Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy.

BACKGROUND: Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child's immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation. METHODS: We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort. We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa=0.42). Timely immunisation occurred in 70% of infants. Independent of their partner's intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR=7.65, 95% CI: 4.87-12.18). Independent of the future mother's intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR=3.33, 95% CI: 2.29-4.84). CONCLUSIONS: During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers' and future fathers' intentions are independently associated with the timeliness of their infant's immunisations.

Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand.

BACKGROUND: Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy. METHODS: An ethnically and socioeconomically diverse sample of 5664 pregnant women living in New Zealand completed a face-to-face interview during the third trimester. Antenatal depression (AD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographic, physical and mental health, and family and relationship characteristics were measured. The association between symptoms of AD and maternal characteristics was determined using multiple logistic regression. RESULTS: 11.9% of the participating women had EPDS scores (13+) that indicated probable AD. When considering sociodemographic predictors of AD symptoms, we found that women from non-European ethnicities, specifically Pacific Islander, Asian and other, were more likely to suffer from AD symptoms. Greater perceived stress during pregnancy and a diagnosis of anxiety both before and during pregnancy were also associated with greater odds of having AD according to the EPDS. LIMITATIONS: The women were in their third trimester of pregnancy at the interview. Therefore, we cannot discount the possibility of recall bias for questions relating to pre-pregnancy status or early-pregnancy behaviours. CONCLUSIONS: AD is prevalent amongst New Zealand women. Ethnicity, perceived stress and anxiety are particularly associated with a greater likelihood of depression during pregnancy. Further attention to supporting maternal mental health status in the antenatal period is required.

The effect of methadone treatment on the quantity and quality of human fetal movement.

OBJECTIVE: To evaluate the effect of daily maternal methadone maintenance treatment on the quality and quantity of fetal movement. METHODS: At 34-37 weeks gestation, real-time ultrasound recordings were obtained from 17 methadone treated and 17 non-opioid-dependent mothers at two time points relative to the methadone mothers' daily dose of methadone. The first observation was just prior to the mother taking her daily dose (Time A) and the second was 1-h postdose (Time B). The incidence and pattern of fetal breathing movements (FBMs), fetal trunk movements (FTMs) and total fetal activity (TFA) were obtained from these ultrasounds. RESULTS: A time by group effect was found for measures of FBM and TFA, Fs(1,32)=6.06 and 4.94, P<0.05. At Time A and Time B for these measures t-tests showed no difference in the incidence of FBM (47.9% vs. 55.4%) and TFA (56% vs. 64%) at Time A between the methadone and comparison groups; however, at Time B the incidence of FBM (16.6% vs. 53.5%) and TFA (27% vs. 65%) was decreased for the methadone group. In addition, there was a between-group difference for two qualitative measures of fetal breathing. A slower rate of fetal breathing (40.3 vs. 47.2 breaths/min) and fewer FBMs per breathing episode (51.7 vs. 92.4) were found for the methadone group regardless of time since the mothers' daily dose. CONCLUSION: Taken together these results suggest that daily maternal methadone maintenance treatment altered both quantitative and qualitative measures of fetal activity that have been found to be related to normal fetal development.

Children born small for gestational age are not at special risk for preschool emotion and behaviour problems.

Despite the wealth of literature examining long term outcomes of preterm low birthweight children, few studies have directly assessed the developmental impact of being born full term but small for gestational age (SGA). We aim to determine whether (i) being SGA increases preschool behavioural problems and (ii) other risk factors operate differently in SGA and appropriate for gestational age (AGA) controls. 550 New Zealand European mothers and their 3.5 year old children participated in this study. All children were born at full term (>37 weeks' gestation) and approximately half were SGA (≤sex specific 10th percentile for gestation) the remainder were AGA controls. Extensive data were collected at the child's birth, 1 year and 3.5 years. Behavioural problems were measured when children were 3.5 years, using the Strengths and Difficulties Questionnaire (SDQ). Multiple regression analyses were used to examine the associations between risk factors and behavioural problems; statistical weighting was used for analyses of the total study group. There was no significant difference in behavioural problems between SGA and AGA groups. In the total sample the significant predictors of behavioural problems included: mothers' school leaving age; smoking during pregnancy; maternal alcohol use during pregnancy; and absence of the father. Predictors of behavioural problems were found to be the same for SGA and AGA groups. These results do not support the view that SGA is a risk for behavioural preschool difficulties or that SGA children are sensitised to risks known to be associated with such difficulties in the preschool years.

Determinants of developmental delay in infants aged 12 months.

The aim of this study was to determine which demographic, maternal, obstetric and postnatal variables were associated with achievement of developmental milestones at the age of 12 months in term infants. Mothers and babies were enrolled in the Auckland Birthweight Collaborative Study shortly after birth. All infants were full term (gestation >or= 37 weeks). Approximately half of the sample were small for gestational age (SGA = birthweight 10th percentile). A maternal interview was conducted soon after birth. Phase 2 of the study occurred 12 months later when mothers were sent a postal questionnaire requesting information about the child's health and development during the first year of life using the Denver Prescreening Developmental Questionnaire. Seven hundred and forty-four (85.4%) European mothers returned the postal questionnaire. SGA children were not at increased risk of developmental delay at 12 months of age. In a sample representative of New Zealand European children, after adjustment for the effects of potential confounders, maternal smoking during pregnancy (OR = 2.1 [95% CI 1.1, 4.0]), maternal smoking during the first year of life (OR = 1.9 [95% CI 1.0, 3.8]) and low levels of satisfaction with parenting (OR = 2.4 [95% CI 1.1, 5.2]) were associated with significantly increased risk of developmental delay. In the subgroup of SGA children, maternal smoking during pregnancy (OR = 2.9 [95% CI 1.4, 6.2]), high levels of stress associated with parenting (OR = 2.2 [95% CI 1.2, 4.0]), and low levels of satisfaction with parenting (OR = 4.3 [95% CI 1.3, 13.5]) were significantly associated with developmental delay after adjustment for the effects of potential confounders. In conclusion, maternal and postnatal factors were better predictors of developmental delay than demographic variables.