Perinatal mental health services for mothers from ethnic minority and migrant backgrounds

Perinatal mental health disorders are among the most common morbidities of the perinatal period with considerable adverse effects on mothers and their offspring. Members of ethnic minority groups, particularly those from migrant backgrounds, are at higher risk of developing mental illness with evidence of ongoing inequality in access to support. We will present an exploratory mixed-methods study scoping ethnic minority and migrant women's experiences accessing perinatal mental health services in the UK. Results showed how women perceived access to services as very challenging and how they experienced ‘suffering in silence', a ‘need for a safe space to talk and to be listened to', and a ‘need of finding other women like them'. We will complement these findings with the lessons learned from a related project, a three-site European study (ORAMMA) evaluating the feasibility of implementing an integrated perinatal care model for migrant mothers comprising maternity peer supporters (MPSs)-women from migrant backgrounds who had lived in the country for a longer time and were trained to support other migrant women during the childbearing continuum-. Results showed that MPSs supported migrant women accessing maternity care, overcoming language barriers, and advocating for them in their encounters with healthcare professionals. Besides, they provided emotional support and increased women's confidence, helping them overcome loneliness, encouraging them to build relationships with others and promoting bonding with the new baby. Bringing these two projects together, we will discuss how MPSs have the potential to help overcome barriers that immigrant women experience in seeking perinatal mental health and how the benefits of maternity peer supporters have the potential to reduce perinatal mental health risks amongst migrant mothers. Findings will point to the need for future research to evaluate the direct impacts of MPSs on immigrant's mother perinatal mental health.

Experiences and expectations of women from ethnic minority background on perinatal mental health

Introduction

Being from ethnic minority backgrounds is a risk factor for poor perinatal mental health (PMH). To enhance services and prevent the devastating impacts of mental health problems on maternal morbidity and mortality, it is important to understand the experiences and expectations of women and families regarding related service provisions.

Methods

This will present the results of a two staged study including: a) a systematic review examining the state of evidence on the experiences of women from ethnic minority backgrounds on PMH. We searched 4 databases and using a convergent approach, synthesised the data thematically. b) an exploratory survey, distributed through a maternity service user and parenting Facebook group. Quantitative data were analysed using descriptive statistics and a thematic analysis was used for the qualitative data.

Results

A total of 15 studies met the inclusion criteria for the systematic review, highlighting the need for an in-depth exploration of these women with issues related to culture stigma and relevance of care provision. The survey questions explored these issues further. There were 51 responses representing 14 different ethnic minority backgrounds, the largest groups being Pakistani and Indian (21.6% and 19.6% respectively). The majority of the respondents reported accessing support for mental health problems very challenging (58.5%). Qualitative data revealed several overarching themes; 'Suffering in silence', 'The need for a safe space to talk' 'What about women like me-community support'?

Conclusions

Women from ethnic minority groups face barriers to seeking help from PMH services due to ongoing stigma, poor attitudes and behaviours of health professionals and inappropriately designed services. Culturally competent care providers with appropriate training are required to ensure women feel safe to access care. The effects of peer supporters as part of PMH services require further investigation.

Key messages

Maternity services should ensure that support for perinatal mental ill health meets the needs of women from ethnic minorities. Research is needed to develop interventions on healthcare professionals' education and cultural competency and services which promote access to culturally appropriate spaces to talk and be listened to.

Experiences of maternal weight management services among women with a raised body mass index

Background

Obesity is associated with increased maternal morbidity and mortality. Maternal weight management services (MWMS) are a good opportunity to influence lifestyle behaviours of mothers. To understand what constitutes the most suitable service, women's views on MWMS are paramount.

Methods

A purposive sample of 13 women with a BMI≥40kg/m² were interviewed at 36 weeks gestation. A semi-structured interview schedule explored their experiences of MWMS provision and advice, awareness of services and the barriers and facilitators to antenatal weight management. Interviews were recorded and transcribed verbatim. Inductive thematic analysis was undertaken.

Results

Four themes emerged. 'Understanding where I am at' showed women's readiness and motivation varied, from being avoidant or unaware of weight as an issue to already making changes. 'Getting information' revealed while a few women felt that they received good information during pregnancy most reported a lack of information or minimal information provided in a 'tick-box' fashion. Women particularly wanted practical advice. 'Difficulties I face' identified physical, emotional and financial barriers and the strategies some women used to overcome these. 'Encountering professionals - a mixed experience' demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals need to tread was evidenced by women thinking they had received inadequate information and yet that there was too much focus on their weight and its related risks during pregnancy.

Conclusions

MWMS should not be seen as a 'tick box' exercise but should be woman-centred to assist women to move forward in their weight management journey, no matter what their starting point. Women desired practical advice provided in a sensitive, respectful manner not just the continual repetition of the risks of being obese during pregnancy.

Key messages

Maternal weight management services require a woman-centred approach to enable women to move forward on their weight management journey. Women want practical, sensitive advice not just the continual repetition of the risks of being obese during pregnancy.

Evaluating the long-term impact of an antenatal healthy lifestyle service: retrospective cohort study

Introduction

Maternal obesity is associated with increased odds of obesity in the offspring. The antenatal period is considered a good opportunity to promote lifestyle improvements. The long-term impact of maternal characteristics and attending a maternal healthy lifestyle service (MHLS) on childhood risk of overweight was evaluated.

Methods

Women with a body mass index (BMI) ≥35kg/m² referred to one MHLS in England from 2009 were included in a retrospective cohort study. Pseudo-anonymised data from the National Child Measurement Programme were matched to data from women referred to this service. Children were classified as 'overweight' if their weight centile was ≥95th centile at 6-8 weeks or 9-12 months or their BMI was ≥95th centile at school entry (4-5 years). Univariate logistic regression determined the odds ratios (OR) and 95% confidence intervals (CI) of childhood overweight according to uptake of the MHLS, gestational weight gain (GWG) and other characteristics.

Results

The proportion of infants classified as overweight increased over time [2.8% at 6-8 weeks (20/713), 13.8% at 9-12 months (89/647) and 30.4% at school entry (206/677)]. The odds of overweight increased with each unit increase in birthweight (OR 39.9 95%CI 13.4-119.1 at 6-8 weeks, OR 3.7 95%CI 2.4-5.7 at 9-12 months and OR 1.9 95%CI 1.4-2.5 at school entry). GWG above Institute of Medicine recommendations increased the odds of overweight at 6-8 weeks (OR 2.9 95%CI 1.1-7.4). Women living in the most deprived quartile (OR 1.6 95%CI 1.1-2.2) or who smoked when booking for antenatal care (OR 1.5 95%CI 1.0-2.2) had increased odds of infant with BMI ≥95th centile at school entry. Attendance at a MHLS and maternal BMI did not significantly impact on child overweight at any time; however the sample only included women with a raised BMI.

Conclusions

Lifestyle during pregnancy, GWG and other wider health determinants such as deprivation have long lasting effects on infant health and childhood obesity.

Key messages

Overweight at school entry is high (>30%) for women with a raised BMI when booking for antenatal care. Addressing maternal socioeconomic conditions, gestational weight gain and smoking during pregnancy are key priorities for the long-term health of children.

The effects of a local dairy food supplement on pregnancy outcomes in Indonesia: A feasibility trial

Introduction

Approximately 20.1% of Indonesian pregnant women are underweight (BMI<18.5kg/m²) and over 50% of women have inadequate gestational weight gain (GWG) [1]. Maternal nutrition is a modifiable factor influencing child health. This project aims to assess the feasibility of a randomised controlled trial (RCT) using a traditional Indonesian yogurt from buffalo milk (Dadih), to improve outcomes for pregnant mothers and their babies.

Methods

This is a two armed feasibility RCT (1:1) in which 200 women with body mass index<27.5kg/m² (Asian BMI classifications) were planned to randomly be allocated to routine care or the intervention group, who will be supplemented with four weekly servings of Dadih.

Results

A total of 107 women were recruited to the trial in the first wave from Dec 2018-March 2019 (recruitment rate of ∼25/month). Of these 81 have been followed up to delivery and will be followed up to 6 months postpartum. Local Dadih production reached its full capacity in one region and recruitment had to be extended to other regions. Comparative trends on study outcomes including GWG, mode of birth, postpartum depression, postpartum haemorrhage, maternal nutritional status, anaemia, birthweight, gestational age, admission to neonatal care unit, breastfeeding, neonatal health status will be reported.

Conclusions

Early results show that the supplementation is acceptable to women and protocol implementation is feasible. In order for this feasibility project to be developed to a full scale RCT, improvements to the infrastructure of supply are required. Such projects may have positive economic impact and provide sustainable solutions to local maternal and neonatal health challenges.

Reference

1. Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. (2017) Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Women's Health.

Key messages

Nutritional supplementation using a traditional Indonesian yogurt (Dadih) made from buffalo milk during pregnancy has been received positively by women. Depending on the observed comparative trends from the study outcomes, infrastructure investment is required to enable the feasibility study to be expanded to a full scale randomised controlled trial.

Birjand longitudinal aging study (BLAS): the objectives, study protocol and design (wave I: baseline data gathering)

Objectives

The pace of population aging is growing rapidly around the world. Aging is associated with the emergence of different health status including geriatric syndrome such as frailty, diabetes, cardiovascular diseases, and dementia. These conditions are the most prominent challenges for health care systems and also elderly people. Therefore, understanding these changes can help scientists to prevent and treat significant health issues and also improve the functional ability of older adults.

Methods

This is a protocol of the first wave of Birjand Longitudinal Aging Study that is an ongoing community-based prospective cohort study with a following up at least 10 years. This study carries out on aged population ≥ 60 years which were residents in Birjand County (urban and rural older subjects). The selection of the participants of this study in urban areas is based on an age group weighted multistage stratified random sample while in the rural region the sample was selected from all ten rural regions of Birjand County by simple random sampling. The rural region sampling was based on the list of the aged population which were under the coverage of the rural health center. Sociodemographic, past medical history, lifestyle, sleep, activities of daily living, cognitive function, quality of life, and social capital were evaluated by interviewing with the participants and one of the informants. Anthropometric measures, electrocardiography, and interpretation of ophthalmologic examination were carried out by experts. Fasting Blood samples were collected and bio-banked in - 80 °C. then finally biochemical and hematologic markers were measured.

Results

This is the protocol of stage one baseline of Birjand Longitudinal Aging Study (BLAS). The BLAS is an enjoining study, the first phase of its baseline was carried out on a community- dwelling aged population sample ≥ 60 years who were residents in urban and rural regions of Birjand County. This is a community based prospective cohort study with at least 10 years follow up of participants. The data for 65% of older subjects (response rate = 65%) that lived in clusters were collected.

Conclusions

This study can help scientists to recognize some risk factors related to the aging process and also aware policymakers about the necessity to create heath care services at regional and even national levels.

Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis

OBJECTIVE

To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening.

METHOD

Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis.

RESULTS

We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram.

CONCLUSION

Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.

An Analysis of Behaviour Change Techniques Used in a Sample of Gestational Weight Management Trials

INTRODUCTION

Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management.

METHOD

All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain.

RESULTS

The most commonly used BCTs were within the categories of "feedback and monitoring," "shaping knowledge," "goals and planning," "repetition and substitution," "antecedents," and "comparison of behaviours." For diet and mixed interventions "feedback and monitoring," "shaping knowledge," and "goals and planning" appeared the most successful BCT categories.

CONCLUSIONS

Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.

Women's and Midwives' Perspectives on the Design of a Text Messaging Support for Maternal Obesity Services: An Exploratory Study

This study was aimed to explore women's and midwives' views on the use of mobile technology in supporting obese pregnant women with healthy lifestyle choices. A purposive sample of 14 women and midwives participated in four focus groups in Doncaster, UK. A content analysis of the transcripts from the first focus group led to the emergence of three main constructs with associated subcategories including Benefits ("modernising," "motivating," "reminding," and "reducing" the sense of isolation), Risks and Limitations (possibility of "being offensive," "creating pressure or guilt," and "being influenced by mood"), and Service Delivery (making it "available to all pregnant women," giving attention to the "message tone" and development of "message content"). They also suggested the use of other modalities such as web-based services for weight management during pregnancy. Based on the above results a text messaging service was developed and presented to the 2nd focus group participants who confirmed the positive views from the first focus group on the use of the text messaging as being supportive and informative. The participants also welcomed "women's engagement and choice" in deciding the content, timing and frequency of messages. The results informed the development of a text messaging service to support maternal obesity management. The implementation and acceptability of this service requires further investigation.

Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour

BACKGROUND

Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour.

OBJECTIVES

The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group Trials register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004).

SELECTION CRITERIA

Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the quality of trials and extracted data.

MAIN RESULTS

Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias.

AUTHORS' CONCLUSIONS

It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour.

A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum

Many women associate one or more of their pregnancies with the development of adult obesity. Such an association has not been fully explored. This longitudinal study examines the changes in maternal anthropometric indices during pregnancy and postpartum. Seventy-seven pregnant subjects were investigated longitudinally at about 13, 25 and 36 weeks gestation, of whom forty-seven continued taking part into the postpartum period. Maternal weight, height and skinfold thickness (triceps, biceps, subscapular, suprailiac and mid thigh) were measured at each visit. Maternal fat mass was estimated from the conversion of the first four skinfold thicknesses. Maternal waist and hip circumferences were also measured at the first visit and 6 weeks and 6 months postpartum. Weight and fat gain during pregnancy (13-36 weeks gestation) was 10.9 (SD 4.7) kg and 4.6 (SD 3.3) kg (P < 0.001) respectively. A significant increase in fat mass from 13 weeks gestation to 6-months postpartum was observed (2.6 (SD 4.5), P < 0.001). The increased weight at 6-months postpartum, however, was not statistically significant (1.1 (SD 6.0) kg, P = 0.20). Based on BMI in early pregnancy, the subjects were divided into groups of underweight, normal weight, overweight and obese. The last three groups were compared using ANOVA. The obese group showed a significant difference in the pattern of changes in the skinfold thickness, waist:hip ratio and fat mass at the postpartum period, in comparison with the other two groups. In conclusion, there is a tendency in the obese group to develop central obesity at the postpartum period.