To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Edited by
Rebecca Leslie, Royal United Hospitals NHS Foundation Trust, Bath,Emily Johnson, Worcester Acute Hospitals NHS Trust, Worcester,Alex Goodwin, Royal United Hospitals NHS Foundation Trust, Bath,Samuel Nava, Severn Deanery, Bristol
Content on the physiology of pregnancy focuses on the commonly examined areas including the cardiovascular, respiratory, endocrine and haematological changes in pregnancy, then the subsequent impact upon conduct of anaesthesia. We include a section on the materno-fetal circulation and the placenta, with an emphasis on the changes that occur at birth.
Early interventions supporting parental sensitivity have proven effective. Despite advancements in telemedicine, research on remote group parenting interventions remains limited. This study evaluated the feasibility and acceptability of “C@nnected,” a brief group videoconferencing intervention aimed at enhancing maternal sensitivity in mother–infant dyads in primary care settings in Santiago, Chile. A feasibility randomized controlled trial (RCT) was conducted using quantitative and qualitative methods. Of 44 mother–infant dyads randomized, 26 were assigned to receive the intervention, whereas 18 were allocated to the control group. Eligibility and recruitment rates were 89% and 36%, respectively, with adherence at 50% and follow-up at 64.5%. The intervention demonstrated high acceptability in both the quantitative and qualitative evaluations. Mothers who participated in the intervention showed high scores in credibility and expectancy and reported increased knowledge, stronger bonds with their children and greater satisfaction and competence in their motherhood role. This pilot study underscores the potential of “C@nnected” while identifying areas for improvement. The findings provide valuable insights into refining and further evaluating its efficacy through an RCT.
Women in the perinatal phase are at an increased risk of experiencing mental health problems, but in low and middle-income countries such as India, perinatal mental health (PMH) care provision is often scarce. This situational analysis presents the formative findings of the SMARThealth Pregnancy and Mental Health (PRAMH) project (Votruba et al. 2023). It investigates the nature and availability of maternal mental health policies, legislation, systems and services, as well as relevant context and community in India on a national, state (Haryana and Telangana) and district (Faridabad and Siddipet) level. A desktop, scoping review and informal interviews with mental health experts were conducted. Socio-demographic and maternal health indicators vary between Haryana and Telangana. No specific national PMH policy or plan is available. General mental health services exist at a district level within Siddipet and Faridabad, but no specific PMH services have been identified.
Limited studies have examined the association between the whole range of parental psychopathology and offspring major depression (MD). No previous study has examined this association by age of onset of offspring MD, or restricting to parental psychiatric diagnoses before offspring birth.
Methods
This nested case–control study included 37,677 cases of MD and 145,068 controls, identified from Finnish national registers. Conditional logistic regression models examined the association between parental psychopathology and MD, adjusting for potential confounders.
Results
Increased risk of MD, expressed as adjusted odds ratio and 95% confidence interval (aOR [95% CI]) were most strongly observed for maternal diagnoses of schizophrenia and schizoaffective disorders (2.51 [2.24–2.82]) and depression (2.19 [2.11–2.28]), and paternal diagnoses of schizophrenia and schizoaffective disorders (2.0 [1.75–2.29]) and conduct disorders (1.90 [1.40–2.59]). The aORs for any psychiatric diagnosis were (2.66 [2.54–2.78]) for mothers, (1.95 [1.86–2.04]) for fathers, and (4.50 [4.24–4.79]) for both parents. When both parents had any psychiatric diagnosis, the highest risk was for MD diagnosed at the age of 5–12 years (7.66 [6.60–8.89]); versus at 13–18 years (4.13 [3.85–4.44]) or 19–25 years (3.37 [2.78–4.07]). A stronger association with parental psychopathology and offspring MD was seen among boys than girls, especially among 13–19 years and 19–25 years.
Conclusions
Parental psychiatric disorders, including those diagnosed before offspring birth, were associated with offspring MD, indicating potential genetic and environmental factors in the development of the disorder.
Postpartum maternal diet quality has been linked with optimal infant feeding practices. However, whether maternal diet quality during pregnancy influences infant feeding practices remains unclear. The present study explored the relationship between maternal diet quality in pregnancy and infant feeding practices in Australian women. A brief 15-item FFQ was used to collect maternal dietary data (n 469). Diet quality was calculated using a modified 2013 Dietary Guideline Index (DGI). Multivariable linear and logistic regressions with adjustment for covariates were used to examine associations between maternal diet quality in pregnancy and infant feeding practices: infant feeding mode, breast-feeding duration and timing of solids introduction. Higher DGI score during pregnancy was associated with higher odds of breast-feeding than formula/mixed feeding (adjusted OR (AOR) 1·03, 95 % CI 1·00, 1·07), longer breast-feeding duration (adjusted β 0·09, 95 % CI 0·03, 0·15) and higher odds of breast-feeding for ≥ 6 months (AOR 1·04, 95 % CI 1·02, 1·07) than for < 6 months. Associations between maternal DGI score and breast-feeding variables were moderated by maternal country of birth, with significant associations observed in Australian-born mothers only. No association was found between maternal DGI score and timing of solids introduction. Higher maternal diet quality was associated with better infant feeding practices, and the association was moderated by country of birth. Our findings provide evidence to support the initiation of dietary interventions to promote diet quality during pregnancy, particularly among Australian-born women. Further research could explore underlying mechanisms linking maternal diet quality and infant feeding practices.
Although maternal, newborn, child, and adolescent health is a well-established determinant of health across the lifecourse and across generations, the underpinning concept of DOHaD has not had significant impact on policymaking. This chapter identifies some of the barriers involved and how DOHaD researchers may overcome them. Policymaking is a complex process that is influenced by many factors other than science. Translating evidence to policy requires brokerage that explains the implications of science in a clear, frank way, accompanied by impactful solutions. Yet, the largely preventive approach advocated by DOHaD science does not inherently offer simple, high-impact interventions but rather a broad shift in thinking within the policy community. DOHaD advocacy will need to demonstrate short- and medium-term, as well as long-term, benefits. A complementary approach is to engage with communities to adjust scientific ideas to local knowledge and expertise.
The study assessed mothers, children and adolescents’ health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.
Background:
Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.
Methods:
This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.
Findings:
While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15–19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).
Conclusion:
Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to ‘Leave no one behind’. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
Methods
In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
Results
Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
Discussion
Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
There is significant evidence that an unhealthy diet greatly increases the risk of complications during pregnancy and predisposes offspring to metabolic dysfunction and obesity. While fat intake is typically associated with the onset of obesity and its comorbidities, there is increasing evidence linking sugar, particularly high fructose corn syrup, to the global rise in obesity rates. Furthermore, the detrimental effects of added sugar intake during pregnancy on mother and child have been clearly outlined. Guidelines advising pregnant women to avoid food and beverages with high fat and sugar have led to an increase in consumption of ‘diet’ or ‘light’ options. Examination of some human birth cohort studies shows that heavy consumption (at least one beverage a day) of non-nutritive sweetener (NNS) containing beverages has been associated with increased risk of preterm birth and increased weight/BMI in male offspring independent of maternal weight, which appears to be offset by breastfeeding for 6 months. Rodent models have shown that NNS exposure during pregnancy can impact maternal metabolic health, adipose tissue function, gut microbiome profiles and taste preference. However, the mechanisms underlying these effects are multifaceted and further research, particularly in a translational setting is required to fully understand the effects of NNS on maternal and infant health during pregnancy. Therefore, this review examines maternal sweetener intakes and their influence on fertility, maternal health outcomes and offspring outcomes in human cohort studies and rodent models.
We investigated the influence of maternal yellow-pea fiber supplementation in obese pregnancies on offspring metabolic health in adulthood. Sixty newly-weaned female Sprague-Dawley rats were randomized to either a low-calorie control diet (CON) or high calorie obesogenic diet (HC) for 6-weeks. Obese animals were then fed either the HC diet alone or the HC diet supplemented with yellow-pea fiber (HC + FBR) for an additional 4-weeks prior to breeding and throughout gestation and lactation. On postnatal day (PND) 21, 1 male and 1 female offspring from each dam were weaned onto the CON diet until adulthood (PND 120) for metabolic phenotyping. Adult male, but not female, HC offspring demonstrated increased body weight and feed intake vs CON offspring, however no protection was offered by maternal FBR supplementation. HC male and female adult offspring demonstrated increased serum glucose and insulin resistance (HOMA-IR) compared with CON offspring. Maternal FBR supplementation improved glycemic control in male, but not female offspring. Compared with CON offspring, male offspring from HC dams demonstrated marked dyslipidemia (higher serum cholesterol, increased number of TG-rich lipoproteins, and smaller LDL particles) which was largely normalized in offspring from HC + FBR mothers. Male offspring born to obese mothers (HC) had higher hepatic TG, which tended to be lowered (p = 0.07) by maternal FBR supplementation.
Supplementation of a maternal high calorie diet with yellow-pea fiber in prepregnancy and throughout gestation and lactation protects male offspring from metabolic dysfunction in the absence of any change in body weight status in adulthood.
To examine the associations of pregnant women’s dietary and sedentary behaviours with their children’s birth weight.
Design:
Secondary data analysis was conducted using data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone, conducted in Australia. Information on mothers’ socio-demographics, dietary and sedentary behaviours during pregnancy was collected by telephone survey at the third trimester. Birth weight data were extracted from the child’s health record book. Multinomial logistic regression models were built to examine the associations of pregnant women’s dietary and sedentary behaviours with children’s birth weight.
Setting:
Participating families.
Participants:
Pregnant women and their children.
Results:
A total of 1132 mother–child dyads were included in the analysis. The majority of infants (87 %, n 989) were of normal birth weight (2500 g to <4000 g), 4 % (n 50) had low birth weight (<2500 g) and 8 % (n 93) had macrosomia (≥4000 g). Mothers who ate processed meat during pregnancy were more likely to have macrosomia (adjusted risk ratio (ARR) 1·80, 95 % CI (1·12, 2·89)). The risk of macrosomia decreased as the number of dietary recommendations met by mothers increased (ARR 0·84, 95 % CI (0·71, 0·99)). Children’s birth weight was not associated with mothers’ sedentary time. Children’s low birth weight was not associated with mothers’ dietary and sedentary behaviours during pregnancy.
Conclusion:
Maternal consumption of processed meat during pregnancy was associated with an increased risk of macrosomia. Increasing number of dietary recommendations met by mothers was associated with a lower risk of macrosomia. The findings suggested encouraging pregnancy women to meet dietary recommendation will benefit children’s birth weight.
Maternal nutrition is essential for optimal health and well-being of women and their infants. This review aims to provide a critical overview of the evidence-base relating to maternal weight, obesity-related health inequalities and dietary interventions encompassing the reproductive cycle: preconception, pregnancy, postnatal and interpregnancy. We provide an overview of UK data showing that overweight and obesity affects half of UK pregnancies, with increased prevalence among more deprived and minoritised ethnic populations, and with significant health and cost implications. The existing intervention evidence-base primarily focuses on the pregnancy period, where extensive evidence demonstrates the power of interventions to improve maternal diet behaviours, and minimise gestational weight gain and postnatal weight retention. There is a lack of consistency in the intervention evidence-base relating to interventions improving pregnancy health outcomes, although there is evidence of the potential power of the Mediterranean and low glycaemic index diets in improving short- and long-term health of women and their infants. Postnatal interventions focus on weight loss, with some evidence of cost-effectiveness. There is an evidence gap for preconception and interpregnancy interventions. We conclude by identifying that interventions do not address cumulative maternal obesity inequalities and overly focus on individual behaviour change. There is a lack of a joined-up approach for interventions throughout the entire reproductive cycle, with a current focus on specific stages (i.e. pregnancy) in isolation. Moving forward, the potential power of nutritional interventions using a more holistic approach across the different reproductive stages is needed to maximise the benefits on health for women and children.
Severe anxiety affects a huge number of women in pregnancy and the postnatal period, making a challenging time even more difficult. You may be suffering from uncontrollable worries about pregnancy and birth, distressing intrusive thoughts of accidental or deliberate harm to the baby, or fears connected to traumatic experiences. This practical self-help guide provides an active route out of feeling anxious. Step-by-step, the book teaches you to apply cognitive behaviour therapy (CBT) techniques in the particular context of pregnancy and becoming a new parent in order to overcome maternal anxiety in all its forms. Working through the book you will gain understanding of your anxiety and how factors from the past and present may be playing a role in how you feel. Together with practical exercises and worksheets to move through at your own pace, you will gain the tools you need to help you move forward and enjoy parenthood.
Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100 % of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an ‘energy-giving’ diet. Some foods were avoided because of religious or cultural taboos, or because they were low status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.
This chapter explores the influence of the women’s liberation movement on Heaney’s poetry, criticism and critical reception by examining the changing status of ‘the feminine’ in his poetics. Heaney’s early criticism subscribed to a Gravesian dichotomy between masculine mastery and feminine receptivity, which he later tones down in light of feminist critique. The controversy over Heaney’s figuration of colonialism as rape in North (1975), and the ensuing debate over the aisling genre, present mixed attitudes both towards patriarchal ideology and towards diverging emphases in contemporary feminism. Heaney proved adept at becoming canonical at a time when the patriarchal biases of literary canon-formation were critiqued by feminists, most notably during the critical furore over the marginalization of women from the 1991 Field Day Anthology. ‘Station Island’ (1985) reveals Heaney’s gift for finding his place in the canon even as his patrilineal trajectory towards ‘major-poet’ status vindicates the feminist case against patriarchal bias.
Globally, the availability and formulations for the administration of cannabis are changing with decriminalization or legalization of recreational use in some jurisdictions, and the prescription of cannabis also occurring. These changes are likely to affect the prevalence of use, including by women of childbearing age. The effects of in utero and infant alcohol and tobacco exposure are well-documented, but the outcomes of cannabis exposure are less certain. The content of delta-9-tetrahydrocannabinol (THC), the psychoactive component of cannabis has progressively increased over several decades. This review explores the limited knowledge surrounding the epidemiology of gestational and postnatal cannabis exposure and implications for the mother–placenta–fetus/neonate triad. We examine cannabis’ effects from antenatal and lactation exposure on (a) pregnancy and perinatal outcomes, (b) placental health, and (c) longer term cardiometabolic and neurodevelopmental risks and outcomes. Though definitive outcomes are lacking, gestational cannabis has been associated with increased risk of other substance use during pregnancy; impaired placental blood flow; increased risk of small for gestational age births; and associated complications. Childhood and adolescent outcomes are sparsely assessed, with suggested outcomes including increased risk of depression and attention-deficit hyperactivity disorder. Cardiometabolic implications of gestational cannabis use may include maternal fatty liver, obesity, insulin resistance, and increased risk of gestational diabetes mellitus (GDM), with potential consequences for the fetus. Clinical implications for pediatric practice were explored in a bid to understand any potential risk or impact on child health and development.
The health and well-being of families is an important consideration for all governments – federal, state and local. Based on past morbidity and mortality rates and recent knowledge of early childhood development (Marmot, 2010), family health policies have evolved to emphasise the importance of providing every child with the best possible start to life. This acknowledges that childhood sets the foundation for future health and well-being and recognises the 1979 United Nations’ Convention on the Rights of the Child (United Nations Children Fund, 2009). In order to have an impact on health inequalities, government policies and services must address the social determinants of early child health, development and well-being (Brinkman et al., 2012; Marmot, 2010). This chapter introduces maternal, child and family health nursing and outlines the key functions of this crucial community nursing role. Foundational principles of primary health care practice are explored and case studies used to explain strengths-based, family-centred care.
The health and well-being of families is an important consideration for all governments – federal, state and local. Based on past morbidity and mortality rates and recent knowledge of early childhood development (Marmot, 2010), family health policies have evolved to emphasise the importance of providing every child with the best possible start to life. This acknowledges that childhood sets the foundation for future health and well-being and recognises the 1979 United Nations’ Convention on the Rights of the Child (United Nations Children Fund, 2009). In order to have an impact on health inequalities, government policies and services must address the social determinants of early child health, development and well-being (Brinkman et al., 2012; Marmot, 2010). This chapter introduces maternal, child and family health nursing and outlines the key functions of this crucial community nursing role. Foundational principles of primary health care practice are explored and case studies used to explain strengths-based, family-centred care.
This chapter describes the ways in which couples undo gender by resisting the mandate for men to prioritize paid work while women prioritize care. In contrast, in diverse cultures couples created equality when men forged an unconventional relation to paid work (e.g., working part-time or passing up promotions that interfere with family life), when they took on stereotypically maternal care tasks (e.g., diapering and comforting), when women freely shared the “maternal” role, when they insisted that their jobs/careers were as important as their partners’, and when couples shared housework.
There has been little research into the well-being of mothers after 12 months post-partum, despite researchers finding that depressive symptoms are more prevalent at 4 years post-partum than at any other time preceding this. The literature suggests that a woman’s view of the mother role impacts on her well-being in the early years of parenting. This qualitative research study investigated the experiences of mothers of preschool-aged children in Melbourne, Australia, and how they incorporated the role of mother into their self. Eight semi-structured interviews were completed, and interpretive phenomenological analysis was used to explore the data. The data revealed four subthemes relating to the emergence of the maternal self: becoming a mother as a journey of self-discovery, the biological imperatives of becoming a mother, remothering and the continued challenges of the emerging mother role. Although the experiences of mothering are as diverse as women themselves, even in the mostly homogenous sample, as in this study, several themes were present that both support and diverge from the existing literature.