Healthy Moms Research Articles

Healthy Moms Clinic: Challenges and Opportunities of Integrating Postpartum Care Into Primary Care and Residency Education.

Healthy Moms Clinic: Challenges and Opportunities of Integrating Postpartum Care Into Primary Care and Residency Education.

Implementation of the "Healthy Moms, Healthy Kids" Program in Head Start: An Application of the RE-AIM QuEST Framework Centering Equity.

Marginalized mothers are disproportionately impacted by depression and face barriers in accessing mental health treatment. Recent efforts have focused on building capacity to address maternal depression in Head Start; however, it is unclear if mental health inequities can be addressed by two-generation programs in Head Start settings. Therefore, this study examined the implementation outcomes and processes of a two-generation program called "Healthy Moms, Healthy Kids" (HMHK) that provided an evidence-based depression treatment to ethnic minority Head Start mothers. Quantitative and qualitative data were collected and merged in a convergent mixed method design in accordance with the RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Qualitative data included interviews with 52 key stakeholders, including intervention participants and staff members, and 176 sets of meeting minutes from the implementation period. Quantitative data included intervention study data and administrative data. It was difficult for HMHK to reach the target population, with only 16.8% of eligible mothers choosing to participate. However, mothers who participated experienced reductions in depressive symptoms and parenting stress and shared a variety of positive impacts in interviews. The program was also more successful in enrolling Latinx mothers who were Spanish-speaking or bilingual rather than English-speaking and Black/African American mothers, limiting its reach. Providing IPT therapy groups was effective in reducing maternal depressive symptoms and stress for those who enrolled, but additional work should focus on reducing barriers to participation, considering other delivery models to meet participants' needs, and identifying culturally relevant ways to meet the needs of Black mothers.

The healthy moms and babies app to prevent postpartum depression: analysis of user-profiles and dropout cases.

Perinatal depression affects mothers, babies and society. Preventive interventions are needed, but face barriers to access. E-health interventions could be an effective and accessible option. To date, few studies have attempted to understand the use of mobile health (m-health) applications and why they are not more widely used. This study aims to understand the demographic characteristics of enrolled participants and examine dropout patterns through the Healthy Moms and Babies app. A longitudinal study was conducted with a sample of 511 women recruited between 2020 and 2022. Data were collected from the app, including sociodemographic information, the participant's progress through the modules of the app, and the permissions granted to use the app. Out of the 511 women who completed the initial form to initiate participation, 279 downloaded the app and completed the evaluation. Results indicated that granting permission to be notified about the module's availability is related to an increase in the use of the first modules. This study shows the importance of establishing follow-ups in the use of mobile apps during the perinatal period.

Home visiting: A lifeline for families during the COVID-19 pandemic

Home visiting: A lifeline for families during the COVID-19 pandemic

Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study

BackgroundDepression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users.ObjectiveThis prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service.MethodsWe conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability.ResultsWe invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood.ConclusionsZuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes.International Registered Report Identifier (IRRID)RR2-10.2196/11800

Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study.

BackgroundDepression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users.ObjectiveThe objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya.MethodsWe will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment.ResultsOur team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019.ConclusionsThe main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population.International Registered Report Identifier (IRRID)DERR1-10.2196/11800

Healthy Moms for Healthy Babies

Healthy Moms for Healthy Babies

Healthy moms. Healthy babies.

Healthy moms. Healthy babies. That's my goal as a board certified OB/GYN. The University of Iowa, most specifically the Women's Health Department, will always remain a special place to me. I will forever be grateful for the knowledge I learned, the support I continue to receive, and for the camaraderie that we have in support of Women's health for all of Iowa.

DP15 - Healthy moms and healthy infants: 12 years of successful mother-to-child HIV transmission prevention in a community health center in Bamako, Mali

DP15 - Healthy moms and healthy infants: 12 years of successful mother-to-child HIV transmission prevention in a community health center in Bamako, Mali

Evaluation of a Health Education Intervention to Improve Knowledge, Skills, Behavioral Intentions and Resources Associated with Preventable Determinants of Infant Mortality

Mississippi has the highest rate of infant mortality in the nation (9.3 infant deaths for 1,000 live births). A health disparity exists between white infants (6.2) and black infants (13.0). This project reports on the effectiveness of a pilot educational program, Healthy Moms and Healthy Babies, which sought to improve knowledge, skills, behavioral intentions and resources related to preventable determinants of infant mortality. A curriculum was developed and piloted with women who were currently pregnant, thinking of becoming pregnant or who had an infant <1 year old. Local Head Start Centers offered recruiting assistance and meeting space for the sessions. Six content areas were developed which addressed pre- and postnatal nutrition and physical activity, smoking, breastfeeding, maternal mental health and safe infant sleep. Sixteen objectives were evaluated to determine intervention effectiveness. Participants were very satisfied with the program overall. Fourteen of sixteen objectives were met. Unmet objectives were gaining the skill of interpreting a nutritional label (Objective 75.0%, Observed 71.4%) and being able to name five health benefits of breastfeeding (Objective 85.0%, Observed 81.0%). Future programs will incorporate participant feedback which included allowing more time to learn about interpreting food labels and addressing financial stress. Reducing preterm birth is a national public health priority. Addressing knowledge gaps through risk-reduction education may reduce behaviors associated with determinants of infant mortality such as low birth weight and preterm birth. Head Start Centers are convenient locations that can serve as hubs of education for the entire family. Addressing knowledge gaps through risk-reduction education and providing adequate resources for smoking cessation and lactation support may increase knowledge and skills and reduce behaviors associated with determinants of infant mortality such as low birth weight and preterm birth.

Game-based online antenatal breastfeeding education: A pilot

AimThe aim of this study was to evaluate the effect of the Healthy Moms intervention on antenatal breastfeeding self-efficacy and intention and to determine the feasibility of using an online game-based learning platform to deliver antenatal breastfeeding education. BackgroundThe Internet has potential for improving breastfeeding rates through improving women's access to antenatal breastfeeding education. MethodsTwelve computer-based breastfeeding education modules were developed using an online learning platform. Changes in participants' breastfeeding self-efficacy and intention pre- and post-intervention were measured using descriptive statistics and a one-way ANOVA. ResultsOf the 25 women submitting the pretest, four completed zero quests; seven, orientation only; eight, one to six breastfeeding quests; and six, 10 to 12 breastfeeding quests. No significant differences in breastfeeding self-efficacy and intention were found among the groups. ConclusionsOnline antenatal breastfeeding education is feasible; however, further research is warranted to determine if it can affect breastfeeding outcomes.

Empowering Women's Prenatal Communication: Does Literacy Matter?

This study was designed to evaluate the impact of an interactive computer program developed to empower prenatal communication among women with restricted literacy skills. A total of 83 women seeing 17 clinicians were randomized to a computer-based communication activation intervention (Healthy Babies Healthy Moms [HBHM]) or prenatal education (Baby Basics [BB]) prior to their prenatal visit. Visit communication was coded with the Roter Interaction Analysis System, and postvisit satisfaction was reported. Participants were on average 24 years of age and 25 weeks pregnant; 80% were African American. Two thirds scored ≤8th grade on a literacy screener. Women with literacy deficits were more verbally active, disclosed more medical and psychosocial/lifestyle information, and were rated as more dominant by coders in the HBHM group relative to their counterparts in the BB group (all ps < .05). Clinicians were less verbally dominant and more patient centered with literate HBHM relative to BB group women (p < .05); there was a similar, nonsignificant trend (p < .1) for lower literate women. Clinicians communicated less medical information and made fewer reassurance statements to lower literate women in the HBHM relative to the BB group (p < .05). There was a trend toward lower visit satisfaction for women with restricted literacy in the HBHM relative to the BB group (p < .1); no difference in satisfaction was evident for more literate women. The HBHM intervention empowered communication of all women and facilitated verbal engagement and relevant disclosure of medical and psychosocial information of women with literacy deficits. Satisfaction, however, tended to be lower for these women.

Here/In This Issue There/Abstract Thinking: Healthy Moms, Healthy Babies (and Brains)

As clinicians striving to improve the mental health of children and adolescents, we crave evidence that will assist us in understanding the long-term impact of our diagnostic and treatment decisions. The longitudinal studies needed to provide this critical information are highlighted in this month’s Journal.

Babies Need Healthy Moms

Healthy Babies Need Healthy Moms (HBNHM) is an innovative education program that combines the recommended 2-hour postpartum oral glucose tolerance test (OGTT) with diabetes prevention education for women who had gestational diabetes mellitus. During the class, the 2-hour OGTT is performed, and in the time between venipunctures, the women participate in group education focused on evidence-based diabetes prevention strategies that promote healthy family nutrition and lifestyle behavior, importance of preconception care for subsequent pregnancies, and the need for follow-up care for women who screen positive for abnormal glucose levels. The purpose of this article is to describe this model to encourage replication in other diabetes programs. The HBNHM program is a low-budget education program that provides postpartum OGTT screening for women who had gestational diabetes mellitus during their pregnancies while simultaneously offering education designed to improve future outcomes. For those women whose screening is positive for overt diabetes or prediabetes, the educational strategies are directed at encouraging follow-up care. For those patients who have normal screening results, the program is designed to help the patient prevent the future development of type 2 diabetes. Preconception counseling is included in an effort to improve outcomes in future pregnancies and provide patients with the tools needed to help enhance the health of their families.

Erratum to: Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Erratum to: Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

LB 2: Impact of a weight management intervention on pregnancy outcomes among obese women: The Healthy Moms Trial

LB 2: Impact of a weight management intervention on pregnancy outcomes among obese women: The Healthy Moms Trial

Brief intervention to prevent fetal alcohol spectrum disorders: Russian physicians’ skills demonstrated in an educational and a clinical trial in Russia

Prenatal alcohol consumption can result in a range of adverse outcomes including fetal alcohol spectrum disorders (FASDs). Russia has high alcohol use, and hazardous drinking among women has increased. Russian women reported that obstetrician-gynecologists (OB-GYNs) would be the best source of information about associated risks of alcohol use during pregnancy. Two initiatives to reduce FASD, Project CHOICES (Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study) and the Healthy Moms intervention, as well as a brief dial-focused physician intervention (DFBPI), were modified for use in Russian OB-GYN care. We compared OB-GYN skills demonstrated in an educational trial and in a clinical trial aimed at preventing alcohol-exposed pregnancies. Sixty-five OB-GYNs participated in the educational trial through continuing medical education (CME) programs at St. Petersburg Pediatric Academy in Russia. Participants’ DFBPI skills were assessed using videotapes of roleplaying with a simulated patient. Audiotapes of 80 clinic visits conducted by 14 OB-GYNs trained in DFBPI were coded. The OB-GYNs and study participants completed exit checklists after each clinic visit. Compared with OB-GYN physicians assigned to regular CME programs, physicians who received DFBPI training had significantly improved skills and higher levels of competency in conducting alcohol screening and interventions. Discussing the difficulties and barriers that may prevent women from achieving alcohol abstinence/reduction goals appeared to be the most difficult component for physicians to implement, and OB-GYNs had difficulty assisting patients in discussing barriers and selecting contraception methods. Russian physicians trained in DFBPI were able to implement skills learned in the clinical trial. In addition to the alcohol focus, a component to improve physicians’ skills in discussing contraceptive use should be added to DFBPI training.

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants ("intervention effect"). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.

Nutrition education and cooking classes with teen and adolescent mothers

A pilot study evaluated the effect of nutrition education and cooking classes on nutrition knowledge, cooking knowledge, self‐efficacy towards cooking and healthy eating, and dietary habits of young mothers enrolled in life‐skill classes at the YWCA of Greensboro. This feasibility study is a two condition (group 1, and group 2) repeated measures (pretest, posttest, and follow‐up) design. The project used a convenience sample of 15 young mothers enrolled in the Teen Parent Mentor Program and Healthy Moms Healthy Babies program at the YWCA. Seven nutrition education and cooking classes were conducted at the YWCA facility as part of their programming. Class topics included information on kitchen safety/ sanitation, how to read a food label, fats, how to shop on a budget, portion control, meal planning, and feeding your child. Mothers helped prepare weekly recipes that included fruits, vegetables, and whole grains. Women received all educational handouts and recipes. Sixty‐four percent of the participants found the class topics in general to be very helpful, while 73% found the cooking activities to be very helpful. Also, 67% of them affirmed that the handouts were very helpful. Findings of this study will be used to continue develop culturally relevant nutrition interventions to improve the nutrition knowledge, eating habits, and cooking skills of young mothers in community‐based environments

Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: Study design and rationale

BackgroundObesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes. Observational studies suggest that minimal or no gestational weight gain (GWG) may minimize the risk of adverse pregnancy outcomes for obese women. ObjectiveThis report describes the design of Healthy Moms, a randomized trial testing a weekly, group-based, weight management intervention designed to help limit GWG to 3% of weight (measured at the time of randomization) among obese pregnant women (BMI≥30kg/m2). Participants are randomized at 10–20weeks gestation to either the intervention or a single dietary advice control condition. Primary outcomesThe study is powered for the primary outcome of total GWG, yielding a target sample size of 160 women. Additional secondary outcomes include weight change between randomization and one-year postpartum and proportion of infants with birth weight>90th percentile for gestational age. Statistical analyses will be based on intention-to-treat. MethodsFollowing randomization, all participants receive a 45-minute dietary consultation. They are encouraged to follow the Dietary Approaches to Stop Hypertension diet without sodium restriction. Intervention group participants receive an individualized calorie intake goal, a second individual counseling session and attend weekly group meetings until they give birth. Research staff assesses all participants at 34-weeks gestation and at 2-weeks and one-year postpartum with their infants. SummaryThe Healthy Moms study is testing weight management techniques that have been used with non-pregnant adults. We aim to help obese women limit GWG to improve their long-term health and the health of their offspring.