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1.
Pregnancy Hypertens ; 20: 14-18, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32143061

RESUMO

OBJECTIVE: Our objective was to evaluate postpartum blood pressure trends, and time to resolution of hypertension among women with hypertensive disorders of pregnancy, specifically focusing on impact of race and BMI on these trends. METHODS: We performed a secondary analysis of a randomized trial that utilized a text-message based home blood pressure monitoring system. BPs for this study included both inpatient postpartum BPs as well as home BPs obtained from the text-based program. Women were followed from 12 h of delivery to 16 days postpartum. Outcomes were: (1) postpartum BP trend summaries from a linear mixed-effects regression model and (2) time to resolution of hypertension (defined as ≥ 48 h of BPs < 140/90) depicted using Kaplan Meier survival curves with hazard ratio estimates of association using Cox models. RESULTS: Eighty-four women were included, of which 63% were black. Non-black women with a BMI < 35 kg/m2 had steady decreases in systolic BP whereas other groups peaked around 6.5 days postpartum. BPs for women in the BMI < 35 group, regardless of race, remained in the normotensive range. Conversely, women with a BMI ≥ 35 had a systolic BP peak into the hypertensive range prior to declining. Diastolic BP peaked at an average of 8.5 days postpartum. Time to resolution of BPs differed by race and BMI groups (p = 0.012). Non-black women with a BMI < 35 had the shortest time to resolution and 81% of these women had resolution of hypertension. Only 49% of black women with a BMI < 35 had resolution of hypertension and approximately 40% of both black and non-black women with BMI ≥ 35 had resolution of hypertension. CONCLUSION: We identified race and BMI to be determinants of postpartum BP trends and hypertension resolution. Further study is needed to determine if race and BMI targeted postpartum hypertension interventions may lead to faster blood pressure recovery and lower maternal morbidity postpartum.


Assuntos
Afro-Americanos , Pressão Sanguínea , Índice de Massa Corporal , Hipertensão Induzida pela Gravidez/etnologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Período Pós-Parto/etnologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Gravidez , Fatores Raciais , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Adulto Jovem
2.
BMC Public Health ; 20(1): 68, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941468

RESUMO

BACKGROUND: Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status. METHODS: Data come from the Bachpan cohort study in rural Pakistan. Chilla participation and social support (Multidimensional Scale of Perceived Social Support) were assessed at 3 months postpartum. Women were assessed for major depressive episodes (MDE) with the Structured Clinical Interview, DSM-IV and for depression symptom severity with the Patient Health Questionnaire (PHQ-9) in their third trimester and at 6 months postpartum. Adjusted linear mixed models were used to assess the relationship between chilla participation and PPD. RESULTS: Eighty-nine percent of women (N = 786) participated in chilla and almost 70% of those that participated took part in all of chilla's aspects. In adjusted models, chilla participation was inversely related to MDE (OR = 0.56;95%CI = 0.31,1.03) and symptom severity (Mean Difference (MD) = - 1.54;95%CI: - 2.94,-0.14). Chilla participation was associated with lower odds of MDE (OR = 0.44;95%CI = 0.20,0.97) among those not prenatally depressed and with lower symptom severity among those prenatally depressed (MD = -2.05;95%CI:-3.81,-0.49). CONCLUSIONS: Chilla is inversely associated with both MDE and symptom severity at 6 months postpartum above and beyond social support. Specifically, chilla is inversely associated with MDE among those not prenatally depressed and with lower symptom severity among those prenatally depressed. This relationship signals an opportunity for interventions aimed at preventing and treating PPD in this region to draw upon chilla and similar traditional postpartum practices in creating community-based, low-cost, sustainable interventions for maternal mental health. TRIAL REGISTRATION: NCT02111915. Registered 18 September 2015. NCT02658994. Registered 22 January 2016. Both trials were prospectively registered.


Assuntos
Depressão Pós-Parto/terapia , Mães/psicologia , Período Pós-Parto/psicologia , Saúde da População Rural , Apoio Social , Adulto , Depressão Pós-Parto/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Paquistão , Período Pós-Parto/etnologia , Gravidez , Saúde da População Rural/etnologia
3.
Eur J Obstet Gynecol Reprod Biol ; 245: 102-106, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31891892

RESUMO

OBJECTIVES: To test the psychometric properties of the culturally adapted Chinese version of the self-administered Australian Pelvic Floor Questionnaire (APFQ) in pregnant and postpartum women. STUDY DESIGN: Between November 2018 and December 2018, a total of 316 pregnant women who met the inclusion criteria in an outpatient setting were enrolled. The participants completed the questionnaire during the third trimester and twice after delivery. The test for validity was composed of face/content validity and construct validity. Reliability testing included internal consistency and test-retest reliability. The degree of responsiveness was assessed using effect size (ES) and standardized response mean (SRM). RESULTS: Two hundred and seventy-four women completed all questionnaires. Content validity, missing data did not exceed 4 % for any questions in the Chinese version of the self-administered APFQ. Construct validity, there was statistically significant difference in the symptoms scores of women with and without subjective suffering bothersome symptoms in bladder function, bowel function, prolapse and sexual function during pregnancy and postpartum periods. Reliability, the total Cronbach's alpha coefficients of the questionnaire in pregnancy and postpartum periods were 0.8, 0.9 and 0.9, respectively, and the intraclass correlation coefficient (ICC) of the total questionnaire was 0.8 during the test-retest. Responsiveness, the Chinese version of APFQ can track changes in bladder function domain and bowel function domain for the women with standardized response mean equal to 0.6 and 0.2, respectively. CONCLUSIONS: The Chinese version of the self-administered APFQ had satisfactory reliability and validity, and can longitudinally monitor changes in pelvic floor symptoms during pregnancy and postpartum periods.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Competência Cultural/psicologia , Distúrbios do Assoalho Pélvico/psicologia , Complicações na Gravidez/psicologia , Inquéritos e Questionários/normas , Adulto , Austrália , China/etnologia , Feminino , Humanos , Distúrbios do Assoalho Pélvico/etnologia , Período Pós-Parto/etnologia , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/etnologia , Terceiro Trimestre da Gravidez/psicologia , Gestantes/etnologia , Gestantes/psicologia , Psicometria , Reprodutibilidade dos Testes , Comportamento Sexual/psicologia
4.
Women Birth ; 33(4): e320-e325, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31371178

RESUMO

BACKGROUND: Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan. METHODS: An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method. RESULTS: The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family. CONCLUSIONS: The first time fathers' experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.


Assuntos
Árabes/psicologia , Emoções , Pai/psicologia , Comportamento Paterno , Período Pós-Parto/etnologia , Adulto , Características Culturais , Feminino , Humanos , Recém-Nascido , Entrevistas como Assunto , Jordânia , Acontecimentos que Mudam a Vida , Masculino , Período Pós-Parto/psicologia , Pesquisa Qualitativa , Religião
5.
MCN Am J Matern Child Nurs ; 45(1): 42-48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31687983

RESUMO

BACKGROUND: Postpartum depression (PPD) affects one in seven women in the United States. Korean Americans are one of the six largest Asian American (AA) subgroups, representing 9% of the AA population in the United States. Women of Asian descent have not always been represented in studies of PPD. PURPOSE: The purpose of this study was to understand postpartum experiences, perceptions of PPD, and mental health help-seeking among Korean women living in the United States. METHODS: Individual, face-to-face, semistructured interviews of Korean immigrant women, over age 18, who were able to read, write, and speak English or Korean, and who had given birth to a live infant within the past 12 months, were conducted using a qualitative exploratory design. Thematic analysis approach was used to analyze qualitative data The Edinburgh Postnatal Depression Screening Scale (EPDS) was used to assess frequency of depressive symptoms over the past week. RESULTS: Eleven women participated. Total EPDS scores ranged from 2 to 17 (mean 6.5, SD = 3.2); three women had scores indicating a high risk for developing PPD. Two overall themes, postpartum experiences and perceptions of PPD and professional help-seeking, along with several subthemes were identified. They included postpartum challenges, importance of keeping Korean postpartum traditions, desire for professional Korean postpartum care, "Sanhoo-Joeri" postpartum support and social networking, normalization of PPD symptoms, family first for health seeking attitude and behavior, and stigma attached to mental health care. CLINICAL IMPLICATIONS: Nurses working with Korean women during postpartum can provide culturally competent care by assessing postpartum care needs, respecting cultural practices, and providing resources such as Korean postpartum care centers Sanhoo-Joeriwon, which can be found in major U.S. cities with large Korean communities (e.g., Los Angeles), and in-home postpartum care providers, Sanhoo-Joerisa. Nurses should be comfortable educating women about normal signs and symptoms of PPD and those requiring immediate medical follow-up.


Assuntos
Depressão Pós-Parto/psicologia , Emigrantes e Imigrantes/psicologia , Período Pós-Parto/etnologia , Adulto , Assistência à Saúde Culturalmente Competente/normas , Depressão Pós-Parto/enfermagem , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Gravidez , Psicometria/instrumentação , Psicometria/métodos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , República da Coreia/etnologia , Estados Unidos
6.
Health Educ Behav ; 46(2_suppl): 114-123, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742447

RESUMO

Internet-based weight loss programs can be effective in promoting weight loss and are less-intensive than traditional face-to-face approaches, which may provide more flexibility for postpartum, low-income women to engage in such programs. Few studies have examined patterns of engagement in internet-based programs for this population. This article used data from the internet-based Fit Moms/Mamás Activas intervention, a 12-month cluster randomized controlled trial that was effective in promoting postpartum weight loss among low-income, predominantly Hispanic women. The overall objectives of this study were to (1) characterize patterns of engagement with the Fit Moms/Mamás Activas website among intervention participants and (2) explore associations between engagement and 12-month weight loss outcomes among study completers (87.4%). A number of engagement variables were calculated for each participant, including website logins; time spent on the website; number of posts to the "Discussion Forum;" number of days tracking weight, diet, and physical activity; number of page visits to various website components; and number of in-person visits attended. The average number of logins was 70.74 (approximately once weekly), and average total time spent on the website was 185.35 minutes (approximately 3 hours) over 1 year. Self-monitoring ("Web Diary") and social support ("Discussion Forum") were the most frequently visited components of the website, and more frequent engagement with these components, as well as greater attendance at in-person group sessions, predicted greater percent weight loss at 12 months. Interventions highlighting these features may be particularly effective for weight loss in this population.


Assuntos
Internet , Período Pós-Parto , Pobreza , Telemedicina , Programas de Redução de Peso , Adulto , Análise por Conglomerados , Feminino , Humanos , Comportamento de Busca de Informação , Período Pós-Parto/etnologia , Estados Unidos
7.
Obstet Gynecol ; 134(5): 995-1001, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31599846

RESUMO

OBJECTIVE: To identify clinical risk factors associated with development of delayed-onset postpartum preeclampsia, and to characterize management and subsequent risk of cardiovascular disease. METHODS: This is a case-control study of women admitted to the hospital with delayed-onset postpartum preeclampsia (defined as a new diagnosis of preeclampsia presenting between 48 hours and 6 weeks postpartum) compared with women with full-term, uncomplicated pregnancies without a hypertensive diagnosis or diabetes. Included women delivered between January 2014 and June 2018 at a single tertiary care center. Women with an antenatal diagnosis of preeclampsia or chronic hypertension were excluded. Univariate analysis was used to identify risk factors associated with delayed-onset postpartum preeclampsia and to compare rates of hypertension and antihypertensive medication use, with follow-up beyond 3 months postpartum among a subset of women in the control group who were matched 2:1 with women in the case group. Multivariable logistic regression was performed and included covariates identified in a backward stepwise approach. RESULTS: Compared with women in the control group (n=26,936), women with delayed-onset postpartum preeclampsia (n=121) were significantly more likely to be of non-Hispanic black race (31.4% vs 18.0%), obese (39.7% vs 20.1%), and deliver by cesarean (40.5% vs 25.8%), all P<.01. For women diagnosed with delayed-onset postpartum preeclampsia, the median postpartum day of presentation was 7.0 (interquartile range 5.0-9.0), with 93.4% presenting secondary to symptoms, which was most commonly a headache. A majority (73.6%) underwent imaging studies, and 49.6% received intravenous antihypertensive agents. A total of 86 (71.0%) women with delayed-onset postpartum preeclampsia and 169 (72.8%) women in the control group had longer term information available, with a median follow-up time of 1.5 years (interquartile range 0.8-2.8). Delayed-onset postpartum preeclampsia was associated with higher blood pressures at 3 months postpartum or later (median systolic 130 mm Hg vs 112 mm Hg and median diastolic 80 mm Hg vs 70 mm Hg, P<.001). CONCLUSION: Delayed-onset postpartum preeclampsia is associated with variable management strategies. There is substantial overlap between the clinical risk factors for delayed-onset postpartum preeclampsia and antepartum preeclampsia. Our findings suggest that delayed-onset postpartum preeclampsia is also associated with an increased risk of progression to chronic hypertension.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão , Pré-Eclâmpsia , Transtornos Puerperais , Adulto , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Período Pós-Parto/etnologia , Período Pós-Parto/fisiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/terapia , Gravidez , Prognóstico , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/fisiopatologia , Transtornos Puerperais/terapia , Fatores de Risco , Estados Unidos
8.
Arch. Health Sci. (Online) ; 26(1): 37-40, 28/08/2019.
Artigo em Português | LILACS | ID: biblio-1046061

RESUMO

Introdução: A primeira consulta puerperal deve ser realizada de sete a dez dias após o parto para uma completa avaliação da mãe e do recém-nascido, indicando precocemente alterações inesperadas, prevenindo agravos e controlando as taxas de morbimortalidade da criança e da mulher. Contudo, apesar de prioridade no âmbito de saúde pública, o retorno da mulher e a primeira ida do filho às consultas pós-parto ainda são reduzidas. Objetivo: Identificar a motivação da adesão e rejeição da primeira consulta puerperal por mulheres atendidas em uma Unidade Básica de Saúde. Casuística e Métodos: Estudo descritivo retrospectivo realizado com a população de 65 mulheres de uma Unidade Básica de Saúde em Campo Grande, MS, Brasil, selecionadas pelo registro no caderno de pré-natal com a Data Provável do Parto delimitada entre fevereiro de 2017 e fevereiro de 2018. Para coleta de dados, foi aplicado um questionário avaliando o período gestacional e o porquê da presença nas consultas puerperais. Resultados: Das 65 mulheres entrevistadas, 47 (72,31%) encontrava-se entre 18 e 30 anos de idade e apenas 7 (10,77%) concluiu o ensino superior. Além disso, as intercorrências neonatais (32,15%) e maternas (25%) sobressaem às taxas de consultas agendadas (42,85%). Adicionalmente, a falta de informação relacionada à importância da consulta puerperal e à necessidade de retorno (13,52%) é o primeiro motivo de rejeição à consulta puerperal no período preconizado. Conclusão: O incentivo e a relação profissional com a comunidade são os principais motivadorespara a adesão à consultapuerperal correta.Orienta-se melhorar a atuação profissional no pré-natal a fim de solidificar elos de confiança e aumentar o número de retornos às consultas no pós-parto.


Introduction: The first puerperal visit should be performed seven to ten days postpartum for a complete evaluation of the mother and the newborn, indicating early unexpected changes, preventing injuries and controlling the morbidity and mortality rates of child and woman. However, despite the public health priority, the return of the woman and the child's first visit to postpartum consultations are still low. Objective: To identify the motivation for adherence and rejection of the first puerperal consultation by women from a Basic Health Unit. Patients and Methods: We carried out a descriptive retrospective study performed on the population of 65 women from a Basic Health Unit in Campo Grande, MS, Brazil, selected for registration in the prenatal care book and with the Probable Childbirth Date delimited between February of 2017 and February of 2018. For data collection, a questionnaire was applied evaluating the gestational period and the reason for the presence in the puerperal consultations. Results: Of the 65 women interviewed, ages ranged from 18 to 30 years-old (n=7; 72.31%)> regarding schooling only 7 (10.77%) completed higher education. In addition, the neonatal (32.15%) and maternal (25%) complications stand out at the rates of scheduled appointments (42.85%). In addition, the lack of information related to the importance of puerperal consultation and the need for follow-up(13.52%) is the first reason for rejection to the puerperal consultation in the period recommended. Conclusion: The incentive and the relation between health professional and the community are the main motivators for the adherence to correct puerperal consultation. It is to improve the professional performance in prenatal care in order to solidify reliable links and increase the number of returns to postpartum consultations.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Atenção Primária à Saúde/estatística & dados numéricos , Período Pós-Parto/etnologia , Centros de Saúde
9.
BMC Public Health ; 19(1): 724, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182062

RESUMO

BACKGROUND: Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV. METHODS: The Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby's check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed. DISCUSSION: The project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).


Assuntos
Promoção da Saúde/métodos , Violência por Parceiro Íntimo/prevenção & controle , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adulto , Computadores de Mão , Grupos Étnicos , Feminino , Humanos , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/psicologia , Centros de Saúde Materno-Infantil , Noruega , Paquistão , Período Pós-Parto/etnologia , Período Pós-Parto/psicologia , Gravidez , Gestantes/etnologia , Gestantes/psicologia , Prevalência , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta , Somália , Inquéritos e Questionários , Traduções
10.
Sleep Health ; 5(5): 479-486, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31171492

RESUMO

OBJECTIVES: Poor sleep among postpartum women is associated with adverse maternal outcomes. Physical activity (PA) is associated with better sleep. However, few studies have been conducted among postpartum Hispanic women. The objective of this study was to examine the association between PA and sleep quality and duration among postpartum Hispanic women. DESIGN: A cross-sectional analysis using baseline data from Estudio PARTO, an ongoing randomized controlled trial aimed at reducing type 2 diabetes risk among Hispanic women. SETTING: Baystate Medical Center, in Western Massachusetts, which serves an ethnically and socioeconomically diverse population. PARTICIPANTS: Hispanic women, at elevated risk for type 2 diabetes, at a mean of 11 weeks (SD = 4.5) postpartum. MEASUREMENTS: PA was measured with the Pregnancy Physical Activity Questionnaire (PPAQ), and sleep was measured with the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Mean sleep duration was 5.9 hour/night (SD = 1.7) and PSQI score was 6.5 (SD = 3.9). In multivariable logistic models, sports/exercise was associated with lower odds of very poor sleep quality (PSQI >10) (OR = 0.18, 95% CI = 0.05 to 0.69). Sports/exercise (OR = 0.05, 95% CI = 0.01 to 0.26) and vigorous intensity PA (OR = 0.13, 95% CI = 0.04 to 0.42) were associated with lower odds of short (vs normal) sleep duration. There were no statistically significant relationships between PA in any other domain or intensity and sleep quality or duration CONCLUSIONS: Findings can inform interventions designed to improve postpartum sleep via increasing opportunities for exercise among postpartum women.


Assuntos
Exercício Físico/fisiologia , Hispano-Americanos/psicologia , Período Pós-Parto/etnologia , Sono/fisiologia , Adolescente , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Período Pós-Parto/psicologia , Risco , Fatores de Tempo , Adulto Jovem
11.
Sleep Health ; 5(4): 327-334, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31122875

RESUMO

BACKGROUND: Despite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete. Moreover, predictors of differential patterns of sleep quality across the perinatal period are poorly defined. METHODS: This study examined subjective sleep quality using the Pittsburgh Sleep Quality Index during each trimester of pregnancy and at 4-11 weeks postpartum among 133 women inclusive of nulliparous and multiparous African Americans and Whites. RESULTS: At any given assessment, 53%-71% of women reported poor overall sleep quality (Pittsburgh Sleep Quality Index total score > 5). Moreover, 92% reported poor overall sleep quality during at least 1 assessment, including 88% at some time during gestation. Compared to nulliparous women, multiparous women reported poorer overall sleep quality, shorter sleep duration, and poorer sleep efficiency during the first trimester; poorer overall sleep quality and longer sleep latency in the second trimester; and more frequent sleep disturbances (eg, night time and early morning awakenings) during the third trimester. Among nulliparous as well as multiparous women, specific aspects of sleep (eg, subjective sleep quality, sleep disturbances, sleep efficiency) were poorer in African American compared to White women at different time points during pregnancy. No effects of race or parity were observed on sleep parameters at postpartum. CONCLUSIONS: Poor sleep quality during pregnancy as well as early postpartum is highly prevalent among both African American and White women. Both multiparous status and African American race are associated with more disturbed sleep at some time points during pregnancy. These individual differences should be considered in future research and clinical efforts to promote perinatal sleep health.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Paridade , Período Pós-Parto/etnologia , Trimestres da Gravidez/etnologia , Transtornos do Sono-Vigília/etnologia , Adulto , Feminino , Humanos , Gravidez , Fatores de Risco , Adulto Jovem
12.
Matern Child Nutr ; 15(3): e12809, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30884175

RESUMO

Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p = 0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.


Assuntos
Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Emigrantes e Imigrantes , Período Pós-Parto/etnologia , Diversidade Cultural , Feminino , Humanos , Saúde Mental/etnologia , Mães , Período Pós-Parto/psicologia , Autoeficácia
13.
Obstet Gynecol ; 133(4): 762-769, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870278

RESUMO

OBJECTIVE: To compare postpartum contraception use between Somali and non-Somali women. METHODS: A retrospective cohort study was performed using the Rochester Epidemiology Project. All Somali women aged 18 and older with live singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) were included, and a group of age-matched non-Somali women (n=317) were identified. Postpartum contraception was defined as the use of any method within 12 months after the first delivery within the study period. Rates of contraception use and types of contraception used were compared between groups using χ analysis. Among Somali women, an a priori list of factors was evaluated for associations with postpartum contraception use by including these factors in a multivariable logistic regression model. RESULTS: After the index birth, 33 Somali women did not present for follow-up, compared with 12 non-Somali women (10.4% vs 3.8%, difference 6.6%, 95% CI 2.3-10.9%). Somali women were less likely to use postpartum contraception than non-Somali women (69.4% vs 92.8%, odds ratio [OR] 0.18, 95% CI 0.11-0.29). Among those using postpartum contraception, both groups had comparable use of long-acting reversible contraception (LARC) (19.9% vs 23.7%, difference -3.8%, 95% CI -11.8% to 4.0%) and non-LARC hormonal contraception (39.3% vs 42.4%, difference -3.1%, 95% CI -12.7% to 6.0%). However, Somali women were more likely to use less reliable methods (40.3% vs 20.8%, difference 19.5%, 95% CI 11.0-28.5%). Among Somali women, contraception use was less likely with older maternal age (OR 0.12 for oldest vs youngest quartile, 95% CI 0.04-0.37) and more likely with prepregnancy contraception use (OR 15.46, 95% CI 5.18-46.18). CONCLUSION: Somali women were less likely to use postpartum contraception. Similar practices and beliefs may also be present in other immigrant populations. Recognition of sociocultural differences in immigrant populations and potential health care provider biases may improve patient-provider relationships and counseling practices.


Assuntos
Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Estudos de Coortes , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Características Culturais , Feminino , Humanos , Incidência , Modelos Logísticos , Minnesota , Análise Multivariada , Período Pós-Parto/etnologia , Gravidez , Estudos Retrospectivos , Medição de Risco , Somália/etnologia , Fatores de Tempo , Adulto Jovem
14.
BMJ Open ; 9(2): e022640, 2019 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-30798304

RESUMO

OBJECTIVES: To explore ethnic differences in changes in body mass index (BMI) from the age of 18 years to 3 months postpartum. DESIGN: A population-based cohort study. SETTING: Child Health Clinics in Oslo, Norway. PARTICIPANTS: Participants were 811 pregnant women (mean age 30 years). Ethnicity was categorised into six groups. PRIMARY OUTCOME MEASURES: The outcome variable was BMI (kg/m2) measured at the age of 18 and 25 years, at prepregnancy and at 3 months postpartum. Body weight at 18 years, 25 years and prepregnancy were self-reported in early pregnancy, while body height and weight at 3 months postpartum were measured. The main statistical method was generalised estimating equations, adjusted for age. The analyses were stratified by parity due to ethnicity×time×parity interaction (p<0.001). RESULTS: Primiparous South Asian women had a 1.45 (95% CI 0.39 to 2.52) kg/m² higher and Middle Eastern women had 1.43 (0.16 to 2.70) kg/m2 higher mean BMI increase from 18 years to postpartum than Western European women. Among multiparous women, the mean BMI increased 1.99 (1.02 to 2.95) kg/m2 more in South Asian women, 1.48 (0.31 to 2.64) kg/m2 more in Middle Eastern women and 2.49 (0.55 to 4.42) kg/m2 more in African women than in Western European women from 18 years to prepregnancy. From 18 years to postpartum, the mean increase was 4.40 (2.38 to 6.42) kg/m2 higher in African women and 1.94 to 2.78 kg/m2 higher in the other groups than in Western European women. CONCLUSIONS: Multiparous women of ethnic minority origin seem substantially more prone to long-term weight gain than multiparous Western European women in Norway.


Assuntos
Índice de Massa Corporal , Grupos Étnicos/estatística & dados numéricos , Ganho de Peso na Gestação/etnologia , Gravidez/etnologia , Adolescente , Adulto , Ásia/etnologia , Estudos de Coortes , Europa (Continente)/etnologia , Feminino , Humanos , Oriente Médio/etnologia , Noruega , Paridade , Período Pós-Parto/etnologia , Período Pós-Parto/fisiologia , Gravidez/fisiologia , Adulto Jovem
15.
Women Health ; 59(5): 569-578, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30422094

RESUMO

Late and moderate preterm (LAMP) neonates are at risk of developing severe complications that can lead to anxiety in mothers. The aim of this study was to determine the effectiveness of a care program on the anxiety level of mothers with LAMP babies and to determine the effectiveness of the care program on the level of anxiety of new mothers in the presence of social support. This quasi-experimental study was conducted on 80 mothers whose late preterm infants were admitted to neonatal intensive care unit at Ali-ibn Abi Talib Hospital, Zahedan. Data were gathered between July 10 and October 13, 2016. The intervention group received the care program. Anxiety and social support were evaluated using the State-Trait Anxiety Inventory and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. After receiving the intervention, the mean MSPSS was higher for the mothers in the intervention group (p = .0025). Additionally, they experienced less state anxiety 72 hours after discharge and 1 month after delivery (p < .0025). Regression analysis showed that mothers with higher social support were 39 percent more likely to be in the "no to moderate STAI" (<51) group. Perceived social support can mediate the effect of care programs on diminishing anxiety.


Assuntos
Ansiedade/terapia , Depressão/terapia , Recém-Nascido Prematuro/psicologia , Terapia Intensiva Neonatal/psicologia , Mães/psicologia , Cuidado Pós-Natal/métodos , Apoio Social , Adulto , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva Neonatal , Irã (Geográfico) , Masculino , Relações Mãe-Filho , Período Pós-Parto/etnologia , Resultado do Tratamento
16.
Res Nurs Health ; 41(6): 519-524, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30431160

RESUMO

Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.


Assuntos
Depressão Pós-Parto/enfermagem , Emigrantes e Imigrantes/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Período Pós-Parto/psicologia , Refugiados/psicologia , Adulto , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/etnologia , Feminino , Humanos , Jordânia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Período Pós-Parto/etnologia , Gravidez , Apoio Social , Valores Sociais , Inquéritos e Questionários , Síria , Adulto Jovem
17.
J Child Adolesc Psychiatr Nurs ; 31(2-3): 61-69, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30288868

RESUMO

PROBLEM: Perinatal depression is a public health concern as it is associated with adverse pregnancy outcomes. Previous studies have recommended further examination of perinatal depression among Mexican-American adolescents. Thus, the purpose of this study was to understand pregnant and postpartum Mexican-American adolescents' knowledge and beliefs concerning perinatal depression. METHODS: This qualitative descriptive study examined perceptions about the causes of perinatal depression, self-help strategies, and how to obtain mental health information. Data were analyzed using deductive and inductive qualitative content analysis. A convenience sample, consisiting of 20 pregnant and postpartum adolescents, self-identified as Mexican-Americans, between the ages of 15 and 19 years was interviewed. FINDINGS: The quality of relationships with their family and significant other and difficulties in transitioning to motherhood were described as potential causes for depression. Journaling, exercising, and spending time with friends and family were identified as self-help strategies. Healthcare providers, the internet, and mothers who have experienced depression were stated as helpful sources of mental health information. CONCLUSION: An assessment of their psychosocial environment is indicated to identify risk or protective factors for perinatal depression. Its consideration and inclusion in interventions may optimize mental health among perinatal adolescents.


Assuntos
Comportamento do Adolescente/etnologia , Transtorno Depressivo , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Complicações na Gravidez , Gravidez na Adolescência/etnologia , Autocuidado , Adolescente , Adulto , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , Feminino , Humanos , Período Pós-Parto/etnologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/terapia , Pesquisa Qualitativa , Instituições Acadêmicas , Estados Unidos , Adulto Jovem
18.
Arch Psychiatr Nurs ; 32(4): 530-535, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30029744

RESUMO

PURPOSE: To examine the relationships among acculturative stress, social support, and postpartum depression (PPD) symptoms among U.S. immigrant women of Arabic descent; and to examine if social support moderates the associations between acculturative stress and PPD symptoms. METHODS: Using a cross-sectional design, a sample of 115 U.S. immigrant women of Arabic descent, all between 1 and 12 months postpartum, were enrolled from clinics in Dearborn, MI. Data were analyzed using correlational and multiple linear regression. RESULTS: Women had a mean age of 29 ±â€¯5 years and were 5 ±â€¯4 months postpartum. Women had been in the U.S. for 7 ±â€¯6 years and had a mean education of 12 ±â€¯4 years. The majority had an annual household income of <$40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%). Higher levels of acculturative stress, higher levels of education, antenatal anxiety, and lower levels of social support predicted PPD symptoms (all significant at p < .05). The moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported. CONCLUSIONS: Acculturative stress, lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms. Future research is needed to examine acculturative stress among immigrant women in different U.S. SETTINGS: Longitudinal studies and utilizing diagnostic assessments of PPD is highly recommended. Nurses need to screen immigrant women of Arabic descent for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve mental health during pregnancy and postpartum.


Assuntos
Aculturação , Árabes/psicologia , Depressão Pós-Parto/diagnóstico , Emigrantes e Imigrantes/estatística & dados numéricos , Apoio Social , Estresse Psicológico/psicologia , Adulto , Estudos Transversais , Depressão Pós-Parto/etnologia , Feminino , Humanos , Michigan , Mães/psicologia , Mães/estatística & dados numéricos , Período Pós-Parto/etnologia , Período Pós-Parto/psicologia , Gravidez
19.
Isr J Health Policy Res ; 7(1): 34, 2018 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-29936911

RESUMO

BACKGROUND: Postpartum suicidality, a result of extreme distress or depression, is a tragedy for the woman, infant, and family. Screening for postpartum depression (PPD) is mandatory in Israel, including a question on suicidal ideation. This study presents and analyzes data regarding rates, trends and characteristics of postpartum women who considered, attempted, or completed suicide, to help direct services aimed at preventing these occurrences. METHODS: Suicidal ideation data based on PPD screening was drawn from various publications and databases. Suicide attempt data was obtained from the Emergency Department database for 2006-2015 and matched with the National Birth Registry. Cause of death from the national database for those years were similarly linked to births to identify postpartum suicides and deaths. Postpartum and non-postpartum suicide attempt rates were computed by year, and by age and ethnic/immigrant group. A multivariate logistic model was used to estimate relative risk for postpartum attempts, controlling for age and ethnic group. RESULTS: Suicidal ideation in recent years has been reported as 1% or less, with higher rates found in studies of Arab women. Suicide attempt rates for non-postpartum women were 3-5 times that of postpartum women, rising over the years, while remaining relatively stable for postpartum women. Adjusted risk of suicide attempt for non-postpartum women was significantly higher; adjusted odds ratio was 4.08 (95% CI 3.75-4.44). It was also significantly higher for Arabs and immigrants from the Former Soviet Union, compared to Israeli-born Jews/veteran immigrants, and for younger women compared to those aged 35-44. Seven postpartum suicides were recorded during 2006-2015, a rate of 0.43 per 100,000 births. CONCLUSION: Postpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for PPD is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally. Prenatal screening should be added as an Israeli Quality Indicator, and postpartum completed suicides should be thoroughly investigated to guide prevention efforts.


Assuntos
Período Pós-Parto/etnologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Depressão/psicologia , Feminino , Humanos , Israel , Período Pós-Parto/psicologia , Gravidez , Fatores de Risco , Tentativa de Suicídio/etnologia
20.
J Behav Med ; 41(5): 668-679, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29740746

RESUMO

Physical activity promotes better health outcomes across the lifespan, and provides physical and mental health benefits for women who have recently given birth. However, research has not adequately characterized physical activity levels or risk factors for inadequate physical activity during the postpartum period. The objective of the present study was to describe levels and correlates of physical activity at 6 months postpartum in mothers of diverse race/ethnicity (55% African American, 23% White, 22% Hispanic/Latina), with the majority living in or near poverty. We analyzed data collected by the five-site Community Child Health Network study. Women (n = 1581) were recruited shortly after the birth of a child. Multinomial logistic regression models tested associations of demographic factors and self-reported stress in several life domains with total physical activity levels at 6-9 months postpartum, including activities done at work, at home, for transportation, and leisure. Thirty-five percent of participants in this sample reported low levels of physical activity. African American race, Latina ethnicity, and living in a rural area were associated with low levels of physical activity, whereas working outside the home was associated with high physical activity. Contrary to hypotheses, chronic stress was not associated with physical activity with the exception of financial stress, which predicted greater likelihood of being highly physically active. These findings suggest that optimal postpartum care should integrate physical activity promotion, and that African American, Latina, and rural-dwelling women may benefit most from efforts to promote activity following birth.


Assuntos
Grupos Étnicos/psicologia , Exercício Físico/psicologia , Comportamentos Relacionados com a Saúde/etnologia , Mães/psicologia , Período Pós-Parto/psicologia , Adulto , Afro-Americanos/psicologia , Atitude Frente a Saúde/etnologia , Demografia , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Hispano-Americanos/psicologia , Humanos , Período Pós-Parto/etnologia , Pobreza , Estudos Prospectivos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
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