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Biswas S, Mondal S, Banerjee A, Alam A, Satpati L. Investigating the association between floods and low birth weight in India: Using the geospatial approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169593. [PMID: 38151131 DOI: 10.1016/j.scitotenv.2023.169593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Frequent natural disasters like floods pose a major threat to India, with significant implications for public health. Low birth weight (LBW) is a critical global health concern, contributing to neonatal mortality. However, the association between floods and LBW remains underexplored. This study aims to address this gap by investigating the association between flood hazards and LBW in India using a geospatial approach. By analyzing data from the National Family Health Survey (NFHS-5) and flood zonation maps, the study aims to uncover the spatial dynamics of this association, offering insights into the implications of floods on birth weight across diverse geographical regions. METHODS The study used the fifth round of NFHS data, 2019-21, which involved 202,194 children selected through a multi-stage stratified sampling technique. The Vulnerability Atlas of India 2019 maps were also utilized to classify areas as flood or non-flood zones. Birth weight data from the NFHS-5 were categorized into three groups: very low, low, and normal birth weight (VLBW, LBW and NBW). Control variables including flood exposure, socio-demographic attributes, and geographic region were considered. Bivariate analysis and multinomial logistic regression were employed for statistical analysis. The spatial analysis involved Moran's I statistics and Geographically Weighted Regression to explore spatial dynamics of the association between floods and birth weight in India. RESULTS Floods predominantly affect India's lower Himalayan belts and western coastal regions. Flood-affected areas show higher proportions of VLBW and LBW infants. Groundwater usage and unimproved sanitation are associated with higher risk of VLBW and LBW. Sex, wealth, maternal education, residence type, and geographic region significantly influence birth weights. Multinomial logistic regression reveals 8 % and 27 % higher risks for LBW and VLBW in flood-affected regions. LISA cluster maps identify high-risk areas for both LBW and floods. Geographically Weighted Regression highlights 52 % of the variability in LBW occurrences can be attributed to the influence of flood hazards. Families hailing from the poorest wealth background and exposed to flood hazards bear a 5 % heightened likelihood of delivering LBW infants, in stark contrast to their counterparts from the same economic background yet unaffected by floods. CONCLUSIONS The significant association between floods and LBW underscores the importance of robust disaster preparedness and public health strategies. By unraveling the spatial intricacies of flood-induced LBW disparities, this research provides valuable insights for promoting healthier birth outcomes and reducing child mortality rates, particularly in flood-prone regions. These findings emphasize the importance of holistic policies that address both environmental challenges and socioeconomic inequalities to safeguard maternal and infant health across the nation.
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Affiliation(s)
- Sourav Biswas
- Department of Population & Development, International Institute for Population Science, Deonar, Mumbai 400088, India.
| | - Suresh Mondal
- Department of Geography, School of Earth Sciences, Central University of Tamil Nadu, Thiruvarur 610005, Tamil Nadu, India.
| | - Adrita Banerjee
- Department of Public Health and Mortality Studies, International Institute for Population Science, Deonar, Mumbai 400088, India.
| | - Asraful Alam
- Department of Geography, Serampore Girls' College, 13, T.C. Goswami Street, Serampore, Hooghly 712201, West Bengal, India.
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BRAVEMAN PAULA. The Black-White Disparity in Preterm Birth: Race or Racism? Milbank Q 2023; 101:356-378. [PMID: 37096619 PMCID: PMC10126979 DOI: 10.1111/1468-0009.12625] [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: 05/25/2022] [Revised: 09/20/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.
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Lopes NA, Ambeskovic M, King SE, Faraji J, Soltanpour N, Falkenberg EA, Scheidl T, Patel M, Fang X, Metz GAS, Olson DM. Environmental Enrichment Promotes Transgenerational Programming of Uterine Inflammatory and Stress Markers Comparable to Gestational Chronic Variable Stress. Int J Mol Sci 2023; 24:ijms24043734. [PMID: 36835144 PMCID: PMC9962069 DOI: 10.3390/ijms24043734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Prenatal maternal stress is linked to adverse pregnancy and infant outcomes, including shortened gestation lengths, low birth weights, cardio-metabolic dysfunction, and cognitive and behavioural problems. Stress disrupts the homeostatic milieu of pregnancy by altering inflammatory and neuroendocrine mediators. These stress-induced phenotypic changes can be passed on to the offspring epigenetically. We investigated the effects of gestational chronic variable stress (CVS) in rats using restraint and social isolation stress in the parental F0 generation and its transgenerational transmission across three generations of female offspring (F1-F3). A subset of F1 rats was housed in an enriched environment (EE) to mitigate the adverse effects of CVS. We found that CVS is transmitted across generations and induces inflammatory changes in the uterus. CVS did not alter any gestational lengths or birth weights. However, inflammatory and endocrine markers changed in the uterine tissues of stressed mothers and their offspring, suggesting that stress is transgenerationally transmitted. The F2 offspring reared in EE had increased birth weights, but their uterine gene expression patterns remained comparable to those of stressed animals. Thus, ancestral CVS induced changes transgenerationally in fetal programming of uterine stress markers over three generations of offspring, and EE housing did not mitigate these effects.
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Affiliation(s)
- Nayara A. Lopes
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mirela Ambeskovic
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Stephanie E. King
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Jamshid Faraji
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Nasrin Soltanpour
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Erin A. Falkenberg
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Taylor Scheidl
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mansi Patel
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Xin Fang
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Gerlinde A. S. Metz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Correspondence: (G.A.S.M.); (D.M.O.); Tel.: +1-403-394-3992 (G.A.S.M.); +1-780-492-8559 (D.M.O.)
| | - David M. Olson
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Correspondence: (G.A.S.M.); (D.M.O.); Tel.: +1-403-394-3992 (G.A.S.M.); +1-780-492-8559 (D.M.O.)
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Miller FA, Marphatia AA, Wells JC, Cortina-Borja M, Manandhar DS, Saville NM. Associations between early marriage and preterm delivery: Evidence from lowland Nepal. Am J Hum Biol 2021; 34:e23709. [PMID: 34862821 DOI: 10.1002/ajhb.23709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. METHODS We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n = 6 243) and multigravida (n = 11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. RESULTS Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. DISCUSSION In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
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Affiliation(s)
- Faith A Miller
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Akanksha A Marphatia
- Department of Geography, University of Cambridge, Cambridge, UK.,Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Jonathan C Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | | | - Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Yalnız Dilcen H, Aslantekin F, Aktaş N. The relationship of psychosocial well‐being and social support with pregnant women's perceptions of traumatic childbirth. Scand J Caring Sci 2020; 35:650-658. [DOI: 10.1111/scs.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Hacer Yalnız Dilcen
- Department of Midwifery Faculty of Health Sciences Bartın University Bartin Turkey
| | - Filiz Aslantekin
- Department of Midwifery Faculty of Health Sciences Balıkesir University Balikesir Turkey
| | - Naciye Aktaş
- Karadeniz Ereğli 04 Famıly Health Center Zonguldak Turkey
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Hair Cortisol Concentrations as a Biological Marker of Maternal Prenatal Stress: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114002. [PMID: 32512943 PMCID: PMC7313007 DOI: 10.3390/ijerph17114002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
Recently, biological markers of maternal prenatal stress, hair cortisol, along with saliva, blood, and urine cortisol, have received attention. However, it is necessary to validate measuring hair cortisol concentrations (HCC) as a biomarker of perceived stress among healthy and high-risk pregnant women. This study aimed to confirm the correlation between HCC and the perceived stress of pregnant women over 18 years of age. In this systematic review, we used various search engines to extract relevant articles using specific keywords related to pregnancy, hair cortisol, and psychological stress. Four out of 3639 studies met the inclusion criteria. We conducted a quality assessment with the help of three independent reviewers using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The correlation between HCC and perceived stress was confirmed in one study. There was only one study on hair washing, shampoo, conditioner, and hair structure that could affect hair samples. In four studies, hair samples differed in length, methods of storage, and laboratory analysis. The review was limited to confirming the relationship between HCC and perceived stress in pregnant women based on the current evidence. Studies on hair cortisol need regulated and standardized methods for collection, storage, and analysis of hair samples.
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Ucar N, Pinar SE. The hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery: A follow-up study. Perspect Psychiatr Care 2020; 56:290-296. [PMID: 31347190 DOI: 10.1111/ppc.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 07/14/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To determine the hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery. DESIGN AND METHODS This descriptive pretest-posttest study consisted of 147 pregnant women with preterm delivery. Follow-up was performed twice. Data were collected using the Personal Information Form, the Beck Depression Inventory, the State Anxiety Inventory (SAI)-Trait Anxiety Inventory, and the Antepartum Hospital Stressors Inventory (AHSI). FINDINGS A statistically significant difference was found between the average scores of the SAI during the first and second measurements. A statistically significant difference was found between the average scores of the first and second measurement of AHSI (P < .05). PRACTICE IMPLICATIONS Anxiety, depression, and hospital stressors negatively affect gestations during both hospitalization and discharge.
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Affiliation(s)
- Nefise Ucar
- Department of Midwifery, Keles Entegre District Hospital, Bursa, Turkey
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Chambers BD, Arabia SE, Arega HA, Altman MR, Berkowitz R, Feuer SK, Franck LS, Gomez AM, Kober K, Pacheco-Werner T, Paynter RA, Prather AA, Spellen SA, Stanley D, Jelliffe-Pawlowski LL, McLemore MR. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health 2020; 36:213-219. [PMID: 31919987 PMCID: PMC7269549 DOI: 10.1002/smi.2922] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 11/12/2022]
Abstract
Research supports that exposure to stressors (e.g., perceived stress and racism) during pregnancy can negatively impact the immune system, which may lead to infection and ultimately increases the risk for having a preterm or low-birthweight infant. It is well known that Black women report higher levels of stressors at multiple timepoints across pregnancy compared with women of all other racial and ethnic groups. This study addresses gaps in the literature by describing pregnant and early post-partum Black women's exposures to structural racism and self-reported experiences of racial discrimination, and the extent to which these factors are related. We used a cross-sectional study design to collect data related to exposures to racism from pregnant and early post-partum Black women residing in Oakland, California, from January 2016 to December 2017. Comparative analysis revealed that living in highly deprived race + income neighborhoods was associated with experiencing racial discrimination in three or more situational domains (p = .01). Findings show that Black women are exposed to high levels of racism that may have negative impacts on maternal health outcomes.
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Affiliation(s)
- Brittany D. Chambers
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Silvia E. Arabia
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Helen A. Arega
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Molly R. Altman
- Family and Child Nursing Department, School of Nursing, University of Washington, Seattle, Washington
| | - Rachel Berkowitz
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sky K. Feuer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Obstetrics, Gynecology, and Reproductive Sciences Department, University of California, San Francisco, San Francisco, California
| | - Linda S. Franck
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Anu M. Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Kord Kober
- Physiological Nursing Department, University of California, San Francisco, San Francisco, California
| | - Tania Pacheco-Werner
- Central Valley Health Policy Institute, California State University, Fresno, California
| | - Randi A. Paynter
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Aric A. Prather
- Center for Health and Community, Psychiatry Department, University of California, San Francisco, San Francisco, California
| | - Solaire A. Spellen
- Expecting Justice, San Francisco Department of Public Health, San Francisco, California
| | - Darcy Stanley
- LifeLong Medical Care Brookside, San Pablo, California
| | - Laura L. Jelliffe-Pawlowski
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Monica R. McLemore
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
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The Effect of Prenatal Stress, Proxied by Marital and Paternity Status, on the Risk of Preterm Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020273. [PMID: 30669349 PMCID: PMC6352213 DOI: 10.3390/ijerph16020273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 01/09/2023]
Abstract
Uncertainty and insecurity in the relationship between the mother and father of a child are responsible for heightened maternal stress, which can lead to preterm birth (PTB). Different intensities of prenatal stress (proxied by four levels of marital status linked with the presence or absence of paternal data on birth records) were defined as the Marital-Father Data index. We assessed the impact of those varying intensities of prenatal stress on PTB with respect to parity among a group of Polish mothers residing in Krakow (N = 87,916). We found a pattern across the adjusted risk ratios (RR) of preterm birth that ordered these estimates in an increasing trend towards higher risk, beginning with the group of married mothers with father data present (baseline), through the groups of legitimizing marriages—married after conception with father data present (RR = 1.1; 95% Confidence Intervals (CI) 1.0–1.2) and unmarried mothers with father data present (RR = 1.3; 95% CI 1.2–1.5) to the group of unmarried mothers with father data absent (RR = 1.9; 95% CI 1.7–2.2). The adjusted p for the linear trend between Marital-Father Data index and PTB was less than 0.001. The adjusted effect of perceived prenatal stress differed with respect to parity (confirmed by statistically significant interactions between Marital-Father Data index levels and parity), with a higher magnitude of this effect noted among multiparous versus primiparous women. Low paternal involvement and support during pregnancy may negatively affect PTB risk and this effect may differ in relation to parity status. More attention should be paid to maternal pregnancy stress, especially of multiparous mothers, to decrease the risk of unfavorable birth outcomes.
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Epigenetic Signature of Chronic Maternal Stress Load During Pregnancy Might be a Potential Biomarker for Spontaneous Preterm Birth. Balkan J Med Genet 2018; 21:27-33. [PMID: 30984521 PMCID: PMC6454236 DOI: 10.2478/bjmg-2018-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Preterm birth is the leading cause of mortality in newborn infants and can lead to significant neonatal morbidities. Spontaneous preterm birth accounts for at least 50.0% of all preterm births. We argue that chronic maternal stress load, which is an important risk factor for spontaneous preterm birth, could be represented by epigenetic signature of several specific genetic loci in the mother’s blood. A literature search was done in PubMed with the following keywords: “DNA methylation,” “epigenetics,” “maternal stress” and “preterm birth” from year 2000 to 2017. We suggest that these genetic loci might be related to vulnerability and hypersensibility of stress response during pregnancy in women with preterm births. The mother’s epi-genetic stress bioprofile was supposed to be a result of chronic maternal stress load since her birth. This epigenetic bioprofile might also be a potential biomarker for spontaneous preterm birth. DNA methylation changes are tissue-specific and human stress response manifests mostly through the central nervous system (CNS). Nevertheless, we found evidence that methylation changes of DNA isolated from blood leucocytes might be a reliable measure of stress-related epigenetic changes that occur in the CNS. Evaluating biological mechanisms through the development of simple assays based on epigenetic changes to measure chronic stress loads in expectant mothers can lead to our ability to prepare more effective measures for the prevention of preterm births, as well as leading to more effective treatment strategies for both expectant mothers and their newborns.
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12
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Ferdos J, Rahman MM. Maternal experience of intimate partner violence and low birth weight of children: A hospital-based study in Bangladesh. PLoS One 2017; 12:e0187138. [PMID: 29073222 PMCID: PMC5658163 DOI: 10.1371/journal.pone.0187138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Intimate partner violence (IPV) is the most prevalent form of gender-based violence worldwide. IPV either before or during pregnancy has been documented as a risk factor for the health of the mother and her unborn child. The aim of this study was to examine the relationship between maternal experience of IPV and low birth weight (LBW). STUDY DESIGN A hospital-based survey was conducted among women in the postnatal wards of a large public hospital at Rajshahi, Bangladesh. Data on socio-economic characteristics, reproductive health characteristics, intimate partner violence, and antenatal, delivery and newborn care were collected from 400 women between July 2015 and April 2016. RESULTS Results of this study indicated that 43% of women reported experiencing any physical IPV in their lifetime, 35.5% of them experienced sexual IPV, and 32.5% experienced both physical and sexual IPV. Approximately one in every three (29.2%) infants was born with LBW. Physical IPV was associated with an increased risk of having a child with low birth weight (adjusted odds ratio [AOR]: 3.01, 95% CI: 2.35-5.81). The risk of infants born with LBW increased with women's lifetime experience of sexual IPV (AOR: 1.98; 95% CI: 1.23-4.15) and both physical and sexual IPV (AOR: 4.05; 95% CI: 2.79-7.33). CONCLUSION Maternal lifetime experience of IPV is positively associated with LBW children. Preventing women from the experience of IPV may help improve neonatal and child mortality in Bangladesh.
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Affiliation(s)
- Jannatul Ferdos
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Abstract
OBJECTIVE Depressed mood is common in pregnancy, is associated with stress, and could result in immune suppression that may lead to latent herpes viral reactivation. This study investigated whether depressed mood is associated with higher herpes viral IgG levels in pregnant women. METHODS Complete cross-sectional data from 247 pregnant women were available for this substudy. The data included demographics, scores on the Perceived Stress Scale and Profile of Mood States (POMS), and a panel of serum IgG levels for human herpesviruses. RESULTS Only the herpes simplex virus type 2 (HSV-2) (genital herpes) IgG level was associated with Perceived Stress Scale and POMS-Depression/Dejection (POMS-D) score. Hierarchical multiple regression analysis was used to examine the association of POMS-D with herpesviral IgG levels adjusting for demographic variables. In the final model, African American race (β = .251, p < .001), older age (β = .199, p = .002), single marital status (β = -.304, p < .001), and depressed mood (β = .122, p = .04) were associated with HSV-2 IgG levels. In logistic regression, the strongest correlates of HSV IgG positivity were single marital status, followed by POMS-D scores and African American race. CONCLUSION Genital herpes is a concern in pregnancy. Antibody titers may indicate asymptomatic viral shedding, viral reactivation, or primary viral infection. Antibody levels may be higher because of the immune changes during pregnancy and potential immune effects of depressed mood causing reactivation of latent HSV-2.
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Hill PD, Aldag JC, Chatterton RT, Zinaman M. Psychological Distress and Milk Volume in Lactating Mothers. West J Nurs Res 2016; 27:676-93; discussion 694-700. [PMID: 16157942 DOI: 10.1177/0193945905277154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article is twofold: (a) to compare psychological distress as measured via self-reported perceived stress, sleep, and fatigue levels in lactating mothers of a term infant and mothers of a preterm infant and(b) to determine whether the addition of psychological distress to a previous model predicts milk volume at Postpartum Week 6 by gestation group. The convenience sample of 95 mothers of a preterm infant (31 weeks) and 98 mothers of a term infant completed the Perceived Stress Visual Analogue Scale, Richards-Campbell Sleep Questionnaire, and the Fatigue Visual Analog Scale. Stress, sleep difficulty, and fatigue levels decreased during the 6-week study period for mothers of a term but not for mothers of a preterm infant. Perceived stress, sleep difficulty, and fatigue during the first 6 weeks postpartum were not related to milk volume; thus, the mother’s perceived psychological distress had no apparent effect on lactation.
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Affiliation(s)
- Pamela D Hill
- College of Nursing, University of Illinois at Chicago, USA
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15
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Racial Disparities in Low Birthweight Risk: an Examination of Stress Predictors. J Racial Ethn Health Disparities 2016; 3:200-9. [PMID: 27271059 DOI: 10.1007/s40615-015-0128-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/12/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This paper describes racial disparities in low birthweight (LBW) risk between Black women and White women and examines the relationship between race and stressors such as socioeconomic factors, access to health care, and social and health characteristics. METHODS We analyzed data from the National Survey of Family Growth dataset collected in the USA between 2006 and 2010 (N = 1516). Multivariate logistic regression models were performed. RESULTS Prevalence of LBW was 5.6 % for pregnancies among White women and 12.2 % among Black women. Black women who had a LBW baby had a lower socioeconomic status (e.g., received assistance to pay for delivery of the baby and public assistance in the prior year). Black women who had a LBW baby were more likely to have reported having good health compared with White women (67.8 vs. 45.1 %, p < .10). Pregnancies of Black women were 2.6 times more likely (odds ratio (OR) = 2.33; 95 % confidence interval (CI), 1.12-6.04) to result in a LBW baby than pregnancies among White women. Pregnancies of women in the income group of 300 % or higher than the poverty level were less likely to be associated with a LBW baby than those among women in the 150-299 % income group (p < .10). Obese women were less likely to have LBW children than those who were underweight or normal weight (p < .10). Among pregnancies of White mothers (n = 943), the only significant variable was self-reported health status. White women who reported having poorer health were 3.7 times more likely to have LBW than those who reported having better health (p < .10). Among Black mothers, the only predictor that was negatively associated with an increased likelihood of having a LBW baby was the SES stressor related to receiving public assistance. CONCLUSION Racial differences between Black and White women were observed in LBW risk based on socioeconomic factors. We analyzed a large number of stressors, but racial differences remained even after taking these stressors into account. Future policies and research should continually address these differences to decrease LBW risk within and across racial groups.
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László KD, Li J, Olsen J, Vestergaard M, Obel C, Cnattingius S. Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth. Psychol Med 2016; 46:1163-1173. [PMID: 26646988 DOI: 10.1017/s0033291715002688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal stress during pregnancy may increase the risk of preterm delivery (PD), but the associations between stress and subtypes of PD are not clear. We investigated maternal loss of a close relative and risks of very and moderately PD (<32 and 32-36 weeks, respectively) and spontaneous and medically indicated PD. METHOD We studied 4 940 764 live singleton births in Denmark (1978-2008) and Sweden (1973-2006). We retrieved information on death of women's family members (children, partner, siblings, parents), birth outcomes and maternal characteristics from nationwide registries. RESULTS Overall, the death of a close family member the year before pregnancy or in the first 36 weeks of pregnancy was associated with a 7% increased risk of PD [95% confidence interval (CI) 1.04-1.10]. The highest hazard ratios (HR) for PD were found for death of an older child [HR (95% CI) 1.20 (1.10-1.31)] and for death of a partner [HR (95% CI) 1.31 (1.03-1.66)]. These losses were associated with higher risks of very preterm [HR (95% CI) 1.61 (1.29-2.01) and 2.07 (1.15-3.74), respectively] than of moderately preterm [HR (95% CI) 1.14 (1.03-1.26) and 1.22 (0.94-1.58), respectively] delivery. There were no substantial differences in the association between death of a child or partner and the risk of spontaneous v. medically indicated PD. CONCLUSIONS Death of a close family member the year before or during pregnancy was associated with an increased risk of PD, especially very PD. Possible mechanisms include both spontaneous and medically indicated preterm birth.
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Affiliation(s)
- K D László
- Clinical Epidemiology Unit, Department of Medicine,Karolinska University Hospital and Karolinska Institute,Stockholm,Sweden
| | - J Li
- Section for Epidemiology,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - J Olsen
- Section for Epidemiology,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - M Vestergaard
- Research Unit for General Practice,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - C Obel
- Research Unit for General Practice,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - S Cnattingius
- Clinical Epidemiology Unit, Department of Medicine,Karolinska University Hospital and Karolinska Institute,Stockholm,Sweden
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Rieger KL, Heaman MI. Factors Associated With High Levels of Perceived Prenatal Stress Among Inner-City Women. J Obstet Gynecol Neonatal Nurs 2016; 45:180-95. [PMID: 26807819 DOI: 10.1016/j.jogn.2015.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To explore the factors associated with high rates of perceived prenatal stress among inner-city women. DESIGN Observational cross-sectional study. SETTING/PARTICIPANTS We conducted a secondary analysis of data from 603 inner-city women. In our study, 330 participants (54.7%) self-identified as First Nations, Metis, or First Nations/Metis. METHODS Prenatal stress was measured with Cohen's Perceived Stress Scale. A social ecological model provided the theoretical framework for the study, and variables representing all levels of the model were selected for study. Data analyses included t tests to compare women with high stress and low/moderate stress, univariable logistic regression analysis to determine the association of selected factors with maternal stress, and multivariable logistic regression analysis to provide adjusted odds ratios and 95% confidence intervals for the factors. RESULTS Of the 603 participants, 17.2% (104) reported high levels of perceived stress, and 82.8% (499) reported low/moderate levels. The high-stress group included a significantly greater proportion of First Nations, Metis, or First Nations/Metis women (76.0%) than the low/moderate-stress group (50.3%). Low rates of self-esteem and social support, residential mobility, abuse before/during pregnancy, and experiencing discrimination were significantly associated with high levels of perceived prenatal stress. CONCLUSION Our findings demonstrated that factors that influence prenatal stress occur at all levels of the social ecological model. The identified factors are amenable to change, and implications for practice include the need for psychosocial risk assessment, alternative forms of prenatal care, relational care, and advocacy initiatives. A greater understanding of the complex factors associated with high rates of perceived prenatal stress can inform the development of effective interventions for inner-city women.
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Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health. Matern Child Health J 2015; 18:2393-407. [PMID: 24748241 PMCID: PMC4220111 DOI: 10.1007/s10995-014-1479-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.
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Association of Mothers' Perception of Neighborhood Quality and Maternal Resilience with Risk of Preterm Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9427-43. [PMID: 26274966 PMCID: PMC4555289 DOI: 10.3390/ijerph120809427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 11/17/2022]
Abstract
We examined the associations of mothers’ perception of neighborhood quality and maternal resilience with risk of preterm birth and whether maternal resilience moderated the effect of neighborhood quality perception. We analyzed data from 10,758 women with singleton births who participated in 2010–2012 Los Angeles Mommy and Baby surveys. Multilevel logistic regression models assessed the effects of mothers’ perception of neighborhood quality and maternal resilience on preterm birth (yes/no), controlling for potential confounders and economic hardship index, a city-level measure of neighborhood quality. Interaction terms were assessed for moderation. Mothers’ perception of neighborhood quality and maternal resilience were each uniquely associated with preterm birth, independent of potential confounders (p-values < 0.05). The risk of preterm birth among mothers who perceived their neighborhood as of poor quality was about 30% greater compared to mothers who perceived their neighborhood as of good quality; the risk was 12% greater among mothers with low resilience compared to those with high resilience. Effects of neighborhood quality were not modified by maternal resilience. The findings suggest that mothers’ perception of neighborhood quality and resilience are associated with the risk of preterm birth. Further research should explore whether initiatives aimed at improving neighborhood quality and women’s self-esteem may improve birth outcomes.
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20
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Bakken KS, Skjeldal OH, Stray-Pedersen B. Immigrants from conflict-zone countries: an observational comparison study of obstetric outcomes in a low-risk maternity ward in Norway. BMC Pregnancy Childbirth 2015; 15:163. [PMID: 26243275 PMCID: PMC4523905 DOI: 10.1186/s12884-015-0603-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/28/2015] [Indexed: 11/26/2022] Open
Abstract
Background Immigrants have higher risks for some adverse obstetric outcomes. Furthermore, refugees are reported to be the most vulnerable group. This study compared obstetric outcomes between immigrant women originating from conflict-zone countries and ethnic Norwegians who gave birth in a low-risk setting. Methods This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period of women from Somalia (n = 278), Iraq (n = 166), Afghanistan (n = 71), and Kosovo (n = 67) and ethnic Norwegians (n = 6826) at Baerum Hospital from 2006–2010. Background characteristics and obstetric outcomes of each immigrant group were compared with ethnic Norwegians with respect to proportions and risks calculated by logistic regression models. Results In total, 7408 women and their births were analyzed. Women from Somalia were most at risk for adverse obstetric outcomes. Compared with ethnic Norwegians, they had increased odds ratios (OR) for emergency cesarean section (OR 1.81, CI 1.17–2.80), postterm birth (OR 1.93, CI 1.29–2.90), meconium-stained liquor (OR 2.39, CI 1.76–3.25), and having a small-for-gestational-age infant (OR 3.97, CI 2.73–5.77). They had a reduced OR for having epidural analgesia (OR 0.40, CI 0.28–0.56) and a large-for-gestational-age infant (OR 0.32, CI 0.16–0.64). Women from Iraq and Afghanistan had increased risk of having a small-for-gestational-age infant with OR of 2.21 (CI 1.36–3.60) and 2.77 (CI 1.42–5.39), respectively. Iraqi women also had reduced odds ratio of having a large-for-gestational-age infant (OR 0.35, CI 0.15–0.83). Women from Kosovo did not differ from ethnic Norwegians in any of the outcomes we tested. Conclusions Even in our low-risk maternity ward, women originating from Somalia were at the greatest risk for adverse obstetric outcomes in the compared groups. We could not find the same risk among the other immigrant women, also originating from conflict-zone countries. Several factors may influence these findings, and this study suggests that immigrant women from Somalia need more targeted care during pregnancy and childbirth.
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Affiliation(s)
- Kjersti S Bakken
- Department of Gynecology and Obstetrics, Baerum Hospital, Vestre Viken Hospital Trust, P.O. Box 800, 3004, Drammen, Norway. .,University of Oslo, Faculty of Medicine, Institution of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway.
| | - Ola H Skjeldal
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, 411 19, Göteborg, Sweden.
| | - Babill Stray-Pedersen
- University of Oslo, Faculty of Medicine, Institution of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway. .,Women and Children's Division and Norwegian Resource Centre for Women's Health, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway.
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21
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Clay SL, Andrade F. Role of stress in low birthweight disparities between black and white women: a population-based study. J Paediatr Child Health 2015; 51:443-9. [PMID: 25332097 PMCID: PMC4382413 DOI: 10.1111/jpc.12735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Abstract
AIM This study examines the role of stress in low birthweight (LBW) risk in Black and White women in the United States. METHODS Data from the 1998-2000 Fragile Family and Child Wellbeing Study were used (n = 3869). We included several self-reported conditions which we categorised as stressors (i.e. socio-economic conditions, health behaviours, access to quality care and cultural factors), then we used logistic regression models to analyse the role of stressors in explaining the health disparities in LBW. RESULTS Most women were unmarried (59% for White women and 87% for Black women). Among unmarried White women, the only stressor associated with a higher likelihood of LBW was smoking (odds ratio (OR) = 2.0, 95% confidence interval (CI) (1.2, 3.3)). Among unmarried Black women, smoking (OR = 1.7, 95% CI (1.2, 2.3)), drug use (OR = 1.7, 95% CI (1.0, 2.6)), paying for the baby's birth with government resources (OR = 1.6, 95% CI (1.1, 2.4)) and religious affiliation (OR = 1.6, 95% CI (1.0, 2.5)) were associated with higher likelihood of LBW. Among married White women, older age (OR = 1.1, 95% CI (1.0, 1.2)), smoking (OR = 5.2, 95% CI (1.7, 15.5)), using governmental resources to pay for birth (OR = 3.6, 95% CI (1.0, 12.4)) and living in governmental housing (OR = 9.1, 95% CI (2.0, 41.1)) were associated with higher likelihood of LBW. No stressors were statistically significant for married Black women. CONCLUSION We analysed a large number of stressors at the individual, household and societal levels and found differences on the stressors among Black and White women. However, the stressors included in the analyses did not fully explain the racial disparities in LBW.
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Affiliation(s)
- Shondra Loggins Clay
- University of Illinois at Urbana-Champaign, Counseling Center, 610 E. John Street, Champaign, Illinois, United States
| | - Flavia Andrade
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Illinois, United States
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22
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Witt WP, Litzelman K, Cheng ER, Wakeel F, Barker ES. Measuring stress before and during pregnancy: a review of population-based studies of obstetric outcomes. Matern Child Health J 2014; 18:52-63. [PMID: 23447085 DOI: 10.1007/s10995-013-1233-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n = 10); three examined stress during both the preconception and pregnancy periods (n = 3). Most studies examined the environmental domain (e.g. life events) only (n = 9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.
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Affiliation(s)
- Whitney P Witt
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 503, Madison, WI, 53726, USA.
| | - Kristin Litzelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA
| | - Erika R Cheng
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA
| | - Fathima Wakeel
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA
| | - Emily S Barker
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA
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Abstract
OBJECTIVE To describe the experience of pregnancy with a chronic illness. DESIGN Qualitative description. SETTING Tertiary Medical Center, Northeast United States. PARTICIPANTS A purposive sample of eight pregnant women with various chronic conditions. METHODS Telephone interviews. RESULTS The participants described their chronic illnesses as deviations from normality and their pregnancies brought them closer to normality. They described pregnancy as a balancing act between the fantasy of being normal and the reality of having a chronic disease. At the same time, women acknowledged the blessings and burdens of physical changes and intense vigilance. Participants also described emotional demands related to the need to be vigilant, additional physiological alternations, and information overload. CONCLUSION Pregnancy may alter chronic illness, increase stress, and create new health care needs for women. In turn, increased stress associated with chronic illness may alter perinatal outcomes. Pregnant women with chronic illness may benefit from interventions aimed at helping them balance the blessings and burdens associated with the symptoms of pregnancy.
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Giurgescu C, Sanguanklin N, Engeland CG, White-Traut RC, Park C, Mathews HL, Janusek LW. Relationships among psychosocial factors, biomarkers, preeclampsia, and preterm birth in African American women: a pilot. Appl Nurs Res 2014; 28:e1-6. [PMID: 25282477 DOI: 10.1016/j.apnr.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/24/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
AIM To explore the relationships among psychosocial factors (optimism, uncertainty, social support, coping, psychological distress), biomarkers (cortisol, cytokines), preeclampsia, and preterm birth in African American women. METHODS Forty-nine pregnant African American women completed psychosocial questionnaires and had blood collected for biomarkers between 26 and 36 weeks of gestation. Birth outcomes were obtained from birth records. RESULTS Women reporting higher levels of social support had lower levels of pro-inflammatory cytokines (IL-2, IL-5, and IL-6). Surprisingly, compared with low-risk pregnant women, women diagnosed with preeclampsia reported more optimism and less avoidance, and had lower levels of cortisol and IFN-γ. Similarly, compared to women with full-term birth, women with preterm birth reported higher levels of optimism and lower levels of avoidance, and had lower levels of IL-10. CONCLUSION Psychosocial factors influence inflammation and pregnancy outcomes. Close assessment and monitoring of psychosocial factors may contribute to improved pregnancy outcomes.
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Affiliation(s)
| | | | | | | | - Chang Park
- College of Nursing, University of Illinois at Chicago
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Seravalli L, Patterson F, Nelson DB. Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women. J Midwifery Womens Health 2014; 59:374-9. [PMID: 24890400 PMCID: PMC4115024 DOI: 10.1111/jmwh.12088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. METHODS Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. RESULTS Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P < .001). DISCUSSION Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth.
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Abbasi M, van den Akker O, Bewley C. Persian couples' experiences of depressive symptoms and health-related quality of life in the pre- and perinatal period. J Psychosom Obstet Gynaecol 2014; 35:16-21. [PMID: 24393024 DOI: 10.3109/0167482x.2013.865722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the effect of changes in depressive symptoms on health-related quality of life (HRQoL) in couples. This was examined before, during and after the pregnancy. In addition, (HRQoL) was examined in relation to the mode of delivery. METHODS A prospective longitudinal study of 416 couples was conducted in two teaching hospitals in Tehran, Iran. The translated Medical Outcomes Study-Short Form 36 (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) were used to measure health-related quality of life and depressive symptoms respectively, and are reported here. RESULTS The results showed that women and their spouses experienced a noticeable decline in their physical HRQoL during and after the pregnancy. However, their mental health functioning showed a significant improvement following conception. The prevalence of depressive symptoms was high but decreased over the course of the pregnancy. Finally, HRQoL was affected by mode of delivery. CONCLUSIONS The results show that women and their husbands experienced marked changes in perceived health-related functioning and depressive symptoms during and after pregnancy. In addition, the study found that those women who had undergone Cesarean section had higher mental well-being scores. Future research should determine the benefits of extending pre-conception and pre-natal guidelines on the benefits of regular physical activity throughout and after pregnancy in Persian couples.
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Affiliation(s)
- Marzieh Abbasi
- Ultrasound Department, Queen Charlotte's & Chelsea Hospital, Imperial College NHS Trust , Hammersmith , London
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Song H, Cramer EM, McRoy S, May A. Information needs, seeking behaviors, and support among low-income expectant women. Women Health 2014; 53:824-42. [PMID: 24215275 DOI: 10.1080/03630242.2013.831019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Previous studies have consistently found associations between low income and infant health outcomes. Moreover, although health information-seeking is a maternal behavior related to improved health outcomes, little is known about the health information-seeking behaviors and information needs of low-income pregnant women. The purpose of the current investigation was to examine the information needs, information-seeking behaviors, and perceived informational support of low-income pregnant women. Accordingly, the study recruited 63 expectant women enrolled in a subsidized prenatal care program in Milwaukee, Wisconsin, during two time periods: March-May 2011 and October-December 2011. Results indicated that participants relied heavily upon interpersonal sources of information, especially family and the father of the baby; rarely used the Internet for health-related information; and desired information beyond infant and maternal health, such as finding jobs and accessing community/government resources. Participants who used family members as primary sources of information also had significantly increased levels of perceived informational support and reduced uncertainty about pregnancy. Our findings have implications for the dissemination of pregnancy-related health information among low-income expectant women.
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Affiliation(s)
- Hayeon Song
- a Department of Communication, University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
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Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight. Int J Gynaecol Obstet 2014; 125:28-32. [DOI: 10.1016/j.ijgo.2013.09.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/24/2013] [Accepted: 12/31/2013] [Indexed: 11/23/2022]
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The balance between stress and personal capital during pregnancy and the relationship with adverse obstetric outcomes: findings from the 2007 Los Angeles Mommy and Baby (LAMB) study. Arch Womens Ment Health 2013; 16:435-51. [PMID: 23812738 PMCID: PMC3833901 DOI: 10.1007/s00737-013-0367-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
Stress during pregnancy is a salient risk factor for adverse obstetric outcomes. Personal capital during pregnancy, defined as internal and social resources that help women cope with or decrease their exposure to stress, may reduce the risk of poor obstetric outcomes. Using data from the 2007 Los Angeles Mommy and Baby study (N = 3,353), we examined the relationships between the balance of stress and personal capital during pregnancy, or the stress-to-capital ratio (SCR), and adverse obstetric outcomes (i.e., pregnancy complications, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA)). Women with a higher SCR (i.e., greater stress relative to personal capital during pregnancy) were significantly more likely to experience at least one pregnancy complication, PTB, and lower gestational age, but not LBW or SGA. Accounting for pregnancy complications completely mediated the association between the SCR and PTB. Our findings indicate that experiencing greater stress relative to personal capital during pregnancy is associated with an increased risk for pregnancy complications, PTB, and lower gestational age and that pregnancy complications may be a mechanism by which the SCR is related to adverse obstetric outcomes.
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Siepmann M, Hennig UD, Siepmann T, Nitzsche K, Mück-Weymann M, Petrowski K, Weidner K. The Effects of Heart Rate Variability Biofeedback in Patients with Preterm Labour. Appl Psychophysiol Biofeedback 2013; 39:27-35. [DOI: 10.1007/s10484-013-9238-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mouradian LE, DeGrace BW, Thompson DM. Art-Based Occupation Group Reduces Parent Anxiety in the Neonatal Intensive Care Unit: A Mixed-Methods Study. Am J Occup Ther 2013; 67:692-700. [DOI: 10.5014/ajot.2013.007682] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined whether an art-based occupation group using scrapbooking in the neonatal intensive care unit (NICU) would reduce parent stress, operationalized as anxiety. We also wanted to understand the parents’ lived experience of the group.
METHOD. Forty parents from a Level 3 NICU in a large metropolitan hospital participated. We administered the State–Trait Anxiety Inventory preactivity and postactivity along with a brief interview.
RESULTS. The decline in parents’ mean state anxiety (12.7 points, SD = 11.8; p < .0001) was clinically significant. The decline in mean trait anxiety (2.6 points, SD = 5.2; p = .0036) was statistically significant but not clinically meaningful. Parents said that participation offered distraction and engagement, pleasure, relaxation, a sense of hope, and an opportunity to share.
CONCLUSION. An art-based occupation group using scrapbooking was an effective brief intervention to reduce parent anxiety in the neonatal intensive care unit; parent interviews suggested that participation has broad clinical implications for parent well-being.
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Affiliation(s)
- Laurie E. Mouradian
- Laurie E. Mouradian, ScD, ATR, OTR/L, is Associate Professor and Program Director, School of Occupational Therapy, Husson University, 1 College Circle, Bangor, ME 04401; . At the time of the study, she was Program Director, Oklahoma Infant Transition Program, and Co-Director, Sooner Newborn Individualized Developmental Care and Assessment Program Training Center, University o
| | - Beth W. DeGrace
- Beth W. DeGrace, PhD, OTR/L, FAOTA, is Assistant Professor, Department of Rehabilitation Science, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David M. Thompson
- David M. Thompson, PT, PhD, is Associate Professor, Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
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Shapiro GD, Fraser WD, Frasch MG, Séguin JR. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med 2013; 41:631-45. [PMID: 24216160 PMCID: PMC5179252 DOI: 10.1515/jpm-2012-0295] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/14/2013] [Indexed: 01/23/2023]
Abstract
AIMS Psychosocial stress during pregnancy (PSP) is a risk factor of growing interest in the etiology of preterm birth (PTB). This literature review assesses the published evidence concerning the association between PSP and PTB, highlighting established and hypothesized physiological pathways mediating this association. METHOD The PubMed and Web of Science databases were searched using the keywords "psychosocial stress", "pregnancy", "pregnancy stress", "preterm", "preterm birth", "gestational age", "anxiety", and "social support". After applying the exclusion criteria, the search produced 107 articles. RESULTS The association of PSP with PTB varied according to the dimensions and timing of PSP. Stronger associations were generally found in early pregnancy, and most studies demonstrating positive results found moderate effect sizes, with risk ratios between 1.2 and 2.1. Subjective perception of stress and pregnancy-related anxiety appeared to be the stress measures most closely associated with PTB. Potential physiological pathways identified included behavioral, infectious, neuroinflammatory, and neuroendocrine mechanisms. CONCLUSIONS Future research should examine the biological pathways of these different psychosocial stress dimensions and at multiple time points across pregnancy. Culture-independent characterization of the vaginal microbiome and noninvasive monitoring of cholinergic activity represent two exciting frontiers in this research.
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Affiliation(s)
- Gabriel D. Shapiro
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada; and CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
| | - William D. Fraser
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Martin G. Frasch
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Jean R. Séguin
- Corresponding author: Jean R. Séguin, Department of Psychiatry Université de Montréal Centre de recherche de l’Hôpital Ste-Justine, Bloc 5, Local 1573 3175 Côte Ste-Catherine Montréal, QC Canada H3T 1C5, Tel.: +1-514-1-345-4931, ext. 4043, Fax: +1-514-345-2176,
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Abstract
The purpose of this phenomenological study was to examine the experiences of mothers of preterm infants during the first 6 months at home following discharge from a neonatal intensive care unit (NICU). A purposeful sample of 8 mothers was gathered and interviews were conducted over a 4-month period. Each interview was audio recorded and took place in the study participant's home or another place of her choosing. Interviews were transcribed verbatim and analyzed independently with themes being identified and organized for each participant. From these analyses, the themes of fear, exhaustion, determination, and thankfulness were identified as being common to all study participants and became the basis for developing the essence of the phenomenon. The essence of this experience for these mothers was their resolve to do whatever was necessary to ensure the best possible outcomes for their infants. The data gathered from these personal interviews will serve to further inform our understanding of this important time from the perspective of those who experienced it, as well as aid in the design of interventions to address the specific needs of these mothers prior to NICU discharge.
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Song H, May A, Vaidhyanathan V, Cramer EM, Owais RW, McRoy S. A two-way text-messaging system answering health questions for low-income pregnant women. PATIENT EDUCATION AND COUNSELING 2013; 92:182-187. [PMID: 23711635 DOI: 10.1016/j.pec.2013.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 04/06/2013] [Accepted: 04/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of the study was to gauge the effectiveness of a low-cost, automated, two-way text-messaging system to distribute pregnancy and health-related information to low-income expectant women. METHODS In total, 20 participants were recruited for a one-month intervention involving the use of cell phones to text pregnancy-related questions to the system. Participants received either a direct answer or encouragement to seek answers from health care providers. Pre- and post-tests as well as a focus group at the end of the intervention were conducted. RESULTS Participants uniformly found the system easy to use and accessible. Using the system increased levels of perceived pregnancy-related knowledge and facilitated patient-provider communication. Moreover, participants reported significant reductions in stress and depression and improved mental health after using the system. The system responded to most known questions quickly and accurately, and also encountered many new topics and linguistic expressions. CONCLUSION Overall, the data indicated that the text messaging system offered psychological benefits and promoted health communication by providing health information and encouraging patient-provider communication. PRACTICE IMPLICATIONS An automated, two-way text messaging system is an efficient, cost-effective, and acceptable method for providing health information to low-income pregnant women.
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Affiliation(s)
- Hayeon Song
- Department of Communication, University of Wisconsin-Milwaukee, Milwaukee 53201, USA.
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Concurrent levels of maternal salivary cortisol are unrelated to self-reported psychological measures in low-risk pregnant women. Arch Womens Ment Health 2013; 16:101-8. [PMID: 23269500 PMCID: PMC3671921 DOI: 10.1007/s00737-012-0321-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022]
Abstract
Associations between salivary cortisol and maternal psychological distress and well-being were examined prospectively on 112 women with normally progressing, singleton pregnancies between 24 and 38 weeks gestation. At each of 5 visits, conducted in 3-week intervals, women provided a saliva sample and completed questionnaires measuring trait anxiety, depressive symptoms, pregnancy-specific hassles and uplifts, and psychological well-being. Maternal salivary cortisol was unrelated to psychological measures with the exception of minor associations detected with measures of anxiety and depressive symptoms between 30 and 32 weeks only. Findings indicate that self-reported maternal psychological distress and well-being are not associated with significant variation in maternal salivary cortisol levels during the second half of gestation. This suggests that studies that measure psychological factors in pregnancy but do not measure maternal cortisol should exercise caution in assuming activation of the maternal hypothalamic-pituitary-adrenal axis is the mechanism through which maternal psychological factors are transduced to the fetus.
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Giurgescu C, Kavanaugh K, Norr KF, Dancy BL, Twigg N, McFarlin BL, Engeland CG, Hennessy MD, White-Traut RC. Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study. J Perinat Neonatal Nurs 2013; 27:81-96. [PMID: 23360946 PMCID: PMC3901405 DOI: 10.1097/jpn.0b013e31828363c3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.
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Affiliation(s)
- Carmen Giurgescu
- College of Nursing, Wayne State University, Detroit, Michigan 48202, USA.
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Small size for gestational age and the risk for infant mortality in the subsequent pregnancy. Ann Epidemiol 2012; 22:764-71. [PMID: 22858049 DOI: 10.1016/j.annepidem.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy. METHODS This is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978-2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted. RESULTS Infant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24-1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21-1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17-1.46). CONCLUSIONS Women with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black-white disparity in infant mortality. Women's previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival.
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Denny CH, Floyd RL, Green PP, Hayes DK. Racial and ethnic disparities in preconception risk factors and preconception care. J Womens Health (Larchmt) 2012; 21:720-9. [PMID: 22559934 DOI: 10.1089/jwh.2011.3259] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE At-risk drinking, cigarette smoking, obesity, diabetes, and frequent mental distress, as well as their co-occurrence in childbearing aged women, are risk factors for adverse pregnancy outcomes. This study estimated the prevalence of these five risk factors individually and in combination among nonpregnant women aged 18-44 years by demographic and psychosocial characteristics, with a focus on racial and ethnic disparities. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) on nonpregnant women aged 18-44 years (n=54,612) were used to estimate the prevalences of five risk factors, pairs of co-occurring risk factors, and multiple risk factors for poor pregnancy outcomes. RESULTS The majority of women had at least one risk factor, and 18.7% had two or more risk factors. Having two or more risk factors was highest among women who were American Indian and Alaska Native (34.4%), had less than a high school education (28.7%), were unable to work (50.1%), were unmarried (23.3%), and reported sometimes, rarely, or never receiving sufficient social and emotional support (32.8%). The most prevalent pair of co-occurring risk factors was at-risk drinking and smoking (5.7%). CONCLUSIONS The high proportion of women of childbearing age with preconception risk factors highlights the need for preconception care. The common occurrence of multiple risk factors suggests the importance of developing screening tools and interventions that address risk factors that can lead to poor pregnancy outcomes. Increased attention should be given to high-risk subgroups.
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Affiliation(s)
- Clark H Denny
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Traviss GD, West RM, House AO. Maternal mental health and its association with infant growth at 6 months in ethnic groups: results from the Born-in-Bradford birth cohort study. PLoS One 2012; 7:e30707. [PMID: 22348019 PMCID: PMC3277587 DOI: 10.1371/journal.pone.0030707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 12/28/2011] [Indexed: 11/24/2022] Open
Abstract
Objective To identify factors associated with infant growth up to 6 months, with a particular focus on maternal distress, and to explore the effect of ethnicity on any relation between maternal distress and infant growth. Methods Cohort study recruiting White and Pakistani women in the United Kingdom (UK). Infant growth was measured at birth and 6 months. Standard assessment of mental health (GHQ-28) was undertaken in pregnancy (26–28 weeks gestation) and 6 months postpartum. Modelling included social deprivation, ethnicity, and other known influences on infant growth such as maternal smoking and alcohol consumption. Results Maternal distress improved markedly from pregnancy to 6 months postpartum. At both times Pakistani women had more somatic and depression symptoms than White women. Depression in pregnancy (GHQ subscale D) was associated with lower infant growth at 6 months. Self-reported social dysfunction in pregnancy (GHQ subscale C) was associated with lower gestational age.. Pakistani women reported higher GHQ scores during pregnancy associated with smaller infants at birth. They lived in areas of higher social deprivation, reported less alcohol consumption and smoking postnatally, all independent influences on growth at 6 months. Conclusions Maternal mental health in pregnancy is an independent influence on infant growth up to 6 months and is associated with ethnicity which was itself associated with deprivation in our sample. There is a complex relationship between symptoms of maternal distress, ethnicity, deprivation, health behaviours, and early infant growth. Measures should include both emotional and somatic symptoms and interventions to reduce risks of poor early growth need to include psychological and social components.
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Affiliation(s)
- Gemma D Traviss
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
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Auger N, Kuehne E, Goneau M, Daniel M. Preterm birth during an extreme weather event in Québec, Canada: a "natural experiment". Matern Child Health J 2012; 15:1088-96. [PMID: 20640493 DOI: 10.1007/s10995-010-0645-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To clarify the relationship between preterm birth (PTB) and extreme weather events, we evaluated PTB during a January 1998 ice storm that had led to a provincial emergency in the middle of winter in the province of Québec, Canada. Singleton live births for three periods (1993-1997, 1998, 1999-2003) were obtained (N = 855,320). PTB was defined as gestational age <37 completed weeks. Births in the Triangle of Darkness, the area most strongly affect by the storm, were geocoded. Multivariate logistic regression was used to calculate the likelihood of PTB for the Triangle relative to metropolitan Montréal, adjusting for maternal age, education, civil status, maternal birthplace, and previous deliveries. Associations for 1998 relative to other periods were evaluated. Short-term (January-February) and long-term (March-October) exposure periods were examined. The proportion PTB for 1998 January-February births in the Triangle (8.7%) was high compared with 1998 March-October births (6.0%) and with the corresponding proportions for 1993-1997 (6.2%) and 1999-2003 (6.9%). Covariate-adjusted odds of PTB for January-February 1998 were 27% higher for the Triangle relative to metropolitan Montréal, though precision was low. Furthermore, adjusted odds were 28% higher for 1998 relative to 1999-2003, despite increasing rates of PTB over time. Odds were not elevated over a long-term exposure period. This study suggests a weak association between PTB and exposure to extreme weather for the two months following an ice storm, but not for later periods after the storm.
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Affiliation(s)
- Nathalie Auger
- Institut national de santé publique du Québec, 190, boulevard Crémazie Est, Montréal, QC, H2P 1E2, Canada.
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Allison SJ, Stafford J, Anumba DOC. The effect of stress and anxiety associated with maternal prenatal diagnosis on feto-maternal attachment. BMC WOMENS HEALTH 2011; 11:33. [PMID: 21749702 PMCID: PMC3148201 DOI: 10.1186/1472-6874-11-33] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/12/2011] [Indexed: 11/17/2022]
Abstract
Background A couple's decision to undergo an invasive test based on a screening test result is a process associated with anxiety. The aim of this study was to determine whether anxiety and prenatal attachment were affected by undergoing an invasive test compared to women in early pregnancy and after a reassuring anomaly scan. Methods 200 women were recruited at booking, 14 women and 20 partners after an invasive test and 81 women following an anomaly scan. A questionnaire was completed using the Beck Anxiety Inventory and Maternal or Paternal Antenatal Attachment Scales. Results Women who have had an invasive test have higher levels of anxiety compared to women at booking (P < 0.01) and after an anomaly scan (P = 0.002). Anxiety declines from booking to the time of an anomaly scan (P = 0.025), whilst attachment increases (P < 0.001). There is a positive correlation between anxiety and attachment in women who have had an invasive test (r = 0.479). Partners of women undergoing an invasive test experience lower levels of anxiety (P < 0.05). Conclusions Women undergoing prenatal diagnostic procedures experience more psychological distress, which may be currently underestimated. Establishment of interdisciplinary treatment settings where access to psychological support is facilitated may be beneficial.
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Affiliation(s)
- Sara J Allison
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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Allison SJ, Stafford J, Anumba DOC. The effect of stress and anxiety associated with maternal prenatal diagnosis on feto-maternal attachment. BMC WOMENS HEALTH 2011. [PMID: 21749702 DOI: 10.1186/1472-6874-11-33; 10.1186/1472-6874-11-33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND A couple's decision to undergo an invasive test based on a screening test result is a process associated with anxiety. The aim of this study was to determine whether anxiety and prenatal attachment were affected by undergoing an invasive test compared to women in early pregnancy and after a reassuring anomaly scan. METHODS 200 women were recruited at booking, 14 women and 20 partners after an invasive test and 81 women following an anomaly scan. A questionnaire was completed using the Beck Anxiety Inventory and Maternal or Paternal Antenatal Attachment Scales. RESULTS Women who have had an invasive test have higher levels of anxiety compared to women at booking (P < 0.01) and after an anomaly scan (P = 0.002). Anxiety declines from booking to the time of an anomaly scan (P = 0.025), whilst attachment increases (P < 0.001). There is a positive correlation between anxiety and attachment in women who have had an invasive test (r = 0.479). Partners of women undergoing an invasive test experience lower levels of anxiety (P < 0.05). CONCLUSIONS Women undergoing prenatal diagnostic procedures experience more psychological distress, which may be currently underestimated. Establishment of interdisciplinary treatment settings where access to psychological support is facilitated may be beneficial.
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Affiliation(s)
- Sara J Allison
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S, Njoya MM. Mind-body interventions during pregnancy for preventing or treating women's anxiety. Cochrane Database Syst Rev 2011; 2011:CD007559. [PMID: 21735413 PMCID: PMC8935896 DOI: 10.1002/14651858.cd007559.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anxiety during pregnancy is a common problem. Anxiety and stress could have consequences on the course of the pregnancy and the later development of the child. Anxiety responds well to treatments such as cognitive behavioral therapy and/or medication. Non-pharmacological interventions such as mind-body interventions, known to decrease anxiety in several clinical situations, might be offered for treating and preventing anxiety during pregnancy. OBJECTIVES To assess the benefits of mind-body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010), MEDLINE (1950 to 30 November 2010), EMBASE (1974 to 30 November 2010), the National Center for Complementary and Alternative Medicine (NCCAM) (1 December 2010), ClinicalTrials.gov (December 2010) and Current Controlled Trials (1 December 2010), searched the reference lists of selected studies and contacted professionals and authors in the field. SELECTION CRITERIA Randomized controlled trials, involving pregnant women of any age at any time from conception to one month after birth, comparing mind-body interventions with a control group. Mind-body interventions include: autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto-suggestion, tai-chi and yoga. Control group includes: standard care, other pharmacological or non-pharmacological interventions, other types of mind-body interventions or no treatment at all. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion all assessed risk of bias for each included study. We extracted data independently using an agreed form and checked it for accuracy. MAIN RESULTS We included eight trials (556 participants), evaluating hypnotherapy (one trial), imagery (five trials), autogenic training (one trial) and yoga (one trial). Due to the small number of studies per intervention and to the diversity of outcome measurements, we performed no meta-analysis, and have reported results individually for each study. Compared with usual care, in one study (133 women), imagery may have a positive effect on anxiety during labor decreasing anxiety at the early and middle stages of labor (MD -1.46; 95% CI -2.43 to -0.49; one study, 133 women) and (MD -1.24; 95% CI -2.18 to -0.30). Another study showed that imagery had a positive effect on anxiety and depression in the immediate postpartum period. Autogenic training might be effective for decreasing women's anxiety before delivering. AUTHORS' CONCLUSIONS Mind-body interventions might benefit women's anxiety during pregnancy. Based on individual studies, there is some but no strong evidence for the effectiveness of mind-body interventions for the management of anxiety during pregnancy. The main limitations of the studies were the lack of blinding and insufficient details on the methods used for randomization.
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Affiliation(s)
- Isabelle Marc
- Centre Hospitalier Universitaire de QuébecDépartement de pédiatrie, Université Laval2705 boulevard LaurierQuébecQuébecCanadaG1V 4G2
| | - Narimane Toureche
- Centre de Recherche Centre Hospitalier Universitaire QuébecDepartment of Pediatrics2705 Boulevard LaurierQuebecCanadaG1V 4G2
| | - Edzard Ernst
- Peninsula Medical School, University of ExeterComplementary Medicine25 Victoria Park RoadExeterDevonUKEX2 4NT
| | - Ellen D Hodnett
- University of TorontoLawrence S. Bloomberg Faculty of Nursing155 College StreetSuite 130TorontoOntarioCanadaM5T 1P8
| | | | - Sylvie Dodin
- Université LavalDepartment of Obstetrics and Gynecology45, Leclerc ‐ Room D6‐723QuebecCanadaG1L 2G1
| | - Merlin M Njoya
- St‐François d'Assise HôpitalCentre de recherche du Centre hospitalier universitaire de Québec (CHUQ)10, rue de l'Espinay, D6‐729QuébecCanadaG1L 3L5
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Tong VT, Zotti ME, Hsia J. Impact of the Red River catastrophic flood on women giving birth in North Dakota, 1994-2000. Matern Child Health J 2011; 15:281-8. [PMID: 20204482 DOI: 10.1007/s10995-010-0576-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To document changes in birth rates, birth outcomes, and pregnancy risk factors among women giving birth after the 1997 Red River flood in North Dakota. We analyzed detailed county-level birth files pre-disaster (1994-1996) and post-disaster (1997-2000) in North Dakota. Crude birth rates and adjusted fertility rates were calculated. The demographic and pregnancy risk factors were described among women delivering singleton births. Logistic regression was conducted to examine associations between the disaster and low birth weight (<2,500 g), preterm birth (<37 weeks), and small for gestational age infants adjusting for confounders. The crude birth rate and direct-adjusted fertility rate decreased significantly after the disaster in North Dakota. The proportion of women giving birth who were older, non-white, unmarried, and had a higher education increased. Compared to pre-disaster, there were significant increases in the following maternal measures after the disaster: any medical risks (5.1-7.1%), anemia (0.7-1.1%), acute or chronic lung disease (0.4-0.5%), eclampsia (0.3-2.1%), and uterine bleeding (0.3-0.4%). In addition, there was a significant increase in births that were low birth weight (OR 1.11, 95% CI 1.03-1.21) and preterm (OR 1.09, 95% CI 1.03-1.16) after adjusting for maternal characteristics and smoking. Following the flood, there was an increase in medical risks, low birth weight, and preterm delivery among women giving birth in North Dakota. Further research that examines birth outcomes of women following a catastrophic disaster is warranted.
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Affiliation(s)
- Van T Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
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Associations between maternal characteristics and pregnancy-related stress among low-risk mothers: An observational cross-sectional study. Int J Nurs Stud 2011; 48:620-7. [DOI: 10.1016/j.ijnurstu.2010.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 09/07/2010] [Accepted: 10/13/2010] [Indexed: 11/20/2022]
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Choi MS, Park YJ. The Effects of Relaxation Therapy on Anxiety and Stress of Pregnant Women with Preterm Labor. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2010; 16:336-347. [PMID: 37697580 DOI: 10.4069/kjwhn.2010.16.4.336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
PURPOSE The purpose of this study was to identify the effect of relaxation therapy on state anxiety, preterm labor stress, blood pressure, skin temperature, pulse rate of pregnant women with preterm labor and heart rate of their babies. METHODS The participants were 55 pregnant women with preterm labor who hospitalized from May, 2009 to January, 2010. 29 participants were assigned to experimental group and the other 26 participants to control group. All of them were not have any other complications except preterm labor. The relaxation therapy was applied to the experimental group for 5 days. Data were analyzed by the SPSS/WIN 14.0 program. RESULTS The state anxiety score and the preterm labor stress score of experimental group were statistically significant lower than those of control group. In addition, the systolic and diastolic blood pressure, pulse rate of experimental group were statistically lower than those of control group. The skin temperature of experimental group was higher than that of control group. However, the fetal heart rate of experimental group was not statistically significant lower than fetal heart rate of control group. CONCLUSION From these findings, it is concluded that relaxation therapy may be an effective nursing intervention for pregnant women with preterm labor.
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Abeysena C, Jayawardana P, Seneviratne RDA. Effect of psychosocial stress and physical activity on preterm birth: a cohort study. J Obstet Gynaecol Res 2010; 36:260-7. [PMID: 20492375 DOI: 10.1111/j.1447-0756.2009.01160.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine trimester-specific effects of risk factors for preterm birth (PTB). METHODS A prospective study was carried out in a district of Sri Lanka. A total of 885 pregnant mothers were recruited at equal to or less than 16 weeks of gestation and followed up until partus. Trimester-specific exposure statuses and potential confounding factors were gathered on average at the 12th, 28th, and 36th weeks of gestation. Physical activities were assessed by obtaining information about the duration of specific postures adopted per day by housewives during each trimester at home and both at home and during working hours for those who were engaged in paid employment. Psychosocial stress was assessed using the Modified Life Events Inventory and the General Health Questionnaire 30. Multiple logistic regression analysis was applied and the results were expressed as adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS Standing equal to or less than 2.5 h/day during the first or second or both trimesters (OR 1.83, 95%CI 1.03, 3.25), maternal age of <25 years (OR 1.73, 95%CI 1.02, 2.95), education up to primary school level (OR 3.30, 95%CI 1.3, 8.36) and past history of low birthweight (OR 2.52, 95%CI 1.16, 5.48) were risk factors for PTB. Psychosocial stress was not found to be a risk factor for PTB. CONCLUSIONS Standing equal to or less than 2.5 h/day during the early trimesters was a risk factor for PTB among uncomplicated pregnancies. Further studies are recommended to assess the trimester-specific effect of psychosocial stress on PTB.
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Affiliation(s)
- Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama.
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Bailey BA. Partner violence during pregnancy: prevalence, effects, screening, and management. Int J Womens Health 2010; 2:183-97. [PMID: 21072311 PMCID: PMC2971723 DOI: 10.2147/ijwh.s8632] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Indexed: 11/23/2022] Open
Abstract
The purpose of this review is to provide an overview of the current state of knowledge regarding the experience of intimate partner violence (IPV) during pregnancy. Pregnancy IPV is a significant problem worldwide, with rates varying significantly by country and maternal risk factors. Pregnancy IPV is associated with adverse newborn outcomes, including low birth weight and preterm birth. Many mechanisms for how IPV may impact birth outcomes have been proposed and include direct health, mental health, and behavioral effects, which all may interact. Screening for IPV during pregnancy is essential, yet due to time constraints and few clear recommendations for assessment, many prenatal providers do not routinely inquire about IPV, or even believe they should. More training is needed to assist health care providers in identifying and managing pregnancy IPV, with additional research needed to inform effective interventions to reduce the rates of pregnancy IPV and resultant outcomes.
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Affiliation(s)
- Beth A Bailey
- Department of Family Medicine, East Tennessee State University, Johnson City, TN, USA
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Martens PJ, Heaman M, Hart L, Wilkins R, Smylie J, Wassimi S, Simonet F, Wu Y, Fraser WD, Luo ZC. North-South Gradients in Adverse Birth Outcomes for First Nations and Others in Manitoba, Canada. THE OPEN WOMEN'S HEALTH JOURNAL 2010; 4:46-54. [PMID: 22523523 PMCID: PMC3329440 DOI: 10.2174/1874291201004020046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective to determine the relationship of north-south place of residence to adverse birth outcomes among First Nations and non-First Nations in Manitoba, Canada, a setting with universal health insurance. Study Design Live birth records (n=151,472) for the province of Manitoba, Canada 1991–2000 were analyzed, including 25,743 First Nations and 125,729 non-First Nations infants. North-south and rural-urban residence was determined for each birth through geocoding. Results Comparing First Nations to non-First Nations, crude rates in North (and South) were: 7.0% versus 8.4% (9.3% versus 7.5%) for preterm birth; 6.1% versus 8.4% (8.7% versus 10.0%) for small-for-gestational-age birth, 4.2% versus 6.5% (6.2% versus 5.7%) for low birth weight, and 20.6% versus 13.7% (17.0% versus 11.0%) for large-for-gestational-age birth; and mortality per 1000 - neonatal 3.2 versus 6.2 (3.8 versus 3.3), post-neonatal 6.4 versus 6.4 (5.8 versus 1.5), and infant 9.5 versus 12.6 (9.6 versus 4.8). Adjusting for observed maternal and infant characteristics and rural versus urban residence, the North was high risk for large-for-gestational-age birth for both First Nations and non-First Nations. First Nations’ risk of preterm, small-for-gestational-age and low birth weight was lowest in the North, but for non-First Nations, the North was lower only for small-for-gestational-age. First Nations mortality indicators were similar North to South, but for non-First Nations, the North was high risk. Conclusion North-South place of residence does matter for adverse birth outcomes, but the effects may differ by ethnicity and could require different intervention strategies.
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Affiliation(s)
- Patricia J Martens
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Lucas FW. Pregnant women of Mexican descent: constructions of motherhood. SOCIAL WORK IN HEALTH CARE 2010; 49:946-962. [PMID: 21113850 DOI: 10.1080/00981389.2010.518875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Past research related to pregnancy outcomes has tended to have a bio-medical focus. More recent research has begun to explore possible social and cultural influences on birth outcomes. Qualitative interviews were conducted with 28 pregnant women of Mexican descent in the Texas/Mexico border region to begin to describe the social and cultural contexts of pregnancy of women of Mexican ancestry. Participants' constructions surrounding pregnancy focused on the mother role. Goodness of fit between constructions of the mother role and women's lives and self-concepts resulted in positive or negative feelings about motherhood.
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Affiliation(s)
- Faith W Lucas
- Department of Social Work, College of Health Sciences, University of Texas at El Paso, 1101 N. Campbell, El Paso, TX 79902, USA.
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