Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study.

BACKGROUND: Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18-44 years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia. METHODS: Two hundred sixty-one rural and remote women, pregnant with an Indigenous infant, from New South Wales in Australia were invited to provide data regarding social disadvantage then complete the Kessler-10 and Stressful Life Events surveys via self-report during each trimester of their pregnancy. Descriptive statistics, Pearson's correlations, Mann-Whitney U and Kruskal-Wallis tests were performed to determine the burden of and any associations between the variables of interest. RESULTS: High rates of psychological distress were reported by participants with 16.9% scoring severe distress levels during their pregnancy. Participants also reported high rates of stressful life events with almost 25% experiencing the death of a family member or friend, almost 14% living in overcrowded accommodation, 11% having someone close to them jailed and 8% experience separation from their partner, during their pregnancies. Distress was associated with numerous stressful life events (e.g. witnessing violence, a family member in jail and overcrowding) and one aspect of social disadvantage (smoking status). CONCLUSIONS: Immediate attention needs to focus on the development of interventions to address the high levels of psychological distress and provide appropriate support services during periods of major life events for pregnant Australian Indigenous women.

The role of socio-economic status and energy-density in Australian women of child-bearing age.

INTRODUCTION: An optimal diet is imperative in preparing women for pregnancy and this may be influenced by socio-economic status (SES). This research aims to investigate the role of SES on the dietary energy density (ED) in Australian women of preconception age. METHODS: A secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12 for females aged 18-39 years (n = 1617) was conducted. Dietary intake was assessed by 24-hr recalls and dietary ED by dietary energy per weight (kJ.g-1 ). ED was further categorised as ED of foods and beverages separately. SES was assessed by three variables: Socio-Economic Indexes for Areas (SEIFA), developed by the Australian Bureau of Statistics; income decile; and level of education. Linear mixed model regressions were used to identify associations between ED and SES. RESULTS: The median ED for food, beverages and combined food and beverages was 9.38 kJ g-1 , 1.02 kJ g-1 and 7.11 kJ g-1 , respectively. No significant variation was explained by SES variables when analysing combined ED in the adjusted model or ED from foods. Income decile reduced ED of beverages, although with little effect (coefficient: -0.04, P = 0.002). Significant confounders included inactivity, which increased ED in both combined ED and ED foods (coefficient: 0.51, P = 0.001 and coefficient: 0.78, P < 0.001). CONCLUSIONS: SES explained little variation in dietary ED in women of childbearing age. A large proportion of women had high energy-dense diets regardless of their SES. These findings suggest that a large proportion of women, who may become pregnant, have diets that exceed the international recommendations for dietary energy density.

Pregnancy stress, healthy pregnancy and birth outcomes - the need for early preventative approaches in pregnant Australian Indigenous women: a prospective longitudinal cohort study.

Adverse pregnancy outcomes including prematurity and low birth weight (LBW) have been associated with life-long chronic disease risk for the infant. Stress during pregnancy increases the risk of adverse pregnancy outcomes. Many studies have reported the incidence of adverse pregnancy outcomes in Indigenous populations and a smaller number of studies have measured rates of stress and depression in these populations. This study sought to examine the potential association between stress during pregnancy and the rate of adverse pregnancy outcomes in Australian Indigenous women residing in rural and remote communities in New South Wales. This study found a higher rate of post-traumatic stress disorder, depression and anxiety symptoms during pregnancy than the general population. There was also a higher incidence of prematurity and LBW deliveries. Unfortunately, missing post-traumatic stress disorder and depressive symptomatology data impeded the examination of associations of interest. This was largely due to the highly sensitive nature of the issues under investigation, and the need to ensure adequate levels of trust between Indigenous women and research staff before disclosure and recording of sensitive research data. We were unable to demonstrate a significant association between the level of stress and the incidence of adverse pregnancy outcomes at this stage. We recommend this longitudinal study continue until complete data sets are available. Future research in this area should ensure prioritization of building trust in participants and overestimating sample size to ensure no undue pressure is placed upon an already stressed participant.

Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study.

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother-child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

The relationship between maternal obesity and diabetes during pregnancy on offspring kidney structure and function in humans: a systematic review.

Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of 'neutral' quality, two of 'negative' and one 'positive' quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study.

BACKGROUND: Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross-sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS), in pregnant women from the Gomeroi gaaynggal cohort (n = 58). METHODS: Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self-administered in the third trimester. Diet quality was determined using the ARFS. Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE) and Australian Nutrient Reference Values (NRVs). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements. RESULTS: None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy-dense, nutrient-poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRVs were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73). CONCLUSIONS: Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

Dietary intakes and anthropometric measures of Indigenous Australian women and their infants in the Gomeroi gaaynggal cohort.

Indigenous Australians continue to experience disparities in chronic diseases, many of which have nutrition-related trajectories. Optimal nutrition throughout the lifespan is protective for a number of adverse health outcomes, however little is known about current dietary intakes and related anthropometric outcomes of Indigenous women and their infants. Research is required to identify nutrition issues to target for health promotion activities. The Gomeroi gaaynggal programme is an ongoing, prospective cohort of pregnant Indigenous Australian women and their children. A cross-sectional examination of postnatal dietary intakes and anthropometric outcomes of mothers and children are reported. To date, 73 mother-child dyads have participated postpartum. Breastfeeding initiation was 85.9% and median (interquartile range) duration of any breastfeeding was 1.4 (0.5-4.0) months. Infants were introduced to solid foods at 5.0 months (4.0-6.0) and cow's milk at 12.0 (10.0-13.0) months. At 12 months postpartum, 66.7% of women were overweight or obese, 63.7% at 2 years. Compared with recommendations, reported median maternal nutrient intakes from 24-h recall were low in fibre, folate, iodine, calcium, potassium and vitamin D and high in proportions of energy from total and saturated fat. Limitations of this study include a small sample size and incomplete data for the cohort at each time point. Preliminary data from this ongoing cohort of Indigenous Australian women and children suggest that women may need support to optimize nutrient intakes and to attain a healthy body weight for themselves and their children.

A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study.

Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child's first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5-43.2, n=110), median birth weight was 3180 g (910-5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.

Using a grid framework to aid constructive thinking.

A transitional route to the recording of specialist practice for community nurses was undertaken via portfolio development. A grid system was developed to give a concise framework to follow.