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PubMed2001

Heritabilities and correlations among body condition scores, production traits, and reproductive performance.

The objectives of this study were to estimate the heritability of body condition scores (BCS) from producer and consultant-recorded data and to describe the genetic and phenotypic relationships among BCS, production traits, and reproductive performance. Body condition scores were available at calving, postpartum, first service, pregnancy check, before dry off, and at dry off from the Dairy Records Management Systems in Raleigh, NC, through the PCDART program. Heritabilities, genetic correlations, and phenotypic correlations were estimated assuming an animal model using average information REML. Herd-year-season effects and age at calving were included in all models. Prior calving interval was included in models for second and third lactations. Analyses that included reproductive traits were conducted with and without mature equivalent milk as a covariable. Heritability estimates for BCS ranged from 0.09 at dry-off to 0.15 at postpartum in first lactation. Heritability estimates ranged from 0.07 before dry-off to 0.20 at pregnancy check in second lactation and from 0.08 before dry-off to 0.19 at first service in third lactation. Genetic correlations between adjacent BCS within first lactation were greater than 0.96 with the exception of calving and postpartum (0.74). In second lactation, adjacent genetic correlations were 1.0 with the exception of calving and postpartum (0.84). Genetic correlations across lactations were greater than 0.77. Phenotypic correlations between scoring periods were highest for adjacent scoring periods and when BCS was lowest. Phenotypic correlations were lower than genetic correlations, i.e., less than 0.70. Higher BCS during the lactation were negatively related to production, both genetically and phenotypically, but the relationship was moderate. Higher BCS were favorably related genetically to reproductive performance during the lactation.

Animals↗
PubMed2001

Health risks and psychosocial outcomes of early childbearing: a review of the literature.

This article presents a review of the literature on the obstetric, medical, and neonatal health risks as well as psychosocial outcomes associated with early childbearing. An important concern in adolescent pregnancies is the increased risk for infant morbidity and mortality as a result of higher incidence of preterm births and low-birthweight infants. Implications for prenatal and postpartum nursing care are discussed. Promising new models to improve care of young mothers and their children, such as home visitation by public health nurses, are presented and features of successful intervention programs outlined.

Adolescent↗
PubMed2002

Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women.

Low-income, multi-ethnic women are at elevated risk for obesity and chronic diseases, yet influences at different levels may act as barriers to changing risk behaviors. Following the birth of a child, childrearing and social isolation can exacerbate these influences. The social ecological framework integrates behavior-change strategies at different levels, providing a strong theoretical base for developing interventions in this high-risk population. The primary purpose of this randomized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet, activity and weight loss among new mothers over a 12-month postpartum period and a 6-month maintenance period. This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels, through collaboration with federal programs for low-income families: the Special Supplemental Food Program for Women, Infants and Children (WIC), and the Expanded Food and Nutrition Education Program (EFNEP). Participants are randomized to the Usual Care, e.g. WIC nutrition and breastfeeding education, or Enhanced EFNEP intervention arm, consisting of Usual WIC Care plus a sustained, multi-component intervention including home visits, group classes and monthly telephone counseling. If shown to be efficacious, this program will be readily sustainable through existing federal agencies.

Adult↗
PubMed1993

Knowledge and attitudes toward breast-feeding: differences among dietitians, nurses, and physicians working with WIC clients.

We assessed the knowledge of and attitude toward breast-feeding of dietitians, nurses, and physicians who work with individuals in the Alabama Special Supplemental Food Program for Women, Infants, and Children. On a scale of 0 to 100, dietitians expressed stronger interest in lactation (78.6) and exhibited greater knowledge (79.6) of the questions asked than nurses (74.5 and 73.0, respectively). Attitude and knowledge scores of physicians (70.2 and 75.5, respectively) were not statistically different from those of dietitians or nurses. Respondents disagreed greatly about the relationship of breast-feeding to weight loss and the appropriateness of oral contraceptives during breast-feeding 6 weeks postpartum. Professionals were more knowledgeable about benefits to infants than about maternal concerns. Results of this study suggest that professional breast-feeding education programs should address maternal concerns such as weight loss, contraception, and mastitis as well as benefits to the infant.

Alabama↗
PubMed1991

Timing of postpartum tubal sterilization using the Filshie clips: an analysis of data from two developing-country centers.

Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.

Developing Countries↗
PubMed2006

Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus.

OBJECTIVE: The purpose of this study was to examine the exercise beliefs and behaviors of postpartum women who had gestational diabetes mellitus (GDM) during a recent pregnancy. RESEARCH DESIGN AND METHODS: Postpartum women with GDM (n = 28) completed a mail survey assessing their self-reported exercise beliefs (advantages, barriers, and important social influences) and behaviors. RESULTS: We found that 1) the strongest perceived advantage of exercise during pregnancy was controlling blood glucose and postpartum it was controlling weight, 2) the most common barrier to exercise during pregnancy was fatigue and postpartum it was a lack of time, 3) women's husband/partner most strongly influenced their exercise during pregnancy and postpartum, 4) women exercised more during the postpartum period than before or during pregnancy, and 5) the number of exercise advantages was positively associated with women's pregnancy and postpartum exercise behavior. CONCLUSIONS: To increase exercise behavior and reduce the risk of type 2 diabetes in women with GDM, researchers and health care professionals are encouraged to use women's exercise beliefs, that is, advantages, social influences, and perceived barriers to exercise, as a framework for designing effective diabetes treatment and prevention programs.

Adult↗
PubMed2006

National program for depression associated with childbirth: the Australian experience.

Routine screening was introduced as a joint research/public-health initiative across 43 health services in Australia, funded by beyondblue, the National Australian Depression Initiative. This program included assessing risk factors and prevalence of depression in perinatal women. Other objectives included increasing awareness of the condition, training of relevant staff, and assessing the feasibility of a screening program. Women were screened antenatally and postnatally with a demographic questionnaire and the Edinburgh Postnatal Depression Scale. A subgroup of women and health professionals was surveyed. Over 40,000 women participated directly in the program. Data and issues for specific groups are presented. There was a high level of acceptability to women and health professionals involved. Screening is acceptable and feasible as part of the mental-health management of perinatal women. It needs to be supplemented with information for women and education and support for staff.

Adult↗
PubMedDate not supplied

Crossing the river: Khmer women's perceptions of pregnancy and postpartum.

In Cambodia, a setting of high maternal mortality, little is known about cultural perceptions of pregnancy. Often, cultural perceptions of what is considered normal or problematic guide a woman's decision to seek care. In some settings, the difference between the emic, or cultural insider's perception, and the biomedical perception of what is a serious obstetrical problem may delay lifesaving care. A qualitative study was undertaken to describe an emic perspective of what Khmer women view as normal and view as complications during pregnancy, birth, and postpartum. Focus group and key informant interviews were held to answer the questions: What do Khmer women and their birth attendants view as complications during pregnancy, birth, and postpartum? How are these complications defined? Eighty-eight rural and urban women of childbearing age participated in focus groups in three rural provinces and Phnom Penh. In-depth, semistructured interviews were held with 41 rural and urban women, traditional birth attendants, and trained midwives. Sixty-six hours of taped interviews were transcribed, translated, and analyzed, and descriptions of emic conditions during pregnancy and postpartum were developed. This report details emic categories of antepartum and postpartum conditions identified by these Khmer women. Specific emic categories of normal pregnancy and postpartum are described in detail as well as abnormal emic conditions occurring during the postpartum period. Recommendations are made for use of traditional emic taxonomies as a foundation for explaining biomedical complications and the need for similar studies to guide the development of safe motherhood programs in areas of high maternal mortality.

Adult↗
PubMed2005

Advances in the prevention of mother-to-child transmission of HIV-1 infection in resource-limited settings.

Ten years after the first trials demonstrating the efficacy of zidovudine (ZDV) for the prevention of mother-to-child transmission (pMTCT) of HIV, different antiretroviral approaches have been validated in resource-limited settings. Remarkable progress has been made in the last 4 years, with trials demonstrating the efficacy of postexposure antiretroviral prophylaxis in Malawi, as well as studies in Thailand and Côte d'Ivoire assessing the efficacy and viral resistance patterns of short-course regimens combining ZDV plus single-dose nevirapine (sdNVP). The field efficacy of a short course of ZDV plus lamivudine (3TC), together with sdNVP, has also been recently reported, with 6-week transmission rates below 5% for the first time in Africa in a population in which 40% breast-feed. The introduction of HAART for pregnant women has begun on a small scale in resource-limited settings and will hopefully further reduce transmission. What remains is the crucial issue of viral resistance after antiretroviral therapy for pMTCT, especially in the context of the growing availability and use of sdNVP in national pMTCT programs. Preliminary data from South Africa and Côte d'Ivoire suggest that the maternal use of ZDV plus 3TC for at least 3 days postpartum may reduce the occurrence of resistance mutations after maternal exposure to sdNVP. In the context of increasing controversy surrounding the use of sdNVP for pMTCT, the World Health Organization has recently reiterate its recommendations for its use for pMTCT in resource-constrained settings within a wide panel of antiretroviral regimens, in order to allow greater and quicker population coverage. The field application of pMTCT study results is a real challenge, and innovative approaches need to be designed an evaluated ot increase uptake of pMTCT programs in resource-poor settings. Research must continue to identify new interventions and new antiretroviral drugs for pMTCT.

Developing Countries↗
PubMed2006

High prevalence of cervical squamous cell abnormalities among HIV-infected women with immunological AIDS-defining illnesses.

AIM: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004. METHODS: As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated. RESULTS: Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4(+) count at delivery was < 200 cells/microL than in women whose CD4(+) count at delivery was > or = 200 cells/microL, with a significant difference (21.2%vs 12.2%). CONCLUSIONS: All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4(+) count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear.

CD4 Lymphocyte Count↗
PubMed1992

Pituitary-thyroid axis reactivity to hyper- and hypothyroidism in the perinatal period: ontogeny of regulation of regulation and long-term programming of responses.

To evaluate the role of perinatal thyroid status in the development of pituitary-thyroid axis regulation, we administered triiodothyronine to newborn rats for the first five days postpartum to achieve hyperthyroidism, or propylthiouracil perinatally to rat dams and pups from gestational day 17 through postnatal day 5 to achieve hypothyroidism. Plasma T4, T3, and TSH levels were determined from birth through 50 days postpartum. Administration of exogenous T3 produced the expected immediate suppression of plasma T4 and TSH, with recovery toward normal values beginning within days of discontinuing the T3 regimen. Plasma T3 values were markedly elevated during the period in which T3 was being given, but subsequently became subnormal, with deficits persisting into young adulthood. With the PTU regimen, plasma T4 and T3 levels were markedly suppressed through postnatal day 10, rose over the ensuing two weeks, but nevertheless showed significant deficits into adulthood. TSH levels in the immediate neonatal period were subnormal in the PTU group, despite the marked lowering of circulating thyroid hormones; TSH then rose dramatically to levels four times normal, subsiding to control values by the end of the first month. These results suggest that a critical period exists in which regulation of pituitary-thyroid axis function is programmed. During this phase, TSH secretion can be suppressed by excess thyroid hormones, but cannot be increased by hormone deficiencies. Perhaps more importantly, perinatal thyroid status "programs" its own future reactivity, so that early hypothyroidism results in reduced T4 and T3 levels in adulthood, despite normal levels of TSH.

Aging↗
PubMed1991

The long term benefits of a comprehensive teenage pregnancy program.

A comprehensive program was founded in 1982 to provide adolescents with prenatal and family planning care. The program's impact through its first five years of operation on medical aspects of pregnancy course and fetal outcome will be the subject of a separate report. This study examines subsequent maternal and infant health of the patients attending the program compared to a control group. Four hundred ninety-eight adolescents and their newborns attending the program's mother-baby family planning clinic from 1982 to 1989 (subject group) were compared to ninety-one adolescents and their newborns receiving postpartum family planning and pediatrics clinics from 1980 through 1989 (control group). Seventy-five percent of the subject group regularly attended mother-baby clinic, compared to 18% of the control group attending family planning and pediatric clinics (P less than or equal to .0001). The subject group experienced less maternal and infant morbidity, greater school attendance, graduation, employment, and contraceptive use than the control group (P less than or equal to .0001). Many parameters improved with each program year indicating continued wide acceptance of our program by area adolescents.

Adolescent↗
PubMed1986

[Evaluation in primary prevention: an obligation, I. The obstetrical point of view].

Evaluation of research in primary prevention is often complicated. Various objections and difficulties are discussed: imprecision or lack of practical definition of the child abuse syndrome, definition of primary prevention, lack of epidemiological data, and the existence of ethical problems. Obstetrical models of evaluation are proposed: evaluation of screening methods, postpartum follow-up and contraception, action against prematurity, and unfollowed pregnancies. Results of a four-year antenatal program are presented as indicators and may be served to determine the efficiency of preventive action. Therefore, evaluation of antenatal prevention is possible for at-risk parents.

Child Abuse↗
PubMed1984

Urban black adolescents who obtain contraceptive services before or after their first pregnancy. Psychosocial factors and contraceptive use.

This paper compares three groups of urban black teenagers at their enrollment in a contraceptive program and at a one-year follow-up. The groups comprise 263 never-pregnant, postabortion, and postpartum teens ages less than or equal to 17 years at their initial family planning visit. Self-report questionnaires examined attitudes and information about pregnancy and contraceptive use, sources of contraceptive information, sexual and contraceptive experience, family and partner support for contraceptive use, and demographic background factors. Emotional, personality, and psychosocial factors were assessed with standard measures. Age, partner relationships, and items relating to the mother's communication about contraception and pregnancy were significant variables in the outcome of never-pregnant and delivery of pregnancy. Self-esteem was highest in the never-pregnant group. Personality factors, emotional distress, and social adjustment scores were in the normal ranges and did not differ between the groups. Contraceptive use at follow-up was most consistent in the never-pregnant group. These data suggest the need for earlier family involvement in educating and guiding teens together with access to contraceptive services in preventing unwanted adolescent pregnancies.

Abortion, Induced↗
PubMedDate not supplied

Is the childbirth experience improved by a birth plan?

From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women's experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.

Female↗
PubMed2006

An intervention to increase father involvement and skills with infants during the transition to parenthood.

This study examined whether a group educational intervention during the transition to parenthood can enhance the quality of father-child interaction and increase father involvement with their children. A randomized experimental design was used to evaluate an 8-session program with 165 couples who were first-time parents, beginning during the second trimester of pregnancy and ending at 5 months postpartum. Outcomes were assessed with time diaries, coded observations of parent-child play, and self-reports of fathers and mothers. The intervention had positive effects on fathers' skills in interacting with their babies and their involvement on work days but not home days. It is concluded that a relatively brief intervention during the transition to parenthood can improve fathering, and possible reasons for differential effects on areas of parenting are explored.

Adolescent↗