Composition of the maternal gastrointestinal microbiome as a predictor of neonatal birth weight.

BACKGROUND: The biological mechanism by which the maternal gastrointestinal microbiota contributes to fetal growth and neonatal birth weight is currently unknown. The purpose of this study was to explore how the composition of the maternal microbiome in varying pre-gravid body mass index (BMI) groups are associated with neonatal birth weight adjusted for gestational age. METHODS: Retrospective, cross-sectional metagenomic analysis of bio-banked fecal swab biospecimens (n = 102) self-collected by participants in the late second trimester of pregnancy. RESULTS: Through high-dimensional regression analysis using principal components (PC) of the microbiome, we found that the best performing multivariate model explained 22.9% of the variation in neonatal weight adjusted for gestational age. Pre-gravid BMI (p = 0.05), PC3 (p = 0.03), and the interaction of the maternal microbiome with maternal blood glucose on the glucose challenge test (p = 0.01) were significant predictors of neonatal birth weight after adjusting for potential confounders including maternal antibiotic use during gestation and total gestational weight gain. CONCLUSIONS: Our results indicate a significant association between the maternal gastrointestinal microbiome in the late second trimester and neonatal birth weight adjusted for gestational age. Moderated by blood glucose at the time of the universal glucose screening, the gastrointestinal microbiome may have a role in the regulation of fetal growth. IMPACT: Maternal blood glucose in the late second trimester significantly moderates the relationship between the maternal gastrointestinal microbiome and neonatal size adjusted for gestational age. Our findings provide preliminary evidence for fetal programming of neonatal birth weight through the maternal gastrointestinal microbiome during pregnancy.

A Review of Factors that Serve to Protect Pregnant and Post-partum Women from Negative Outcomes Associated with Adverse Childhood Experiences.

PURPOSE: The objective of this review is to examine factors, during the perinatal period, that serve to protect women and infants from poor mental or physical outcomes most commonly associated with maternal adverse childhood experiences (ACEs). METHODS: The electronic databases of PubMed, Ovid MEDLINE, CINAHL and Web of Science were searched. The searches were conducted using the following mesh terms and keywords: ('adverse childhood experiences' or 'ACEs') and ('protective factor' or 'social support' or 'buffer' or 'resilience') and ('pregnan*' or 'prenatal' or 'postpartum' or 'maternal' or 'antenatal'). Studies that examined the association of maternal ACEs and protective factors during the perinatal period were included. A total of 317d articles were screened and 19 are included in this review. The quality of the articles was evaluated with the Newcastle-Ottawa-Scale (NOS). RESULTS AND CONCLUSION: This review indicates a positive association between maternal ACEs and protective perinatal factors including social support, resiliency and positive childhood experiences.

Intimate partner violence during the perinatal period by disability status: Findings from a United States population-based analysis.

AIMS: The aim of the current study was to compare the prevalence of intimate partner violence (IPV) during the perinatal period among respondents with self-reported disability compared with those without a disability. DESIGN: We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS: A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The exposure was perinatal IPV, defined as experiencing abuse by a current or ex-partner in the year before or during pregnancy. Regression models were used to calculated odds of IPV by disability status while accounting for relevant sociodemographic characteristics. RESULTS: Respondents who self-reported disabilities experienced IPV at a higher rate than those without disabilities, both before and during pregnancy. In fully adjusted models, respondents with disabilities had about 2.6 times the odds of experiencing IPV before pregnancy, and about 2.5 times the odds of experiencing IPV during pregnancy, compared with those without disabilities. CONCLUSION: Respondents with disabilities experienced IPV at higher rates than the general population, and thus are at increased risk for adverse maternal, neonatal and infant health outcomes. IMPACT: Perinatal IPV is a significant issue globally, and our findings suggest perinatal IPV is particularly salient for persons with disability. Findings highlight the need to screen women with disabilities for IPV during the perinatal period as well as the importance of providing them appropriate, accessible information, resources and referrals.

Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System.

AIMS: The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability. DESIGN: We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS: A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy. RESULTS: Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities. CONCLUSION: Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes. IMPACT: Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring. PATIENT OR PUBLIC CONTRIBUTION: We thank our Community Advisory Board members who have been instrumental in the conception of this study.

Experiences of racism and perinatal depression: Findings from the pregnancy risk assessment monitoring system, 2018.

AIM: To estimate the association between feeling upset by experiences of racism and self-reported depression during pregnancy among non-Hispanic Black women using a large population-based sample from the United States. DESIGN: We conducted a secondary analysis of nationally representative cross-sectional survey data with retrospective measures. METHODS: Analysis of Phase 8 (2018) data from the Pregnancy Risk Assessment Monitoring System survey included 7328 non-Hispanic Black respondents with a recent live birth from 11 states and New York City. Multivariable logistic regression models were used to estimate the association between self-report of feeling upset due to experience of racism during the year prior to delivery and self-reported depression during pregnancy, controlling for potential confounders. RESULTS: The prevalence of feeling upset due to experiences of racism was 11.4% and the prevalence of depression during pregnancy was 11.4%. Respondents who reported feeling upset due to the experience of racism had over two-fold higher odds (OR 2.37, 95% CI 1.67, 3.37) of experiencing depression during pregnancy compared to respondents who did not report feeling upset due to the experience of racism, adjusted for maternal age, educational attainment, marital status, pre-pregnancy insurance type, region, and pre-pregnancy depression. CONCLUSION: Respondents who felt upset due to the experience of racism in the year prior to delivery experienced significantly higher odds of depression during pregnancy, and thus are at an increased risk for adverse maternal outcomes. IMPACT: Stress from racism and racial discrimination during the perinatal period may contribute to maternal morbidity, including perinatal depression, among Black women. NO PATIENT OR PUBLIC CONTRIBUTION: The data in this study were collected by the Centers for Disease Control and Prevention for the Pregnancy Risk Assessment Monitoring System. To our knowledge, the conduct of the study did not include patient or public contribution. Neither did the analysis, interpretation, nor manuscript preparation include patient or public contribution because we did not have funding to support the study or their involvement.

A Review of Treatments and Clinical Guidelines for Perinatal Depression.

Perinatal depression occurs in approximately 1 in 7 women and is considered the most common complication of pregnancy and childbearing. Management of perinatal depression may include a combination of nonpharmacological and pharmacological therapies depending on the severity of symptoms, the stage of gestation, and maternal preference. Healthcare providers are recommended to review current guidelines and provide information to women during pregnancy and postpartum regarding the risks and benefits of nonpharmacological and pharmacological treatment options for perinatal depression. In addition, healthcare providers should consider common barriers to treatment including inadequate screening and social stigma. This article reviews common treatments of perinatal depression as well as the clinical guidelines provided by the American Association of Obstetricians and Gynecologists (ACOG), the American Psychiatric Association (APA), and the US Preventive Services Task Force (USPSTF). Discussion of nonpharmacological therapies includes cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Pharmacological treatments are reviewed by drug class and include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), norepinephrine/dopamine reuptake inhibitors (NDRIs), and tricyclic antidepressants (TCAs). Adjunctive treatments of severe depression, including second-generation antipsychotics (SGAs), are also discussed.

Gut microbiota composition is associated with newborn functional brain connectivity and behavioral temperament.

The gut microbiome appears to play an important role in human health and disease. However, only little is known about how variability in the gut microbiome contributes to individual differences during early and sensitive stages of brain and behavioral development. The current study examined the link between gut microbiome, brain, and behavior in newborn infants (N = 63; M [age] = 25 days). Infant gut microbiome diversity was measured from stool samples using metagenomic sequencing, infant functional brain network connectivity was assessed using a resting state functional near infrared spectroscopy (rs-fNIRS) procedure, and infant behavioral temperament was assessed using parental report. Our results show that gut microbiota composition is linked to individual variability in brain network connectivity, which in turn mediated individual differences in behavioral temperament, specifically negative emotionality, among infants. Furthermore, virulence factors, possibly indexing pathogenic activity, were associated with differences in brain network connectivity linked to negative emotionality. These findings provide novel insights into the early developmental origins of the gut microbiome-brain axis and its association with variability in important behavioral traits. This suggests that the gut microbiome is an important biological factor to consider when studying human development and health.

A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity.

To conduct a pilot study of a group-based perinatal depression intervention, the Mothers and Babies Course, on depressive symptomatology, maternal-fetal attachment, and maternal sensitivity, 60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group at their initial prenatal care visit. Measures of depressive symptomatology and maternal-fetal attachment were collected at baseline and 36 weeks gestation. At 12 weeks postpartum, participants completed a measure of depressive symptomatology, and an objective measure of maternal sensitivity was collected. Participants randomized to the intervention group completed an average of 5.2 sessions, and 70% of women completed all six sessions. Exploratory analyses showed that at 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment via the Maternal Fetal Attachment Scale (MFAS) as compared to 4.60 among participants in usual care. Maternal sensitivity scores, assessed via the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding), were higher at 12 weeks postpartum for women in the intervention group as compared to women in usual care (59.2 and 51.8, respectively). Our pilot study findings provide preliminary support for the benefits of a perinatal depression intervention, delivered in a group setting, on reducing depressive symptomatology, and improving maternal-fetal attachment and maternal sensitivity. Further research, conducted with larger samples, is necessary to determine the effect of this intervention on indicators of maternal attachment.

Cardiovascular Risk and Outcomes in Women Who Have Experienced Intimate Partner Violence: An Integrative Review.

BACKGROUND: Cardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood. OBJECTIVE: This integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience. METHODS: Three electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS: Of the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with nonabused women. CONCLUSIONS: Intimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.

Healthcare Providers' Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases.

PURPOSE: The purpose of this study was to identify healthcare providers' experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. DESIGN AND METHODS: A qualitative, descriptive design was used with 13 pediatric healthcare providers. FINDINGS: Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. CONCLUSIONS: Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. PRACTICE IMPLICATIONS: The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.

A primer on investigating the role of the microbiome in brain and cognitive development.

Incorporating information regarding the gut microbiota into psychobiological research promises to shed new light on how individual differences in brain and cognitive development emerge. However, the investigation of the gut-brain axis in development is still in its infancy and poses several challenges, including data analysis. Considering that the gut microbiome is an eco-system containing millions of bacteria, one needs to utilize a breadth of methodologies and data analytic techniques. The present review serves two purposes. First, this review will inform developmental psychobiology researchers about the emerging study of the gut-brain axis in development and second, this review will propose methodologies and data analytic strategies for integrating microbiome data in developmental research.

Fertility Desires and Intentions Among U.S. Women by Disability Status: Findings from the 2011-2013 National Survey of Family Growth.

Objectives We compared fertility desires and intentions among women with disabilities and women without disabilities in the United States, using a new evidence-based measure of disability. Methods We analyzed data from a sample of 5601 US women 15-44 years of age in the 2011-2013 National Survey of Family Growth. The data were analyzed via cross-tabulation and logistic regression. We classified women into those with a disability and those without a disability. Results Women with disabilities were about as likely to want a baby (61%) as women without disabilities (60%). But only 43% of women with disabilities intended to have a baby in the future, compared with 50% of women without disabilities. Thus, the difference between the percent who want a baby and the percent who intend to have one was larger for disabled women. Women with disabilities were also less certain of their fertility intentions. Multivariate analysis shows that having a disability lowers the odds of intending another birth, after controlling for several other determinants of fertility intentions. Conclusions for Practice All women, regardless of disability status, desired more children than they actually planned to have, but the gap was larger for most groups of women with disabilities than for non-disabled women. Given the sample sizes available in this analysis, future research should use more detailed classifications of disability, however, we have shown that women living with disabilities constitute large populations with unexplored family planning needs.

"I'M OPENING MY ARMS RATHER THAN PUSHING AWAY:" PERCEIVED BENEFITS OF A MINDFULNESS-BASED INTERVENTION AMONG HOMELESS WOMEN AND YOUNG CHILDREN.

Family homelessness is associated with adverse outcomes in mothers and their young children. Evidence-based programs are needed to support the socioemotional needs of these families. The purpose of this qualitative study was to explore the perceived benefits of participating in a mindfulness program in mother-child dyads receiving services at a therapeutic nursery serving homeless children under the age of 3 years. A convenience sample of 17 predominantly African American mothers participated in in-depth qualitative interviews. Four themes were derived from the data regarding the perceived benefits of the mindfulness program: "me" time, maternal self-regulation, dyadic connectedness, and child well-being. Results demonstrate the perceived benefits of mindfulness on the parent-child relationship and have important implications for families at an increased risk of adverse outcomes. Because homelessness and residential instability confer considerable risk for young children, interventions to support effective parenting are critical.

Intimate partner violence and suicidal ideation in pregnant women.

Intimate partner violence (IPV) during pregnancy is a major public health issue with significant implications for maternal mental health. Less studied is the association between IPV during pregnancy and suicidal ideation. This study reports the prevalence and correlates of suicidal ideation among low-income pregnant women receiving prenatal care at a university obstetrical clinic from February 2009 to March 2010. We performed a cross-sectional analysis of 166 women surveyed between 24 and 28 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen (AAS). Multiple logistic regression identified factors associated with antenatal suicidal ideation. The prevalence of suicidal ideation was 22.89 %. In the fully adjusted model, antenatal depressive symptomatology (OR = 17.04; 95 % CI 2.10-38.27) and experiencing IPV (OR = 9.37; 95 % CI 3.41-25.75) were significantly associated with an increased risk of antenatal suicidal ideation. The prevalence of antenatal suicidal ideation in the current study was higher than other population-based samples though this sample was predominantly single, low-income, and 19 % experienced IPV during pregnancy. Given the strong association of antenatal suicidal ideation, depressive symptomatology, and IPV, health care providers are urged to identify those women at risk so that antenatal care can be tailored to best support optimal maternal and neonatal outcomes.

A safety app to respond to dating violence for college women and their friends: the MyPlan study randomized controlled trial protocol.

BACKGROUND: Research demonstrates high rates of physical and sexual victimization of women by intimate partners on college campuses (Black et al. 2001). College women in abusive relationships must weigh complex factors (health, academics, economics, and social stigma) during critical decision-making regarding the relationship. Rather than access formal support systems (e.g., campus security, administrators, counselors), research indicates abused college women most often turn to informal networks; specifically friends (Perspect Psychiatr Care 41:162-171, 2005), who often lack the knowledge or resources to provide effective support (Nurs Res 54(4):235-242, 2005). Decision aids have been shown to assist with health-related decisions by improving knowledge, creating realistic expectations, and resolving decisional conflict (Cochrane Database Syst Rev 1:1-332, 2014). METHODS/DESIGN: This study is a randomized controlled trial testing the effectiveness of an interactive safety decision aid web-based and smartphone application (App) for abused college women and their friends. Three hundred female college students experiencing abuse and three hundred friends of female college students experiencing abuse will be recruited in Maryland and Oregon and randomized to either the intervention safety decision aid, accessible by website or smartphone App, or a usual safety planning control website/App. The intervention App allows users to enter information on: a) relationship health; b) safety priorities; and c) severity of violence/danger in relationship. The App uses this information to provide personalized safety planning information and resources. Self-reported outcome measures for abused college women on safety seeking behaviors, decisional conflict, IPV exposure and mental health will be collected at baseline, six, and 12-months post-baseline via the study App/website. Outcomes measured for friends are IPV awareness, confidence to intervene, supportive behaviors and decisional conflict. Protocols for safely recruiting, retaining and collecting data from abused women via web/App are discussed. DISCUSSION: This trial may provide important information on the impact of an App and web-based safety planning tool on college women's decisional conflict and safety behavior use when making difficult safety decisions. This study is the first, to our knowledge, to test an intervention that engages friends of abused college women. The trial may also inform researchers on the feasibility of safely conducting research with abused women using online recruitment and enrollment methods and collecting data via an App or website. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02236663.

A Mixed-Methods, International, Multisite Study to Develop and Validate a Measure of Nurse-to-Physician Communication in Simulation.

AIM: This study examined the reliability and validity of the ISBAR Interprofessional Communication Rubric (IICR). BACKGROUND: Improving education regarding communication in health care is a global priority. Communication is difficult to measure and no evaluation rubrics were located that uniquely focused on nurse-to-physician communication in simulation. METHOD: This study used a mixed-methods design and included five sites. RESULTS: The IICR was determined reliable among nurse educator raters (r = 0.79). The scale was found valid as assessed by nurse and physician experts (content validity index = 0.92). When describing their experience of using the tool, nurse educator raters described three categories: overall acceptability of the tool, ease of use, and perceptions of the importance of communication skills for patient safety. CONCLUSION: Teaching and evaluating communication in simulation with a standardized rubric is a research area in need of further exploration and refinement.

Impact of deployment on military families with young children: A systematic review.

BACKGROUND: More than 40% of children in military families are <6 years old, a period when children are most dependent on their parents' physical and emotional availability. PURPOSE: This systematic review describes the impact of deployment since 9/11 on the mental health of military families with young children, evaluates evidence-based interventions for military parents with young children, and identifies gaps in the science limiting our ability to support the needs of these families. METHODS: Databases were reviewed from 2001 to 2014 using preferred reporting items for systematic reviews and meta-analyses approach; 26 studies met review criteria. RESULTS: Deployment was associated with increased parent stress, child behavior problems, health care utilization, and child maltreatment. Few studies tested interventions or focused on racial/ethnic minority or veteran families. A number of methodological limitations are noted. CONCLUSIONS: More research using multiple methods, stronger designs, and more diverse samples is needed to understand and address the needs of military families with young children.

Intimate partner violence, substance use, and adverse neonatal outcomes among urban women.

OBJECTIVE: To assess the prevalence of intimate partner violence, substance use, and their co-occurrence during pregnancy and to examine their associations with adverse neonatal outcomes. STUDY DESIGN: Between February 2009-February 2010, pregnant women receiving obstetrical care at 3 urban clinics were screened for intimate partner violence and substance use between 24-28 weeks gestation. A chart review was conducted upon delivery to assess for adverse neonatal outcomes of low birth weight, preterm birth, and small for gestational age (SGA). RESULTS: Maternal and neonatal data were collected on 166 mothers and their neonates. Overall, 19% of the sample reported intimate partner violence during their pregnancies. Of the study's neonates, 41% had at least 1 adverse neonatal outcome. Nearly one-half of the mothers reported using at least 1 substance during pregnancy. Women experiencing intimate partner violence had a higher prevalence of marijuana use than their nonabused counterparts (P < .01). Experiencing intimate partner violence was associated with a 4-fold increase in having a SGA neonate (aOR = 4.00; 95% CI 1.58-9.97). Women who reported marijuana use had 5 times the odds of having a neonate classified as SGA (aOR = 5.16, 95% CI 2.24-11.89) or low birth weight (aOR 5.00; 95% CI 1.98-12.65). CONCLUSIONS: The prevalence of intimate partner violence during pregnancy and substance use is high in urban mothers, the risks of which extend to their neonates. Pediatric providers are urged to routinely screen for both issues and recognize the impact of co-occurrence of these risk factors on poor neonatal and childhood outcomes.