The Effects of Race and Socioeconomics on the Relationship Between Gestational Diabetes Mellitus and Birth Outcomes: An Analysis of Southern US PRAMS data.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women.

OBJECTIVES: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Infant sleep behaviors relate to their later cognitive and language abilities and morning cortisol stress hormone levels.

This longitudinal study examined parents' perceptions of infant sleep behaviors in relation to cognitive and language development, and infants' stress hormone (cortisol) levels. Infants were recruited and assessed at 8 months and then again 6 months later at 14 months. At both times, parents reported on infants' home sleep environment and sleep behaviors; the infants' childcare classroom teachers completed standardized questionnaires on the children's cognitive and language development skills; and researchers collected numerous saliva samples from infants at both times to assay cortisol stress hormone levels. Pearson correlation analyses indicated that 8-month-old infants' optimal sleep in their home environment positively and modestly related to their cognitive skills and language development when they were 14-month-old toddlers. These results suggest that cognitive development and language learning in the first year of life are linked to sleep behaviors. Additionally, optimal home sleep in toddlerhood was positively and moderately correlated with higher morning stress hormone levels. The development of the HPA axis in infancy and toddlerhood is discussed as is the development and regulation of the hypothalamic-pituitary-adrenal axis and diurnal cycles.

Moderate pressure is essential for massage therapy effects.

Moderate pressure appears to be necessary for massage therapy effects. Studies comparing moderate and light pressure massage are reviewed and they suggest that growth and development are enhanced in infants and stress is reduced in adults, but only by moderate pressure massage. The stimulation of pressure receptors leads to increased vagal activity which, in turn, seems to mediate the diverse benefits noted for massage therapy.

The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy.

BACKGROUND:: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. RESEARCH AIMS:: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. METHODS:: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. RESULTS:: Cronbach's alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. CONCLUSIONS:: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women's self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

Prenatal dysthymia versus major depression effects on maternal cortisol and fetal growth.

To determine differences between pregnant women diagnosed with Dysthymia versus Major Depression, depressed pregnant women (N=102) were divided by their diagnosis into Dysthymic (N=48) and Major Depression (N=54) groups and compared on self-report measures (depression, anxiety, anger, daily hassles and behavioral inhibition), on stress hormone levels (cortisol and norepinephrine), and on fetal measurements. The Major Depression group had more self-reported symptoms. However, the Dysthymic group had higher prenatal cortisol levels and lower fetal growth measurements (estimated weight, femur length, abdominal circumference) as measured at their first ultrasound (M=18 weeks gestation). Thus, depressed pregnant women with Dysthymia and Major Depression appeared to have different prenatal symptoms.

Maternal psychological distress, prenatal cortisol, and fetal weight.

OBJECTIVE: The objective of this study was to examine the effects of maternal psychological distress on estimated fetal weight during midgestation and explore the maternal hypothalamic-pituitary axis and sympathoadrenal dysregulation as potential risk factors for these effects. METHODS: Fetal ultrasound biometry measurements and maternal sociodemographic characteristics, emotional distress symptoms, and first morning urine samples were collected during a clinical ultrasound examination for a cross-sectional sample of 98 women who were between 16 and 29 weeks pregnant. Fetal weight was estimated from ultrasound biometry measurements; maternal emotional distress was assessed using the daily hassles (stress), Center for Epidemiologic Studies-Depression (depression), and State-Trait Anxiety Inventory (anxiety) scales; and urine samples were assayed for cortisol and norepinephrine levels. RESULTS: Correlation analyses revealed that both maternal psychological (daily hassles, depression, and anxiety) and biochemical (cortisol and norepinephrine) variables were negatively related to fetal biometry measurements and estimated fetal weight. A structural equation model further revealed that when the independent variance of maternal sociodemographic, psychological distress, and biochemistry measures were accounted for, prenatal cortisol was the only significant predictor of fetal weight. CONCLUSIONS: Women exhibiting psychological distress during pregnancy exhibit elevated cortisol levels during midgestation that are in turn related to lower fetal weight.

Impact of a massage therapy clinical trial on immune status in young Dominican children infected with HIV-1.

PURPOSE: The effectiveness of massage therapy on immune parameters was evaluated in young Dominican HIV+ children without current access to antiretroviral therapies. METHODS: Eligible children, who were followed at the Robert Reid Cabral Hospital (San Domingo, Dominican Republic), were randomized to receive either massage treatment or a control/friendly visit twice weekly for 12 weeks. Blood was drawn at baseline and following the 3-month intervention for determinations of CD4, CD8, and CD56 cell counts and percentage, along with activation markers (CD25 and CD69). RESULTS: Despite similar immune parameters at baseline in the two groups, significantly more of the control group exhibited a decline in CD4 cell count (>30%, p = 0.03), postintervention. The decrease was particularly evident in older (5-8 years) children in the control arm, who demonstrated a significant reduction in both CD4 and CD8 cell counts compared to massage-treated older children who remained stable or showed immune improvement. Additionally, a significant increase in CD4+CD25+ cells was observed over the 12-week trial in the massage-treated older children (p = 0.04) but not in the control group. In younger massage-treated children, (2-4 years old), a significant increase in natural killer cells was shown. CONCLUSION: Together these findings support the role for massage therapy in immune preservation in HIV+ children.

The development of infant learning about specific face-voice relations.

This study examined the development of infants' ability to perceive, learn, and remember the unique face-voice relations of unfamiliar adults. Infants of 2, 4, and 6 months were habituated to the faces and voices of 2 same-gender adults speaking and then received test trials where the faces and voices were synchronized yet mismatched. Results indicated that 4- and 6-month-olds, but not 2-month-olds, detected the change in face-voice pairings. Two-month-olds did, however, discriminate among the faces and voices in a control study. Results of a subsequent intermodal matching procedure indicated that only the 6-month-olds showed matching and memory for the face-voice relations. These findings suggest that infants' ability to detect the arbitrary relations between specific faces and voices of unfamiliar adults emerges between 2 and 4 months of age, whereas matching and memory for these relations emerges somewhat later, perhaps between 4 and 6 months of age.

Monitoring of infant feeding behavior using a jaw motion sensor.

Rapid weight gain during infancy increases the risk of obesity. Given that infant feeding may contribute to rapid weight gain, it would be useful to develop objective tools which can monitor infant feeding behavior. This paper presents an objective method for examining infant sucking count during meals. A piezoelectric jaw motion sensor and a video camera were used to monitor jaw motions of 10 infants during a meal. Videotapes and sensor signals were annotated by two independent human raters, counting the number of sucks in each 10 second epoch. Annotated data were used as a gold standard for the development of the computer algorithms. The sensor signal was de-noised and normalized prior to computing the per-epoch sucking counts. A leave-one-out cross-validation scheme resulted in a mean error rate of -9.7% and an average intra-class correlation coefficient value of 0.86 between the human raters and the algorithm.

Breast cancer patients have improved immune and neuroendocrine functions following massage therapy.

OBJECTIVES: Women with breast cancer are at risk for elevated depression, anxiety, and decreased natural killer (NK) cell number. Stress has been linked to increased tumor development by decreasing NK cell activity. The objectives of this study included examining massage therapy for women with breast cancer for (1) improving mood and biological measures associated with mood enhancement (serotonin, dopamine), (2) reducing stress and stress hormone levels, and (3) boosting immune measures. METHODS: Thirty-four women (M age=53) diagnosed with Stage 1 or 2 breast cancer were randomly assigned postsurgery to a massage therapy group (to receive 30-min massages three times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching techniques to the head, arms, legs/feet, and back. On the first and last day of the study, the women were assessed on (1) immediate effects measures of anxiety, depressed mood, and vigor and (2) longer term effects on depression, anxiety and hostility, functioning, body image, and avoidant versus intrusive coping style, in addition to urinary catecholamines (norepinephrine, epinephrine, and dopamine) and serotonin levels. A subset of 27 women (n=15 massage) had blood drawn to assay immune measures. RESULTS: The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes. CONCLUSIONS: Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety, and anger and for enhancing dopamine, serotonin, and NK cell number and lymphocytes.

Sucrose attenuates a negative electroencephalographic response to an aversive stimulus for newborns.

Reports that sweet taste calms crying in newborns and is analgesic against the pain caused by a heel lance served as the basis for this study. Electroencephalographic (EEG) activity, heart rate activity, and infants' facial behaviors were recorded before and after a noninvasive, but noxious, heelstroke (procedure from the Brazelton Neonatal Behavior Assessment Scale). In a randomized and controlled trial, 34 newborns were administered 2 mL of water or sucrose solution before the heelstroke. Frontal EEG asymmetry scores were computed, and power in the 3 to 6 Hz frequency band was analyzed. Infants who received water showed increased relative right frontal EEG activation from baseline to the post-heelstroke phase, a pattern that typifies negative affect. The EEG of infants in the sucrose group did not change. Heart rate increased rapidly in both groups during the heelstroke phase. However, after the heelstroke, the heart rate of infants who received sucrose returned to baseline, whereas the heart rate of infants who tasted water remained elevated. During the heelstroke, the infants in the water group cried and grimaced twice as long as the infants in the sucrose group. These findings add to the growing literature showing that sucrose attenuates newborns' negative response to aversive or noxious stimuli.

Massage treatment in HIV-1 infected Dominican children: a preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication.

OBJECTIVES: More than 1.4 million children are living with HIV and global access to antiretrovirals is not yet readily available. Massage therapy, which has been shown to improve immune function in HIV+ adults and adolescents, may provide an important complementary treatment to boost immune status in young children living with HIV disease, especially those without access to antiretroviral medications. No studies have been conducted, however, that specifically target massage therapy to enhance immune function in HIV+ children. DESIGN: Clinical trial with eligible, consented HIV+ children randomized to receive either massage therapy or a friendly visit (controls). SETTINGS/LOCATION: CENISMI/Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic. SUBJECTS: HIV+ children ages 2-8 years. INTERVENTION: Massage therapy sessions (20 minutes, twice weekly, for 12 weeks), conducted by trained nurses, following a structured protocol of moderate pressure stroking and kneading of muscles, using a non-scented oil. The friendly visit control group, (reading, talking, playing quiet games), met with the nurse twice weekly for 12 weeks. OUTCOME MEASURES: At the initial evaluation, and following the 12-week intervention, blood was drawn to determine absolute helper (CD4/T4) and suppressor (CD8/T8) counts. RESULTS: Children in the control arm had a greater relative risk of CD4 count decline (>20%) than massage-treated children (RR = 5.7, p = 0.03). Lymphocyte loss was also more extensive in the controls (p < 0.02), and more of the control group than the massage group lost >50 CD8 lymphocytes (p = 0.03). CONCLUSIONS: The efficacy of massage therapy in maintaining immunocompetence may offer a viable alternative to the thousands of children worldwide without antiretroviral access.

Right frontal EEG and pregnancy/neonatal outcomes.

Fifty-two pregnant women recruited during their second trimester were given EEGs and divided into greater relative right and left frontal EEG activation groups. The greater relative right frontal EEG women had lower dopamine levels during their second trimester and lower dopamine and higher cortisol levels during the neonatal period. The newborns of the right frontal EEG mothers also showed greater relative right frontal EEG, had lower dopamine and serotonin levels, spent more time in indeterminate sleep and had inferior Brazelton scores. A discriminant function analysis based on the mothers' prenatal depression scores and biochemical measures correctly classified 74% of the women as greater relative right or left frontal EEG group members.

Music effects on EEG in intrusive and withdrawn mothers with depressive symptoms.

The EEG patterns of 48 intrusive and withdrawn mothers with depressive symptoms were assessed following a 20-minute music session to determine if the music had mood-altering effects. Half the mothers listened to classical music while half listened to rock music. Intrusive mothers were expected to have more positive responses and more symmetrical EEG following the calming classical music, while withdrawn mothers were expected to have a more positive response and symmetrical EEG following the energizing rock music. Although more positive EEGs were noted for rock music in both groups, only the withdrawn mothers showed a significant change in EEG toward symmetry following rock music, and only the intrusive mothers showed a decrease in cortisol levels following the rock music. Their State Anxiety Inventory (STAI) anxiety levels also decreased, while the Profile of Mood States (POMS) depressed mood levels decreased significantly for all four groups following music.

Prepartum, postpartum, and chronic depression effects on newborns.

In order to assess the effects of the onset and chronicity of maternal depression on neonatal physiology, eighty pregnant women were assessed for depression during mid-pregnancy (M gestational age = 25.9 weeks) and shortly after delivery. The women were classified as reporting depressive symptoms 1) only during the prepartum assessment; 2) only during the postpartum assessment; 3) during both the prepartum and postpartum assessments; or 4) reporting no depressive symptoms at either the prepartum or the postpartum assessment. Maternal mood and biochemistry were assessed during pregnancy, and the EEG and biochemical characteristics of their 1-week-old infants were assessed shortly after birth. As predicted, the newborns of the mothers with prepartum and postpartum depressive symptoms had elevated cortisol and norepinephrine levels, lower dopamine levels, and greater relative right frontal EEG asymmetry. The infants in the prepartum group also showed greater relative right frontal EEG asymmetry and higher norepinephrine levels. These data suggest that effects on newborn physiology depend more on prepartum than postpartum maternal depression but may also depend on the duration of the depressive symptoms.

Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder.

In the present study, 30 students between the ages of 7 and 18 years (M = 13 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) were randomly assigned to a massage group or a wait-list control group. The massage group received massage therapy for 20 minutes twice per week over the course of one month. The results revealed that massage therapy benefited students with ADHD by improving short-term mood state and longer-term classroom behavior.

Aggressive adolescents benefit from massage therapy.

Seventeen aggressive adolescents were randomly assigned to a massage therapy group or a relaxation therapy group to receive 20-minute therapy sessions, twice a week for five weeks. The massaged adolescents had lower anxiety after the first and last sessions. By the end of the study, they also reported feeling less hostile and they were perceived by their parents as being less aggressive. Significant differences were not found for the adolescents who were assigned to the relaxation group.

The relationship between mothers' coping patterns and children's anxiety about their hospitalization as reflected in drawings.

This study explored the relationships between hospitalized children's anxiety level, mothers' use of coping strategies, and mothers' satisfaction with the hospital experience. Twenty-four hospitalized children and their mothers participated in this study. Children were asked to draw a person in the hospital, which was then coded as a projective measure of anxiety; mothers were asked to complete questionnaires on their coping behaviors and their satisfaction with their child's hospital experience. The use of more coping strategies by the mothers was related to less anxiety in the children. In addition, the more coping strategies the mothers used, the higher they reported their satisfaction. The findings suggest the importance of providing resources aimed at increasing maternal coping and satisfaction with the quality of care of a child's hospitalization in order to minimize the negative effects of the hospitalization on the children.

Preterm infant weight gain is increased by massage therapy and exercise via different underlying mechanisms.

OBJECTIVE: To compare the effects of massage therapy (moderate pressure stroking) and exercise (flexion and extension of limbs) on preterm infants' weight gain and to explore potential underlying mechanisms for those effects. METHODS: Weight gain and parasympathetic nervous system activity were assessed in 30 preterm infants randomly assigned to a massage therapy group or to an exercise group. Infants received 10min of moderate pressure massage or passive flexion and extension of the limbs 3 times per day for 5days, and EKGs were collected during the first session to assess vagal activity. RESULTS: Both massage and exercise led to increased weight gain. However, while exercise was associated with increased calorie consumption, massage was related to increased vagal activity. CONCLUSION: Taken together, these findings suggest that massage and exercise lead to increased preterm infant weight gain via different underlying mechanisms.