WOMEN'S POSTNATAL EXPERIENCE FOLLOWING A MEDICALLY COMPLICATED PREGNANCY

Within the social science literature on reproduction, relatively little attention has been paid to the areas of major illness during pregnancy and postnatal physical health. In this paper I present the results of a qualitative study of the postnatal health experiences of 15 women who had suffered a serious illness during pregnancy, the onset of which either predated or developed during pregnancy. Recently delivered women with continuing health problems face additional difficulties at a time when they are recovering from the physical and psychological processes of birth and are adjusting to the care of the new baby or grieving a loss. A few women in this study had experienced health problems that were resolved at or soon after the birth. Those with continuing or chronic illness described attempts to regain normality that involved both restoring bodily health and reestablishing their control over symptoms of the illness. Professional help with this process was often reported to be limited.     

Alcohol consumption after the recognition of pregnancy and correlated factors among indigenous pregnant women in Taiwan

To examine the rates and factors associated with alcohol consumption after the recognition of pregnancy among indigenous pregnant women, as well as the rates and factors associated with continuing alcohol consumption after the recognition of pregnancy among indigenous pregnant women who drank alcohol before the recognition of pregnancy in 10 hospitals in southern and eastern Taiwan. A total of 806 indigenous women who had just given birth in 10 hospitals in southern and eastern Taiwan were recruited. They were interviewed to collect their substance use information, demographic characteristics, psychological health status, history of physical abuse, and pregnancy history. The rates of alcohol consumption after the recognition of pregnancy in all indigenous pregnant women and the rates of continuing alcohol consumption after the recognition of pregnancy among those who drank alcohol before the recognition of pregnancy were calculated. The factors relating to alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were examined using logistic regression analyses. The results of this study found that 26.6% of indigenous pregnant women drank alcohol at any stage after the recognition of pregnancy, and 52.5% of indigenous pregnant women who drank alcohol before the recognition of pregnancy persisted in drinking alcohol after the recognition of pregnancy. Multiple parities, smoking or chewing betel quid after the recognition of pregnancy, and a higher frequency of drinking alcohol before the recognition of pregnancy were significantly associated with alcohol consumption and continuing alcohol consumption after the recognition of pregnancy. Meanwhile, being single or divorced, and intimate partner violence after the recognition of pregnancy were significantly associated with alcohol consumption after the recognition of pregnancy. High prevalence rates of alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were found among indigenous pregnant women in Taiwan. Early detection of alcohol consumption and effective intervention for alcohol consumption during pregnancy are needed.     

济南市1223名计划妊娠女性健康检查结果分析

目的了解济南市女性健康状况及影响因素,为做好优生优育工作提供科学依据。方法选取2014年3月至2015年12月在济南市计划生育服务中心进行孕前优生健康体检的1 223名女性为研究对象。对其进行优生优育项目检测、风险因素评估及跟踪随访。结果研究对象有病史异常及不良嗜好、不良环境接触史者188例,占15.37%;检出各类疾病411例,疾病发生率为33.61%;其中30~39岁年龄组、低文化程度组、农村人口疾病检出率较高(P0.05)。1 223名女性中有1 012名接受了跟踪随访,其中未孕538名,已孕474名;已孕的474名女性中,正常分娩266名,自然流产8例,人工流产5例,婴儿出生缺陷1例。结论孕前优生健康检查中发现的绝大部分危害优生优育的因素可以通过孕前健康教育和医学检查而避免;重视孕前健康教育及提高孕前优生健康检查的参检率,可以减少不良妊娠结局及婴儿出生缺陷的发生。     

Protocol for the Women And Their Children's Health (WATCH) study: a cohort of pregnancy and beyond

Background

The developmental origins of health and disease is a conceptual framework that helps explain the links between our early life exposures and later health outcomes, and is a burgeoning field of research. In this report, we describe the study protocol used in a prospective cohort of women recruited during pregnancy, with postnatal follow-up of the mothers and offspring.

Methods

The Women And Their Children’s Health (WATCH) cohort (n = 180 women) is being conducted at the John Hunter Hospital, Australia (from June 2006). Women attended study visits during pregnancy at 19, 24, 30, and 36 weeks’ gestation. Postnatal follow-up of the women and their offspring occurred at 3-month intervals during the first year after birth and annually thereafter, until age 4 years. Fetal ultrasound scans were performed at each pregnancy visit. Pregnancy and birth data were obtained from hospital records. Data collection has included maternal and child anthropometric, biochemical, dietary, physical activity, socioeconomic, medical, and other variables.

Conclusions

The 2 most novel components of our prospective cohort study are (1) the regular and systematic tracking of fetal and child growth and body composition, starting in the second trimester of pregnancy and continuing to age 4 years, and (2) the detailed maternal and child dietary data collection, including biochemical parameters. Detailed cohorts that collect data on the early nutritional, physiological, and social determinants of health are valuable. Despite its relatively small sample size, many hypotheses on developmental origins can be tested or piloted using data collected from the WATCH cohort.Key words: child, diet, growth, pregnancy, weight     

A Wise Wife and Good Mother: Reproductive Health and Maternity among Women with Disability in South Korea

As the first national survey on disability and reproductive health in South Korea, the present study was undertaken to describe experiences and needs related to pregnancy, childbirth, and postnatal care among women with physical disability (WWPD). Using a stratified random sampling method, 410 married WWPD between the ages of 18 and 50 participated in the survey regarding respondents’ socio-demographic profiles, disability-related characteristics, and reproductive health during pregnancy, childbirth, and postnatal care. Findings of this study indicated that most respondents wanted to have a child and perceived child care as possible with appropriate social support. Unlike the conventional wisdom and low societal expectation for these women to perform a maternal role, they gave birth and became caregivers for their child(ren) and family members. This study highlights a wide range of barriers experienced by WWPD with regards to taking care of their reproductive health. Implications for practice and policy are discussed.     

Mental Illness as a Risk Factor for Uninsurance Among Mothers of Infants

The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers’ health insurance status 12–18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother’s and child’s physical health status, the father’s physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.     

Women's Sexuality After Childbirth: A Pilot Study

A pilot study was carried out investigatingwomen's sexual health in the postnatal period. Postalquestionnaires were sent to a cohort of 158 primiparouswomen approximately 7 months after delivery. Women who had resumed sexual intercourse were askeda detailed set of questions about problems experienced,sexual practices, frequency of intercourse, satisfactionwith sex life, and consultation for postnatal sexual problems. All women were asked about theinformation they received on postnatalhealth prior tothe birth and any information or help and advice theyreceived from health professionals on the subject after the birth. Ninety-eight women (62%)responded. Women experienced significant levels ofmorbidity in the postnatal period; 3 months afterdelivery 58% experienced dyspareunia, 39% experiencedvaginal dryness, and 44% suffered loss of sexualdesire. These figures had reduced to 26, 22, and 35%,respectively, by the time of answering the questionnaire(approximately 8 to 9 months after delivery). Compared to before pregnancy, there was a decrease infrequency and satisfaction with sexual intercourse,although sexual practices changed little. Of the 67women who reported a postnatal sexual problem, only 19% discussed this with a health professional.Conversations with health professionals in routinepostnatal health contacts were mainly aboutcontraception, and only rarely discussed problems withintercourse.     

Pregnancy, illness and the concept of career

This paper explores a neglected area of women's reproductive experience, namely major illness during pregnancy. It draws on a qualitative study of 15 women who had either a pre-existing illness or developed a major health problem during pregnancy, and explores in detail the accounts of four contrasting case histories. Analysis is framed by the concept of career. It is argued, however, that an understanding of the women's experiences requires that pregnancy and illness are treated as separate, but co-existent, career paths. Pregnancy and illness were more than a concatenation of contingencies for each other. Pregnancy and the subsequent birth were influenced by the preceding and envisaged course of the illness, and the experience of illness was partly configured by the events of pregnancy. The paper considers the conceptual implications of multiple career analysis, and argues that a multiple career analytic approach has relevance for an understanding of other areas of health care, such as the experience of patients suffering from two or more concurrent illnesses.     

Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets

OBJECTIVE: The purpose of this study was to explore first-generation Bangladeshi women's understandings and experiences of postnatal distress, and to describe coping strategies during the postnatal period. METHODS: This was a qualitative study using focus groups. Subjects were drawn from three existing community groups in Tower Hamlets, a multiethnic, socially deprived borough in east London. Thematic content analysis was used to explore and present the data. RESULTS: Many women received little practical or emotional support once home from hospital with a new baby, because of the lack of extended family networks; this contrasts with the 40 day rest period common in Bangladesh. These women understood emotional distress as separate from physical symptoms or illness, and recognized that one may influence or cause the other. Distinctive language was used to describe these thoughts and feelings. The roles of health visitors, midwives and GPs were understood solely in terms of physical care. Accordingly, they did not access professionals for emotional or psychological problems. Lack of language support services contributed to the women not seeking help. CONCLUSIONS: Information about services, and professional roles in the postnatal period should be extended to include key family members such as husbands and mothers-in-law. Dialogue with Bangladeshi women may ensure that women understand the extended roles of GPs, health visitors and midwives in providing help for emotional distress, alongside their role in physical health care. More language support and advocacy is needed if women are to access the full range of health services.     

Postnatal depression, eating, exercise, and vomiting before and during pregnancy

OBJECTIVE: To examine the postnatal distress and the eating, exercise, and weight losing behavior of women before and during pregnancy. METHOD: The subjects were healthy women who had given birth to a singleton healthy baby in the week before the study. They were drawn from two consecutive series of mothers of babies whose birth weights were either < or =2,500 g or >2,500 g. A total of 181 women were interviewed using a standardized interview modified for pregnancy and related behaviors. They also completed the Edinburgh Postnatal Distress Questionnaire. RESULTS: Regression analysis produced a final model containing variables that made a unique contribution to predicting the level of distress of women in the week following childbirth. The model accounted for 25% of the variance and included four variables that were associated with greater distress: fear of weight gain before and during pregnancy, being distracted by thoughts of food during pregnancy, being afraid of gaining more weight than the pregnancy would explain, and vomiting more frequently during the first 3-4 months of pregnancy. A fifth variable accounted for less distress, that is, participating in low-intensity exercise for reasons of shape and weight during months 3-4 of pregnancy. Other variables associated with distress only in the preliminary analysis were maternal age, binge eating, and vomiting before pregnancy. The most distressed mothers were suffering from an eating disorder at the time of pregnancy. The binge and/or purge type of eating disorder was associated with more distress than a food restriction type. DISCUSSION: Postnatal distress is associated with body weight and shape concerns, with disordered eating before and during pregnancy, and with vomiting during pregnancy. The protective role of low-intensity exercise during early pregnancy needs to be explored. Women with eating disorders should be considered at risk for postnatal problems.     

Prevalence,risk factors,and complications of violence against pregnant women in a hospital in Peninsular Malaysia

Violence against women is a worldwide public health problem and becomes more crucial when it involves pregnant women. The primary aim of this study was to determine the prevalence of violence against pregnant women (VAPW), while the secondary aim was to identify the factors associated with violence and complications of violence during pregnancy. This was a cross-sectional study conducted in 1,200 postnatal women from March 1, 2015 through August 31, 2015 using a validated Malay Version of the WHO Women’s Health and Life Experiences Questionnaire. Data on pregnancy complications were obtained from antenatal records and discharge summaries. The prevalence of any form of VAPW was 35.9%, consisting of: any psychological (29.8%); any physical (12.9%); and any sexual (9.8%) violence. VAPW was significantly associated with: (1) women’s use of drugs, having had exposure to violence during childhood, having a violence-supporting attitude, having two or more children; and (2) having partners who were smokers, alcohol drinkers, or had controlling behavior. VAPW was significantly associated with anemia, urinary tract infection, premature rupture of membranes, antepartum hemorrhage, poor weight gain during pregnancy, low birth weight, and prematurity. In conclusion, the high prevalence of violence requires further research on preventive strategies for VAPW.     

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.     

Jail incarceration and birth outcomes

This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.     

Lifetime and current abuse,pregnancy risks,and outcomes among Native American women

This study examines the effects of current abuse, battering during pregnancy, and lifetime physical and sexual abuse on pregnancy risks and outcomes among 30 urban Native American women. One-third of the women in this study were battered during the index pregnancy, and nearly two-thirds had been abused by their current partner. All but 3 women had experienced physical or sexual abuse in their lifetime, and nearly three-fourths had been multiply abused. Significant relationships were found between current partner abuse, decreased birth weight, and inadequate prenatal care. The variable, increased lifetime abuse events, was significantly associated with increased risk factors for preterm birth/low birth weight. High rates of substance use and sexually transmitted diseases were noted among women in this study. Further research is needed to examine abuse and relationships between abuse and pregnancy risks and outcomes among Native American women.     

Outcome of maternal nutritional supplementation: a comprehensive review of the Bacon Chow study

In a double blind controlled intervention, two groups of nutritionally at-risk rural Taiwanese women were given a nutrient-rich dietary supplement (group A, n = 114) or a placebo (group B, n = 111) beginning after the birth of one child and continuing through the lactation period for a subsequent child. Outcome variables assessed include infant birth measurements postnatal physical growth, motor, mental, and dental development, morbidity, and maternal weight and skinfold changes during pregnancy and lactation. While few A-B differences in mean values of outcome variables were found, there were significant responses in subgroups of the sample. Comparisons of infants born after a nutrient-supplemented pregnancy (A2) versus an unsupplemented pregnancy (A1) showed that A2 male infants weighed more than A1 males at birth, and A1-A2 sibling correlations in birth measurements, especially Rohrer's index (wt/l3) were significantly reduced. Important mediators of supplement effects included sex of the offspring, season of birth, maternal body size, and birth of a previous infant characterized by dysmorphic prenatal growth. The limited effects of supplementation on the population as a whole may reflect the operation of long term adaptations which allow women to maintain reproductive success despite their apparent marginal nutritional status.     

Demographic Characteristics,Health Behaviors Before and During Pregnancy,and Pregnancy and Birth Outcomes in Mothers with Different Pregnancy Planning Status

Studies on pregnancy intentions and their consequences have yielded mixed results. Here, we comprehensively analyzed the maternal characteristics, health behaviors before and during pregnancy, as well as pregnancy and birth outcomes, across three different pregnancy planning status in 861 women participating in an ongoing Asian mother-offspring cohort study. At 26–28 weeks’ gestation, the women’s intention and enthusiasm toward their pregnancy were used to classify their pregnancy into planned or unplanned, and unplanned pregnancy was further subdivided into mistimed or unintended. Data on maternal characteristics, health behaviors, and pregnancy outcomes up to that stage were recorded. After delivery, birth outcomes of the offspring were recorded. Linear and logistic regression analyses were performed. Overall, 56 % had a planned pregnancy, 39 % mistimed, and 5 % unintended. Compared to women who planned their pregnancy, women with mistimed pregnancy had higher body mass index and were more likely to have cigarette smoke exposure and less likely to have folic acid supplementation. At 26–28 weeks’ gestation, unintended pregnancy was associated with increased anxiety. Neonates of mistimed pregnancy had shorter birth length compared to those of planned pregnancy, even after adjustment for maternal baseline demographics. These findings suggest that mothers who did not plan their pregnancy had less desirable characteristics or health behaviors before and during pregnancy and poorer pregnancy and birth outcomes. Shorter birth length in mistimed pregnancy may be attributed to maternal behaviors before or in the early stages of pregnancy, therefore highlighting the importance of preconception health promotion and screening for women of child-bearing age.     

The impact of pregnancy on anorexia nervosa and bulimia

The present study examines the impact of pregnancy on anorexia nervosa and bulimia. A survey of women with an active eating disorder involving anorexia nervosa, bulimia, or mixed symptoms 6 months prior to their first pregnancy was undertaken to gain information on attitudes toward becoming pregnancy, fears and concerns related to the unborn child, the impact on eating disorder behaviors prenatal and postnatal, weight gain and weight gain of the baby as an indicator of its health, and the obstetricians view of the pregnancy and health status of the infant upon delivery. The results indicate that pregnancy had a pronounced beneficial impact on anorexic and bulimic symptoms during pregnancy. However, lasting psychological benefit was limited to a minority of the sample in the first year after childbirth. In contrast to previous research, infants had normal birth weights and deliveries with an absence of congenital defects. The implications of these results and suggestions for future research are discussed.     

Partner violence among women before, during, and after pregnancy: multiple opportunities for intervention.

OBJECTIVES: Although partner violence during pregnancy has serious consequences for women's health, little is known about how physical partner violence may change throughout pregnancy transitions. Even less is known about changes in sexual and psychological partner violence throughout pregnancy transitions. In addition, few research studies on pregnancy and partner violence have examined these changes among both victimized women (i.e., women who report physical partner violence at the beginning of their pregnancies) and comparison women (i.e., women who do not report physical partner violence during this same time period). METHODS: This longitudinal research study investigated 76 women's experiences with partner violence beginning 1 year before their pregnancies, and continuing throughout their pregnancies until 1 year after delivery. Four structured interviews were administered to participants, and information was collected concerning the women's partner violence experiences. Hierarchical linear modeling was used to determine whether there were statistically significant differences between the violence rates experienced by the victimized women relative to the comparison women at each time period. RESULTS: The results show that partner violence rates do change throughout pregnancy transitions, and that these changes are seen for both victimized and comparison women. CONCLUSIONS: Pregnant and postpartum women are in need of comprehensive services that promote both their health and safety. This study offers care providers clinical implications for their work with pregnant and postpartum women, as well as policy and research recommendations.     

Predicting postnatal mental disorder with a screening questionnaire: a prospective cohort study from Zimbabwe

BACKGROUND: Postnatal mental disorders are common causes of morbidity but are rarely diagnosed or treated in busy primary care clinics in developing countries. OBJECTIVE: To determine whether a brief psychiatric screening questionnaire used in the 8th month of pregnancy can predict postnatal mental disorder. STUDY DESIGN: Prospective cohort study. SITE: A peri-urban settlement in Zimbabwe. POPULATION: 500 women in the 8th month of pregnancy identified by traditional birth attendants and primary care clinics. SAMPLE: "High risk" cohort consisted of all women who scored 8 or more on the Shona Symptom Questionnaire (SSQ), an indigenous psychiatric questionnaire (n = 95). Low risk cohort consisted of 105 women randomly selected from the remainder of the sampling frame. OUTCOME MEASURE: Revised Clinical Interview Schedule at six to eight weeks postpartum; scores of 14 or more indicate psychiatric caseness. RESULTS: The prevalence of postnatal mental illness was 16%. Odds ratios (95% confidence intervals) for high risk women becoming cases in the postnatal period were 10.6, 4.8, 23.9, p < 0.0001 after adjustment for age, marital status, and occupation. CONCLUSIONS: A brief method of detecting women at high risk of developing a postnatal mental disorder can be used with reasonable accuracy in the 8th month of pregnancy. Further research is needed to determine whether interventions applied to this high risk group can reduce their postnatal morbidity.

 

     

Tai Dam health care practices: Asian refugee women in Iowa

This study discusses several aspects of health care utilization and health care practices for a group of Tai Dam refugee women who today are living in central Iowa. Several important variables examined in this discussion include: ideas about illness etiology, choice and use of health care providers, birth control practices, and the use of preventive health care in the form of prenatal health care visits. Salient findings include: Tai Dam belief that the majority of illnesses are caused by temperature and weather changes or bad food and water, or that illnesses are caused by the supernatural. Two-thirds of the women do not use and have never used any form of birth control. Although the average Tai Dam woman had been living in the U.S. for seven years at the time of the study, communications with physicians and understanding of written medicine instructions is difficult for many due to language problems. One-quarter of the women are not covered by medical insurance of any kind.