Experience Implementing a Public Health Surveillance System Designed for Fathers of Infants on a South Dakota American Indian Reservation.

INTRODUCTION: Paternal behaviors and attitudes during pregnancy are not known. A health survey for fathers of recently born infants was developed to be administered concurrently with a maternal survey to assess parental behaviors and attitudes before, during and after pregnancy. METHODS: Participants were parents of 149 American Indian infants born from April 1 and Dec. 31, 2015 who were recruited prospectively from data of all births in prespecified reservation counties representing Sisseton Wahpeton Oyate of the Lake Traverse Reservation. Data collection was via hard-copy or online survey. RESULTS: Response rate among mothers was 62 percent (n=92). Of 149 births, 126 listed a father on the birth certificate and 51 percent (n=64) of these completed surveys on average 4.7 months post-birth. Healthwise, 90 percent of fathers reported being overweight or obese, but a small percent visited a health care worker in the previous year to be checked for diabetes (11 percent) or hypertension (14 percent). Among fathers who smoked in the last two years (73 percent), 77 percent of the mothers also smoked compared to 20 percent of mothers smoking if the father did not smoke. Nearly three-fourths of fathers were supportive of breastfeeding (70 percent), and mothers whose partners were supportive were more likely to breastfeed than those with unsupportive partners (91 percent vs. 50 percent, respectively. The majority of fathers attended prenatal visits (57 percent), the delivery (88 percent), and some or all well-baby checks (73 percent) with the main barrier stated as not being able to take time off work. CONCLUSION: Conducting a health survey with both fathers and mothers in a reservation setting is feasible and the father's attitudes and behaviors related to breastfeeding and smoking were associated with maternal health behaviors. Most fathers attended health care visits with the mother, but they were not being screened for health conditions despite a large proportion being overweight and smokers. Prenatal and antenatal visits may provide an opportune time to engage fathers and address paternal health issues.

Alcohol consumption and other maternal risk factors for fetal alcohol syndrome among three distinct samples of women before, during, and after pregnancy: the risk is relative.

Data were obtained from three samples of women of childbearing age. One sample of women is from prenatal clinics serving Plains Indian women. The second sample is of women from the Plains whose children were referred to special diagnostic developmental clinics, as their children were believed to have developmental issues consistent with prenatal alcohol consumption. The third sample is of women from South Africa, each of whom has given birth to a child diagnosed with full fetal alcohol syndrome (FAS). Data across samples conform to expected trends on many variables. For example, the maternal age at time of pregnancy, a major risk factor for FAS, ranged from a mean of 23.5 years for the prenatal clinic sample, to 23.8 years for the developmental clinic sample, to 27.6 for the sample of women who have delivered children with FAS. Other variables of maternal risk for FAS expected from the extant literature, such as high gravidity and parity, binge drinking, heavy intergenerational drinking in the mother's extended family and immediate social network, and length of drinking career, were compared across the three samples with variable results. However, normative measures of drinking problems are unreliable when reported across cultures. An unexpected finding from this three-sample comparison was the differential risk found when comparing U.S. women to South African women. Women in the U.S. Plains Indian samples report a high consumption of alcohol in a binge pattern of drinking, yet there is less detectable damage to the fetus than among the South African women. Body mass index (BMI) and lifelong and current nutrition may have a substantial impact, along with the above factors, in relative risk for an FAS birth. The level of risk for producing a child with FAS is influenced by environmental and behavioral conditions that vary between populations and among individual women. Also, because many syndromes are genetically based, there is a need for full behavioral and genetic histories of the mother, family, and child being studied. Collecting extensive behavioral information as well as genetic histories will provide the requisite information for making an accurate diagnosis of FAS.