A longitudinal study on the maternal–fetal relationship and postnatal maternal sensitivity

Objective: The present study examined whether early signs of maternal sensitivity can be detected during pregnancy by focusing on the maternal–fetal relationship and postnatal maternal sensitivity. Background: Earlier research has identified maternal sensitive behaviour as an important factor for the quality of the mother–infant relationship and the child’s emotional and cognitive development later in life. Research on this topic has predominantly focused on the postnatal period and little is known about early predictors (i.e. during pregnancy) of maternal sensitivity. Methods: Participants were 273 women and their (unborn) infants. Mothers’ attitudes, thoughts and feelings towards the fetus were assessed by the Maternal Antenatal Attachment Scale at 26 weeks of gestation. At the infant’s age of 6 months, maternal sensitivity was assessed in three different situations (i.e. face-to-face play, caregiving and free play) using the NICHD global rating scales. Results: Mothers with a higher quality of the maternal–fetal relationship displayed more maternal sensitivity towards their 6-month-old infant in caregiving and free play situations, even when controlling for covariates such as parity, ethnicity, maternal education, maternal age and the postnatal mother–infant relationship. No associations were found in the face-to-face situation. Conclusion: This study shows that mothers who reported a higher quality of the maternal–fetal relationship were more sensitive while interacting with their infants during caregiving and free play, but not during face-to-face play.     

Does maternal diet affect infantile colic?

Objective: The aim of this study was to investigate the effect of maternal diet on infantile colic without any interventions or food restrictions.

Methods: Thirty colicky and 29 non-colicky infants were included in this prospective study. Mother’s diet and baby crying time were recorded for 1 week by mothers; nutritionist classified contents of mother’s diet and compared the diet of mother in colicky and non-colicky infants.

Results: It was found that mothers of non-colicky infants consumed significantly more grapes and lemons than mothers of colicky infants (p?=?0.044). The crying time was moderately negatively correlated with the percentage of protein in the maternal diet (R?=?–0.45, p?=?0.01) and the presence of potatoes in the maternal diet (R?=?–0.38, p?=?0.034) and positively correlated with the maternal consumption of walnut (R?=?0.38, p?=?0.034), banana (R?=?0.44, p?=?0.01).

Conclusions: Removing bananas from the maternal diet may reduce colic. The consumption of a protein-rich maternal diet, grapes, lemons and potatoes by breastfeeding mothers may protect infants from colic.     

The relationship between maternal–fetal attachment and maternal self-efficacy in Iranian women: a prospective study

Introduction: This prospective study was conducted to determine the relationship between maternal–fetal attachment and maternal self-efficacy. Maternal self-efficacy contributes significantly to the mental health of the mother and infant. Maternal–fetal attachment facilitates maternal role attainment and might improve maternal self-efficacy.

Methods: This study was conducted on 242 women. The data collection tools used included a socio-demographic and obstetric questionnaire, Cranley’s Maternal–Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Maternal Self-Efficacy Scale. A multivariate linear regression was used to estimate the extent to which maternal–fetal attachment affects maternal self-efficacy.

Results: Pearson’s correlation test showed a moderate but significant positive correlation between maternal–fetal attachment and self-efficacy (r = 0.48, P < 0.001). The highest correlation with self-efficacy was observed in the domain of ‘differentiation of self from fetus’ (r = 0.43) and the lowest in the domain of ‘giving of self’ (r = 0.25). According to the multivariate linear regression, the domain of ‘Interaction with fetus’ had a significant relationship with maternal self-efficacy (P = 0.009).

Conclusion: Maternal–fetal attachment would appear to be a factor related to postpartum maternal self-efficacy which suggests identifying and supporting women with low self-efficacy may increase maternal–fetal attachment and thereby maternal self-efficacy.     

Is maternal obesity a predictor of shoulder dystocia?

OBJECTIVE: To explore the relationship between maternal obesity and shoulder dystocia while controlling for the potential confounding effects of other variables associated with obesity. METHODS: We performed a case-control study of provincial delivery records audited by the Northern and Central Alberta Perinatal Outreach Program. Risk factors evaluated were selected based on previously published studies. Cases and controls were drawn from 45,877 live singleton cephalic vaginal deliveries weighing more than 2500 g between January 1995 and December 1997. There were 413 cases of shoulder dystocia (0.9% incidence). Controls (n = 845) were randomly chosen from the remainder of the target population to create a 1:2 case/control ratio. Univariate analysis with calculation of odds ratios (ORs) was used to determine which of the chosen risk factors were significantly related to the incidence of shoulder dystocia. Multivariable regression analyses were then used to determine the independently associated variables, and the adjusted ORs were obtained for each relevant risk factor. RESULTS: Maternal obesity was not significant as an independent risk factor for shoulder dystocia after adjusting for confounding variables (adjusted OR 0.9; 95% confidence interval [CI] 0.5, 1.6). Fetal macrosomia was the single most powerful predictor. The adjusted ORs were 39.5 (95% CI 19.1, 81.4) for birth weight greater than 4500 g and 9.0 (95% CI 6.5, 12.6) for birth weight between 4000 and 4499 g. CONCLUSION: The strongest predictors of shoulder dystocia are related to fetal macrosomia. For obese nondiabetic women carrying fetuses whose weights are estimated to be within normal limits, there is no increased risk of shoulder dystocia.     

Does maternal obesity impact pregnancy-related deaths? Michigan experience

Obesity is a multifactorial non-communicable condition that has become a public health epidemic worldwide. The Fifth Millennium Development Goal established the goal of a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. Maternal mortality has been difficult to track over time. Obesity affects pregnancy in more than 50% of women of reproductive age in the state of Michigan; the potential impact of maternal obesity and pregnancy-related deaths (PRDs) has not been studied in Michigan. We conducted a secondary analysis of maternal death cases originally reviewed by the Michigan Maternal Mortality Review Committee from 2004 to 2006 seeking to evaluate the impact of maternal obesity on PRD. Two hundred and five maternal deaths occurred during the period of the study, 61 were classified as PRD. The observed occurrence of PRDs in the obese population was 36 cases while in the non-obese was 25 cases. The study showed a 3.7× risk of PRD in the obese parturient.     

Placental ratio—its relationship with mild maternal anaemia

To determine whether placental ratio is influenced by maternal anaemia, a retrospective observational study was performed in a regional tertiary hospital in Hong Kong. The gestational age, birthweight, placental weight, and placental ratio were studied in 152 mothers with anaemia due to thalassaemia trait, 232 mothers with anaemia due to iron deficiency, and 279 non-anaemic mothers as controls. All had singleton pregnancies. Compared to the control group, the iron deficiency group had higher placental weight (P=0.001) and placental ratio (P<0.001) while the thalassaemia trait group had higher placental ratio (P=0.011) and, after including gestational age as covariate for analysis, higher placental weight (P=0.019) as well. There was, however, no difference in the placental weight or ratio between the two anaemia groups. The placental ratio was not correlated to the haemoglobin levels at booking, third trimester, or the lowest one, in any group, but it was correlated with these three haemoglobin levels with the three groups combined. Placental ratio was also correlated to gestational age in all groups. The results confirm the observation that the placental ratio is increased in anaemic pregnancies, and indicate that anaemia, rather than underlying iron deficiency, is the cause for an increased placental ratio.     

Is maternal anxiety a barrier to exclusive breastfeeding?

Objective: To assess the association of maternal anxiety with nonadherence to exclusive breastfeeding.

Methods: This questionnaire-based study was conducted at a tertiary care teaching hospital in South India mothers with infants less than 6 months of age and not exclusively breastfeeding were interviewed and their demographic and clinical details were noted. The Iowa Infant Feeding Attitude Scale (IIFAS) and Hospital Anxiety and Depression Scale (HADS) were administered to these mothers.

Results: A total of 85 mother–infant dyads were included. The mean age of the mothers was 26 years and 57% were from urban areas. Among the additional feeds given, cow’s milk was the commonest (57.6%), followed by gripe water (28.2%) and formula feeds (16.5%). The mean HADS anxiety subscale score was 12.2 (±5.3) and HADS depression subscale score was 9.5 (±3.8). The mean score on IIFAS was 58.4 (±3.6) suggesting a relatively favorable attitude toward breastfeeding. On linear regression analysis, higher HADS depression score, lower birth weight and lower per capita income were independent predictors of poorer attitudes toward breastfeeding.

Conclusion: Maternal anxiety may be an independent risk factor for nonadherence to exclusive breastfeeding for the initial six months.     

How many maternal deaths are there in Portugal?

Introduction: Maternal mortality is a public health issue, internationally considered an indicator of women’s status in society, indirectly translating access to health facilities. However, it is difficult to measure and is usually underestimated by official records. Methods: Maternal deaths missed by the official statistics in Portugal between 2001 and 2006 were estimated by multiple-recapture methods using three different data sources. An upper limit to the number of deaths was derived from the application of the mortality function of women in reproductive age to the estimated annual number of pregnancies. Results: Maternal mortality decreased from 40 to less than 10 deaths per 100?000 live births between 1978 and 1986. Between 2001 and 2006, it varied from 2.5 to 19 and was underestimated by 9%–26%. Nevertheless, within the same age range, the risk of a pregnant women to die was four times less than a women in the general population. Conclusion: Like in other developed countries, official statistics in Portugal have systematically underestimated maternal deaths. These deaths are a rare event, but the consistent increase in the average age at pregnancy may exacerbate the main causes of death, raising concerns for the future and prompting the need for emergency facilities nearby maternities.     

Would it be too late? A retrospective case–control analysis to evaluate maternal–fetal outcomes in advanced maternal age

Purpose

To evaluate maternal–fetal outcomes in women of advanced maternal age (AMA; >35 years old) and women of physiological maternal age as controls (C; <35 years old).

Methods

Single-center, retrospective case–control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ ² test and Fisher exact test (when required). A p value < 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %.

Results

We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination (p = 0.022; OR = 1.59), iterative cesarean section (p = 0.026; OR = 2.33), SA (p = 0.001; OR = 12.82), preterm delivery (p = 0.001; OR = 69.84), congenital malformations (p = 0.036; OR = 3.94). In C there was a greater number of nulliparous (p = 0.009; OR = 0.52) and vaginal deliveries (p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies (p = 0.862; OR = 0.97), first cesarean section (p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes.

Conclusion

AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations.     

Does external tocodynamometry increase maternal perception of uterine contractions?

A prospective study was performed on 63 women at risk for preterm delivery who recorded maternally perceived contractions for 1 hour before and after placement of an external tocodynamometer. Fifteen women had an increase, 11 had a decrease, and 37 had no change (P not significant) in the number of perceived contractions after placement of the tocodynamometer.     

Could maternal pre-pregnancy body mass index affect Apgar score?

Objective

Obesity is one of global health problems and maternal obesity may be associated with increase in risk of pregnancy complications and neonatal death. The purpose of this study was to evaluate the effect of maternal pre-pregnancy body mass index (BMI) on neonate Apgar score at minute 5.

Methods

In a retrospective cohort study, Apgar score at minute 5 of all singleton term babies of nulliparous women whom were delivered in Shahid Sadoughi Hospital, Yazd, Iran, from 2007 to 2009 were evaluated. Body mass index (BMI: weight in kg/height in m²) of the mothers were calculated and BMI less than 18.5, 18.5–24.9, 25–29.9 and more than 30 were considered underweight, normal, overweight and obesity, respectively. Neonatal Apgar score of 3–7 and less than three was considered as low and very low Apgar score, respectively.

Results

Eighty-eight (2.8 %) women were underweight, 1,401 (44.9 %) normal weight, 1,389 (44.5 %) overweight and 242 (7.8 %) were obese. 477 (15.3 %) and 31(0.7 %) neonates had low and very low Apgar score, respectively at minute 5. Logistic regression analysis showed maternal overweight [in odd ratio of 3.7, 95 % CI 2.4–4.6] and obesity [in odd ratio of 13.4, 95 % CI 9.7–14.1] were risk factors of neonatal low Apgar score, but they had not any statistically significant effect on neonatal very low Apgar score.

Conclusion

Maternal pre-pregnancy overweight should be more concerned to prevent complication of low Apgar score in their newborns.     

Association of maternal serum α-fetoprotein with persistent placenta previa

Objective: To evaluate the relationship between maternal serum α-fetoprotein (MSAFP) and the risk of persistent placenta previa.

Methods: We conducted a retrospective cohort study of singleton pregnancies with sonographic evidence of placenta previa at 15?–?20 weeks' gestation, between October 1991 and August 2000. Only pregnancies with MSAFP determination at 15?–?20 weeks' gestation and non-anomalous live-born infants ??24 weeks' gestation were included. Pregnancies in which Cesarean delivery was performed for placenta previa were considered persistent; this was the primary outcome.

Results: Of 275 women with previa at 15?–?20 weeks' gestation, 33 (12%) had previa at delivery. Trend analysis revealed a greater likelihood of persistent previa with increasing MSAFP values (p?=?0.01). Mid-trimester MSAFP <?1 multiple of the median (MoM) was associated with a decreased incidence of persistence of 4%, significantly less than the risk at ??1 MoM (16%; p?=?0.01).

Conclusions: There is an association between increasing MSAFP values and greater likelihood of persistent placenta previa. An MSAFP value <?1 MoM is associated with a reduction in the risk of persistence of previa to delivery.