Prevalence and Predictors of Alcohol Use in Pregnancy and Breastfeeding Among Australian Women

Background: Previous research suggests that alcohol use during pregnancy and breastfeeding has a negative impact on birth and neonatal outcomes. No threshold for this effect has been determined. The aim of this study is to determine the prevalence and correlates of alcohol use in pregnancy and lactation in a large representative sample of Australian women. Method: Data were used from a large representative sample of Australian women drawn from the 2007 National Drug Strategy Household Survey. A complex sampling framework was used to elicit prevalence estimates for alcohol use during pregnancy and lactation. A logistic regression analysis was used to determine the psychosocial characteristics associated with alcohol use during the perinatal period. Results: Alcohol use was reported by 29 percent of women who were pregnant in the past 12 months. In addition, 43 percent of women who were breastfeeding in the past 12 months reported alcohol use, whereas 36 percent of women who were both pregnant and breastfeeding in the past 12 months reported alcohol use. Most women (95%) reported a reduction in the quantity of their alcohol use while pregnant or breastfeeding. Older age was significantly associated with alcohol use in pregnancy, and also with alcohol use while breastfeeding (after controlling for other psychosocial characteristics). Higher educational attainment, and breastfeeding for more weeks in the past 12 months were significantly associated with alcohol use while breastfeeding, after controlling for confounding psychosocial factors. Conclusions: More research is needed to ease uncertainty about “safe” levels of alcohol use during pregnancy and while breastfeeding. A high proportion of the sample reported alcohol use during pregnancy or lactation, despite uniform international government guidelines recommending that no alcohol should be consumed during the prenatal and postnatal periods. These results indicate that public health education campaigns about the risks of alcohol during these periods are needed. (BIRTH 38:1 March 2011)     

Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women

ObjectivesTo explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes.DesignA prospective, longitudinal, cohort study.SettingThe postpartum units of two general hospitals in eastern Canada.ParticipantsNinety-seven mother–infant dyads.MethodsWe recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression.ResultsOne childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn’s gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes.ConclusionInduction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother–infant dyad for breastfeeding issues and to intervene to prevent or remediate them.     

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women

ObjectiveTo assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women.DesignSecondary analysis of a cross-sectional household survey.SettingHaiti Demographic and Health Survey, 2016 to 2017.ParticipantsWomen (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age.MethodsWe used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding.ResultsThe prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]).ConclusionAntenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.     

农村妇女避孕方法使用及其影响因素分析

本文使用的数据来源于1986年在江苏省进行的“农村已婚育龄妇女使用避孕方法的变异”的调查。本次调查的目的是对已婚育龄妇女避孕方法使用的类型及动力学进行综合研究。调查的数据表明,江苏农村已婚育龄妇女的避孕率为85%,其中,宫内节育器和女性绝育术为最普遍使用的方法。在使用避孕方法的妇女中,宫内节育器和女性绝育术的使用比例分别为46.6%和36.4%。妇女对正在使用的避孕方法的评价和希望使用新方法的意愿都存在着差别。从这些差别的分析中不难看出,面对广大育龄妇女的避孕要求,我们应提供较为先进的避孕方法的信息及咨询服务,从而扩大避孕方法的可选择范围,避免一些方法的错误使用,提高使用者的满意程度。     

Prevalence and Correlates of Smoking During Pregnancy: A Comparison of Aboriginal and Non‐Aboriginal Women in Manitoba

ABSTRACT: Background: Prenatal smoking rates vary substantially among racial and ethnic groups. Although prevalence of smoking among Aboriginal people in Canada is higher than in the general population, little is known about smoking rates during pregnancy among Aboriginal women or the characteristics of Aboriginal women more likely to smoke during pregnancy. The study purpose was to describe and compare the prevalence and correlates of smoking during pregnancy among Aboriginal and non‐Aboriginal women giving birth in the Canadian province of Manitoba. Methods: Data were obtained from interviews with 684 postpartum women who delivered a live singleton infant in two tertiary hospitals in Manitoba. Stratified analysis was used to describe effect‐measure modification for correlates of smoking among the Aboriginal and non‐Aboriginal groups. A multivariable logistic regression was conducted for the total sample. Results: A significantly higher proportion of Aboriginal women (61.2%) than non‐Aboriginal women (26.2%) smoked during pregnancy. No correlates of smoking during pregnancy were specific to Aboriginal women, but several maternal characteristics were associated with smoking among non‐Aboriginal women. After controlling for other factors, significant correlates of smoking during pregnancy for the total sample included inadequate prenatal care, low support from others, single marital status, illicit drug use, Aboriginal race/ethnicity, and noncompletion of high school among non‐Aboriginal women. Conclusions: The high prevalence of smoking during pregnancy, particularly among Aboriginal women, necessitates coordinated efforts aimed at smoking prevention and cessation. (BIRTH 32:4 December 2005)     

Aboriginal Women and Menopause

Objective: To determine the characteristics of menopause in Aboriginal women, in particular Canadian Aboriginal women.Methods: An extensive review of articles extracted from both medical and non-medical databases was undertaken. The search strategy combined the key word “menopause” with any of the following terms: Aboriginals. Native Americans, Natives, Indians, Métis, Inuit, Eskimo, and Indigenous people.Results: A total of 29 records were found, 13 of which had results relevant to the objective of the study. These articles suggest that menopause may have a positive effect on the lives of Aboriginal women with respect to increasing their freedom within the community. Aboriginal women appear to experience fewer vasomotor symptoms than other North American women.Conclusion: More research needs to be done to determine the effect menopause has on Canadian Aboriginal women and their coexisting diseases such as cardiovascular disease, hypertension, and diabetes mellitus. This work will allow health care providers to make more informed decisions on managing Aboriginal women’s transition through menopause in areas such as hormone replacement therapy.     

Randomized Controlled Trial of Motivational Interviewing to Support Breastfeeding Among Appalachian Women

ObjectiveTo determine the effectiveness of a single session of prenatal motivational interviewing (MI) to enhance breastfeeding outcomes.DesignA randomized controlled trial with two groups (MI and psychoeducation) with repeated measures: preintervention, postintervention, and at 1 month postpartum.SettingThe intervention was conducted at a university-associated clinic, community locations, and participants’ homes. Postpartum follow-up was conducted by telephone.ParticipantsA total of 81 women with low-risk pregnancies enrolled at 28 to 39 weeks gestation who lived in Appalachia.MethodsParticipants were randomly assigned to MI or psychoeducation on infant development. Pre- and postintervention outcome measures included intention to breastfeed, confidence in and importance of breastfeeding plan, and breastfeeding attitudes. At 1 month postpartum, participants completed a telephone interview to assess actual breastfeeding initiation, exclusivity, and plans to continue breastfeeding.ResultsAt 1 month postpartum, women in the MI group were more likely to report any current breastfeeding than women in the psychoeducation group, regardless of parity, χ²(1, N = 79) = 4.30, p = .040, Φ = .233. At the postintervention time point, the MI intervention had a significant effect on improving attitudes about breastfeeding among primiparous women only (p < .05).ConclusionOne session of MI was effective to promote breastfeeding at 1 month postpartum and to enhance positive attitudes toward breastfeeding among primiparous women in Appalachia.     

Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States

Objective

To identify differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with gestational diabetes mellitus (GDM) and women without GDM.

The Prevalence of Domestic Violence Among Women Seeking Abortion

Objective: To determine the prevalence of self-reported abuse in a population of women aged 18 years or older seeking elective pregnancy termination, and to compare abused and nonabused women with respect to the primary reasons for pregnancy termination.Methods: A self-administered questionnaire was returned by 486 women seeking outpatient abortion. The survey included demographic information, abuse screening, and items regarding partner involvement/awareness of the pregnancy, and abuse as a determinant of the abortion decision. One open-ended item asking the primary reason for pregnancy termination was included.Results: The prevalence of self-reported abuse in this population was 39.5%. White women were significantly more likely to report any history of abuse than nonwhite women. Relationship issues were the only reason for pregnancy termination given more often by women with an abuse history than by nonabused women. Women with abuse histories were significantly less likely than nonabused women to inform the partner of the pregnancy or to have partner support for or involvement in the abortion decision.Conclusion: The prevalence of abuse reported by women in this population suggests that many women seeking abortion services may have abuse histories. Abused women may have different reasons for pregnancy termination than nonabused women and may be more likely to make the abortion decision without partner involvement. When routine screening for abuse is included in abortion counseling, health providers have the opportunity for developing a safety plan and initiating appropriate referral.     

甘肃省不孕症患病率及其影响因素分析

目的:了解甘肃省育龄夫妇不孕症(infertility)患病率现状及其可能的影响因素。方法:运用分层整群抽样法抽取自然人群中具有代表性的2 621个已婚育龄家庭为研究对象,采用问卷调查方式,对甘肃省育龄夫妇不孕症患病情况进行横断面调查,同时调查其有关的流行病学因素。采用EpiData软件建立数据库,双人录入法进行数据录入,数据采用SPSS 15.0软件进行统计学分析。结果:甘肃省原发不孕的患病率为13.08%,继发不孕的患病率为35.25%;调查结果显示,育龄妇女年龄、月经周期及男方的体质量指数(BMI)和吸烟情况均是原发不孕的危险因素;继发不孕除以上因素外,育龄夫妇的活产次数、死胎次数、自然流产数、人工流产数及药物流产史也是其危险因素。结论:甘肃省原发不孕患病率为13.08%,促进和帮助欠发达地区的经济发展、加大教育及医疗卫生的投入、加强宣传,消除生殖健康隐患将有助于降低不孕率。     

Lifestyle Factors Related to Postpartum Weight Gain and Body Image in Bottle- and Breastfeeding Women

Objective: To explore the relationship of lifestyle variables to postpartum weight gain and body image attitudes of bottle- and breastfeeding women.
Design: Mail survey of new mothers at approximately 4 months postpartum.
Setting: Southwestern community.
Participants: One hundred one bottle-feeding women (69% white, 20% Hispanic, 11 % other) and 106 breastfeeding women [76% white, 19% Hispanic, 5% other) without diabetes. Bottle- and breastfeeding women did not differ on gestational weight gain or weight gain sustained postpartum.
Main outcome Measures: Postpartum weight gain (relative to prepregnancy weight) and body image attitudes.
Results: Feeding method (breast or bottle) was not associated with postpartum weight gain in the sample as a whole. Bottle-feeding mothers with higher postpartum gains exercised less, had higher fat intake habits, and were more dissatisfied with body image than mothers with lower gains. Breastfeeding mothers with higher and lower gains did not differ on any lifestyle factors. Overall lifestyle and psychologic skill in managing emotions were related negatively to postpartum body image dissatisfaction in both groups of women.
Conclusions: Breastfeeding women did not differ from bottle-feeding women in sustained postpartum weight gain. In bottle-feeding women, lifestyle factors were associated with levels of weight gain. Lifestyle-focused programs for weight management would potentially benefit these women.     

Prevalence,Clinical and Laparoscopic Features of Endometriosis Among Infertile Women

Objective

To study the prevalence, clinical and laparoscopic characteristics of endometriosis in infertile women.

Study Design

This is a hospital-based prospective study.

Patients

Five hundred and two (502) patients underwent diagnostic laparoscopy for evaluation of cause for infertility. Staging of endometriosis was done according to the rAFS scoring system.

Results

Out of 502 women, 276 (54.98 %) showed the presence of endometriosis, while 226 (45.01 %) did not have endometriosis. One hundred and eighty-three (66.3 %) women had stage I endometriosis, 49 (17.77 %) had stage II, 23 (8.33 %) had stage III and 21 (7.6 %) had stage IV endometriosis.

Conclusion

More than 50 % of patients in our study were asymptomatic; however, the presence of menorrhagia, dysmenorrhoea, dyspareunia and chronic pelvic pain are also clinically statistically significant. So, we would like to recommend the evaluation and treatment of a patient reporting in gynaecological OPD with the above-mentioned complaints with high suspicion of endometriosis.

     

Inconsistencies Among Nurses in Breastfeeding Knowledge and Counseling

Two hundred three nurses involved in the hospital care of women and their newborn completed a pre-test survey associated with a telephone conference in support of the breastfeeding mother. Inconsistencies among the majority of nurses in their ability to support the breastfeeding women and understand the mechanisms of successful breastfeeding were demonstrated. Results of the survey are presented as well as implications for education of nurses who care for the childbearing family.     

Prevalence and Risk Factors of Central Sensitization in Women with Endometriosis

Study ObjectiveTo assess prevalence of central sensitization (CS) and its association with demographic and clinical factors in patients with endometriosis.DesignSingle-center, observational, cross-sectional study.SettingTertiary center.PatientsConsecutive patients with endometriosis referred to the center from January 15, 2022, to April 30, 2022.InterventionsFor each enrolled patient, demographic and clinical data were collected, and the presence of CS was measured using the CS Inventory questionnaire (score ≥40).Measurements and Main ResultsPrimary study outcome was CS prevalence, and secondary study outcomes were the associations between demographic and clinical factors and CS. The 95% confidence intervals for CS prevalence were obtained with Bayesian-derived Jeffreys method, and the associations between CS and demographic and clinical factors were evaluated with the chi-square test and Fisher's exact test, where appropriate. The variables significantly associated with CS were then included in a multivariable logistic regression model. The significance level was set at .05 for all analyses.During the study period, 285 eligible women were enrolled. CS prevalence was 41.4% (95% confidence interval, 35.8–47.2). At univariable analysis, infertility, moderate to severe pain symptoms (except for dyschezia), altered bowel movements, posterolateral parametrium involvement, hormonal therapy failure (HTF), and most of central sensitivity syndromes were significantly associated with CS occurrence. Multivariable analysis only confirmed the significant association of CS with moderate to severe chronic pelvic pain, posterolateral parametrium involvement, HTF, migraine or tension-type headache, irritable bowel syndrome, and anxiety or panic attacks.ConclusionCS has a high prevalence in patients with endometriosis, especially in those with moderate to severe chronic pelvic pain, posterolateral parametrium involvement, HTF, and 3 central sensitivity syndromes (i.e. migraine or tension-type headache, irritable bowel syndrome, anxiety or panic attacks). Given the association with HTF, identifying CS through CS Inventory might be useful to counsel the patient and to choose multimodal treatment.