Assessment Of Maternal Health Research Articles

Maternal perinatal depression and child neurocognitive development: A relationship still to be clarified.

Pregnancy frequently is associated with emotional conditions such as anxiety and depression. Perinatal depression has an incidence of around 12%. Only recently researcher put the attention on the effects of pre- and postpartum psychopathology on infant neurocognitive development. Neurobiology studies indicate that perinatal maternal depression can significantly affect the structure and function of children's prefrontal cortex and modulate the development of cognitive abilities from intrauterine life. On the topic, the scientific literature appears ambiguous, reporting mixed results. Some studies have found no significant differences in developmental outcomes between prenatal and postpartum exposure to maternal depression, others have suggested a greater burden of depression in pregnancy than in postpartum, and still others have emphasized the role of chronicity of symptoms rather than the period of onset. Few studies have examined the effects of different developmental trajectories of maternal depression on children's neurocognitive outcomes. The assessment of maternal health has for years been limited to postpartum depression often neglecting the timing of onset, the intensity of symptoms and their chronicity. These aspects have received less attention than they deserve, especially in relation to the effects on children's neurocognitive development. The aim of this Perspective was to highlight inconsistencies and gaps that need to be filled in the approach to the study of this problem. Given the wide heterogeneity of data in the current literature, further studies are needed to clarify these interactions. This Perspective provides an overview of current progress, future directions, and a presentation of the authors' views on the topic.

Using electronic tablets for data collection for healthcare service and maternal health assessments in low resource settings: lessons learnt

BackgroundHealth service and health outcome data collection across many low- and middle-income countries (LMICs) is, to date largely paper-based. With the development and increased availability of reliable technology, electronic tablets could be used for electronic data collection in such settings. This paper describes our experiences with implementing electronic data collection methods, using electronic tablets, across different settings in four LMICs.MethodsWithin our research centre, the use of electronic data collection using electronic tablets was piloted during a healthcare facility assessment study in Ghana. After further development, we then used electronic data collection in a multi-country, cross-sectional study to measure ill-health in women during and after pregnancy, in India, Kenya and Pakistan. All data was transferred electronically to a central research team in the UK where it was processed, cleaned, analysed and stored.ResultsThe healthcare facility assessment study in Ghana demonstrated the feasibility and acceptability to healthcare providers of using electronic tablets to collect data from seven healthcare facilities. In the maternal morbidity study, electronic data collection proved to be an effective way for healthcare providers to document over 400 maternal health variables, in 8530 women during and after pregnancy in India, Kenya and Pakistan.ConclusionsElectronic data collection provides an effective platform which can be used successfully to collect data from healthcare facility registers and from patients during health consultations; and to transfer large quantities of data. To ensure successful electronic data collection and transfer between settings, we recommend that close attention is paid to study design, data collection, tool design, local internet access and device security.

Obstetric near-miss and maternal death: the case of Ayder Teaching Hospital, Mekelle, Ethiopia

AbstractObjective: To study severe acute maternal morbidity and maternal death in Ayder teaching Hospital.Methodology: Facility-based survey of severe acute maternal morbidity and maternal death with consecutive entry of casesfrom records for all pregnant, recently delivered or aborted patients who appeared and were admitted to Ayder referral teachingHospital from January, 2008 through December, 2010.Results: There were 2107 hospitalizations for maternal health services; of these, 204 were severe acute maternal morbiditiesand 9 direct maternal deaths with almost 23 severe acute morbidities for each maternal death, with an overall rate of severeacute maternal morbidity of 101 per 1000 deliveries and a maternal mortality ratio of 427 per 100,000 live births.Conclusion: In the era of countdown to 2015 and with the meager chance of Millennium Development Goals (MDG5) beingachieved in many African countries, including Ethiopia, the analysis of severe acute maternal morbidity along with maternaldeath should be a new paradigm in the assessment of maternal health and its progress at all levels. Ayder Teaching Hospitalshould have its own uniform criteria for inclusion of severe acute maternal morbidity based on other hospitals’ experiences andthe scientific plausibility to tackle facility-based avoidable severe maternal morbidity and mortality. Furthermore, a prospectivestudy should be done to exactly know the level of substandard care(Ethiopian Journal of Reproductive Health , 2012,6(1): 56-63).Key Words: Near miss, maternal, mortality, morbidity, Ayder, Survey, pregnancy, complication

Assessment of Maternal Health and Thyroid Activity by Determination of TSH, fT3 and fT4 in Pregnant Women Taking a Vitamin Supplement Containing Iodine

Background : During pregnancy, important changes occur in maternal thyroid function. The thyrotropic activity of human chorionic gonadotropin (hCG) has been studied by many authors. This hormone has similarities to thyroid-stimulating hormone (TSH). This has led to the supposition that hCG is indirectly involved in thyroid stimulation. In pregnancy, TSH is inhibited, with low levels of fT3 and fT4; in recent years, some authors have found a relationship between raised thyroid hormones and the onset of hyperemesis gravidarum. Thus, increasing or starting levothyroxine therapy is not indicated in the first trimester of pregnancy. Nutritional supplements may have an important role; in fact, iodine may encourage more physiological thyroid function and could affect the onset or absence of hyperemesis gravidarum. Materials and Methods : To identify the incidence of hyperemesis gravidarum in two groups of women treated with multivitamin supplementation with or without iodine, we analysed TSH, fT3 and fT4 levels and the severity of symptoms in pregnant women with nausea and vomiting. Results : TSH levels were significantly reduced in the group treated with iodine. fT3 and fT4 showed a significant decrease in the group treated with the multivitamin supplement containing iodine. Conclusions : Our results also show that the multivitamin supplement containing iodine was more effective in controlling the onset of hyperemesis gravidarum, improving TSH, fT3 and fT4 levels.

Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial

BackgroundUndetected and untreated developmental problems can have a significant economic and social impact on society. Intervention to ameliorate potential developmental problems requires early identification of children at risk of future learning and behaviour difficulties. The objective of this study was to estimate the prevalence of risk for developmental problems among preschool children born to medically low risk women and identify factors that influence outcomes.MethodsMothers who had participated in a prenatal trial were followed up three years post partum to answer a telephone questionnaire. Questions were related to child health and development, child care, medical care, mother's lifestyle, well-being, and parenting style. The main outcome measure was risk for developmental problems using the Parents' Evaluation of Developmental Status (PEDS).ResultsOf 791 children, 11% were screened by the PEDS to be at high risk for developmental problems at age three. Of these, 43% had previously been referred for assessment. Children most likely to have been referred were those born preterm. Risk factors for delay included: male gender, history of ear infections, a low income environment, and a mother with poor emotional health and a history of abuse. A child with these risk factors was predicted to have a 53% chance of screening at high risk for developmental problems. This predicted probability was reduced to 19% if the child had a mother with good emotional health and no history of abuse.ConclusionOver 10% of children were identified as high risk for developmental problems by the screening, and more than half of those had not received a specialist referral. Risk factors for problems included prenatal and perinatal maternal and child factors. Assessment of maternal health and effective screening of child development may increase detection of children at high risk who would benefit from early intervention.Trial registrationCurrent Controlled Trials ISRCTN64070727