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PubMed2003

Structured diet and physical activity prevent postpartum weight retention.

BACKGROUND: Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in the United States. This study examines the impact of an individualized, structured diet and physical activity intervention on weight loss in overweight women during the first year postpartum. METHODS: Forty overweight postpartum women were randomized to either a structured (STR) or a self-directed (SELF) intervention. Measurements included body weight, percent body fat, daily caloric intake, habitual physical activity, and cardiorespiratory fitness. Subjects in STR received individualized diet and physical activity prescriptions derived from baseline measurements. They met weekly for the first 12 weeks and kept daily food and activity diaries. Subjects in SELF received a single 1-hour educational session about diet and activity. RESULTS: Only 23 of 40 participants remained in the study at 1 year postpartum. Of those, STR (n = 13) had a significant weight loss (7.3 kg, p < 0.01), a significant decrease in percent body fat (6%, p < 0.01), and no change in fat-free mass. SELF (n = 10) had no significant change in weight, percent body fat, or fat-free mass. CONCLUSIONS: Women who committed to this one class per week for 12 weeks postpartum had a high likelihood of successful weight loss that persisted at 1 year. Women who were overweight before pregnancy were unlikely to lose the pregnancy-related weight without the help of a formal intervention. This suggests that healthcare professionals should strongly encourage postpartum women to enroll in a structured diet and exercise program.

Adipose Tissue↗
PubMed1983

Effect of informed parental consent on mothers' knowledge of newborn screening.

To determine whether knowledge was improved as a result of obtaining informed consent from parents for newborn screening of their infants for phenylketonuria (PKU) and other hereditary metabolic disorders, new mothers in seven Maryland hospitals were interviewed either before receiving a standard disclosure (n = 210) or after giving consent (n = 418). The mean knowledge score of the women interviewed after giving consent was significantly higher (P less than .001). Receiving the disclosure was a more powerful predictor of knowledge score, accounting for 40% of the variance, than demographic factors, which accounted for 9%. Women whose consent was obtained just prior to discharge tended to have lower knowledge scores than women whose consent was obtained earlier (P = .03). Women with higher knowledge scores were somewhat less likely to favor consent than women with lower scores. Although consent may not be appropriate for some low-risk procedures, informing parents can be easily and inexpensively accomplished.

Attitude↗
PubMedDate not supplied

Postpartum depression and social support in adolescents.

OBJECTIVE: The purpose of the study was to determine the effectiveness of a social support intervention delivered to pregnant adolescent girls between 32 and 36 weeks of gestation in preventing symptoms of depression at 6 weeks postpartum. DESIGN: The study used a repeated measures design. SETTING: Data were collected at a teenage parenting program, an educational option of the public school system. PARTICIPANTS: Participants (n = 128) were pregnant and postpartum adolescents. MAIN OUTCOME MEASURE: Symptoms of depression at 6 weeks postpartum. INTERVENTION: Participants completed the Postpartum Support Questionnaire, Rosenberg's Self-Esteem instrument, and the Center for Epidemiological Studies of Depression instrument at baseline, then were randomly assigned to one of three intervention groups (pamphlet, video, or pamphlet plus video) or the control group. The content of the intervention was based on a synthesis of the literature describing social support needed and desired by postpartum adolescents. RESULTS: No significant differences were found in Center for Epidemiological Studies of Depression instrument scores among the groups at 6 weeks postpartum. Using path analysis, the authors found that predictors of symptoms of depression at 6 weeks postpartum were (a) receiving more support from friends, family, and others and (b) having low self-esteem. CONCLUSION: These findings differ from earlier studies, and both research and clinical implications are discussed.

Adolescent↗
PubMed1986

Prepartum grain feeding and subsequent lactation forage program effects on performance of dairy cows in early lactation.

One hundred fifty-six Holstein cows were balanced prior to drying off to one of three diets offered during the dry period (dry matter basis): A) forage only (50% corn silage:50% alfalfa silage), B) forage as A plus a standard dairy grain mix (1.73% calcium), and C) same as B except a low calcium grain mix (.35% calcium). Grain feeding started 3 wk prepartum. Cows from each dry treatment were assigned to one of two treatments during the first 21 d postpartum: total mixed ration (dry matter basis); 50% grain:50% corn silage; or 50% grain:25% corn silage:25% alfalfa silage. Dry period feeding program had no effect on postpartum dry matter intake, milk yield, or composition. Prepartum grain feeding resulted in increased body weight gain during the last 3 wk of the dry period. Feeding corn silage postpartum as the sole forage resulted in higher dry matter intakes (15.0 vs. 14.1 kg/d), milk production (31.3 vs. 29.7 kg/d), and less body weight loss (36 vs. 58 kg) during the first 21 d postpartum than feeding a 50% corn silage:50% alfalfa silage mixture. However, differences varied depending on dry cow feeding program. All dry cow treatments resulted in a high incidence of milk fever (11.5, 11.5, and 15.5% for A, B, and C, respectively). Dry cow rations containing as little as 50% alfalfa silage appear to predispose cows to increased incidence of milk fever.

Animal Feed↗
PubMed1994

Hospital-based perinatal home-care program.

In recent years, hospitals have established home-care programs to provide care on a continuum, meeting needs in the hospital and home setting, whichever is most appropriate and efficient in response to defined patient needs. Hospital-based home-care programs with specialization in perinatal nursing have been established to meet the care needs of patients and their families during antepartum, postpartum, and neonatal periods. One of the greatest advantages of a hospital-based program is the internal availability of highly knowledgeable and skilled nursing staff. Physicians are more likely to refer patients to a program that is staffed with nurses they know and trust from the hospital setting. More cost-effective and coordinated care is achieved through the appropriate use of resources across the continuum.

Community Health Nursing↗
PubMed1994

Incentives enhance postpartum compliance among adolescent prenatal patients.

OBJECTIVE: To test the hypothesis that incentives enhance compliance with postpartum appointments. METHOD: We studied a multiracial group of 240, poor, 12-to-19 year olds. At 34 weeks gestation consecutively enrolled patients were randomized to incentive and non-incentive groups. Patients in the incentive group were told that they would receive a Gerry "Cuddler" if they returned for an examination within 12 weeks of delivery. The groups were compared with Student's t-tests and chi-square and logistic regression analyses. RESULTS: We found no significant group differences in age, race, Medicaid status, gravidity, parity, the timing of the first prenatal visit, compliance with prenatal appointments, or well-baby care site. One hundred and seventy-five (73%) of the 240 patients returned for a postpartum examination. Patients randomized to the incentive group were significantly more likely to return for an examination within 12 weeks of delivery (82.4% vs. 65.2%, chi 2 = 9.0; p = .003). The logistic regression analysis revealed that in addition to membership in the incentive group, three characteristics were significantly associated with postpartum compliance: primiparity, compliance with prenatal care, and school enrollment. CONCLUSIONS: Among adolescents who obtained prenatal care in a multidisciplinary adolescent-oriented maternity program, the offer of an incentive significantly improved compliance with the 6-week postpartum appointment. Since other factors associated with improved postpartum compliance are less amenable to change we recommend that health care providers consider offering a postpartum incentive, especially to their multiparous adolescent patients who are not enrolled in school and/or are non-compliant with prenatal appointments.

Adolescent↗
PubMed1989

Birth-interval dynamics in rural Bangladesh and maternal weight.

This article reports on the results of a study conducted in rural Bangladesh on the influence of maternal weight on the components of birth intervals, including gestation and intrauterine mortality, the duration of postpartum amenorrhea, and the duration of waiting time to conception (the menstrual interval). When biological factors (including maternal age, parity, and supplementation practices) and behavioral variables, including religion, education, and occupation, were controlled, maternal weight was found to be related to the risk of intrauterine mortality and to the probability of resuming menses in the postpartum period. The implications of these findings for policies and programs in developing countries are discussed.

Amenorrhea↗
PubMedDate not supplied

Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies.

OBJECTIVE: Review and examine existing research, current strategies, and directions for future research on smoking cessation relapse and relapse prevention in pregnancy and postpartum. METHODS: A MEDLINE/PubMed search in 2002 and 2003 for articles containing the key words "smoking," "pregnancy," "cessation," and "cessation relapse prevention" and references of retrieved papers yielded a review of more than 500 articles. Only 14 of these addressed program-based strategies to increase cessation among pregnant women through relapse prevention programs. CONCLUSION: Although there is much information on the rationale and strategies for smoking cessation for pregnant women, fewer studies exist on how to prevent relapse. Maintaining and accelerating progress in cessation during pregnancy and postpartum requires more research that focuses on relapse prevention and cessation. Programs should incorporate stresses particular to postpartum women, should be part of routine health care, and should involve the woman's social support network, including her partner, to maximize effectiveness.

Decision Making↗
PubMed1997

Receipt of home health care after early discharge: results from a national managed care organization.

OBJECTIVES: To determine the frequency of home visits during the postpartum period among women discharged within 24 hours after childbirth, to identify characteristics of women who received at least one home visit, and to examine whether a home visit was related to postpartum experiences. METHOD: Women who were enrolled in a Prudential HealthCare plan and had a recent normal vaginal delivery completed a 15-minute telephone survey (N = 5201). Only women who were discharged within 24 hours after delivery were included in this analysis (N = 3121). Selected variables, including maternal characteristics, pregnancy-related and postpartum experiences, and social support factors, were compared for women who received visits and those who did not receive visits within two weeks after delivery. RESULTS: Slightly more than 30% of women participating in the survey received at least one home health care visit within 2 weeks after delivery discharge. Women who received a home visit were more likely to be Black, employed, primaparous, enrolled in a health maintenance organization, or not living in the Southern United States. Compared with women who did not receive a home visit, women who received a visit were more likely to have their newborn receive a phenylketonuria test after discharge, receive a follow-up phone call or housekeeping service, and access to a 24-hour hotline. CONCLUSIONS: Managed care organizations as well as other organized systems of care should be focused on improving the quality of prenatal and postpartum services, and increasing satisfaction of women using these services.

Adult↗
PubMedDate not supplied

Mothers, midwives, and HIV/AIDS in Sub-Saharan Africa.

This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. Feminization of the epidemic is related to gender inequalities that facilitate the spread of HIV and make pregnant women an especially vulnerable group. Nurses and midwives are the primary health care providers for most of the population in sub-Saharan Africa. They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.

Adolescent↗
PubMed2000

Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up.

OBJECTIVE: To evaluate the long term effect of a postpartum pelvic floor muscle training course in prevention and treatment of urinary incontinence. DESIGN: A prospective matched controlled trial. SAMPLE AND METHODS: All women who had participated in a matched controlled study evaluating the effect of an eight-week pelvic floor muscle training program in prevention and treatment of urinary incontinence in the immediate postpartum period were contacted by telephone one year after delivery. They were invited to participate in a follow up study. The study group consisted of 81 matched pairs (n = 162), with a mean age (range) 28 years (19-40), and mean number (range) of deliveries 1.8 (1-5). Seventy-six pairs had normal vaginal deliveries and five elective caesarean sections. Registration of continence status was by structured interview and a standardised pad test. Clinical assessment of pelvic floor muscle function and strength were by vaginal palpation and vaginal squeeze pressure. MAIN OUTCOME MEASURE: Stress urinary incontinence. RESULTS: At the one year follow up, significantly more women in the former control group than in the training group reported stress urinary incontinence and/or showed urinary leakage at the pad test (P < 0.01). A significantly greater (P < 0.01) muscle strength increase in the period between 16th week and one year postpartum was demonstrated in the former training group (mean 4.4 cm H2O, 95% CI 3.2-5.6) than in the control group (mean 1.7 cm H2O, 95% CI 0.8-2.7). CONCLUSION: This one year follow up study demonstrates that a specially designed postpartum pelvic floor muscle training course was effective in the prevention and treatment of stress urinary incontinence. The benefits from pelvic floor muscle training are still present one year after delivery.

Adult↗
PubMed2003

Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women.

OBJECTIVE: Antenatal depression is a significant risk factor for postpartum depression, with a 10%-12% prevalence in all pregnancies. Rates of depression are higher for pregnant women with chronic stressors, financial and housing problems, and inadequate social support. Despite the prevalence and associated family and infant morbidity, there are no controlled clinical treatment trials regarding this topic, to the authors' knowledge. APA has identified treatment of depression during pregnancy as a priority for clinical guidelines. METHOD: A 16-week bilingual controlled clinical trial compared a group receiving interpersonal psychotherapy for antepartum depression to a parenting education control program. Fifty outpatient antepartum women who met DSM-IV criteria for major depressive disorder were randomly assigned to interpersonal psychotherapy or a didactic parenting education program. Thirty-eight women remained in the study and were included in the data analysis. Depressed mood was measured with the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory, and the Hamilton Depression Rating Scale. The Clinical Global Impression (CGI) and the Hamilton depression scale measured recovery. RESULTS: The interpersonal psychotherapy treatment group showed significant improvement compared to the parenting education control program on all three measures of mood at termination. Recovery criteria were met in 60% of the women treated with interpersonal psychotherapy, according to a CGI score of < or = 2. In addition, there was a significant correlation between maternal mood and mother-infant interaction. CONCLUSIONS: Interpersonal psychotherapy is an effective method of antidepressant treatment during pregnancy and should be a first-line treatment in the hierarchy of treatment for antepartum depression.

Adult↗
PubMed2004

Stages of change for weight management in postpartum women.

OBJECTIVE: This study examined factors related to stages of change for weight-management behaviors in postpartum women. DESIGN: Cross-sectional data, collected at baseline, are reported from the Mothers' Overweight Management Study (MOMS), a randomized, controlled trial conducted in postpartum women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Subjects/Setting Subjects were a sample of WIC recipients (N=151) older than 18 years of age with a child younger than 2 years. Statistical analysis The dependent variables were the stages of change for weight-management behaviors (losing weight, avoiding high-fat foods, eating a high-fiber diet, and exercising). Demographic, health, and psychosocial variables were examined as independent variables. One-way analysis of variance was used to compare means, and chi(2) was used for proportions. RESULTS: Whereas 55% of women were in the action stage for weight loss, fewer women were in the action stage for the following weight management behaviors: avoiding high-fat foods (24%), increasing fiber (19%), and exercising three times per week (29%). Identifying pros for weight management was related to stages for losing weight, high-fat food avoidance, and exercise (F=13.4, P<.001; F=10.5, P<.001; F=3.7, P<.007, respectively). Self-efficacy for choosing a low-fat restaurant meal or using food labels was positively related to later stages for avoiding high-fat foods and increasing fiber intake (chi(2)=16.4, P=.003; chi(2)=11.7, P=.02). CONCLUSIONS: Emphasizing the pros for weight-management behaviors, decreasing the cons for exercising, increasing confidence to select low-fat restaurant choices, and improving skills for using food labels are four strategies that nutrition professionals can use to help women become more ready to change behaviors for weight management.

Adolescent↗
PubMed1996

Effect of skim milk supplementation of the maternal diet on lactational amenorrhea, maternal prolactin, and lactational behavior.

Effect of skim milk supplementation of the maternal diet on lactational amenorrhea was studied in 30 pairs of healthy lactating women matched for parity, body mass index, and previous experience of lactational amenorrhea. Supplementation of the maternal diet had no significant effect on the time of resumption of regular menstruation or ovulation, maternal prolactin concentrations, breast-feeding pattern, maternal body mass index, or infant weight. However, the supplemented group breast-fed nearly exclusively (supplemental feeds were introduced but did not exceed 20% of total feeds) for a significantly longer duration (P < 0.05) than did the control group. Previous experience of lactational amenorrhea was significantly positively correlated with the time of resumption of menstruation in the supplemented (P < 0.01) and control (P < 0.05) groups when frequency of breast-feeding, maternal body mass index, and supplementary feeds to the infant were controlled for. Thus, maternal nutritional supplementation does not appear to affect the contraceptive benefit of lactation when the frequency of breast-feeding is not compromised but apparently lengthens the duration of nearly full breast-feeding.

Adult↗
PubMed2005

Extramarital sex among Nigerian men: polygyny and other risk factors.

The AIDS epidemic in Nigeria is generalized, with infection primarily occurring through heterosexual transmission. It is important to understand patterns of sexual behavior to assess their impact on the epidemic and to design appropriate intervention strategies. This study examined risk factors for extramarital sex among Nigerian men, with a particular focus on polygyny and peri- and postpartum abstinence. Data from the 2003 Nigeria Demographic and Health Survey were analyzed for 1153 men and their wives. Eleven percent of men reported extramarital sex in the previous year. Logistic regression models showed that men with 3 or more wives were at the greatest risk for extramarital sex, followed by monogamous men, when compared with men with 2 wives. Other significant predictors included region, religion, wealth, age at sexual debut, and self-perceived risk of HIV infection. Peri- and postpartum abstinence was not significant. Based on these findings, HIV prevention programs should include men with 3 or more wives and those living in the southwest region, in addition to activities targeting men of all ages. Given the heterogeneity within Nigeria, further in-depth studies should be undertaken to explore the relation between number of wives, peri- and postpartum abstinence, and extramarital sex within specific communities.

Adolescent↗
PubMed1994

Antepartum and postpartum depression and infant feeding pattern: a prospective study.

Mother's depression during pregnancy and postpartum is a risk factor that can adversely affect mother's relationship with her infant. As breast feeding is an important situation for early mother-child interaction the effect of mother's depression on her breast feeding attitude and practice was decided to be studied prospectively. In this study, 158 primigravidae attending antenatal clinics in two MCH centres were interviewed at third trimester. The interview data covered social background, attitudes to breast feeding as well as self rating of depression using the Edinburgh Postnatal Depression Scale (EPDS). At postnatal interview 72 mother-infant pairs could be reached between 6-16 weeks after birth. They were subjected again to EPDS along with inquiry about type of infant feeding and breast feeding practices. Findings revealed that the prevalence of antepartum depression was 25.32%. Antepartum depression was significantly linked to postpartum depression and negative attitudes to breast feeding. Persistent maternal depression (ante- and postpartum) was a risk factor for early resorting to mixed infant feeding, retarded infant growth as well as some adverse maternal and infant health outcomes. Logistic analysis indicated that negative mothers' attitudes to breast feeding and postpartum depressive scores taken together predicted mixed infant feeding. Hence, preventive programs should be directed specifically towards modifying the mother's psychological status and her attitude on behalf of her infant.

Adolescent↗
PubMed2006

Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial.

BACKGROUND: Low back and pelvic pain is common in pregnancy and postpartum, but there is no well documented effect of treatment in pregnancy. The aim of the study was to assess whether a group intervention program for pregnant women with pelvic girdle pain has any effect on pain and daily function postpartum. METHODS: Pregnant women with pelvic pain between the 18th and 32nd week of gestation were invited to participate in a randomized clinical study. Among 958 examined women, 569 (59%) fulfilled the inclusion criteria. Women randomized to the intervention group (n=275) participated in an education program that consisted of information, ergonomics, exercises, pain management, advice for daily life movement, pelvic belt/crutches, and information about delivery. Women randomized to the control group (n=285) were not offered any treatment, but were free to seek advice or other treatment. Clinical measures and self-evaluated utility of the intervention were measured by a visual analogue scale 0-10. RESULTS: Mean debut of pelvic girdle pain in pregnancy was at week 15. Altogether 42% of the women reported problems with low back pain earlier, and 34% reported a family history of pelvic girdle pain in pregnancy. Median visual analogue scale score for all activities at inclusion was 6 both in the control group and the intervention group. At 6 and 12 months postpartum the score was reduced to 1.7/1.6 and 1.1/0.9. In the intervention group, 75% marked a self-evaluated utility visual analogue scale score >7. In the control group, 60% had searched for alternative treatment. CONCLUSIONS: Postpartum pelvic girdle pain improved with time both in the intervention group and the control group, but there were no statistically significant differences between the groups. Self-evaluated utility of the intervention was, however, high in the intervention group.

Activities of Daily Living↗