Defining vulnerability in European pregnant women, a Delphi study.

OBJECTIVE: Vulnerability among pregnant women is an important and complex theme in the everyday practice of midwives. Exchanging knowledge and best practices about vulnerability between midwives in Europe can contribute to improving the knowledge and skills of midwives and as a result improve the care for vulnerable pregnant women. We therefore start a consortium with midwives, midwifery teachers, researchers and students from organizations of seven European cities with the aim to exchange knowledge and best practices concerning vulnerable pregnant women between midwives. To be able to effectively exchange knowledge and best practices, our consortium started with this study focuses on establishing a mutual definition of vulnerable pregnant women. Therefore, the aim of this study is to develop a mutual definition of vulnerable pregnant women and to identify aspects related to vulnerability. DESIGN: Delphi study with four rounds: (1) gathering existing knowledge from literature and definitions used by partners of the consortium, (2) and (3) two survey rounds and (4) an in-person consensus meeting. SETTING: Consortium of midwives, midwifery teachers, researchers and students from Antwerp (Belgium), Ghent (Belgium), Turku (Finland), Milan (Italy), Pila (Poland), Lisbon (Portugal) and Rotterdam (The Netherlands) PARTICIPANTS: We included all consortium members in the Delphi study. FINDINGS: Various aspects related to vulnerability and appropriate definitions were identified during the Delphi rounds. Consensus about the aspects related to vulnerability and the definition of vulnerable pregnant women was reached during the final consensus meeting. A vulnerable pregnant woman was defined as a woman who is threatened by physical, psychological, cognitive and/or social risk factors in combination with lack of adequate support and/or adequate coping skills. KEY CONCLUSION: We reached consensus about a mutual definition of vulnerable pregnant women and aspects related to vulnerability within this consortium. The Delphi approach led to interesting discussions and was a valuable method to define the concept of vulnerable pregnant women within our project . IMPLICATIONS FOR PRACTICE: In order to accomplish a project that aimed to improve care for vulnerable pregnant women it was important to first identify the population of vulnerable pregnant women with a mutual definition.

Antenatal maternal anxiety is associated with problem behaviour at age five.

BACKGROUND: Developmental programming by maternal stress during pregnancy is found to influence behavioural development in the offspring. AIM: To prospectively investigate the association between antenatal maternal anxiety and children's behaviour rated by their mothers and teachers. METHODS: In a large, community based birth-cohort (the ABCD-study) antenatal maternal state-anxiety (M = 36.7, SD = 9.8) was measured around the 16th week of gestation. Five years later, 3,446 mothers and 3,520 teachers evaluated 3,758 children's overall problem behaviour, emotional symptoms, conduct problems, hyperactivity/inattention problems, peer relationship problems and pro-social behaviour. RESULTS: Hierarchical multiple regression analysis using a large number of potential covariates revealed that children of mothers who reported higher levels of anxiety during their pregnancy showed more overall problem behaviour, hyperactivity/inattention problems, emotional symptoms, peer relationship problems, conduct problems and showed less pro-social behaviour when mothers rated their child's behaviour. When teachers rated child behaviour, children showed more overall problem behaviour and less pro-social behaviour that was related to antenatal anxiety. The child's sex moderated the association between antenatal anxiety with overall problem behaviour and hyperactivity/inattention problems when reported by the mother. In boys, exposure to antenatal anxiety was associated with a stronger increase in overall problem behaviour compared to girls. Furthermore, antenatal anxiety was significantly related to an increase in hyperactivity/inattention problems in boys, while this was not the case in girls. CONCLUSIONS: Exposure to antenatal maternal anxiety is associated with children's problem behaviour, with different outcome patterns for both sexes. Nevertheless, effect sizes in this study were small.