Investigation of Relationship Between Maternal Religious Attitude and Mental Health of Infant at Birth

Background: Mentally disabled adolescents have limitations that make them are at greater risk of dental caries. There is a lack of studies on the factors associated with dental caries in adolescents using Social Learning Theory. This study aimed to determine factors associated with dental caries among mentally disabled adolescents using Social Learning Theory. Subjects and Method: This was an analytic observational study using cross-sectional design. The study was conducted at several special schools for disabled children (SLB) Surakarta, including: SLB C Setya Darma, SLB C YPSLB, SLB CG YPPCG Bina Sejahtera, and SLB C1 YSSD, in Surakarta, Central Java, from June to July 2017. A sample of 150 mentally disabled school children were selected for this study by purposive sampling. The dependent variable was caries dental status. The independent variables were parenting time, maternal oral health knowledge, maternal attitude towards oral health, maternal oral hygiene practice, child oral hygiene practice, maternal sweet food intake, child sweet food intake. Dental caries status was measured by decay, missing, filled-teeth (DMF-T) index. The other data were collected by questionnaire. The data were analyzed by path analysis. Results: Dental caries was directly and positively associated with sweet food intake (ƅ= 0.27, SE= 0.09, p= 0.002), poor child oral hygiene practice (ƅ= 0.09, SE= 0.04, p= 0.018), and poor maternal oral health knowledge (b= 0.36, SE= 0.10, p<0.001). Maternal oral hygiene practice was associated with maternal attitude towards oral health (ƅ= 0.33, SE= 0.13, p= 0.012) and maternal oral health (ƅ= 0.18, p<0.001). Child oral hygiene practice was associated with maternal oral hygiene practice (ƅ= 0.33, SE= 0.06, p= 0.012), maternal oral health knowledge (ƅ= 0.91, SE= 0.18, p<0.001), and parenting time (ƅ= 1.39, SE= 0.18, p<0.001). Conclusion: Dental caries is associated with sweet food intake, poor child oral hygiene practice, and poor maternal oral health knowledge. Maternal knowledge, attitude, and practice in oral hygiene have an important role on dental caries in mentally disabled adolescents. Keywords: dental caries, adolescents, maternal oral health practice, social learning theory

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

Black women are disproportionately impacted by chronic illness and are significantly more likely to experience severe morbidity and mortality as a consequence of pregnancy and childbirth.1, 2 As seen in a myriad of stories on maternal death and "near misses", Black women often experience maltreatment in clinical settings.3-5 With rising national media and scientific attention to the depth of racial inequities, Black maternal health has emerged as a priority for government and private funders.6-9 Providing financial support for maternal health research and programming is necessary, but insufficient, in eliminating disparate outcomes. There must be intentional, sustainable investments in the people best able to understand: Black women. Absent from the current landscape is a robust, well-supported cadre of Black maternal health scholar-activists who combine scientific and policy knowledge with the socio-cultural expertise that accompanies lived experience. Federal research institutes and private sector funders in the United States have acknowledged preventable inequities and have dedicated resources to identify causes, mechanisms of influence, and solutions for reducing disparate outcomes.7, 8 However, the conceptualization, design, and conduct of these studies (as well as funding decisions to support them) occur primarily among White researchers, which plausibly limits reductions in inequities.10 Specific investments in the educational trajectory of Black women are urgent and necessary to further enhance the quality, diversity, and impact of the maternal child health (MCH) field. The Public Health and MCH workforce needs to be further diversified with Black women scholar-activists because they are also culturally representative of the very populations at the greatest risk to experience maternal and infant health disparities. For example, Black women are 3.2 times more likely to die from pregnancy-related deaths compared to their White counterparts, and these disparities increase with age to 4–5 times more likely.11 Simultaneously, research demonstrates that when Black newborns are cared for by Black physicians, their mortality rate as compared to White infants is cut in half.12 By increasing the MCH workforce to include Black women scholar-activists and health care providers, the likelihood for improvement in health inequities increases. The goal of this commentary is to provide: (1) a brief overview of challenges Black women encounter on the path to and within science careers, (2) examples of successful approaches used to overcome these challenges, and (3) an urgent call to action for the field to commit to the training and development of Black women scholars in public and maternal health with the goal of eliminating maternal health inequities. In a similar manner to how structural racism and sexism produce adverse outcomes in labor and delivery,13-15 these same mechanisms also produce unfavorable outcomes for Black women in academia. At every level of the professional path to a career in scientific research, Black women consistently face bias: unwarranted and seemingly unavoidable experiences that make it more challenging for them to enroll in and graduate from school. For example, Black women describe experiencing isolation, invisibility, exclusion, pressure to continuously prove themselves worthy, a lack of mentorship, and a lack of sponsorship throughout scholarship.16 In addition, after graduation, they are often met with structural, interpersonal, and intrapersonal challenges in obtaining, managing, and remaining in research-focused academic and other scientific positions.17 Obstacles include exclusion from collaborative opportunities, questioning of credentials and expertise by students and colleagues, criticism of their chosen outlets for publication, extra service requests and additional mentoring burden.18 Hindering the progression of Black women into high level leadership positions also presents barriers to the mentorship of burgeoning Black female scholars, thus continuing this pernicious cycle. Many training programs have been used to improve graduation and retention rates among Black students in higher education. These programs are of particular importance due to the evidence that Black students' experiences on college campuses have a significant impact on their academic longevity.19 For Black college students, factors such as the level of faculty support, availability of research-based programming, and feelings of institutional connectedness and belonging have dramatic effects on their personal and academic development and matriculation.19 The Meyerhoff Scholars Program at the University of Maryland, Baltimore County is an example of a training program that has successfully increased the numbers of Black undergraduate college students who succeed in science, mathematics, and engineering.20 Meyerhoff students were more than 10 times as likely than the historical African American sample to attend graduate school in science, technology, engineering and mathematics (STEM) fields, and almost two times as likely to attend medical school.20 Raising Achievement in Mathematics and Science scholar and similar programs at historically Black colleges and universities (HBCUs) are used to improve retention and graduation rates among minority students specifically in the STEM fields.21 A study at Winston-Salem State University found that prior to the implementation of these training programs, graduation rates for full-time students were 17.8% in 2008 and for STEM majors it was 9.3%.21 With the programs in place, graduation rates increased dramatically. The Raising Achievement in Mathematics and Science scholar program participants had a 98.8% graduation rate over 4 years and 100% of the 2009 scholar cohort graduated in STEM and were enrolled in either MS/PhD graduate programs or professional schools.21 Spelman College also employs several programs to orient and support Black women students in STEM careers. Spelman has the Research Initiative for Scientific Enhancement training program, which supports the career pursuits of women and underrepresented minorities interested in biomedical research.22 In addition, between 2015 and 2019, Spelman College was ranked by the National Science Foundation as the number 1 institution of origin for Black PhDs in STEM disciplines.23 These types of programs and the contributions of Historically Black Colleges and Universities (HBCU's) to the Black female scientific workforce emphasizes their importance and necessity in contributing toward the development and advancement of Black women in research and advocacy. The W. Montague Cobb/National Medical Association Health Institute (also known as The Cobb Institute) is an organization that focuses on improving health inequities and addressing structural racism through research, education, and mentorship.24 The Cobb Scholars Program was launched in 2016 for senior residents, fellows, postdoctoral scientists, or early-stage investigators that come from underrepresented groups and are interested in biomedical and behavioral research.24 The scholars receive mentorship in leadership and research from interdisciplinary senior fellows which provides for collaboration and coaching across sectors to enrich their experience. Predominately White institutions can also help advance this goal. For example, the Pathways for Students into Health Professions program, housed within the University of California, Los Angeles campus, focuses on supporting underrepresented minority undergraduate students in MCH professions through the provisions of faculty mentorship, paid internships, and learning opportunities through various seminars.25 Although the program is not specifically built for Black students, it does prioritize students coming from non-dominant racial and ethnic groups, and research has found that students who completed the program were significantly more likely to report an interest in MCH topics and careers when compared to pre-enrollment.25 Many mentorship and training programs are open to those coming from other non-dominant racial and ethnic groups, as well as multiple gender identities.26 However, Black women often face different and distinct challenges as compared to their Black male counterparts or women of other racial backgrounds.27 Thus, there is a critical need to focus on the unique training and mentorship needs of Black women in academia. To bolster impacts within the MCH field, it would be useful to develop and implement programs to support Black women in their matriculation in public health, social sciences, and health care graduate programs with a focus on MCH research. There are a few graduate programs designed to support Black women in health care and health sciences that can be adapted for scholar-activists. For example, the Association of Black Women Physicians offers the Sister-to-Sister Mentoring Program that provides mentorship to Black women physicians, residents, and medical students.28 The program, Black Girl White Coat, is a social media mentorship initiative that hopes to provide further representation for groups that have been historically marginalized and oppressed.29 In addition, the ADVANCE Institutional Transformation Project of Jackson State University is a STEM mentorship program designed to support and empower Black women scholar-activists as well as provide a mentorship pipeline for early career scientists.30 Each of these programs aim to cultivate community and camaraderie among women who frequently, by nature of their racial and gender identity, are isolated in academic and professional settings. By adapting these mentorship programs to accommodate the needs of aspiring Black maternal health scholars, we can expand the support of early career professionals beyond undergraduate trainings. The profound impact of intentional investment in the form of mentorship, academic skill building, and providing opportunities for advocacy in the next generation of leaders cannot be overstated. This common thread among the following programs remain at the crux of the case for increased financial and programming support dedicated to the academic and career development of Black maternal health scholars. HBCU's must be central in the creation of a pipeline of leaders and scholars from historically underrepresented communities trained to work toward health equity in maternal health. For the past few years, Health Resources Services Administration through the Maternal and Child Health Bureau has formed an Alliance with 10 HBCU's to enhance the resources and expertise of faculty and students in HBCU's to address health inequities in MCH populations.31 The Alliance meets monthly to discuss strategies to strengthen research, outreach, advocacy, and services and has recently presented recommendations to the Maternal and Child Health Bureau. The Charles Drew University's Black Maternal Health Center of Excellence is one of the promising new programs underway that has been designed to address the persisting birthing disparities that disproportionately impact Black birthing people in Los Angeles County and the local Charles Drew community.32 The initiative names racism as a root cause to the disproportionately higher rates of infant and maternal death for Black birthing people countywide.33 In response to growing maternal morbidity and mortality rates in the state of Georgia, The Morehouse School of Medicine launched the Center for Maternal Health Equity in 2019.34 Their approach to tackling maternal health inequities is multifaceted; the Center utilizes research, workforce training, community engagement, and policy advocacy to improve reproductive justice.34 There is a paucity of evaluated programs tailored to meet the needs of Black women scholar-activists. However, many of the programs that currently exist offer foundations and frameworks that can be augmented to fit the needs of Black women and students within the MCH fields. The Diversity Scholars Leadership Program at the Boston University School of Public Health Center of Excellence in MCH is designed for students from underrepresented minority communities during their public health graduate studies in MCH.35 The National Birth Equity Collaborative is a Black-led organization that serves as a hands-on training program for promising scholars in the field.36 The Collaborative recruits interns from across multiple public health disciplines with experience in research, policy, training, advocacy, and community-centered work, with a commitment to reproductive justice and advancing birth equity.37 Founded in July 2020 during the dual pandemics of racism and COVID-19, The Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab at Tufts University School of Medicine was created with two main goals: (1) to train, mentor, and engage bright scholars of color and White allies; and (2) to provide a research and training space to ensure scholars are supported as they prepare to go into their respective fields to dismantle systemic racism.38 Through a keen focus on the development of research skills, advocacy, and leadership among its students, the MOTHER Lab provides a framework for the development of maternal health scholars that can serve as model for other research labs housed in schools of public health or medicine. The MOTHER Lab is a unit within the newly formed Center for Black Maternal Health and Reproductive Justice that houses faculty, staff, and students with a dedicated interest in addressing maternal health inequities. This center would contribute to immense progress in filling current gaps for mentorship, research, and sustainable change in this field.39 Research has shown that mentorship for students of color in White spaces are especially beneficial and can become a positive predictor component to their academic and professional futures; this center would provide training, research, and mentorship opportunities for scholars and providers in the field of Black maternal health equity.40, 41 Additionally, the Center for Black Maternal Health and Reproductive Justice and the MOTHER Lab scholarly program for maternal health students are founded and run by Black female scholars with lived experience, thus representing a unique opportunity to engage and train the next generation of leaders. Finally, policy agendas such as the Black Maternal Health Momnibus Act of 2021 (suite of 12 bills proposed in Congress), provide new and exciting ways to support the development of scholar-activists at the local, national, and state level that are dedicated to eliminating maternal mortality and morbidity in Black women.42 These 12 bills address current Black maternal health disparities through numerous distinct methods, but prominently include expanded funding for research on the topic and diversifying the MCH workforce as important methods. One of these bills (Protecting Moms Who Served Act of 2021) has been signed into law, while parts of several others have been partially incorporated in the proposed Build Back Better Act (Data to Save Moms Act, Kira Johnson Act, Maternal Health Pandemic Response Act of 2020, Perinatal Workforce Act, Protecting Moms and Babies Against Climate Change Act, and the Tech to Save Moms Act).43 Unique obstacles encountered from secondary school and throughout graduate education contribute to a lack of adequate representation of Black women in public health. This ultimately leads to a lack of lived experience and scholarship of scholars from communities most affected by the Black maternal health crisis. Modeling the success of other heavily invested pipeline mentorship and training programs, increased support of burgeoning Black maternal health scholar-activists may help mitigate this issue. Furthermore, existing policies and proposed legislation to diversify the public health workforce create the platform needed to build out the investment in Black women scholars who can lead the movement for maternal health equity. The authors have no funding to report.

Background: Sierra Leone’s high maternal mortality rate is attributed to inadequate healthcare, low health literacy, distrust in healthcare facilities, and cultural norms. The Mothers of Sierra Leone team produces films aimed at empowering women, improving maternal health attitudes, and facilitating care-seeking behaviors. This study quantifies the efficacy of two films on Sierra Leonean mothers’ and fathers’ knowledge and beliefs. Subjects and Method: This pre- and post-survey study was conducted in Makeni and Freetown, Sierra Leone, with 76 participants recruited through convenience sampling - 19 mothers and 19 fathers per film group. Participants viewed films on either family planning or maternal mental health. The independent variables included the film subject, family planning, or maternal mental health, and the dependent variables involved changes in knowledge, attitudes, and behavior from pre- to post-intervention. Measurement instruments included surveys with questions on a Likert scale. Statistical analyses were performed in RStudio, using Wilcoxon Signed-Rank, Mann-Whitney, Fisher’s exact, and Spearman’s Rho tests to assess post-intervention changes and the efficacy of the films. Results: Findings revealed a 20.8% increase in perceived understanding (p = 0.02), a 61.1% increase in willingness to seek family planning services (p = 0.03) in mothers, and a 20.9% increase in the likelihood of managing mental health (p = 0.01) in mothers. Fathers’ willingness to be involved in their partners’ healthcare increased by 53.4% (p &lt; 0.001). The family planning film was better received than the mental health film (U = 121.5, p = 0.03o). Gender differences were observed, with fathers more inclined (p &lt; 0.001) to address their mental health compared to mothers. Conclusion: Leveraging film as an educational tool to amplify community members’ stories can enhance health literacy, improve attitudes and behaviors, and support maternal health outcomes.

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

Infant mental health is interconnected with and affected by maternal mental health. A mother or birthing person's mental health before and during pregnancy and the postpartum period is essential for a child's development. During the first year of life, infants require emotional attachment and bonding to strive. Perinatal mood disorders are likely to hinder attachment and are associated with an increased risk of adverse mental health effects for children later in life. The Black community is faced with a crisis as Black mothers experience a higher prevalence of perinatal mood disorders, including postpartum depression and anxiety, compared to the United States national estimates. The aim of the research is to identify social, structural, and economic disparities of Black perinatal women and birthing people's experience to understand the impact of perinatal mental health on infants' mental health. Black mothers and birthing people may often face social and structural barriers that limit their opportunity to seek and engage with interventions and treatment that address the root causes of their perinatal mood disorder. To enhance understanding of racial disparities caused by social and structural determinants of health on Black mothers and birthing people's mental health and health care experiences that influence infant mental health, the study team conducted semi-structured interviews among self-identified cisgender Black women health professionals nationwide, who provide care to pregnant or postpartum Black women and birthing people. Our study attempted to identify themes, pathways, interventions, and strategies to promote equitable and anti-racist maternal and infant mental health care. Using a Rigorous and Accelerated Data Reduction (Radar) technique and a deductive qualitative analytic approach it was found that limited access to resources, lack of universal screening and mental health education, and the disjointed healthcare system serves as barriers, contribute to mental health issues, and put Black mothers and birthing people at a disadvantage in autonomous decision making. Our study concluded that instituting education on healthy and culturally appropriate ways to support infant development in parent education programs may support Black parents in establishing healthy attachment and bonds. Prioritizing strategies to improve maternal mental health and centering Black parents in developing these educational parenting programs may optimize parenting experiences.

Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study

BackgroundMobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited.MethodsA pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care.ResultsTwo thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05–2.4, p = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07–2.75, p = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38–2.33, p = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49–4.35, p = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54–0.88, p = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23–0.91, p = 0.027). Both groups’ knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards.ConclusionsThis study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings.Trial registrationThe mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111).

Support from grandparents plays a role in mothers’ perinatal mental health. However, previous research on maternal mental health has mainly focused on influences of partner support or general social support and neglected the roles of grandparents. In this narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed. Searches in PubMed, EMBASE, MEDLINE, Scopus, and PsycINFO yielded 11 empirical studies on N = 3381 participants, reporting on 35 effect sizes. A multilevel approach to meta-analysis was applied to test the association between grandparental support and maternal mental health. The results showed a small, statistically significant association (r = .16; 95% CI: 0.09–0.25). A moderator test indicated that the association was stronger for studies reporting on support from the maternal grandmother in particular (r = .23; 95% CI: 0.06–0.29). Our findings suggest that involved grandparents, in particular mother’s own mother, constitute a protective factor for the development of maternal postpartum mental health problems. These findings have clear implications for interventions. Future studies should examine whether stimulating high-quality support from grandparents is a fruitful avenue for enhancing maternal postpartum mental health.

IntroductionThe first five years of life is an important developmental period that establishes the foundation for future health and well-being. Mothers play a primary role in providing emotional and physical nourishment during early childhood. This systematic review aims to explore the association between maternal health and child health in the first five years of the child’s life.Materials and methodsAs primary aims, we systematically synthesised published evidence relating to the first five years of life for associations between maternal health exposures (mental, physical and Health-Related Quality of Life (HRQoL) and child health outcomes (physical health, mental health, HRQoL and Health Service Use (HSU) /cost). As a secondary aim, we explored how the above associations vary between disadvantaged and non-disadvantaged populations. The search was limited to studies that published and collected data from 2010 to 2022. The systematic review was specific to countries with similar health systems to Australia. The search was conducted in MEDLINE, CINAHL, APA PsycINFO, GLOBAL HEALTH, and EMBASE databases. The quality of the included studies was assessed by The Effective Public Health Practice Project (EPHPP) tool.ResultsThirteen articles were included in the final synthesis from the identified 9439 articles in the primary search. Six (46%) explored the association between maternal mental health and child’s physical health, two (15%) explored maternal and child’s physical health, one (8%) explored maternal and child’s mental health, one (8%) explored maternal physical health and child’s HRQoL, and three (23%) explored maternal mental health and child’s HSU. We found an association between maternal health and child health (physical and mental) and HSU outcomes but no association between maternal health and child’s overall HRQoL. The results for disadvantaged communities did not show any difference from the general population.Discussion and conclusionOur review findings show that maternal health influences the child’s health in the first five years. However, the current evidence is limited, and the findings were primarily related to a specific maternal or child’s health condition. There was no evidence of associations of child health outcomes in healthy mothers. There is an extensive research gap investigating maternal health exposures and child outcomes in quality of life and overall health.

Parents living in low-income contexts shouldered disproportionate hardships during the COVID-19 pandemic with consequences to maternal mental health and child adjustment. The current study uses a sample of first-time mothers (N = 147) of young toddlers, all living in low-income contexts, to examine the roles of pre-pandemic and COVID-19-specific risk and individual resilience factors in the prediction of changes to maternal mental health coinciding with the onset of the pandemic. Maternal mental health symptoms, in turn, were examined as predictors of child adjustment problems across 6 months of the pandemic and as a potential mechanism conferring pandemic risks to children. While pre-pandemic cumulative contextual risk (i.e., low income, single parent status, adolescent parent status, financial instability) did not predict changes in maternal mental health from prior to during the pandemic, COVID-19-specific health risks predicted changes in maternal mental health from before the pandemic, as well as across 6 months of the pandemic. Regarding individual resilience factors to changes in maternal mental health, pre-pandemic self-compassion predicted better maternal mental health during the pandemic, as did COVID-19-specific appraisal and coping strategies. In turn, maternal mental health predicted children’s early pandemic levels of adjustment problems and changes in adjustment problems across 6 months of the pandemic, with maternal mental health serving an indirect pathway of COVID-19-specific health risks to children’s adjustment. The findings highlight pathways of risk and resilience during a global health crisis and point to targets for interventions in community level crises to promote maternal and child mental health.

BackgroundRates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill.AimsUsing data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes.MethodsData were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models.ResultsPreterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3rd trimester were twice as likely to develop gestational hypertension.ConclusionsSDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health.

Maternal perinatal mental health and infant and toddler neurodevelopment - Evidence from low and middle-income countries. A systematic review

WHAT IS KNOWN ABOUT THE TOPIC?: Mental health-related problems in pregnancy are now becoming a global health concern. However, most studies have reported that midwives are unable to assess and support maternal mothers due to poor preservice education. The findings of these studies needed to be explored further from the available literature to address the gap. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The paper has identified maternal mental health core competencies and innovative clinical teaching strategies that nurse educators can utilize when supporting students theoretically and during clinical practice so that students should be adequately prepared for maternal mental health practice. Challenges and recommendations for clinical teaching were also identified. However, there are still gaps in the literature related to the effectiveness of teaching strategies to promote competence acquisition in maternal mental health. WHAT ARE THE IMPLICATIONS FOR EDUCATION?: The study results can be used by nurse educators to develop effective clinical teaching practices in maternal mental health care. The findings can be used in the development of best clinical teaching guidelines for maternal or perinatal mental health to be used by nurse educators for the undergraduate midwifery training programmes. ABSTRACT: Introduction Maternal mental health problems are commonly experienced by women; however, they are usually not adequately recognized and treated by midwives in Malawi. Evidence suggests poor preservice education by nursing colleges which affects the development of essential maternal mental health competencies. Aim The aim of the study was to review existing evidence on clinical teaching practices by nurse educators in teaching student midwives maternal mental health care. Method Integrative review method was used, and various databases were searched. Out of 1768 articles, 27 research articles met the inclusion criteria. The critical appraisal skills programme checklist tools were used to assess data quality. Thematic analysis was done by comparing, grouping and integrating data. Results Six themes emerged, namely: core maternal mental health competencies, professional regulation, interactive teaching strategies, collaborative partnerships, capacity building and shortage of resources. Discussion Clinical teaching is an important aspect of midwifery education. Utilizing student-centred teaching approaches helps students acquire competencies in maternal mental health care. Further research is required to identify the effectiveness of the clinical teaching methods. The Implication to Practice The study results can assist nurse educators to provide comprehensive clinical teaching practices in maternal mental health care which will aid in the development of maternal mental health competencies among student midwives.

Background: Gestational diabetes mellitus (GDM) is associated with poorer maternal mental health (depression and anxiety). Maternal mental health and GDM are likely to influence diet, which in turn impacts the course of GDM. Maternal diet may also be directly or indirectly associated with changes in infant anthropometry. The aims of this study are to (1) examine the associations between maternal GDM, mental health and diet, and (2) evaluate the associations between these maternal factors, breastmilk composition and infant anthropometry. Methods: This prospective, observational, longitudinal cohort study compares a cohort of women with and without GDM. Maternal mental health and diet are assessed using validated questionnaires. Breastmilk composition is measured with the Human Milk Analyzer, and infant body composition is measured with air displacement plethysmography. Significance and Impact: Once data have been collected, PsyNBIOsis will provide evidence for the associations between maternal mental health, GDM status and diet, and their impact on breastmilk composition and early infant growth. The results may inform the Developmental Origins of Health and Disease framework and provide data on which to build cost-effective interventions to prevent both the development of mental health issues in mothers and adverse growth patterns in infants.