Maternal exposure to SSRIs or SNRIs and the risk of congenital abnormalities in offspring: A systematic review and meta-analysis.

BACKGROUND: The association of maternal exposure to selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) with the risk of system-specific congenital malformations in offspring remains unclear. We conducted a meta-analysis to examine this association and the risk difference between these two types of inhibitors. METHODS: A literature search was performed from January 2000 to May 2023 using PubMed and Web of Science databases. Cohort and case-control studies that assess the association of maternal exposure to SSRIs or SNRIs with the risk of congenital abnormalities were eligible for the study. RESULTS: Twenty-one cohort studies and seven case-control studies were included in the meta-analysis. Compared to non-exposure, maternal exposure to SNRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.64 with 95% CI: 1.36, 1.97), anomalies of the kidney and urinary tract (pooled OR: 1.63 with 95% CI: 1.21, 2.20), malformations of nervous system (pooled OR: 2.28 with 95% CI: 1.50, 3.45), anomalies of digestive system (pooled OR: 2.05 with 95% CI: 1.60, 2.64) and abdominal birth defects (pooled OR: 2.91 with 95%CI: 1.98, 4.28), while maternal exposure to SSRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.25 with 95%CI: 1.20, 1.30), anomalies of the kidney and urinary tract (pooled OR: 1.14 with 95%CI: 1.02, 1.27), anomalies of digestive system (pooled OR: 1.11 with 95%CI: 1.01, 1.21), abdominal birth defects (pooled OR: 1.33 with 95%CI: 1.16, 1.53) and musculoskeletal malformations (pooled OR: 1.44 with 95%CI: 1.32, 1.56). CONCLUSIONS: SSRIs and SNRIs have various teratogenic risks. Clinicians must consider risk-benefit ratios and patient history when prescribing medicines.

Telomere Length and Preterm Birth in Pregnant Mexican-Origin Women.

OBJECTIVES: Despite the obstacles of limited education and employment opportunities-and the stress associated with immigration and pregnancy-Mexican immigrant women have low rates of preterm birth (PTB) compared to the US national average for all races and ethnicities. Stressors during pregnancy, and stressors associated with acculturation, may accelerate cellular aging manifested by shortened telomere length (TL) in pregnant women. Our objectives were to: (1) determine whether women with PTBs had shorter telomere lengths compared to women who had full term births; (2) assess the association of acculturation with TL and PTB. METHODS: This prospective pilot study collected data from 100 self-identified Mexican-origin pregnant women. Survey data included self-administered sociodemographic and acculturation measures and was collected from participants via paper and pen, while biologic data was collected via a single blood draw during a regularly scheduled prenatal visit between 26 and 36 weeks gestation. PTB data was collected from the participant's medical record after delivery. RESULTS: TL was significantly associated with PTB; the median TL of the women with PTB was less than the median TL for the full sample (p = 0.02). Based on regression analysis for PTB vs acculturation, we found no significant associations between acculturation and PTB or TL. CONCLUSIONS FOR PRACTICE: This study provides important evidence of the association between shortened maternal TL and adverse birth outcomes. By linking social, clinical and biologic data, we can enhance our understanding of social determinants that may affect racial and ethnic disparities in preterm birth.

Narrative Analysis of Childbearing Experiences During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has disrupted health care delivery and services around the world causing rapid changes to maternity care protocols and pregnant women to give birth with tight restrictions and significant uncertainties. There is a gap in evidence about expectant and new mothers' experiences with birthing during the pandemic. We sought to describe and understand pregnant and new mothers' lived experiences during the COVID-19 pandemic using authentic birth stories. STUDY DESIGN AND METHODS: Using a narrative analysis framework, we extracted relevant YouTube birth stories using predetermined search terms and inclusion criteria. Mothers' birth stories were narrated in their second or third trimester or those who had recently given birth during the pandemic. Birth stories were analyzed using an inductive and deductive approach to capture different and salient aspects of the birthing experience. RESULTS: N = 83 birth stories were analyzed. Within these birth stories, four broad themes and 13 subthemes were identified. Key themes included a sense of loss, hospital experiences, experiences with health care providers, and unique experiences during birth and postpartum. The birth stories revealed that the COVID-19 pandemic brought unexpected circumstances, both positive and negative, that had an impact on mothers' overall birthing experience. CLINICAL IMPLICATIONS: Results provided a detailed description of women's lived experience with giving birth during the COVID-19 pandemic. Maternity nurses should try to provide clear communication and compassionate patient-centered care to relieve women's anxieties about uncertain and unpredictable policy changes on COVID-19 as the pandemic continues to evolve.

Pregnant Hispanic women's views and knowledge of prenatal genetic testing.

Pregnant Hispanic women are underserved with their needs for genetic counseling, despite birth defects remaining the leading cause of infant death in the United States. We present the qualitative findings of a study to understand knowledge and perceptions of prenatal testing in a sample of hard-to-reach underrepresented Hispanic pregnant women in South Texas. The sample for this study was 10 Hispanic pregnant women who were recruited from a high-risk prenatal clinic in South Texas in 2019. The semi-structured interview questions were created based on the researchers' clinical experiences with this population and were designed to examine knowledge and perceptions of participants toward prenatal testing. Analysis of the qualitative data yielded several themes related to prenatal testing: (a) knowledge, (b) confusion, (c) partner's and support persons' opinions, (d) information sharing from providers, (e) psychological benefits, (f) preparation for baby, (g) obstacles, (h) religious influence, and (i) educational tools to assist with understanding. Women's understanding and knowledge of prenatal testing was limited, specifically regarding its purpose, how it works, the benefits, and why it was recommended by their provider. Lack of clarity about why they should take the test and its risks for them and their babies was perceived as something that could impede their acceptance of prenatal testing. All participants agreed that healthcare providers should share more information about prenatal testing in a way that uses 'everyday language' so that they can understand it better. All respondents mentioned that prenatal testing provides information about their baby's health conditions, alleviates their stress and concerns, and psychologically prepares them and their family for what is to come. Identifying ways to increase culturally appropriate education delivered by genetic counselors such as through the adoption of telemedicine and mobile technology can help fill the gap for this underserved population.

'Now My Eyes are Open': Latina women's experiences in long-term support groups for intimate partner violence survivors.

One in four women has experienced intimate partner violence in their lifetimes. The effects of intimate partner violence on women's mental health may be long-term; possible conditions include post-traumatic stress disorder, depression, and anxiety. Latina women may be particularly vulnerable to long-term effects of intimate partner violence. The purpose of this study was to describe Latina women's experiences in long-term support groups for survivors of intimate partner violence. Forty-nine Latina women were interviewed about their experiences in a nurse-led long-term support group, with participation from 2 months to 9 years. The women ranged in age from 26 to 73 years and all but two interviews were in Spanish. Five themes emerged from the qualitative data: awakening, transformation, community, empowerment, and advocate. Women described their thoughts of still feeling the 'ugliness of the abuse', even years after it occurred with some women enduring abuse for as long as 32 years. The need for long-term support groups was evident as women described the value of the group for providing support and gaining an understanding that they are not alone, or their awakening to the idea that they can have a life without abuse. Long-term support groups give voice to Latina women who are survivors of intimate partner violence. By raising their awareness and sense of community, women survivors can be transformed and empowered to improve their lives and advocate for others who face similar struggles.

Religiosity, Acculturation, and Preterm Birth in Mexican-Origin Women: A Pilot Study.

INTRODUCTION: Explanations for racial disparities in preterm birth (PTB) are elusive, especially when comparing high rates in some racial groups with low rates in Mexican-immigrant women. The purpose of this study was to examine potential protective factors against PTB such as religiosity and acculturation. METHODS: This study was a prospective investigation of Mexican- and U.S.-born pregnant women. Women were recruited from a low-income-serving prenatal clinic in Texas. Survey instruments included socioeconomic variables, acculturation, and religiosity/spirituality (R/S). Logistic regression was used to examine the associations between acculturation, religiosity, and PTB. Because of the low prevalence of PTB in our sample, we were not able to adjust for confounding characteristics. RESULTS: Ninety-one low-income women, mostly Mexican immigrants, participated in the study. PTB in our sample was lower than the national average in the United States (5.5% vs. 9.9%) and was positively but moderately associated with high R/S. R/S scores were high, particularly for frequency of attendance, prayer, and religious coping. Women with lower acculturation had higher scores on the religiosity measures. CONCLUSION: Further research is needed with a larger sample to include other ethnic and racial minorities to more fully understand the relationships between acculturation, religiosity, and PTB.

Religiosity and Health: A Holistic Biopsychosocial Perspective.

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

Challenges and Opportunities on Health Sciences Regional Campuses: A Multidiscipline, Multicampus Survey.

AIM: We explored faculty and staff perceptions of the challenges and opportunities of working on regional campuses of a large academic health science center. BACKGROUND: The growth of multicampus academic institutions presents numerous issues for intercampus planning and for organizational/professional relationships. We were interested in learning how regional campus faculty and staff experienced these issues, with the practical goal of making recommendations to both central and regional campus administrations. METHOD: A cross-sectional, online survey was distributed to faculty and staff who worked at regional campuses of a large health sciences university. RESULTS: Regional faculty and staff felt more valued by local colleagues and administrators than by their central campus counterparts. Top challenges were central administration's lack of communication and understanding of regionals' unique circumstances and needs. CONCLUSION: Regional campuses' workplace experience is significantly different from that of central campus. More timely communication and active solicitation of regional campus input are needed.

Empowerment in Latina Immigrant Women Recovering From Interpersonal Violence: A Concept Analysis.

Latina immigrant women are vulnerable and may experience higher levels of interpersonal or intimate partner violence (IPV) due to their immigrant status and cultural emphasis on familism. The concept of empowerment within the cultural context of Latina immigrant women experiencing IPV was analyzed using a modified version of Walker and Avant's concept analysis technique. The technique considers usage and definitions in the literature, antecedents, attributes, empirical referents, and the inclusion of a model and contrary case. This analysis encompasses a comparative approach and includes a discussion of how the definition of empowerment compares across the nursing literature. Defining attributes include reciprocal relationships, autonomy, and accountability. Antecedents comprise willingness to learn and motivation to create change. Consequences encompass self-esteem, self-efficacy, and competence for making life decisions. Empowerment has the potential to improve total well-being, having a positive and profound impact on the lives of women experiencing IPV.

Psychosocial factors associated with patterns of smoking surrounding pregnancy in fragile families.

Although research has documented factors associated with maternal smoking, we need a more in-depth understanding of the risk factors associated with changes in smoking behaviors during the postpartum period. We investigate smoking patterns during pregnancy and 1 year postpartum as a function of relevant psychosocial factors. We use data on 3,522 postpartum mothers from the Fragile Families and Child Wellbeing Study to analyze the predictors of smoking among mothers who did not smoke during pregnancy but smoked at 1 year postpartum, mothers who smoked both during pregnancy and postpartum, and mothers who did not smoke during either period. Our covariates are grouped into four categories of risk factors for smoking: socioeconomic status, health care, life course and health, and partner and social support. Postpartum mothers in our sample were more likely to smoke throughout or after their pregnancies if they had only a high school education or less, had a household income three or more times below the poverty line, had public or no health insurance, breastfed for less than 5 months, were not married to the infant's father, if the infant's father currently smoked, and if they attended religious services less than once a week. Mental health problems were consistently associated with an increased risk of constant and postpartum smoking relative to non-smoking. Psychosocial factors play a role in postpartum smoking, but they have a stronger effect in predicting smoking that persists throughout pregnancy and the first year postpartum.

Does religiosity affect health risk behaviors in pregnant and postpartum women?

OBJECTIVES: We examined the association between religious involvement and health risk behaviors such as smoking, drinking, marijuana use, and having multiple sex partners among a multiethnic sample of pregnant and postpartum women. METHODS: Using data from the National Survey of Family Growth, we estimated multivariate logistic regression models to determine the association between various aspects of religious involvement (e.g., attendance, salience, and denomination) and certain behaviors known to be risky for pregnant women and their offspring. RESULTS: Frequent (more than once a week) and regular (once a week) attenders at religious services had 80% and 60% (respectively) lower odds of drinking alcohol compared to women who attended less than once a week. Similar patterns surfaced with regard to smoking tobacco with the odds of smoking roughly 85% lower (OR = 0.146, P < 0.001) among frequent attenders, and nearly 65% lower among regular attenders (OR = 0.369, P < 0.001). For smoking marijuana, religious attendance again emerges as a strong predictor. The odds of marijuana smoking are nearly 75% lower for women who attend services frequently (OR = 0.260, P < 0.05) and more than 65% lower for those who attend regularly (OR = 0.343, P < 0.01), as compared with their counterparts who attend services less often. CONCLUSIONS: Religious attendance emerged as an important correlate of less-risky health behaviors among this nationwide sample of pregnant and postpartum women. Future research should include an examination of the links between religious involvement and other important lifestyle factors that may influence maternal and child health.

Acculturation in Mexican immigrants: a concept analysis.

The concept of acculturation in Mexican immigrants was analyzed using the concept analysis technique developed by Walker and Avant. The related concepts for acculturation are assimilation, separation, and marginalization. The defining attributes identified for acculturation are original cultural identity, exposure to a culture different from one's own, and changes in the behavioral, affective, and/or cognitive domains of one's functioning after exposure to a new culture. An antecedent for acculturation is that identification with one's culture of origin must be well established. Another antecedent is the willingness to modify one's original cultural identity. Transition is identified as a consequence of acculturation. Acculturation is a complex, multifaceted concept and cannot be adequately captured by measures that use language preference alone. Other factors such as social class, employment, education, and income should also be considered when acculturation is a factor in nursing practice and research.

Positive pregnancy outcomes in Mexican immigrants: what can we learn?

OBJECTIVE: To provide an integrated review of the literature of potential explanations for better than expected pregnancy outcomes in Mexican immigrants, focusing on socioeconomics, social support, desirability of pregnancy, nutrition, substance use, religion, acculturation, and prenatal care. DATA SOURCES: Computerized searches of MEDLINE and CINAHL databases, as well as reference lists from published articles on low birth weight and prematurity in immigrants and acculturation in immigrants from January 1989 to December 2002. Search terms were Mexican immigrant women, childbearing, and pregnancy outcome, and only English-language articles were reviewed. STUDY SELECTION: Literature was selected from refereed publications in the areas of nursing, medicine, public health, family, and sociology. DATA EXTRACTION: Data were extracted using keywords pertinent to pregnancy outcome in Mexican immigrants. DATA SYNTHESIS: Despite having many of the risk factors for poor pregnancy outcomes, Mexican immigrants have superior birth outcomes when compared to U.S.-born women. Social support, familism, healthy diet, limited use of cigarettes and alcohol, and religion may play a role in improved outcomes. The superior outcomes diminish with the process of acculturation as the individual adapts to her new culture. CONCLUSIONS: Low birth weight and prematurity are public health concerns in the United States. Through further study of the factors that lead to superior birth outcomes among Mexican immigrant women, rates of low birth weight and prematurity in the United States may be reduced.