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PubMed2006

Telecare for women with postpartum depression.

Data were collected to pilot test the feasibility and effects of telecare as an intervention for depression in a small group of mothers with postpartum depression. Treatment involved a 10-week telecare therapy consisting of three related aspects: cognitive-behavioral therapy, relaxation techniques, and problem-solving strategies. Beck Depression Inventory II scores were significantly lower after telecare treatment. Women identified psycho-education as the greatest help to them.

Adaptation, Psychological↗
PubMed2004

The Electronic Report on Adolescent Pregnancy (ERAP).

PURPOSE: To create a data management system that: (1) standardizes antecedent, program, and outcome variables relevant to the shared goals of adolescent-oriented maternity programs while allowing users to add variables pertaining to unique aspects of their work; (2) cues providers to physiologic and psychosocial characteristics that predispose teenagers to adverse pregnancy and parenting outcomes, (3) standardizes patient care by guiding providers through adolescent-oriented prenatal, postpartum, and well baby visits, and (4) establishes the infrastructure to collect data from a nationally representative sample of pregnant and parenting teens. METHOD: We adapted a powerful, state-of-the-art relational database framework (Microsoft Access 2000) to create an easy-to-use data management system-The Electronic Report on Adolescent Pregnancy (ERAP)-that requires minimal training to use on a personal computer. RESULTS: ERAP is designed to meet the administrative and analytic needs of adolescent-oriented maternity programs. It consists of six linked core data tables (teen, pregnancy, prenatal visits, child, interconception interval, and interconception interval visits), that allow users to analyze data from these multiple views while preserving the family structure. In addition, the database standardizes methods for collecting and storing the information and automatically computing the variables needed to monitor and evaluate an adolescent-oriented maternity program. Since by adding variables and appending supplementary tables, users can modify the core database to accommodate unique aspects of their programs and/or research, ERAP is also an ideal conduit for translating research findings into clinical practice. Similarly, because ERAP actually structures the care patients receive, the database provides the infrastructure needed to develop and implement best practice guidelines for treating teen-headed families. Finally, the confidentiality of all subject data is assured because ERAP is password-protected and automatically prepares files for batched external analyses by removing personal identifiers. CONCLUSIONS: ERAP provides the infrastructure needed to create a teen-pregnancy databank at the national level and an efficient patient monitoring system at the program level. By standardizing variable definitions and data collection techniques, serving as a repository for data collected at multiple sites, and tracking the multidisciplinary aspects of the care patients receive, ERAP has the potential to facilitate collaboration between adolescent-oriented maternity programs, increase the scientific rigor of teen pregnancy research, and improve the quality of care individual teen-headed families receive by prompting compliance with best practice guidelines.

Adolescent↗
PubMed2002

ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed1996

The impact of intensive case-managed intervention on substance-using pregnant and postpartum women.

This study examines the impact of the Women's Intervention Services and Education (WISE) Project in serving substance-using pregnant and postpartum women through an array of case-managed services and supports. A descriptive analysis of multiple outcome indicators was performed on 152 women who had a minimum 6 months of exposure to WISE services at the time of the analysis. The variables used in the analysis to assess client and program outcomes included substance use, employment, arrests, incarceration, birthweight, and social support. This group of women showed statistically significant improvements across each of these multiple outcome indicators from pre-WISE to WISE discharge. Although the findings of this study are not conclusive because no control group was employed, the results are encouraging and supportive of a growing body of literature that suggests that pregnant and postpartum polydrug-using women can be responsive to case-managed, intensive intervention, with aftercare support.

Adult↗
PubMed1999

Wellness intervention with pregnant soldiers.

The purpose of this study was to measure the effects that wellness program intervention for pregnant soldiers, exercise and/or education, had on methods of delivery, pregnancy outcomes, rates of complications, Army Physical Fitness Test scores, and labor and delivery costs. The study consisted of a retrospective review and analysis of 823 active duty Army obstetric and newborn records, 181 Army Physical Fitness Test records, and 411 initial and 148 postpartum subjective questionnaires. Data were collected from records of soldiers who delivered at Madigan Army Medical Center (Tacoma, Washington) between January 1992 and December 1994. Group I (N = 211) included soldiers who received wellness intervention, group II (N = 147) included those who did not receive wellness intervention. Limited data from the records of soldiers who delivered before a wellness program was offered on post constituted group III, a historical control group (N = 413). Group IV included data from a high-risk population (N = 52) collected during the wellness program. Data were also divided into additional subgroups to ascertain if one aspect of the wellness program (i.e., exercise versus education) influenced any or all of the dependent variables. A soldier's data were excluded if a pregnancy was terminated before 20 weeks of gestation or if it was a multiple gestation. Demographic data and variables were compared using multivariate methods of analysis to evaluate the effect of the independent variable, wellness intervention. Results indicated that infants of the wellness group participants had proportionately increased gestational age and birth weight, with reduced incidence of the complications fetal bradycardia, hyperbilirubinemia, preeclampsia, and premature labor. Likewise, African-American female soldiers in this study, assessed in other studies as a high-risk group, had a lower incidence of premature delivery and low birth weight when they participated in wellness intervention. Of clinical interest, it appeared as though wellness intervention shortened labor duration and reduced the number of neonatal intensive care unit admissions and the number of neonatal intensive care unit days, which resulted in reduced health care costs.

Adult↗
PubMed1985

Xenobiotic imprinting of the hepatic monooxygenase system. Effects of neonatal phenobarbital administration.

The ability of phenobarbital (PB) to neonatally "imprint" or "program" the hepatic microsomal cytochrome P-450-dependent monooxygenase system (MOS) was investigated. Phenobarbital (30 mg/kg) was administered subcutaneously to neonatal rats of both sexes on days 1-5 postpartum. Various hepatic MOS activities were measured at 6, 22, 50 and 140 days of age. Six-day-old animals of both sexes displayed the increased hepatic microsomal protein levels and enzyme activities expected from the action of phenobarbital as a transitory MOS inducer. Most of these increases dissipated by 22 and 50 days of age. However, at 140 days of age rats of both sexes that had received neonatal phenobarbital showed increased levels of cytochrome P-450, as well as both P-450 and cytochrome c reductase, ethoxycoumarin O-deethylation, glucuronyl transferase activity, in vitro covalent binding of benzo[a]pyrene to DNA and in vivo covalent binding of aflatoxin B1 to hepatic macromolecular fractions. Neonatal phenobarbital administration can alter the metabolic profile of rats in adulthood, apparently by a mechanism different from that responsible for either transitory PB induction or testosterone imprinting.

Animals↗
PubMed1986

Evaluating improvements in multistaged health care: the risk-care-outcome cycle.

A new method of program evaluation was developed in Israel to assess the impact of improved care on the health of mothers and infants. Care before conception and during the prenatal, intrapartum, and postpartum periods form an interrelated sequence. The method, therefore, evaluates the interplay among risks, health care quality improvements, and outcomes within each stage of care, and measures the impact of improved outcomes on subsequent stages. The expansion or modification of pilot maternal and infant health efforts in 42 Israeli communities will be based on the results of this evaluative effort. The concepts employed in this assessment are applicable in many other situations that involve sequences of health services (eg, preoperative, operative, and postoperative care) where the success of each phase of care affects the risks of the succeeding stage.

Academic Medical Centers↗
PubMedDate not supplied

Smoking in pregnancy: patient and provider risk reduction behavior.

OBJECTIVE: To describe the range of risk reduction behaviors among women who continue to smoke after learning of their pregnancy, including reduced tobacco use, eventual cessation, and sustained abstinence as well as the patient-reported smoking cessation-promoting behaviors of prenatal care providers. METHODS: This research is part of a larger prospective, community-based study conducted to assess the association between maternal stress and birth outcomes and infant health and development. Over a 2-year period, from February 2000 to November 2001, women receiving prenatal care at a consortium of public health centers in Philadelphia, Pennsylvania, were consecutively recruited (n = 1,451) completing interviews at their initial prenatal visit and again 3 to 4 months following their delivery. Smoking rates during pregnancy were determined from responses given during the first postpartum interview, at 3 to 4 months postpartum. RESULTS: Of the 1,451 women interviewed at 3 to 4 months postpartum, 24.9 percent indicated smoking during their pregnancy. Of these antenatal smokers, 89.0 percent reported reducing their cigarette consumption during pregnancy. However, only 25.4 percent attained abstinence during their pregnancy. Among women who achieved abstinence during their pregnancy, 21.7 percent were still not smoking at the time of the postpartum interview. Antenatal smokers reported that prenatal care providers asked about their smoking (90.6%) and advised about quitting (76.5%). However, only 27.9 percent were given referrals to smoking cessation programs. CONCLUSION: While cessation was achieved by only a quarter of antenatal smokers, almost 90 percent reduced their cigarette consumption. Prenatal care providers identified and provided cessation advice to the majority of women who were smoking but they did not follow through with material assistance in the form of referrals to smoking cessation programs.

Adult↗
PubMed1996

Treatment of perinatal cocaine addiction: use of the modified therapeutic community.

Treatment outcome was evaluated for perinatal cocaine addicts admitted to a hospital-based day treatment clinic, organized as a modified therapeutic community (TC) modality. The perinatal program consisted of a specialized track for women embedded within this larger coed day treatment clinic. A total of 87 perinatal women (28 pregnant at intake, the remaining 59 postpartum) were compared with cohorts of nonperinatal women (N = 63) and men (N = 158) admitted during the period of evaluation (September 1989 through December 1993). In logistic regression analysis, successful discharge urine status (last three urines prior to discharge drug-free) was associated with current child custody involvement (odds ratio = 2.80, 95% C.I. = 1.16-6.72), entering treatment when not postpartum (odds ratio = 0.15, 95% C.I. = 0.05-0.42), and taking psychiatric medication (odds ratio = 2.04, 95% C.I. = 1.11-3.72). Both pregnant and postpartum perinatal women showed a similar pattern of shorter treatment as compared with nonperinatal women and male clients, averaging 2 months of treatment as compared with 4 months for nonperinatal clients. Factoring out pregnancy and postpartum status, the women in treatment fared as well as men with respect to both retention and discharge urine standings. This finding indicates that programmatic modifications need to address specific perinatal issues and not gender issues per se. Also, a differential pattern in discharge urine status of women who enter treatment while pregnant vs. those who enter when postpartum suggests that outreach and recruitment be targeted, but not limited, to pregnant women.

Adult↗
PubMed1978

Monitoring of plasma and milk progesterone for evaluation of postpartum estrous cycles and early pregnancy in mares.

Plasma and milk progesterone concentrations in 13 mares were determined 3 times a week for 5 months, beginning at parturition. The estrous cycle was divided into 2 phases. Estrus was considered to occur when the plasma progesterone concentration was less than 1 ng/ml, with diestrus occurring when plasma progesterone content was greater than or equal to 1 ng/ml. Based on this classification, the period of estrus averaged 8.9 days, diestrus averaged 13.9 days, and the estrous cycle averaged 22.8 days. During estrus, the progesterone concentration in plasma averaged 0.4 ng/ml and in milk averaged 2.2 ng/ml. During diestrus corresponding values were 6.8 and 6.9 ng/ml. In the early pregnant mare, the average progesterone concentration was 5.4 ng/ml for plasma and 4.7 ng/ml for milk. The progesterone pattern was similar in milk and in blood plasma, and the correlation between 362 paired values was 0.7 (P less than 0.01). It was concluded that the estrous cycle of the mare can be mapped accurately by measuring plasma or milk progesterone content at 2- to 3-day intervals. A breeding program based on monitoring blood progesterone was outlined.

Animals↗
PubMed2003

First Breath prenatal smoking cessation pilot study: preliminary findings.

Despite the many dangers associated with smoking during pregnancy, it remains a salient public health problem for Wisconsin women. The First Breath pilot program was developed in an attempt to reduce rates of smoking during pregnancy among low-income women. Preliminary results suggest that the First Breath counseling-based approach is effective, with a quit rate of 43.8% among First Breath enrollees at 1 month postpartum. Women receiving First Breath cessation counseling also had higher quit rates at every measurement period versus women in a comparison group who were receiving whatever cessation care was available in their county in the absence of First Breath. The First Breath pilot study has demonstrated success in helping pregnant women quit smoking and in creating a model for integration of cessation services into prenatal health care service provision. It is through this success that First Breath is expanding beyond the pilot study stage to a statewide program in 2003.

Adolescent↗
PubMed1989

Enzyme-linked immunosorbent assay of apolipoprotein B in blood spotted onto filter paper, suitable for neonatal screening.

This assay was developed to measure apolipoprotein (apo) B in blood samples spotted onto filter paper. The long-term aim is to detect young families with the dominantly inherited familial hypercholesterolemia, during current neonatal screening programs. The interassay CV was 5.6%, and apo B concentrations correlated closely with values measured by radial immunodiffusion. In the present assay, the primary apo B standard selected and the serum samples behaved similarly. Use of Triton X-100 in the extraction of apo B from dried blood prevented the decrease in apo B immunoreactivity that otherwise occurred during storage for 20 days at 4 degrees C. In 57 neonates two to six days postpartum, the mean (and SD) apo B concentration in whole blood was 186 (78) mg/L, and the apo A-I/apo B ratio was higher in female than in male neonates (P less than 0.001), as is also true for adults. The assay is suitable for use in screening programs for newborns, and the observations add to our understanding of lipid metabolism in neonates.

Apolipoproteins B↗
PubMed2004

Researching practice: the methodological case for narrative inquiry.

Research interest in the analysis of stories has increased as researchers in many disciplines endeavor to see the world through the eyes of others. We make the methodological case for narrative inquiry as a unique means to get inside the world of health promotion practice. We demonstrate how this form of inquiry may reveal what practitioners value most in and through their practice, and the indigenous theory or the cause-and-consequence thinking that governs their actions. Our examples draw on a unique data set, i.e. 2 two years' of diaries being kept by community development officers in eight communities engaged in a primary care and community development intervention to reduce postnatal depression and promote the physical health of recent mothers. Narrative inquiry examines the way a story is told by considering the positioning of the actor/storyteller, the endpoints, the supporting cast, the sequencing and the tension created by the revelation of some events, in preference to others. Narrative methods may provide special insights into the complexity of community intervention implementation over and above more familiar research methods.

Community Networks↗
PubMed1991

Postnatal alterations in beta-adrenergic receptor binding in rat brain regions after continuous prenatal exposure to propranolol via maternal infusion.

Early exposure of developing postsynaptic receptors to the appropriate neurotransmitter is thought to be important for establishing the pattern of receptor development and function. We have examined the role of fetal catecholamines in central nervous system beta-adrenergic receptor maturation by administering the beta-adrenergic antagonist, propranolol, throughout gestation via continuous maternal infusion in rats. After birth, we examined beta-receptor binding of [125I]pindolol in three brain regions. In the cerebral cortex, receptor binding was relatively normal in the propranolol group during the immediate postpartum period, but eventually became elevated in young adulthood. Binding characteristics were not significantly affected in midbrain + brainstem or cerebellum. These data support a role for fetal catecholamines in the programming of subsequent receptor development, but in a fashion selective for specific brain regions.

Animals↗