Personalized Mobile Health-Enhanced Cognitive Behavioral Intervention for Maternal Distress: Examining the Moderating Role of Adverse Childhood Experiences.

BACKGROUND: Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum. METHODS: Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics. Participants (N = 100) were randomized to MB-P (n = 49) or control (n = 51). Analyzable data were collected for 95 participants. Analyses tested progression of change (slope) and at individual timepoints (panel analysis) for perinatal mental health outcomes. RESULTS: The majority of participants (n = 68, 71%) reported experiencing > 1 ACE (median = 1, range: 0-11). Participants demonstrated significant differential effects for depressive symptoms in absence of ACEs (standardized mean differences [SMD] = 0.82; 95% confidence interval [CI] = [0.13-1.51]) vs in presence of ACEs (SMD = 0.39; 95% CI = [-0.20 to 0.97]) and perceived stress in absence of ACEs (SMD = 0.92; 95% CI = [0.23-1.62]) vs in presence of ACEs (SMD = -0.05; 95% CI = [-0.63 to 0.53]). A panel analysis showed significantly reduced depressive symptoms postintervention and increased negative mood regulation at 3 months postpartum for individuals with ACEs. CONCLUSIONS: Findings support effectiveness of the MB-P intervention to reduce prenatal distress for all pregnant individuals. Preliminary exploration suggests the possibility that individuals with ACEs may benefit from enhanced trauma-informed content to optimize the effects of a perinatal intervention.

Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology.

Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24 months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18 months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.

How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers' perspectives.

Introduction: Laws regulating substance use in pregnancy are changing and may have unintended consequences on scientific efforts to address the opioid epidemic. Yet, how these laws affect care and research is poorly understood. Methods: We conducted semi-structured qualitative interviews using purposive and snowball sampling of researchers who have engaged pregnant people experiencing substance use. We explored views on laws governing substance use in pregnancy and legal reform possibilities. Interviews were double coded. Data were examined using thematic analysis. Results: We interviewed 22 researchers (response rate: 71 per cent) and identified four themes: (i) harms of punitive laws, (ii) negative legal impacts on research, (iii) proposals for legal reform, and (iv) activism over time. Discussion: Researchers view laws penalizing substance use during pregnancy as failing to treat addiction as a disease and harming pregnant people and families. Respondents routinely made scientific compromises to protect participants. While some have successfully advocated for legal reform, ongoing advocacy is needed. Conclusion: Adverse impacts from criminalizing substance use during pregnancy extend to research on this common and stigmatized problem. Rather than penalizing substance use in pregnancy, laws should approach addiction as a medical issue and support scientific efforts to improve outcomes for affected families.

Lability of prenatal stress during the COVID-19 pandemic links to negative affect in infancy.

The association between prenatal stress and children's socioemotional development is well established. The COVID-19 pandemic has been a particularly stressful period, which may impact the gestational environment. However, most studies to-date have examined prenatal stress at a single time point, potentially masking the natural variation in stress that occurs over time, especially during a time as uncertain as the pandemic. This study leveraged dense ecological momentary assessments from a prenatal randomized control trial to examine patterns of prenatal stress over a 14-week period (up to four assessments/day) in a U.S. sample of 72 mothers and infants. We first examined whether varied features of stress exposure (lability, mean, and baseline stress) differed depending on whether mothers reported on their stress before or during the pandemic. We next examined which features of stress were associated with 3-month-old infants' negative affect. We did not find differences in stress patterns before and during the pandemic. However, greater stress lability, accounting for baseline and mean stress, was associated with higher infant negative affect. These findings suggest that pathways from prenatal stress exposure to infant socioemotional development are complex, and close attention to stress patterns over time will be important for explicating these pathways.

Young mother risk-taking moderates doula home visiting impacts on parenting and toddler social-emotional development.

This longitudinal randomized controlled trial examined the impact of a doula home visiting intervention for young, low-income mothers on parenting and toddler social-emotional development and tested whether intervention effects were moderated by maternal emotional and behavioral health characteristics. 156 mothers were offered home visits from a home visitor starting in mid-pregnancy through several years postpartum, with a community doula also working with the mother during pregnancy and after the birth. 156 received case management. Interviews, video recordings of mother-child interactions, and toddler assessments were conducted at 3 weeks, 3 months, 13 months, and 30 months of age. Intent-to-treat analyses conducted with the full sample showed some intervention effects. Moderation analyses, however, showed that most effects were concentrated among mothers engaged in high levels of risk-taking (delinquent behaviors, school suspensions, smoking, alcohol use, sexual risk-taking). Among higher risk-taking mothers, the intervention was related to less intrusiveness during early infancy, less psychological and physical aggression during toddlerhood, more sensitive parenting attitudes, and greater toddler social relatedness. Maternal depressive symptoms were only a moderator for toddler behavior problems. These findings suggest that doula home visiting may be a particularly effective model for enhancing sensitive, non-aggressive parenting among young mothers with a history of risk-taking behavior.

Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure.

The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5 year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.

A longitudinal investigation of young mothers' prenatal attachment, depressive symptoms, and early parenting behaviour.

OBJECTIVES: This study explores whether young, low-income mothers' prenatal attachment to their infants is related to attachment and parenting behaviour postnatally. BACKGROUND: A small literature has documented continuity in maternal attachment from pregnancy to postpartum and shown that early maternal attachment is associated with positive parenting behaviour. Less is known about whether prenatal attachment has a unique impact on parenting behaviour, or if it is primarily a step in the development of postnatal attachment, which in turn influences parenting. Additionally, it is unclear whether associations between attachment and early parenting might be attributable to other factors such as depressive symptoms. METHOD: This longitudinal study followed young primiparous mothers from pregnancy through 3-weeks postnatal. 240 ethnically/racially diverse low-income American women reported their attachment-related thoughts and feelings and their depressive symptoms during pregnancy and postnatally. At 3 weeks postpartum, mothers were observed interacting with their infant. RESULTS: There was stability in attachment and depressive symptoms from pregnancy to postpartum. In multivariate path models, prenatal attachment was directly associated with two types of parenting behaviour: positive engagement and encouragement of learning, even when accounting for depressive symptoms and postnatal attachment. There was an indirect effect of prenatal attachment on sensitivity through postnatal attachment. CONCLUSION: The foundation of a mother's emotional connection to her infant begins before birth. Parenting support programmes for young mothers should begin during pregnancy. Supporting the establishment of positive prenatal attachment may also have a positive influence on later parenting behaviour among mothers, including mothers experiencing depressive symptoms.

Associations between parenting representations and behavior among young mothers and mothers with opioid use disorder.

Mothers' representations reflect how they experience their child and their relationship, and can guide parenting behavior. While studies of representations typically focus on infancy, this study examines associations between mothers' representations and behavior with their preschoolers using two samples: young mothers (n = 201; 42% African American, 42% Latina, 8% European-American, 8% multi-ethnic; Mage  = 32 months) and mothers in treatment for opioid use disorder (OUD; n = 150; 100% African American; Mage  = 49 months). This study aims to identify the distribution of representations within these populations, differences in parenting between mothers classified with balanced and non-balanced representations, and distinct parenting behaviors associated with distorted and disengaged representations. The Working Model of the Child Interview was conducted to assess representations, and mother-child interactions were video-recorded. The distribution of balanced, distorted, and disengaged representations was 59%, 25%, and 15% among young mothers, and 21%, 39%, and 40% among mothers with OUD. Balanced representations (coherent, rich, engaged, respectful) were associated with positive parenting, including sensitivity, autonomy support, cognitive support and less negative regard among young mothers, and sensitivity and encouragement in the OUD sample. Mothers with disengaged representations (emotionally distant, lacking detail, indifferent) demonstrated less support for learning compared to mothers with distorted representations (involved but inconsistent, negative, or bizarre descriptions of child).

Las representaciones de las madres reflejan cómo ellas perciben a sus niños y sus relaciones y pueden guiar la conducta de la crianza. Mientras que los estudios sobre representaciones típicamente se enfocan en la infancia, este estudio examina las asociaciones entre las representaciones de las madres y el comportamiento con sus niños prescolares usando dos grupos muestra: madres jóvenes (n=201; 42% afroamericanas, 42% latinas, 8% europeo-americanas, 8% multiétnicas; edad promedio=32 meses) y madres bajo tratamiento por trastornos por uso de opioides (OUD; n=150; 100% afroamericanas; edad promedio=49 meses). El estudio se propuso identificar la distribución de las representaciones dentro de estos grupos de población, diferencias en la crianza entre madres clasificadas con representaciones equilibradas y no equilibradas, y conductas de crianza distintivas asociadas con representaciones distorsionadas y desconectadas. La Entrevista del Modelo de Trabajo del Niño se usó para evaluar las representaciones y se grabaron en video las interacciones madre-niño. La distribución de representaciones equilibradas, distorsionadas y desconectadas fue 59%, 25% y 15% entre madres jóvenes, y 21%, 39% y 40% entre madres con OUD. Las representaciones equilibradas (coherentes, generosas, participativas, respetuosas) se asociaron con una crianza positiva, incluyendo sensibilidad, apoyo de autonomía, apoyo cognitivo y menos consideración negativa entre madres jóvenes, y sensibilidad y estímulo en el grupo OUD. Las madres con representaciones desconectadas (emocionalmente distantes, con falta de detalles, indiferentes) demostraron menos apoyo en el aprendizaje comparadas con madres con representaciones distorsionadas (participativas pero inconsistentes, negativas o extrañas descripciones del niño).

Les représentations des mères reflètent la manière dont elles font l'expérience de leur enfant et de leur relation, et peuvent dguider le comportement de parentage. Alors que les études sur les représentations se focalisent typiquement sur la petite enfance cette étude examine les liens entre les représentations des mères et le comportement de leurs enfants d'âge pré-scolaire en utilisant deux échantillons : des jeunes mères (n=201;42% afro-américaines, 42% de culture latine américaine, 8% européennes-américaines, 8% multi-ethnic; Mâge=32mois) et des mères en traitement pour un trouble de consommation d'opioïde (TCO; n=150; 100% afro-américaines; Mâge=49mois). Cette étude s'est donnée pour but d'identifier la distribution des représentations au sein de ces populations, les différences dans le parentage entre les mères classifiées comme ayant des représentations équilibrées ou non-équilibrées, et les comportements distincts de parentage liés à des représentations déformées et désengagées. Le Modèle Fonctionnel de l'Entretien de l'Enfant a été choisi afin d'évaluer les représentations et les interactions mère-enfant ont été filmées à la vidéo. La distribution de représentations équilibrées, déformées et désengagées était de 59%, 25%, et 15% chez les jeunes mères et de 21%, 39%, et 40% chez les mères avec un TCO. Les représentations équilibrées (cohérentes, riches, engagées, respectueuses) étaient liées au parentage positif, y compris à la sensibilité, au soutien de l'autonomie, au soutien cognitif et à moins d'égard négatif chez les jeunes mères, et à la sensibilité et à l'encouragement dans l'échantillon TCO. Les mères avec des représentations désengagées (émotionnellement distantes, manquant de détail, indifférentes) ont fait preuve de moins de soutien à l'apprentissage comparées aux mères avec des représentations déformées (impliquées mais descriptions incohérentes, négatives ou bizarres de l'enfant).

Statewide Real-Time Tracking of Beds and Ventilators During Coronavirus Disease 2019 and Beyond.

This brief report describes the rapid deployment of a real-time electronic tracking board for all hospitals in the state of Oregon. In preparation for the coronavirus disease 2019 surge on hospital resources, and in collaboration across health systems, with health authorities and an industry partner, we combined existing infrastructures to create the first automated tracking board for our entire state, including bed types by health system and geographic area, and with granularity to the individual unit level for each participating hospital. At the time of submission, we have a live snapshot of 87% of beds in the state, including real-time ventilator data across eight health systems. The tracking board allows for rapid assessment of available bed and ventilator resources and pulls electronic health record data that is created through normal care processes rather than relying upon manual entry. It is updated every 5 minutes and is drillable from state to unit level. Together these factors make the data actionable, which is essential in a crisis. The new tracking system integrates seamlessly with our preexisting statewide, manually updated tracking board via bidirectional data sharing to ensure existing processes across the state can continue. This new tool allows any health system in our state to visualize occupancy by type and location in real time. Amid pandemic uncertainty, having a reliable tool for tracking critical hospital resources will enhance our statewide ability to maintain healthcare functionality in a world with coronavirus disease 2019.

Young First-Time Mothers' Parenting of Infants: The Role of Depression and Social Support.

OBJECTIVES: This study examines the contributions of social support and depressive symptoms on sensitive parenting behaviors, parenting attitudes and parenting stress among first-time young mothers. Additionally, the study tests the moderating role of depression in associations between various types and sources of social support and parenting outcomes. METHODS: Young (M = 17.4 years), low-income, African American mothers (n = 192) were interviewed and video-recorded interacting with their 4-month-old infants. RESULTS: Regression analyses showed that depressive symptoms (CES-D) were associated with less sensitivity observed during mother-infant interactions, less sensitive attitudes (AAPI) and greater parenting stress (PSI), but the role of social support was more nuanced. Direct infant care support from the mother's parent figure (typically her own mother) was related to more sensitive parenting behaviors and attitudes, while general support and direct infant care support from the father of the baby were related to reduced parenting stress. Depressive symptoms moderated the relationship between general support from the parent figure and parenting outcomes. Specifically, higher levels of general support contributed to more sensitive maternal behaviors and attitudes only when depressive symptoms were low. CONCLUSIONS FOR PRACTICE: For young mothers, their parent figure and the father of the baby can be important sources of support in promoting positive parenting and reducing parenting stress. Young mothers with depression, however, are at risk for problematic parenting and may have difficulty taking advantage of the support offered by their parent figure.

Correction to: Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health.

The article "Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health", written by Sydney L. Hans, Renee C. Edwards and Yudong Zhang, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 18 July 2018 to

Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health.

Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex.

Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.

Tension-Free Vaginal Tape Failure After Robotic Sacrocolpopexy and Tension-Free Vaginal Tape for Concomitant Prolapse and Stress Incontinence.

OBJECTIVE: Evidence of surgical cure with tension free vaginal tape (TVT) is robust for isolated stress urinary incontinence, but rigorous studies investigating combined prolapse and incontinence are lacking. Our study measured cure of stress incontinence in concomitant robotic sacrocolpopexy and retropubic sling (TVT). We hypothesized a higher rate of objective failure as measured by the cough stress test (CST) compared to failures reported in recent randomized trials of TVT in patients without prolapse (aggregate 8% failure). METHODS: Prospective cohort of patients with stress incontinence and prolapse, scheduled for robotic sacrocolpopexy and TVT. Outcomes assessed at 12 months: CST (primary aim), Patient Global Impression of Improvement (PGI-I), Pelvic Floor Distress Inventory, and the Sandvik questionnaire. RESULTS: Sixty-six of 77 subjects (86%) completed follow-up. Average age was 65 years, 96% were white, with mean body mass index of 28.1 kg/m2. Mean parity was 2.7, 50% had a previous hysterectomy. Mean leading edge of prolapse was +2.3 cm. All patients underwent the planned surgery; additionally, 50% underwent hysterectomy and 38% posterior colporrhaphy.The TVT failure (+CST) was 19.7% (95% confidence interval, 11.3%-31.7%; P < 0.001 compared to 8%). Neither preoperative disease severity, nor preoperative prolapse stage affected risk of failure of TVT. Eighty-three percent of the subjects were happy or very happy (PGI-I). However, those with a positive CST (failure) had significantly less satisfaction on PGI-I, UDI-6, and Pelvic Floor Distress Inventory-20. CONCLUSIONS: In this population with advanced prolapse, cure of stress urinary incontinence by TVT in setting of robotic sacrocolpopexy is lower compared to published trials where prolapse is absent. Women are less satisfied when the postoperative CST is positive.

Infant risk factors associated with internalizing, externalizing, and co-occurring behavior problems in young children.

The purpose of the current study was to examine the unique and interactive contributions of infant negative emotionality and family risk factors in the development of internalizing-only, externalizing-only, and co-occurring behavior problems in early childhood. The sample included 412 infants and their primary caregivers. Interviews and temperament assessments took place when infants were 5-7 months old, and primary caregivers completed child behavior ratings at ages 2 1/2 and 5 years. Mixed-effects multinomial logistic regression was used to examine associations between infant risk factors and "pure" and co-occurring child behavior problems, and test whether these associations changed over time. The results of this study showed that hostile parenting during infancy increased the likelihood that children would develop internalizing-only problems, whereas infants who were highly distressed in response to novelty were at increased risk of developing externalizing-only problems. Multiple risk factors, including maternal anxious and depressive symptoms, family conflict, and younger maternal age, independently predicted early childhood co-occurring problems. Additionally, there was a significant interaction between infant anger/frustration and hostile parenting: In the context of hostile parenting, infants high in anger were at increased risk of developing early co-occurring problems, though this association faded by age 5. These findings point to the importance of considering the infant's family context, and differentiating between "pure" and co-occurring behaviors when examining the etiology of early childhood behavior problems.

The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: a propensity score matching approach.

OBJECTIVE: This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers. SUBJECTS AND METHODS: Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding. RESULTS: One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation. CONCLUSIONS: This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.

Breastfeeding and complementary food: randomized trial of community doula home visiting.

OBJECTIVES: Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers. METHODS: Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention. Intervention-group mothers received services from paraprofessional doulas: specialized home visitors trained as childbirth educators and lactation counselors. Doulas provided home visits from pregnancy through 3 months postpartum, and support during childbirth. Control-group mothers received usual prenatal care. Data were obtained from medical records and maternal interviews at birth and 4 months postpartum. RESULTS: Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers (64% vs 50%; P = .02) and were more likely to breastfeed longer than 6 weeks (29% vs 17%; P = .04), although few mothers still breastfed at 4 months. The intervention also impacted mothers' cereal/solid food introduction (P = .008): fewer doula-group mothers introduced complementary foods before 6 weeks of age (6% vs 18%), while more waited until at least 4 months (21% vs 13%) compared with control-group mothers. CONCLUSIONS: Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines. The intervention's success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting, and the doula's presence at the birth, where she supports early breastfeeding experiences.

Supportive relationships and the trajectory of depressive symptoms among young, African American mothers.

The purpose of this longitudinal study was to examine changes in young mothers' depressive symptoms from pregnancy through the first two postpartum years and how supportive relationships with key individuals were related to mothers' depressive symptoms over time. Data were collected from young, low-income African American mothers (N = 248) during pregnancy and at 4, 12, and 24 months postpartum. Hierarchical Linear Modeling (HLM) analyses revealed that depressive symptoms were highest during pregnancy and declined through 24 months postpartum. Supportive relationships with the father of the baby and the mother's parent figure were related to lower levels of depressive symptoms. Although the association between father support and the mother's depressive symptoms remained consistent over time, support from the parent figure became increasingly more important during the young mother's transition to parenting. Further analyses also revealed that the association between support and depressive symptoms depended on other aspects of these relationships. Greater support from the baby's father was only related to fewer depressive symptoms for mothers who were partnered with the father of the baby. Greater support from the parent figure was only related to fewer depressive symptoms for mothers who were coresiding with the parent. Finally, having a repeat pregnancy during the early postpartum years was related to higher levels of depressive symptoms during the subsequent pregnancy. These findings suggest that screening and interventions for depression in young mothers should begin during pregnancy and include a focus on her proximal social relationships.

Mesh erosion in robotic sacrocolpopexy.

OBJECTIVE: This study aimed to compare the incidence of mesh erosion after robotic sacrocolpopexy between women undergoing total and those undergoing supracervical hysterectomy (SH). METHODS: This is a retrospective cohort study of women who underwent sacrocolpopexy and concomitant hysterectomy using the DaVinci surgical robot between May 2007 and December 2010 at 2 sites. Baseline data were gathered before surgery. The primary outcome was mesh erosion identified during 3 months of follow-up. RESULTS: A total of 102 women underwent sacrocolpopexy, of whom 45 were with concomitant SH and 57 were with total hysterectomy (TH). Their mean age was 58 years, mean body mass index was 26.8 kg/m, 98% were white, 6% smoked, and 25% were on systemic hormone replacement therapy. Mean preoperative Ba = +1.4, C = -2.2. These were not different between the 2 groups or by site. Within 3 months of surgery, mesh erosion was diagnosed in 8 women, all of whom had TH. No mesh erosions occurred in the SH group (14% vs 0%). Total hysterectomy mesh erosion rate at site 1 was 37% compared with 3% [corrected] at site 2. Mesh type was the only identifiable difference between sites: self-cut polypropylene at site 1, precut polypropylene at site 2. Two women in the SH had abnormal uterine pathology: 1 endometrial adenocarcinoma and 1 focus of hyperplasia with atypia. CONCLUSIONS: No mesh erosions were associated with SH within the first 3 months. In TH, the graft material used may be a modifiable factor needing further investigation. Unexpected abnormal uterine pathologic diagnosis remains a possibility with SH. Longer-term follow-up and a randomized trial are warranted to answer these questions.

Complications associated with transobturator sling procedures.

This study aims to determine the complications associated with trans-obturator slings as reported to a national database. We required "MAUDE", a database that collects reports of complications associated with medical devices and which is maintained by the Food and Drug Administration. We searched for complications associated with three different, commercially available trans-obturator slings. We then tabulated the results by type of complication, by date of occurrence, and by type of sling. Between January 2004 and July 2005, 140 reports of 173 complications associated with trans-obturator tapes were reported to the MAUDE database. Previously unreported injuries, such as obturator nerve injuries, large blood losses (>or=600cc), and ischiorectal fossa abscesses, were documented. Serious complications occur with the trans-obturator tape systems, but the rates are unknown due to database limitations. The type of complication appears to differ between devices and this may reflect different implantation systems and different polypropylene mesh formulations. Improved tracking of device complications is necessary to maximize patient safety.