Maternal Decisions Research Articles

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Maternal Decision-making about Social Media after Leaving an Abusive Relationship: an Exploratory Descriptive Case Study of Women in Ontario

Maternal Decision-making about Social Media after Leaving an Abusive Relationship: an Exploratory Descriptive Case Study of Women in Ontario

Understanding infant and young child feeding (IYCF) practices among Muslim mothers/caregivers: A qualitative study in the Bangsamoro Autonomous Region in Muslim Mindanao, Philippines

BackgroundThe study focused on understanding infant and young child feeding practices (IYCF) among Muslim mothers in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), Philippines.ObjectiveRecognizing the cultural and religious sensitivities associated with these practices, the research aimed to identify influencing factors and assess the influence of advertisements on maternal decisions regarding infants' and children's diets.MethodsA total of 74 Muslim mothers with infants 6-23 months old were recruited and participated in the focus group discussions (FGD). Ten FGD sessions were conducted in Maguindanao Province, Philippines from July to August 2021. Verbatim transcriptions of audio-recorded discussions were transcribed into Microsoft Word files and QSR NVivo version 12 was used in the coding and analysis of the transcripts.ResultsMothers exhibited limited awareness of such important complementary feeding issues as preferring fruits and vegetables while avoiding junk food as chips. IYCF information came primarily from health workers and other mothers - their own mothers, mothers-in-law, and midwives. Television commercials were identified as particularly influential in shaping maternal feeding decisions.ConclusionsThere was a diversity of breastfeeding practices and limited knowledge, especially of complementary feeding among these Muslim mothers. Both traditional beliefs and marketing were said to influence feeding choices. This underscores the need for culturally-sensitive interventions and targeted educational initiatives to enhance maternal knowledge and advocate for optimal infant feeding practices within Muslim communities, as well as regulation of the marketing of commercial infant foods.

Women’s autonomy and maternal health decision making in Kenya: implications for service delivery reform - a qualitative study

BackgroundMaternal and neonatal outcomes in, Kakamega County is characterized by a maternal mortality rate of 316 per 100,000 live births and a neonatal mortality rate of 19 per 1,000 live births. In 2018, approximately 70,000 births occurred in the county, with 35% at home, 28% in primary care facilities, and 37% in hospitals. A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya to improve the progress of these indicators. Research has shown that women’s ability to make decisions (voice, agency, and autonomy) is critical for gender equality, empowerment and an important determinant of access and utilization. As part of the Kakamega SDR process evaluation, this study sought to understand women’s processes of decision-making in seeking maternal health care and how these affect women’s ability to access and use antenatal, delivery, and post-natal services.MethodsWe adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment to focus on the interrelated concepts of “female autonomy”, and “women’s agency” with the latter incorporating ‘voice’, ‘choice’ and ‘power’. Our adaptation did not consider the influence of sexual relationships and leadership on SRH decision-making. We conducted key informant interviews, in-depth interviews, small group interviews and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, women attending post-natal clinics, and men in Kakamega County. A thematic analysis approach was used to analyze the data in NVivo 12.ResultsThe results revealed notable findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women’s agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare.ConclusionsIndividual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women’s decision-making power and control over their utilization of maternal health services. This study offers valuable insights that can guide the ongoing implementation of an innovative service delivery redesign model, emphasizing the critical need for developing context-specific strategies to promote women’s voices for sustained use.

A qualitative study of pregnant women’s perceptions and decision-making regarding COVID-19 vaccination in Thailand

To identify pregnant women’s attitudes towards, and acceptance and rejection of, COVID-19 vaccination. This prospective, descriptive, implementation study was conducted in the Antenatal clinic of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 pregnant women were interviewed. Phase II consisted of questionnaire development and data validation. In Phase III, the questionnaire was administered to 400 participants. Pregnant women’s attitudes towards and acceptance and rejection of COVID-19 vaccination. Most pregnant women were uncertain about the potential harm of vaccination to themselves or their unborn child, including risks such as miscarriage or premature birth (59–66/101 [58.4%–65.3%]; OR 2.53–8.33; 95% CI 1.23–3.60, 5.17–19.30; P < 0.001) compared to those who disagreed with vaccination. Their vaccination decisions were significantly influenced by social media information regarding vaccination complications in pregnant women (74/101 [73.3%]; OR 15.95; 95% CI 2.15–118.55; P = 0.001) compared to those who disagreed with vaccination. Most pregnant women opined that they should not receive a COVID-19 vaccination during pregnancy (adjusted odds ratio [AOR] 6.57; 95% CI 2.44–17.70; P = 0.001). Most also rejected vaccination despite being aware of its benefits (AOR 17.14; 95% CI 6.89–42.62; P < 0.001). Social media messages and obligatory vaccination certifications influence maternal vaccination decisions. Pregnant women believe vaccination helps prevent COVID-19 infection and reduces its severity. Nevertheless, the primary reason for their refusal was concern about potential harm to their unborn child or themselves during pregnancy.The Thai clinical trials registry: TCTR20211126006.

The Impact of Lifestyle Factors During Pregnancy on the Epigenome and Subsequent Risk of Disease

While genetic factors have long been known to play a significant role in determining the risk of diseases, less understood is the role lifestyle factors have. Epigenetics is an emerging area of study that seeks to explain how the environment can indirectly influence our genome by causing chemical changes surrounding our DNA. These modifications, collectively called the epigenome, are often permanent and thus can be passed down to future generations. Concerningly, epigenetic modifications have been associated with a wide range of diseases, including cancer, diabetes, and schizophrenia. The rapid development of fetal cells has made pregnancy a time of added worry over the possible implications of such changes, especially considering the dependence of the fetus on maternal decisions. This review focuses on three major lifestyle factors during pregnancy, including diet, stress, and the presence or absence of smoking, and evaluates the risk of each in the development of future diseases. Understanding the connection between lifestyle and disease could help prevent disease development in the future and give a better understanding of the causes of diseases altogether.

Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia.

Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia. A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant. The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility. The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.

Experiences and Reasons on Maternal Decision-Making Process Regarding Place of Delivery: A Qualitative Study on Maternal Health Care Services for Universal Health Care

Experiences and Reasons on Maternal Decision-Making Process Regarding Place of Delivery: A Qualitative Study on Maternal Health Care Services for Universal Health Care

Risky moms, risky kids? fertility and crime after the fall of the wall

Following the collapse of the Berlin Wall, the birth rate halved in East Germany. Using detailed state-cohort-level arrest-data, and a difference in differences strategy, we show that individuals born during this period of socio-economic turmoil were markedly more likely to be arrested than those conceived a few years earlier. This is the case for most crime types and both for boys and girls. Since these children grew-up in the same re-unified German environment, the differences in criminal activity are consistent with negative parental selection. We use individual-level data to highlight risk attitude as a potential mechanism linking maternal fertility decisions and children’s criminal activities. We show that mothers who gave birth between 1991 and 1993 in East Germany have a significantly greater preference for risk, and so do their children. Finally, we provide novel evidence of the strong correlation between high levels of risk preference and criminal participation.

No evidence for the involvement of juvenile hormone III and 20-hydroxyecdysone in maternal decisions for embryonic diapause and diapause entry in the band-legged ground cricket Dianemobius nigrofasciatus (Orthoptera: Trigonidiidae)

No evidence for the involvement of juvenile hormone III and 20-hydroxyecdysone in maternal decisions for embryonic diapause and diapause entry in the band-legged ground cricket Dianemobius nigrofasciatus (Orthoptera: Trigonidiidae)

Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis.

The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives. Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia. We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation. The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.

Prenatal counseling and maternal health behavior: The case of Ramadan fasting during pregnancy

Abstract Background Ramadan during pregnancy has been found to be associated with various adverse health effects in the offspring, which are largely attributed to maternal intermittent fasting. At the same time, many pregnant Muslims decide to fast during Ramadan. With a growing Muslim population in Europe, Ramadan fasting during pregnancy may become an even more prominent issue in the future. Since pregnant women regularly exchange with healthcare professionals, it is pivotal to evaluate the role of prenatal consultation on Ramadan for the maternal fasting decision. Methods This study uses survey data on pregnant Muslims from Mainz, Germany (N = 326). Data on fasting during pregnancy, consultation with healthcare professionals on fasting during pregnancy, as well as a rich set of socio-economic background characteristics were collected. We estimate the effect of prenatal consultation on the number of days fasted using a log-normal hurdle model. To test whether our controlled estimates might be biased by unobservable confounders, we use the Oster (2019) method. Results The share of women who fasted at least one day was 36.5% (mean: 17 fasted days). Among these women, receiving prenatal consultation on fasting during pregnancy reduced the number of fasted days by 10.8 days (95% CI: -19.03, -2.56). Results from the Oster method show that this result is not biased by unobservable confounders. Conclusions This study shows that prenatal consultation on Ramadan fasting reduces the number of fasted days among pregnant Muslims who intend to fast during pregnancy. These findings imply that prenatal caregivers should be encouraged to discuss Ramadan fasting with their Muslim patients. Further research is needed to develop guidelines for prenatal advice on Ramadan during pregnancy in a framework of shared decision-making. Key messages • Controlled effect estimates show that potentially harmful maternal Ramadan fasting behavior during pregnancy can be mitigated by prenatal caregivers. • This study demonstrates a novel way to exploit real-world data in the absence of randomization by quantitatively assessing the impact of unobservable confounders.

Medication Safety in Breastfeeding Mothers. The Current Situation in the Greek National Healthcare System

Mothers during lactation may encounter barriers including the need of medication intake due to a chronic or acute illness, which may affect mainly the duration of breastfeeding. In these cases, the issue of medication safety during lactation arises and maternal decisions usually depend on professional counseling. Providing scientifically valid information on the benefits of breastfeeding and the risk of exposure of the newborn/infant to medicines through breast milk is a responsibility of healthcare professionals. Reliable sources on the compatibility of medicines with breastfeeding vary and the information among them is conflicting or even insufficient, creating as a consequence difficulty for healthcare professionals to provide counseling. Given the fact that breastfeeding mothers are excluded from clinical trials as they are considered a vulnerable population, the scientific community has turned to alternative methods based on pharmacokinetic population modeling for medication safety during lactation. In addition, through pharmacovigilance science, databases related to drug compatibility with breastfeeding can be enriched with new data. Undoubtedly, the contribution of midwives and other healthcare professionals involved in breastfeeding plays a key role in the pharmacovigilance process through the observation and reporting of side effects. In the Greek national healthcare system, telephone helplines have been established to provide information on medication safety during lactation. Finally, information is provided on the guiding principles for midwives and other healthcare professionals regarding medication safety in breastfeeding mothers. The ultimate goal is to support and prolong breastfeeding with evidence-based knowledge.

Kondisi Psikologis Primigravida dengan Preeklampsia Berat dan Future Direction Strategi Komunikasi Perawat: A Case Report

Background. Preeclampsia is a pregnancy complication with a high risk of maternal and fetal morbidity and mortality. This case report aimed to describe primigravid pregnancies with severe preeclampsia and physical-psychological problems that impact patient-family’s decision-making for the health of the mother and fetus.&#x0D; Research Methods. This case report was conducted to improve understanding of a case primigravida pregnancies with severe preeclampsia. The stages of a case report included: defining the case; choosing a case; collecting and analyzing data; interpreting data; and reporting results. Data was collected through interviews, physical examinations, examination of health documents, discussions with patients and families, and information from other health workers—anxiety assessment using the Hamilton Rating Scale for Anxiety. Data analysis was done by reading the collected data, coding the primary data, comparing it, and summarizing it as a case presentation.&#x0D; Results. Primigravida, 33 weeks, severe preeclampsia and requires hourly monitoring. Complaints of frontal headaches, blurred vision and conveyed the results of high blood pressure examination at a clinic near the house. General condition: composmentis, blood pressure: 160/112 mmHg, N;118 x/min, R;24x/min, Temperature; 36.50 C, dry lips, oedema in the left lower extremity, MEWS score 4-5, fetal heart rate 134x/minute. Anxiety assessment with the Hamilton Rating Scale for Anxiety resulted in moderate-severe anxiety category. Husbands expressed the wishes of the mother and baby to be safe and to be born immediately with surgery.&#x0D; Conclusion. Severe preeclampsia with uncontrolled blood pressure requires appropriate treatment and intensive observation by health workers, especially nurses. Pregnancy with severe preeclampsia raises anxiety for patients and families, which risks further increasing blood pressure and threatening the fetus's well-being. Anxiety impacts interaction situations between patients, families, and caregivers, as well as family decision-making. A therapeutic communication approach by paying attention to comprehensive needs and holistic patient conditions is an effective nurse strategy for families to make maternal and fetal health decisions.

Factors influencing breastfeeding continuation and formula feeding beyond six months in rural and urban households in Indonesia: a qualitative investigation

BackgroundGlobal and Indonesian guidelines suggest that breastfeeding should continue for at least the first two years of life. While many studies have focused on six-month exclusive breastfeeding practices, little is known about why mothers do not sustain breastfeeding beyond this period. This qualitative study aimed to explore factors influencing breastfeeding continuation and formula feeding beyond six months, regardless of any additional food consumed, focusing on Indonesia’s rural and urban areas.MethodsWe collected the data through 46 in-depth interviews in Pati District and Surakarta City, Central Java, Indonesia. Participants were mothers, grandmothers, health care practitioners, and village kader (frontline female health workers). We used thematic analysis combining deductive and inductive techniques for analysing the data.ResultsRural mothers practised breastfeeding and intended to breastfeed for a longer duration than urban mothers. Maternal attitude towards breastfeeding, breastfeeding knowledge, previous experiences, and other breastfeeding strategies (e.g., enhancing maternal dietary quality) positively influenced breastfeeding sustainability. In the urban setting, mothers encountered several breastfeeding barriers, such as perceived breast milk insufficiency and child hunger and satiety, child biting, and breastfeeding refusal, causing them to provide formula milk as a breast milk substitute or supplement. In addition, families, communities, health practitioners, and employment influenced maternal decisions in breastfeeding continuation and formula-feeding practices.ConclusionsOptimal breastfeeding practices up to two years of age are determined by the individual and setting (i.e., community, healthcare, employment) factors. Providing breastfeeding education covering practical breastfeeding guidance will encourage mothers to breastfeed for longer. Such interventions should involve families, communities, health workers, and the work environment as a breastfeeding support system. Policymakers should develop, enforce, and monitor the implementation of breastfeeding policies to protect, promote, and support breastfeeding in households, communities, health systems, and work settings.

Effects of Housing Insecurity on Breastfeeding: A Scoping Review

Objective:Breastfeeding is essential to save the lives of young children; however, housing insecurity has been connected to a lower likelihood of commencing or continuing to breastfeed because of the numerous barriers it creates for breastfeeding mothers. Housing insecurity and household conditions are one of the social determinants that influence the initiation, duration, and exclusivity of breastfeeding. To analyze the housing-related vulnerability of breastfeeding mothers, this review examines the impact of housing and living conditions on the breastfeeding practices of mothers and presents housing-related factors that negatively affect the maternal decision to breastfeed.Methods:This scoping review was undertaken using four major databases, including JSTOR, EBSCO, PubMed, and OVID Medline. Evidence-based articles were searched without placing any restrictions on the year of publication or geographic location. A total of 18 articles published until 2022 were included in the scoping review.Results:This review suggests that multiple factors associated with housing impacts the maternal intent and duration of breastfeeding. The housing factors that directly and indirectly affect breastfeeding practices include the type of housing, stress related to housing, housing conditions, unfair allocation of housing, social support in households and neighborhoods, safe space to breastfeed, and homelessness after the catastrophe.Conclusions:Demographic characteristics of breastfeeding mothers must be examined, and mothers facing housing insecurity must be offered need-based support, guidance, and breastfeeding counseling. Creating and improving screening techniques that recognize the complexity of housing instability is necessary, particularly for communities most at risk for nonexclusive breastfeeding. The systemic barriers to breastfeeding related to housing can be reduced by collaborating with patient partners, communities, interdisciplinary healthcare providers, policymakers, and government and nongovernmental organizations.

The Turkish validity and reliability of the maternal health literacy inventory in pregnancy

BackgroundThere is no Turkish scale measuring maternal health literacy during pregnancy. This study adapted the Maternal Health Literacy Inventory in Pregnancy (MHELIP) to Turkish. MethodsA methodological study's sample consisted of 500 pregnant women admitted to the antenatal clinics of a Maternity Hospital in Ankara, Türkiye. Data were collected using a personal information form, the MHELIP and the Turkish Health Literacy Index (HLI). Language, content, and construct validity were determined. Cronbach's alpha coefficient and item analysis were used to assess reliability. Equivalent-form reliability was evaluated using the HLI. ResultsThe scale has a four-factor structure that fits well with 48 items (factor loadings: 0.57–0.92; fit index: 4.15 x2/df, 0.08 RMSEA, 0.07 SRMR). The total scale has a Cronbach's alpha of 0.96. The subscales “maternal health knowledge,” “search for maternal health information,” “assessment of maternal health information,” and “maternal health decision making and behavior” have Cronbach's alpha of 0.96, 0.91, 0.86, and 0.94, respectively. There is a correlation between MHELIP and HLI scores (r = 0.570, p<0.001). ConclusionThe MHELIP is a valid and reliable tool for measuring and screening the maternal health literacy of Turkish pregnant women.

Multiple micronutrient supplementation cost-benefit tool for informing maternal nutrition policy and investment decisions.

Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision-making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost-benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost-benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost-effectiveness and benefit-cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost-benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost-effective in multiple scenarios for these countries. The cost per DALY averted averages at US$ 23.61 and benefit-cost ratio ranges from US$ 41-US$ 1304: $1.0, which suggest MMS is good value for money compared with IFAS. With its user-friendly design, open access availability, and online data-driven analytics, the MMS cost-benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence-based analyses to inform policy-decision and investments towards the scale-up of MMS for pregnant women globally.

Association between maternal decision-making and mental health and the nutritional status of children under 6 years of age in sub-urban Nigeria

BackgroundWe assessed the association between decision-making power and mental health status of mothers and the nutritional status of their children less than 6 years old in Ile-Ife, Nigeria.MethodsThis was a secondary data analysis of 1549 mother-child dyads collected through a household survey conducted between December 2019 and January 2020. The independent variables were maternal decision-making and mental health status (general anxiety, depressive symptoms, parental stress). The dependent variable was the child’s nutritional status (thinness, stunting, underweight and overweight). Confounders were maternal income, age, and education status, and the child’s age and sex. The associations between the dependent and independent variables were determined using multivariable binary logistic regression analysis after adjusting for confounders. The adjusted odds ratios (AORs) were determined.ResultsChildren of mothers with mild general anxiety had lower odds of stunting than children of mothers with normal anxiety (AOR: 0.72; p = 0.034). Mothers who did not make decisions on children’s access to health care (AOR: 0.65; p < 0.001) had children with lower odds of being thin than those whose mothers made decisions on their access to health care. Children of mothers with clinically significant parenting stress levels (AOR: 0.75; p = 0.033), severe depressive symptoms (AOR: 0.70; p = 0.041) and who were not decision makers on the access of their children to health care (AOR: 0.79; p = 0.035) had lower odds of underweight.ConclusionsMaternal decision-making status and mental health status were associated with the nutritional status of children less than 6 years in a sub-urban community in Nigeria. Further studies are needed to understand how maternal mental health is associated with the nutritional status of Nigerian preschool children.

Drivers of decision-making regarding infant sleep practices among mothers with opioid use disorder.

To understand the perspectives and perceived facilitators of and barriers to following safe infant sleeping practices among mothers with opioid use disorder (OUD). Using the Theory of Planned Behavior (TPB) framework, we conducted qualitative interviews with mothers with OUD regarding infant sleep practices. We created codes and generated themes, concluding data collection upon achieving thematic saturation. Twenty-three mothers with infants 1-7 months of age were interviewed from 08/2020 to 10/2021. Mothers chose sleeping practices they perceived made their infants safer, more comfortable, and minimized infant withdrawal symptoms. Mothers in residential treatment facilities were influenced by facility infant sleep rules. Hospital sleep modeling and varied advice by providers, friends and family influenced maternal decisions. Mothers reported factors unique to their experience with OUD that influenced their decisions about infant sleep that should be considered when developing tailored interventions to promote safe infant sleep in this population.