Maternal and Child Health Journal最新文献

Objectives: The aim of this study was to assess whether the combination of home visits and traditional antenatal care leads to better perinatal outcomes than standard antenatal care alone does and to assess the level of perinatal knowledge.

Methods: A randomized controlled trial design was used in this study. The study was conducted with pregnant women in their first trimester who were registered at Family Health Centers (primary care) in a district of Istanbul. The study sample consisted of 32 women in the intervention group and 32 women in the control group. Pregnant women in the intervention group participated in an antenatal care program integrated with home visits, whereas those in the control group participated in a standard antenatal care program. The primary outcome of this randomized controlled trial was the change in perinatal knowledge score, which was assessed using a validated perinatal knowledge questionnaire administered before the intervention (pretest) and after program completion (posttest). Secondary outcomes included birth-related characteristics such as mode of delivery, maternal postpartum depressive symptoms as measured by the Edinburgh Postnatal Depression Scale, and breastfeeding self-efficacy as assessed by the Breastfeeding Self-Efficacy Scale.

Results: No statistically significant difference was observed between the intervention and control groups in terms of sociodemographic characteristics. Following the intervention, perinatal knowledge scores significantly increased in both groups; however, the increase was significantly greater in the intervention group (P < .05). Whereas pretest knowledge scores were comparable between groups, posttest scores were significantly higher in the intervention group. Additionally, the quality and completeness of antenatal care received were markedly better among women in the intervention group. The rate of term deliveries (≥ 40 weeks) was significantly greater and the rate of preterm/early-term deliveries was significantly lower in the intervention group than in the control group (P < .05). Although there was a statistically significant relationship between group allocation and the planned mode of delivery, there were no significant differences between groups in terms of postpartum depression scores or breastfeeding self-efficacy levels.

Conclusions for practice: Integrating structured home visits into routine antenatal care significantly improves the level of perinatal knowledge and quality of care received. This intervention increases maternal readiness and contributes to more informed and confident decision-making during pregnancy and childbirth.

Clinical study registration: Since our research constituted a randomised controlled study, it was registered on the ClinicalTrials.gov website under ClinicalTrials ID No. NCT04628598.

Background: Global concern about unwarranted childbirth interventions has intensified, with calls for respectful, evidence-based intrapartum care that supports physiologic birth. While antenatal education for expectant parents is common, the impact of multidisciplinary childbirth education for obstetricians has been underexplored.

Methods: In a study of obstetricians (N = 112, M_age = 44.1 years, SD = 6.8, 57% female), those completing the Istanbul Birth Academy's Childbirth Educator and Doula Training (CEDT) program (n = 67) were compared with obstetricians without such training (n = 45) via a survey. Group differences were tested with independent-samples t test (Bonferroni-adjusted) and ANCOVA controlling for age, academic title, experience, low-risk caseload, and employer.

Results: Of 31 practices, 26 differed by t test; 19 remained significant after correction. In adjusted models, 21 practices differed. CEDT-trained clinicians reported lower routine enemas, frequent digital exams, continuous CTG, routine IV lines, and IV fluids to shorten labor, with greater oral intake and nonpharmacologic pain relief; they more often supported instinctive pushing, upright positions, and delayed cord clamping, and less often used lithotomy and routine neonatal suctioning. Primary cesarean in nulliparas was lower.

Conclusion: This study's significance is that multidisciplinary childbirth educator-doula training for obstetricians is associated with fewer routine interventions and lower nulliparous primary cesarean rates. Prospective studies are warranted.

Objective: To investigate evidence regarding the association between carbohydrate intake (general and sugar) during pregnancy and offspring's diet pattern and/or food preference in animals and humans until adolescence.

Methods: Interventional and observational studies with animals (AS) and humans (HS) were included. Six databases and gray literature were consulted. Risk of bias was assessed using the SYRCLE tool for AS and the Newcastle-Ottawa Scale (NOS, 9 stars in total) for HS. The certainty of evidence was evaluated using GRADE.

Results: Eleven articles were included. In AS (n = 6), general carbohydrate intake during pregnancy was associated with offspring's preference for high-fat and high-fat-protein diets, while in HS (n = 5) it was associated with increased carbohydrate consumption by children (p = 0.002) and a Western diet pattern in infants. AS studies on maternal sugar intake during pregnancy showed inconsistent results, with some associating it with offspring's sucrose preference and others finding no effect. In HS, maternal sugar intake was linked to the consumption of high-sugar products by infants up to adolescence. A high risk of bias was attributed to most categories in AS. In HS, NOS scores ranged from 7 (n = 2) to 8 (n = 3) stars, indicating methodological flaws. All studies were classified as having low certainty of evidence.

Conclusion: Maternal carbohydrate intake during pregnancy was associated in some studies with offspring's dietary patterns and preferences, supporting nutritional guidance during this period to promote healthier long-term habits. However, the evidence remains limited, reinforcing the need for further research.

Objective: Unintentional injury poses a health threat to children, and toddlerhood (2 to 4 years) is a particularly vulnerable period. At this stage, parental intervention and monitoring are essential for mitigating injury risk. Maternal depressive symptoms are associated with greater frequency of injuries to young children in the home, however, our understanding of why remains limited. This study examined associations between maternal depressive symptoms and reactions to children's injury-risk behaviors, as well as children's injury rates.

Method: The sample comprised 84 mothers of children (24-47 months) and included a broad range of scores for symptoms of depression. Participants provided questionnaire and observational data.

Results: Mothers with more elevated depressive symptoms had children who experienced higher injury rates. These mothers showed frequent reactions to intervene when children were engaging in risk behaviors, however, they responded with ineffective strategies (i.e., increased prohibitions, reduced teaching).

Conclusion: Mothers having greater depressive symptoms focused more on stopping children's risk behaviors than teaching about safety, and children had higher injury rates.

Purpose: To describe the Children's Healthy Weight State Capacity Building Program (CHW-SCBP) and report on progress after 3 years of program implementation.

Description: The CHW-SCBP was a 5-year cooperative agreement (2020-2025) between the Association of State Public Health Nutritionists (ASPHN) and the Health Resources & Services Administration (HRSA), with the specific objective of developing state models in maternal child health (MCH) nutrition integration, which could then be implemented and replicated in states nationwide. Three states - North Dakota, Oregon, and Wisconsin - were selected to be part of CHW-SCBP and worked with ASPHN on their specific priorities and models of MCH nutrition integration. The implementation of the CHW-SCBP program followed two strategies, based on the goals of the HRSA Notice of Funding Opportunity (HRSA-20-043): (1) the workforce strategy, focused on increasing the MCH nutrition competency of the state Title V workforce and (2) the data strategy, focused on optimizing MCH nutrition-related data sources to contribute to data-driven programs and activities related to assessment, policy development, and assurance, within states' Title V.

Assessment: Activities implemented within the workforce and data strategies, as well as each state's outcomes, are summarized and discussed. Results from Year 3 program evaluation are also included.

Conclusion: The CHW-SCBP program successfully engaged with the three selected states, increasing the MCH nutrition competency of their Title V workforce and their knowledge and usage on MCH nutrition data. Sustainability plans need to be developed for program gains to be maintained beyond the CHW-SCBP funding period.

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.

Objectives: Having a child is a shared experience where partners influence each other's adaptation to parenthood. While much research focuses on mother-infant bonding, the impact of partners' psychological functioning on this outcome is underexplored. This study investigated how mothers' perceptions of partners' pre- and postnatal depressive and anxiety symptoms affect mother-infant bonding difficulties and whether mothers' own symptoms mediate these relationships.

Method: A sample of 525 Portuguese women (M age = 32.85, SD = 5.13) with infants < 24 months completed an online survey from February to March 2020. Assessments included history of depression and anxiety, current symptoms, perceptions of partners' symptoms, and mother-infant bonding difficulties. Multiple hierarchical linear regressions and mediation analyses were conducted.

Results: Women's current depressive symptoms and perceptions of partners' current anxiety symptoms were associated with greater bonding difficulties. In contrast, perceptions of partners' prenatal anxiety symptoms were associated with fewer bonding difficulties. Perceptions of higher levels of partners' current depressive symptoms were indirectly related to increased bonding difficulties through mothers' own depressive symptoms.

Conclusions: Partners' psychological functioning impacts mothers' adaptation to motherhood differently across the perinatal period. Perceived prenatal anxiety in partners may serve as a protective factor, whereas postpartum depressive and anxiety symptoms contribute to bonding difficulties. These findings highlight the importance of considering dyadic processes in understanding and supporting parent-infant relationships.