Determinants Of Maternal Health Research Articles

Maternal preconception stress produces sex-specific effects at the maternal:fetal interface to impact offspring development and phenotypic outcomes†.

Entering pregnancy with a history of adversity, including adverse childhood experiences and racial discrimination stress, is a predictor of negative maternal and fetal health outcomes. Little is known about the biological mechanisms by which preconception adverse experiences are stored and impact future offspring health outcomes. In our maternal preconception stress (MPS) model, female mice underwent chronic stress from postnatal days 28-70 and were mated 2 weeks post-stress. Maternal preconception stress dams blunted the pregnancy-induced shift in the circulating extracellular vesicle proteome and reduced glucose tolerance at mid-gestation, suggesting a shift in pregnancy adaptation. To investigate MPS effects at the maternal:fetal interface, we probed the mid-gestation placental, uterine, and fetal brain tissue transcriptome. Male and female placentas differentially regulated expression of genes involved in growth and metabolic signaling in response to gestation in an MPS dam. We also report novel offspring sex- and MPS-specific responses in the uterine tissue apposing these placentas. In the fetal compartment, MPS female offspring reduced expression of neurodevelopmental genes. Using a ribosome-tagging transgenic approach we detected a dramatic increase in genes involved in chromatin regulation in a PVN-enriched neuronal population in females at PN21. While MPS had an additive effect on high-fat-diet (HFD)-induced weight gain in male offspring, both MPS and HFD were necessary to induce significant weight gain in female offspring. These data highlight the preconception period as a determinant of maternal health in pregnancy and provides novel insights into mechanisms by which maternal stress history impacts offspring developmental programming.

Determinants of maternal health four weeks after delivery: cross-sectional findings from the KUNO-kids health study

BackgroundThe aim of this study was to examine the interaction of a multitude of socio-economic, lifestyle, environmental, psychosocial and birth related determinants and their effect on maternal health four weeks after delivery.MethodsWe used data from a German birth cohort study, the KUNO-Kids health study. Social determinants, as well as the self-rated maternal health and the physical and mental health status of mothers (indicated by means of the SF-12-questionnaire) were assessed through standardized questionnaires and personal interviews right after delivery and four weeks later. Linear regression models were calculated to determine the relationship between influencing factors and health outcomes.Results1428 women were included in the analysis. Maternal self-rated health showed significant positive associations with breastfeeding (B (regression coefficient) 2.67; 0.86–4.48 (95% Confidence interval)) and estimating one’s child as rather healthy (B 0.27; 0.19–0.34) and negative associations with social and emotional strains (B -3.50; -5.11- -1.88), obesity (B -2.56; -4.69- -0.42), having experienced a C-section (B -1.73; -3.23- -0.23), a positive history of somatic diseases (B -2.14; -3.53- -0.74), parental stress (B -0.39; -0.66- -0.11) and education of more than ten years (B -2.42; -3.95- -0.90).Maternal physical health status showed significant negative associations with age (B -0.13; -0.25- -0.01), employment before maternity leave (B -1.90; -3.59- -0.21), social and emotional strains (B -1.50; -2.67- -0.34), parental stress (B -0.28; -0.45- -0.12), C-section (B -4.06; -5.12- -2.99), having the first child (B -2.03; -3.09- -0.97) and a history of somatic diseases (B -2.00; -2.99- -1.01).Maternal mental health status showed significant positive associations with education of more than 10 years (B 2.27; 0.98–3.56) and a high level of social support (B 1.20; 0.06–2.34), while social and emotional strains (B -4.16; -5.48- -2.84) and parental stress (B -0.70; -0.92- -0.47) were negatively associated.ConclusionsWe identified important protective factors for maternal health four weeks after delivery, such as a high level of social support. However, parental stress and social and emotional strains in particular seem to have a negative influence on maternal health. These findings have public health relevance.

Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach

BackgroundAn awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers’ knowledge, perception of enabling environments, and perception of severity of maternal sepsis.MethodsWe used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ2. Logistic regressions were performed to adjust for selected variables.ResultsAnalysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities.ConclusionsAwareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.

How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India

BackgroundSocial accountability mechanisms have been highlighted as making a contribution to improving maternal health outcomes and reducing inequities. But there is a lack of evidence on how they contribute to such improvements. This study aims to explore social accountability mechanisms in selected districts of the Indian state of Gujarat in relation to maternal health, the factors they address and how the results of these mechanisms are perceived.MethodsWe conducted qualitative research through in-depth interviews and focus group discussions with actors of civil society and government health system. Data were analyzed using a framework of social determinants of maternal health in terms of structural and intermediary determinants.ResultsThere are social accountability mechanisms in the government and civil society in terms of structure and activities. But those that were perceived to influence maternal health were mainly from civil society, particularly women’s groups, community monitoring and a maternal death review. The social accountability mechanisms influenced structural determinants – governance, policy, health beliefs, women’s status, and intermediary determinants – social capital, maternal healthcare behavior, and availability, accessibility and the quality of the health service delivery system. These further positively influenced the increased use of maternal health services. The social accountability mechanisms, through the process of information, dialogue and negotiation, particularly empowered women to make collective demands of the health system and brought about changed perceptions of women among actors in the system. It ultimately improved relations between women and the health system in terms of trust and collaboration, and generated appropriate responses from the health system to meeting women’s groups’ demands.ConclusionSocial accountability mechanisms in Gujarat were perceived to improve interaction between communities and the health system and contribute to improvements in access to and use of maternal health services. The influence of social accountability appeared to be limited to the local/district level and there was lack of capacity and ownership of the government structures.

Feasibility of community level interventions for pre-eclampsia: perspectives, knowledge and task-sharing from Nigeria, Mozambique, Pakistan and India.

Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia and eclampsia, remain one of the leading causes of maternal mortality and are contributory in many foetal/newborn deaths. This editorial discusses a supplement of seven papers which provide the results of the first round of the CLIP (Community Level Interventions for Pre-eclampsia) Feasibility Studies. These studies report a number of enablers and barriers in each setting, which have informed the implementation of a cluster–randomized trial (cRCT) aimed at reducing pre-eclampsia-related, and all-cause, maternal and perinatal mortality and major morbidity using community-based identification and treatment of pre-eclampsia in selected geographies of Nigeria, Mozambique, Pakistan and India. This supplement unpacks the diverse community perspectives on determinants of maternal health, variant health worker knowledge and routine management of HDP, and viability of task sharing for preeclampsia identification and management in select settings. These studies demonstrate the need for strategies to improve health worker knowledge and routine management of HDP and consideration of expanding the role of community health workers to reach the most remote women and families with health education and access to health services.

Systemic and Individual Determinants of Maternal Morbidity in the United States

s / Annals of Epidemiology 25 (2015) 702e719 712 P40. Systemic and Individual Determinants of Maternal Morbidity in the United States Riddhi Doshi MBBS, MPH, Gregory Vaughan, Jun Yan PhD, Kiesha Benn MD, Robert H. Aseltine Jr. PhD. University of Connecticut Purpose: Obstetric trauma to the perineum and vulva was among the top five causes of hospitalization among young adults, resulting in almost 7.5 million hospital stays among Medicaid beneficiaries alone. Childbirth and related complications cost over 16 billion US dollars annually. The primary objective of this study is to determine the prevalence of perineal lacerations during childbirth, examine the associations with individual and systemic predictors and predict the risk of obstetric trauma. Methods: For this large retrospective cohort study, we utilized data regarding hospital deliveries from 30 hospitals integrated through the Connecticut Acute Care Hospital Inpatient Discharge Database (HIDD). Predictors can be broadly classified into individual (demographic, socioeconomic, clinical) and systemic (facility volume, payer/insurance type). Outcomes examined were 3rd and 4th degree perineal lacerations. R statistical package was utilized to perform generalized linear models. Logistic regressionmodeling was utilized to predict the risk of perineal injuries with significant systemic determinants. Results: Insurance type (p<0.001) and facility volume (p<0.001) of the delivering hospital were found to be significant systemic determinants of perineal injuries after childbirth. Income (p<0.025), maternal age (p<0.001) and instrument use (p<0.001) were significant predictors of trauma. Asian race doubled the odds of trauma (OR: 2.15; 95%CI 1.89-2.44) while instrument use increased it four times (OR: 3.98; 95%CI 3.56-4.44). Conclusions: The association between systemic factors like larger facility volume in terms of number of deliveries is a critical finding. This warrants further temporospatial investigation into facility-based systemic determinants of maternal health. P41. Systematic Determinants of Anemia Among Women in India: A Dis-integrated Analyses of Pregnant, Lactating and Non-Pregnant and Non-Lactating Women Riddhi Doshi MBBS, MPH, Srinivas Goli PhD. University of Connecticut Purpose: The prevalence of anemia among pregnant women in developing countries is almost five times that among developed countries [Prevalence: development (14%); developing (51%)]. India bears a high burden (upto 70%) of anemia prevalence. This study aims to determine the predictors of anemia among pregnant and lactatingwomen, thereby providing guidance for tailored health policy and programs. Methods: Analyses were performed on data from the National Family Health Survey (2005-06). Three binary logistic regression models determined the association of sociodemographic and economic predictors with the occurrence of anemia among pregnant, lactating, non-pregnant and non-lactating women. In addition, the regression models for pregnant and lactating women included predictors related to healthcare-seeking during pregnancy. Results: For pregnant women, duration of pregnancy, 2 children, work status, education of partners, wealth quintile, nutritional advice and supplementary nutritionwere found to be significant predictors. Among lactating women, the odds of anemia significantly increased during the third trimester. Young age (15-24 years), primary education among women and secondary education among partners significantly reduced the odds of developing anemia. For nonpregnant, non-lactating women, age 25 years, caste, secondary and higher education among women, primary education among partners, highest wealth quintile had a protective effect. Conclusions: Economic, cultural and individual factors need to be considered while assessing risk of anemia among pregnant and lactating women. India needs to strengthen Maternal and Child Health programs through a focus on nutritional care during pregnancy in order to improve the overall health outcomes among women.

Maternal Health and Care in India: Why a Major Public Health Strategy Is Essential

India has large inequalities in maternal health and high maternal mortality and morbidity rates. A social model of maternal health was used as a framework for a broad review of online published literature to appraise the approaches used by India to address these issues and to examine the potential for reducing the country’s maternal health inequalities.The review found the following:• An apparent lack of coordinated economic, social, and health strategy and policies focused on improving maternal health• No acknowledgment in national health policy of the limitations of the medical model of maternal health and little apparent mention of the social model• No evident national frameworks for quality assurance in maternity care• Lack of recognition of the importance of woman-centered care• No evident comprehensive maternal health needs assessment to underpin coordinated multisector working• An apparent lack of reliable national data collection for setting inequality targets and monitoring progress• No apparent performance-focused management system for improving maternity care nationally.Although India has made large increases in maternal health care provision over recent decades, a pragmatic review of government policies, the reports of international agencies, and the findings of published research studies indicate that major barriers exist to reducing maternal health inequalities and to achieving good quality care for disadvantaged women. The main barrier appears to be the widespread use at all levels, including government, of the medical model of maternal health, which focuses mostly on obstetric interventions and fails to address the wider economic and social determinants of maternal health or to use a woman-centered approach to maternity care.We recommend that Indian governments adopt instead a “social model” approach to maternal health improvement and urgently employ a public health strategy led by a national multisector task force to reduce inequalities in maternal health.

To Love and Look After

Domestic violence, which is one aspect of family relationship quality, is now well established as a determinant of maternal health in non-Western contexts. However, the potential health benefits of positive aspects of relationship quality remain neglected. Thus, this study uses qualitative data to explore the pathways linking high-quality family relationships to maternal health in one non-Western context, namely, one Indian village. The exploration suggests that high-quality family relationships may benefit maternal health in a variety of ways. Potential mechanisms include improving women’s subjective happiness, increasing nutritional intake, facilitating communication about sensitive health matters, and increasing the use of health care and attention inside and outside the home. High-quality family relationships can also act as a barrier to hospital delivery however. More broadly, high-quality relationships appear to motivate family members to do their best for women, but their best may not always be beneficial.