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PubMed1998

The weanling's dilemma reconsidered: a biocultural analysis of breastfeeding ecology.

Infant feeding practices exert recognized effects on infant survival and command close attention from pediatricians, nutritionists, public health workers, demographers, social scientists, and parents. Despite considerable research and public health efforts, models to inform decision-making about timing of supplementation in policy and practice remain unsatisfactory. In the present review, new models are derived through analysis of the weanling's dilemma. After approximately 6 months, breast milk alone cannot meet the infant's nutritional requirements for growth, but nutritional supplementation raises risks of illness and malnutrition. Timing of supplementation is conditioned by complex short- and long-term trade-offs among infant and maternal needs and constraints. No formulaic solution can be prescribed for this dilemma, but optimal timing of supplementation can be ascertained from infant-, maternal-, and locale-specific conditions. Models for these determinants and trade-offs are presented and applied to data from longitudinal studies of breastfeeding, infant development, and interbirth interval.

Age Factors↗
PubMed2002

Ongoing maternal drug use, parenting attitudes, and a home intervention: effects on mother-child interaction at 18 months.

This prospective study examined the effects of ongoing maternal drug use, parenting attitudes, and a home-based intervention on mother-child interaction among drug-using women and their children. At 2 weeks postpartum, mothers and infants were randomly assigned to either an Intervention (n = 67) or Control (n = 64) Group. Intervention families received weekly visits until 6 months postpartum and biweekly visits from 6 to 18 months by trained lay visitors. The home intervention was designed to increase maternal empowerment and promote child development. Control families received brief monthly tracking visits. Mother-child interaction was evaluated at 18 months through observation of play. Mothers who continued to use cocaine and/or heroin had lower competence scores (p <.05); poor parenting attitude was also associated with lower competence scores during mother-child interaction (p <.05). Although the intervention had no measured effect, ongoing maternal drug use and poor parenting attitudes were associated with less optimal maternal behavior during mother-child interaction.

Attitude↗
PubMed1996

The cost of poor birth outcomes in employer-sponsored health plans.

OBJECTIVES: The authors examine the cost and incidence of poor birth outcomes in employer-sponsored health insurance plans. METHODS: An extensive study of national inpatient and outpatient claims data for prenatal, delivery, and postnatal care of nearly 59,000 mother-infant pairs was conducted. All maternal and infant costs incurred over a 2-year period were analyzed, and, furthermore, the longitudinal claims experience of a cohort of 20,000 mothers and infants was examined in detail. RESULTS: The study revealed that 25% of deliveries resulted in poor birth outcomes, which accounted for 40% of total costs over a 2-year period. Extrapolated nationwide, the net direct medical care cost of poor birth outcomes in employer plans has been estimated at approximately $5.6 billion for 1990, approximately 3% of aggregate after-tax corporate profits that year. CONCLUSIONS: Costs related to maternity and infant care are a major source of cost for employer-sponsored health insurance plans. Poor birth outcomes represent significantly higher cost for both the mother and infant at all stages of care-prenatal, at birth, and postnatal. To the extent that poor birth outcomes relate to maternal behavior and are preventable, their very high and protracted cost may justify substantial health promotion activity by employers and insurers.

Adult↗
PubMedDate not supplied

Social and professional support for pregnant and parenting women.

PURPOSE: A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women. DATA SOURCES: Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts). STUDY SELECTION: The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered. DATA EXTRACTION: Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes. DATA SYNTHESIS: Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes. CONCLUSIONS: Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Clinical Competence↗
PubMed2003

Island-finding ability of marine turtles.

Green turtles (Chelonia mydas) swim from foraging grounds along the Brazilian coast to Ascension Island to nest, over 2200 km distant in the middle of the equatorial Atlantic. To test the hypothesis that turtles use wind-borne cues to locate Ascension Island we found turtles that had just completed nesting and then moved three individuals 50 km northwest (downwind) of the island and three individuals 50 km southeast (upwind). Their subsequent movements were tracked by satellite. Turtles released downwind returned to Ascension Island within 1, 2 and 4 days, respectively. By contrast, those released upwind had far more difficulty in relocating Ascension Island, two eventually returning after 10 and 27 days and the third heading back to Brazil after failing to find its way back to the island. These findings strongly support the hypothesis that wind-borne cues are used by turtles to locate Ascension Island.

Animal Migration↗
PubMed2001

Closely related proteins MBD2 and MBD3 play distinctive but interacting roles in mouse development.

MBD2 and MBD3 are closely related proteins with consensus methyl-CpG binding domains. MBD2 is a transcriptional repressor that specifically binds to methylated DNA and is a component of the MeCP1 protein complex. In contrast, MBD3 fails to bind methylated DNA in murine cells, and is a component of the Mi-2/NuRD corepressor complex. We show by gene targeting that the two proteins are not functionally redundant in mice, as Mbd3-/- mice die during early embryogenesis, whereas Mbd2-/- mice are viable and fertile. Maternal behavior of Mbd2-/- mice is however defective and, at the molecular level, Mbd2-/- mice lack a component of MeCP1. Mbd2-mutant cells fail to fully silence transcription from exogenous methylated templates, but inappropriate activation of endogenous imprinted genes or retroviral sequences was not detected. Despite their differences, Mbd3 and Mbd2 interact genetically suggesting a functional relationship. Genetic and biochemical data together favor the view that MBD3 is a key component of the Mi-2/NuRD corepressor complex, whereas MBD2 may be one of several factors that can recruit this complex to DNA.

Age Factors↗
PubMed2004

Dissociation in the effects of neonatal maternal separations on maternal care and the offspring's HPA and fear responses in rats.

The development of the hypothalamic-pituitary-adrenal (HPA) response to stress is influenced by the early mother-infant relationship. In rats, early handling (brief daily mother-offspring separations) attenuates the adult offspring's HPA and fear responses compared to both nonhandling (no separations) and maternal separation (prolonged daily separations). It has been proposed that variation in the amount of maternal care mediates these effects of neonatal manipulations on the adult offspring's stress and fear responses. Here we tested this hypothesis by assessing maternal care and the adult offspring's HPA and fear responses in Lister hooded rats which were subjected to either early handling (EH) or maternal separation (MS) from postnatal day 1-13, or were left completely undisturbed (nonhandled, NH) throughout this period. Both EH and MS induced a more active nursing style and elevated levels of maternal care compared to NH. Total levels of maternal care were indistinguishable between EH and MS, but diurnal distribution differed. MS dams showed elevated levels of maternal care following the 4-h separation period, thereby fully compensating for the amount of maternal care provided by EH dams during the time MS dams were separated from their pups. However, while EH resulted in reduced HPA and fear responses in the adult offspring compared to NH, MS and NH offspring did not differ. Our findings therefore demonstrate dissociation in the effects of EH and MS on maternal care and on the stress and fear responses in the offspring. This indicates that maternal care cannot be the sole mediator of these effects.

Animals↗
PubMed1995

Associations among adult attachment representations, maternal sensitivity, and infant-mother attachment in a sample of adolescent mothers.

Associations among adolescent attachment organization, maternal sensitivity, and infant attachment organization were examined prospectively in 74 teenaged mother-infant dyads. Pregnant teenagers' attachment organizations predicted both sensitivity and infant-mother attachments. Mothers classified autonomous (F) in the prenatal period showed higher levels of sensitivity at both 3 and 9 months than mothers classified dismissing (Ds), preoccupied (E), or unresolved (U). Correspondence between maternal attachment (F vs. Ds/E/U) and infant attachment (secure [B] vs. avoidant [A]/resistant [C]/disorganized [D]) was observed in 58 of 74 (78%) dyads. Exact 4-group (Ds/E/F/U and A/B/C/D) agreement was observed in 50 of 74 (68%) families. In contrast, associations between maternal sensitivity and infant attachment were not significant, leading to questions about the processes that link attachment representations, maternal behavior, and infant attachment in adolescent mothers.

Adolescent↗
PubMed1988

Toddlers' concentration: does maternal depression make a difference?

Twenty-five mother-toddler dyads with depressed mothers were compared with 25 dyads with well mothers on measures of attention during 20 min of spontaneous play in a home-like setting. Children of depressed women focused attention on more objects for shorter durations. Group differences could be accounted for by mothers' involvement in their children's play. Depressed women initiated and terminated more instances of attention to objects than well mothers. Correlations between maternal behaviors and children's attention were statistically significant. Results support the hypothesis that poorer attention of children of depressed women is at least in part mediated by inculcation.

Adult↗
PubMed1990

Women's views of second-stage labor as assessed by interviews and videotapes.

Twenty women were selected from public and private maternity services and interviewed by nurses and nurse-midwives on a research team. The women were shown videotapes of their second-stage labors that for 15 of them had been recorded by 2 other members of the research team. Four videos were provided by mothers who had had home births and one from a mother whose birth was filmed at a birth center. The interviews were analyzed for major themes; the theme reported here is women's experiences of pushing. Women reported wide variations in sensations during the second stage. Whereas 9 of 16 women expressed feelings of relief or pressure and stretching, 7 described pushing as painful, miserable, or horrible. Thirteen of 19 women had well defined urges to push, 1 had an intermittent urge, and 5 had no urge. Women often felt unprepared for the sensations and work of second-stage labor, and caregivers' instructions commonly did not seem to be in synchrony with physiological responses. We conclude that childbirth educators and caregivers must prepare women more realistically for the second stage. They would be more effective if they responded to maternal behavior, rather than giving arbitrary instructions about pushing.

Adolescent↗
PubMed2006

Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.

BACKGROUND: Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. RESULTS: In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI -3.72 to -0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. CONCLUSIONS: No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.

Adult↗
PubMedDate not supplied

Early discharge with home follow-up: impacts on low-income mothers and infants.

Low-income mothers and infants discharged at 24 to 47 hours after birth were compared to two control groups: early discharge with infant separation and conventional discharge. No differences among the three groups in maternal or infant morbidity at seven to 15 days postdelivery were recorded. Simultaneous early discharge was associated with higher maternal attachment scores, fewer maternal concerns, and greater maternal satisfaction with discharge type than early discharge with infant separation. All three groups had substantial morbidity in the first two weeks of life. A shorter hospital stay and more health monitoring postdischarge may be a better use of health resources than a conventional hospital stay for low-income mothers and their infants.

Aftercare↗
PubMed1999

Perineal swelling during pregnancy in common chimpanzees and puerperal pathology.

Perineal swelling during pregnancy in captive common chimpanzees (Pan troglodytes) was studied to examine if the swelling pattern is consistent with known fluctuations in estrogens and progesterone and to test associations between reduced swelling and pathological outcome. Analyses of swelling during 107 pregnancies with a variety of outcomes revealed that a majority of swelling patterns fit an endocrinological model closely, but that a small minority (6.6%) from low parity mothers had exaggerated and extended swelling, suggesting an altered sensitivity of the swelling to steroids. Disregarding this extreme minority, swelling was found to be significantly reduced from that of normal outcome pregnancies for sub-groups with varying degrees of maternal incompetence, neonatal fatality, and stillbirth. This reduction was most marked for pregnancies in nursery-reared mothers. Given the validity of the correspondence between swelling patterns and steroid concentrations, lower estrogen concentrations are implicated in the etiology of the puerperal pathologies seen. That steroid hormone concentrations during pregnancy may influence maternal behavior in apes provides a clue to the etiology of post-partum depression in women.

Animals↗