Psychosocial factors in pregnancy and birthweight: Path analysis

Reliability and Validity of a Theory-Based Determinants of Eating and Physical Activity Behaviors Questionnaire for Chinese Elementary School Children

OBJECTIVE

The primary objective of this study was to develop and validate a Social Cognitive Theory-based instrument to identify psychosocial factors that influence diet and physical activity among Chinese children aged 10-12 years.

DESIGN

This is a cross-sectional study, with data collected from questionnaires.

SETTING

Two elementary schools in Beijing, China.

PARTICIPANTS

Fourth to sixth-grade students (N = 1,486) aged 10-12 years were recruited.

VARIABLES MEASURED

Gender, height, weight, nation, and grade were collected. Energy-balanced eating behaviors and their related sociopsychological factors were surveyed.

ANALYSIS

Confirmatory factor analysis, Pearson correlations, Cronbach α index, and mediation analysis were used.

RESULTS

(1) Confirmatory factor analysis revealed a 6-factor solution (51 items) and all factor loadings > 0.32, indicating that the model fitness was acceptable. (2) All correlation coefficients are statistically significant. All of the Cronbach α indexes were > 0.65, indicating acceptable reliability. (3) The mediating effect of goal intention and outcome expectations between self-efficacy and habit strength was statistically significant (P < 0.01), verifying the theory structure.

CONCLUSIONS AND IMPLICATIONS

This questionnaire exhibits good internal consistency, reliability, and structural validity. It can be effectively employed to investigate energy-balanced eating behaviors related to the Social Cognitive Theory in Chinese children.

Antepartum Intimate Partner Violence: Development of a Risk Prediction Model

Objectives: To explore socio-behavioral, clinical, and imaging findings associated with antepartum intimate partner violence (IPV) and aid in risk stratification of at-risk individuals. Methods: We analyzed electronic medical records during indexed pregnancies for 108 pregnant patients who self-reported antepartum IPV (cases) and 106 age-matched pregnant patients who did not self-report antepartum IPV (controls). Sociodemographic, clinical, and radiology data were analyzed via chi-squared and Fisher's exact tests with p < 0.05 as the threshold for significance. Stepwise logistic regression was applied to derive a risk prediction model. Results: The proportion of cases reporting emotional IPV (76% vs. 52%) and/or physical IPV (45% vs. 31%) during pregnancy significantly increased from prior to pregnancy. Cases were significantly more likely to report prepregnancy substance use (odds ratio [OR] = 2.60; 95% confidence interval [CI]: 1.13-5.98), sexually transmitted infections (OR = 3.48; 95%CI: 1.64-7.37), abortion (OR = 3.17; 95%CI: 1.79, 5.59), and preterm birth (OR = 5.97; 95%CI: 1.69-21.15). During pregnancy, cases were more likely to report unstable housing (OR = 5.26; 95%CI: 2.67-10.36), multigravidity (OR = 2.83; 95%CI: 1.44-5.58), multiparity (OR = 3.75; 95%CI: 1.72-8.20), anxiety (OR = 3.35; 95%CI: 1.85-6.08), depression (OR = 5.58; 95%CI: 3.07-10.16), substance use (OR = 2.92; 95%CI: 1.28-6.65), urinary tract infection (UTI) (OR = 3.26; 95%CI: 1.14-9.32), intrauterine growth restriction (OR = 10.71; 95%CI: 1.35-85.25), and cesarean delivery (OR = 2.25; 95%CI: 1.26-4.02). Cases had significantly more OBGYN abnormalities on imaging and canceled more radiological studies (OR = 5.31). Logistic regression found housing status, sexually transmitted infection history, preterm delivery history, abortion history, depression, and antepartum UTI predictive of antepartum IPV. The risk prediction model achieved good calibration with an area under the curve of 0.79. Conclusions: This study identifies significant disparities among patients experiencing antepartum IPV, and our proposed risk prediction model can inform risk assessment in this setting.

The relationships of spiritual health, pregnancy worries and stress and perceived social support with childbirth fear and experience: A path analysis

BACKGROUND

Given maternal health is a major health indicator, the present research aimed at determining the causal relationships of spiritual health, worries, stress and perceived social support with the fear and experience of childbirth in pregnant women.

METHODS

The present longitudinal prospective research recruited 352 pregnant women presenting to selected health centers in Qazvin, Iran in 2021. The data were collected using the Childbirth Experience Questionnaire-2 (CEQ-2), the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), the Multidimensional Scale of Perceived Social Support (MSPSS), the Persian version of the Pregnancy Worries and Stress Questionnaire (PWSQ), the Spiritual Health Questionnaire, the Socioeconomic Status (SES) questionnaire and a sociodemographic checklist, and were analyzed in SPSS-25 and Lisrel-8.8.

RESULTS

The mean age of the participants was 28.1±6.8 years. According to the results of the path analysis, among the variables related to fear of childbirth, childbirth experience (B = -0.37, CI:-0.44;-0.22) in the direct path and perceived social support (B = -0.51, CI:-0.58;-0.43) in both direct and indirect paths demonstrated the most significant negative relationship. Among the variables related to childbirth experience, pregnancy worries and stress had a negative causal relationship (B = -0.06, CI:-0.079;-0.043) in the direct path, spiritual health showed the highest significant positive relationship (B = 0.01, CI: 0.008; 0.012) in the indirect path, and perceived social support (B = 0.112, CI: 0.092; 0.131) and the number of children (B = 0.32,CI: 0.30; 0.34) demonstrated the highest significant positive relationship in both direct and indirect paths. In other words, childbirth experience becomes more desirable as spiritual health, social support, and the number of children increases, and it becomes less desirable as pregnancy worries and stress rise.

CONCLUSION

According to the present findings, various psychological, social, and spiritual factors are associated with childbirth fear and experience. It is thus necessary to utilize appropriate methods and promote training and support to reduce the adverse outcomes of childbirth.

Intimate partner violence during pregnancy and maternal and child health outcomes: a scoping review of the literature from low-and-middle income countries from 2016 - 2021

Background

Intimate partner violence (IPV) during pregnancy is significantly associated with negative outcomes for both mother and child. Current evidence indicates an association between low levels of social support and IPV, however there is less evidence from low-and-middle income countries (LMIC) than high-income countries. Globally, the COVID-19 pandemic has radically altered how women can access social support. Hence since 2020, studies investigating IPV and pregnancy have occurred within the changing social context of the pandemic.

Objective

This scoping review summarizes the evidence from LMICs about the effects of IPV during pregnancy on maternal and child health. The review includes the impact of the COVID-19 pandemic on social support as mentioned in studies conducted since 2020.

Design

Library databases were used to identify papers from 2016 to 2021. These studies reported the maternal and child health outcomes of IPV during pregnancy, and described how social support during pregnancy, and the COVID-19 pandemic, were associated with rates of IPV during pregnancy. Observational study designs, qualitative and mixed methods studies were included.

Results

Twenty - six studies from 13 LMICs were included. Half (n = 13) were cross sectional studies which only collected data at one time-point. IPV during pregnancy was significantly associated with higher odds of postpartum depression, low birth weight, preterm birth and less breastfeeding in the year after birth. Lower levels of social support increased the odds of experiencing IPV during pregnancy, whilst higher levels of social support reduced antenatal anxiety and depression in women experiencing IPV during pregnancy. Of the four studies that investigated IPV during pregnancy throughout the COVID-19 pandemic, only one compared prevalence before and after the pandemic and unexpectedly reported a lower prevalence.

Conclusions

Further research on the impact of IPV during pregnancy on maternal and child outcomes in LMICs is required, especially evidence from longitudinal studies investigating a wider range of outcomes. To date, there is limited evidence on the impact of the COVID-19 pandemic on IPV during pregnancy in LMICs, and this should be prioritized as the pandemic continues to affect women’s access to social support globally.

Supplementary information

The online version contains supplementary material available at 10.1186/s12884-022-04604-3.

Sex-specific association of high maternal psychological stress during pregnancy on newborn birthweight

Birthweight is an important predictor of newborn health and has been linked to maternal psychological stress during pregnancy. However, it is unclear whether prenatal stress affects birthweight similarly for both male and female infants. We used a well-established pregnancy cohort to investigate the impact of high maternal psychological stress during pregnancy on birthweight as a function of infant sex. Overall, 5702 mother-newborn pairs were analysed. Of these, 198 mothers reported high levels of stress using the Psychological Stress Measure (nine-items version; PSM-9). Maternal psychological stress was assessed between the 24^th and 28^th week of gestation and analyses were performed jointly and independently as a function of neonatal sex (separate analyses for male and female infants). Newborns exposed to high maternal psychological stress during pregnancy (a score above 26 measured using the PSM-9 questionnaire, corresponding to >97.5^th percentile) were compared to newborns of mothers who reported lower stress. ANCOVAs revealed that high levels of maternal stress during pregnancy were linked to infant birthweight as a function of infant sex. Male infants of mothers who reported high levels of stress had a greater birthweight whereas female infants had a lower birthweight under the same conditions, in comparison to mothers who did not report greater levels of stress. Although the effect size is small, these results underline the possibility that male and female fetuses may use different strategies when adapting to maternal adversity and highlight the need to consider infant sex as a moderator of the association between maternal psychological stress during pregnancy and infant birthweight.

Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort

BACKGROUND

Factors associated with low birth weight at term (TLBW), a proxy for intrauterine growth restriction (IUGR), are not well-elucidated in socioeconomically vulnerable populations. This study aimed to identify the factors associated with TLBW in impoverished Brazilian women.

METHODS

Records in the 100 Million Brazilian Cohort database were linked to those in the National System of Information on Live Births (SINASC) to obtain obstetric, maternal, birth and socioeconomic data between 2001 and 2015. Multivariate logistic regression was performed to investigate associations between variables of exposure and TLBW.

RESULTS

Of 8,768,930 term live births analyzed, 3.7% presented TLBW. The highest odds of TLBW were associated with female newborns (OR: 1.49; 95% CI: 1.47-1.50), whose mothers were black (OR: 1.20; 95% CI: 1.18-1.22), had a low educational level (OR: 1.57; 95% CI: 1.53-1.62), were aged ≥35 years (OR: 1.44; 95% CI: 1.43-1.46), had a low number of prenatal care visits (OR: 2.48; 95% CI: 2.42-2.54) and were primiparous (OR: 1.62; 95% CI: 1.60-1.64). Lower odds of TLBW were found among infants whose mothers lived in the North, Northeast and Center-West regions of Brazil compared to those in the South.

CONCLUSION

Multiple aspects were associated with TLBW, highlighting the need to comprehensively examine the mechanisms underlying these factors, especially in more vulnerable Brazilian populations, in order to contribute to the elaboration of health policies and promote better conditions of life for poor and extremely poor mothers and children.

Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis

Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Using path analysis, we examined associations between multiple self-reported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N = 510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2^nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI] = 1.60, 5.85) and 2.67 (95% CI = 1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β = 1.63, 95% CI = 0.29, 3.07; β = 1.48, 95% CI = 0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.

Sleep Disturbance in Early Pregnancy, but Not Inflammatory Cytokines, May Increase Risk for Adverse Pregnancy Outcomes

BACKGROUND

It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines.

METHOD

Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10-20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data.

RESULTS

Diary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05).

CONCLUSION

Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.

Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico

Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population.

Socioeconomic Status in Pregnant Women and Sleep Quality During Pregnancy

This review focuses on factors contributing to sleep quality among pregnant women with low socioeconomic statuses during the third trimester of their pregnancy. Electronic searches were conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched for published, peer reviewed, English language primary research articles using electronic databases including PubMed, EMBASE, Ovid, MEDLINE and Google Scholar ending June 2019. All references were reviewed manually and independently by authors. After applying the inclusion criteria, 56 articles were selected; 38 of which are full-text and included in this review. All articles related to the analysis of poor sleep quality among uncomplicated pregnant women were included. Pregnant women with a specific pathology were excluded.

We found poor sleep quality among pregnant women is correlated with low socioeconomic levels. Pregnant women with lower incomes tend to have inadequate diets, which further complicates the health of the mother and the baby. External factors including low income, poor quality of life and poor diet tend to increase the possibility of future health complications in both mother and child, and can result in complications such as preterm labor, low birth weight, preeclampsia, perinatal death, and spontaneous abortion.

Sleep Disturbances and Modulations in Inflammation: Implications for Pregnancy Health

When a woman becomes pregnant, there is a vast series of physiological, vascular, and psychological changes. Among the most commonly reported changes are those involving sleep. Pregnant women report that their ability to maintain sleep and acquire continuous refreshing sleep is impaired during the perinatal period as compared to the non-pregnant period. A growing literature supports the hypothesis that disturbed sleep (which comes in many forms) during the perinatal period is associated with an increased risk of adverse maternal, delivery, and infant outcomes. Among the suggested biological pathways linking sleep and adverse outcomes are disturbances in the immune and hormonal systems. The following paper will discuss (1) the various sleep processes that are commonly disturbed during the perinatal period and the methods used to collect sleep data; (2) the evidence linking sleep to adverse outcomes; and (3) how one specific biological pathway, the immune system, likely mediates these associations. The goal of this paper is to clarify the role that sleep disturbance has during pregnancy.

A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later

INTRODUCTION

Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended.

METHODS

Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team.

RESULTS

Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills.

DISCUSSION

This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.

The effect of cognitive-behavioral counseling on anxiety in the mothers of infants in the NICU: A randomized controlled trial

Background: Pressures and tensions in everyone's life can cause a wide range of mental disorders such as anxiety. One of these tensions is the birth of a baby who requires special care, which can cause personal and social problems for the mother if no appropriate measures are taken to help them. The present study was conducted to determine the effect of cognitive-behavioral counseling on anxiety in the mothers of infants in the Neonatal Intensive Care Unit. Methods: This randomized controlled trial recruited 90 women presenting to Kowsar Hospital in Qazvin in 2016. They were enrolled by convenience sampling and randomly assigned to control and intervention groups. Eight sessions were held for each group. Beck Anxiety Inventory was filled by mothers at the beginning of intervention, at the end of the eighth session and three weeks after the intervention. The data was analyzed by generalized estimating equations (GEE) method. Results: According to the results, maternal anxiety showed no significant differences between the two groups before intervention (p = 0.408 and p = 0.881). Based on GEE test, the mean score of anxiety was significantly different in the two groups (p = 0.026) immediately and three weeks after the intervention in that it was lower in the intervention group. Friedman test results also confirmed the reducing trend of mean score of anxiety in the three stages (p = 0.000). Conclusions: Counseling has a positive effect on reducing the anxiety of mothers of children with special needs, therefore it can be used to improve their condition.