Investigation of maternal breastfeeding guarantee policy needs and influencing factors: a cross-sectional study in China.

Background: The promotion of breastfeeding is an important strategy to prevent neonatal death and improve maternal and infant health. But Chinese efforts to improve breastfeeding practices have not been particularly effective. There is still a long way to go to achieve the national health development goals. We aimed to explore the maternal demand for breastfeeding guarantee policy in China and to determine the impact of a range of socio-demographic and neonatal-related variables on breastfeeding guarantee policy demand. Methods: The study was carried out in the Obstetrics and Gynecology hospital of Shanghai, one of China's earliest provincial and municipal maternal and child health care institutions. From June to November 2021, 1,292 women were recruited for the cross-sectional study in child health clinic. We collected relevant socio- demographic and neonatal-related data. Maternal breastfeeding needs were measured through a self-designed questionnaire on breastfeeding guarantee policy demands of mothers. Results: The mean score of breastfeeding guarantee policy demand was 4.42 ± 0.51. There were statistically significant differences in the effects of maternal age, education level, family income per capita (Yuan), medical payment type, baby age, work status, and current feeding methods on the demand for breastfeeding guarantee policies (P < 0.05). Multiple linear regression analyses showed that higher education level (B = 4.437, P < 0.001), baby age (B = 2.150, P = 0.002), and current feeding methods (B = 2.754, P = 0.005) were significantly associated with a higher demand for a breastfeeding guarantee policy, the effect of medical payment type is the most influencing factor (B = -7.369, P < 0.001). Conclusions: The maternal needs for breastfeeding guarantee policy are multi-faceted and urgent. In the process of improving and implementing policies, the government and relevant departments should take into account the actual needs of women who have different education levels, baby ages, family economics, and feeding methods.

Coping Profiles and Differences in Psychological Distress and Quality of Life in Clients Undergoing Assisted Reproductive Techniques: A Latent Profile Analysis.

Purpose: Receiving assisted reproductive technology is stressful due to its long-lasting process, which might pose negative impacts on clients' psychological well-being and quality of life. This study was to investigate coping profiles among couples undergoing assisted reproductive technology and examine their associations with psychological distress and quality of life. Methods: This cross-sectional study was conducted at the IVF center of a specialized hospital in Shanghai, China. Of 502 eligible clients completed a structured, online survey of socio-demographic information, Dyadic Coping Inventory, Kessler Psychological Stress Scale, and Fertility quality of life. Coping profiles were identified using latent profile analysis and differences between identified profiles on psychological distress and quality of life were examined using analyses of covariance. Results: A three-profile solution was supported: low dyadic coping group (n = 168, 33.50%), moderate dyadic coping group (n = 241, 48.00%), and high dyadic coping group (n = 93, 18.50%). Significant differences between those groups were found in psychological distress and quality of life. Conclusion: The findings of this study have revealed dyadic coping profiles in clients undergoing assisted reproductive technology, which are differentially associated with psychological distress and quality of life.

Translation and validation of the Breastfeeding Motivation Scale in China.

BACKGROUND: There are several versions of the Breastfeeding Motivation Scale (BMS), which have been shown to measure maternal breastfeeding motivation, but there is not a Chinese version yet. The study aimed to translate the BMS into Chinese and subsequently assess its psychometric properties among Chinese mothers during the postpartum period. METHODS: The study was composed of two phases. The translation of BMS closely followed the principals of good practices. Phase 1 included a comprehensive translation, back-translation, cross-cultural adaptation, and pretest to develop the Chinese version of the BMS. From 1 December 2021 to 1 July 2022, the Chinese version of the BMS was administered to 206 postnatal mothers in our maternity wards to assess its psychometric properties. Phase 2 involved psychometric property testing, including testing of the internal consistency, test-retest reliability, content validity, construct validity, convergent validity and discriminant validity. RESULTS: Minor modifications in four items were recommended after translations. The Cronbach's α coefficient of the Chinese version of the BMS was .887, and the intraclass correlation coefficient was .897 (P < 0.001). The model fit was acceptable (χ2/df = 2.40, P < 0.001, RMSEA = 0.08, CFI = 0.91, IFI = 0.92 and TLI = 0.90) according to the confirmatory factor analysis. The composite reliability values corresponding to each latent variable were 0.733 ~ 0.926, and the average variance extracted values were 0.476 ~ 0.653. The correlations among the five measured variables were all lower than .85 and the square roots of average variance extracted from the variable were greater than the interconstruct correlations among the five measured variables in the model. CONCLUSIONS: The Chinese version of the BMS has good reliability and validity and provides a reliable assessment tool for measuring maternal breastfeeding motivation. It also provides support to develop culturally sensitive interventions for Chinese mothers' who are breastfeeding.

The prevalence of trimester-specific dietary supplements and associated factors during pregnancy: An observational study.

Objectives: This study aimed to assess the prevalence of trimester-specific dietary supplements (DS)s use and their possible correlates during pregnancy. Method: Pregnant women were convenience sampled and recruited from a comprehensive obstetric care center in Shanghai, China. Data relating to the use of DS during pregnancy, social support and other social-demographic and obstetric data were collected. Trimester-specific DS use and factors related DS were explored. Results: Of the 2803 women participating in this study, 94.8%, 96.2%, 93.8%, and 94.4% reported the use of at least one DS during pregnancy (all trimesters) and in the first, second, and third trimesters of pregnancy, respectively. Significant differences were noted in the use of DS containing folic acid, calcium, iron, vitamins, and docosahexaenoic acid (DHA), during the three trimesters of pregnancy. A higher proportion of DS use was negatively associated with certain categories of pregnant woman, including unemployed/housewife, low education level, obese, and low social support. A positive association was identified with gestational age. Conclusion for practice: Considering the high prevalence of DS use during pregnancy, future studies are needed to evaluate the accuracy and suitability of DS usage during pregnancy.

Serum profiles of inflammatory cytokines associated with intrahepatic cholestasis of pregnancy.

BACKGROUND: The pathogenesis of intrahepatic cholestasis of pregnancy (ICP) is not clear, and some researchers have compared the differences in serum levels of inflammatory cytokines between ICP patients and normal pregnant women, but there are few studies and different conclusions. AIM: To investigate the levels of inflammatory cytokines such as interleukins (IL) -4, IL-6, IL-8, and tumor necrosis factor alpha (TNF-α) in patients with ICP and their potential role in pathophysiology. METHODS: This case-control study was conducted in Shanghai First Maternity and Infant Health Hospital, and we recruited ICP patients and age-matched healthy pregnant women as a control group. Plasma samples from 40 subjects with ICP and 40 subjects without ICP were tested for concentration of the following inflammatory cytokines: interferon-gamma, IL-1 alpha, IL-1 beta, IL-2, IL-4, IL-6, IL-8, IL-10, and TNF-α. Analyzed inflammatory cytokines were then assessed, either individually or in combination with regard to ICP. RESULTS: The cytokine composition of the ICP and CTL group was significantly different. We compared levels of inflammatory cytokines with regard to the presence of ICP symptoms. Levels of IL-4, IL-6, and TNF-α were significantly lower in ICP subjects, and IL-8 were significantly higher in ICP subjects, compared with CTL subjects. The TNF-α showed the best performance for ICP identification (area under the curve [AUC]: 0.829). Performance was increased when TNF-α was combined with IL-4 and IL-8 analysis (AUC, 0.901). Spearman correlation and linear regression analysis revealed that the TNF-α concentrations correlated with IL-4 and IL-6 levels, and inversely correlated to TBA, ALT, AST, and IL-8 levels. CONCLUSION: IL-4, IL-6, and TNF-α were significantly decreased, while IL-8 was significantly increased in the ICP group compared with the healthy control group. TNF showed the best single marker discriminatory potential; however, combining TNF-α, IL-4, and IL-8 analyses increased performance for ICP identification.

Association Between Maternal Characteristics and the Risk of Isolated Maternal Hypothyroxinemia.

Objective: We aimed to determine the association between maternal characteristics and isolated maternal hypothyroxinemia (IMH). Methods: Pregnancies registered at Shanghai First Maternity and Infant Hospital between January 2014 and September 2020 were included in this cross-sectional study. IMH was defined as free thyroxine (FT4) levels below the 10th percentile with TSH within the normal reference range. Multivariate logistic regression models were used to identify potential risk factors for IMH, including demographic information, anthropometric measurements and nutritional status. Results: A total of 54586 singleton pregnancies were included, involving 6084 women with IMH and 48502 euthyroid women. Multivariate logistic regression analyses showed that the variables for women with ages ≥35 (adjusted OR = 1.30, 95% CI:1.20-1.40), non-local residence (adjusted OR = 1.16, 95% CI:1.09-1.23), multiparas (adjusted OR = 1.11, 95% CI:1.03-1.21), pre-pregnancy overweight (adjusted OR = 1.37, 95% CI:1.27-1.49) or obesity (adjusted OR = 1.35, 95% CI:1.18-1.54), and iron deficiency (adjusted OR = 1.27, 95% CI:1.20-1.35) were independent risk factors for IMH in the overall study population, which were identical to those in the first trimester subgroup. Conclusions: Maternal characteristics were associated with the onset of IMH. Maternal age, residence of origin, parity, pre-pregnancy body mass index (BMI) and iron status should be comprehensively considered to evaluate the risk of IMH, according to which obstetricians could determine an optimal assessment time for thyroid function.

Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors.

BACKGROUND: Despite the increased global interest from researchers in postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD), studies of PPD in China have shown a wide range of variability. Indeed, the prevalence and risk factors for PP-PTSD have received little attention in China. AIM: To determine the prevalence of PPD and PP-PTSD in China, and to examine the relationships between a range of sociodemographic, pregnancy-related, and newborn-related variables, and PPD and PP-PTSD. METHODS: A cross-sectional study involving 1136 women who returned to the obstetrics clinic for routine postpartum examination were enrolled. The sociodemographic, pregnancy-related, and newborn-related characteristics were collected. Social support, and PPD and PP-PTSD symptoms were measured by the Perceived Social Support Scale (PSSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Post-traumatic Stress Questionnaire (PPQ). RESULTS: The prevalence rates of PPD and PP-PTSD symptoms were 23.5 and 6.1%, respectively. A multivariate model showed that the presence of PP-PTSD was the strongest risk factor for PPD symptoms and vice versa. Other risk factors for PPD included low sleep quality, low social support and newborn's incubator admission. In terms of PP-PTSD symptoms, risk factors included the presence of PPD symptoms, non-Han ethnicity, and low social support, while having one child was a protective factor. CONCLUSIONS: This study addressed some gaps in the literature and provided a better understanding of PPD and PP-PTSD in China, which may contribute to early detection and intervention. Attention should be paid to women who are most susceptible to PPD and/or PP-PTSD, including those with low social support, low sleep quality, newborn's incubator admission, non-Han ethnicity, and women with siblings.

Women's experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China.

BACKGROUND: Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women's experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience. METHODS: The study is a cross-sectional survey of 4192 women who had natural birth from March-June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women's experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used. RESULTS: In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes' postpartum guidance. Negative satisfaction was seen with perineal pain and edema. CONCLUSION: Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.

The relationship between birthing related factors and maternal breastfeeding confidence in China.

PROBLEM: The relationship between birthing related factors and breastfeeding confidence remain unknown among Chinese mothers. BACKGROUND: Breastfeeding confidence in the early postpartum period is an important predictor of breastfeeding duration. There are many postpartum and socio-demographic factors that have been linked to breastfeeding confidence. However, the relationship between birthing related factors and this confidence remain unknown. AIM: To explore the relationship between birthing related factors and breastfeeding confidence among Chinese mothers. METHODS: This is a cross-sectional study of 450 mothers who were recruited after birth and before discharge from hospital. From November 2018 to March 2019, we collected data related to socio-demographics and obstetric characteristics, as well as the Chinese version of Breastfeeding Self-Efficacy Scale and the Chinese version of Labor Agentry Scale. Associations of birthing related factors with breastfeeding self-efficacy were investigated. RESULTS: There was a significant correlation between perception of control during labor and breastfeeding confidence. Multiple linear regression showed that higher perception of control in labor scores were significantly associated with higher breastfeeding self-efficacy scores (B=0.282, P=<0.001), and lower breastfeeding self-efficacy scores were associated with women living in an extended family (B=-12.622, P=<0.001), perceived of insufficient milk supply (B=-5.514, P=0.038), mild fatigue (B=-8.021, P=0.03), moderate fatigue (B=-12.955, P=0.004). CONCLUSION: There is a significant relationship between perception of control during labor and maternal breastfeeding confidence in the early postpartum period. Strengthening perception of control during labor can improve breastfeeding self-efficacy. Providing professional and emotional support for women during the intrapartum period should be strengthened.

Prevalence and Associated Factors of Postpartum Anxiety and Depression Symptoms Among Women in Shanghai, China.

BACKGROUND: Postpartum anxiety (PPA) and postpartum depression (PPD) are associated with immediate and long-term health risks for both mothers and babies. The purpose of this paper was to evaluate relationships between sociodemographic, perinatal variables, and PPA and PPD symptoms of parturients 6 weeks postpartum. METHODS: A cross-sectional survey with 1204 women who had a healthy and term birth in a baby-friendly hospital, Shanghai, China. PPA and PPD symptoms were measured by using the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The mean score of SAS and EPDS was 40.79 ± 8.48 and 8.18 ± 5.80, respectively. The estimated prevalence of PPA and PPD symptoms was 15.2% and 23.2%, respectively. Multivariable logistic regression analysis showed that the presence of fatigue and PPD symptoms were risk factors for PPA symptoms, whereas having support from family and being satisfied with labor experience were protective factors. In terms of PPD symptoms, its risk factors included smoking before pregnancy, maternal separation from baby, fatigue, encountering difficulties in breastfeeding, and the presence of PPA symptoms. In contrast, the protective factors for PPD symptoms were having support from family and having support from colleagues or friends. LIMITATIONS: Convenience sampling and voluntary participation may have led to a selection bias. CONCLUSION: PPA and PPD symptoms occur commonly among parturients in Shanghai, China. The findings from this research provide a better understanding of factors associated with PPA and PPD symptoms and will help guide personalized approaches to the management of postpartum anxiety and depression.

Breastfeeding Self-Efficacy Among Parturient Women in Shanghai: A Cross-Sectional Study.

BACKGROUND: Breastfeeding self-efficacy has been shown to be a strong predictor of breastfeeding initiation and duration; however, factors associated with breastfeeding self-efficacy in China are unclear. RESEARCH AIMS: The aims were (a) to describe the breastfeeding self-efficacy of parturient women in Shanghai, China and (b) to identify the sociodemographic factors associated with mothers' breastfeeding self-efficacy. METHODS: This is a cross-sectional retrospective descriptive study. Through convenience sampling, breastfeeding mothers (N = 801) were recruited to assess breastfeeding self-efficacy before discharge from the hospital. Descriptive statistics were used to analyze the sociodemographic and perinatal characteristics, level of breastfeeding self-efficacy, and correlations between them. RESULTS: In the process of breastfeeding, 52.2% (n = 418) of participants encountered breastfeeding problems, 37.1% (n = 297) perceived an insufficient milk supply, 82.4% (n = 660) reported attending breastfeeding classes, but only 37.1% (n = 297) chose exclusive breastfeeding. Chinese mothers reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.67 (score = 1-5). Whether or not encountering breastfeeding problems, infant feeding pattern (fully breastfeeding, partial breastfeeding, no breastfeeding) in the previous 24 hours, whether or not perceiving insufficient milk, and main caregiver's positive attitude toward breastfeeding (ranging from 1 to10, higher score indicating more positive attitude) were correlated with participants' breastfeeding self-efficacy score. (The correlation coefficients were -0.432, 0.377, -0.364, and 0.353, respectively.). CONCLUSION: The misperception of insufficient milk and main caregiver's attitude toward breastfeeding were important factors for breastfeeding self-efficacy. Greater efforts should be made during breastfeeding education and support.

Social support and second trimester depression.

BACKGROUND: Depression is the most prevalent psychiatric disease during and after pregnancy (Aktas and Yesilcicek, 2015). Social supportive system (SSS) serves to protect against the development of depressive symptoms (Moshki and Cheravi, 2016). The mitigating effect of SSS on depression among expectant Chinese women is unclear. OBJECTIVES: To evaluate the SSS for pregnant women in Shanghai, China and identify any correlation between social support components and perinatal depression. METHODS: This is a quantitative study using a cross sectional self-reporting survey. Two thousand pregnant women were recruited during their second trimester routine pregnancy check-up. Descriptive statistics were used to analyze the socio-demographic and perinatal characteristics, level of social support and depression among the study group. The correlation analysis was conducted between groups of different socio-economic and perinatal factors and SSS, as well as between different SSS components and perinatal depression. RESULTS: Components of social support most influencing perinatal depression were "Support from partner", "The number of close friends accessible of getting support" and "Support from colleagues" [r = -0.226, 0.206, -0.200, respectively]. Among the different components of the SSS, the items ranking high were: "Support from partner", "The living conditions in the last year" and "Support from parents". Meanwhile, "Support from neighborhood", "Participation in group activities" and "The number of close friends accessible of getting support" ranked low. CONCLUSION: Support from the family may be a protective factor against perinatal depression among Chinese pregnant women. The study of social support during pregnancy could help us preferably understand and effectively use social resources to guide and support women in pregnancy. Context-tailored support enhancement should be based on the availability of social networks.