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Dib S, Fewtrell M, Wells JCK. Maternal capital predicts investment in infant growth and development through lactation. Front Nutr 2023; 10:1272938. [PMID: 37885440 PMCID: PMC10598761 DOI: 10.3389/fnut.2023.1272938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. Methods The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Results Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Conclusion Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.
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Affiliation(s)
| | | | - Jonathan C. K. Wells
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Banda PDNP, Amarasinghe GS, Agampodi SB. Determinants of birthweight in rural Sri Lanka; a cohort study. BMC Pediatr 2023; 23:40. [PMID: 36690991 PMCID: PMC9869565 DOI: 10.1186/s12887-022-03830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Identifying determinants of birthweight among disadvantaged communities is critical to further reducing the inequitable burden of perinatal health issues in low-and-middle income settings. Therefore, we adopted a bio-psycho-social approach to identify the determinants of birthweight in a mother-infant cohort from a rural setting in Sri Lanka, a lower-middle-income country. METHODS All third-trimester pregnant women with a singleton pregnancy registered for the national antenatal care programme at Ipalogama health division in 2017 were invited for a prospective cohort study. Data was collected using a self-completed questionnaire and data extraction from health records. The mother-infant cohort was followed up until one month after delivery. A principal component analysis was performed using economic, social, and psychological variables, and two composite variables were achieved. Care from husband and household members, perceived wellbeing, frequency of abuse, and affect during the third trimester strongly loaded to the variable 'psychosocial wellbeing'. Monthly income, husband's education level, and use of biomass fuel strongly loaded to the variable 'socioeconomic status'. Hierarchical logistic regression was used to predict factors associated with birthweight. Maternal age, parity, baby's sex, and gestational period at pregnancy registration were entered at the first step. BMI, psychosocial wellbeing, socioeconomic status, hypertensive disorders, and gestational/chronic diabetes were entered at step two. Preterm birth was entered at step three. RESULTS 532 women were recruited, and 495 were retained at the postpartum follow-up. 421 (74.8%) had reported being abused at least once during the preceding month. Birthweight was approximately normally distributed (mean 2912 g, SD 456.6 g). Low birthweight was present in 72 (14.6%, 95% CI 11.7,17.9), and 46 (9.3%, 95% CI 7.0,12.1) had birthweights > 3500 g. The regression model explained 13.2% of the variance in birthweight. Preterm birth, maternal BMI, and mid-pregnancy psychosocial wellbeing could explain 6.9%(p < 0.001), 3.9(p < 0.001), and 1.2%(p = 0.02) of unique variance, respectively. CONCLUSIONS In a setting where a large proportion of pregnant women suffer 'abuse' in their homes, psychosocial wellbeing during pregnancy was an important determinant of birthweight of babies. Expanding routine maternal care services, especially at the primary care level, to cater to the psychosocial issues of pregnant women would help reduce inequities in perinatal health.
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Affiliation(s)
| | - Gayani Shashikala Amarasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saiyapura, Sri Lanka
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Tesfaye M, Wu J, Biedrzycki RJ, Grantz KL, Joseph P, Tekola-Ayele F. Prenatal social support in low-risk pregnancy shapes placental epigenome. BMC Med 2023; 21:12. [PMID: 36617561 PMCID: PMC9827682 DOI: 10.1186/s12916-022-02701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Poor social support during pregnancy has been linked to inflammation and adverse pregnancy and childhood health outcomes. Placental epigenetic alterations may underlie these links but are still unknown in humans. METHODS In a cohort of low-risk pregnant women (n = 301) from diverse ethnic backgrounds, social support was measured using the ENRICHD Social Support Inventory (ESSI) during the first trimester. Placental samples collected at delivery were analyzed for DNA methylation and gene expression using Illumina 450K Beadchip Array and RNA-seq, respectively. We examined association between maternal prenatal social support and DNA methylation in placenta. Associated cytosine-(phosphate)-guanine sites (CpGs) were further assessed for correlation with nearby gene expression in placenta. RESULTS The mean age (SD) of the women was 27.7 (5.3) years. The median (interquartile range) of ESSI scores was 24 (22-25). Prenatal social support was significantly associated with methylation level at seven CpGs (PFDR < 0.05). The methylation levels at two of the seven CpGs correlated with placental expression of VGF and ILVBL (PFDR < 0.05), genes known to be involved in neurodevelopment and energy metabolism. The genes annotated with the top 100 CpGs were enriched for pathways related to fetal growth, coagulation system, energy metabolism, and neurodevelopment. Sex-stratified analysis identified additional significant associations at nine CpGs in male-bearing pregnancies and 35 CpGs in female-bearing pregnancies. CONCLUSIONS The findings suggest that prenatal social support is linked to placental DNA methylation changes in a low-stress setting, including fetal sex-dependent epigenetic changes. Given the relevance of some of these changes in fetal neurodevelopmental outcomes, the findings signal important methylation targets for future research on molecular mechanisms of effect of the broader social environment on pregnancy and fetal outcomes. TRIAL REGISTRATION NCT00912132 ( ClinicalTrials.gov ).
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Affiliation(s)
- Markos Tesfaye
- Section of Sensory Science and Metabolism (SenSMet), National Institute on Alcohol Abuse and Alcoholism & National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jing Wu
- Glotech, Inc., contractor for Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Richard J Biedrzycki
- Glotech, Inc., contractor for Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, MD, Bethesda, USA
| | - Paule Joseph
- Section of Sensory Science and Metabolism (SenSMet), National Institute on Alcohol Abuse and Alcoholism & National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, MD, Bethesda, USA.
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Do AD, Pham TTP, Nguyen CQ, Hoang DV, Fukunaga A, Stickley A, Yazawa A, Phan DC, Hachiya M, Jimba M, Huynh DV, Le HX, Do HT, Mizoue T, Inoue Y. Individual-level social capital is associated with depressive symptoms among middle-aged community dwellers in rural Vietnam: a cross-sectional study. BMJ Open 2022; 12:e064998. [PMID: 36600355 PMCID: PMC9730365 DOI: 10.1136/bmjopen-2022-064998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES There has been comparatively little research on the association between social capital and depressive symptoms in low- and middle-income countries. To address this deficit this study examined the association among middle-aged adults in rural Vietnam. DESIGN A cross-sectional study. SETTING Data came from the baseline survey of the Khánh Hòa Cardiovascular Study, which is an ongoing prospective cohort study aiming to elucidate the determinants of cardiovascular diseases. PARTICIPANTS A total of 3000 people aged 40-60 years old residing in rural communes in Khánh Hòa province, Vietnam. EXPOSURE OF INTEREST Cognitive social capital (ie, low, middle and high) and structural social capital (in terms of social participation; yes or no) were assessed via a questionnaire. PRIMARY OUTCOME MEASURE Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies Depression Scale. RESULTS A robust Poisson regression model revealed that adults in the highest versus lowest cognitive social capital tertile had a 61% lower prevalence of depressive symptoms (prevalence ratio (PR)=0.39, 95% CI=0.31 to 0.49). Individuals with higher structural social capital were also significantly less likely to experience depressive symptoms (PR=0.74, 95% CI=0.61 to 0.90). CONCLUSION In a cohort of 3000 middle-aged rural residents in Vietnam, both cognitive and structural social capital assessed at the individual level were inversely associated with the prevalence of depressive symptoms.
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Affiliation(s)
- An Dang Do
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Thuy Thi Phuong Pham
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Chau Que Nguyen
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Dong Van Hoang
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Aki Yazawa
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Danh Cong Phan
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Dong Van Huynh
- Khanh Hoa Center for Diseases Control, Nha Trang, Khanh Hoa, Vietnam
| | - Huy Xuan Le
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Hung Thai Do
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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Does armed conflict increase individuals’ religiosity as a means for coping with the adverse psychological effects of wars? Soc Sci Med 2022; 296:114769. [DOI: 10.1016/j.socscimed.2022.114769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
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West R, DiMeo A, Langer A, Shah N, Molina RL. Addressing Racial/Ethnic Inequities in Maternal Health Through Community-Based Social Support Services: A Mixed Methods Study. Matern Child Health J 2022; 26:708-718. [PMID: 34982340 PMCID: PMC8724658 DOI: 10.1007/s10995-021-03363-5] [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] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
Introduction In the US, there are striking inequities in maternal health outcomes between racial and ethnic groups. Community-based organizations (CBOs) provide social support services that are critical in addressing the needs of clients of color during and after pregnancy. Methods We conducted a descriptive, cross-sectional mixed methods study of CBOs in Greater Boston that provide social support services to pregnant and postpartum clients. In May–August 2020, we administered an online survey about organizational characteristics, client population, and services offered. In July–August 2020, we conducted semi-structured interviews focused on services provided, gaps in services, and the impact of structural racism on clients. We used descriptive statistics to characterize CBOs and services and used thematic analysis to extract themes from the qualitative data. Results A total of 21 unique CBOs participated with 17 CBOs completing the survey and 14 participating in interviews. CBOs served between 10 and 35,000 pregnant and postpartum clients per year (median = 200), and about half (n = 8) focused their programming on pregnant and postpartum clients. The most significant gaps in social support services were housing and childcare. Respondents identified racism and lack of coordination among organizations as the two primary barriers to accessing social support. Discussion CBOs face multiple challenges to providing social support to pregnant and postpartum clients of color, and significant gaps exist in the types of services currently provided. Improved coordination among CBOs and advocacy efforts to develop community-informed solutions are needed to reduce barriers to social support.
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Affiliation(s)
- Rebecca West
- Boston University School of Public Health, Boston, MA USA
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Amanda DiMeo
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Neel Shah
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Rose L. Molina
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
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Leroy JL, Koch B, Roy S, Gilligan D, Ruel M. Social Assistance Programs and Birth Outcomes: A Systematic Review and Assessment of Nutrition and Health Pathways. J Nutr 2021; 151:3841-3855. [PMID: 34590144 PMCID: PMC8643580 DOI: 10.1093/jn/nxab292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 08/06/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Poor birth outcomes are an important global public health problem. Social assistance programs that provide cash or in-kind transfers, such as food or vouchers, hold potential to improve birth outcomes but the evidence on their effectiveness has not been reviewed. OBJECTIVES We systematically reviewed studies that used experimental or quasi-experimental methods to evaluate the impacts of social assistance programs on outcomes in low- and middle-income countries. METHODS The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to assess the certainty of the evidence for birth weight and neonatal mortality (most common outcomes reported). We summarized the evidence on hypothesized nutrition and health pathways of impact. RESULTS We included 6 evaluations of 4 different cash transfer programs and 1 evaluation of a community-based participatory learning and action program that provided food and cash transfers. The 4 studies that assessed birth weight impacts found significant (P < 0.05) effects ranging from 31 to 578 g. Out of 3 studies that assessed neonatal mortality impacts, 2 found significant effects ranging from 0.6 to 3.1 deaths/1000 live births. The certainty of the evidence for both outcomes was rated as very low due to several methodological limitations. In terms of potential pathways, some studies documented positive effects on maternal diet, antenatal care (ANC) utilization, and delivery in a health facility. CONCLUSIONS Better-designed evaluations are needed to strengthen the evidence base on these programs. Evaluation studies should elucidate underlying mechanisms of impact by including outcomes related to maternal diet, ANC seeking, use of skilled delivery, and women's empowerment in nutrition and health domains. Studies should also assess potential unintended negative consequences of social assistance, such as reduced birth spacing and excess pregnancy weight gain.
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Affiliation(s)
| | - Bastien Koch
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Shalini Roy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Daniel Gilligan
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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