Psychosocial and demographic factors related to health behaviors in the 1st trimester

Mental health among pregnant women under public health interventions during COVID-19 outbreak in Wuhan, China

Coronavirus disease 2019 (COVID-19) has become a pandemic. As the first city struck by the COVID-19 outbreak, Wuhan had implemented unprecedented public health interventions. The mental health of pregnant women during these anti-epidemic controls remains unknown. A total of 274 pregnant women living in Wuhan during the COVID-19 outbreak took part in our investigation online. The data on mental health conditions were evaluated using Edinburgh Postnatal Depression Scale (EPDS), Self-Rating Anxiety Scale (SAS), Chinese Perceived Stress Scale (CPSS), and Pittsburgh Sleep Quality Index (PSQI). We also collected the information on physical health status and precautionary measures against COVID-19. The prevalence of depression, anxiety, stress, and poor sleep quality was 16.1%, 13.9%, 42.7%, 37.6%, respectively. Comparing to SAS, PSQI score in pregnant women who participated in the survey after April 8 (date of Wuhan reopening), those data collected before April 8 were significantly higher. High levels of stress, severe health concerns over the fetus, and poor hygienic practices were negatively associated with mental health conditions. In conclusion, a large proportion of pregnant women reported psychological symptoms during the epidemic, which negatively related to the severe health concerns over fetus and poor hygienic practices. More psychological support during the epidemic would promote maternal mental well-being.

Validity and reliability of the Brazilian version of the Body Image in Pregnancy Scale

OBJECTIVES

To describe the translation and cultural adaptation, and evaluate the psychometric properties of the Body Image in Pregnancy Scale when applied to Brazilian pregnant women.

BACKGROUND

Poor body image of pregnant women is associated with negative outcomes for maternal and child health. However, there is a lack of psychometric studies aiming to evaluate the body image experiences during pregnancy.

METHODS

A methodological study was carried out with 187 Brazilian pregnant women. We performed translation and cross-cultural adaptation (evidence of content validity), and evaluated the psychometric properties (factorial validity through principal component analysis, discriminant validity, and estimated internal consistency) of the Brazilian version of the Body Image in Pregnancy Scale.

RESULTS

The scale items presented semantic, idiomatic, cultural, and conceptual equivalences, showing evidence of content validity. Principal component analysis resulted in a 6-factor structure with 35 items which showed an adequate adjustment of the scale among Brazilian pregnant women. Adequate estimated internal consistency (Cronbach's α = .88) was found. The Brazilian version was not able to discriminate pregnant women from different gestational age.

CONCLUSION

The Brazilian version of the Body Image in Pregnancy Scale showed evidence of content validity, factorial validity, and estimated internal consistency.

Comparison of health-promoting behaviours, eating behaviour patterns and perceived social support in normal-weight and overweight pregnant women: An unmatched case-control study

Aim

The interventions based on adopting a healthy lifestyle during pregnancy have conflicting results. This study aimed to compare health-promoting, dietary patterns and social support in normal and overweight pregnant women.

Design

An unmatched case-control design was used.

Methods

A total of 360 pregnant women were selected using multistage cluster sampling and divided into two groups of normal and overweight cases. Data were collected using demographic and obstetrics characteristics, health-promoting lifestyle, perceived social support and eating behaviour questionnaires.

Results

The evaluation of the health-promoting behaviours and dietary patterns demonstrated a significant difference between the mean of total scores and their subdomains including self-actualization, nutrition, consumption of healthy and low-fat foods, fast food and sweets, as well as emotional eating and accidental planning. There was no significant difference between the two groups about social support.

Factors influencing the adoption of health promoting behaviors in overweight pregnant women: a qualitative study

Background

The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy.

Methods

This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control.

Results

The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness).

Conclusion

The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.

Pre-pregnancy BMI, gestational weight gain and body image are associated with dietary under-reporting in pregnant Japanese women

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25 % of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19-23 weeks of gestation, thirty-five participants (12·9 %) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR) = 0·81) and lower gestational weight gain (AOR = 0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR = 2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

Meta-Analyses of Predictors of Health Practices in Pregnant Women

The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor-health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal-fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.

Parenting stress among parents of children with Neurodevelopmental Disorders

In recent years, studies have shown that parents of children with Neurodevelopmental Disorders (NDDs) experience more parenting stress than parents of typically developing children, but the relation between the type of disorders and parenting stress is far from clear. The purpose of this study was to compare the parenting stress experienced by parents of 239 children with Specific Learning Disorders (SpLD), Language Disorders (LD), Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and typical development (TD). Parents of children with NDDs experience more parenting stress than those of children who have TD. Although, parents of children with ASD or ADHD report the most high scores of parenting stress, also the parents of children with SpLD or LD report higher parental stress compared with parent of children without NDDs. Another interesting finding was that IQ level or emotional and behavioral problems are associated with the higher levels of parenting stress. This study suggest that parent, both mothers and fathers, of children with different type of NDDs should be provided with interventions and resources to empower them with the knowledge and skills to reduce their stress and to enhance their quality of life.

Psychometric Properties of The Persian Version of The Prenatal Attachment Inventory in Pregnant Iranian Women

Background

In 1993, Muller developed the Prenatal Attachment Inventory (PAI) which has been used widely in many studies and translated into several languages. The current study aimed to translate the PAI into Persian, assess the underlying structure of the PAI, and the appropriateness of the one-factor solution proposed by Muller.

Materials and Methods

In this cross-sectional study, we recruited a total of 322 primi- gravidae in their 27^th to 34^th gestational weeks that referred to private and governmental prenatal clinics in Tehran, Iran. All participants completed the Persian versions of the PAI and a demographic questionnaire. Participants were re-tested 2 weeks after the initial test- ing. The following psychometric properties of the PAI were investigated: construct validity by confirmatory factor analysis (CFA), internal consistency reliability with Cronbach’s alpha, and test-retest reliability according to the intraclass correlation coefficient (ICC).

Results

The CFA results indicated that a single-factor model provided good fit to the data, which confirmed the original model by its developer. The Cronbach’s alpha coef- ficient for PAI was 0.856 and the test-retest reliability with ICC was 0.784. Consider- ing the duration between marriage and pregnancy, women with low duration scored significantly higher than women with high duration on PAI (P=0.043).

Conclusion

The Persian version of the PAI showed that one factor structure was ad- equate and could be used for measuring psychological affectionate attachment between Iranian mothers and their fetuses.

Psychological factors and trimester-specific gestational weight gain: a systematic review

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.

Stress, Depression, and Fetal Attachment in Pregnant Women having Infertility Treatments

PURPOSE

The purpose of this study was to determine the stress, depression, and fetal attachment of pregnant women who underwent infertility treatment, and to identify factors associated with fetal attachment.

METHODS

As a correlation survey design, data were collected from 136 pregnant women who underwent infertility treatment. Data were analyzed using chi2-test, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression.

RESULTS

Stress, depression, and fetal attachment averaged 3.01+/-0.60 (range of scale 1~5), 10.02+/-6.51 (out of a possible 63), and 3.64+/-0.55 (range of scale 1~5), respectively. Level of fetal attachment was higher when mother's age was less than 35, having other children, and having prenatal education experience. Lower score of depression and client's age less than 35 were significant factors affecting fetal attachment.

CONCLUSION

Infertility is a life-affecting trauma for the individual, and personal and social changes due to infertility cause physical and psychological difficulties even after a successful pregnancy with infertility treatment. Therefore, prenatal management programs need to be developed giving consideration to the emotional and physical changes in order to promote physical and psychological stability in the women pregnant following infertility treatment.

Ethnicity, smoking status, and preterm birth as predictors of maternal locus of control

A woman's psychological health can affect prenatal behaviors. The purpose of this study was to examine the relationship between maternal beliefs, prenatal behaviors, and preterm birth (PTB) in a multiethnic population. This was a planned secondary analysis of a cross-sectional trial of postpartum women with singleton gestation. In all, 210 participants were given the Fetal Health Locus of Control (FHLC) scale to measure three primary maternal beliefs that influenced their prenatal behaviors (Internal Control, Chance, Powerful Others). Women who experienced preterm delivery and those who smoked during pregnancy scored the Chance category significantly higher than those who delivered term infants (p = .05; p = .004, respectively). This suggests those who smoked during pregnancy had a greater degree of belief that Chance influenced their infant's health status. Cultural differences also emerged specific to the impact of health care providers on PTB; with Hispanic women scoring Powerful Others the highest among the groups (p = .02). Nurses can plan a critical role in identifying at-risk women (smoking, strong Chance beliefs) while providing a clear message that taking action and modifying high-risk behaviors can reduce risk for adverse pregnancy outcome.

Pregnant Turkish women with low income: their anxiety, health-promoting lifestyles, and related factors

This paper presents anxiety levels, health-promoting lifestyles and related factors among pregnant Turkish women with low income. A descriptive correlation and cross-sectional study was conducted at a state maternity hospital in Western Turkey. The paper reports on the data (n = 195) from the Spielberg State and Trait Anxiety Inventory (STAI), the Health-Promoting Lifestyle Profile (HPLP) and a sociodemographic questionnaire. The average HPLP score was low (mean 2.57, SD 0.42). The average STAI score was high (40.67 ± 9.48; 46.40 ± 8.09, respectively). A significant relation was detected between the trait anxiety, state anxiety, antenatal visit, perception of social support, living environment, family type and HPLP (P < 0.05). A moderately negative relation was detected between the mean STAI and HPLP scores. The findings indicate information and data should be provided for service planning and community care to support pregnant Turkish women with low income in communities.

Associations between depressive and anxious symptoms and prenatal alcohol use

Symptoms of depression and anxiety are prevalent during pregnancy and may influence women's health behaviors. The impact of women's mental health on alcohol use may be particularly important to consider as prenatal alcohol use is common and may have serious negative consequences for the developing fetus. The objectives of this study were to investigate the relationships between elevated symptoms of depression and anxiety and subsequent likelihood of any alcohol use and binge drinking during pregnancy. The sample consisted of 12,824 women from a prospective, population-based study from the United Kingdom, the Avon Longitudinal Study of Parents and Children. Participants completed questionnaires assessing alcohol use and depressive and anxious symptoms during the first and third trimesters of pregnancy. A series of multivariable regression models was fit using multiply imputed data. Thirty four percent of women reported having at least one alcoholic drink at 32 weeks' gestation and 17% reported binge drinking. We found a weak association between elevated symptoms of anxiety and any alcohol use but not between elevated symptoms of depression and any alcohol use. Modest associations were found between both elevated symptoms of depression and anxiety at 18 weeks' gestation and binge drinking at 32 weeks' gestation. Elevated symptoms of depression and anxiety may increase risk for binge drinking during pregnancy. Further research into the impact of symptoms of depression and anxiety on binge drinking during pregnancy is needed as this could represent an opportunity for public health intervention.

Primigravid and multigravid women: prenatal perspectives

A paucity of prenatal data is available concerning prenatal experiences of primigravid women compared with those of multigravid women. Therefore, the objectives of this study were twofold: to compare prenatal personal (demographic and other descriptive elements, including self-esteem) and psychosocial variables (maternal-fetal attachment, marital satisfaction) and to describe perceived pregnancy experiences for both primigravid and multigravid women. Both quantitative and qualitative data were collected using a descriptive mixed-methods design. The data were part of a larger, longitudinal study focused on adjustment to parenthood in military and civilian couples. Married pregnant women who resided on the east and west coasts of the United States were recruited from prenatal care facilities. Participants included 50 pregnant primigravid and 50 multigravid married women recruited during the last trimester of a healthy, uncomplicated pregnancy. The main outcome measures included personal and psychosocial variables (demographics, self-esteem, maternal-fetal attachment, marital satisfaction) and perceived pregnancy experiences. Multigravid women had significantly lower levels of maternal-fetal attachment (p < .00) and marital satisfaction (p < .00) than did primigravid women during their third trimester of pregnancy. The pregnant women's responses clearly reveal that unique and distinct differences exist between the needs of primigravid women and those of multigravid women. Innovative prenatal educational interventions tailored to meet the distinct needs of primigravid and multigravid women are suggested.

The relationships of social support, uncertainty, self-efficacy, and commitment to prenatal psychosocial adaptation

AIMS

To report a study of the relations of prenatal psychosocial adaptation, social support, demographic and obstetric characteristics, uncertainty, information-seeking behaviour, motherhood normalization, self-efficacy, and commitment to pregnancy.

BACKGROUND

Prenatal psychosocial assessment is recommended to identify psychosocial risk factors early to prevent psychiatric morbidities of mothers and children. However, knowledge on psychosocial adaptation and its explanatory variables is inconclusive.

DESIGN

This study was non-experimental, with a cross-sectional, correlational, prospective design.

METHODS

The study investigated Hong Kong Chinese women during late pregnancy. Convenience sampling methods were used, with 550 women recruited from the low-risk clinics of three public hospitals. Data was collected between January-April 2007. A self-reported questionnaire was used, consisting of a number of measurements derived from an integrated framework of the Life Transition Theory and Theory of Uncertainty in Illness. Explanatory variables of psychosocial adaptation were identified using a structural equation modelling programme.

RESULTS

The four explanatory variables of the psychosocial adaptation were social support, uncertainty, self-efficacy, and commitment to pregnancy. In the established model, which had good fit indices, greater psychosocial adaptation was associated with higher social support, higher self-efficacy, higher commitment to pregnancy, and lower uncertainty.

CONCLUSION

The findings give clinicians and midwives guidance in the aspects to focus on when providing psychosocial assessment in routine prenatal screening. Since there are insufficient reliable screening tools to assist that assessment, midwives should receive adequate training, and effective screening instruments have to be identified. The explanatory role of uncertainty found in this study should encourage inquiries into the relationship between uncertainty and psychosocial adaptation in pregnancy.

Understanding prenatal health care for American Indian women in a Northern Plains tribe

Early and regular prenatal care appointments are imperative for the health of both the mother and baby to help prevent complications associated with pregnancy and birth. American Indian women are especially at risk for health disparities related to pregnancy and lack of prenatal health care. Previous research has outlined a basic understanding of the reasons for lack of prenatal care for women in general; however, little is known about care received by pregnant women at Indian Health Service hospitals. Qualitative interviews were carried out with 58 women to better understand the prenatal health experiences of American Indian women from one tribe in the Northern Plains. Several themes related to American Indian women's prenatal health care experiences were noted, including communication barriers with physicians, institutional barriers such as lack of continuity of care, and sociodemographic barriers. Solutions to these barriers, such as a nurse midwife program, are discussed.

The experiences of prenatal depression among Taiwanese women

AIM

This paper is a report of a study to describe Taiwanese women's experiences of prenatal depression.

BACKGROUND

Despite its long-term adverse effects for both mother and child, prenatal depression has received less scholarly attention than postpartum depression. Studies to date have proposed structured measures for quantifying prenatal depression, but the characteristics of this phenomenon have not been qualitatively analysed.

METHOD

A convenience sample of 12 Taiwanese pregnant women scoring above 15 on the Edinburgh Perinatal Depression Scale participated in in-depth interviews during 2005. The interviews were transcribed verbatim and analysed using content analysis.

FINDINGS

Unbalanced commitment to motherhood was the primary theme of the life experiences of prenatal depression in these Taiwanese women, which summarized their feelings of engagement and ambivalence towards their experiences of transition to motherhood. Five recurring sub-themes were identified: multiple conflicting roles, lack of social support, dissatisfaction with body image, future uncertainty and emotional instability.

CONCLUSION

Prenatal depression is a painful growth experience represented by silent and unbalanced commitment during the maternal role transition. Our findings may help healthcare professionals to understand the vulnerable experiences of pregnant women and devise preventive intervention strategies, such as prenatal education for both parents and comprehensive screening for prenatal depression in at-risk pregnant women, so that they are better prepared for the transition to motherhood.

Psychosocial determinants of adequacy of gestational weight gain

Pregnancy is a critical time window for evaluating weight gain on subsequent risk for obesity among women of childbearing age. The purpose of this investigation was to determine whether symptoms of depression, anxiety, stress, self-esteem, and fetal health locus of control (FHLC) beliefs were significant risk factors for adequacy of gestational weight gain (GWG) when maternal sociodemographic characteristics and health behaviors were considered. A total of 1,605 women were prospectively followed from < or =20 weeks' gestation through delivery. Participants completed standard self-report questionnaires. Adequacy of GWG was expressed as the ratio of observed/expected weight gain based on Institute of Medicine recommendations. Multivariate ANOVA models were conducted and generalized linear models were performed to calculate risk ratios. Higher depressive symptoms reported throughout pregnancy were significantly associated with higher adequacy ratios. Stronger beliefs in chance in determining fetal health predicted inadequate relative to adequate GWG and was positively associated with larger GWG ratios overall. Several relationships were attenuated when adjusted for covariates. The relationship between psychosocial status and adequacy of GWG is significantly impacted by maternal sociodemographic factors and health practices engaged in during pregnancy. Women who tend to believe that external factors primarily determine fetal health appear to be more vulnerable to nonadherence to clinical GWG guidelines. These results have important implications for targeting prevention and intervention efforts for improving maternal and fetal outcomes secondary to GWG patterns.

Prenatal depression restricts fetal growth

OBJECTIVE

To identify whether prenatal depression is a risk factor for fetal growth restriction.

METHODS

Midgestation (18-20 weeks GA) estimated fetal weight and urine cortisol and birthweight and gestational age at birth data were collected on a sample of 40 depressed and 40 non-depressed women. Estimated fetal weight and birthweight data were then used to compute fetal growth rates.

RESULTS

Depressed women had a 13% greater incidence of premature delivery (Odds ratio (OR)=2.61) and 15% greater incidence of low birthweight (OR=4.75) than non-depressed women. Depressed women also had elevated prenatal cortisol levels (p=.006) and fetuses who were smaller (p=.001) and who showed slower fetal growth rates (p=.011) and lower birthweights (p=.008). Mediation analyses further revealed that prenatal maternal cortisol levels were a potential mediator for the relationship between maternal symptoms of depression and both gestational age at birth and the rate of fetal growth. After controlling for maternal demographic variables, prenatal maternal cortisol levels were associated with 30% of the variance in gestational age at birth and 14% of the variance in the rate of fetal growth.

CONCLUSION

Prenatal depression was associated with adverse perinatal outcomes, including premature delivery and slower fetal growth rates. Prenatal maternal cortisol levels appear to play a role in mediating these outcomes.

A literature update on maternal-fetal attachment

OBJECTIVE

To critically review and synthesize original research published since 2000 designed to measure factors that influence maternal-fetal attachment.

DATA SOURCES

EBSCOhost Research Databases that included PubMed, CINAHL Plus, PsycINFO, and SCOPUS were searched for journal articles published in the past 7 years (2000-2007) that examined variables thought to increase, decrease, or cause no change in level of maternal-fetal attachment. Keyword searches included maternal-fetal attachment, parental attachment, and prenatal attachment.

STUDY SELECTION

Twenty-two studies were selected that met the inclusion criteria of original research, clear delineation of the measurement of maternal-fetal attachment, measurement of maternal-fetal attachment during pregnancy, and inclusion of women or couples, or both.

DATA EXTRACTION

Studies measuring maternal-fetal attachment included a broad range of variables as potential risk or protective factors, or both. Factors associated with higher levels of maternal-fetal attachment included family support, greater psychological well-being, and having an ultrasound performed. Factors such as depression, substance abuse, and higher anxiety levels were associated with lower levels of maternal-fetal attachment.

DATA SYNTHESIS

The large majority of studies reviewed were limited by small, homogenous samples deemed insufficient to detect significant differences, inconsistent measurement of maternal-fetal attachment during gestational periods, and cross-sectional designs.

CONCLUSIONS

Further research is essential to identify factors influencing maternal-fetal attachment. Specifically, research needs to be conducted on larger sample sizes of greater racial and ethnic diversity.

The relationship between perceived stress and health-promoting behaviors in high-risk pregnancy

OBJECTIVE

The purpose of this study was to examine the relationship between maternal perceived stress and health-promoting self-care behaviors in women experiencing high-risk pregnancies.

DESIGN

Descriptive correlational.

SAMPLE

Women (N=69) who had a complication in pregnancy that required referral to a perinatologist at a tertiary care center and ere in the third trimester of pregnancy.

MEASURES

The Perceived Stress Scale is a 14-item scale measuring the extent to which one appraises life situations as stressful. Health-Promoting Lifestyle Profile II is a 52-item scale from which scores for an overall health promotion scale and 6 subscales (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management) are calculated.

RESULTS

There was a significant and negative relationship between perceived stress and health-promoting lifestyle. The relationships between perceived stress and spiritual growth, interpersonal relations, and stress management were significant and negative.

CONCLUSIONS

During a high-risk pregnancy, women who engage in more health-promoting behaviors may experience less stress; however, the causal relationship between stress and health promotion is not known. Nurses can offer stress management techniques and health-promoting self-care during this stressful time to encourage health in mother and neonate.

Sleep disorders in women: clinical evidence and treatment strategies

Sleep disorders are more prevalent in women than in men. Sex hormones modulate sleep-wake behaviors and mood and may contribute to heightened risk across the life cycle of women. Sleep disorders may have a unique expression in women, emerging throughout their reproductive life cycle. These conditions require careful treatment strategy to manage medical, hormonal, and behavioral contributing factors to poor sleep efficiency and impaired quality of life. This review focuses on clinical evidence for sleep disorders in women and discusses existing evidence of risk factors and treatment options for insomnia and sleep-disordered breathing in women.

Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development

: Statistically, women, particularly pregnant women and new mothers, are at heightened risk for depression. The present review describes the current state of the research linking maternal depressed mood and children's cognitive and language development. Exposure to maternal depressive symptoms, whether during the prenatal period, postpartum period, or chronically, has been found to increase children's risk for later cognitive and language difficulties. The present review considers both the timing of maternal depression and the chronicity of mothers' depression on children's risk for cognitive and language delays. Infancy is frequently identified as a sensitive period in which environmental stimulation has the potential to substantially influence children's cognitive and language development. However, children's exposure to chronic maternal depression seems to be associated with more problematic outcomes for children, perhaps because depression interferes with mothers' ability to respond sensitively and consistently over time. Consistent with this expectation, interventions targeting parenting practices of depressed mothers have been found to increase children's cognitive competence during early childhood. The current review provides a synthesis of the current state of the field regarding the association between maternal depression and children's cognitive and language development during early childhood.

Identifying Healthy Eating Strategies in Low-Income Pregnant Women: Applying a Positive Deviance Model

Using positive deviance methodology, we identified strategies that enabled some low-income pregnant women to eat healthy meals while others did not. We used a descriptive design consisting of small group interviews of low-income pregnant women and identified 6 of 18 women as eating healthy diets. Women with healthy diets knew to eat balanced meals, had family support, were willing to prepare foods that were different than other family members, and ate at home more frequently than women with unhealthy diets. Health care providers can use the positive deviance approach to guide the development of interventions to improve women's diets using community-specific solutions to enhance the health of mothers and infants.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

OBJECTIVES

The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.

SUBJECTS/SETTING

Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum.

DESIGN

At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized.

RESULTS

For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity.

CONCLUSIONS

Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.

Health-Related Behavior and Beliefs of Pregnant Smokers

To determine the association of smoking with other health-compromising behavior and beliefs during pregnancy, a cross-sectional survey of 1,203 women in the United Kingdom assessed smoking status, stage of change, fetal health locus of control, alcohol consumption, folic acid intake, and use of vitamin and iron supplements. Twenty percent were current smokers, and 33% were alcohol users. Pregnant smokers (especially those in the precontemplative stage) were less likely to increase folic acid intake, less likely to take vitamin and iron supplements, and less likely to feel personally responsible for the health of the fetus. Infants of smokers may be placed at an intrauterine disadvantage, not only in terms of smoking, but also in terms of nutrition.

Healthy behaviors and sources of health information among low-income pregnant women

This article addresses responses from two open-ended questions, describing the healthy behaviors and sources of health information in 150 low-income pregnant women. Data for this exploratory study were collected as part of a larger descriptive correlational study. Qualitative content analysis was used in the analysis. One hundred fifty English-speaking pregnant women aged 18 and over were interviewed at a public prenatal clinic in the Southeastern United States at their first prenatal visit. Health behaviors were placed into seven mutually exclusive categories: food-related behaviors, substance-related behavior, exercise/rest/activity, self-awareness/appearance, learning, focus on baby, and no specific behaviors. Sources of information questions were placed into seven mutually exclusive categories: family, health personnel, reading, hearing, other people, self-intuitive, and no response. Low-income pregnant women are aware of healthy behaviors and report practicing them during their pregnancies. Because family members are a common source of information for health practices, they should be included in health education efforts.

Prepartum, postpartum, and chronic depression effects on newborns

In order to assess the effects of the onset and chronicity of maternal depression on neonatal physiology, eighty pregnant women were assessed for depression during mid-pregnancy (M gestational age = 25.9 weeks) and shortly after delivery. The women were classified as reporting depressive symptoms 1) only during the prepartum assessment; 2) only during the postpartum assessment; 3) during both the prepartum and postpartum assessments; or 4) reporting no depressive symptoms at either the prepartum or the postpartum assessment. Maternal mood and biochemistry were assessed during pregnancy, and the EEG and biochemical characteristics of their 1-week-old infants were assessed shortly after birth. As predicted, the newborns of the mothers with prepartum and postpartum depressive symptoms had elevated cortisol and norepinephrine levels, lower dopamine levels, and greater relative right frontal EEG asymmetry. The infants in the prepartum group also showed greater relative right frontal EEG asymmetry and higher norepinephrine levels. These data suggest that effects on newborn physiology depend more on prepartum than postpartum maternal depression but may also depend on the duration of the depressive symptoms.

Psychosocial influences on weight gain attitudes and behaviors during pregnancy

OBJECTIVE

To examine pregnant women's weight-related attitudes and behaviors in relation to a constellation of psychosocial characteristics, prepregnancy body habitus, and gestational weight gain.

PARTICIPANTS

One hundred-thirty women with low-risk, normal pregnancies.

DESIGN

Cross-sectional, observational study assessed attitudes about weight gain at 36 weeks' gestation. Psychosocial characteristics, including anxiety, depression, social support, emotionality, and pregnancy-specific and nonspecific stress appraisal were assessed between 28 and 36 weeks' gestation.

STATISTICAL ANALYSIS PERFORMED

Principal components factor analysis, Pearson correlations, t tests, and analysis of variance.

RESULT

A range of positive and negative attitudes about weight gain was expressed. Twenty-one percent (n=27) of the sample endorsed at least one weight-restrictive behavior during pregnancy. Women who reported more weight-restrictive behaviors were more anxious (r=.24, P<.01), depressed (r=.29,P<.001), angry (r=.29, P<.001), stressed (r=.23, P<.01), and felt less uplifted (r=-.21, P<.05) about their pregnancies in general. Higher Positive Pregnancy Body Image scores were associated with feeling better about the pregnancy in general (r=.35, P<.001), fewer depressive symptoms, and less anger (both r=.20, both P<.01). Women who were self conscious about their weight gain felt more hassled by their pregnancies (r=.21, P<.05), greater anger (r=.21, P<.05), and more support from partners (r=.22, P<.05). Prepregnancy body mass index was unrelated, but negative attitudes about weight gain existed even among women who gained within recommended ranges.

CONCLUSION

Women's attitudes about weight gain in pregnancy are imbedded in their orientation toward pregnancy as well as their general psychological functioning. Effective nutrition counseling for pregnant women should include consideration of weight-restrictive behaviors, the degree to which the pregnancy is perceived as positive and uplifting, and whether weight gain attitudes may be associated with their relationship with a spouse or partner.

The interrelationship of maternal stress, endocrine factors and inflammation on gestational length

Preterm birth rates continue to rise in the United States despite the advent of tocolytic agents and the identification of risk factors for preterm birth, such as vaginal infection and a shortened cervix. Although improvement in gestational-age-related survival of preterm infants has occurred as a result of the use of antenatal corticosteroids, neonatal surfactant therapy, and regionalization of perinatal care, there has been no reduction in the incidence of preterm birth. Recently, investigators have appreciated that the etiology of preterm birth is heterogeneous, perhaps accounting for one reason for the failure of current interventions to improve pregnancy outcome. Both abnormal maternal hormonal homeostasis and intrauterine inflammatory responses appear to contribute to a significant proportion of the cases of preterm birth, and the interaction of the maternal endocrine and immunologic systems may contribute to the pathophysiology of this condition. An important modulator of endocrine and immune function is perceived emotional and social stress. Maternal stress has been strongly associated with preterm birth, but the links between maternal stress and resultant aberrations of maternal endocrine and immune function remain difficult to quantify and investigate. However, new insights into the role of perceived maternal stress on gestational length suggest that specific interventions to alleviate stress could contribute to an increase in gestational length and a decrease in the risk for preterm birth. This review addresses the role of maternal stress on the regulation of maternal hormone and inflammatory responses and how aberrations in these systems may lead to preterm birth.

A comparison of pregnancy health practices of women in inner-city and small urban communities

OBJECTIVE

To examine whether the relationships among pregnancy health practices, maternal-fetal attachment, and prenatal depression differ between women living in the inner city and women living in a smaller urban community.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Clinics in inner-city and small urban communities in the Midwest.

PARTICIPANTS

Fifty-five pregnant women living in the inner city and 197 pregnant women living in a smaller urban setting.

MAIN OUTCOME MEASURES

Health Practices Questionnaire, a self-report instrument that measures pregnancy health practices.

RESULTS

Women living in the inner city reported lower levels of health practices than women in urban settings, but this was moderated by maternal-fetal attachment. Inner-city women with lower levels of maternal-fetal attachment had poorer health practices than inner-city women with higher levels of maternal-fetal attachment; there was no relationship for women residing in the small urban area. Depression was negatively associated with health practices for all women; however, there was no difference by residence.

CONCLUSION

Maternal-fetal attachment contributed differently to health practices in women from the inner city compared with women from small urban communities. Nurses can use this information to help identify women at risk for poor pregnancy health practices. More research is needed to identify the interventions that most effectively improve health practices.

Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women

The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Resourcefulness and self-care in pregnant women with HIV

The human immunodeficiency virus (HIV) has caused suffering in the lives of humans worldwide. Pregnant Thai women now constitute the fastest-growing segment of individuals diagnosed with HIV/AIDS. Few studies have looked at self-care or resourcefulness among pregnant women with HIV. Using Rosenbaum's theory of learned resourcefulness, this study examined the direct effects of depression and resourcefulness on prenatal self-care as well as the mediating effects of resourcefulness on depression and self-care. A model testing study with 153 pregnant Thai women compared the effects of depression and resourcefulness on prenatal self-care in HIV-positive and HIV-negative groups. Regression analyses indicated direct effects of depression and resourcefulness on prenatal self-care. The effect of depression on prenatal self-care was mediated by resourcefulness. HIV status did not predict prenatal self-care. The findings on the relationships of depression, resourcefulness, and prenatal self-care can help nurses provide effective services to pregnant Thai women, including counseling on self-care.

Psychosocial thriving during late pregnancy: relationship to ethnicity, gestational weight gain, and birth weight

OBJECTIVE

To test the relationships between psychosocial thriving (depressive symptoms, health-related lifestyle) and gestational weight gain and birth weight. To test the influences of ethnicity on the relationships between psychosocial thriving and gestational weight gain and birth weight.

DESIGN

Baseline data taken from the Austin New Mothers Study.

SETTING

A community hospital in Texas.

PARTICIPANTS

305 low-risk African American, Hispanic, and White women with full-term pregnancies, singleton births, and Medicaid coverage.

MAIN MEASURES

Center for Epidemiologic Studies Depression Scale, Self Care Inventory, Food Habits Questionnaire, gestational weight gain, and birth weight.

RESULTS

Newborns of African American women had lower birth weights (3,240 g) than newborns of Hispanic (3,422 g) or White women (3,472 g), even though no ethnic differences were found among the mothers on psychosocial variables. Late in pregnancy, women had high levels and prevalence (> 70%) of depressive symptoms regardless of ethnicity, and 50% exceeded recommended gestational weight gains. In full regression models, psychosocial variables were not significant predictors of gestational weight gain or birth weight. Ethnicity also was not a significant moderator of weight outcomes.

CONCLUSIONS

Psychosocial thriving late in pregnancy was unrelated to gestational weight gain or birth weight. Ethnicity did not moderate psychosocial-weight relationships. Although ethnic differences were not found on psychosocial variables, high levels of depressive symptoms and greater than recommended gestational weight gains were prevalent. These findings have implications for maternal health during and beyond pregnancy.

Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy

The purpose of this study was to investigate a conceptual model in which depression was proposed to have direct negative effects on positive health practices as well as indirect negative effects through maternal-fetal attachment (MFA). Participants were 252 adult pregnant women, between 20 and 40 weeks postgestation, who were recruited from five prenatal care sites. Data were collected using mailed self-report instruments measuring MFA, depression, health practices, and demographic and pregnancy information. Hierarchical regression was used to examine direct and indirect effects of depression, person characteristics (maternal age, pregnancy risk status, parity, ethnicity, education, income, marital status), and MFA on health practices. Results of the study supported the conceptual model. Higher education, lower parity, and being partnered predicted more positive health practices (p <05). After controlling for person characteristics, depression was found to be a significant predictor of MFA. Both depression and MFA were significant predictors of positive health practices but in opposite directions. Depression had a negative relationship and MFA a positive relationship with positive health practices.