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Anaesthesia ; 76 Suppl 4: 69-75, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33682091


Infectious diseases can directly affect women and men differently. During the COVID-19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in-person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex-based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID-19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk-benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID-19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.

/epidemiología , Salud Materna , Anestesia Obstétrica , /inmunología , Femenino , Humanos , Salud Mental , Embarazo , Atención Prenatal
BMJ Open ; 11(3): e045163, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653760


INTRODUCTION: There is a need to continue primary healthcare services through digital communication for disadvantaged women living in underdeveloped areas of Pakistan, especially in the age of the coronavirus pandemic, social distancing and lockdown of communities. This project will be the first of its kind in aiming to implement a digital health literacy intervention, using smartphone and internet, to disadvantaged women through female community healthcare workers. Improved health literacy in women of reproductive years is known to promote maternal, child and family health overall. METHODS AND ANALYSIS: The study will include a baseline survey, a pre- and post-test survey and a 3-month lasting intervention on (1) hygiene and prevention and (2) coronavirus awareness and prevention. Women of reproductive years will be sampled from disadvantaged areas across the four provinces of Pakistan (Baluchistan, Khyber Pakhtunkhwa, Punjab and Sindh), and the selection criteria will be poor, semiliterate or illiterate, belonging to underdeveloped neighbourhoods devoid of universal healthcare coverage and dependent on free primary health services. A target of 1000 women will comprise the sample, with 500 women each assigned randomly to the intervention and control groups. Analysis of variance and multivariate analysis will be used for analysing the intervention's effects compared with the control group. ETHICS AND DISSEMINATION: Ethics approval for this study has been received from the Internal Review Board of the Forman Christian College University (reference number: IRB-252/06-2020). Results will be published in academic journals of repute and dissemination to the international scientific community and stakeholders will also be planned through workshops. TRIAL REGISTRATION NUMBER: NCT04603092.

Salud del Niño , Salud de la Familia , Alfabetización en Salud , Salud Materna , Atención Primaria de Salud , Femenino , Humanos , Pakistán , Ensayos Clínicos Controlados Aleatorios como Asunto
BMC Pregnancy Childbirth ; 21(1): 112, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557764


BACKGROUND: Global crises inevitably increase levels of anxiety in postpartum populations. Effective and efficient measurement is therefore essential. This study aimed to create a 12-item research short form of the 51-item Postpartum Specific Anxiety Scale [PSAS] and validate it for use in rapid response research at a time of global crises [PSAS-RSF-C]. We also present the same 12-items, in five other languages (Italian, French, Chinese, Spanish, Dutch) to increase global accessibility of a psychometric tool to assess maternal mental health. METHODS: Twelve items from the PSAS were selected on the basis of a review of their factor loadings. An on-line sample of UK mothers (N = 710) of infants up to 12 weeks old completed the PSAS-RSF-C during COVID-19 'lockdown'. RESULTS: Principal component analyses on a randomly split sample (n = 344) revealed four factors, identical in nature to the original PSAS, which in combination explained 75% of the total variance. Confirmatory factor analyses (n = 366) demonstrated the four-factor model fit the data well. Reliability of the overall scale and of the underlying factors in both samples proved excellent. CONCLUSIONS: Findings suggest the PSAS-RSF-C may prove useful as a clinical screening tool and is the first postpartum-specific psychometric scale to be validated during the COVID-19 pandemic. This offers psychometrically sound assessment of postpartum anxiety. By increasing the accessibility of the PSAS, we aim to enable researchers the opportunity to measure maternal anxiety, rapidly, at times of global crisis.

Ansiedad/epidemiología , /psicología , Salud Materna , Pandemias , Periodo Posparto/psicología , Escalas de Valoración Psiquiátrica , Psicometría/métodos , Adolescente , Adulto , Ansiedad/psicología , /virología , Análisis Factorial , Femenino , Humanos , Lactante , Recién Nacido , Salud Mental , Persona de Mediana Edad , Pandemias/prevención & control , Embarazo , Cuarentena/psicología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Traducciones , Reino Unido/epidemiología , Adulto Joven
BMC Pregnancy Childbirth ; 21(1): 114, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557768


BACKGROUND: This retrospective study aimed to identify possible intensification of mental health difficulties among women seeking support in the postpartum period during the epidemic state in Poland. We assumed that the epidemic crisis, social isolation, and restrictions in hospitals which affect pregnant and postpartum women - lack of family labors, lack of the possibility to be with the newborn when he/she is hospitalized, may increase fear and reduce psychosocial resources of women, hinder their normal process of transition to motherhood and thus contribute to the intensified severity of depressive symptoms. METHODS: The study participants were women seeking support at the on-line platform of the project 'Next Stop: Mum', which is a part of the postpartum depression prevention's program implemented by the Ministry of Health in Poland, and enables remote self-screening for the severity of the postpartum depression symptoms with the Edinburgh Postnatal Depression Scale developed by Cox and collaborators. The analyzed data in this study were obtained from 139 women: 61 filled forms from October 1 - November 10, 2019 (non-epidemic period), and 78 filled forms from February 20-March 30 (beginning of the COVID-19 epidemic), 2020. RESULTS: A statistically significant difference in the severity of postpartum depression symptoms were observed among women making a self-assessment with EPDS scale at the beginning of the COVID-19 epidemic in Poland (M = 15.71; SD = 6.23), compared to the pre-epidemic neutral period (M = 13.56; SD = 6.46). CONCLUSIONS: The results of this study indicate that the epidemic crisis may be associated with an increased need for additional caution and support of women's mental health in the postpartum period. We believe that recommendations for medical staff, policy, and families of women struggling with postpartum depression symptoms during crisis should be widespread as the second wave of COVID-19 disease may develop in the autumn-winter 2020 and spring 2021.

/epidemiología , Depresión Posparto/epidemiología , Depresión/epidemiología , Salud Materna , Pandemias , Periodo Posparto/psicología , Sistemas de Apoyo Psicosocial , Adulto , Depresión/prevención & control , Depresión/psicología , Depresión Posparto/prevención & control , Depresión Posparto/psicología , Femenino , Humanos , Recién Nacido , Salud Mental , Polonia/epidemiología , Embarazo , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Autoinforme , Autoevaluación
Nutr. hosp ; 38(1): 50-59, ene.-feb. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-198840


INTRODUCCIÓN Y OBJETIVOS: la lactancia materna (LM) es un método de alimentación infantil que aporta múltiples beneficios para la salud de los lactantes y las madres. Este estudio pretende determinar la prevalencia de la LM durante el primer año de vida de los hijos/as de una serie de mujeres que dan a luz en una clínica privada de Bizkaia, e identificar los determinantes facilitadores y los motivos de abandono. MÉTODO: estudio observacional, descriptivo, longitudinal y prospectivo de una muestra aleatoria de 453 recién nacidos (RN), reclutada entre 2016 y 2017. RESULTADOS: en total, 366 mujeres aceptaron participar en todas las fases de estudio. La prevalencia de la lactancia materna exclusiva (LME) fue del 51,7 % al inicio, del 77,1 % al alta y del 21,6 % al sexto mes; y la de la LM, del 87,1 % al inicio, del 48,4 % al sexto mes y del 20,6 % al año. Los factores facilitadores de la LME fueron: al inicio, no utilizar nido ni sacaleches; 15 días satisfacción con la LM y no utilizar chupete ni sacaleches; 4 meses satisfacción con la LM; 6 meses acudir a Grupos de Apoyo a la Lactancia (GAL) y no introducir alimentación complementaria (AC); los de la LM al año, acudir a GAL. Los principales motivos de abandono fueron: la iniciativa propia, la incorporación al trabajo y la escasa ganancia de peso del RN. CONCLUSIONES: uno de cada 5 RN recibieron LME hasta los 6 meses y LM hasta el año. Sería necesario promover estrategias que favorezcan el amamantamiento, como: suprimir el nido, desaconsejar el sacaleches y el chupete al inicio, iniciar la AC a partir del sexto mes y organizar GAL durante el primer año

INTRODUCTION AND OBJECTIVES: breastfeeding (BF) is a feeding method that provides multiple benefits for the health of infants and their mothers. This study aimed to determine the prevalence of BF during the first year of life of children of women who gave birth in a private clinic in Biscay, Basque Country, Spain, and to identify the facilitating determinants and reasons for abandonment. METHOD: an observational, descriptive, longitudinal and prospective study in a random sample of 453 newborns (NBs) recruited between 2016 and 2017. RESULTS: in all, 366 women agreed to participate in all the study phases. The prevalence of exclusive breastfeeding (EBF) was 51.7 % at baseline, 77.1 % at discharge, and 21.6 % after sixth months; and that of BF, 87.1 % at the beginning, 48.4 % at month six, and 20.6 % at one year. The facilitating factors of EBF were: at the beginning, not using a nest or breast pump; 15 days satisfaction with LM and not using a pacifier or breast pump; 4 months satisfaction with LM; 6 months attending Lactation Support Groups (GAL) and not introducing complementary feeding (CA); and those of LM at 1 year, attending GAL. The main reasons for abandonment were: own initiative, incorporation to work, and little weight gain by the NB. CONCLUSIONS: one in 5 newborns received EBF up to 6 months and BF up to one year. It would be necessary to promote strategies that favor breastfeeding, such as eliminating the nest, advising against breast pumps and pacifiers at the beginning, starting CA from the sixth month, and organizing GALs during the first year

Humanos , Femenino , Adulto , Lactancia Materna/métodos , Nutrición del Lactante , Causalidad , Salud del Niño , Salud Materna , Estudios Longitudinales , Estudios Prospectivos , Análisis Estadístico
Artículo en Inglés | MEDLINE | ID: mdl-33573190


In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infant mortality. A thematic analysis of qualitative data including interviews and surveys and a quantitative spatial analysis using Geographic Information Systems was applied. Spatial inequalities were found which may lead to avoidable infant mortality. Inequalities exist in freedom of choice and autonomy in care, within a medicalized system. Changes in approach to and organization of care would further enhance equitable spatial access to care in maternal health and reduce avoidable infant mortality.

Mortalidad Infantil , Salud Materna , Femenino , Humanos , Lactante , Políticas , Portugal/epidemiología , Embarazo
JAMA ; 325(7): 658-668, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33591345


Importance: Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child. Objective: To examine associations between maternal gestational CVH and offspring CVH. Design, Setting, and Participants: This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48% of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada. Exposures: Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics. Main Outcomes and Measures: Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers. Results: Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95% CI, 3.03-12.82]). Conclusions and Relevance: In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.

Salud del Adolescente , Sistema Cardiovascular , Salud del Niño , Salud Materna , Embarazo , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Niño , Estudios de Cohortes , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Prevalencia
BMC Pregnancy Childbirth ; 21(1): 79, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485310


BACKGROUND: Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India's most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. METHODS: Secondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program's effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level. RESULTS: SHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics. CONCLUSIONS: The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.

Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/estadística & datos numéricos , Promoción de la Salud/organización & administración , Complicaciones del Trabajo de Parto/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto , Femenino , Educación en Salud/estadística & datos numéricos , Humanos , India , Salud Materna , Complicaciones del Trabajo de Parto/epidemiología , Embarazo , Atención Prenatal/organización & administración
Rev. enferm. UFPE on line ; 15(1): [1-13], jan. 2021. ilus
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1145732


Objetivo: elaborar um protótipo para um aplicativo móvel a fim de ampliar a disponibilidade de apoio social para as gestantes. Método: trata-se de um estudo misto, tipo transversal, realizado com gestantes usuárias da atenção básica à saúde de unidades vinculadas ao Sistema Único de Saúde (SUS). Elaborou-se, a partir dos resultados obtidos na pesquisa, um protótipo para aplicativo móvel no modelo SCRUM para sistema operacional Android. Resultados: nominou-se o protótipo de Apoia. Revelam-se as funcionalidades do Apoia de proporcionar a interação entre a gestante e as pessoas por ela escolhidas para comporem a rede social, possibilitar a troca de mensagens de apoio, resgatar a disponibilidade das pessoas em oferecer ajuda, assessorando, dessas formas, a mulher grávida no processo de viabilização do apoio social. Conclusão: acredita-se que o Apoia é um recurso inovador, com o intuito de construir e ampliar o apoio social para gestantes usuárias a partir da construção e flexibilização da rede social com o uso das tecnologias da informação e comunicação na saúde.(AU)

Objective: to develop a prototype for a mobile application in order to increase the availability of social support for pregnant women. Method: this is a cross-sectional, mixed study conducted with pregnant women who use basic health care in units linked to the Unified Health System (UHS). Based on the results obtained in the research, a prototype for a mobile application in the SCRUM model for the Android operating system was elaborated. Results: the prototype of Apoia was named. The functionalities of Apoia are revealed: to provide interaction between the pregnant woman and the people she has chosen to make up the social network, to enable the exchange of support messages, to rescue people's willingness to offer help, thus assisting the pregnant woman in the process of making social support possible. Conclusion: It is believed that Apoia is an innovative resource, with the aim of building and expanding social support for pregnant users from the construction and flexibility of the social network with the use of information and communication technologies in health.(AU)

Objetivo: desarrollar un prototipo de aplicación móvil con el fin de aumentar la disponibilidad de apoyo social para mujeres embarazadas. Método: se trata de un estudio mixto, transversal, realizado con mujeres embarazadas usuarias de atención primaria de salud en unidades vinculadas al Sistema Único de Salud (SUS). A partir de los resultados obtenidos en la investigación se elaboró un prototipo de aplicación móvil en el modelo SCRUM para sistema operativo Android. Resultados: se nombró el prototipo de Apoia. Las características de Apoia se revelan para brindar interacción entre la gestante y las personas elegidas por ella para componer la red social, posibilitar el intercambio de mensajes de apoyo, rescatar la disponibilidad de personas para ofrecer ayuda, asesorando así a la mujer. embarazada en el proceso de habilitar el apoyo social. Conclusión: se cree que Apoia es un recurso innovador, con el objetivo de construir y ampliar el apoyo social a usuarias embarazadas desde la construcción y flexibilización de la red social con el uso de tecnologías de la información y la comunicación en salud. (AU)

Humanos , Femenino , Embarazo , Atención Primaria de Salud , Apoyo Social , Mujeres Embarazadas , Tecnología de la Información , Medios de Comunicación Sociales , Aplicaciones Móviles , Salud Materna , Redes Sociales en Línea , Salud Materno-Infantil , Estudios Transversales
Rev. enferm. UFPE on line ; 15(1): [1-14], jan. 2021. ilus, tab
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1145809


Objetivo: verificar, na literatura, as características das consultas de pré-natal às gestantes para oferecimento do teste rápido para o Vírus da Imunodeficiência Humana. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, sem limite temporal, realizado por meio das bases de dados BDENF, LILACS, MEDLINE, CINAHL, Scopus e Web of Science. Incluíram-se artigos originais em português, inglês ou espanhol. Analisaram-se os dados de forma descritiva. Resultados: identificaram-se 1726 publicações, das quais dez compuseram a amostra. Verificaram-se, em geral, as características do estudo e as estratégias para a melhoria das consultas, do aconselhamento e do oferecimento de testes efetivos. Conclusão: conclui-se que a análise dos estudos permitiu a síntese de características, conteúdos, recursos e técnicas de abordagem, além de lacunas e dificuldades tanto dos profissionais quanto das gestantes para a efetivação do aconselhamento para a execução dos testes rápidos para o Vírus da Imunodeficiência Humana em gestantes.(AU)

Objective: to verify, in the literature, the characteristics of prenatal consultations to pregnant women to offer the rapid test for the Human Immunodeficiency Virus. Method: It is a bibliographic, descriptive, integrative literature review type study, without time limit, carried out through the BDENF, LILACS, MEDLINE, CINAHL, Scopus and Web of Science databases. Original articles in Portuguese, English or Spanish are included. The data were analyzed in a descriptive manner. Results: 1726 publications were identified, of which ten composed the sample. In general, the characteristics of the study and the strategies for the improvement of consultations, counseling and offer of effective tests were verified. Conclusion: it is concluded that the analysis of the studies allowed the synthesis of characteristics, contents, resources and techniques of approach, besides gaps and difficulties of both professionals and pregnant women for the realization of counseling for the execution of rapid tests for the Human Immunodeficiency Virus in pregnant women.

Objetivo: verificar, en la literatura, las características de las consultas prenatales a gestantes para ofrecer la prueba rápida del Virus de Inmunodeficiencia Humana. Método: se trata de una revisión bibliográfica, descriptiva, integradora de la literatura, sin límite de tiempo, realizada utilizando las bases de datos BDENF, LILACS, MEDLINE, CINAHL, Scopus y Web of Science. Se incluyeron artículos originales en portugués, inglés o español. Los datos se analizaron de forma descriptiva. Resultados: se identificaron 1726 publicaciones, de las cuales diez componen la muestra. En general, se verificaron las características del estudio y las estrategias para mejorar las consultas, el asesoramiento y la oferta de pruebas efectivas. Conclusión: se concluye que el análisis de los estudios permitió la síntesis de características, contenidos, recursos y técnicas de abordaje, además de vacíos y dificultades tanto de los profesionales como de las gestantes para la efectividad del asesoramiento para la ejecución de las pruebas rápidas para el Virus de la Inmunodeficiencia Humana en mujeres embarazadas.(AU)

Humanos , Femenino , Embarazo , Atención Prenatal , Atención Primaria de Salud , Infecciones por VIH , Infecciones por VIH/diagnóstico , Síndrome de Inmunodeficiencia Adquirida , VIH , Mujeres Embarazadas , Salud Materna , MEDLINE , LILACS
Epidemiol Psychiatr Sci ; 30: e6, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33416045


AIMS: There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. METHODS: Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. RESULTS: Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). CONCLUSIONS: Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

Desarrollo Infantil , Renta , Salud Materna/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Madres/psicología , Conducta Social , Adulto , Niño , Preescolar , Estudios de Cohortes , Emociones , Femenino , Humanos , Trastornos Mentales/psicología , Madres/estadística & datos numéricos , Embarazo , Estudios Prospectivos , Singapur , Clase Social , Factores Socioeconómicos
Reprod Health ; 18(1): 10, 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33461593


INTRODUCTION: The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. METHODS: A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. RESULTS: The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. CONCLUSION: Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.

Servicios de Salud Materna , Salud Materna , Pandemias , Complicaciones Infecciosas del Embarazo , Lactancia Materna , Parto Obstétrico , Violencia Doméstica , Femenino , Equidad de Género , Humanos , Salud Mental , Embarazo
BMC Public Health ; 21(1): 176, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478445


The response to the coronavirus outbreak and how the disease and its societal consequences pose risks to already vulnerable groups such those who are socioeconomically disadvantaged and ethnic minority groups. Researchers and community groups analysed how the COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity, and discussed future strategies on how best to engage and involve local groups in research to improve outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity. Discussions centred around: access, engagement and quality of care; racism, discrimination and trust; the need for engagement with community stakeholders; and the impact of wider social and economic inequalities. Addressing biomedical factors alone is not sufficient, and integrative and holistic long-term public health strategies that address societal and structural racism and overall disadvantage in society are urgently needed to improve health disparities and can only be implemented in partnership with local communities.

Disparidades en el Estado de Salud , Salud Materna , Características de la Residencia/estadística & datos numéricos , /epidemiología , Diversidad Cultural , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Salud Materna/etnología , Áreas de Pobreza , Embarazo , Reino Unido/epidemiología