Maternal and Child Health Journal最新文献

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.

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.

Introduction: Black women face several obstacles in breastfeeding promotion, education, support, and continuation. The Black church symbolizes a powerful beacon of health and advocacy within the Black community. However, there are limited studies that investigate the impact of the church on Black women's breastfeeding practices and experiences. This study examines how the Black church influences Black women's breastfeeding experiences.

Methods: Three breastfeeding cohorts of Black women in Kentucky (n = 15) completed 45-60-minute individual semi-structured qualitative interviews on their breastfeeding initiation, sources of support, challenges, successes, and healthcare experiences. Reflexive thematic analysis was used to analyze the data.

Results: Five themes captured how the church influenced Black women's breastfeeding experiences: (1) Reflecting breastfeeding as normal in church, (2) Designated spaces for breastfeeding, (3) Breastfeeding etiquette at church, (4) The role of elders, and (5) Breastfeeding as a natural or spiritual choice.

Discussion: Findings emphasize the Black church's unique and advantageous position in supporting nursing women by normalizing breastfeeding and fostering advocacy through partnerships with health organizations. Such efforts have the potential to address breastfeeding disparities and advance health equity for Black women by aligning support with their cultural and communal values.

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.

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: To evaluate the impact of BMI class increase during pregnancy on perinatal outcomes.

Methods: This retrospective cohort study from 2009 to 2022 included singleton pregnancies with a pre-gravid BMI ≥ 30 kg/m² that then increased ≥ 3 BMI points by the time of delivery. Patients without obesity and those who decreased BMI class were excluded. The primary composite outcome included fetal growth abnormalities, cesarean delivery, oligohydramnios, polyhydramnios, and stillbirth. Both superiority and equivalence analyses were performed.

Results: 16,835 pregnancies were included. The majority of patients were White/not Hispanic (80.3%) and multiparous (65.6%); co-morbidities increased as BMI increased. An increase from BMI class I to II led to more adverse outcomes than maintaining class I BMI (aOR 1.17, 95% CI 1.06, 1.28), and equivalent outcomes as those who had a pre-gravid class II BMI (adjusted 90% CI, -0.022, 0.019; p < 0.01). This increased odds of adverse outcomes doubled when the BMI increase from I to II occurred prior to 30 weeks gestation (aOR 1.34, 95% CI 1.21, 1.48). An increase from BMI class II to III led to higher odds of adverse outcomes than maintaining BMI class II (aOR 1.40, 95% CI 1.25, 1.58). The data does not provide sufficient evidence that the outcomes were equivalent to those with a pre-gravid BMI class III (adjusted 90% CI, -0.52, -0.017; p = 0.26).

Conclusions for practice: For pregnant patients with obesity, recommendations for pregnancy management should be based on current BMI, rather than pre-gravid BMI.

The maternal health crisis in the United States continues to affect some communities more severely than others, often due to historic and systemic barriers to care. Addressing these challenges requirehs solutions that are built with, and trusted by, the communities they serve. This supplement highlights the Safer Childbirth Cities initiative, a multi-year investment by Merck for Mothers and philanthropic partners that supported twenty community-based organizations across the country. These organizations implemented a wide range of approaches-including community-based doula care, storytelling initiatives, health information exchange systems, and new ways of defining and measuring evidence-to improve maternal health outcomes in their cities. By elevating local leadership, building trust through collaboration, and tailoring care to reflect the knowledge and needs of patients, the efforts featured here provide valuable lessons on how maternal health systems can be reshaped to deliver high quality, accessible, and culturally responsive care.