Maternal Population Research Articles

Comparative Transcriptomic Analyses Reveal Differences in the Responses of Diploid and Triploid Eastern Oysters to Environmental Stress.

Triploid oysters are commonly used as the basis for production in the aquaculture of eastern oysters along the USA East and Gulf of Mexico coasts. While they are valued for their rapid growth, incidents of triploid mortality during summer months have been well documented in eastern oysters, especially at low salinity sites. We compared global transcriptomic responses of diploid and triploid oysters bred from the same three maternal source populations at two different hatcheries and outplanted to a high (annual mean salinity = 19.4 ± 6.7) and low (annual mean salinity = 9.3 ± 5.0) salinity site. Oysters were sampled for gene expression at the onset of a mortality event in the summer of 2021 to identify triploid-specific gene expression patterns associated with low salinity sites, which ultimately experienced greater triploid mortality. We also examined chromosome-specific gene expression to test for instances of aneuploidy in experimental triploid oyster lines, another possible contributor to elevated mortality in triploids. We observed a strong effect of hatchery conditions (cohort) on triploid-specific mortality (field data) and a strong interactive effect of hatchery, ploidy, and outplant site on gene expression. At the low salinity site where triploid oysters experienced high mortality, we observed downregulation of transcripts related to calcium signaling, ciliary activity, and cell cycle checkpoints in triploids relative to diploids. These transcripts suggest dampening of the salinity stress response and problems during cell division as key cellular processes associated with elevated mortality risk in triploid oysters. No instances of aneuploidy were detected in our triploid oyster lines. Our results suggest that triploid oysters may be fundamentally less tolerant of rapid decreases in salinity, indicating that oyster farmers may need to limit the use of triploid oysters to sites with more stable salinity conditions.

ASPECTOS SOCIOECONÔMICOS E GESTACIONAIS RELACIONADOS A OCORRÊNCIA DE BAIXO PESO AO NASCER

The objective of this article is to estimate the prevalence and factors related to the risk of Low Birth Weight (LBW), and its impact on socioeconomically disadvantaged populations. A cross-sectional, analytical study was used, based on data available in the Information Technology Department of the Unified Health System (DATASUS), more specifically, in the Live Birth Information System (SINASC). For data analysis, the EPI-INFO 7.0 program was used, where bivariate analysis was used with the Chi-square test considering the Mantel-Haenszel method to identify which factors are associated with LBW. 49,481 live births were examined in the State of Mato Grosso, 8.78% of which were affected by LBW. In the bivariate analysis, LBW was mostly recorded in children of pregnant women who were in the risk age group, marital status in which they lived alone/separated, indigenous race or skin color, black or mixed race, and lived in a region with low HDI . Furthermore, there are other factors related to pregnancy that had a strong influence on LBW, including: number of prenatal consultations and type of pregnancy. Regarding the characteristics of newborns, LBW presented a majority in female babies and those born prematurely and/or with malformations or congenital anomalies. The results found in the present study justify the need to improve actions capable of serving the maternal and child population so that economic and demographic factors have less impact on the occurrence of LBW.

Systematic Review of the Efficacy and Safety of RSV-Specific Monoclonal Antibodies and Antivirals in Development.

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection amongst all ages, causing a significant global health burden. Preventative and therapeutic options for RSV infection have long been under development, and recently, several widely-publicised vaccines targeting older adult and maternal populations have become available. Promising monoclonal antibody (mAb) and antiviral (AV) therapies are also progressing in clinical trials, with the prophylactic mAb nirsevimab recently approved for clinical use in infant populations. A systematic review on current progress in this area is lacking. We performed a systematic literature search (PubMed, Embase, Web of Science, ClinicalTrials.gov, EudraCT, ANZCTR-searched Nov 29th, 2023) to identify studies on all RSV-specific mAbs and AV therapies that has undergone human clinical trials since year 2000. Data extraction focused on outcomes related to the therapeutic efficacy and safety of the intervention on trial, and all studies were graded against the OCEBM Levels of Evidence Table. Results from 59 studies were extracted, covering efficacy and safety data on six mAbs (motavizumab, motavizumab-YTE, nirsevimab, ALX-0171, suptavumab, clesrovimab) and 12 AV therapies (ALN-RSV01, RSV604, presatovir, MDT-637, lumicitabine, IFN-α1b, rilematovir, enzaplatovir, AK0529, sisunatovir, PC786, EDP-938). Of the mAbs reviewed, nirsevimab and clesrovimab hold considerable promise. The timeline for RSV-specific AV availability is less advanced, although EDP-938 and AK0529 have reported promising phase 2 efficacy and safety data. Moving forward, passive immunisation and treatment options for RSV infection will play a significant role in reducing the health burden of RSV, complementing recent advancements in vaccine development. TRIAL REGISTRATION: PROSPERO registration: CRD42022376633.

Global trends in prevalence of maternal overweight and obesity: A systematic review and meta-analysis of routinely collected data retrospective cohorts

Pregnant women with obesity are at greater risk of complications during pregnancy, peripartum and post-partum, compared to women with healthy BMI. Worldwide data demonstrating the changes in trends of maternal overweight and obesity prevalence informs service development to address maternal obesity, while directing resources to areas of greatest need. This systematic review and meta-analysis of population level data sought to evaluate global temporal changes in prevalence of maternal obesity and overweight/obesity, and compare trends between regions. Pooled prevalence of obesity and overweight/obesity was estimated using random effects meta-analysis. Temporal and geographical trends in prevalence of obesity and overweight/obesity were examined using linear regression. From 11,684 publications, 94 met inclusion criteria representing 121 study cohorts (Europe n = 71; North America n = 23; Australia/Oceania n = 10; Asia n = 5; South America n = 12), totalling 49,009,168 pregnancies. No studies from Africa met the inclusion criteria. Eighty studies (85.1%) were evaluated as having a low risk of bias and 14 studies (14.9%) moderate. In the most recent full decade (2010-2019), global prevalence of maternal obesity was estimated as 16.3% (95% confidence interval (CI): 15.1-17.5%), or approximately one in six pregnancies. Combined overweight/obesity in pregnancy had a pooled prevalence of 43.8% (95%CI: 42.2-45.4%), approaching half of all pregnancies. In each continent, an upward trend similar to the global trend was observed. North America demonstrated the highest prevalence (obesity: 18.7% (95%CI: 15.0-23.2%)); overweight/obesity: 47.0% (95%CI: 45.7-48.3%)) and Asia demonstrated the lowest prevalence (obesity: 10.8% (95%CI: 7.0-16.5%)); overweight/obesity: 28.5% (95%CI: 18.3-41.5%)). Both maternal obesity and combined overweight/obesity prevalence increased annually by 0.34% and 0.64% (p < 0.001), respectively. Our linear regression model estimates current global prevalence of maternal obesity as 20.9% (95%CI 18.6-23.1%) and projects that this will increase to 23.3% (95%CI 20.3-26.2%) by 2030. Globally, maternal obesity and overweight/obesity prevalence is high and increasing, but varies greatly between regions, being highest in North America and lower in Asia. Maternity services across the globe should be adequately resourced to cope with the complexity of needs of pregnant women living with obesity. Future public health interventions should focus on reversing the high prevalence of maternal obesity observed across the globe. The availability of population-level data and research varies between regions, with more data required to understand the needs of maternal populations in the continents of Africa and Asia. Globally, there is a need for improved harmonisation and publication of data for monitoring and improvement of maternal inequalities.

Correlation of Maternal Vitamin D Status in Early Pregnancy and Vitamin D Supplementation during Pregnancy with Atopic Dermatitis in Infants: A Prospective Birth Cohort Study.

This study aimed to investigate the association of maternal first-trimester vitamin D levels and vitamin D supplementation during pregnancy with infant atopic dermatitis (AD) and to determine the effect of variables such as mode of conception on the association. This study was based on the Shanghai sub-cohort of the International Birth Cohort of China. A total of 4051 woman-infant pairs with singleton pregnancies were recruited. Vitamin D deficiency and insufficiency were defined as serum 25-hydroxyvitamin D concentrations of 25 and 50 nmol/L, respectively. AD in infants was assessed during the first six months using a standardized questionnaire based on the British Working Party criteria. Modified Poisson regression estimated the association between maternal vitamin D status and infant AD. The risk of AD in infants was higher in women with deficient 25-hydroxyvitamin D levels in the first trimester (RR: 1.77, 95% CI: 1.41-2.23). This increased risk was seen in naturally conceived pregnancies, but not in those conceived using assisted reproductive technology (ART). The incidence of AD decreased in infants of mothers who took multi-vitamin (RR: 0.79, 95% CI: 0.67-1.98) and vitamin D supplements (RR: 0.51, 95% CI: 0.37-0.71) compared to those whose mothers did not take any supplements. Maternal vitamin D deficiency had varying effects on AD risk based on passive smoking exposure and breastfeeding patterns. Our findings highlight the importance of monitoring and supplementing vitamin D during pregnancy, especially in specific maternal populations, to reduce the risk of AD in offspring.

Development and Validation of the Maternal Drinking Motives Scale (M-DMS)

Background Alcohol use is a gendered behavior and motherhood is a life stage which may influence drinking motives. However, there are no drinking motive scales uniquely tailored to maternal populations. This work developed a new maternal drinking motives scale (M-DMS) and determined associations between the M-DMS and alcohol-related behavior. Methods An online observational survey (n = 534) and online test–retest survey (n = 164) were conducted with adult, UK mothers. From the observational study, data on drinking motives was extracted to determine M-DMS items and factor loading. This was split into two data sets for exploratory and confirmatory factor analyses. Alcohol Use Disorders Identification Test (AUDIT) and Timeline Follow back data, taken from both surveys, were combined to determine the M-DMS’s predictive validity. Results Following a parallel analysis and exploratory factor analysis, a two-factor model (positive reinforcement motives, negative reinforcement motives) was deemed the best fit. Probability functional analysis identified items with problematic responses. These were removed before confirmatory factor analysis (on the second dataset) demonstrated a good fit for the two-factor model. All factor loadings were significant and positive (βs > 0.56). Reliability of the two subscales was excellent: negative reinforcement (ωT = 0.95), positive reinforcement (ωT = 0.89). Test–retest reliability was good for both negative (ICC = 0.84, 95%CI = 0.80–0.88) and positive (ICC = 0.77, 95% CI = 0.71–0.82) subscales. Both subscales predicted AUDIT and quantity of alcohol consumption (ps < 0.001). Conclusion The first tailored Maternal Drinking Motives Scale (M-DMS) provides a more valid research tool for assessing psychological mechanisms of alcohol use in mothers.

Disparities in spatiotemporal clustering of maternal mental health conditions before and during the COVID-19 pandemic

Mounting evidence indicates the worsening of maternal mental health conditions during the COVID-19 pandemic. Mental health conditions are the leading cause of preventable death during the perinatal and postpartum periods. Our study sought to detect space-time patterns in the distribution of maternal mental health conditions in pregnant women before (2016–2019) and during (2020–2021) the COVID-19 pandemic in North Carolina, USA. Using the space-time Poisson model in SaTScan, we performed univariate and multivariate cluster analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), maternal mental disorders of pregnancy (MDP), suicidal thoughts, and suicide attempts during the pre-pandemic and pandemic periods. Clusters were adjusted for age, race, and insurance type. Significant multivariate and univariate PMAD, SMI, and MDP clustering persisted across both periods in North Carolina, while univariate clustering for both suicide outcomes decreased during the pandemic. Local relative risk (RR) for all conditions increased drastically in select locations. The number of zip code tabulation areas (ZCTAs) included in clusters decreased, while the proportion of urban locations included in clusters increased for non-suicide outcomes. Average yearly case counts for all maternal mental health outcomes increased during the pandemic. Results provide contextual and spatial information concerning at-risk maternal populations with a high burden of perinatal mental health disorders before and during the pandemic and emphasize the necessity of urgent and targeted expansion of mental health resources in select communities.

Increase in methicillin-resistant Staphylococcus spp. colonization among pregnant individuals during COVID-19 pandemic

Methicillin-resistant Staphylococcus (MRS) has been associated with neonatal infections, with colonization of the anovaginal tract being the main source of vertical transmission. The COVID-19 pandemic has altered the frequency of antibiotic usage, potentially contributing to changes in the dynamics of bacterial agents colonizing humans. Here we determined MRS colonization rates among pregnant individuals attending a single maternity in Rio de Janeiro, Brazil before (January 2019–March 2020) and during (May 2020–March 2021) the COVID-19 pandemic. Anovaginal samples (n = 806 [521 samples before and 285 during the pandemic]) were streaked onto chromogenic media. Colonies were identified by MALDI-TOF MS. Detection of mecA gene and SCCmec typing were assessed by PCR and antimicrobial susceptibility testing was done according to CLSI guidelines. After the onset of the pandemic, MRS colonization rates increased significantly (p < 0.05) from 8.6% (45) to 54.7% (156). Overall, 215 (26.6%) MRS isolates were detected, of which S. haemolyticus was the most prevalent species (MRSH, 84.2%; 181 isolates). SCCmec type V was the most frequent among MRS (63.3%; 136), and 31.6% (68) of MRS strains had a non-typeable SCCmec, due to new combinations of ccr and mecA complexes. Among MRS strains, 41.9% (90) were resistant to at least 3 different classes of antimicrobial agents, and 60% (54) of them were S. haemolyticus harboring SCCmec V. MRS colonization rates and the emergence of multidrug-resistant variants detected in this study indicate the need for continuing surveillance of this important pathogen within maternal and child populations.

P363 A retrospective review of fat-soluble vitamins A, D and E levels and vitamin supplementation in a cystic fibrosis (CF) maternal health population

P363 A retrospective review of fat-soluble vitamins A, D and E levels and vitamin supplementation in a cystic fibrosis (CF) maternal health population

Reclaiming narratives of empowerment around Black maternal health: a strengths-based, community-informed focus group study

ABSTRACT Objectives Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. Design Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. Results Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. Conclusion Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women’s health and wellness, and offered direction on our research design and intervention.

Increases in drug-related infant mortality in the United States.

We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022. We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death. In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning dueto exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics. Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations.

Ensuring neonatal human milk provision: A framework for estimating potential demand for donor human milk

Using donor human milk (DHM) for preterm infants, where the mother's milk is unavailable, protects infants against potentially fatal necrotising enterocolitis. When used optimally, DHM can support mothers to establish breastfeeding. Understanding the relationship between clinical choices for DHM provision and the resulting demand is important. For policymakers, it informs decision-making around the provision of DHM based on cost-benefit analyses. For milk banks, it helps plan for required capacity, donor recruitment and supply-side collections. This study presents a framework for estimating DHM potential demand for infants born preterm, which allows for various sources of secondary population data, different feeding protocols and policy options for DHM provision. A Monte Carlo Simulation (MCS) is developed which follows the framework, simulating annual births (based on historical data) and incorporating uncertainty related to infant and maternal populations. A case study on human milk banking serves as the basis for the application of the framework and the modelling approach. Our model estimates the overall demand for DHM in England and Wales, the local level demand for NHS Trusts in England and provides an indication of the associated uncertainties. Our study provides a useful tool to enrich the strategic and operational level decision-making environment, benefitting both policymakers and milk bankers by providing a better understanding of the impact of policy decisions on the future development of the milk bank infrastructure.

Social Determinants of Health Needs Among Immigrant and U.S.-Born Pregnant Persons in Central Brooklyn: A Cross-Sectional Survey [ID 2683549

INTRODUCTION: Social determinants of health (SDOH) have been linked to poor health outcomes in maternal and infant populations. An epicenter of the maternal health crisis in New York City, Central Brooklyn has a disproportionately high population of immigrants. This cross-sectional survey assesses demographic distributions and SDOH needs of immigrant and U.S.-born pregnant individuals in Central Brooklyn. METHODS: The American Academy of Family Practitioners (AAFP) SDOH screening tool was given to 700 pregnant persons with immigrant status defined by country of origin. Institutional review board-approved data were collected through REDCap, and associations were evaluated via χ2, Fisher's exact tests, and logistic regression in STATA. RESULTS: Compared to U.S.-born pregnant persons, immigrants tended to be older (P=.000), married (P&lt;.000), and more educated (P=.028). Social determinants of health needs differed significantly by nativity status for housing instability (P=.039), food worry (P=.000), and food inadequacy (P=.018), all of which were higher for immigrants. After adjusting for age and education level, immigrant pregnant persons were significantly more likely to report five or more SDOH needs. Rates of food insecurity (39.86% among immigrants and 27.02% among U.S.-born) were much higher than the national average of 10.2%. Rates of all other SDOH needs were higher for immigrants, except for transportation, but these differences were insignificant. CONCLUSION: Our study underscores the criticality of monitoring SDOH needs in marginalized populations to inform targeted interventions aimed at dismantling systemic barriers to health care access during pregnancy. By doing so, we can foster greater engagement in care and promote more equitable health outcomes for pregnant and postpartum individuals.

Enhancing Maternal Population Health Training Through Maternal Mortality Review Committees: Innovative Models and Impact

Enhancing Maternal Population Health Training Through Maternal Mortality Review Committees: Innovative Models and Impact

Maternal Sleep Health, Social Support, and Distress: A Mixed–Methods Analysis of Mothers of Infants and Young Children in Rural US

ABSTRACT Objectives The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. Methods 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. Results Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. Conclusions Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Knowledge, Attitudes, and Practices of Family Planning among Mothers attending Antenatal Care in Rural Uganda: Implications for Maternal Health and Population Growth

Family planning remains a critical aspect of maternal health and population management in Uganda, particularly in rural areas. Despite concerted efforts to increase awareness and accessibility, utilization rates remain suboptimal. This descriptive cross-sectional study aimed to assess the knowledge, attitudes, and practices of family planning among mothers attending antenatal care in Kyotera district, Uganda. A sample of 138 participants completed questionnaires, revealing a nuanced landscape: while overall knowledge of family planning was high (73.9%), a significant minority demonstrated poor understanding (26.1%). Similarly, though the majority exhibited positive attitudes towards family planning (71.0%), a substantial proportion held negative views (29.0%). Notably, 62.3% of mothers were not utilizing any family planning methods, despite 37.7% reporting usage, with injectable contraceptives being the most common (42.3%). These findings underscore the need for targeted education campaigns, enhanced service accessibility, and dispelling misconceptions to promote informed decision-making and uptake of family planning methods. Addressing these challenges is vital for improving maternal health outcomes and managing population growth in rural Uganda. Keywords: Family planning, Maternal health, Kyotera district, Rural Uganda, Antenatal care, Knowledge, Attitudes, Practices.

Postpartum Psychosis and Maternal Filicide- Case Report and Literature Review

IntroductionPostpartum period is defined as the 12 weeks following the birth of a child as per ACOG guidelines. This period is crucial for women to physically and emotionally adapt to major changes in their lives. If concerns are not addressed properly it can result in fatal outcomes such as filicide and suicide in context of untreated mental illness with postpartum onset. Postpartum psychosis is considered a psychiatric emergency and literature shows that up to 4.5% of patients with depressive symptoms with psychosis commit filicide. However, postpartum psychosis is not recognized as a formal psychiatric disorder in DSM-5, leading to a delay in identification and treatment of the condition in a timely fashion.ObjectivesThe primary purpose of the case report is to inform the clinical picture and the legal implications associated with postpartum psychosis, a poorly understood and underdiagnosed psychiatric illness and to emphasize the importance of considering other psychiatric illnesses with peripartum onset that affect maternal and pediatric population wellbeing.Methods A comprehensive review of literature using databases, such as PubMed and Google Scholar as well as observation of the patient in the Emergency Department by the psychiatry team.Results We present the case of a female in her 20s, mother of two toddlers, with a history of PTSD and postpartum depression, who was brought to our Emergency Department for stabbing her children in the context of a psychotic episode. The patient endorsed persecutory delusions and religious preoccupation, stating that she was experiencing “demonic energy inside” and that demons were speaking through her sons. Upon further assessment, it was noted that symptom onset was during the peripartum period, initially with depressed mood, and later with psychotic features. Organic causes of psychosis were ruled out with an extensive workup. Patient was transferred to an inpatient forensic unit for further stabilization. From a legal perspective, literature review shows that mothers may face the death penalty in the US in contrast with other countries such as England for instance. In the context of the current case, the plausible diagnoses are MDD with psychotic features or the first psychotic episode with peripartum onset that was left untreated resulting in a fatal health and legal outcome.ConclusionsAs postpartum psychosis is not currently recognized as an independent diagnosis under the DSM-5, further attention is warranted for such critical psychiatric condition that afflicts the lives and well-being of the maternal and pediatric populations globally. Postpartum psychosis affects mothers despite their past psychiatric history, socioeconomic status, educational level, and supportive network. Thus, it is essential to target proper and timely identification of symptoms and address those to prevent filicide and maternal suicide.Disclosure of InterestNone Declared

Psychometrics of the breastfeeding self-efficacy scale and short form: a systematic review

BackgroundThe Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals.ResultsForty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from .72 to .97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not.ConclusionThe BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions.

Optimal duration of breastfeeding

Introduction. The question of the optimal timing of cessation of lactation from the perspective of maternal-child relationships remains controversial.Aim. Тo determine the optimal timing for stopping breastfeeding based on data on the formation of the child’s personal characteristics and the relationship with the mother.Materials and methods. The results of a prospective study of mother-child relationships during the period of cessation of breastfeeding are presented. The age of the child was assessed at the termination of breastfeeding, the difficulties experienced by the mother and the child at its termination (affective attachment, characteristics of the child’s behavior). Observation was carried out in the classroom in the group of short-term stay in preschool conditions 1–2 times a week for at least 1.5 hours. 108 mother-child pairs were under observation. Depending on the duration of breastfeeding, couples were divided into two groups. The first group – 64 children who are breastfed for no more than 18 months, the second group – 44 children who are breastfed for more than 18 months. Statistical processing of the obtained data was carried out using the Excel program using Student’s t-test and Pearson’s χ2 method. Differences were considered statistically significant at p &lt; 0.05.Results and discussion. Since the conditions of the children’s polyclinic do not allow for monitoring the child and his mother, the study was carried out in a group of short-term stay in a preschool educational institution, which is quite typical for the modern urban maternal population. The work was carried out jointly with teachers and psychologists who developed criteria for assessing mother-child relations and the child’s behavioral characteristics. In the group of children who were breastfed after 18 months, affective attachment to the mother, use of the breast to soothe them in the absence of breast milk, anxiety when falling asleep, were 2 times more common than in children who were breastfed for less than 18 months. The data obtained indicate the need to inform nursing mothers about the mental characteristics of a child’s development in certain age periods, a decrease in lactation after a year, and its frequent termination by 18 months.Conclusions. Based on the data obtained, it can be considered appropriate the optimal duration of breastfeeding up to one and a half years.

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

BackgroundMaternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021.MethodsWe conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective.ResultsConsidering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women.ConclusionsThese findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.