Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design

Social-emotional and behavioural problems in young children of healthcare worker mothers during the COVID-19 outbreak: a case-control study

BACKGROUND

The pandemic has had a significant impact on the daily lives of children and their families, particularly the children of health care workers, due to changes in family routines as a result of their parents' work schedules. We aimed to explore the socioemotional and behavioural (SEB) problems of children of healthcare worker mothers (HCWM) during the COVID-19 pandemic and compare them with age-matched children and their mothers from other occupations.

METHOD

A case-control study design was applied, and a snowball approach was used to enrol volunteered participants aged between 6 and 36 months of age, through a Google survey. We used the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire to assess children's SEB problems and a Brief Symptom Inventory (BSI) to evaluate the psychological distress of mothers. Differences in BITSEA, BSI and MSPSS scores were examined using chi-square and Mann-Whitney U tests, as appropriate. A logistic regression model was used to identify independent predictors of children's behavioural and emotional problems.

RESULTS

In total, 600 questionnaires were analysed. It was observed that children in the HCWM group were separated from their mothers more often and for longer periods of time than their counterparts (p < 0.010, p = 0.002). Changes in the child's structured outdoor activities during the pandemic period were more likely to be observed in the HCWM group (p < 0.05). The percentage of children with the BITSEA problem subscale above the subclinical cut-off, externalizing and dysregulation scores were significantly higher in the HCWM group (p = 0.044, p = 0.031, and p = 0.016). Moreover, each point increase in BSI global index scores (p < 0.001, RR:3.34, 95%CI:1.91-5.82) was found as a risk factor for clinically significant SEB problems.

CONCLUSION

Overall, the current study suggests HCWM's have experienced occupational inequality, and young children of HCWM's were at increased risk for externalizing and dysregulation problems during the pandemic. Maternal psychological stress had a significant impact on their children's socio-emotional well-being.

Home-visiting Parenting Programs to Improve Mother-Infant Interactions at Early Ages: A Systematic Review

Objective: To systematically review studies examining the effects of home-visiting preventive parenting programs (HV-PPs) on improving the quality of mother-child interactions in early childhood. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we identified 3,586 studies published between 2018 and 2022 by searching the following databases: PubMed, Web of Science, BVS/LILACS, SciELO, and PsycNET/PsycINFO. After applying the eligibility criteria, 17 articles were selected for review. Results: Most studies were conducted in high-income countries (53%) and the remainder were conducted in upper-middle-income countries, predominantly using a randomized controlled trial design and with strong methodological quality. The 17 studies applied 13 different HV-PPs, predominantly using video feedback, based on various dosages and schedules. Most studies (77%) showed significant positive effects on mother-child interactions by improving mainly positive maternal behaviors (e.g., sensitivity and responsiveness). Positive effects occurred independent of the study design, sample characteristics, measures, and constructs assessed. However, the findings suggest that the combination of fewer than six sessions, durations shorter than three months, and a very early start did not impact mother-child interactions, as expected. Few studies have explored negative maternal behaviors, children's behaviors, and dyadic interactions such as mutuality and synchrony. Conclusions: HV-PPs positively impacted mother-child interactions in early childhood despite the large heterogeneity across program designs, outcome measures, and overlapping constructs. Based on the results, we discuss the practical and economic implications of using parenting programs as a preventive approach.

Maternal History of Adversity and Subsequent Mother-Child Interactions at Early Ages: A Systematic Review

Adverse childhood experiences (ACEs) can negatively impact physical, emotional, cognitive, and social development, consequently affecting the next generation. The aim of the present study was to systematically review evidence from empirical studies on the association between maternal history of adversity in childhood (maltreatment and household dysfunction) and subsequent mother-child interactions at an early age. A search was performed in the PubMed, Web of Science, PsycINFO, EMBASE, Scopus, LILACS, and SciELO databases to identify studies, including measures of maternal childhood adversities and mother-child interaction, published between 2016 and 2022. Twenty-nine studies met the inclusion criteria. The results showed that in 90% of the studies, maternal childhood adversities negatively impacted subsequent mother-child interactions in early childhood, reducing maternal displays of affection, emotional availability, sensitivity, mother-child communication, and bonding. Biological factors (e.g., genetic and hormonal) and maternal emotional recognition moderated these associations. In addition, biological factors (i.e., neurobiological and hormonal) and psychosocial factors (e.g., depression, executive functioning, and violence) acted as mediators. Preventive interventions should be implemented to break out of the intergenerational cycle of violence that impacts mother-child interactions.

Quality of prenatal care and maternal fetal attachment among primigravid mothers in the Philippines: A cross sectional study

BACKGROUND

The prenatal period is a proper chance for evaluating maternal-fetal attachment.

AIM

To determine the relationship between quality of prenatal care and maternal-fetal attachment among primigravida mothers during late pregnancy period.

METHODS

The study conducted a survey using a 46-item Quality of Prenatal Care Questionnaire and 24-item Maternal-Fetal Attachment Scale among 343 primigravida mothers in village health stations. Pearson correlation was used to correlate maternal-fetal attachment scores and quality of prenatal scores. Linear regression was used to determine relationships between variables.

RESULTS

Maternal-fetal attachment scores is correlated with: age ≤19 years (4.10 [95 % CI 1.81-6.39]), companion during visits (2.76 [95 % CI 0.34-5.18]), education (3.45 [95 % CI 0.93-5.97]). On multivariate analysis, the following were significantly associated with maternal-fetal attachment scores: information sharing (8.67 [95 % CI 4.74 - 12.60]), sufficient time (-2.34 [95 % CI -3.45 - -1.24]), support and respect (8.49 [95 % CI 4.54 - 12.45]), maternal age < 19 years (-3.78 [-5.81 to -1.75]), and unmarried (2.55 [95 % CI 0.70 - 4.41]).

CONCLUSION

The quality of prenatal care is correlated significantly with maternal-fetal attachment. Women valued the care given when it was individualized and the health workers were approachable in their ways and addressed their own particular needs. Combination of prenatal education and counselling tailored to address own particular emotional and social concerns of pregnant mothers are interventions that should be integrated in maternal care services.

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

OBJECTIVES

The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

DESIGN

A longitudinal study with follow-ups from 42 days to 6 months after delivery.

SETTINGS AND PARTICIPANTS

A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

METHODS

Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

RESULTS

Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.

CONCLUSIONS

Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Galactagogue Food Consumption, Perception of Insufficient Milk Supply, and Exclusive Breastfeeding in Chinese Postpartum Women: An Analysis of Repeated Measures

INTRODUCTION

Little research has explored galactagogue food consumption in China. This study aims to investigate consumption patterns and how they relate to perceived insufficient milk supply and exclusive breastfeeding.

METHODS

Data were collected from postpartum women in China at six time points: baseline demographic questionnaire before hospital discharge (T0), galactagogue food questionnaire at 1 month postpartum (T1), Hill and Humenick Lactation Scale at 6 weeks postpartum (T2), and breastfeeding practices at 1, 2, 3 and 4 months postpartum (T1, T3, T4, T5).

RESULTS

Of 218 participants who completed the galactagogue food questionnaire, 64.68% were consumers. No association was found between galactagogue food consumption and perceived insufficient milk supply. Consumers were less likely to breastfeed exclusively.

DISCUSSION

Future research should emphasize a deeper understanding of consumer behaviors and family support in providing professional guidance on postpartum nutrition that considers not only social and cultural experiences but also broader medical aspects.

Parenting self-efficacy and social support among parents in mainland China across the first six months postpartum: A prospective cohort study

OBJECTIVE

Knowledge of parenting self-efficacy and social support can help healthcare professionals to facilitate the parents' transition to parenthood. However, few studies have explored parenting self-efficacy and social support in Chinese mothers and fathers across six months postpartum. Thus, this study aimed to (a) investigate changes in parenting self-efficacy and social support over the six months postpartum; (b) explore the relationships between parenting self-efficacy and social support; and (c) compare the differences in parenting self-efficacy and social support between the mothers and fathers.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study was carried out from September 24, 2020, to October 8, 2021, at a local teaching hospital in Guangzhou, China. One hundred and sixteen pairs of Chinese parents who gave birth to a single full-term newborn were included in this study.

MEASUREMENTS

The Parenting Self-Efficacy Subscale of the Parenting Sense of Competence Scale and Social Support Rating Scale were completed within 2-3 days after delivery (T1), six weeks postpartum (T2), three months postpartum (T3), and six months postpartum (T4). Demographic and obstetric information was collected at T1.

FINDINGS

Maternal parenting self-efficacy decreased from T1 to T2 and then increased to T3 and T4, while paternal parenting self-efficacy remained stable throughout the six months postpartum. Overall, maternal and paternal social support declined during the six months postpartum. Parenting self-efficacy had a positive correlation with social support. Moreover, maternal subjective support was significantly lower than that of fathers at T1 and T4.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The present study highlighted the changes and relationships between parenting self-efficacy and social support in mothers and fathers across six months postpartum in mainland China. Healthcare professionals should treat mother and father as a system to help their transition to parenthood.

The role of midwives in supporting the development of the mother-infant relationship: a scoping review

BACKGROUND

The mother-infant relationship is complex and dynamic, informing the psychological development of the infant through bonding and attachment. Positive early interactions influence the quality of this relationship. Midwives are well placed to support the developing relationship between the mother and baby, yet there has been limited research exploring the role of the midwife in this context.

AIM

To explore interventions that have been provided by the midwife which support the development of the maternal-fetal or mother-infant relationship amongst a low-risk population from pregnancy, and up to six weeks postnatal. The review also sought to understand the types of interventions developed, format and delivery, outcomes measured and if cultural considerations had been incorporated.

METHODS

A scoping review of the research literature was undertaken using the Joanna Briggs Institute framework. Five online databases were searched for relevant articles published in English from 2000 to 2021.

FINDINGS

Sixteen articles met the inclusion criteria. Three themes emerged: (1) viewing the fetus as separate from the mother, (2) focused activities on the maternal-infant relationship and (3) targeted educational interventions.

DISCUSSION

Providing focused activities and targeted education during the pre and postnatal periods support the development of the mother-infant relationship. Significantly, there was insufficient research that considered the influence of culture in supporting the mother-infant relationship.

CONCLUSION

Further research is required to develop interventions that include a diverse sample to ensure culturally appropriate activities can be integrated into care during pregnancy and/or the postnatal period provided by midwives.

Parenting sense of competence and its predictors among primiparous women: a longitudinal study in China

BACKGROUND

Parenting sense of competence significantly affects the quality of parenting behaviours and healthy infant development. However, primiparous women without parenting experience may lack confidence and feel stress. This study aimed to explore the status of parenting sense of competence and identify its predictors among primiparous women.

METHODS

A longitudinal study design was used. Primiparous women were recruited by using a convenience sample from two women's and children's hospitals in two cities in China. All primiparous women completed questionnaires on demographic characteristics, infant characteristics, family function, and parenting sense of competence at 1 month postpartum. At 3 months postpartum, each women's parenting sense of competence was re-assessed. Generalised linear regression was applied to identify the predictors of parenting sense of competence at 3 months postpartum.

RESULTS

A total of 743 Chinese primiparous women were included in the analysis. The average parenting sense of competence score of the participants at 3 months postpartum was 70.18 (SD = 12.33). According to the generalised linear regression analysis, higher levels of parenting sense of competence at 3 months postpartum were significantly associated with older age (β = 0.13, P = 0.005), better family function (β = 0.37, P <  0.001), and higher levels of parenting sense of competence (β = 0.35, P <  0.001) at 1 month postpartum. In contrast, lower levels of parenting sense of competence at 3 months postpartum were associated with poorer self-rated economic status (β = - 0.16, P = 0.027), poorer infant health (β = - 0.26, P = 0.007), and mixed or formula feeding (β = - 0.11, P = 0.018) at 1 month postpartum.

CONCLUSIONS

Chinese primiparous women have a relatively good parenting sense of competence, but there is still room for improvement. Maternal age, economic status, family function, infant health, and feeding patterns were significant predictors. To improve their parenting sense of competence, more attention should be paid to primiparous women who are young, with poor economic status, having an unhealthy infant, and mixed or formula feeding. In addition, measures should also be taken during the early postpartum period to improve family function.

Predictor role of COVID-19 anxiety on maternal competency with mediating role of mother-infant attachment: A study of structural equation modeling

Introduction

COVID-19 pandemic is one of the factors that can increase anxiety and stress levels in pregnant women. Anxiety reduces the maternal-infant attachment. Mother-infant attachment can play an important role in maternal competency. The aim of this study was to predict effect of COVID-19 anxiety during pregnancy and the postpartum period on the maternal competency with mediating role of maternal-infant attachment.

Method

A prospective longitudinal study was conducted on 253 pregnant women in the third trimester of pregnancy that referred to the health centers of Iran University of Medical Sciences and met the study inclusion criteria. Demographic questionnaire and the COVID-19 anxiety scale completed during the third trimester of pregnancy and after the delivery and Müller's mother-infant attachment and maternal competency questionnaire completed at 48 h and 6 weeks after delivery by self-report method. Smart partial lease square version 3 was used to assess the validity and reliability of the model and the relationship between the variables.

Results

The findings of this study demonstrated that the COVID-19 anxiety during postpartum had a significant negative effect on the maternal-infant attachment (β = -0.183). Also, the maternal-infant attachment had a significant positive effect on the maternal competency (β = 0.48). Moreover, the conceptual model had good validity, reliability, quality and fit. And also the two variables of anxiety and mother-infant attachment together explained 25% of maternal competency.

Discussion

Mothers experience higher levels of the COVID-19 anxiety during pregnancy and postpartum; therefore, it is recommended that particular attention should be given to the psychological support of pregnant women during the COVID-19 pandemic and quarantine. Also, the COVID-19 anxiety during the postpartum period had a negative effect on the maternal-infant attachment and competency, which necessitates the need for the support of mother-infant relationship and providing the online training to promote the maternal-infant attachment patterns and maternal competency during the COVID-19 pandemic.

Analysis of Obstetric Clinical Nursing Integrating Situational Teaching Simulation

This paper applies the situational teaching mode to obstetric clinical nursing. When explaining the nursing operation skills, according to the pre written script, design some common clinical nurse-patient conflicts and carry out situational simulation performances, so as to inspire students to think about how to effectively communicate with patients and their families and establish a harmonious nurse-patient relationship. At the same time, this paper also urges students to improve their initiative of autonomous learning and actively participate in the whole process of learning, rather than passively accept knowledge. Finally, the teaching methods of combining obstetric clinical nursing teaching with experimental teaching were compared to explore the effectiveness of situational teaching simulation teaching mode. Through the experimental comparative analysis, it can be seen that the obstetric clinical nursing teaching model based on situational teaching simulation has a certain effect and has a good guiding significance for the practical teaching of obstetric clinical nursing.

Sensitivity Training for Mothers With Premature Infants: A Randomized Controlled Trial

OBJECTIVE

This single-blind parallel design randomized controlled trial evaluated the feasibility and effectiveness of a modified version of the Mother-Infant Transaction Program (MITP) in enhancing Chinese mothers' sensitivity towards their premature infants' physiological and social cues.

METHODS

Sixty mothers of hospitalized premature infants (mean gestational age = 32.1 weeks; SD = 2.8) were randomly assigned to either the MITP group or the treatment-as-usual control group. The intervention group (n = 30) received four sessions of parental sensitivity training adapted from the MITP, delivered by clinical psychologists before the infants were discharged. The control group (n = 30) received standard care provided by the hospitals. Each dyad was assessed at baseline (Time 1), immediately after intervention (Time 2), and when the infants were at the gestation-corrected ages of 3, 6, 9, and 12 months (Times 3-6). Maternal sensitivity, mother-infant interaction quality, parenting stress, postpartum depression, and mother's perception of infant's temperament were measured at Times 1-4, whereas infants' weight gain and developmental performance were assessed at Times 3-6.

RESULTS

The MITP group showed significantly higher maternal sensitivity and better mother-infant interaction quality after completing the training. They also reported less parenting stress and postnatal depression than the control group at Time 2 and subsequent follow-ups. The intervention significantly predicted better weight gain and developmental outcomes in infants across Times 3-6, mediated by maternal wellbeing and interaction quality.

CONCLUSION

 Our results demonstrated the feasibility and effectiveness of this adapted sensitivity training among Chinese mothers with premature infants. [ClinicalTrials.gov NCT04383340].

The Lived Experience of First-time Mothers with Congenital Heart Disease

PURPOSE

Nowadays most children with congenital heart disease (CHD) are expected to survive to adulthood. The healthcare focus needs to pay close attention to the important developmental tasks during their growth process. The women with CHD face some challenges in their critically developmental stages during pregnancy, delivery and even motherhood. The lived experience of being a mother need to be further concerned. This study aimed to explore the lived experience of first-time mothers with CHD.

METHODS

Descriptive phenomenological design was adopted. Semi-structured interviews were conducted from April-August 2018 with eleven primiparous women with CHD, who were recruited from the pediatric and adult cardiology outpatient departments at a medical center and who had a child aged between 6 months and 3 years. Giorgi's phenomenological analysis method was employed.

RESULTS

Six main themes arose from the analysis: (1) recognizing pregnancy risks, (2) performing self-care for health, (3) building self-worth from my baby, (4) adapting to postpartum life and adjusting priorities, (5) enjoying being a first-time mother, and (6) the factors contributing to success in high-risk childbirth.

CONCLUSIONS

The experiences that occurred prior to and after labor that were identified in this study can assist women with CHD to more capably prepare for and understand the process of becoming a mother, including recognition of the importance of a prepregnancy evaluation. The findings of this study can help women with CHD to better understand the path to becoming a mother, and prepare themselves for the challenges that lie ahead.

Impairments of Social Interaction in Depressive Disorder

OBJECTIVE

Despite the numerous findings on the altered emotion recognition and dysfunctional social interaction behavior of depressive patients, a lot of the relationships are not clearly clarified.

METHODS

In this pilot study, 20 depressive patients (mean±SD, 38.4±14.2) and 20 healthy subjects (mean±SD, 38.9±15.3) (each in dyads) were videographed. We then analyzed their social interaction behavior and emotion processing in terms of emotion recognition, their own emotional experience, and the expression of emotions under the conditions of a semi-structured experimental paradigm.

RESULTS

Patients showed more significant impairment regarding the dimensions of social interaction behavior (i.e., attention, interest, and activity) and their interaction behavior was characterized by neutral affectivity, silence, and avoidance of direct eye contact. This interactive behavioral style was statistically related to depressive psychopathology. There were no differences concerning emotion recognition.

CONCLUSION

Impairments of non-verbal and verbal social interaction behavior of depressive patients seem to be less associated with disturbances of basic skills of emotion recognition.

Design of Exercise Nursing Program for Pelvic Floor Muscle Function Recovery at 42 Days Postpartum

In order to explore the effect of exercise nursing intervention for pelvic floor muscle function recovery at 42 days postpartum, this paper conducts experimental research through controlled experiments, combines statistical methods to carry out digital processing, and sets a single variable of nursing intervention to provide a basis for experimental control, and statistical test results are used for effect evaluation. It has been discovered via experimental study that pelvic floor muscle function recovery exercise training for normal delivery women may enhance the mother's compliance with the pelvic floor muscle function exercise. Moreover, it can reduce the occurrence of urinary incontinence and pelvic organ prolapse, improve the postpartum pelvic floor function of postpartum women, improve the quality of life, and have a significant recovery effect. In addition, it is a simple, noninvasive, and highly safe continuation nursing measure, which can effectively improve the quality of obstetric care and has strong clinical use value.

A Cross-Sectional Survey of Family Care Behaviors for Children with Upper Respiratory Tract Infections in China: Are There Opportunities for Improvement?

OBJECTIVE

To describe family care behaviors for children with upper respiratory tract infections (URTIs) and explore related factors.

DESIGN AND METHODS

Parents of children with URTIs were included in this cross-sectional study. Family care behaviors, disease-related knowledge, and parental self-efficacy were evaluated with validated measures.

RESULTS

Among the 419 participants, 73.80% recognized diseases based on their children's abnormal presentation. Self-medication was the main home care measure (36.28% used only self-medication; 27.92% used both self-medication and physical cooling methods), and 36.5% received suggestions from medical professionals. All the participants took their children to the hospital, and 28.20% did so two or three times. The proportions of visits to level II or III hospitals were 49.64% and 83.87% for first and third hospital visits, respectively. Parents who had less disease knowledge and assessed children' diseases as more serious took their children to the hospital more often (p < 0.05); those whose nearest medical institution was a community health center were more likely to visit such centers (p < 0.001).

CONCLUSIONS

Most of the parents recognized symptoms of URTIs and provided home care but lacked enough knowledge and professional support to take reasonable measures. Hospital visits were their primary choice.

PRACTICAL IMPLICATIONS

Family care behaviors for children with URTIs could be improved through health education, and an internet nursing service or family doctor system is suggested. A hierarchical medical system is necessary to reduce hospital visits, as are more community health centers with pediatric services.

Symptoms of Common Mental Disorders in Brazilian Parents During the COVID-19 Pandemic: Associated Factors

COVID-19 pandemic has become a significant international public health problem. In addition to dealing with the pandemic's impact on mental health, parents need to cope with specific changes in their routines caused by social distance measures. This study aimed to investigate common mental disorders (CMD) symptoms in Brazilian parents during the COVID-19 pandemic and its associated factors. A total of 232 Brazilian parents ranging from 20 to 48 years old (M = 33.85; SD = 4.83) with children aged 1-36 months (M = 17.00; SD = 9,87) participated in an online survey. Parents answered a sociodemographic questionnaire, Self-Report Questionnaire (SRQ-20), Perceived Stress Scale (PSS-4), and Parenting Sense of Competence Scale. Chi-square tests, correlations, and multiple linear regression were performed. Results showed that parents' symptoms of CMD were negatively associated to perceived parental competence (β =- 0.130; p = 0.011) and family income (β =- 0.190; p = 0.024). Furthermore, perceived stress was the most related variable to parents' symptoms of CMD (β = 0.618; p < 0.001), showing a positive association. The model explained 49.5% of the variation. Results suggest that lower family income may increase symptoms of CMD in Brazilian parents, which is a concern in a country of high social inequality. Parental sense of competence may be a relevant protective factor. Interventions targeting parental competence and stress reduction should be considered to address the mental health impacts of the pandemic.

A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial

Background

Enhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore.

Methods

This three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women’s and Children’s Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022.

Discussion

This study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes.

Trial registration

ClinicalTrials.gov NCT04275765. Registered on 19 February 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05144-5.