What Are the Maternal Factors that Potentially Intervenes in the Nutritional Composition of Human Milk?

Background: To evaluate the potential factors associated with the nutritional composition of human milk of puerperal women. Methods: cross-sectional study, conducted between March 2016 and August 2017, with 107 women, selected in a Tertiary Health Care Tertiary Health Facility of the Unified Health System (SUS) in the Municipality of Rio de Janeiro. Data were collected two months after delivery. The dependent variable of the study was the nutritional composition of human milk. We divided the independent variables into hierarchical levels: distal (age, schooling, parity and pregestational nutritional status), intermediate (number of prenatal visits and gestational weight gain) and proximal (alcohol consumption, smoking, diabetes mellitus and hypertension). For data analysis, we applied the multiple linear regression, centered on the hierarchical model. Only the variables associated with the nutritional composition of breast milk remained in the final model at a 5% level of significance. Results: The nutritional composition of human milk yielded by women with pregestational overweight, smokers and hypertensive had higher amounts of lipids and energy. Conversely, women with gestational weight gain below the recommended had lower amounts of these components. Conclusion: The evaluation of factors associated with the nutritional composition of human milk is extremely important to assist post-partum care practices. In this study, we observed that lipid and energy contents were associated to pregestational nutritional status, gestational weight gain, smoking and hypertension.     

“Making Room”: A Thematic Analysis Study of the Process of Postpartum Maternal Adjustment

Maternal and Child Health Journal - Mothers are especially vulnerable to the onset or recurrence of psychological symptoms during the postpartum period. However, protective psychosocial factors may...     

Maternal Zika virus infection and newborn microcephaly—an analysis of the epidemiological evidence

Purpose

To evaluate whether existing data and evidence support a causal link between maternal Zika virus (ZIKV) infection and newborn microcephaly.

An analysis of the implementation of Committees on Maternal Mortality in Brazil: a case study of the São Paulo State Committee

The precarious available information and difficulties in obtaining consistent data on maternal deaths in Brazil raise doubts as to the reliability of official statistics. The Committees on Maternal Mortality are considered an important strategy for overcoming these difficulties. This article discusses certain aspects of the Committees' performance, based on the case of the State of S o Paulo, demonstrating the Committee's role as a policy and advocacy instrument, thus going beyond merely an epidemiological surveillance strategy. This position has produced impasses in the work involving investigation of maternal deaths, and the resulting adversities, including limited institutional authority and power to intervene, have greatly jeopardized its functions both in the technical and political arenas. The Committee should be repositioned in order to strengthen itself as both a mechanism for investigation and a collective stakeholder to propose measures for the prevention and reduction of maternal mortality.     

Do Maternal Factors and Milk Expression Patterns Affect the Composition of Donor Human Milk?

A primary role of Human Milk Banks (HMBs) is to provide human milk (HM) for preterm infants and to support the mothers of these infants as they establish their own milk supply. A better understanding of the variation in the energy and macronutrients contents of donor human milk (DHM) potentiates targeted nutrition for preterm babies. Therefore, the aim of this study was to assess the variability of energy and macronutrients content in DHM and to investigate the impact of maternal factors and feeding practices on the nutritional value of DHM. The study involved 49 donors registered in the HMB in the Holy Family Hospital in Warsaw, Poland. Samples from each donor were pooled within a maximum of two weeks. The composition of DHM, including energy content, protein, fat, and carbohydrate concentrations, was analyzed using the Miris Human Milk Analyzer. The analyses were performed before the pasteurization process. The mean time of milk donation to HMB was 13.2 ± 6.0 weeks. There were no significant differences in energy and macronutrients contents of DHM in the beginning and at the end of milk donation to HMB, however, HM fat concentration was positively correlated with afternoon feedings (r = 0.289, p = 0.044). The method of feeding (breastfeeding vs. feeding only expressed milk) also did not impact the nutritional value of DHM. Future research for the DHM should include a further cross-sectional observational study with the collection of detailed donor information and characteristics of milk expression and feeding practices to further evaluate the pooling processes and the effect on DHM composition.     

Maternal and perinatal health status in the State of S?o Paulo, Brazil

The assistance offered during pregnancy and labour as also to the newborn child, and its relationship to maternal and perinatal mortality in the State of S. Paulo in 1984, is analysed on the basis of official available data. With respect to prenatal care the number of visits per woman was considered to be "sufficient" though of doubtful quality. The proportion of cesarean sections was very high (46.2%). Maternal mortality was found to be 4.86 deaths per 10,000 live births, but despite its being high, this figure is certainly too low and the correct figure is probably twice as high. The principal cause of maternal deaths is toxemia in pregnancy, followed by hemorrhage and abortion. Most of these deaths could have been avoided with care during pregnancy and labour. The rate of perinatal mortality was found to be 29.2 deaths per thousand births in 1984. This figure is also very high. The analysis of the causes of death for this period showed that the disorders which arose during the perinatal period were responsible for 90 per cent of the total number of deaths. The main causes of death in this group were the intra-uterine hypoxias and anoxias, asphyxia, respiratory distress syndrome and massive aspiration syndrome. These data bring to light the poor quality of the care offered to this group. The authors trust that the new policy of the Decentralized and Unified System of Health will take the quality of care as much as the integration of services into consideration with a view to overcoming the precarious maternal and perinatal health situation in S. Paulo.     

Length of Maternal Hospital Stay for Uncomplicated Deliveries, 1988–1995: The Impact of Maternal and Hospital Characteristics

Objectives: To determine the independent association of selected maternal and hospital characteristics with length of maternal hospital stay for uncomplicated vaginal deliveries. Method: Linear regression analysis using National Hospital Discharge Survey data from 1988 to 1995. Independent variables were year, maternal age and race, method of payment, and hospital ownership, size, and geographic location. The outcome measure was length of maternal hospital stay for uncomplicated vaginal deliveries. Results: Length of stay was independently associated with year, geographic region, payment method, and hospital size. From 1988 to 1995, the mean length of stay fell from 2.1 to 1.5 days. The rate of decrease was similar for all regions, methods of payment, and hospital size. Women in the West had a shorter mean length of stay (1.5 days) than women in the Northeast (2.2 days). The difference by method of payment was smaller. Length of stay was shortest for women without insurance (1.8 days) and longest for women covered by Blue Cross (2.1 days). Maternal age and race and type of hospital ownership were not independently associated with the length of stay. Conclusions: Significant variations existed in the length of time women are hospitalized for normal childbirth. These variations are primarily associated with where a woman lives and whether she is insured. Given the current public debate on the impact of shortened hospital stays, these variations need to be explored and their effects on maternal and infant well-being clarified.     

After Graduation,What? An Analysis of the Job Placements of Graduates of Public Health Maternal and Child Health Training Programs

Objectives: In 1995, the Association of Teachers of Maternal and Child Health (ATMCH) decided that information about the employment status of program graduates was essential to attempts to improve MCH curricula. Method: ATMCH requested information from 13 MCH programs in schools of public health funded by the federal Maternal and Child Health Bureau and 12 provided information about their master's degree graduates in the 1990-1994 period, including the year of graduation, degree, Bureau traineeship support, position held, and employing agency. Results: The total number of graduates was 742. Four programs averaged less than 8 graduates per year (small); six, 10–16 (midsize); and two more than 22 (large). More than 90% of graduates received a M.P.H. In the 10 programs that provided data on Bureau support, 46% received traineeship support from the Bureau. Midsize programs had the largest percentage of graduates receiving traineeship support. Overall, 45% of graduates were in administrative positions, 32% were involved in patient care, 20% were in policy-analytic positions, and 3% in other positions. Forty-seven percent of program graduates entered into or continued in community-based agencies, 18% in government agencies, 17% in academic or research agencies, and 18% in other agencies. Program size was significantly associated with both position and the agency in which the graduate was employed. Bureau traineeship support was associated with employing agency. Conclusions: The study suggests the need for changes in MCH curricula, enhanced education opportunities in specialty skill areas, and an ongoing survey of graduates of MCH programs.A Project of the Association of Teachers of Maternal and Child Health.     

Maternal Deaths in the City of Rio de Janeiro, Brazil, 2000�C2003

The study describes the characteristics of maternal deaths in the city of Rio de Janeiro, Brazil, during 2000–2003. After investigation by public-health services, 217 maternal deaths were identified among predominantly non-white (48.9%), single (57.1%) women aged 29.6±7.3 years on average. Direct obstetric causes corresponded to 77.4% of the maternal deaths, mainly due to hypertensive disorders. HIV-related diseases accounted for 4% of the maternal deaths. Almost three-fourths of the mothers who died were aged 20–39 years, although the highest risk of maternal death corresponded to the age-group of 40–49 years (248.9 per 100,000 livebirths). The socioeconomic and demographic profiles of maternal deaths in the city of Rio de Janeiro reflected a vulnerable social situation. Appropriate interventions aimed at reducing maternal mortality need to encompass all women of childbearing age, irrespective of the magnitude of the risk of maternal death.Key words: Causes of death, HIV, Hypertensive disorders, Maternal health, Maternal mortality, Vital statistics, Women''s health, Brazil     

Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?

Objective To examine the association between gestational weight gain and adverse maternal and infant outcomes among overweight women [body mass index (BMI) 26.0–29.0 kg/m²]. Methods A population-based cohort study using birth certificate data (1990–2004) from 34,143 singleton, full-term deliveries to nulliparous, Missouri residents ages 18–35. Gestational weight gain was divided into three categories: below Institute of Medicine (IOM) recommendations (<15 lbs), within IOM recommendations (15–25 lbs), and above IOM recommendations (>25 lbs). Categories of 10-lb increments were also evaluated. The primary outcomes were preeclampsia, cesarean section, macrosomia, low birth weight (LBW), and perinatal death. Adjusted relative risks and 95% confidence intervals (CI) were calculated using Mantel–Haenszel pooled estimator. Results Compared to women who gained 15–25 lbs, women who gained <15 lbs were 0.8 (95% CI 0.6–1.0), 0.9 (0.8–1.0), 0.6 (0.5–0.8), and 1.7 (1.4–2.2) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. Conversely, women who gained >25 lbs were 1.7 (1.5–1.9), 1.3 (1.2–1.4), 2.1 (1.9–2.3), and 0.6 (0.5–0.7) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. The lowest risk of adverse outcomes was for women who gained in the 6–14 and 15–24 lb categories. There was no association between gestational weight gain and perinatal death. Conclusions Increasing gestational weight gain appears to decrease the risk of LBW but elevates the risks of preeclampsia, cesarean section, and macrosomia. Overweight women should gain within current IOM recommendations.     

How Do Undiagnosed Symptoms of Maternal Psychological Distress During the Postnatal Period Affect Child Developmental Outcomes?

Maternal and Child Health Journal - Evidence suggests that maternal psychological distress is an under-diagnosed condition that can have lasting impacts on child outcomes. Models based solely on...     

Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight

In this study, we investigate how three alternative measures of maternal body mass index (BMI) relate to youth overweight. We contrast the typical cross-sectional measure of maternal BMI with a longitudinal mean and a standard deviation in maternal BMI. Using National Longitudinal Survey of Youth data, we estimate logistic regressions that relate maternal BMI to the risk of a youth being overweight while controlling for other familial characteristics. Participants in this study are 918 males and 841 females who were age 16–21 and either healthy weight or overweight in 2006. To be eligible for inclusion, teens were 15 years old by December 2006. After comparing several measures of maternal weight, we find that higher mean maternal BMI measured over the life of the adolescent has the strongest relationship with the odds of youth overweight for both male and female adolescents. For boys, a one unit increase in mother’s mean BMI increases the odds of being overweight by 16% (OR = 1.16, 95% CI 1.11–1.20) while for girls the increase in the odds of being overweight is 13% (OR = 1.13, 95% CI 1.09–1.18). Our findings suggest that researchers should move beyond static measures of maternal weight when examining the correlates of youth BMI. Maternal weight histories offer additional insights about the youth’s home environment that are associated with the risk of a youth being overweight.     

The Association between the Macronutrient Content of Maternal Diet and the Adequacy of Micronutrients during Pregnancy in the Women and Their Children’s Health (WATCH) Study

Nutrition during pregnancy can induce alterations in offspring phenotype. Maternal ratio of protein to non-protein (P:NP) energy has been linked to variations in offspring body composition and adult risk of metabolic disease. This study describes the dietary patterns of pregnant women by tertiles of the P:NP ratio and compares diet to Australian recommendations. Data are from 179 Australian women enrolled in the Women and Their Children’s Health Study. Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating and Australian Nutrient Reference Values. Higher maternal P:NP tertile was positively associated with calcium (P = 0.003), zinc (P = 0.001) and servings of dairy (P = 0.001) and meat (P = 0.001) food groups, and inversely associated with the energy dense, nutrient poor non-core (P = 0.003) food group. Micronutrient intakes were optimized with intermediate protein (18%E–20%E), intermediate fat (28%E–30%E) and intermediate carbohydrate (50%E–54%E) intakes, as indicated in tertile two. Results suggest a moderate protein intake may support pregnant women to consume the largest variety of nutrients across all food groups.     

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.     

Maternal use of oral contraceptives and risk of hypospadias – a population-based case-control study

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67–2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46–1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.     

Verbal Autopsy of Maternal Deaths in Two Districts of Pakistan��Filling Information Gaps

In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year—2007 (prospective) and the past two years—2005 and 2006—(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death.Key words: Causes of death, Maternal mortality, Risk factors, Socioeconomic factors, Verbal autopsy, Pakistan     

The Association between Maternal Smoking during Pregnancy and Childhood Obesity Persists to the Age of 9–10 Years

Background

We previously reported that a number of factors related to maternal lifestyle during early pregnancy, including smoking, are associated with childhood obesity at 5 years of age. In the present study, we investigated whether the association with maternal smoking persisted to the age of 9–10 years.

Methods

The study population comprised children born between April 1, 1991 and March 31, 1999, and their mothers. The dependent variables—childhood overweight and obesity at 5 and 9–10 years of age—were defined according to internationally acknowledged cut-off values. Maternal smoking during early pregnancy was used as the independent variable.

Results

Mothers who completed a specifically designed questionnaire gave birth to a total of 1644 infants during the study period. Anthropometric data were collected from 1302 of these children during medical checkups at 9–10 years of age (follow-up rate: 79.2%). Maternal smoking during early pregnancy was associated with obesity in 9- to 10-year-old children (adjusted odds ratio, 1.91; 95% confidence interval, 1.03–3.53). However, the point estimates at the age of 9–10 years were considerably lower than those at the age of 5 years.

Conclusions

Our results suggest that fetal environment, including exposure to maternal smoking, continues to be associated with childhood obesity at the age of 9–10 years.Key words: smoking, pregnancy, life styles, obesity, fetal programming