A qualitative exploration of body image experiences of women progressing through pregnancy

BACKGROUND: Pregnancy provides an interesting challenge to body image theories in that the natural physiological changes push women further from the socioculturally prescribed thin ideal which these theories hinge upon. The impact that these significant physiological changes have on the woman's body image during pregnancy may depend on the extent to which they retain or revise the ideal. However, little is known about body image experiences during pregnancy. AIM: To provide a comprehensive exploration of the body image experiences of pregnant women. METHODS: Individual structured interviews were conducted with 19 currently pregnant women. Transcriptions were analysed using a thematic content analysis approach. FINDINGS: Themes extracted from the qualitative data included: (1) women's body image experiences during pregnancy were complex and changing, and shaped by the salience of specific body parts, the women's expectations for future changes to their body within the perinatal period, the functionality of the body, and their experience of maternity clothing, (2) women were able to negotiate the changes to their bodies as they recognised the functionality of the pregnant body, (3) women were surprised by the public nature of the pregnant body, (4) partner support and positive feedback about the pregnant body was highly valued, and (5) the importance of open communication around weight and body image in antenatal healthcare. DISCUSSION: Our findings highlight the need for the adaptation and expansion of existing body image theories to be used as a framework for women's experiences of pregnancy.

Views of women and health professionals on mHealth lifestyle interventions in pregnancy: a qualitative investigation

BACKGROUND: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women's and health professionals' views of mHealth in antenatal care are limited.

OBJECTIVE: This study aimed to explore women's and health professionals' views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy.

METHODS: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed.

RESULTS: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women's advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care.

CONCLUSIONS: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care.

Challenges for midwives: pregnant women and illicit drug use

Objective - The purpose of the paper is to introduce illicit drug use as a societal problem and describes the response of the Australian Government. Specifically the paper examines the use of illicit drugs by pregnant women and the role of midwives in supporting these women throughout pregnancy and birth.

Setting - Maternity services, specifically antenatal care clinics.

Conclusion - In Australia the rate of pregnant women who use illicit drugs is escalating. These pregnancies are high obstetric risk with potential for harm to both the mother and the baby. Pregnancy however is seen as ‘window of opportunity’; a time to provide education, choices and support. The literature describes that for health professionals working with pregnant women who are illicit drug users is challenging and for some health professionals their interaction can be negative. Australia advocates harm minimisation and encourages harm reduction strategies. Midwives are in a position to implement these strategies within the maternity setting. Further research is recommended as well as professional development programs for midwives to upgrade knowledge and cultivate engagement skills to enable appropriate and positive interaction with pregnant women who use illicit drugs.

Distress symptomatology in men during their partner's pregnancy

This thesis explored predictors of elevated distress symptoms in men during their partner’s pregnancy. Results demonstrated that depression, anxiety and stress (distress symptoms) in men have a bi-directional relationship with one another across their partner’s pregnancy, and that distress symptoms are predictive of that measure across the antenatal period.

A review of the relationship between socioeconomic position and the early-life predictors of obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Classification tree analysis of postal questionnaire data to identify risk of excessive gestational weight gain

OBJECTIVE: overweight/obese weight status during pregnancy increases risk of a range of adverse health outcomes for mother and child. Whereas identification of those who are overweight/obese pre-pregnancy and in early pregnancy is straightforward, prediction of who will experience excessive gestational weight gain (EGWG), and thus be at greater risk of becoming overweight or obese during pregnancy is more challenging. The present study sought to better identify those at risk of EGWG by exploring pre-pregnancy BMI as well as a range of psychosocial risk factors identified as risk factors in prior research. METHODS: 225 pregnant women completed self-reported via postal survey measures of height, weight, and psychosocial variables at 16-18 weeks gestation, and reported their weight again at 32-34 weeks to calculate GWG. Classification and regression tree analysis (CART) was used to find subgroups in the data with increased risk of EGWG based on their pre-pregnancy BMI and psychosocial risk factor scores at Time 1. FINDINGS: CART confirmed that self-reported BMI status was a strong predictor of EGWG risk for women who were overweight/obese pre-pregnancy. Normal weight women with low motivation to maintain a healthy diet and who reported lower levels of partner support were also at considerable risk of EGWG. IMPLICATIONS FOR PRACTICE: present findings offer support for inclusion of psychosocial measures (in addition to BMI) in early antenatal visits to detect risk of EGWG. However, these findings also underscore the need for further consideration of effect modifiers that place women at increased or decreased risk of EGWG. Proposed additional constructs are discussed to direct further theory-driven research.

Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25[OH]D3) and food allergy

BACKGROUND: There is evolving evidence that vitamin D insufficiency may contribute to food allergy, but findings vary between populations. Lower vitamin D-binding protein (DBP) levels increase the biological availability of serum vitamin D. Genetic polymorphisms explain almost 80% of the variation in binding protein levels. OBJECTIVE: We sought to investigate whether polymorphisms that lower the DBP could compensate for adverse effects of low serum vitamin D on food allergy risk. METHODS: From a population-based cohort study (n = 5276) we investigated the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and food allergy at age 1 year (338 challenge-proven food-allergic and 269 control participants) and age 2 years (55 participants with persistent and 50 participants with resolved food allergy). 25(OH)D3 levels were measured using liquid chromatography-tandem mass spectrometry and adjusted for season of blood draw. Analyses were stratified by genotype at rs7041 as a proxy marker of DBP levels (low, the GT/TT genotype; high, the GG genotype). RESULTS: Low serum 25(OH)D3 level (≤50 nM/L) at age 1 years was associated with food allergy, particularly among infants with the GG genotype (odds ratio [OR], 6.0; 95% CI, 0.9-38.9) but not in those with GT/TT genotypes (OR, 0.7; 95% CI, 0.2-2.0; P interaction = .014). Maternal antenatal vitamin D supplementation was associated with less food allergy, particularly in infants with the GT/TT genotype (OR, 0.10; 95% CI, 0.03-0.41). Persistent vitamin D insufficiency increased the likelihood of persistent food allergy (OR, 12.6; 95% CI, 1.5-106.6), particularly in those with the GG genotype. CONCLUSIONS: Polymorphisms associated with lower DBP level attenuated the association between low serum 25(OH)D3 level and food allergy, consistent with greater vitamin D bioavailability in those with a lower DBP level. This increases the biological plausibility of a role for vitamin D in the development of food allergy.

Can a health coaching intervention delivered during pregnancy help prevent excessive gestational weight gain?

This study evaluated: (1) the efficacy of a health coaching (HC) intervention designed to prevent excessive gestational weight gain (GWG); and (2) whether there were improved psychological, motivational, and behavioural outcomes for women in the HC intervention compared to a "usual care" control group. In this quasi-experimental study, 267 pregnant women ≤18 weeks gestation were recruited between August 2011 and June 2013 from two hospital antenatal clinics in Melbourne, Australia. Intervention women received four individual HC and two group HC/educational sessions informed by theories of behaviour change. Women completed questionnaires assessing psychological, motivational and behavioural outcomes at 16-18 (baseline) and 33 (post-intervention) weeks gestation. Weight measures were collected. Compared to usual care, the intervention did not limit GWG or prevent excessive GWG. However, HC women reported greater use of active coping skills post-intervention. Despite lack of success of the HC intervention, given the risks associated with excessive weight gain in pregnancy, health professionals should continue to recommend appropriate GWG.

Screening for post 32-week preterm birth risk: how helpful is routine perinatal data collection?

BACKGROUND: Preterm birth is a clinical event significant but difficult to predict. Biomarkers such as fetal fibronectin and cervical length are effective, but the often are used only for women with clinically suspected preterm risk. It is unknown whether routinely collected data can be used in early pregnancy to stratify preterm birth risk by identifying asymptomatic women. This paper tries to determine the value of the Victorian Perinatal Data Collection (VPDC) dataset in predicting preterm birth and screening for invasive tests.

METHODS: De-identified VPDC report data from 2009 to 2013 were extracted for patients from Barwon Health in Victoria. Logistic regression models with elastic-net regularization were fitted to predict 37-week preterm, with the VPDC antenatal variables as predictors. The models were also extended with two additional variables not routinely noted in the VPDC: previous preterm birth and partner smoking status, testing the hypothesis that these two factors add prediction accuracy. Prediction performance was evaluated using a number of metrics, including Brier scores, Nagelkerke's R(2), c statistic.

RESULTS: Although the predictive model utilising VPDC data had a low overall prediction performance, it had a reasonable discrimination (c statistic 0.646 [95% CI: 0.596-0.697] for 37-week preterm) and good calibration (goodness-of-fit p = 0.61). On a decision threshold of 0.2, a Positive Predictive Value (PPV) of 0.333 and a negative predictive value (NPV) of 0.941 were achieved. Data on previous preterm and partner smoking did not significantly improve prediction.

CONCLUSIONS: For multiparous women, the routine data contains information comparable to some purposely-collected data for predicting preterm risk. But for nulliparous women, the routine data contains insufficient data related to antenatal complications.

Maternal mental well-being during pregnancy and glucocorticoid receptor gene promoter methylation in the neonate

Maternal mental health during pregnancy has been linked to health outcomes in progeny. Mounting evidence implicates fetal “programming” in this process, possibly via epigenetic disruption. Maternal mental health has been associated with glucocorticoid receptor methylation (nuclear receptor subfamily 3, group C, member 1 [NR3C1]) in the neonate; however, most studies have been small (n < 100) and have failed to control for multiple testing in the statistical analysis. The Barwon Infant Study is a population-derived birth cohort with antenatal recruitment. Maternal depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale and psychological distress using the Perceived Stress Scale. NR3C1 cord blood methylation levels were determined using Sequenom MassArray for 481 participants. Maternal psychological distress and anxiety were associated with a small increase in neonate NR3C1 methylation at specific CpG sites, thus replicating some previous findings. However, associations were only nominally significant and did not remain after correction for the number of CpG sites and exposures investigated. As the largest study to explore the relationship between maternal well-being and offspring NR3C1 cord blood methylation, our results highlight the need for caution when interpreting previous findings in this area. Future studies must ensure they are adequately powered to detect the likely small effect sizes while controlling for multiple testing.

B is for baby: the use of iPhone app technology in childbirth education

Midwives play an important role in antenatal education and there is a need for child birth education to be delivered more effectively and in the earlier stages pregnancy. There are numerous inconsistencies existing between the theory and practice of child birth education. A new direction is needed. The evolution of child birth education needs to quickly gain pace to meet the needs of today's expectant women. Contemporary technology presents a modern approach to support and promote child birth education classes. Consequently, this recent post graduate diploma student midwife project was to investigate the introduction of the use of iPhone app technology as a valuable tool in which to deliver child birth education. The conduction of the project included several elements, beginning with an extensive literature review, ethics approval; a survey completed by thirty two midwives at St Vincents Private Hospital (StVPH) was collected and generated the foundations for the prototype childbirth education iPhone App, and B is for Baby was constructed. This was then presented back to the midwives at St Vincent's Private Hospital as a means to compliment and contribute to the traditional face to face child birth sessions.

Maternal creatine supplementation during pregnancy prevents acute and long-term deficits in skeletal muscle after birth asphyxia: a study of structure and function of hind limb muscle in the spiny mouse

BACKGROUND: Maternal antenatal creatine supplementation protects the brain, kidney, and diaphragm against the effects of birth asphyxia in the spiny mouse. In this study, we examined creatine's potential to prevent damage to axial skeletal muscles.

METHODS: Pregnant spiny mice were fed a control or creatine-supplemented diet from mid-pregnancy, and 1 d before term (39 d), fetuses were delivered by c-section with or without 7.5 min of birth asphyxia. At 24 h or 33 ± 2 d after birth, gastrocnemius muscles were obtained for ex-vivo study of twitch-tension, muscle fatigue, and structural and histochemical analysis.

RESULTS: Birth asphyxia significantly reduced cross-sectional area of all muscle fiber types (P < 0.05), and increased fatigue caused by repeated tetanic contractions at 24 h of age (P < 0.05). There were fewer (P < 0.05) Type I and IIa fibers and more (P < 0.05) Type IIb fibers in male gastrocnemius at 33 d of age. Muscle oxidative capacity was reduced (P < 0.05) in males at 24 h and 33 d and in females at 24 h only. Maternal creatine treatment prevented all asphyxia-induced changes in the gastrocnemius, improved motor performance.

CONCLUSION: This study demonstrates that creatine loading before birth protects the muscle from asphyxia-induced damage at birth.

Perinatal maternal depression and cortisol function in pregnancy and the postpartum period : a systematic literature review

BACKGROUND: Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. METHOD: A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. RESULTS: In total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. DISCUSSION AND CONCLUSION: Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.

The return of the traditional birth attendant

The World Health Organization has noted much progress towards the realisation of Millennium Development Goals related to maternal and child health. Eighty percent of women in many developing economies now receive at least one visit during pregnancy by a skilled birth attendant (although only 52% had the recommended four visits), and 68% of women across developing regions receive skilled health attendant care (up from 56% in 1990). However, disparities follow regional and urban-rural gaps. Sub-Saharan Africa and Southern Asia lag behind other regions in the provision of antenatal care and skilled attendance at birth (although typically attended by a family member or villager) and over 32 million of the 40 million births not attended by skilled health personnel in 2012 occurred in rural areas. Overall, one-quarter of women in developing nations still birth alone or with a relative to assist them. While increased numbers of medically-trained midwives and health workers or midwife assistants would increase coverage by up to 40%, these are longer-term solutions. In the short term, gross disparities in services in some resource-poor areas have been alleviated by recruiting Traditional Birth Attendants (TBAs) re-trained in emergency obstetric skills to deal with emergency situations and to refer women onto health facilities when necessary. Samoa and Bangladesh are examples. For many women for a range of reasons TBAs are preferable to hospital care. It therefore makes sense to recognise their place within maternity care, to offer basic and ongoing training and to set up registration procedures thus better ensuring the monitoring of outcomes. Incorporating TBAs into the formal healthcare system would meet both physiological and relational components of birth. In terms of the latter, TBAs would act as cultural brokers between Western and traditional cosmologies and provide women with continuity of care from a known carer; in the West a demonstrably simple but effective intervention promoting physiological safety and reducing the need for higher level medical interventions.

"If you can have one glass of wine now and then, why are you denying that to a woman with no evidence": Knowledge and practices of health professionals concerning alcohol consumption during pregnancy.

BACKGROUND: Alcohol consumption during pregnancy has the potential to cause significant harm to the foetus and the current Australian guidelines state that it is safest not to drink alcohol while pregnant. However, conflicting messages often appear in the media and it is unclear if the message to avoid alcohol is being effectively conveyed to pregnant women. AIMS: This research aims to explore the advice that health professionals provide to pregnant women about alcohol consumption; the knowledge of health professionals regarding the effects of alcohol consumption; and their consistency with following the Australian guidelines. METHODS: Ten semi-structured face to face interviews were conducted with health professionals who regularly provide antenatal care. These include midwives, obstetricians, and shared care general practitioners. A six-stage thematic analysis framework was used to analyse the interview data in a systematic way to ensure rigour and transparency. The analysis involved coding data extracts, followed by identifying the major themes. FINDINGS: Health professionals displayed adequate knowledge that alcohol can cause physical and mental difficulties that are lifelong; however, knowledge of the term FASD and the broad spectrum of difficulties associated with alcohol consumption during pregnancy was limited. Although health professionals were willing to discuss alcohol with pregnant women, many did not make this a routine part of practice, and several concerning judgements were noted. CONCLUSION: Communication between health professionals and pregnant women needs to be improved to ensure that accurate information about alcohol use in pregnancy is being provided. Further, it is important to ensure that the national guidelines are being supported by health professionals.