Maternal and Child Health Journal最新文献

Objectives: Military families experience lifestyle and circumstance-specific stressors that may impact their parental stress, family resilience, and emotional support for parenthood. These outcomes may influence parenting behaviors and mental health that have further implications on child development and growth. Research is needed to examine these outcomes among military families in the United States on a national scale due to the importance of potential intergenerational implications.

Methods: This cross-sectional study used data from the 2021-2022 National Survey of Children's Health to investigate the relationship between caregiver military status and outcomes of parental stress, family resilience, and emotional support for parenthood (n = 99,869). Bivariate analyses through chi-square tests were calculated to determine differences between outcomes from military caregivers and civilian caregivers with select covariates. Multivariable regression analyses were calculated to further explore the relationship between caregiver military status and emotional support for parenthood.

Results: The prevalence of emotional support with parenthood was higher among military caregivers compared to civilian caregivers (82.8% vs. 75.0%, p < 0.0001); however, this difference was not statistically significant in adjusted analyses. No statistically significant differences were found between military families and civilian families in parenting stress and family resilience.

Conclusions: This study extended previous research that have focused on state or station specific outcomes in military families by examining these outcomes on a national scale. This study has important implications towards expanding research and interventions that reduce parenting stress and improve family resilience and emotional support for parenthood to ensure continued positive outcomes.

Objectives: This study explored how tandem-feeding mothers felt supported or unsupported by their family members, to identify common responses to this breastfeeding practice.

Methods: Free-text data were collected via an online questionnaire from a global sample of 1,209 tandem-feeding mothers. An emergent content analysis was conducted on 795 statements describing supportive experiences and 1,342 statements describing unsupportive experiences. Coding categories were developed inductively from the data.

Results: Five coding categories emerged from supportive comments and seven from unsupportive comments. The most prevalent supportive categories were normalisation of breastfeeding and respect for the mother's choice (52%), emotional support and encouragement (19%), and support provided without specific context (11%). The most prevalent unsupportive categories were questioning, challenging or pressuring mothers to stop tandem feeding (34%); disapproving comments, gestures or insults that caused mothers to feel uncomfortable (22%); and misinformed comments about tandem feeding (18%).

Conclusions for practice: Tandem-feeding mothers frequently experience both support and opposition from family members, with unsupportive responses often characterised by judgment and misinformation. These findings highlight the need for increased education and visibility of tandem feeding to normalise this practice and reduce stigma. Improving family understanding of tandem feeding may enhance social support for mothers and contribute to more positive breastfeeding experiences.

Objectives: To explore the practices and preferences of perinatal and infant mental health (PIMH) clinicians, towards the clinical assessment of the parent-infant relationship in mental health settings.

Methods: A cross-sectional, multilingual, 36-item survey was distributed globally from December 2019 to June 2020. Data from 321 qualified health professionals (Medicine, Nursing, Psychology, Social Work, Occupational Therapy, Speech Pathology) from 16 countries were examined. The survey captured participants' own assessment preferences and practices (clinician perspective) and their perceptions of the attitudes and practices of the service in which they work (service perspective). Differences between clinician and service perspectives were examined using Chi-squared tests of proportions.

Results: Respondents endorsed the clinical importance of assessing parent-infant relationship quality across outpatient and inpatient settings. A dyadic focus to assessment, evaluating the parent-infant relationship as a unit rather than assessing the parent or infant separately, was more popular as a personal preference (52.6%) than as a service preference (31.7%), PD = 20.9% [95% CI 12.6-28.8], χ²(1, N = 268) = 24.0, p < .0001. Most respondents endorsed partner involvement in PIMH care; however, a minority belonged to a service that provided partner-infant assessments (49.2%). Only a small proportion reported family-focused assessment as their individual preference (14%) or service preference (7%).

Conclusions: The positive attitudes suggest overall support among clinicians for the assessment of parent-infant relationship quality as a routine practice within PIMH service delivery. Survey findings also suggest efforts should be made to include greater partner involvement and a family focus.

Objective: SPARK36 is a structured interview tool for nurse-led consultations with parents of 3-year-olds in Youth Health Care. Previous studies demonstrated its feasibility, reliability and known-groups validity. This study examined its convergent validity.

Methods: In a cross-sectional study during the COVID-19 period, associations between scores on 12 SPARK36 domains and conceptually related subscales of three parent-reported instruments were explored. Correlations were assessed using Kendall's Tau-C.

Results: Of the 599 parents of children attending a SPARK36 consultation, 286 (41.7%) did not return a questionnaire. These parents more often had lower educational levels, non-Belgian nationalities, less often spoke Dutch at home, and more often showed increased or high risk based on the SPARK36 (19.9% vs. 13.7% respectively; p = 0.04), indicating potential selection bias. None of 32 tested correlation coefficients (e.g., SPARK36 'child behavior' with SDQ scales) exceeded 0.20.

Conclusion for practice: Convergent validity could not be demonstrated possibly due to the overall response rate, selective non-reporting, and the fact that most children showed no developmental or parenting problems. Three lessons emerged: (1) equity challenges occur, when parent-report tools are used among higher-risk families; (2) ongoing support may be needed to ensure consistent data collection by the nurses, given the large variation in data collection across them; (3) crisis situations disturb data collection, though a 50% questionnaires response rate may still be achievable during adverse contexts. The lessons also suggest that interview formats like SPARK36 may help reduce inequities that arise when preventive care relies on parent-report questionnaires.

Objective: To ascertain whether former small for gestational age (weight-for-gestational age < 10th percentile, SGA), compared to non-SGA, US-born women have greater SGA rates in their grandchildren.

Methods: A multi-step strategy utilizing mother's date of birth and full name was used to link the vital records of Chicago-born infants (born 2005-2017) to the Illinois transgenerational birth-file of their mothers (born 1989-1991) and maternal grandmothers (born 1956-1976). These matches accounted for differing naming practices, misspellings, and typographical errors. Our population was used to define generation-one women's SGA based on sex. A population-based reference was used to define generation-three infant's SGA based on sex average birthweight. Stratified and multivariable log binomial regression analyses were performed on singleton births. The Population Attributable Risk (PAR) percentages were calculated: P_E|D * [(adjRR-1)/adjRR] were calculated.

Result: Former SGA women (n = 1510) had a greater percentage of SGA births in their grandchildren than former non-SGA women (n = 9466): 23.3% versus 17.6%; RR = 1.30 (1.14, 1.52). The adjusted (controlling for daughters' selected covariates including race, education, prenatal care usage, and cigarette smoking) RR of grandchildren SGA among former SGA (compared to non-SGA) women equaled 1.22 (1.09, 1.36). The PAR of maternal grandmother's SGA status equaled 4.3% percent among African-Americans. There were too few non-Latina White women to calculate a meaningful PAR%.

Conclusions: In the US, urban women who were themselves born SGA (compared to non-SGA) have a modest increased SGA frequency in their grandchildren. A small percentage of SGA African-American births is attributable to their maternal grandmother's SGA status.

Objectives: Perinatal Mood and Anxiety Disorders (PMADs) are an important public health issue that can have detrimental consequences to both the woman and the child. Despite our extensive understanding about the consequences and the availability of treatments, only 3% individuals with PMADs are treated to remission. Our aim was to understand the community's needs, barriers to accessing care for PMADs, and obtain feedback on current services.

Methods: In this study, we carried out qualitative interviews with 32 relevant individuals from varied backgrounds to understand the complexities related to PMADs and barriers to help-seeking. These narratives were transcribed, and an inductive thematic analysis approach was used to identify codes which were used in an iterative manner until data saturation was reached.

Results: Three broad themes were identified related to the key questions including prevalence, barriers to care and finally, service needs and home visiting programs. All participants acknowledged the high prevalence of PMADs, particularly during and after the COVID-19 pandemic. They identified multiple barriers related to individual attitudes, knowledge, and stigma; health systems knowledge, attitude and access; and social determinants including poverty, race, geography, childcare and insurance. They also identified societal and cultural attitudes and the role of social support systems in help-seeking. All participants acknowledged the importance of home-visiting programs in addressing the needs of peripartum individuals.

Conclusion: Our findings provide an in-depth insight into the complex underpinnings of PMADs, particularly barriers to accessing care. This information, along with the positive feedback on home-visiting programs, can contribute to the development of innovative programs.

Background: Most mothers in the UK are not meeting the breastfeeding recommendations set by the World Health Organisation (WHO, Breastfeeding - Recommendations. https://www.who.int/health-topics/breastfeeding#tab=tab_2 , 2023). Maternal obesity has variably been associated with lower initiation and shorter duration of breastfeeding, but few studies have examined the impact of maternal adiposity estimated from skinfold thicknesses.

Aim: To investigate the relationship between maternal adiposity and breastfeeding initiation and duration.

Methods: Data from 2,873 mother-offspring pairs in the Southampton Women's Survey (SWS) mother-offspring cohort study were used to assess the relationship between a mother's adiposity and breastfeeding initiation and duration. The exposure variables were body mass index (BMI) and body fat percentage, calculated from 4-site skinfold thickness measurements measured prior to conception. The outcome variables were breastfeeding initiation and duration. All analyses were adjusted for confounders identified using a Directed Acyclic Graph.

Results: After adjustment for confounders, no associations were found between maternal BMI (RR 0.99 per 5 kg/m², 95% CI 0.97, 1.01) or body fat percentage (RR 0.99 per 5%, 95% CI 0.97, 1.00) and initiation of breastfeeding. After adjustment for confounders, amongst women who initiated breastfeeding, higher maternal BMI (β -0.09 SDs per 5 kg/m², 95% CI -0.13, -0.04) and body fat percentage (β -0.10 SDs per 5%, 95% CI -0.16, -0.04) were associated with shorter breastfeeding duration.

Conclusions: In this study maternal adiposity had little impact on breastfeeding initiation but higher maternal adiposity was associated with shorter breastfeeding duration. This study suggests that more support should be given to mothers with overweight and obesity to promote longer duration of breastfeeding.

Background: Child malnutrition remains a major public health concern in low and middle-income countries, and Uttar Pradesh (UP), India, continues to experience some of the highest levels of stunting, wasting, and underweight among children under five.

Objectives: This study examines the determinants of child malnutrition and its association with morbidity using data from the National Family Health Survey (NFHS-5).

Methods: Univariate and bivariate analyses, generalized Structural Equation Modeling (GSEM), and spatial analysis (Moran's I statistics and LISA cluster maps) were applied to assess both individual-level and district-level patterns. The NFHS-5 sample for Uttar Pradesh included 59,232 children under five, providing statistically robust estimates at both state and district levels.

Results: GSEM results indicated that maternal height, place of delivery, child age, caste, wealth index, and maternal education were significantly associated with stunting. Wasting was influenced by maternal height, birth order, child age, caste, wealth index, place of residence, and maternal education. Underweight was associated with maternal height, work status, child age, caste, wealth index, and maternal education. Malnutrition had a significant positive association with childhood morbidity (β = 0.032), indicating higher morbidity levels among malnourished children. Spatial analysis revealed clear geographic clustering of stunting, wasting, and underweight across districts, identifying several high-burden hotspots.

Conclusion: These findings highlight the need for integrated, geographically targeted interventions addressing socio-economic inequalities, healthcare access, maternal factors, and environmental conditions to improve child nutrition and health outcomes in Uttar Pradesh.

Objective: The primary goal of this study is to investigate whether a race/ethnicity match between parents and home visitors (HV) is associated with their relationship quality and whether quality ratings differ depending on parent or HV report.

Methods: Participants included 1,461 parent/HV dyads who participated in the Maternal Infant Health Program, Michigan's largest evidence-based home visiting program for Medicaid-eligible pregnant people and infants. At the time of discharge, parents and HVs were asked to complete a brief survey and reported on their background, program experiences, and relationship quality. We ran a series of multivariable logistic regression analyses and regressed HV- and parent-reported relationship quality ratings on race/ethnicity (mis)match controlling for covariates that likely contribute to the HV-parent relationship quality.

Main findings: Both parents and HVs rated the relationship quality positively, but their ratings were only moderately correlated, which suggests that parents and HVs use different criteria to determine relationship quality. When there is a race/ethnicity match, HVs rate the relationship quality higher, but match is not associated with parents' relationship quality ratings. In general, Black parents reported lower relationship quality ratings compared to White parents, which suggests that Black parents' dissatisfaction is stemming from sources other than a race/ethnicity mismatch.