Maternal Social Support and Neighborhood Income Inequality as Predictors of Low Birth Weight and Preterm Birth Outcome Disparities: Analysis of South Carolina Pregnancy Risk Assessment and Monitoring System Survey, 2000–2003

Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000–2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14–3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.     

Maternal religious attendance and low birth weight

We use data from the U.S. Fragile Families and Child Wellbeing study to test whether maternal religious attendance is protective against low birth weight. Building on previous research, we also consider the mediating influence of mental health, cigarette use, alcohol use, illicit drug use, poor nutrition, and prenatal care. Our results indicate that maternal religious attendance is protective against low birth weight. In fact, each unit increase in the frequency of religious attendance reduces the odds of low birth weight by 15%. Religious attendance is also associated with lower odds of cigarette use and poor nutrition, but is unrelated to mental health, alcohol use, illicit drug use, and prenatal care. Although lower rates of cigarette use help to mediate or explain 11% of the association between maternal religious attendance and low birth weight, we find no evidence to substantiate the mediating influence of mental health, alcohol use, illicit drug use, poor nutrition, or prenatal care. Our results suggest that the health benefits of religious involvement may extend across generations (from mother to child); however, additional research is needed to fully explain the association between maternal religious attendance and low birth weight. It is also important for future research to consider the extent to which the apparent health advantages of religious adults might be attributed to health advantages in early life, especially those related to healthy birth weight.     

Maternal Hemoglobin Concentrations and Birth Weight,Low Birth Weight (LBW), and Small for Gestational Age (SGA): Findings from a Prospective Study in Northwest China

Birth weight and related outcomes have profound influences on life cycle health, but the effect of maternal hemoglobin concentration during pregnancy on birth weight is still unclear. This study aims to reveal the associations between maternal hemoglobin concentrations in different trimesters of pregnancy and neonatal birth weight, LBW, and SGA. This was a prospective study based on a cluster-randomized controlled trial conducted from July 2015 to December 2019 in rural areas of Northwest China. Information on maternal socio-demographic status, health-related factors, antenatal visits, and neonatal birth outcomes were collected. A total of 3748 women and their babies were included in the final analysis. A total of 65.1% and 46.3% of the participants had anemia or hemoglobin ≥ 130 g/L during pregnancy. In the third trimester, maternal hemoglobin concentration was associated with birth weight in an inverted U-shaped curve and with the risks of LBW and SGA in extended U-shaped curves. The relatively higher birth weight and lower risks for LBW and SGA were observed when hemoglobin concentration was 100–110 g/L. When maternal hemoglobin was <70 g/L or >130 g/L, the neonatal birth weight was more than 100 g lower than that when the maternal hemoglobin was 100 g/L. In conclusion, both low and high hemoglobin concentrations in the third trimester could be adverse to fetal weight growth and increase the risks of LBW and SGA, respectively. In addition to severe anemia, maternal hemoglobin >130 g/L in the third trimester should be paid great attention to in the practice of maternal and child health care.     

The influence of maternal childhood and adulthood social class on the health of the infant

The aim of this study is to investigate how maternal childhood and adulthood social class contribute to social inequalities in low birth weight, neonatal mortality and postneonatal mortality. In particular I consider the combined influence of childhood and adult class, and compare outcomes with regard to the time distance from birth. Analyses were performed on a large sample of Swedish births from 1973 to 1990, restricted to infants of women with both childhood and adult class, classified as manual or non-manual. Logistic regression is used to compare odds ratios for social classes. The results indicate that manual maternal childhood class is consistently associated with higher risks for low birth weight and neonatal mortality, even when adult class was adjusted for. The influence of adult class was greater than that of childhood class for all health outcomes. Compared to higher/middle non-manual workers, unskilled workers in the service sector and workers in the manufacturing sector displayed the highest odds ratios for all adverse health outcomes. When both childhood and adult class were taken into account, social differences were greater for low birth weight and neonatal mortality than for postneonatal mortality. Maternal childhood class had more influence on low birth weight and neonatal mortality than on postneonatal mortality. I conclude that maternal childhood and adulthood social class are both independently associated with inequalities in health-related birth outcomes, and that social differences are greater for health outcomes closer to birth.     

Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

BackgroundWhile obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.ObjectiveA systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy.DesignA comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included.Main outcome measuresOutcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores.ResultsThirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent.ConclusionsBariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.     

浅析责任制助产护理对产科产妇分娩方式及母婴结局的影响

目的：对产妇行责任制助产护理，观察其分娩方式以及母婴结局。方法：择取本院于2015年1月-2016年6月期间收治的产妇90例，按照随机双盲法，将产妇划分为观察组与参照组，每组各45例。对参照组产妇行传统分娩护理，对观察组产妇行责任助产方式分娩，对比两组产妇的分娩方式以及母婴结局。结果：在分娩方式方面，观察组产妇的自然分娩率为91.11%，剖腹产率为8.89%；参照组产妇的自然分娩率为66.67%，剖腹产率为33.33%，对比两组数据，组间差异统计学意义具有明显性，即P<0.05；在母婴结局方面，观察组产妇的产后出血量、下肢疼痛麻木率、胎儿窘迫率以及新生儿窒息率与参照组产妇进行对比，相应数据组间优势显著，即P<0.05，存在明显的统计学意义。结论：产妇临床分娩过程中，对其行责任制助产护理，不仅可以提高产妇自然分娩率，还能促使母婴结局实现良性发展，对于保证母婴生命安全与健康，具有非常重要的现实意义，值得临床实践普及应用。     

Women's health after pregnancy and child outcomes at age 3 years: a prospective cohort study

OBJECTIVES: This study examined the persistence and comorbidity of women's physical and mental health conditions after pregnancy and the association of these conditions with child outcomes. METHODS: A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age approximately 3 years). RESULTS: Women's poor physical health and smoking had strong, graded associations with children's physical health and behavior problems, whereas women's depressive symptoms were associated with children's delayed language and behavior problems. CONCLUSIONS: Substantial persistence and comorbidity of women's health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women's health outside the context of pregnancy.     

Comprehensive Challenges for the Well Being of Young Children: A Population-based Study of Publicly Monitored Risks in a Large Urban Center

This population-based study investigated the unique and cumulative relations between risks that are monitored by public surveillance systems and academic and behavioral outcomes for an entire cohort of third graders in a large, urban public school system. Using integrated, administrative records from child welfare, public health, housing, and education for a population of over 10,000 students, this study documented the disproportionate prevalence of early risks that included low birth weight or preterm birth, inadequate prenatal care, teen mother, high lead exposure, low maternal education, child maltreatment, and homelessness. Multiple logistic regression analyses demonstrated that low maternal education (i.e., mothers without a high school degree) had the strongest association with third grade reading and math achievement, attendance, and school suspensions, controlling for child demographics, poverty, and all other risks. Classroom behavior was significantly influenced by familial and social risks (i.e., teen mother, low maternal education, homelessness, and maltreatment), but not biological risks (i.e., preterm or low birth weight and high lead). The cumulative number of risk experiences was significantly related to both academic and behavioral outcomes and was most strongly associated with school attendance problems. Implications of the study for national child welfare and educational policy are discussed.     

Type 2 diabetes in grandparents and birth weight in offspring and grandchildren in the ALSPAC study

OBJECTIVE: To examine the association between a history of type 2 diabetes and birth weight of offspring and grandchildren. DESIGN: Prospective observational study. Diabetic status, as reported by mothers (F1 generation) was collected on grandparents (F0) of babies (F2) born to mothers (F1) who participated in a study of maternal and child health. Associations between risk of grandparental diabetes and birth weight in mothers (F1) and grandchildren (F2) were analysed using linear and logistic regression. SETTING: Avon: comprising of the city of Bristol and surrounding areas. PARTICIPANTS: 12 076 singleton babies (F2), their parents (F1) and maternal and paternal grandparents (F0). RESULTS: Women (F1) who had no parents with type 2 diabetes had lower birth weights than women with one or two diabetic parents, after controlling for the age of both parents. There was a U shaped association between maternal birth weight and grandmaternal diabetes, but no evidence of an association with grandpaternal diabetes. The grandchildren of maternal grandparents with type 2 diabetes were more likely to be in the top tertile of birth weight than grandchildren of non-diabetics. There was evidence for an inverted U shaped association between birth weight of grandchildren and diabetes in paternal grandmothers. CONCLUSIONS: This is the first study to show intergenerational associations between type 2 diabetes in one generation and birth weight in the subsequent two generations. While the study has limitations mainly because of missing data, the findings nevertheless provide some support for the role of developmental intrauterine effects and genetically determined insulin resistance in impaired insulin mediated growth in the fetus.     

白银市2003～2010年婴儿死亡分析

目的:根据白银市2003～2010年婴儿死亡的调查统计资料,对婴儿死亡率的变化及其主要死因进行统计分析,为确定妇幼保健工作的重点与对策提供参考依据。方法:根据甘肃省5岁以下儿童死亡监测方案,利用全市5个县区5岁以下儿童死亡监测点2003～2010年儿童死亡监测资料中婴儿死亡相关资料进行统计、分析。结果:2003～2010年来全市婴儿死亡率下降明显,但农村婴儿死亡率明显高于城市;2003～2008年婴儿前3位死因顺位为肺炎、出生窒息、早产和低出生体重;其中肺炎、早产低出生体重死亡率下降明显,出生窒息死亡率下降不明显,2009～2010年婴儿前3位死因顺位为出生窒息、早产和低出生体重、先天性心脏病。先天性心脏病、其他先天异常等出生缺陷死因顺位上升。婴儿死亡构成中,新生儿占84.60%,其中早期新生儿占69.57%。结论:降低新生儿死亡率是降低婴儿乃至5岁以下儿童死亡率的关键。儿童保健工作的重点应放在农村,应加大对农村及边远贫困地区的妇幼卫生投入,加强农村三级妇幼卫生网络和卫生服务能力建设,促进城乡间协调发展;重视先天异常的预防、提高其检测水平。     

Does Maternal Birth Outcome Differentially Influence the Occurrence of Infant Death Among African Americans and European Americans?

The United States continues to have one of the highest infant mortality rates (IMR). Although studies have examined the association between maternal and infant birth outcomes, few studies have examined the impact of maternal birth outcome on infant mortality. This study was designed to examine the influence of maternal low birth weight and preterm birth on infant mortality. The 1997–2007 Virginia birth and infant death registry was analyzed. The infant birth and death data was linked to maternal birth registry data using the mother’s maiden name and date of birth. From the mother’s birth registry data, the grandmother’s demographic and pregnancy history was obtained. Logistic regression modeling was used to estimate adjusted odds ratios and their 95% confidence intervals. There was a statistically significant association between maternal birth outcome and subsequent infant mortality. Infants born from a mother who was low birth weight were 2.3 times more likely to have an infant die within the first year of life. Similarly, infants born from a mother born preterm were 2.2 times more likely to have an infant die. Stratification by race showed that there was no statistical association between maternal birth weight and infant death among Whites. However, a strong association was observed among Blacks. Maternal birth outcomes may be an important indicator for infant mortality. Future longitudinal studies are needed to understand the underlying cause of these associations.     

Impact of increasing inter-pregnancy interval on maternal and infant health

Short inter-pregnancy intervals (IPIs) have been associated with adverse maternal and infant health outcomes in the literature. However, many studies in this area have been lacking in quality and appropriate control for confounders known to be associated with both short IPIs and poor outcomes. The objective of this systematic review was to assess this relationship using more rigorous criteria, based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. We found too few higher-quality studies of the impact of IPIs (measured as the time between the birth of a previous child and conception of the next child) on maternal health to reach conclusions about maternal nutrition, morbidity or mortality. However, the evidence for infant effects justified meta-analyses. We found significant impacts of short IPIs for extreme preterm birth [<6 m adjusted odds ratio (aOR): 1.58 [95% confidence interval (CI) 1.40, 1.78], 6-11 m aOR: 1.23 [1.03, 1.46]], moderate preterm birth (<6 m aOR: 1.41 [1.20, 1.65], 6-11 m aOR: 1.09 [1.01, 1.18]), low birthweight (<6 m aOR: 1.44 [1.30, 1.61], 6-11 m aOR: 1.12 [1.08, 1.17]), stillbirth (aOR: 1.35 [1.07, 1.71] and early neonatal death (aOR: 1.29 [1.02, 1.64]) outcomes largely in high- and moderate-income countries. It is likely these effects would be greater in settings with poorer maternal health and nutrition. Future research in these settings is recommended. This is particularly important in developing countries, where often the pattern is to start childbearing at a young age, have all desired children quickly and then control fertility through permanent contraception, thereby contracting women's fertile years and potentially increasing their exposure to the ill effects of very short IPIs.     

Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.     

State estimates of neonatal health-care costs associated with maternal smoking--United States, 1996

Smoking during pregnancy can cause poor outcomes for both the pregnant woman and her unborn child and also result in added health-care expenditures. To characterize costs by state, CDC analyzed pregnancy risk surveillance and birth certificate data to estimate the association between maternal smoking and the probability of infant admission to a neonatal intensive care unit (NICU). Neonatal health-care costs, in 1996 dollars, were assigned on the basis of data from private health insurance claims. This report summarizes the results of that analysis, which estimated smoking-attributable neonatal expenditures (SAEs) of 366 million dollars in the United States in 1996, or 704 dollars per maternal smoker, and indicated wide variations in SAEs among states. These costs are preventable. States can use these data to justify or support their prevention and cessation treatment strategies.     

The roles of birth inputs and outputs in predicting health, behaviour and test scores in early childhood

The goal of this study is to address directly the predictive value of birth inputs and outputs, particularly birth weight, for measures of early childhood development in a simultaneous equations modelling framework. Strikingly, birth outputs have virtually no structural/causal effects on early childhood developmental outcomes, and only maternal smoking and drinking during pregnancy have some effects on child height. Not surprisingly, family child-rearing environment has sizeable negative and positive effects on a behavioural problems index and a mathematics/reading test score, respectively, and a mildly surprising negative effect on child height. Despite little evidence of a structural/causal effect of birth weight on early childhood developmental outcomes, our results demonstrate that birth weight nonetheless has strong predictive effects on early childhood outcomes. Furthermore, these effects are largely invariant to whether family child-rearing environment is taken into account. Family child-rearing environment has both structural and predictive effects on early childhood outcomes, but they are largely orthogonal and in addition to the effects of birth weight.     

肇庆市2006—2010年儿童保健指标完成情况分析

目的：了解肇庆市2006—2010年儿童保健指标的变化和儿童保健工作情况,分析肇庆市儿童健康状况。方法：根据肇庆市2006—2010年的妇幼卫生年报表,对年报表的部分儿童保健指标进行回顾性分析。结果：比较2006与2010年的儿童保健指标,围产儿死亡率、新生儿死亡率、婴儿死亡率、婴儿后期死亡率、5岁以下儿童死亡率和低出生体重发生率均呈下降趋势,差异有统计学意义俨〈0．001）;3岁以下儿童系统管理率和7岁以下儿童保健覆盖率呈上升趋势,差异有统计学意义（P〈0．001）;新生儿破伤风发生率和5岁以下儿童中重度营养不良患病率变化不明显,差异无统计学意义;上述各项指标均达到《中国儿童发展纲要（2001—2010）》目标。婴儿死亡率与低出生体重发生率有关联。结论：应继续加强各级妇幼保健人员的专业知识、技能培训,不断提高肇庆市儿童保健工作水平。     

Folic acid supplements modify the adverse effects of maternal smoking on fetal growth and neonatal complications

Maternal smoking during pregnancy leads to increased risks of neonatal complications. The use of folic acid supplements might reduce the adverse effects of smoking. We examined whether folic acid supplement use modifies the associations of maternal smoking with first trimester plasma homocysteine concentrations, fetal growth characteristics, and risks of neonatal complications. The associations were studied in 6294 mothers participating in a prospective population-based cohort study in The Netherlands. Main outcomes measurements were first trimester plasma homocysteine concentrations, fetal growth characteristics, and neonatal complications, including preterm birth, low birth weight, and small-size-for-gestational-age. Continued maternal smoking was associated with higher first trimester plasma homocysteine concentrations [difference 0.52 μmol/L (95% range = 0.20, 2.14)], lower third trimester fetal weight (difference -44 g (95% CI = -57, -31)], and birth weight [difference -148 g (95% CI = -179, -118)]. There were significant interactions between maternal smoking and folic acid supplements on all outcome measures (all P-interaction < 0.040). Among mothers who continued smoking during pregnancy, those who did not use folic acid supplements had the highest risk of delivering a child with low birth weight [OR = 3.45 (95% CI = 1.25, 9.54)] compared to those who did use periconceptional folic acid supplements. No significant effects were observed for the risks of preterm birth and small-size-for-gestational-age at birth. Our results suggest that some adverse effects of maternal smoking on fetal growth and neonatal outcomes might be reduced by the use of folic acid supplements. The observed interaction seems to be mainly driven by smoking in the first trimester only.     

Maternal Early Life Risk Factors for Offspring Birth Weight: Findings from the Add Health Study

The aim of this study was to examine the pathways that link mothers’ early life socio economic status (SES) and mothers’ experience of childhood maltreatment with birth weight among their later born offspring. Data were drawn from a nationally representative longitudinal survey of school-aged respondents, initially enrolled during adolescence in Wave I (1994–1995) and Wave II (1996) of the National Longitudinal Study of Adolescent Health and followed-up in adulthood in Wave III (2001–2002). Data on offspring birth weight were obtained from nulliparous females (N = 1,897) who had given birth between Waves II and III. Analyses used structural equation modeling to examine the extent to which early life maternal risk predicted offspring birth weight, and demonstrated that maternal childhood SES and maternal childhood maltreatment predicted offspring birth weight through several mediated pathways. First, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood SES and offspring birth weight. Second, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Third, adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Fourth, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood maltreatment and offspring birth weight. Finally, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood maltreatment and offspring birth weight. To our knowledge, this is the first study to identify maternal childhood maltreatment as an early life risk factor for offspring birth weight among a nationally representative sample of young women, and to demonstrate the mechanisms that link childhood SES and maltreatment to offspring birth weight. These findings suggest the importance of designing and implementing prevention and intervention strategies to address early life maternal social conditions in an effort to improve inter generational child health at birth.     

Paediatricians' perspectives on global health priorities for newborn care in a developing country: a national survey

ABSTRACT: BACKGROUND: An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. METHODS: Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with MannWhitney U test. RESULTS: Valid responses were received from 152 (65.8%) of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. CONCLUSIONS: Current global priorities for neonatal survival in Nigeria largely accord with paediatricians' views except for neonatal jaundice which is commonly subsumed under miscellaneous neonatal conditions. While the importance of these priority conditions extends beyond mortality thus suggesting the need for a broader conceptualisation of newborn health, paediatricians should be actively engaged in advancing the attainment of global priorities for child survival and health in this population.     

Easing maternal anxiety: an update

Maternal mental health is an important public health issue because of its effects not only on the mother's well-being and functional status, but also her relationship with her partner and the development of her children. There is accumulating evidence of the adverse sequelae of maternal anxiety on fetal development, obstetrical complications, pregnancy outcomes such as low birth weight, and subsequent child development. Evaluation of maternal anxiety and intervention to reduce these symptoms, may ensure optimal developmental outcomes, particularly in high-risk infants such as those born at very low birth weights. This article will outline recent advances in our understanding of the etiology, assessment and impact of maternal anxiety, and describe intervention strategies to promote maternal well-being.