Maternal and Child Health Commons^™

A Multicountry Randomized Controlled Trial Of Comprehensive Maternal Nutrition Supplementation Initiated Before Conception: The Women First Trial., K. Michael Hambidge, Jamie E. Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S. Goudar, Sangappa M. Dhaded, Omrana Pasha, Sumera A. Ali, Antoinette Tshefu, Adrien Lokangaka, Richard J. Derman, Robert L. Goldenberg, Carl L. Bose, Melissa Bauserman, Marion Koso-Thomas, Vanessa R. Thorsten, Amaanti Sridhar, Kristen Stolka, Abhik Das, Elizabeth M. Mcclure, Nancy F. Krebs

Global Health Articles

Background: Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited.

Objectives: This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3).

Methods: Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was(DRC), Guatemala, India, and …

The Influence Of Unpredictable, Fragmented Parental Signals On The Developing Brain, Laura M. Glynn, Tallie Z. Baram

Psychology Faculty Articles and Research

Mental illnesses originate early in life, governed by environmental and genetic factors. Because parents are a dominant source of signals to the developing child, parental signals - beginning with maternal signals in utero - are primary contributors to children’s mental health. Existing literature on maternal signals has focused almost exclusively on their quality and valence (e.g. maternal depression, sensitivity). Here we identify a novel dimension of maternal signals: their patterns and especially their predictability/unpredictability, as an important determinant of children’s neurodevelopment. We find that unpredictable maternal mood and behavior presage risk for child and adolescent psychopathology. In experimental models, fragmented/unpredictable …

Racial Discrimination And Preterm Birth Among African American Women: The Important Role Of Posttraumatic Stress Disorder, Amelia Gavin, Nancy Grote, Kyaien Conner, Taurmini Fentress

Journal of Health Disparities Research and Practice

Among African American infants, preterm birth (PTB) is the most frequent cause of infant mortality. In the United States, there remains a stark African American-Non-Hispanic White difference in PTB (< 37 weeks of completed gestation). When compared to Non-Hispanic White infants, African American infants have greater than three times the risk of preterm-related mortality. Prior research studies have examined whether traditional prenatal risk factors explain the African American-Non-Hispanic White difference in PTB. However identification of these factors fails to explain the disparity. The lack of progress in addressing the African American - Non-Hispanic White difference in PTB suggests that exposures to risk factors across the life-course may be vital to addressing the African American-Non-Hispanic White difference in PTB. One potential life-course risk exposure is racial discrimination, which has been shown to influence the increased risk of PTB among African American women. However, research is needed to reveal the mechanisms that underlie the association between racial discrimination and PTB. Posttraumatic stress disorder (PTSD) may be one potential mechanism by which African American women's exposure to racial discrimination contributes to increased risk of PTB. This concept paper strives to advance our understanding of the increased risk of PTB among African American women. Recommendations are suggested to mitigate the impact of racial discrimination and PTSD on the PTB risk among African American women.

Meeting The Needs Of Orphans And Other Vulnerable Children: Learnings From Project Soar, Project Soar

HIV and AIDS

Orphans and other vulnerable children (OVC), including those living with HIV, often have a range of unmet needs, such as education, food security, psychosocial support, and access to health care. Project SOAR is documenting the unique vulnerabilities of OVC and their caregivers, and examining strategies to mitigate the impacts of HIV on them. This brief presents a summary of the SOAR portfolio, including a prospective cohort study of young people living with HIV in Zambia, an evaluation of an HIV risk screening tool among OVC in Tanzania, and a systematic review of promising interventions to support engagement and treatment adherence …

Women's Postpartum Experiences, Courtney Watkins

Online Theses and Dissertations

Current literature explores childbirth options and evidence-based approaches for care of an infant such as kangaroo care and breastfeeding, but there is little to no research on women’s birthing experiences and its impact on daily routines. This paper will reveal themes related to postpartum experiences and the impact on occupations for women who have given birth in the last six months. This qualitative study, using a convenience sample, explores a woman’s birthing experience and the influence it has on her postpartum occupations. The Centers for Disease Control and Prevention (2017) listed almost four million births that occurred during 2016 in …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Kenya, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

"I Don't Know If I Have The Courage" Reproductive Choices In Times Of Zika, Ana Rosa Linde, Grace Furtado, Elisa Tristán-Cheever, Carlos Eduardo Siqueira

Gastón Institute Publications

In this transnational study, we aimed at providing insights into women's views and attitudes towards their reproductive rights during the Zika epidemic. Women of distinct nationalities and ethnicities were recruited from various locations in Brazil, Puerto Rico, and the United States. We conducted semistructured interviews that suggest that participants reproductive decisions were intimately related to personal convictions and cultural beliefs, and their actions and thoughts were embedded in their sociocultural norms. The majority of women interviewed communicated that it takes courage to make the extreme, emotional, and overwhelming decision to have an abortion. The findings of this study suggest that …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

The Impact Of Maternal Nutrition During Pregnancy On Inflammation And Birth Outcomes, Lori Ogden

Theses and Dissertations--Nursing

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is …

The Relationship Between Maternal Plasma Homocysteine In Early Pregnancy And Birth Weight, Shona Cawley, Eimer O'Malley, Rachel Kennedy, Ciara Reynolds, Anne Molloy, Michael Turner

Articles

Background: There is limited evidence that plasma homocysteine (Hcy) is increased in women with adverse pregnancy outcomes, such as low birth weight (LBW).

Objective: We examined the relationship between maternal Hcy at the first prenatal visit and birth weight.

Study design: In a prospective observational study, women were recruited during their first prenatal visit after sonographic confirmation of gestational age. Along with the standard tests, blood was also taken for the measurement of maternal serum and red blood cell (RBC) folate, vitamin B12, and Hcy. In addition to collecting standard clinical and sociodemographic details, a detailed questionnaire on vitamin supplementation …

A Web-Based Dietary Intervention In Early Pregnancy And Neonatal Outcomes: A Randomized Controlled Trial, Rachel Ak Kennedy, C.M.E. Reynolds, Shona Cawley, E. O'Malley, D.M. Mccartney, M.J. Turner

Articles

Background Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes.

Methods Women < 18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women.

Results Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy …

Development Of A Novel Periconceptual Nutrition Score (Pens) To Examine The Relationship Between Maternal Dietary Quality And Fetal Growth, Rachel Ak Kennedy, Michael J. Turner

Articles

Background Maternal nutrition may influence intrauterine fetal development. To date, the relationship between contemporary European dietary guidelines and fetal growth has not been examined.

Aims To develop a novel Periconceptual Nutrition Score (PENS) to assess maternal dietary quality in early pregnancy and examine its relationship with fetal growth.

Study design Women were recruited conveniently at their first clinic visit and completed a supervised four day retrospective diet history. The PENS was developed using European Food Safety Authority recommended dietary intakes for pregnancy. The relationship between PENS and fetal growth was examined.

Subjects Women with a singleton pregnancy.

Outcome measures Birthweight, …

Accelerating Action To End Child Marriage In Bangladesh—Project Brief, Population Council

Poverty, Gender, and Youth

Bangladesh ranks among the five countries with the highest rate of child marriage in the world. Community norms and values are among the underlying factors that support the practice of child marriage in Bangladesh. The Population Council is partnering with the Ministry of Women and Children Affairs to delay marriage as part of the UNFPA-UNICEF Global Program to Accelerate Action to End Child Marriage. This program is being implemented to generate evidence on reduction of child marriage through an adolescent skills-building program. The project works to empower girls with life-skills and livelihood and gender-awareness trainings, as well as engaging communities …

Antihypertensive Drugs, Population Council

Reproductive Health

Pre-eclampsia (PE) is a condition in pregnant women marked by an increase in blood pressure and protein in the urine after 20 weeks gestation. Eclampsia is a life-threatening condition characterized by convulsions in women with PE. PE/E and other hypertensive disorders in pregnancy increase risk of preterm births. Providing high-quality and regular antenatal care improves the prevention and early detection of PE and can prevent its progression to eclampsia. Prescribing low-dose aspirin and calcium to at-risk women can prevent PE and eclampsia. PE and eclampsia can be managed by administering antihypertensive drugs and magnesium sulphate (MgSO4). MgSO4 is the safest …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Bangladesh, Pooja Sripad, Sharif M.I. Hossain, Charity Ndwiga, Charlotte E. Warren

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Ethiopia, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Assessing The Effect Of A Primary Health Care Intervention For Improving Pre-Eclampsia And Eclampsia Knowledge And Practice In Bangladesh, Sharif M.I. Hossain, Shongkour Roy, Kanij Sultana, Charlotte E. Warren

Reproductive Health

In resource-poor countries such as Bangladesh, proven life-saving commodities for pregnant women have not been optimally examined, such as magnesium sulphate (MgSO4) to manage severe pre-eclampsia/eclampsia, use of anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of PE/E, as well as task shifting to lower health-worker cadres, and community involvement. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. With support from USAID, the Ending Eclampsia project has been expanding access to proven, underutilized interventions and commodities for PE/E prevention, early detection, …

Engaging Community Women’S Groups To Improve Maternal Health Care Delivery In Cross River: Implementation Research Report, Pooja Sripad, Emmanuel Nwala, Tracy Mcclair, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Ending Eclampsia’s main objective is to improve access to underutilized interventions and commodities by training community health extension workers in preventing, detecting (screening), and managing pre-eclampsia and eclampsia. While the broader project emphasizes primary health care interventions, this implementation research (IR) study focused on a community intervention in one state, in areas where the facility interventions were active. This final research report describes IR testing the feasibility and utility of employing women’s groups as community platforms to increase women’s access to quality antenatal service utilization, using pre-eclampsia screening as the entry point. The study was conducted in 48 communities in …

Feasibility And Acceptability Of Community Health Extension Workers To Identify And Treat Hypertension Associated With Pregnancy: Implementation Research Report, Emmanuel Nwala, Udochisom Anaba, Pooja Sripad, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing …

Implementing Components Of The Primary Health Care Pre-Eclampsia/Eclampsia Model In Bangladesh: A Cost Analysis, Sharif M.I. Hossain, Pooja Sripad, Sara Chace Dwyer

Reproductive Health

Between 2016 and 2018, the Population Council, in collaboration with the Directorate General of Family Planning and Obstetrical and Gynecological Society of Bangladesh, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E). This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Bangladesh comprised two components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers (Family Welfare Visitors, Sub-Assistant Community Medical Officers, and Nurse-Midwives), and 2) Introducing antihypertensive drug provision …