Finding a 'safe' place on the risk continuum: a case study of pregnancy and birthing in Lao PDR (Lao People's Democratic Republic)

This paper addresses two questions. Firstly: are the risk regimes faced, and perceived, by pregnant women in rural Lao PDR substantially different from those experienced by pregnant women in western societies? Secondly, if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved without Laotians inheriting the risk regimes of late modernity experienced by many women in western societies? Secondary analysis is undertaken of data collected in 2005 for the evaluation of a pilot maternity waiting home in Bolikhan, Lao PDR. The results suggest significantly different risk perceptions and experiences between Lao and western communities, based on contrasting views of embodiment, identity construction and cosmologies. In the Lao rural communities studied, there is little evidence yet of 'risk society' despite the introduction of western technologies and practices to improve maternal mortality and morbidity. It is argued that 'risk society' can be avoided.

Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study

BACKGROUND: The long-term effects of pregnancy and lactation on measures of bone mineral in women remain unclear.

OBJECTIVE: We studied whether pregnancy or lactation has deleterious long-term effects on bone mineral in healthy women.

DESIGN: We measured bone mineral density (BMD; g/cm(2)) in women aged > or = 18 y. Analyses were performed on 3 data sets: study 1, 83 female twin pairs (21 monozygous and 62 dizygous) aged (x +/- SD) 42.2 +/- 15.5 y who were discordant for ever having been pregnant beyond 20 wk; study 2, 498 twin pairs aged 42.3 +/- 15.0 y; and study 3, 1354 individual twins, their siblings, and family members.

RESULTS: In study 1, there were no significant within-pair differences in unadjusted BMD or BMD adjusted for age, height, and fat mass at the lumbar spine or total-hip or in total-body bone mineral content (BMC; kg) (paired t tests). In study 2, there was no significant within-pair difference in measures of bone mineral or body composition related to the within-pair difference in number of pregnancies. In study 3, subjects with 1 or 2 (n = 455) and > or = 3 pregnancies (n = 473) had higher adjusted lumbar spine BMD (2.9% and 3.8%, respectively; P = 0.001) and total-body BMC (2.2% and 3.1%; P < 0.001) than did nulliparous women (n = 426). Parous women who breast-fed had higher adjusted total-body BMC (2.6%; P = 0.005), total-hip BMD (3.2%; P = 0.04), and lower fat mass (10.9%; P = 0.01) than did parous non-breast-feeders.

CONCLUSION: We found no long-term detrimental effect of pregnancy or breast-feeding on bone mineral measures.

Smoking cessation programs in pregnancy: systematically addressing development, implementation, women's concerns and effectiveness

Objectives:  To increase a review's relevance to practitioners and service users and identify the implications for systematic review methodology. Methods:  A systematic review of the effects of smoking cessation programmes implemented during pregnancy integrated process indicators and the views of maternity service users and health promotion specialists. Additional qualitative data were extracted systematically from included randomised control trials (RCTs) to determine whether the design of interventions and conclusions arising from their evaluation related to the views of service users. On completing the review we reflected on the types of observational and qualitative research it drew on, where this research was incorporated into the review, and its added value. Results:   Incorporating process indicators into the review revealed: 1) problems with implementation and transplantation of some interventions and 2) studies with more stringent quality criteria and process evaluations demonstrated greater impact (weighted mean difference in smoking). Pregnant smokers were rarely involved in the design or evaluation of the interventions. Prior observational and qualitative studies and small scale consultations influenced the criteria by which the effectiveness of the interventions were judged, and revealed to what extent these criteria are adopted in practice.
Conclusions:   Systematically abstracting data about the development and delivery of interventions revealed gaps that might be filled by the active involvement of service users.

How well do women adapt to changes in their body size and shape across the course of pregnancy

This study examined body image across pregnancy. Pregnant women ( N = 158) completed measures of general attractiveness, feeling fat, fitness and strength, salience of weight and shape, and ideal and current body size at pre-pregnancy (retrospective), and in early, middle and late pregnancy. Body image was found to be fairly stable across pregnancy such that women who started with greater body concerns maintained them over time. Although women were least satisfied with their stomach size at late pregnancy, women's ideal body shape increased in parallel with increases in body size. Women with the most body concerns reported more depressive symptoms, tendency towards dieting, and smoking during pregnancy suggesting they were at greater risk in terms of health and well-being during pregnancy.

Use of complementary and alternative medicines by a sample of Australian women during pregnancy

Background: The use of complementary and alternative medicines (CAM) is growing in Australia, with women higher users than men. Yet, only a few Australian studies have explored the use of CAM during pregnancy.

Aims: To explore the use of CAM, the types of CAM practitioners consulted, physical symptoms/complaints for which CAM are used by a sample of pregnant Australian women, and women's perceptions of the efficacy of CAM in treating those complaints.

Methods: Three hundred and twenty-one pregnant women, who volunteered for a study exploring women's well-being during pregnancy, completed a self-report questionnaire in their late second/early third trimester.

Results: Seventy-three per cent of women had used at least one kind of complementary therapy in the prior eight weeks of pregnancy. Over one-third of the women had visited at least one alternative medicine practitioner during pregnancy. Approximately one-third of the women reported taking CAM to alleviate a specific physical symptom, with 95.7% of these women reporting they either got completely better or a little bit better with use of CAM; one quarter reported planning to use an alternative therapy to assist with labour preparation. Age, number of physical symptoms experienced, income level and level of education were not associated with greater use of CAM (P < 0.05); however, women reporting more physical symptoms were more likely to consult a CAM practitioner.

Conclusion: Findings highlight the substantial use of CAM during pregnancy and the need to have all health professionals adequately informed about such therapies during this life stage.

Sleep quality and depression during pregnancy: a prospective study

For the first time, the relationship between depressive symptoms and sleep quality was explored prospectively during pregnancy. Participants (n = 273) completed the Pittsburgh Sleep Quality Index and Beck Depression Inventory at three 8-week intervals, starting from 15–23 weeks gestation. In addition to sleep quality and depression remaining relatively stable during pregnancy, findings revealed that sleep quality earlier in pregnancy predicted higher levels of depressive symptoms at later stage in pregnancy (after controlling for prior depression levels). In contrast, there was no evidence to suggest that depressive symptoms earlier in pregnancy impacted on sleep quality later on. Given that depressive symptomatology can lead to major depression and given the prevalence of pre- and postnatal depression, our findings suggest that screening for sleep problems during pregnancy may be of clinical significance.

Neurodevelopmental effects of maternal nutritional status and exposure to methylmercury from eating fish during pregnancy

Fish contain nutrients that promote optimal brain growth and development but also contain methylmercury (MeHg) that can have toxic effects. The present study tested the hypothesis that the intake of selected nutrients in fish or measures of maternal nutritional status may represent important confounders when estimating the effects of prenatal methylmercury exposure on child development. The study took place in the Republic of Seychelles, an Indian Ocean archipelago where fish consumption is high. A longitudinal cohort study design was used. A total of 300 mothers were enrolled early in pregnancy. Nutrients considered to be important for brain development were measured during pregnancy along with prenatal MeHg exposure. The children were evaluated periodically to age 30 months. There were 229 children with complete outcome and covariate data for analysis. The primary endpoint was the Bayley Scales of Infant Development-II (BSID-II), administered at 9 and 30 months of age. Combinations of four secondary measures of infant cognition and memory were also given at 5, 9 and 25 months. Cohort mothers consumed an average of 537 g of fish (nine meals containing fish) per week. The average prenatal MeHg exposure was 5.9 ppm in maternal hair. The primary analysis examined the associations between MeHg, maternal nutritional measures and children's scores on the BSID-II and showed an adverse association between MeHg and the mean Psychomotor Developmental Index (PDI) score at 30 months. Secondary analyses of the association between the PDI and only MeHg alone or nutritional factors alone showed only a borderline significant association between MeHg and the PDI at 30 months and no associations with nutritional factors. One experimental measure at 5 months of age was positively associated with iodine status, but not prenatal MeHg exposure. These findings suggest a possible confounding role of maternal nutrition in studies examining associations between prenatal MeHg exposures and developmental outcomes in children.

The relationship between depression and body dissatisfaction across pregnancy and the postpartum : a prospective study

The overall aim of this study was to examine the relationship between depression and body dissatisfaction across pregnancy and the first 12 months postpartum. During pregnancy, women's (N = 116) perceived attractiveness and strength/fitness remained stable, while feeling fat and salience of weight/shape decreased in late pregnancy. During the postpartum, feeling fat and salience of weight/shape increased. Depression and body dissatisfaction scores were correlated with each other concurrently and across multiple time points. However, in baseline-controlled prospective analyses, only a model of greater depression late in pregnancy predicting body dissatisfaction at six weeks postpartum and feeling fat throughout the postpartum was supported.

Assessing Sleep during Pregnancy - a study across two time points examining the pittsburg sleep quality index and associations with depressive symptoms

Background and Purpose: Sleep quality seems to be an antecedent to depressive symptoms during pregnancy. We sought to 1) examine the psychometrics of the Pittsburgh Sleep Quality Index (PSQI) in pregnancy; 2) examine whether sleep quality predicted increases in depressive symptoms; and 3) compare PSQI scores across 3 or 2 levels of depressive symptoms.

Methods: Each of the 252 participants completed the Beck Depression Inventory (short form) and a sleep quality measure at mid and late pregnancy.

Results: PSQI total scores showed good internal consistency and construct validity. An improved model of the internal structure of the PSQI in pregnancy was found with 1 factor labeled Sleep Efficiency, a second labeled Night and Daytime Disturbances, and an Overall Sleep Quality component associated with, but separate from, both of these 2 factors. Although PSQI scores showed moderate stability over time, sleep disturbance scores increased in late pregnancy. Importantly, PSQI prospectively predicted increases in depressive symptoms.

Conclusions: Findings suggest that the PSQI is useful in pregnancy research. Findings also support the idea that sleep problems are prospective risk factors for increases in depressive symptoms during pregnancy. Practitioners are advised to screen for sleep quality during early pregnancy.

Frequency, severity and effect of life of physical symptoms experienced during pregnancy

This study aimed to: 1) describe the number, frequency, severity of discomfort and effect of symptoms on life of 29 physical symptoms women experienced at 15 to 25 weeks of gestation; 2) explore whether experiencing this group of physical symptoms more frequently and intensely was associated with a higher score of depressive symptoms and lower self-esteem; (3) examine whether discomfort and effect ratings aided prediction of well being over and above symptom frequency; and (4) investigate which individual physical symptoms contributed most to predicting depressive symptoms and self-esteem. Pregnant women (n = 215) completed the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and a physical symptoms questionnaire. Frequency, discomfort, and the effect of physical symptoms all consistently correlated with higher scores for depressive symptoms, but less consistently with lower self-esteem. Discomfort and the effect of symptoms predicted variance in depressive symptoms after accounting for symptom frequency. Higher frequency, more discomfort, and the effect of fatigue and effect of flatulence were related to depressive symptoms. Relationships between pregnancy-related physical symptoms, depressive symptoms, and low self-esteem suggest that when women report any of these constellation of factors, further screening is indicated. A comprehensive assessment of physical symptoms includes frequency, discomfort, and effect on life.

My baby body : a qualitative insight into women's body-related experiences and mood during pregnancy and the postpartum

An inductive qualitative approach was employed to explore women's experiences of their body and mood during pregnancy and the postpartum. In-depth interviews were conducted with 20 perinatal women (n at late pregnancy=10; n in the early postpartum period=10). While most of the sample reported adapting positively to body changes experienced during pregnancy, the postpartum period was often associated with body dissatisfaction. Women reported several events unique to pregnancy which helped them cope positively with bodily changes (e.g. increased perceived body functionality, new sense of meaning in life thus placing well-being of developing foetus above body aesthetics, perceptual experiences such as feeling baby kick, increased sense of social connectedness due to pregnancy body shape, and positive social commentary); however, these events no longer protected against body dissatisfaction post-birth. While women reported mood lability throughout the perinatal period, the postpartum was also a time of increased positive affect for most women, and overall most women did not associate body changes with their mood. Clinical implications of these findings included the need for education about normal postpartum body changes and their timing, and the development of more accurate measures of perinatal body image.

Depressive and anxiety symptoms through late pregnancy and the first year post birth : an examination of prospective relationships

One hundred and fifty-nine women were measured for depressive and anxiety symptoms from late pregnancy through to 12 months postpartum. Partial correlations revealed stability of depressive and anxiety symptoms across time. Depressive symptoms did not predict anxiety at any time point. Anxiety predicted increases in depressive symptoms from late pregnancy to early postpartum, but not from early postpartum to mid postpartum. Anxiety predicted depressive symptoms from mid postpartum to late postpartum, however, not when social support in late pregnancy was controlled for.

Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.