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Prenatal Wellbeing and Maternal and Child Health Outcomes

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Nursing".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 28570

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Special Issue Editors

Dr. Karen Lindsay

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Guest Editor

Department of Pediatrics and Susan Samueli Integrative Heath Institute, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA 92697, USA
Interests: pregnancy; nutrition; psychological stress; fetal programming; gestational metabolism; childhood obesity; integrative health; health inequities; women’s health

Dr. Yuqing Guo

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Guest Editor

Sue & Bill Gross School of Nursing, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA 92697, USA
Interests: perinatal mental health; self-management; maternal-infant bonding; mind-body intervention; maternal and infant health disparities

Special Issue Information

Dear Colleagues,

Pregnancy is often considered a window of opportunity to elicit positive health behavior change. Mothers may be more motivated to improve their health for the wellbeing of their future children during this life stage, and frequent contact with healthcare providers offers many opportunities for teachable moments. Prenatal health behaviors not only influence pregnancy and postpartum maternal outcomes, such as risk for gestational diabetes, hypertensive disorders, prenatal depression/anxiety, preterm birth, postpartum weight retention, and future cardiometabolic disease, but can also impact fetal development, long-term susceptibility to disease states in the child, and maternal–child bonding. This includes increased risk for offspring obesity, diabetes, cardiovascular disease, asthma, allergies, psychiatric conditions, and neurodevelopmental disorders.

Many of the predisposing adverse conditions during gestation are potentially modifiable, such as suboptimal nutrition (under or overnutrition, poor diet quality), excess weight gain, sedentariness, psychological distress, poor sleep quality, and toxin exposures through environmental pollutants and/or alcohol, tobacco or substance abuse, yet poor maternal–child health outcomes continue to be of primary concern for many developing and developed societies, likely exacerbated by health inequities that increase vulnerability among those from underserved minority groups. Thus, ongoing efforts are required to develop efficacious interventions from different levels that may better support maternal health throughout the critical life stage of pregnancy so that we may lessen the health burdens on our future generations.

This Special Issue will accept manuscripts addressing health behaviors during pregnancy and their relationship with pregnancy complications or maternal–child health outcomes. Pregnancy behaviors may be addressed at an individual, institutional, community, or ecological level. Health outcomes may be biochemical, clinical, behavioral, or psychosocial in nature. We especially invite manuscripts that address the link between health inequities and wellbeing in pregnancy, as well as integrative health approaches that consider mind–body–spiritual wellbeing and the impact on maternal–child health outcomes. The Special Issue invites submissions of the following article types:

Primary research (qualitative, quantitative and mixed-methods studies)
Systematic reviews and meta-analyses
Scoping, integrative, and narrative reviews
Methodological papers
Case studies
Brief reports
Commentaries and position papers

Dr. Karen Lindsay
Dr. Yuqing Guo
Guest Editors

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Keywords

maternal nutrition
physical activity in pregnancy
sleep in pregnancy
prenatal toxin exposure
prenatal mental health
mind–body interventions
pregnancy and birth outcomes
maternal metabolic health
child health outcomes
maternal–child bonding
fetal programming
social and behavioral determinants of health

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Published Papers (8 papers)

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Research

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12 pages, 971 KiB

Open AccessArticle

Exclusive Breastfeeding at Discharge in Regional New South Wales, Australia: The Role of Antenatal Care (2011–2020)

by Emma Woolley, Gretchen Buck, Jackie Jackson, Rebekah Bowman, Louise Fox, Shirlena Gallagher, Malindey Sorrell and Pramesh Raj Ghimire

Int. J. Environ. Res. Public Health 2023, 20(12), 6135; https://doi.org/10.3390/ijerph20126135 - 15 Jun 2023

Cited by 2 | Viewed by 2311

Abstract

Increasing the number of infants exclusively breastfeeding on discharge from the hospital after birth is a key goal of breastfeeding policy in New South Wales (NSW), Australia. Despite consistent efforts, exclusive breastfeeding on discharge rates have declined over the past decade. Using pooled data from the New South Wales Perinatal Data Collection from 2011 to 2020, we examined the association between antenatal care (ANC) and exclusive breastfeeding at discharge from birth admission outcomes for mother–baby dyads in Southern New South Wales Local Health District (SNSWLHD). Our study confirmed that exclusive breastfeeding rates in SNSWLHD have declined over the past decade, providing local evidence to support action. Late entry to ANC and a failure to attend the recommended number of ANC visits were important predictors of a lower rate of exclusive breastfeeding on discharge. Improving accessibility to ANC visits for rural and regional mothers has potential to positively impact breastfeeding rates in SNSWLHD. We suggest that wider implementation of caseload midwifery models may have a positive impact on breastfeeding outcomes in the region for all mother–baby dyads, but particularly for Aboriginal mothers and infants, younger mothers and mothers experiencing disadvantage. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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14 pages, 341 KiB

Open AccessArticle

Adolescent Pregnancy in South Asia: A Pooled Analysis of Demographic and Health Surveys

by Samikshya Poudel, Timothy Dobbins, Husna Razee and Blessing Akombi-Inyang

Int. J. Environ. Res. Public Health 2023, 20(12), 6099; https://doi.org/10.3390/ijerph20126099 - 10 Jun 2023

Cited by 3 | Viewed by 3852

Abstract

Adolescent pregnancy has important health and social implications. Despite the availability of nationally representative household survey data, there are limited studies that analyze factors associated with adolescent pregnancy across countries of South Asia. This study aimed to identify factors associated with adolescent pregnancy across South Asia. This study used the most recent Demographic and Health Survey (DHS) data from six countries in South Asia: Afghanistan, Bangladesh, India, the Maldives, Nepal, and Pakistan. Pooled individual record data from 20,828 ever-married women aged 15–19 years were used for the analysis. Multivariable logistic regression analysis, informed by the World Health Organization framework on social determinants of health, was performed to examine factors associated with adolescent pregnancy. Adolescent pregnancy was highest in Afghanistan compared to Bangladesh, Nepal, Pakistan, India, and the Maldives. Multivariable analyses confirmed that being from a poor household or male-headed household, increasing maternal age, having no access to newspapers, and having no knowledge of family planning were significantly associated with adolescent pregnancy. The use or intention to use contraceptives was protective against adolescent pregnancy. To reduce adolescent pregnancy in South Asia, interventions targeting adolescents from poor households with limited access to mass media should be considered, especially those from households with an existing patriarchal structure. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

15 pages, 751 KiB

Open AccessFeature PaperArticle

Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective

by Pramesh Raj Ghimire, Gretchen Buck, Jackie Jackson, Emma Woolley, Rebekah Bowman, Louise Fox, Shirlena Gallagher, Malindey Sorrell and Lorraine Dubois

Int. J. Environ. Res. Public Health 2023, 20(2), 977; https://doi.org/10.3390/ijerph20020977 - 5 Jan 2023

Cited by 5 | Viewed by 3519

Abstract

Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child’s healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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12 pages, 612 KiB

Open AccessFeature PaperArticle

Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial

by Doireann Roche, Anthony Rafferty, Sinead Holden, Sarah Louise Killeen, Maria Kennelly and Fionnuala M. McAuliffe

Int. J. Environ. Res. Public Health 2023, 20(1), 34; https://doi.org/10.3390/ijerph20010034 - 20 Dec 2022

Cited by 7 | Viewed by 3427

Abstract

We aimed to determine whether early pregnancy well-being was associated with the stage of behaviour change during an antenatal lifestyle intervention using a secondary analysis of data from the Pregnancy Exercise and Nutrition Research Study (PEARS). Pregnant women (n = 277) with well-being data in early pregnancy were included. Maternal well-being was measured using the World Health Organisation Five-Item Well-Being Index. The intervention consisted of a mobile health (mHealth) phone application, supported by antenatal education and exercise, to prevent gestational diabetes in a population with overweight. Stage of behaviour change was measured in late pregnancy using a five-stage classification. Ordinal logistic regression was used to examine if well-being, the study group, or their interaction, were related to behaviour change. Maternal well-being (OR 1.03, 95% CI 1.01, 1.04, p < 0.01) and the study group (OR 2.25, 95% CI 1.44, 3.51, p < 0.01) both significantly influenced the positive stage of behaviour change. The probability of being at stage 5 increased from 43 to 92% as well-being increased from 0 to 100% and was higher in the intervention (53%) compared to the control (34%) group (p ≤ 0.01 (8.65, 29.27). This study demonstrates the potential importance of well-being in enabling women to engage with a healthy lifestyle, and the role that mHealth technology has in facilitating beneficial behaviour change. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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13 pages, 341 KiB

Open AccessArticle

Navigating Pregnancy and the Healthcare System during COVID-19: A Qualitative Study with Perinatal Women of Color

by Tuyet-Mai H. Hoang, Wan-Jung Hsieh, B. Andi Lee, Kaylee Marie Lukacena and Karen M. Tabb

Int. J. Environ. Res. Public Health 2022, 19(20), 13698; https://doi.org/10.3390/ijerph192013698 - 21 Oct 2022

Cited by 7 | Viewed by 3608

Abstract

Objective: To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth) by exploring the intersectional experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women during the COVID-19 pandemic. In this study, participants were asked if and how COVID-19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare. Methods: Between November 2021 and March 2022 our team conducted eight virtual focus groups comprising perinatal BIPOC women. A semi-structured interview protocol was used, and interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis. Results: Three major themes common in BIPOC perinatal healthcare experiences during COVID-19 were generated through engaging in reflexive thematic analysis: (1) an overwhelming lack of support from providers, (2) experiences of blame and shame, and (3) difficulties navigating institutional policies that were unclear or ever-changing during the COVID-19 pandemic. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID-19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating an exciting and busy time. Relevance: These findings have implications for trauma-informed and inclusive perinatal care that can reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers a discussion of implications for future training for maternal health providers and implications for community-based programs. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

Review

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16 pages, 786 KiB

Open AccessReview

Effects of Non-Essential “Toxic” Trace Elements on Pregnancy Outcomes: A Narrative Overview of Recent Literature Syntheses

by Maria Dettwiler, Angela C. Flynn and Jessica Rigutto-Farebrother

Int. J. Environ. Res. Public Health 2023, 20(8), 5536; https://doi.org/10.3390/ijerph20085536 - 17 Apr 2023

Cited by 8 | Viewed by 2541

Abstract

Adverse pregnancy outcomes and their complications cause increased maternal and neonatal morbidity and mortality and contribute considerably to the global burden of disease. In the last two decades, numerous narrative and systematic reviews have emerged assessing non-essential, potentially harmful, trace element exposure as a potential risk factor. This narrative review summarizes the recent literature covering associations between exposure to cadmium, lead, arsenic, and mercury and pregnancy outcomes and highlights common limitations of existing evidence that may hinder decision-making within public health. Several initial scoping searches informed our review, and we searched PubMed (latest date July 2022) for the literature published within the last five years reporting on cadmium, lead, arsenic, or mercury and pre-eclampsia, preterm birth, or prenatal growth. Pre-eclampsia may be associated with cadmium and strongly associated with lead exposure, and exposure to these metals may increase risk of preterm birth. Many reviews have observed cadmium to be negatively associated with birth weight. Additionally, lead and arsenic exposure may be negatively associated with birth weight, with arsenic exposure also adversely affecting birth length and head circumference. These findings should be interpreted with caution due to the limitations of the reviews summarized in this paper, including high heterogeneity due to different exposure assessment methods, study designs, and timing of sampling. Other common limitations were the low quality of the included studies, differences in confounding variables, the low number of studies, and small sample sizes. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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25 pages, 744 KiB

Open AccessReview

Exploring the Application of Intersectionality as a Path toward Equity in Perinatal Health: A Scoping Review

by Tuyet-Mai H. Hoang and Ainslee Wong

Int. J. Environ. Res. Public Health 2023, 20(1), 685; https://doi.org/10.3390/ijerph20010685 - 30 Dec 2022

Cited by 17 | Viewed by 4658

Abstract

Objective: To conduct a scoping review to determine how past studies have applied the theory of intersectionality, a critical feminist research paradigm, to understand the physical health and mental health outcomes of perinatal people as a step toward addressing maternal health disparities and injustice. The study includes a review of existing research on maternal physical and mental health outcomes, presents the strengths and limitations of existing studies, and provides recommendations on best practices in applying intersectionality in research to address systemic issues and improve outcomes for the perinatal population. Methods: We conducted an extensive literature search across four search engines, yielding 28 publications using the intersectionality framework that focused on the outcomes of perinatal people, with a total sample of 9,856,042 participants. We examined how these studies applied intersectionality and evaluated them based on three areas: conceptualization, research method, and interpretation/findings. Results: Our findings indicate that maternal health researchers have provided good descriptions of the interaction of systemic inequalities and have used analysis that allows for the examination of interlocking and mutually reinforcing social positions or systems. We find that improvement is needed in the areas of conceptualization, reflexivity, and understanding of power structure. Recommendations are provided in the form of a checklist to guide future research toward an impactful approach to addressing perinatal health disparities. Relevance: Our scoping review has implications for improving applied health research to address perinatal health disparities, mortality, and morbidity. Recommendations are given along with references to other tools, and a guidance checklist is provided to support scholars in creating an impactful approach to applying intersectionality in the goal of addressing maternal health disparities. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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Other

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9 pages, 748 KiB

Open AccessBrief Report

Feasibility and Acceptability of a Mindfulness-Based Smartphone App among Pregnant Women with Obesity

by Kerrie Ward, Anjali Herekar, Peiyi Wang and Karen L. Lindsay

Int. J. Environ. Res. Public Health 2023, 20(7), 5421; https://doi.org/10.3390/ijerph20075421 - 6 Apr 2023

Cited by 3 | Viewed by 2553

Abstract

Maternal obesity is associated with an increased risk for prenatal depressive symptoms. Mindfulness-based interventions (MBIs) have been shown to reduce the risk of prenatal depression. This pilot study assesses the feasibility and acceptability of a smartphone-based MBI among pregnant women with obesity, and its potential for improving maternal mental and behavioral health outcomes. Five second-trimester pregnant women with a prepregnancy body mass index > 30 kg/m² participated in a 30-day audio-guided mindfulness practice using the Headspace app. All participants engaged in the pregnancy module, while three concurrently engaged in the mindful eating module. Daily engagement with the app was tracked and a post-trial survey assessed maternal acceptability. Validated pre- and post-trial questionnaires explored changes in perceived stress, anxiety, depression, and eating habits. All participants completed the study with varying levels of adherence to the prescribed daily practice; the average number of days of engagement was 23/30 (77%) for the pregnancy module and 20/30 (67%) for the mindful eating module. All subjects reported some degree of perceived benefit, and none reported negative experiences. Trends were observed for improvements in maternal mental wellbeing and eating behaviors. This pilot study shows that a smartphone-based MBI is feasible, acceptable, and perceived to provide benefit among pregnant women with obesity. Full article

(This article belongs to the Special Issue Prenatal Wellbeing and Maternal and Child Health Outcomes)

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