The Effects of a Woman-Focused,Woman-Held Resource on Preventive Health Behaviors During Pregnancy: The Pregnancy Pocketbook

We evaluated the effectiveness of a woman-held pregnancy record (‘The Pregnancy Pocketbook’) on improving health behaviors important for maternal and infant health. The Pregnancy Pocketbook was developed as a woman-focused preventive approach to pregnancy health based on antenatal management guidelines, behavior-change evidence, and formative research with the target population and health service providers. The Pregnancy Pocketbook was evaluated using a quasi-experimental, two-group design; one clinic cohort received the Pregnancy Pocketbook (n = 163); the other received Usual Care (n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service-entry) and 12-weeks. Approximately two-thirds of women in the Pregnancy Pocketbook clinic recalled receiving the resource. A small, but significantly greater proportion of women at the Pregnancy Pocketbook site (7.6%) than the UC site (2.1%) quit smoking. No significant effect was observed of the Pregnancy Pocketbook on fruit and vegetable intake or physical activity. Few women completed sections that required health professional assistance. The Pregnancy Pocketbook produced small, but significant effects on smoking cessation, despite findings that indicate minimal interaction about the resource between health staff and the women in their care. A refocus of antenatal care toward primary prevention is required to provide essential health information and behavior change tools more consistently for improved maternal and infant health outcomes.     

Intention to breastfeed and other important health-related behaviour and beliefs during pregnancy

BACKGROUND: It is widely accepted that breastfeeding is the best form of infant feeding for the first 4-6 months of life. OBJECTIVE: This study explored whether intention to breastfeed is associated with other positive maternal health-related behaviours and beliefs during pregnancy. METHOD: A cross-sectional survey was carried out with 789 women attending antenatal clinics at Leicester Royal Infirmary NHS Trust. A structured questionnaire assessed feeding intention, use of folic acid, vitamin and iron supplementation, smoking status, smoking stage of change, and fetal health locus of control during pregnancy. RESULTS: Forty percent of the women stated that they intended to breastfeed exclusively, 27% planned to bottle feed, 23% intended to combine breast and bottle feeding and 10% were undecided. Women planning to breastfeed (either exclusively or in combination with bottle feeding) were more likely than those with alternative feeding plans to: have increased their folic acid intake, taken vitamin/iron supplements and have a primarily internal locus of control (perceive themselves to have control over the health of their unborn baby). Women intending to breastfeed were also less likely to smoke. Of the women who did smoke, those planning to breastfeed were more likely to be either considering or preparing to quit smoking during their pregnancy. CONCLUSION: In addition to educating pregnant smokers about the risks of maternal smoking, primary health care practitioners could also usefully address their knowledge, health beliefs and feeding intentions during antenatal care.     

阳江市1230例孕产妇的孕产期保健状况调查

目的 了解阳江市1230例孕产妇的孕产期保健现状,为提高孕产期保健质量提供依据.方法 采用分层整群随机抽样方法,对阳江市3个县(区)1230例孕产妇的基本情况,孕期保健知识及服务状况、妊娠分娩期健康状况等4个方面进行人户问卷横断面调查,并对结果进行统计分析.结果 本次研究有效问卷1220份,产妇对孕产期保健知识总体知晓...     

Nutrition and maternal health: What women want and can we provide it?

Aim:  Maternal dietary behaviours are associated with some maternal and infant health outcomes during and after pregnancy. However, effective Maternal Health Dietetic models of care are limited. The aim of this study was to benchmark our services against other Australian Maternal Health Dietetic services and to describe nutrition knowledge and use of dietetic services in a major Australian women's hospital.
Method:  During 2008, 15 Australian tertiary Maternal Health Dietetic services were surveyed collecting staffing and service delivery information. Patients in a maternity hospital were also surveyed to assess nutrition knowledge, attitudes, behaviour, education preferences and dietetic service awareness.
Results:  The benchmarking survey response rate was 73%. There was considerable variation in staffing levels and services delivered. Individual antenatal inpatient and outpatient counselling dominated dietetic time. Few evidence-based models of care or guidelines were used by dietitians. Of the 309 antenatal (RR 24%) and 102 postnatal (RR 17.4%) patients surveyed, half were primiparous; over one-third had prepregnancy body mass indices > 25.9 kg/m², and average pregnancy weight gain was 14.1 ± 6.7 kg. Few antenatal women knew their recommended pregnancy weight gain range. Excessive weight gain occurred in 33.3% to 100% of women (per body mass index range). Women had poor diet quality, despite identifying healthy eating as a personal priority. Nutrition education delivery preferences were identified.
Conclusion:  Considerable variation exists in Australian Maternal Health Dietetic services and referral guidelines. There is a role for Maternal Health Dietitian/Nutritionists to advocate for improved staffing levels and for the implementation and evaluation of evidence-based services. Potential service delivery improvements are suggested, including a model of dietetic care.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

Improved perinatal health through qualified antenatal care in urban Phnom Penh,Cambodia

Objectives  The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods  A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results  Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12–5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05–0.95) and low birth weight (OR=0.05,95% CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT₁, and DTP₃ immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions. Conclusion  This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.     

Maternal smoking during pregnancy predicts nicotine disorder (dependence or withdrawal) in young adults – a birth cohort study

Objective: To investigate whether maternal smoking during pregnancy predicts offspring nicotine disorder (dependence or withdrawal) at 21 years.
Method: Participants comprised a prospective birth cohort involving 7,223 singleton children whose mothers were enrolled between 1981 and 1983 at the first antenatal visit to the Mater Mothers' Hospital, Brisbane, Queensland. The present sub-cohort consisted of 2,571 youth who completed the Composite International Diagnostic Interview-computerised version (CIDI-Auto) that assesses nicotine dependence and withdrawal according to DSM-IV diagnostic criteria at the 21-year follow-up.
Results: 12.8% of offspring met criteria for nicotine dependence and 8.5% met criteria for withdrawal. 16.6% met criteria for either dependence or withdrawal. Smoking during pregnancy resulted in offspring being more likely to have dependence or withdrawal at 21 years than offspring of mothers who never smoked (age adjusted odds ratio 1.53 (95% CI: 1.19-1.96).
Conclusions: Findings emphasise the long-term adverse effects of maternal smoking during pregnancy, including nicotine dependence in young adult offspring.
Implications: Public health approaches should strengthen arguments for mothers to cease smoking during pregnancy in view of the long-term health implications for offspring, and reinforce measures to help smokers among pregnant women and women of childbearing age to stop.     

Maternal Vegetable and Fruit Consumption during Pregnancy and Its Effects on Infant Gut Microbiome

Maternal nutrition intake during pregnancy may affect the mother-to-child transmission of bacteria, resulting in gut microflora changes in the offspring, with long-term health consequences in later life. Longitudinal human studies are lacking, as only a small amount of studies showing the effect of nutrition intake during pregnancy on the gut microbiome of infants have been performed, and these studies have been mainly conducted on animals. This pilot study explores the effects of high or low fruit and vegetable gestational intake on the infant microbiome. We enrolled pregnant women with a complete 3-day dietary record and received postpartum follow-up. The 16S rRNA gene sequence was used to characterize the infant gut microbiome at 2 months (n = 39). Principal coordinate analysis ordination revealed that the infant gut microbiome clustered differently for high and low maternal fruit and vegetable consumption (p < 0.001). The linear discriminant analysis effect size and feature selection identified 6 and 17 taxa from both the high and low fruit and vegetable consumption groups. Among the 23 abundant taxa, we observed that six maternal intake nutrients were associated with nine taxa (e.g., Erysipelatoclostridium, Isobaculum, Lachnospiraceae, Betaproteobacteria, Burkholderiaceae, Sutterella, Clostridia, Clostridiales, and Lachnoclostridium). The amount of gestational fruit and vegetable consumption is associated with distinct changes in the infant gut microbiome at 2 months of age. Therefore, strategies involving increased fruit and vegetable consumption during pregnancy should be employed for modifying the gut microbiome early in life.     

Association Between Changes in Smoking Habits in Subsequent Pregnancy and Infant Birth Weight in West Virginia

West Virginia has one of the highest prenatal smoking prevalence rates in the nation. While overall national prenatal smoking rates have been declining, the prevalence rates in West Virginia continue to climb. Smoking in pregnancy has been associated with deleterious health outcomes in infants, including decreased birth weight. Yet, minimal research has been done on changes in smoking behaviors over time and the association of the changes in infant birth weights. The aim of the current study is to examine the change in prenatal smoking status of West Virginia women and the associated changes in infant birth weights. Population-based secondary data analysis was conducted using West Virginia birth certificates for all singleton infant siblings born between 1989 and 2006, linked based on mother. Infants born to women who smoked during pregnancy had significantly lower birth weights than infants born to non-smokers. Repeated measures analysis used to examine the changes with time showed that women who smoked during their first pregnancy but refrained from smoking during their subsequent pregnancy had significantly increased birth weight for the second infant, and conversely, infants born to women who initiated smoking with the subsequent pregnancy had significantly decreased birth weight compared to the previous infant. Findings of the study may be used to inform and to guide the development of population focused interventions to decrease maternal prenatal smoking in first and in subsequent pregnancies in an effort to improve infant birth weight outcomes.     

北京市朝阳区孕产妇母婴健康知识认知情况调查

【目的】 了解孕产妇母婴健康相关知识的认知情况,为完善孕产期健康教育宣传内容及形式提供依据。【方法】 采用问卷调查的方法,选择2011年2-3月份在北京市朝阳区妇儿医院进行孕期检查和住院分娩的孕产妇作为研究对象进行问卷调查。 【结果】 本次调查及格率为31.0%,其中孕产妇保健知识及格率为57.7%,新生儿保健知识及格率为16.6%;产妇的及格率(42.4%)明显高于孕早期妇女(25.3%);涉及孕产妇不同妊娠时期的具体生理指标或婴儿不同月龄的具体生理现象等健康知识问题,正确率均较低。 【结论】 根据孕产期不同阶段的需求,通过适宜的途径、采用恰当的载体,及时地开展适时、有效的健康知识宣传,以更好的提高孕产妇母婴健康知识掌握程度。     

Aboriginal mothers, breastfeeding and smoking

Objective : To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.
Method : A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire.
Results : Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non-Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non-smokers (58% vs. 64%), this difference was not significant.
Conclusions : The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers.
Implications : Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.     

The stigmatisation of pregnancy: societal influences on pregnant women’s physical activity Behaviour

Many women going through the major life transition of pregnancy experience decreases in physical activity behaviour, which may compromise maternal and infant health and wellbeing. Although research suggests that the social environment plays a large role in influencing women’s physical activity behaviour, little is known about the association between societal attitudes and physical activity behaviour during the course of pregnancy. Through a qualitative longitudinal study, we explored women’s physical activity experiences throughout pregnancy and how these were formed, supported and/or opposed by their social environment. This research included telephone interviews with 30 pregnant participants, recruited via a regional public hospital. Using a feminist standpoint analysis incorporating modern dialectics, three major tensions were identified, reflecting dominant societal discourses around physical activity and pregnancy: (1) engaging in physical activity and keeping the baby safe, (2) engaging in physical activity and obtaining social approval and (3) listening to oneself and to others. These findings present previously unrecognised opportunities for developing tailored and effective physical activity interventions among pregnant women.     

Knowing is not doing: The relationship between health behaviour knowledge and actual health behaviours in people with serious mental illness

ObjectivesLow levels of physical activity and poor dietary habits are common in people with serious mental illness and contribute to the poorer overall health and early mortality observed in this population. This paper examines the relationships between health behaviour knowledge and self-reported health behaviours in people with serious mental illness.MethodsWe examined the health behaviour knowledge, level of physical activity, consumption of fruits and vegetables and attitudes towards saturated fat intake in 21 community-based mental health consumers in a regional city in Queensland, Australia. Relationships between dichotomous variables of health behaviour knowledge, physical activity levels, daily fruit and vegetable intake, and attitude towards saturated fat intake were examined using Phi coefficients and point biserial relationships respectively.ResultsThe mean score for health behaviour knowledge was 10.2 out of a possible maximum score of 14 points. No statistically significant relationships were observed between the dichotomous variables of health behaviour knowledge and level of physical activity, consumption of fruits and vegetables or attitudes towards saturated fat intake. A weak statistically significant relationship was observed between raw health knowledge score and the number of daily serves of vegetable.ConclusionsThe lack of significant relationships between health behaviour knowledge and self-reported health behaviours is supported by health behaviour theory which proposes that knowledge alone is insufficient to elicit behaviour. In this regard, people with serious mental illness may not be dissimilar to the general population.     

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BACKGROUND: Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women. OBJECTIVE: We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients. DESIGN: Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings. RESULTS: Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9). CONCLUSION: Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.     

Improving communication between health professionals and women in maternity care: a structured review

Objective  To review trials of the effectiveness of interventions aimed at improving communication between health professionals and women in maternity care.
Search strategy  The electronic databases Medline, PsycLit, The Cochrane Library, BIDS Science and Social Science Indexes, Cinahl and Embase were searched. Final searches were carried out in April 2000.
Inclusion criteria  Controlled trials of interventions explicitly aimed at improving communication between health professionals and women in maternity care were included. Other trials were included where two reviewers agreed that this was at least part of the aim.
Data extraction and synthesis  95 potentially eligible papers were identified, read by one reviewer and checked against the inclusion criteria. The 11 included trials were read, assessed for quality and summarized in a structured tabular form.
Results  The included trials evaluated interventions to improve the presentation of information about antenatal testing, to promote informed choice in maternity care, woman-held maternity records and computer-based history taking. Four trials in which women were provided with extra information about antenatal testing in a variety of formats suggested that this was valued by women and may reduce anxiety. Communication skills training for midwives and doctors improved their information giving about antenatal tests. The three trials of woman-held maternity records suggested that these increase women's involvement in and control over their care.
Conclusions  The trials identified by this review addressed limited aspects of communication and focused solely on antenatal care. Further research is required in several areas, including trials of communication skills training for health professionals in maternity care and other interventions to improve communication during labour and in the postnatal period.     

Factor analysis shows association between family activity environment and children's health behaviour

Objective: To characterise the family activity environment in a questionnaire format, assess the questionnaire's reliability and describe its predictive ability by examining the relationships between the family activity environment and children's health behaviours – physical activity, screen time and fruit and vegetable intake. Method: This paper describes the creation of a tool, based on previously validated scales, adapted from the food domain. Data are from 106 children and their parents (Adelaide, South Australia). Factor analysis was used to characterise factors within the family activity environment. Pearson‐Product Moment correlations between the family environment and child outcomes, controlling for demographic variation, were examined. Results: Three factors described the family activity environment – parental activity involvement, opportunity for role modelling and parental support for physical activity – and explained 37.6% of the variance. Controlling for demographic factors, the scale was significantly correlated with children's health behaviour – physical activity (r=0.27), screen time (r=‐0.24) and fruit and vegetable intake (r=0.34). Conclusions: The family activity environment questionnaire shows high internal consistency and moderate predictive ability. This study has built on previous research by taking a more comprehensive approach to measuring the family activity environment. Implications: This research suggests the family activity environment should be considered in family‐based health promotion interventions.     

Identification of 'hot spots' of obesity and being underweight in early pregnancy in Liverpool

Background:  Obesity and being underweight in pregnancy are related to an increased risk of maternal and foetal morbidity, yet their prevalence is often unknown. The present study aimed to identify neighbourhoods with a higher than average prevalence or 'hot spots' of obesity and/or being underweight among first trimester pregnant women.
Methods:  A database was compiled consisting of postcode, height and weight for 7981 women who had booked-in for antenatal care between July 2004 and June 2005 at Liverpool Women's Hospital. Body mass index (BMI) was calculated and women were categorised accordingly. Postcodes for 6865 cases across Merseyside were converted to geolocations (pin-points on a map) using conversion software ( http://www.census.ac.uk/cdu/ ).
Results:  There was a very high prevalence of being overweight (27%) and obesity (17%); 3.8% of women were underweight and probably malnourished (BMI < 18.5 kg m⁻²); and a further 10.7% of women were possibly malnourished (BMI < 20.0 kg m⁻². Deriving case density from the geolocations allowed visualisation and identification of six neighbourhoods with above average levels of obesity and three neighbourhoods had marked concentrations of both being underweight and obesity.
Conclusions:  These neighbourhoods, particularly those identified as 'hot spots' for both being underweight and obesity, include some of the most deprived wards in the UK. As dietetic intervention may help to promote optimal weight gain during pregnancy and improve dietary intake for pregnant women and their families, primary health care providers should target these localities with a high prevalence of low and high BMI as a priority.     

Smoking during pregnancy--United States, 1990-2002

Cigarette smoking during pregnancy adversely affects the health of both mother and child. The risk for adverse maternal conditions (e.g., premature rupture of membranes, abruptio placentae, and placenta previa) and poor pregnancy outcomes (e.g., neonatal mortality and stillbirth, preterm delivery, and sudden infant death syndrome) is increased by maternal smoking. Infants born to mothers who smoke weigh less than other infants, and low birthweight (<2,500 grams) is a key predictor for infant mortality. Infertility and conception delay also might be elevated by smoking. National health objectives for 2010 target an increase in cessation to 30% among pregnant smokers during the first trimester and abstinence from cigarettes by 99% of women giving birth. To assess progress toward these goals, CDC analyzed state-specific trends in maternal smoking during 1990-2002 by using data collected on birth certificates. This report summarizes the results of those analyses, which indicated that whereas participating areas observed a significant decline in maternal smoking during the surveillance period, 10 states reported recent increases in smoking by pregnant teens. Although the widespread public health message to abstain from smoking during pregnancy has helped decrease maternal smoking, to reduce prevalence further, implementation of additional interventions are required.     

Randomized controlled trial of a web-based primary care intervention for multiple health risk behaviors

BACKGROUND: Physical inactivity, low fruit and vegetable intake, hazardous drinking, and smoking are leading risk factors for disease and injury. The aim of this study was to obtain estimates of efficacy in reducing the first three of these behaviors. METHOD: The design was a randomized controlled trial: 218 patients (17-24 years) attending a student health service at a New Zealand university in 2003 were assigned to: (A) web-based assessment and personalized feedback (n = 72); or (B) assessment only (n = 74); or (C) minimal contact (n = 72). Outcome measures were the proportion meeting recommendations for fruit and vegetable consumption, physical activity, and alcohol consumption 6 weeks later. RESULTS: Follow-up assessments were attained for 86% of participants, with no evidence of differential attrition. There were significant differences in the proportion meeting recommendations for fruit and vegetable consumption and physical activity in group A relative to C. Hazardous drinking prevalence did not vary significantly by group. CONCLUSIONS: Differences appear attributable to the intervention. The intervention could be routinely provided in primary care, and its efficacy could be assessed in a large randomized controlled trial.