fathers' Relationships with their Partners during Pregnancy and Postpartum

PURPOSE

To describe the characteristics of participants in the Fathers Matter study for a better understanding of fathers of the baby who engage in pregnancy research involving primarily Black couples and their relationships with their partners.

STUDY DESIGN AND METHODS

The Fathers Matter Study uses a prospective design, identifying father-mother dyads during pregnancy and following them until birth as part of the Biosocial Impacts on Black Births Study. Participants completed prenatal and postpartum questionnaires.

RESULTS

Our analyses are based on 111 fathers. Nearly all ( n = 101, 91.1%) of fathers identified as Black and 51.4% ( n = 57) had a high school diploma, graduate equivalency diploma, or higher. About half ( n = 57, 51.4%) reported annual incomes of $10,000 or less. Most reported that relationships with the mother were very close both before ( n = 100, 89.9%) and during ( n = 85, 76.6%) pregnancy. However, substantial variability was found in relationship satisfaction, involvement in the pregnancy, financial support provided, and scales of conflict and support.

CLINICAL IMPLICATIONS

We found homogeneity in sociodemographic and basic relationship measures. Complex measures of the father-mother relationships demonstrated considerable variability. Data from fathers may identify their contributions to successful birth outcomes. Understanding relationships between fathers and mothers could identify risk or protective characteristics to be addressed at the family or community levels.

Social mobility and perinatal depression in Black women

Background

Higher socioeconomic position is associated with better birth outcomes and maternal mental health, although this relationship is less consistent for Black women. The literature is limited on the impact of social mobility across the life course on mental health of pregnant women. This study examines the impact of perceived financial status across the life-course on depressive symptoms during pregnancy among Black women.

Methods

Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among pregnant Black women in metropolitan Detroit, Michigan. Depressive symptoms in the two weeks prior to birth were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Social mobility was determined at three intervals over the life course using self-report of financial status during childhood, adolescence, and current age in pregnancy.

Results

1,410 pregnant women participated, ranging in age from 18 to 45 years old. CES-D scores ranged from 0 to 53 (mean = 15.3) and 26% of the sample reported high depressive symptoms. In each age interval, higher financial status was associated with significant protective effect on depressive symptoms, and the magnitude of the effect increased across the life course. Trajectory analysis demonstrated that both the upward (4.51; 95% CI, 2.43-6.6) and downward (4.04; 95% CI, 2.62-5.46 and 3.09; 95% CI, 1.57-4.62) life-course social mobility groups had increased mean CES-D scores compared to the static social mobility group.

Conclusion

This study describes the importance of previous childhood and current financial status effects on mental health in Black pregnant women.

Addressing Adverse Childhood and Adult Experiences During Prenatal Care

Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.

Black fathers' contributions to maternal mental health

This mixed-methods research study aimed to assess the contribution of interparental relationship quality and paternal support for mothers to maternal mental health among Black parents in a metro area characterized by severe racial disparities. We also explored Black parents' understanding of meaningful paternal support for mothers. Using survey data collected from Black mothers (N = 75), we examined correlations among the study variables, then conducted mediation and moderation analyses to examine whether relationship quality would mediate the association between paternal support and maternal mental health and to test whether relationship quality would moderate the association between paternal support and maternal self-reported overall health. We used inductive thematic analysis to analyze data from focus groups with Black parents (N = 15). We found that mothers' mental health was positively correlated with relationship quality, mothers' subjective health was positively correlated with paternal support, and relationship quality significantly mediates the relationship between paternal support and maternal mental health while controlling for relationship status. Our thematic analysis yielded four themes to characterize meaningful paternal support for mothers and a high quality interparental relationship: (1) Teammates; (2) Multidimensional, everyday support; (3) Communication is key; and (4) Challenge racism and disrupt intergenerational trauma. Findings suggest that paternal support and interparental relationship quality can play a protective role, promoting maternal mental health and wellbeing. Providers of perinatal services should support Black parents to support one another, including as advocates in confronting racism.

The Role of Paternal Involvement on Behavioral Sensitive Responses and Neurobiological Activations in Fathers: A Systematic Review

As fathering research has flourished, a growing body of studies has focused on behavioral and neurobiological mechanisms, respectively associated with caregiving sensitivity and responsiveness to infant stimuli. However, the association between these aspects and the key concept of paternal involvement in childcare (i.e., contribution in infant care in terms of time, availability, and responsibility) has been poorly investigated. The current work aims to systematically review the role of involvement in childcare on both neural activations and sensitive behaviors in fathers by examining (a) how paternal involvement has been measured and (b) whether paternal involvement has been associated with neurobiological activation and behavioral sensitive responses. Inclusion criteria were peer-reviewed quantitative studies, concerning fathers responding to infant stimuli at neurobiological or behavioral level, and including a quantitative measurement of paternal involvement in childcare. A quality rating for each study has been performed based on the measurements adopted to assess paternal involvement. Of 2,529 articles, 27 studies were included. According to our quality rating, 10 out of 27 studies included fairly good-standard measures for measuring paternal involvement, whereas 17 studies used good-standard measures. In addition, 11 studies provided details of paternal involvement in the context of neurobiological responses to infant stimuli, whereas 16 addressed paternal sensitive behaviors. Overall, only 8 studies reported relevant findings about the relationship between paternal involvement and neurobiological responses or sensitive behaviors in fathers. The present study is the first systematically evaluating the scope of paternal involvement in the field of Paternal Brain and fathers' sensitive responsiveness research. When high-standard measures are used, paternal involvement seems to play a significant role in modulating both the hormonal and the neural pathways associated with paternal behaviors. Remarkably, the role of paternal engagement may underpin an adaptive nurturance that is not dependent on pregnancy and childbirth but on caregiving experience. A promising positive link between paternal involvement and behavioral sensitivity may be expected in further studies, which will need to corroborate our conclusion by adopting detailed and appropriate measures assessing paternal involvement. As a future line of research, the inclusion of gay fathers may be beneficial for the field.

Emotional Intelligence, Depression, and Risk Factors in Pregnant Peruvian Andean Adolescents: A Multivariate Logistic Regression Study

Background

There has recently been a high increase in the prevalence of adolescent pregnancies, especially in developing countries, because they are considered vulnerable populations. The objective of this study was to determine the risk factors for low emotional intelligence and for depression in pregnant Peruvian Andean adolescents seen in a public health centre.

Methods

The study was a correlational analysis of 280 pregnant Peruvian Andean adolescents using logistic regression analysis. Emotional intelligence and depression were considered dependent variables, while independent variables were age, marital status, and education. The instruments used were Beck's Depression Inventory and the BarOn Emotional Quotient Inventory: Youth version. The threshold of significance was P < 0.05.

Results

Age, marital status, and level of education were not risk factors for lower emotional intelligence, because they had respective ORs of 0.8 (95% CI: 0.5-1.4), 1.6 (95% CI: 0.8-3.4), and 0.7 (95% CI: 0.0-1.1). Nor were they risk factors for depression, showing ORs of 0.8 (95% CI: 0.4-1.5), 0.6 (95% CI: 0.2-1.3), and 0.6 (95% CI: 0.3-1.1), respectively.

Conclusions

Thus, the risk factors studied do not significantly influence emotional intelligence or depression in pregnant Peruvian Andean adolescents.

Effects of Paternal Obesity on Fetal Development and Pregnancy Complications: A Prospective Clinical Cohort Study

OBJECTIVES

To evaluate the association between paternal obesity and fetal development and pregnancy complications.

STUDY DESIGN

This prospective cohort clinical trial analyzed data from 7683 women with singleton pregnancies. All study subjects were sequentially divided into four groups based on paternal BMI. We compared the differences in fetal growth and pregnancy complications between different paternal BMI groups by univariate logistic regression and independent t-test. Finally, the independent predictors of SGA and macrosomia were determined.

RESULTS

The incidences of preeclampsia, cesarean section, SGA, macrosomia, and postpartum hemorrhage in the paternal obesity group were significantly higher than the normal BMI group. With the increase of paternal BMI, fetal ultrasound measurement parameter, neonatal and placental weight showed an increasing trend (trend P < 0.05). However, these differences disappeared in the obese group. The test for interaction showed the effect of paternal obesity on SGA and macrosomia was significantly affected by maternal obesity. We also found paternal obesity was an independent predictor of both SGA and macrosomia. Based on the above results, we plotted the Nomograms for clinical prediction.

CONCLUSION

Paternal obesity can affect fetal growth parameters and placental development, which has an adverse impact on pregnancy outcomes. Optimizing the paternal BMI will help improve the health of the next generation.

The Impact of a Father's Adverse Childhood Experiences (ACEs) on the Relationship He Has with the Mother of His Baby

The relationship between the father and mother during pregnancy has been linked to pregnancy outcomes. However, factors that influence this relationship have not been studied in depth. Adverse childhood experiences (ACEs) of the father have been associated with poor health and functioning in adulthood, and may be important factors that impact the prenatal relationship between the parents. We recruited 117 fathers from a study that examined the risk of preterm birth in pregnant Black women. Of the fathers recruited, 113 completed questionnaires and provided survey data to determine behavioral, health, psychosocial, social, and sociodemographic characteristics. The mean ACEs score represents 107 fathers with 6 missing. The fathers' ACEs scores were measured using a 10-item self-report survey assessing whether each of the presented ACEs were experienced by the participant prior to the age of 18 years. Perceived conflict in the relationship between the father of the baby and mother of the baby was measured using a 5-item questionnaire scored on the 5-point Likert scale. For the Likert scale, 112 fathers provided data with 1 missing. A t-test was then used to compare the average score on the conflict scale with the mean ACEs of 67 fathers with 2 or fewer ACEs, and 40 fathers with 3 or more ACEs (6 missing). This study hypothesized that fathers with higher rates of exposure to ACEs would have higher scores on the conflict scale, indicating more conflict with the mother. The average score on the conflict scale was significantly higher (difference in means, 2.20 points, p=0.023) for fathers with an ACEs of 3 or more (mean± standard deviation: 12.2±4.6) relative to those with an ACEs of 2 or lower. (mean± standard deviation:14.4±5.0).

Prevalence of Preterm Birth Rate During COVID-19 Lockdown in a Tertiary Care Hospital, Riyadh

Background On March 3, 2020, the first case of coronavirus disease (COVID-19) was reported by the Ministry of Health, Kingdom of Saudi Arabia. Within days, the government confirmed more cases and adopted lockdown measures with travel restrictions from March to June 2020. A distinctive coronavirus was isolated from 190,823 patients by June 30. The pandemic resulted in a significant risk to public health. The study aimed to evaluate the impact of COVID-19 lockdown on the rate of premature births. Method In this cross-sectional study, we observed premature births at the Neonatal Intensive Care Unit (NICU). The study site is a 1,500-bed teaching hospital, with around 4,500 annual deliveries, 70 beds in level II and level III, and tertiary care NICU. We compared the birth rates among preterm infants between March 1 to June 30, 2017-2019, to the similar calendar months of 2020. Information on nationality, gestational age, and maternal conditions were collected from the medical records. We used the Poisson regression model to assess the preterm birth rate's temporal trends before lockdown versus during lockdown. Results Among 7,226 total live neonates, we recorded 1,320 preterm infants during the study period of 2017-2020. The preterm birth rate per 1,000 live births during lockdown showed a 23% drop in the overall preterm birth rate with Prevented Fraction of 36% in extremely preterm (<28 weeks gestational age) births and 26% in moderate/late premature (32 weeks to 36 weeks + 6 days gestational age) births. The estimated preterm birth rate among the Saudi expats (15.11/1,000 live births) showed an increased tendency compared to Saudi nationals (odds ratio [OR]=1.07; 95% CI: 0.75-1.52) and was statistically not significant during the strict lockdown. Conclusion There was a significant reduction in the birth rate of extremely preterm and moderate/late preterm infants during lockdown when compared to the preceding three years. A national dataset is required to evaluate the extent of lockdown's impact on the preterm birth rate.

Engaging fathers in the first 1000 days to improve perinatal outcomes and prevent obesity: Rationale and design of the First Heroes randomized trial

BACKGROUND

Early pregnancy through the first year of life represents an important period for family health promotion and obesity prevention. Overall, preventive interventions in pregnancy and infancy have insufficiently engaged fathers. We describe the rationale and design of First Heroes, an intervention to improve perinatal and obesity-related outcomes among mother-father-infant triads beginning in pregnancy.

METHODS/DESIGN

First Heroes is a hybrid type 1 effectiveness-implementation randomized trial of mother-father-infant triads recruited in the second trimester of pregnancy from a large Obstetric practice in eastern Massachusetts and continuing through 12 months of infant age. Triads are randomized to the intervention arm or to an enhanced safety education control group. Triads randomized to the intervention arm receive three virtual visits with a health educator, in the 3rd trimester of pregnancy, at 3-4 weeks, and 3-4 months postpartum, and receive continuous multimedia education through text messaging, print material, and videos. The educational curriculum addresses parent health behaviors, family relationships, social determinants of health, and infant feeding, sleep, and development. The primary outcome is prevalence of rapid infant weight gain from birth to 6 months of age. Secondary outcomes include parent anthropometrics, parent obesogenic behaviors, family functioning, and infant behaviors.

DISCUSSION

First Heroes will evaluate the extent to which intentional mother-father dyad engagement, coaching on adoption of early life health behaviors, and addressing social determinants of health, influence obesogenic behaviors and outcomes in the first year of life. Findings from this work will inform future obesity prevention efforts, especially those focused on whole family inclusion.

Family involvement in pregnancy and psychological health among pregnant Black women

Social determinants of health influence psychological health in pregnancy and contribute to health inequities in birth outcomes. This study examines the association between family involvement during pregnancy and psychological health among Black women. Pregnant women in Detroit, MI and Columbus, OH were recruited between 8 and 29 weeks' gestation (n = 203). Higher family involvement was associated with lower depressive symptoms (CES-D; β = -1.3, p < 0.001), perceived stress (β = -0.8, p < 0.001), and anxiety (β = -0.39, p < 0.01), and higher levels of psychological well-being (β = 2.2, p < 0.001). Family involvement may be a protective factor for pregnant Black women.

Paternal impact on the life course development of obesity and type 2 diabetes in the offspring

The aetiologies of obesity and type 2 diabetes are incredibly complex, but the potential role of paternal influences remains relatively understudied. A better understanding of paternal influences on offspring risk of obesity and type 2 diabetes could have profound implications for public health, clinical practice and society. In this review, we outline potential biological and social mechanisms through which fathers might exert an impact on the health of their offspring. We also present a systematically compiled overview of the current evidence linking paternal factors to offspring development of obesity and type 2 diabetes throughout the life course. Although evidence is accumulating to support paternal associations with offspring outcomes, more high-quality research is needed to overcome specific methodological challenges and provide stronger causal evidence.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies

OBJECTIVE

Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days.

METHODS

The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement.

RESULTS

Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics.

CONCLUSIONS

Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Relationship With the Father of the Baby and Perceived Stress Among Black Women

OBJECTIVE

The purpose of this study was to examine whether the relationship with the father of the baby was related to psychological stress among Black women.

METHODS

This is a secondary analysis of data derived from a retrospective cohort study of 1,410 Black new mothers participating in the Life-course Influences on Fetal Environments (LIFE) study conducted in the Detroit Metropolitan area. Data were obtained from maternal interview and medical records abstraction. Perceived stress was measured by the Cohen's Perceived Stress Scale. The mother's relationship with the father of the baby before and after pregnancy was measured using two questions.

RESULTS

Women who reported sometimes close/sometimes distant relationship with the father of the baby prior to pregnancy had higher levels of perceived stress compared with women who reported close relationship with the father of the baby prior to pregnancy (38.73 and 35.10, respectively, p < .001). Women who reported current distant relationship (38.82 and 34.45, respectively, p < .001) and sometimes close/sometimes distant relationship (38.83 and 34.45, respectively, p < .001) reported higher levels of perceived stress compared with women who had current close relationship with the father of the baby.

CLINICAL IMPLICATIONS

Women who reported to have a close relationship with the father of the baby before and during the pregnancy reported lower levels of stress compared with women with a distant relationship with the father of the baby. Nurses should assess women's relationship with the father of the baby and their levels of stress.

Can support from the father of the baby buffer the adverse effects of depressive symptoms on risk of preterm birth in Black families?

BACKGROUND

While maternal depressive symptoms during pregnancy have been linked to preterm birth (PTB; birth before 37 completed weeks of gestation), little has been reported on potential buffering factors, particularly specific to Black women who are at much higher risk. We examined the association between depressive symptoms and PTB in pregnant Black women, with father of the baby (FOB) support as a potential buffering factor.

METHODS

Data were obtained from the life-course influences on fetal environments study (2009-2011), a cohort of 1,410 Black women in metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to measure depressive symptoms. The 14-item social networks in adult relations questionnaire was used to assess the mother's relationship with the FOB. Logistic regression was used to explore the interaction between CES-D and FOB support with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care and BMI.

RESULTS

The PTB rate in this cohort was 17.7%. Among women with FOB scale < 60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥ 23 (severe depressive symptoms) as compared to CES-D scores < 23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94; p < 0.001]. Among women with FOB scores ≥ 60 (more support), the odds of PTB in women with CES-D scores ≥ 23 did not significantly differ from the odds of PTB in women with CES-D scores < 23 (OR = 1.34; 95% CI: 0.74, 2.44; p = 0.3). After adjustment for covariates, among women with FOB scores < 60, the OR of PTB for women with CES-D scores ≥ 23 compared to < 23 was 2.79 (95% CI: 1.75, 4.45; p < 0.001). Among women with FOB scores ≥ 60, the odds of PTB in women with CES-D scores ≥ 23 was not statistically significantly different compared to the odds of PTB in women with CES-D scores < 23 (OR = 1.21; 95% CI: 0.62, 2.35; p = 0.6). The interaction term was statistically significant (p = 0.04).

DISCUSSION/CONCLUSIONS

The adverse effect of depressive symptoms on risk of PTB may be buffered by factors such as a supportive relationship with the FOB.

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study

OBJECTIVE

To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. However, what constitutes these specific needs is poorly understood, particularly in Sub-Saharan Africa. This paper explores women's needs for communication and emotional support during facility-based childbirth.

METHODS

Qualitative research was conducted in a large referral maternity hospital and its catchment communities in Akure, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework.

RESULTS

Forty-two IDIs and 10 FGDs are included in this analysis. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers.

CONCLUSION

To increase, improve, and sustain facility-based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Practical and sustainable actions should be taken to meet these needs, within the confines of the acceptable sociocultural norms.