Exploring lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the COVID-19 lockdown in China: A phenomenological study.

OBJECTIVE: We aimed to explore the lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the early stage of China's COVID-19 lockdown and potential measures to address the challenges. DESIGN: This is a phenomenological qualitative study. SETTING: The study was carried out in a leading teaching hospital in Southwest China. PARTICIPANTS: We recruited 15 informal caregivers for healthy pregnant women on routine antenatal visits about six months after China launched the city-wide lockdown and other control measures for COVID-19, including 10 males and 5 females with diverse demographic backgrounds. MEASURES AND FINDINGS: The research team developed a demographic form and an interview outline with key questions, conducted semi-structured interviews with the informal caregivers, and analyzed the data using the Colazzie's method. Five themes of lived experiences were revealed, i.e., increased caregiving burdens, disruption of routines in family life, lack of accurate information and knowledge, active role adjustment, and positive attitudes and coping in a difficult time. Some caregivers reacted positively to the lockdown experience and saw it as an opportunity to rethink their lives and improve family relations. KEY CONCLUSIONS: The informal caregivers experienced increased physical and psychological burdens. Strategies such as adoption of a less frequent prenatal visit schedule, use of tele-medicine technologies, and provision of accurate information and knowledge may help to ease the increased informal caregiving burdens. Psychological counseling, community services and disaster response policies specially targeting pregnant women and their informal caregivers may also be valuable resources. IMPLICATIONS FOR PRACTICE: Attention should be drawn to the group of informal caregivers for pregnant women during a COVID-19 lockdown, including professional assistance delivered by nursing and other related professionals. Measures are called for to minimize exposure opportunities such as adoption of a new prenatal care schedule and tele-medicine technologies. Patient education with reliable information should be provided, preferably by nursing staff and physicians. Social support efforts including professional mental counseling may added and work with other resources such as community services and policy makers.

Informal caregiver burden and influencing factors in gynaecological oncology patients hospitalized for chemotherapy: a cross-sectional study.

OBJECTIVE: To determine the level and influencing factors of informal caregiver burden in gynaecological oncology inpatients receiving chemotherapy. METHODS: This cross-sectional study enrolled gynaecological oncology patients and their informal caregivers between May 2018 and November 2018 and measured the caregivers' burden using the Caregiver Burden Inventory. The influencing factors were evaluated with univariate regression analysis and multivariate linear stepwise regression analysis. RESULTS: A total of 138 patients and their informal caregivers completed the questionnaire. The mean ± SD total informal caregiver burden score was 53.18 ± 10.97. The highest mean ± SD score was recorded in the dimension of time-dependent burden (14.28 ± 2.74), followed by developmental burden (13.65 ± 2.15), physical burden (10.52 ± 2.07), social burden (7.61 ± 2.58) and emotional burden (7.12 ± 1.43). Multivariate analysis showed that the informal caregiver's sex, relationship to the patient, daily duration of care, presence of chronic health problems and the duration of the patient's disease were factors influencing the level of caregiver burden. CONCLUSIONS: The informal caregivers of gynaecological cancer patients hospitalized for chemotherapy experience a moderate level of burden. Nursing measures should be considered to reduce informal caregiver burden and improve the quality of lives of both patients and their caregivers.

Exploring the breastfeeding knowledge level and its influencing factors of pregnant women with gestational diabetes mellitus.

BACKGROUND: Studies reveal that promoting the breastfeeding knowledge level help to improve breastfeeding behaviors. Promoting breastfeeding knowledge is a simple and economical way to increase breastfeeding rates. However, there are no studies focus on the level of breastfeeding knowledge and factors influencing the knowledge in women with gestational diabetes mellitus (GDM), which is defined as any degree of glucose tolerance impairment first diagnosed during pregnancy. Thus, the objectives of this study were to investigate the breastfeeding knowledge level of GDM pregnant women and explore factors influencing the knowledge level. METHODS: Cross-sectional survey and convenience sampling were conducted in this study. The sociodemographic characteristics, caregivers in pregnancy, knowledge source, breastfeeding status and breast status information of participants were collected. Breastfeeding Knowledge Scale was used to assess the breastfeeding knowledge level of pregnant women with GDM. Multiple linear regression was used to analyze the influence factors of breastfeeding knowledge level in this study. RESULTS: A total of 226 questionnaires were issued and finally 212 valid questionnaires were collected. Some misconceptions still existed (e.g. 'breastfeeding cannot prevent your baby from being overweight' and 'it is advisable to breastfeed 3-4 times per day within 2-3 days after delivery'), although women with GDM had a good score of breastfeeding knowledge (mean score: 103.5 ± 10.4). Multiple linear regression analysis found that gestational age, family per capita monthly income, educational level, knowledge source were the independent protective factors for breastfeeding knowledge and minority nationality was the independent risk factor. The educational level had the greatest influence on the breastfeeding knowledge level of GDM pregnant women (ß = 0.210, t = 2.978, P = 0.003). CONCLUSION: GDM pregnant women with insufficient gestational age, low educational level, low family per capita monthly income and single access to knowledge should be included in the focus of health education on breastfeeding. In-depth and systematic health education should be conducted for pregnant women with GDM to improve their breastfeeding rate.

Investigation on the status of oral intake management measures during labor in China.

The World Health Organization recommended that the oral intake of low-risk pregnant women during labor should not be restricted. Hospitals in different countries take different measures to manage the intake during labor, but it is not clear about the current situation of oral intake management measures in the hospital during labor in China. Thus, the objective of this study was to investigate the current situation of oral intake management measures during labor in China, so as not only provide references for developing appropriate midwifery technology training and formulating relevant policies, but also provide a basis for exploring and implementing better oral intake management measures in the future.A cross-sectional survey was conducted. From December 2017 to November 2018, the oral intake management measures of 1213 hospitals in 22 provinces, cities, and autonomous regions in China were investigated by a self-designed questionnaire. χ test was used for statistical analysis.Different hospitals in China have adopted different oral intake management measures. Among the 1213 hospitals, 939(77.4%) hospitals took measures to allow pregnant women to bring the easily digestible food, 813(67.0%) hospitals took measures to allow pregnant women to eat what she wanted to eat. Few hospitals provide pregnant women with oral nutrition solution or provide a suitable diet for pregnant women. Thirty-four (2.8%) hospitals still restrict pregnant women's fluid intake.Oral intake management measures that are more suitable for Chinese pregnant women should be explored to better ensure the women energy needs and they safely go through childbirth.

Continuous feeding versus intermittent bolus feeding for premature infants with low birth weight: a meta-analysis of randomized controlled trials.

BACKGROUND/OBJECTIVES: Clinical risks and advantages of both continuous feeding and intermittent feeding for preterm infants have been presented in previous studies. To determine the most appropriate feeding method for low-birth-weight infants, a meta-analysis was conducted. SUBJECTS/METHODS: Articles related to this topic were searched in PubMed, EMBASE, and Cochrane Library electronic database from the onset to May 2019. Heterogeneity analysis was performed with Chi-square and I2 test. Pooled analysis was based on fixed effects model, if heterogeneity between the eligible studies was negligible (I2 < 50%, P > 0.05). In contrast, a random effects model was carried out. The quality of including studies were evaluated by Cochrane assessment tool. RESULTS: A total of 1030 articles identified. Altogether, eight articles including 707 infants were included in final analysis based on eligibility criteria. In continuous feeding infants, time to achieving full feeds was longer (weight mean difference 0.98 (95% CI 0.26-1.71, P = 0.008) days) compared with intermittent feeding infants. Pooled analysis indicated there were no significant difference in other variables such as feeding intolerance, duration of hospitalization, days to regain birth weight, days to first successful oral feeding, duration of parenteral feeding, weight growth, length increment, head circumference growth, proven necrotizing enterocolitis, and probable necrotizing enterocolitis. In subgroup analysis for birth weight (<1000 g and >1000 g), we did not identify significant difference in time to full feeds, time to regain birth weight, and duration of hospitalization. CONCLUSIONS: Intermittent feeding may be more beneficial for low-birth weight infants, However, well-designed studies and evidenced-based clinical practice are required to determine the most appropriate feeding method for premature infants with low birth weight.

[Effect of Individualized Intervention on Postpartum Breast-feeding Behavior after Cesarean Section].

OBJECTIVE: To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section (CS). METHODS: 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group (171 cases) and control group (170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups. RESULTS: There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups (P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group (P < 0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group (P < 0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge. CONCLUSION: The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.

The association of body composition with the risk of gestational diabetes mellitus in Chinese pregnant women: A case-control study.

Studies have found that the measurement of body composition can be used to identify the gestational diabetes mellitus (GDM) risk in pregnant women. However, few studies focused on the relationship between body composition and GDM development in low GDM risk population. Thus, the objective of this study was to examine the association between body composition and the development of GDM in pregnant women with low risk of gestational diabetes.A retrospective case-control study was conducted. We reviewed the medical records of 3965 pregnant women who had body composition measurement from March, 2016 to May, 2018 in our hospital. Their sociodemographic, clinical data, and body composition information were collected from medical record. Multiple logistic regression analyses were used.A total of 2698 subjects were eligible for the study. The mean age of the gravidas was 30.95 ±â€Š4.01 years old. Of all gravidas, 462 had gestational diabetes. Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy body mass index (BMI) (odds ratio = 1.786, 95% confidence interval = 1.112-2.866, P = .02). The age and extracellular water/intracellular water ratio were independently associated with gestational diabetes.Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy BMI. Assessment of body composition may provide important guidance to identify gestational diabetes in pregnant women with low gestational diabetes risk.

Relationship between the IADPSG-criteria-defined abnormal glucose values and adverse pregnancy outcomes among women having gestational diabetes mellitus: A retrospective cohort study.

To explore the influence of the 75 g oral glucose tolerance test (OGTT) on pregnancy outcomes and to determine the risk factors for adverse outcomes among women with gestational diabetes mellitus (GDM).This retrospective cohort study was conducted among women who had GDM and were treated between January 1, 2015 and December 31, 2017. The diagnostic criteria for GDM were proposed by the International Diabetes and Pregnancy Research Organization (IADPSG) in 2010. Women with GDM were stratified according to the number of abnormal OGTT values or the presence/absence of adverse pregnancy outcomes. Maternal characteristics, OGTT values, pregnancy outcomes, and the relationship between the latter 2 were analyzed.In total, 3221 pregnant women with GDM were included. The incidence of adverse outcomes was affected by maternal age (28-37 years, in particular; odds ratio [OR], 1.403; 95% confidence interval [CI], 1.037-1.899; P = .028), days of pregnancy (OR, 0.904; 95% CI, 0.894-0.914; P < .001), gestational weight gain (OR, 1.018; 95% CI, 1.000-1.036;, P = .048), and age of menarche (OR, 0.925; 95% CI, 0.863-0.992; P = .029). Both fasting plasma glucose (FPG) and 2-h OGTT were positively correlated with adverse outcomes, of which FPG was more predictive (FPG: OR, 1.143; 95% CI, 1.007-1.297; P = .038; 2-h OGTT: OR, 1.074; 95% CI, 1.018-1.133; P = .009). Meanwhile, higher abnormal OGTT values were associated with significantly increased risks of antenatal insulin treatment, cesarean delivery, premature delivery, gestational hypertension, premature rupture of membranes, preeclampsia, macrosomia, neonatal asphyxia, and full term low weight infants.OGTT values and the number of abnormal glucose are associated with various adverse pregnancy outcomes. Stratified management is recommended for pregnant women with GDM, especially those with fasting hyperglycemia and/or 3 abnormal OGTT values.

[Factors affecting maternal physical activities: an analysis based on the structural equation modeling].

OBJECTIVE: To analyze the factors affecting maternal physical activities at different stages among pregnant women. METHODS: Self-designed questionnaires were used to investigate the physical activities of women in different stages, including 650 in the first, 650 in the second, and 750 in the third trimester of pregnancy. The factors affecting maternal physical activities were analyzed using the structural equation model that comprised 4 latent variables (attitude, norm, behavioral attention and behavior) with observed variables that matched the latent variables. RESULTS: The participants ranged from 18 to 35 years of age. The women and their husbands, but not their mothers or mothers-in-law, were all well educated. The caregiver during pregnancy was mostly the mother followed by the husband. For traveling, the women in the first, second and third trimesters preferred walking, bus, and personal escort, respectively; the main physical activity was walking in all trimesters, and the women in different trimester were mostly sedentary, a greater intensity of exercise was associated with less exercise time. Structural equation modeling (SEM) analysis showed that the physical activities of pregnant women was affected by behavioral intention (with standardized regression coefficient of 0.372); attitude and subjective norms affected physical activity by indirectly influencing the behavior intention (standardized regression coefficients of 0.140 and 0.669). CONCLUSIONS: The pregnant women in different stages have inappropriate physical activities with insufficient exercise time and intensity. The subjective norms affects the physical activities of the pregnant women by influencing their attitudes and behavior intention indirectly, suggesting the need of health education of the caregivers during pregnancy.

[A Survey and Analysis of Exercise Among Pregnant Women Conducted Using the Theory of Reasoned Action].

BACKGROUND: Prior research has highlighted the significant relationship between gestational weight gain and pregnancy outcomes. Exercise is one of the main factors that affects body weight. Therefore, exercising appropriately during pregnancy is an important activity for promoting healthy pregnancy outcomes. PURPOSE: To explore the status and features of maternal exercise during pregnancy and to analyze the related influence factors using the "theory of reasoned action" in order to provide evidence-based guidance on exercise during pregnancy. METHODS: Convenience sampling was used to recruit pregnant women from four hospitals of different administrative levels in Chengdu, China. A self-developed questionnaire was used to collect data. Data were input using Epidata and analyzed using SPSS 21.0. RESULTS: Data provided by 587 pregnant women in their first trimester, 522 in their second trimester, and 522 in their third trimester were used in analysis. Significant differences were found between the three groups in terms of housework loading and lifting. Further, participants in the third trimester were significantly more likely to exercise less than 3 times per week and less than 30 minutes per session than their first and second trimester peers (p < .001). Structural equation modeling identified that: behavior intention had a significant effect on level of physical activity; attitudes and norms affected behavior by affecting intention; monthly income and educational background affected behavior by influencing attitude; and educational background affected behavior by influencing perceived norms. CONCLUSIONS: The findings of the present study support that personal situation, the family, and social norms impact the behavior of women significantly more during pregnancy than before pregnancy.

[A Survey of Maternal Dietary Behavior Based on Theory of Reasoned Action].

OBJECTIVE: To detect the diet behavior and influencing factors of related behavior at different stages among pregnant women. METHODS: Based on the Theory of Reasoned Action (TRA), literature review, expert evaluation and preliminary investigation, we designed and finalized three questionnaires. Diet behaviors among women in early term, medium term and late term were investigated by using the questionnaires. RESULTS: 624 early term, 619 medium term and 738 late term valid questionnaires were returned. Participants ranged from 18 to 45 years of age. 74% pregnancy body mass index (BMI) was within the normal range. More than 43% care taking was provided by the mother, followed by the husband. The participants had a good eating behavior on the whole. At 3 stages, carbohydrate intake, protein intake and fat intake were no significant difference when compared with that of recommended value (P> 0. 05). The pregnant women intaked insufficient cereal, beans, dairy and aquatic products, while fruit and nuts were more than needed (P<0. 05). Subjective norms influenced their eating behavior indirectly through influencing their behavior attitude and behavioral intention. The attitude could influence behavior directly without involving the intention. CONCLUSION: The participants had relatively good diet behavior, but still had problems on food choice and a reasonable combination of a variety of food. Subjective norms influenced their behavior attitude and behavioral intention. The mother had the strongest influence on the pregnant woman's diet attitude and behavioral intention among all those had direct contact with the pregnant woman.

Mental disorders of pregnant and postpartum women after earthquakes: a systematic review.

OBJECTIVE: The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action. METHODS: A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes. RESULTS: Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations. CONCLUSIONS: Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.

Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVES: We performed a systematic review and meta-analysis to assess the effects of physical activity in preventing gestational diabetes mellitus (GDM). SEARCH STRATEGY: We searched the literature in six electronic databases and bibliographies of relevant articles. SELECTION CRITERIA: We included randomised controlled trials on pregnant women who did not have GDM and other complications previously and had increased physical activity as the only intervention. The risk of developing GDM was documented separately for the intervention and control groups. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data and assessed quality independently. Data from the included trials were combined using a fixed-effects model. The effect size was expressed as relative risk (RR) and 95% CI. MAIN RESULTS: Of the 1110 studies identified, six randomised controlled trials met the inclusion criteria. In three trials, the incidence of GDM was lower in the intervention group than in the control group, whereas two trials showed a higher incidence of GDM in the intervention group and the remaining trial found no GDM in either the intervention or control group. The meta-analysis resulted in a relative risk (RR) of GDM of 0.91 (95% CI 0.57 to 1.44), suggesting no significant difference in the risk of developing GDM between the intervention and the control groups. No indication of publication bias was found. CONCLUSIONS: Evidence was insufficient to suggest that physical activity during pregnancy might be effective to lower the risk of developing GDM.

[The regulation of Akt signaling on axonal density after hypoxic-ischemic brain injury in neonatal rat].

OBJECTIVE: To investigate the activity of protein kinase B (Akt) and its downstream protein, glycogen synthase kinase-3beta (GSK-3beta) under hypoxia-ischemia (HI), and the possible regulation for axonal density. METHODS: Postnatal day 10 SD rats were suffered the right common carotid artery ligation and 8% mixture of oxygen and nitrogen hypoxia 2.5 h to produce HI model. The expression of total and phosphorylated Akt and GSK-3beta was detected by western blot after HI. After pretreatment of Akt inhibitor, wortmannin or LY294002, Western blot detect the expression of total and phosphorylated of Akt, GSK-3beta at 4 h and 24 h after HI. After pretreatment of wortmannin, axonal density was determined by Bielschowsky silver impregnation, and histological injury was evaluated by hematoxylin and eosin (HE) staining. RESULTS: The expression of total Akt and GSK-3beta remained unchanged after HI. p-Akt protein significantly decreased at 0.5 h, increased at 2 h and reached the highest at 4 h, returned to baseline at 8 h, declined at 24 and 48 h after HI, and finally returned to baseline again at 72 h compared with that of sham controls, p-GSK-3beta protein decreased at 0. 5 h, increased at 2 h, reached the highest at 4 h, returned to baseline at 8 and decreased at 24 h, reached the lowest at 48 h, and returned to baseline at 72 h. Wortmannin or LY294002 intervention didn't change the expression of total Akt and GSK-3beta, while decrease the p-Akt and p-GSK-3beta expression. HI cause decreased axonal density, and the histological injury of brain. Wortmannin pretreatment could aggravate the histological injury and decrease axonal density after HI. CONCLUSION: The Akt pathway is involved in axonal density and histological brain injury after HI in neonatal rat.