Sociodemographic factor associations with maternal and placental outcomes: A cluster and partial least squares regression analysis.

INTRODUCTION: Maternal social disadvantage adversely affects maternal and offspring health, with limited research on placental outcomes. Therefore, we examined maternal sociodemographic factor associations with placental and birth outcomes in general (Lifeways Cross-Generation Cohort) and at-risk (PEARS Study of mothers with overweight or obesity) populations of pregnant women. METHODS: TwoStep cluster analysis profiled Lifeways mothers (n = 250) based on their age, parity, marital status, household income, private healthcare insurance, homeowner status, and education. Differences in placental and birth outcomes (untrimmed placental weight (PW), birthweight (BW) and BW:PW ratio) between clusters were assessed using one-way ANOVA and chi-square tests. Partial least squares regression analysed individual effects of sociodemographic factors on placental and birth outcomes in Lifeways and PEARS mothers (n = 461). RESULTS: Clusters were classified as "Married Homeowners" (n = 140, 56 %), "Highest Income" (n = 58, 23.2 %) and "Renters" (n = 52, 20.8 %) in the Lifeways Cohort. Renters were younger, more likely to smoke, have a means-tested medical card and more pro-inflammatory diets compared to other clusters (p < 0.01). Compared to Married Homeowners, renters' offspring had lower BW (-259.26 g, p < 0.01), shorter birth length (-1.31 cm, p < 0.01) and smaller head circumference (-0.59 cm, p = 0.02). PLS regression analyses identified nulliparity as having the greatest negative effect on PW (Lifeways and PEARS) while being a homeowner had the greatest positive effect on PW (Lifeways). CONCLUSION: Certain combinations of sociodemographic factors (particularly homeownership) were associated with less favourable lifestyle factors, and with birth, but not placental outcomes. When explored individually, parity contributed to the prediction of placental and birth outcomes in both cohorts of pregnant women.

Maternal Well-Being in Pregnancy and Breastfeeding Practices: Findings from the ROLO Study.

OBJECTIVE: Low mood is common during the perinatal period, which may negatively impact breastfeeding practices. Exploring predictors of successful breastfeeding is a health priority area. This study investigated if maternal well-being during pregnancy is associated with breastfeeding practices. STUDY DESIGN: This is a secondary analysis of a randomized control trial of a low glycemic index diet in pregnancy. A total of 610 secundigravida women were recruited in the National Maternity Hospital, Dublin, Ireland. Data on maternal education attainment, early pregnancy body mass index (BMI), and age were collected from hospital records. Well-being was self-reported by mothers between 10 and 28 weeks' gestation using the World Health Organization 5-Item well-being index. Scores were transformed to give percentage well-being. Mothers recorded breastfeeding practices at hospital discharge and at the study follow-up appointments. Chi-squares and independent t-tests determined initial differences in breastfeeding practices. Multiple and logistic regression analyses were used to adjust for confounders. RESULTS: Average maternal age was 32.7 years; average BMI was 26.6 kg/m2, and 56% had achieved third-level education. The average well-being score was 58.2%. In unadjusted analysis, high well-being scores were associated with exclusive breastfeeding (56.2% breastfed vs. 46%, breastfed p < 0.03). After adjusted analysis, these associations were no longer significant (odds ratio: 1.00, 95% confidence interval: 0.99-1.01). No other associations were found. CONCLUSION: Our findings indicated 25% of pregnant women in the first trimester reported low well-being scores. Associations between maternal well-being and breastfeeding patterns were explained by maternal age and education level, suggesting low mood may not be a barrier to breastfeeding initiation or duration. This trial is registered at: https://www.isrctn.com/ ISRCTN54392969. KEY POINTS: · Well-being during pregnancy is often diminished and the WHO 5-Item well-being index is a useful measure in clinical settings to assess maternal well-being.. · Breastfeeding is a high-priority research area, particularly in an Irish setting.. · Well-being was not related to breastfeeding, however age, BMI and education were the main predictors of low well-being during pregnancy..

The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R).

INTRODUCTION: Evaluation in healthcare services has become a priority, globally1. The Government of Ireland has highlighted the importance of stakeholder engagement to identify the needs of women in the design and delivery of high-quality health services, driven by necessity rather than financial ability2. The Birth Satisfaction Scale-Revised (BSS-R), an internationally validated tool, and recommended for measuring childbirth satisfaction by the International Consortium for Health Outcomes Measurement (ICHOM)3; however, it has yet to be considered in the Irish context. The aim of the study was to explore birth satisfaction with a sample of new mothers in Ireland. METHODS: A mixed-methods study was conducted including a survey that involved collection of data from the BSS-R 10-item questionnaire from 307 mothers over an 8-week period in 2019, in one urban maternity hospital in Ireland. Quantitative and qualitative data were collected. Qualitative data from the free-text comments of the survey questions were analyzed using content analysis. RESULTS: Overall, women reported positive relationships with their care providers and were satisfied with the communication and support they received, as well as high levels of control and choice. Postnatal care, however, was highlighted as being less satisfactory with staffing levels described as inadequate. CONCLUSIONS: Understanding women's birth experiences and what is important to them could facilitate midwives and other health professionals to improve the quality of their care and develop guidelines and policies that focus on women and their families' needs. The vast majority of women rated their birthing experience as extremely positive. The main elements of care that contributed to a positive birthing experience for women were quality relationships with clinicians, choice and control, and emotional safety.

'Labour Hopscotch': Women's evaluation of using the steps during labor.

INTRODUCTION: Concerns have been expressed globally about the decline in rates of physiological birth and rising intervention rates during labor and birth. The 'Labour Hopscotch' Framework, a visual depiction of steps required to remain active during labor was implemented in a large tertiary maternity hospital in Ireland. The aim of this study was to evaluate the steps of the Labour Hopscotch women found most useful, examine the use of non-pharmacological and pharmacological methods of pain relief used during labor and finally to investigate the labor and birth outcomes of women who used 'Labour Hopscotch' during labor. METHODS: A descriptive cross-sectional study was conducted using a study specific questionnaire. RESULTS: A total of 809 women completed the questionnaire. The Labour Hopscotch Framework was positively evaluated. Mobilizing, the birthing ball, birthing stool, and water therapy were found to be the most useful steps. Primiparous women were more likely to use non-pharmacological methods of pain relief. Pharmacological methods used by women were entonox (67.5%), pethidine (8%) and epidural analgesia (38.5%). Primiparous women were more likely to have epidural analgesia than multiparous women (p<0.00001). Women that attended either private (p=0.004) or public-led obstetric (p=0.005) antenatal care were more likely to have epidural analgesia in labor. Women attending the community midwives were least likely to receive epidural analgesia during labor. The rates of spontaneous vaginal birth, assisted birth and cesarean section, were 77.1%, 14% and 8.7%, respectively. CONCLUSIONS: Our study findings contribute to the increasing national and international evidence that initiatives such as Labour Hopscotch can promote and advocate for women to be active and mobile during labor to support physiological birth.

Exploring midwives' experiences of implementing the Labour Hopscotch Framework: A midwifery innovation.

INTRODUCTION: Midwives are ideally placed to promote physiological birth and improve women's birth experiences. Freedom of movement in labor is highly recommended as it reduces a need for obstetric interventions in labor and prevents and corrects labor complications, such as poor progress and malposition of the fetus. The Labour Hopscotch Framework (LHF) provides women and midwives with a visual depiction of the steps they can undertake to remain active and, in this way, support physiological birth processes. The objective of this study was to explore midwives' experiences of supporting women during labor with the Labour Hopscotch Framework and identify any improvements necessary to the Labour Hopscotch Framework. METHODS: A two phased mixed-method sequential explanatory design study consisting of a survey (women, n=809 and partners, n=759) and focus group (n=8 midwives) was completed to evaluate the LHF following its implementation. This article presents the findings reporting midwives' perceptions of using the Labour Hopscotch Framework with women and their birthing partners. The setting was a large urban teaching maternity hospital in Dublin, Ireland, where eight midwives practiced in the following areas: labor suite, antenatal unit, and community midwifery. RESULTS: The Labour Hopscotch Framework was described as beneficial in promoting physiological birth, using a creative, attractive visual depiction to guide women in, and before, labor. The Labour Hopscotch Framework was deemed helpful in increasing midwifery students and newly qualified midwives' confidence to provide women with tangible, supportive assistance during labor and increased partners' involvement in the labor process. CONCLUSIONS: Labour Hopscotch Framework should be more widely promoted to all women attending the hospital for maternity care and a clear explanation of each step given and demonstrated to increase women's understanding of the steps within. Labour Hopscotch training should be included in midwifery education programs.

Maternal C3 complement and C-reactive protein and pregnancy and fetal outcomes: A secondary analysis of the PEARS RCT-An mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity.

OBJECTIVES: Elevated circulating levels of complement component 3 (C3) and C-reactive protein (CRP) have been linked with adverse pregnancy outcomes. Lifestyle interventions may hold potential to ameliorate these effects. We investigated the effect of an antenatal healthy lifestyle intervention on maternal C3 and CRP concentrations and assessed their relationship with maternal and fetal metabolic markers and outcomes. STUDY DESIGN: Secondary analysis of data from the Pregnancy Exercise And Nutrition Research Study (PEARS) randomized controlled trial. METHODS: Women (n = 406) with C3 and CRP concentrations determined in early pregnancy (14-16 weeks) and/or late pregnancy (28-weeks) with corresponding fasting glucose, insulin, c-peptide, and lipid profiles were included in the analysis. Pregnancy outcomes included: diagnoses of gestational diabetes (GDM), pre-eclampsia (PET) or pregnancy induced hypertension (PIH), pre-term birth (delivery < 37 weeks), low birth weight (<2500 g), small-for-gestational age (SGA) defined using < 5th or 10th centile for birthweight and cord blood measures of glucose and lipid metabolism. T-tests investigated changes in C3 and CRP over time. Chi-square, Pearson's' correlations and multiple regression investigated relationships with outcomes. RESULTS: The PEARS intervention did not influence maternal C3 or CRP concentrations in pregnancy. There was no relationship between CRP concentrations and any maternal or infant outcome. Women who developed GDM had higher C3 concentrations in early (p = 0.01) and late pregnancy (p = 0.02). Women who developed PIH/PET had lower C3 concentrations in early (p = 0.02), but not late (p = 0.10) pregnancy. Maternal C3 concentrations in early pregnancy were a small but significant predictor of maternal insulin concentrations in early (ß = 0.40, 95% CI 0.27, 0.53; p < 0.001) and late (ß = 0.30, 95% CI 0.17, 0.43p < 0.001) pregnancy, early total cholesterol (TC), and both early and late triglycerides, LDL and HDL Cholesterol concentrations (all p < 0.001). Women who delivered SGA babies (<10th centile) had lower C3 concentrations than women who did not in both early (p < 0.001) and late pregnancy (p = 0.01). No relationship between maternal C3 or CRP and fetal glucose concentrations or lipid profiles was observed. CONCLUSION: Maternal C3 may play a role in multiple adverse pregnancy outcomes including cardiometabolic ill-health. Further research on this, and strategies to reduce C3 in a pregnant population, are warranted.

Effect of an Antenatal Lifestyle Intervention on Dietary Inflammatory Index and Its Associations with Maternal and Fetal Outcomes: A Secondary Analysis of the PEARS Trial.

We investigated the effect of an antenatal lifestyle intervention of a low-glycaemic index (GI) diet and physical activity on energy-adjusted dietary inflammatory index (E-DIITM) and explored its relationship with maternal and child health in women with overweight and obesity. This was a secondary analysis of 434 mother-child pairs from the Pregnancy Exercise and Nutrition Study (PEARS) trial in Dublin, Ireland. E-DIITM scores were calculated for early (10-16 weeks) and late (28 weeks) pregnancy. Outcomes included lipids, inflammation markers, insulin resistance, mode of delivery, infant size, pre-eclampsia, and gestational diabetes. T-tests were used to assess changes in E-DIITM. Chi-square, correlations, and multiple regression were employed to investigate relationships with outcomes. The mean (SD) age of participants was 32.45 (4.29) years with median (IQR) BMI 28.25 (26.70, 31.34) kg/m2. There was no change in E-DIITM in the controls (-0.14 (1.19) vs. -0.07 (1.09), p = 0.465) but E-DIITM reduced by 10% after the intervention (0.01 (1.07) vs -0.75 (1.05), p < 0.001). No associations were found between early pregnancy E-DIITM and maternal and child outcomes, except for increased odds of adverse cardiometabolic phenotype in women who delivered male (OR = 2.29, p = 0.010) but not female infants (OR = 0.99, p = 0.960). A low-GI antenatal intervention can reduce the inflammatory potential of diets. Sex differences should be explored further in future research.

Quality of life and sexual function after a pregnancy complicated by placenta accreta spectrum.

BACKGROUND AND AIMS: Little is known about the impact of Placenta Accreta Spectrum (PAS) on quality of life (QoL). This study aims to explore QoL and sexual function after a pregnancy complicated by PAS. METHODS: Women who experienced a pregnancy complicated by PAS were invited to complete an online survey. Two validated surveys were completed: Short Form 36 (SF-36) and Female Sexual Function Index (FSFI). The mean scores were calculated and were compared between women by pregnancy outcomes. Continuous variables were presented as mean (standard deviation (SD)) and were compared to assess for significance between groups using independent t-test and one-way analysis of variance. Categorical variables were compared using χ2 test. RESULTS: A total of 142 women responded to the survey. For the SF-36, physical health was significantly higher for women at 24-36 months postpartum compared to those from 0-6 months postpartum for physical functioning (mean difference 21.9 (95% confidence interval (CI) 10.2, 33.5), role limitation due to physical function (mean difference 32.1 (95% CI 9.4, 54.7)) and pain (mean difference 15.5 (95% CI 3.4, 30.9)). For the mental health domains, only vitality improved at 24-36 months compared to the first six months postpartum (mean difference 12.8 (95% CI 0.2, 25.5)). The mean FSFI score was 24.8 (±5.8), lower than the critical score of 26.5 indicating sexual dysfunction, and 56.8% (n = 75), scored less than 26.5. CONCLUSION: Women after a pregnancy complicated by PAS had high scores on the physical health domains of SF-36. The mental health scores were lower for all women regardless of time since birth.

Perineal management: Midwives' confidence and educational needs.

OBJECTIVE: The overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth. DESIGN: A mixed-methods sequential exploratory design was used. PARTICIPANTS AND SETTING: Midwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study. MEASUREMENTS: A questionnaire and two focus groups were used to collect the data. FINDINGS: Fifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy. KEY CONCLUSIONS: This study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies. IMPLICATIONS FOR PRACTICE: Midwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.

Limited Impact of Fetal Sex and Maternal Body Mass Index on Fetal and Maternal Insulin Resistance and Lipid Metabolism: Findings from the PEARs Study.

The intrauterine environment can have a significant impact on fetal and maternal well-being, both during pregnancy and in later life. We aimed to identify how fetal sex and maternal body mass index (BMI) influence insulin resistance and metabolic function during pregnancy with maternal BMI > 25 kg/m2. This secondary analysis assessed data from the PEARS-randomized controlled trial that recruited pregnant women with body mass indexes 25-39.9 kg/m2. Longitudinal measurements of maternal and fetal insulin resistance and metabolic function were recorded throughout pregnancy. Regression models tested the effects of fetal sex and maternal BMI on markers of metabolic function and insulin regulation. A total of 484 women and their newborns (252 (52%) males vs. 232 (48%) females) were included in the analysis. A total of 333 (69%) women were overweight and 151 (31%) were obese. Male newborns were heavier and larger than females, and had a higher rate of instrumental delivery. Males had a lower LDL, but no other markers of insulin resistance or metabolic function were affected by fetal sex. Women with obesity had elevated markers of insulin resistance and metabolic dysfunction compared with women that were overweight, but maternal BMI did not impact these variables in the fetus. Fetal sex did not impact maternal and fetal metabolic parameters in women with BMI > 25 kg/m2. However, a higher BMI caused increasingly deranged maternal blood lipid concentrations and markers of insulin resistance as pregnancy progressed. Lipid monitoring and interventions to reduce lipids during pregnancy therefore require further evaluation.