1
|
McKay FH, Zinga J, van der Pligt P. Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study. Nutr Diet 2024; 81:228-236. [PMID: 37845189 DOI: 10.1111/1747-0080.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/18/2023]
Abstract
AIM To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy. METHOD Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand. RESULTS Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand. CONCLUSIONS AND IMPLICATIONS Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.
Collapse
Affiliation(s)
- Fiona H McKay
- Faculty of Health, School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Julia Zinga
- Faculty of Health, School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Paige van der Pligt
- Faculty of Health, The Institute for Physical Activity and Nutrition (IPAN) and School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Nutrition, Western Health, Footscray, Victoria, Australia
| |
Collapse
|
2
|
Rajasekera TA, Galley JD, Mackos AR, Chen HJ, Mitchell JG, Kleinman JJ, Cappelucci P, Mashburn-Warren L, Lauber CL, Bailey MT, Worly BL, Gur TL. Stress and depression-associated shifts in gut microbiota: A pilot study of human pregnancy. Brain Behav Immun Health 2024; 36:100730. [PMID: 38323225 PMCID: PMC10844036 DOI: 10.1016/j.bbih.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Background Psychosocial stress and mood-related disorders, such as depression, are prevalent and vulnerability to these conditions is heightened during pregnancy. Psychosocial stress induces consequences via several mechanisms including the gut microbiota-brain axis and associated signaling pathways. Previous preclinical work indicates that prenatal stress alters maternal gut microbial composition and impairs offspring development. Importantly, although the fecal and vaginal microenvironments undergo alterations across pregnancy, we lack consensus regarding which shifts are adaptive or maladaptive in the presence of prenatal stress and depression. Clinical studies interrogating these relationships have identified unique taxa but have been limited in study design. Methods We conducted a prospective cohort study of pregnant individuals consisting of repeated administration of psychometrics (Perceived Stress Scale (PSS) and Center for Epidemiological Studies Depression Scale (CES-D)) and collection of fecal and vaginal microbiome samples. Fecal and vaginal microbial community composition across psychometric responses were interrogated using full-length 16S rRNA sequencing followed by α and β-diversity metrics and taxonomic abundance. Results Early pregnancy stress was associated with increased abundance of fecal taxa not previously identified in related studies, and stress from late pregnancy through postpartum was associated with increased abundance of typical vaginal taxa and opportunistic pathogens in the fecal microenvironment. Additionally, in late pregnancy, maternal stress and depression scores were associated with each other and with elevated maternal C-C motif chemokine ligand 2 (CCL2) concentrations. At delivery, concordant with previous literature, umbilical CCL2 concentration was negatively correlated with relative abundance of maternal fecal Lactobacilli. Lastly, participants with more severe depressive symptoms experienced steeper decreases in prenatal vaginal α-diversity. Conclusion These findings a) underscore previous preclinical and clinical research demonstrating the effects of prenatal stress on maternal microbiome composition, b) suggest distinct biological pathways for the consequences of stress versus depression and c) extend the literature by identifying several taxa which may serve critical roles in mediating this relationship. Thus, further interrogation of the role of specific maternal microbial taxa in relation to psychosocial stress and its sequelae is warranted.
Collapse
Affiliation(s)
- Therese A. Rajasekera
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey D. Galley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amy R. Mackos
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Helen J. Chen
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
| | | | | | - Paige Cappelucci
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Christian L. Lauber
- Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Michael T. Bailey
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brett L. Worly
- Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tamar L. Gur
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, USA
- College of Medicine, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
3
|
Moghassemi S, Adib Moghaddam E, Arab S. Safe motherhood in crisis; threats, opportunities, and needs: a qualitative study. BMC Pregnancy Childbirth 2024; 24:4. [PMID: 38166665 PMCID: PMC10759654 DOI: 10.1186/s12884-023-06202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The coronavirus disease (COVID)-19 pandemic has affected many aspects of life, including pregnancy, childbirth, and safe motherhood so that pregnancy and childbirth take place in completely novel and unusual conditions for people. Therefore, we aimed to determine the opportunities, threats, and needs of pregnant women during a crisis. METHODS The present qualitative study was conducted among women who had a history of pregnancy and childbirth during the COVID-19 pandemic period in 2022. The data were collected by conducting face-to-face, semi-structured and in-depth interviews with 20 purposefully selected participants. Interviews continued until data saturation was attained. Data were analyzed through conventional qualitative content analysis based on the Graneheim and Lundman approach. RESULTS The data were categorized under three main themes: 1("Opportunities for safe motherhood in crisis"(2 Sub‑themes), 2) "Threats to safe motherhood in crisis"(2 Sub‑themes), and 3) "Needs for safe motherhood in crisis" (3 Sub‑themes). CONCLUSIONS Crisis is not always a threat. By developing an awareness of the opportunities, threats, and needs that safe motherhood faced during the COVID-19 crisis, policy makers can identify the existing gaps affecting the health of mothers and take the necessary measures to improve their conditions, experiences, and health in further crises.
Collapse
Affiliation(s)
- Sedigheh Moghassemi
- Counseling and Reproductive Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences(GOUMS), Gorgan, Iran
| | - Elham Adib Moghaddam
- Counseling and Reproductive Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences(GOUMS), Gorgan, Iran
| | - Sahar Arab
- Counseling and Reproductive Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences(GOUMS), Gorgan, Iran.
| |
Collapse
|
4
|
Creisher PS, Perry JL, Zhong W, Lei J, Mulka KR, Ryan WH, Zhou R, Akin EH, Liu A, Mitzner W, Burd I, Pekosz A, Klein SL. Adverse outcomes in SARS-CoV-2-infected pregnant mice are gestational age-dependent and resolve with antiviral treatment. J Clin Invest 2023; 133:e170687. [PMID: 37581940 PMCID: PMC10575736 DOI: 10.1172/jci170687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
SARS-CoV-2 infection during pregnancy is associated with severe COVID-19 and adverse fetal outcomes, but the underlying mechanisms remain poorly understood. Moreover, clinical studies assessing therapeutics against SARS-CoV-2 in pregnancy are limited. To address these gaps, we developed a mouse model of SARS-CoV-2 infection during pregnancy. Outbred CD1 mice were infected at E6, E10, or E16 with a mouse-adapted SARS-CoV-2 (maSCV2) virus. Outcomes were gestational age-dependent, with greater morbidity, reduced antiviral immunity, greater viral titers, and impaired fetal growth and neurodevelopment occurring with infection at E16 (third trimester equivalent) than with infection at either E6 (first trimester equivalent) or E10 (second trimester equivalent). To assess the efficacy of ritonavir-boosted nirmatrelvir, which is recommended for individuals who are pregnant with COVID-19, we treated E16-infected dams with mouse-equivalent doses of nirmatrelvir and ritonavir. Treatment reduced pulmonary viral titers, decreased maternal morbidity, and prevented offspring growth restriction and neurodevelopmental impairments. Our results highlight that severe COVID-19 during pregnancy and fetal growth restriction is associated with heightened virus replication in maternal lungs. Ritonavir-boosted nirmatrelvir mitigated maternal morbidity along with fetal growth and neurodevelopment restriction after SARS-CoV-2 infection. These findings prompt the need for further consideration of pregnancy in preclinical and clinical studies of therapeutics against viral infections.
Collapse
Affiliation(s)
- Patrick S. Creisher
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie L. Perry
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Weizhi Zhong
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jun Lei
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen R. Mulka
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - W. Hurley Ryan
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elgin H. Akin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anguo Liu
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Wayne Mitzner
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irina Burd
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Julceus EF, Olatosi B, Hung P, Zhang J, Li X, Liu J. Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018-2021. BMC Pregnancy Childbirth 2023; 23:686. [PMID: 37741980 PMCID: PMC10517534 DOI: 10.1186/s12884-023-05983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals' decision of not admitting pregnant women's partner or support person, and pregnant women's fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race. METHODS We utilized 2018-2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic. RESULTS A total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 - June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20-1.33) and White women (OR 1.10, 95% CI 1.06-1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13-1.24) and White women (OR 1.09, 95% CI 1.04-1.13). CONCLUSIONS Compared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.
Collapse
Affiliation(s)
- Emmanuel Fabrice Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| |
Collapse
|
6
|
Hefelfinger LM, DeFranco EA, Mendez C, McFarland K, Kelly E, Forde B. Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population. AJOG GLOBAL REPORTS 2023; 3:100225. [PMID: 37292417 PMCID: PMC10200035 DOI: 10.1016/j.xagr.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Social determinants of health are a well-described influencer of pregnancy-related morbidity and mortality. It is unclear how societal changes secondary to the COVID-19 pandemic altered the social determinants of health among pregnant patients. OBJECTIVE This study aimed to investigate differences in the social determinants of health among patients who experienced pregnancy before and during the COVID-19 pandemic. STUDY DESIGN This was a secondary analysis of an ongoing prospective cohort study examining the social determinants of health in postpartum patients at a single inner-city academic medical center. The planned secondary analysis was to compare the social determinants of health between patients that experienced societal changes before the pandemic and patients that experienced societal changes during the pandemic. Patients were included in the pandemic group if they delivered on or after March 30, 2020; moreover, patients in the pandemic group were compared with those who delivered before March 30, 2020 (referent group). Medical records were used to collect sociodemographic, pregnancy, and infant outcome data. The study participants were interviewed to collect detailed information regarding their perceived social, emotional, and physical environment as indicators of social determinants of health. Generalized linear modeling estimated the influence of social determinants of health on births during the COVID-19 pandemic. RESULTS Overall, 577 patients were enrolled in the study, of which 452 (78%) delivered before the COVID-19 pandemic and 125 (22%) delivered during the pandemic. Patients who delivered during the pandemic were more likely to report limited social or emotional support (relative risk, 1.62; 95% confidence interval, 1.02-2.59) and higher race-based discrimination (relative risk, 1.59; 95% confidence interval, 1.00-2.53). Mothers in the prepandemic group were more likely to have used federally funded programs, such as Medicaid, food stamps, and the Special Supplemental Nutrition Program for Women, Infants, and Children, during their pregnancy. Furthermore, the referent group reported more limited access to transportation. In addition, mothers in the prepandemic group were more likely to initiate prenatal care at a later gestational age and have fewer total prenatal care visits. CONCLUSION The COVID-19 pandemic created unprecedented changes in pregnancy care, and these were reflected in social determinants of health. It is imperative that we focus on the social determinants of health that were mitigated during this time and their effects on maternal and infant health.
Collapse
Affiliation(s)
- Leah M Hefelfinger
- University of Cincinnati College of Medicine, Cincinnati, OH (Mses Hefelfinger, Mendez, and McFarland)
| | - Emily A DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs DeFranco and Forde)
| | - Christina Mendez
- University of Cincinnati College of Medicine, Cincinnati, OH (Mses Hefelfinger, Mendez, and McFarland)
| | - Katy McFarland
- University of Cincinnati College of Medicine, Cincinnati, OH (Mses Hefelfinger, Mendez, and McFarland)
| | - Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Dr Kelly)
| | - Braxton Forde
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs DeFranco and Forde)
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Forde)
| |
Collapse
|
7
|
Phipps JE, Whipps MDM, D'Souza I, LaSalle JM, Simmons LA. Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19. Matern Child Health J 2023:10.1007/s10995-023-03657-w. [PMID: 37029891 PMCID: PMC10083068 DOI: 10.1007/s10995-023-03657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Pregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century. METHODS We conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health. RESULTS Many of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week. DISCUSSION Pregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.
Collapse
Affiliation(s)
- Jennifer E Phipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Mackenzie D M Whipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Indira D'Souza
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Leigh Ann Simmons
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| |
Collapse
|
8
|
Hazfiarini A, Zahroh RI, Akter S, Homer CS, Bohren MA. Indonesian midwives’ perspectives on changes in the provision of maternity care during the COVID-19 pandemic: A qualitative study. Midwifery 2022; 108:103291. [PMID: 35279435 PMCID: PMC8881222 DOI: 10.1016/j.midw.2022.103291] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
Objective To explore how COVID-19 influenced the provision of high-quality maternity care in Indonesia. Design and methods A qualitative descriptive study using in-depth interviews was undertaken. Thematic analysis was used to analyse data, and behaviour change frameworks (Theoretical Domain Framework (TDF) and Capability, Opportunity, and Motivation (COM-B)) were used to identify and map facilitators and barriers influencing maternity care provision during the COVID-19 pandemic. Setting and participants Fifteen midwives working in community maternity care facilities in Surabaya and Mataram, Indonesia were included. Surabaya is in western Indonesia, with around 56,000 births per year and a population of around 3 million. Mataram is in eastern Indonesia, with around 7,000 births per year and a population of around 500,000. Findings The main changes to maternity care provision during the COVID-19 pandemic were reduced frequency of antenatal and postpartum care visits, reduced support for women, including unavailability of maternity care and reduced number of antenatal care and labour companions, changes in location of provision of care, and public health changes related to COVID-19. The main factors influencing the provision of high-quality maternity care during the COVID-19 pandemic were behavioural regulation, professional role and identity, and environmental context and resources. Key conclusions and implications for practice Maternity care provision underwent substantial changes during the COVID-19 pandemic in Indonesia. Findings from this study can contribute to better understanding of how maternity care provision changed during the pandemic, and how positive changes can be reinforced, and negative changes can be addressed.
Collapse
|