Maternal Concern Research Articles

Understanding Sociodemographic Determinants of Voluntary Cesarean Section Deliveries in India through Geospatial Modeling using Multiscale Geographically Weighted Regression (MGWR)

IntroductionOver the period of time, the increasing trend of voluntary cesarean section (CS) delivery has become a serious maternal health concern. Previous studies have shown wide geographic variations in the prevalence of voluntary CS delivery constraints by several sociodemographic determinants. However, none of them have attempted to disentangle this phenomenon by using spatially varying coefficient models to consider local factors. This study aims to identify the spatially heterogeneous relationships among voluntary CS deliveries against the backdrop of sociodemographic determinants in India.Data and MethodsThis study utilized data from the National Family Health Survey (NFHS-5), 2019-21. The ordinary least square (OLS) model was used as a base model, and multiscale geographically weighted regression (MGWR) was employed at the district level to consider the local factors associated with voluntary CS delivery. An appropriate model diagnostic check was also performed to make our model robust and reliable. Several maps were produced using ArcGIS Pro to visualize the distribution of coefficients of several factors.ResultsMore than half (58%) of the total CS deliveries were voluntary; however, choropleth maps have shown that southern peninsular and northeastern districts have a higher prevalence than the rest. The distribution of voluntary CS deliveries with a Moran’s Index of 0.22 was also spatially autocorrelated. Moreover, the values of Jarque–Bera statistics and Koenker (BP) Statistics show that the OLS model residuals were not normally distributed and reflected heteroskedasticity. The estimates from the MGWR show that four and above ANC visits and mass media exposure show a positive relationship with voluntary CS deliveries. The local R-squared map explains nearly half of the variation for voluntary CS deliveries for all northeastern districts. The model fit metric shows higher R square and lower corrected Akaike’s Information Criterion (AICc) values for the MGWR model, which validates that the MGWR model is more robust and parsimonious.ConclusionThe present study revealed that although voluntary CS deliveries are at an increasingly alarming pace, the geographic distribution of voluntary CS deliveries is, albeit unequally. Therefore, this investigation has made an effort to examine how spatial analysis can help identify the geographic patterns and factors that explain this variation in voluntary CS deliveries across space. These findings add value to our understanding of how geographic space and scale matter when health is examined. Public health practitioners can recognize such variations when devising targeted interventions for CS deliveries in India and other developing nations.

Prevalence of HIV/AIDS among pregnant women in North American region: A systematic review and meta-analysis.

As a major maternal health concern, the prevalence of human immunodeficiency virus (HIV) among pregnant women was previously investigated in European, African, and Latin American regions other than the North American region. This study analyzed the prevalence of HIV among pregnant women in the North American region including 3 major countries: the USA, Canada, and Mexico. Relevant studies were screened from 3 online databases: Google Scholar, PubMed, and ScienceDirect using specific search keywords. Ultimately, 10 studies of the North American region were included with a total of 339,831 pregnant women residing in the USA, Canada, and Mexico. The overall pooled prevalence was 0.6% (95% confidence interval [CI]: 0.4-0.8) with a high degree of heterogeneity (I2 = 97%). Pooled prevalence rates of HIV among pregnant women in Canada, Mexico, and the USA were 0.3% (95% CI: 0.1-0.5), 0.5% (95% CI: 0.2-0.8), and 2.3% (95% CI: 0.0-5.7), respectively with high degrees of heterogeneity. The overall prevalence rate of HIV among pregnant women in the USA, Canada, and Mexico was minimal as compared with the countries of Eastern Europe, sub-Saharan Africa, or Latin America. Awareness, adequate testing and healthcare facilities, better socioeconomic, and geopolitical conditions might be crucial to lowering the prevalence of HIV among pregnant women.

Congenital hallux valgus occurs in Fibrodysplasia Ossificans Progressiva and BMPR1B-associated dysplasia: an important distinction

BackgroundFibrodysplasia Ossificans Progressiva (FOP; OMIM #135100) is an ultrarare genetic disorder characterised by congenital bilateral hallux valgus (CBHV), intermittent soft tissue swellings and progressive heterotopic ossification. We report a three-month-old girl with great toe abnormalities similar to FOP, in whom comprehensive clinical workup and genetic investigations illustrates an alternative diagnosis.Case presentationA three-month-old girl presented with CBHV. The antenatal period was unremarkable, she was born by spontaneous vaginal delivery with an uneventful subsequent course, except for maternal concern of her bent toes which received reassurance from several health professionals. Her mother’s persisting concerns were explored via the internet and social media leading her to request referral to an expert bone centre for consideration of FOP. On examination, she was thriving, there was no dysmorphism, subcutaneous lumps, skeletal or extra-skeletal deformity except for shortened great toes with lateral deviation of the proximal and distal phalanges. FOP was a feasible diagnosis, for which CBHV is highlighted as an early sign. A cautionary potential diagnosis of FOP was counselled, including advice to defer intramuscular immunisations until genetic results available. Genetic investigation was undertaken through rapid whole genomic sequencing (WGS), with analysis of data from a skeletal dysplasia gene panel, which demonstrated no ACVR1variants. The only finding was a heterozygous variant of unknown significance in BMPR1B (c1460T>A, p.(Val487Asp)), which encodes a bone morphogenic receptor involved in brachydactyly syndromes A1, A2 and D and acromesomelic dysplasia 3 (only the latter being an autosomal recessive condition).ConclusionThis report highlights that CBHV serves as a vital diagnostic indicator of FOP and affected infants should be considered and investigated for FOP, including precautionary management whilst awaiting genetic studies. The second educational aspect is that CBHV may not represent a generalised skeletal disorder, or one much less significant than FOP. Receptor-ligand BMP and Activins mediated interactions are instrumental in the intricate embryology of the great toe. Recognition of non-FOP conditions caused by alterations in different genes are likely to increase with new genomic technology and large gene panels, enhancing understanding of bone signaling pathways.

Child Age at Time of First Maternal Concern and Time to Services Among Children with Autism Spectrum Disorder.

Early treatment of autism spectrum disorder (ASD) can improve developmental outcomes. Children with ASD from minority families often receive services later. We explored factors related to child's age at time of mother's first concerns about child's development and subsequent time to service initiation among children with ASD. Analysis included 759 preschool-age children classified with ASD based on comprehensive evaluations. Factors associated with retrospectively reported child age at time of first maternal concern and subsequent time to service initiation were investigated using multiple linear regression and Cox proportional hazards. Earlier maternal concern was associated with multiparity, ≥1 child chronic condition, externalizing behaviors, and younger gestational age, but not race/ethnicity. Time to service initiation was longer for children of non-Latino Black or other than Black or White race and higher developmental level and shorter for children with ≥1 chronic condition and older child age at first maternal concern. Parity, gestational age, and child health and behavior were associated with child age at first maternal concern. Knowledge of child development in multiparous mothers may allow them to recognize potential concerns earlier, suggesting that first time parents may benefit from enhanced education about normal development. Race/ethnicity was not associated with child's age when mothers recognized potential developmental problems; hence, it is unlikely that awareness of ASD symptoms causes racial/ethnic disparities in initiation of services. Delays in time to service initiation among children from racial/ethnic minority groups highlight the need to improve their access to services as soon as developmental concerns are recognized.

Maternal concern and perception about child overweight risk, maternal feeding practices, and child eating behaviors: A cross-sectional study.

Abundant efforts have been directed to understand the global obesity epidemic and related obesogenic behaviors. However, the relationships of maternal concern and perception about child weight with child eating behaviors in Saudi Arabia have not been investigated. Therefore, this study aimed to examine the associations of maternal concern and perception about child overweight risk with maternal feeding practices and child eating behaviors among mothers and their children in Saudi Arabia. Mothers of 115 children aged 3-5 years old were recruited from eight preschools. Child eating behaviors (enjoyment of food, responsiveness to foods, food fussiness, satiety responsiveness, and slowness in eating) and maternal feeding practices (restriction, monitoring, and using food as a reward), maternal concern about child weight, and maternal perception about child overweight risk were assessed using validated questionnaires. Multiple linear regression models, adjusted for maternal body mass index (BMI) and child's BMI-z score and sex, were tested to examine the independent associations of maternal concern and perception about child overweight risk with child eating behaviors and maternal feeding practices. Maternal concern about child weight was positively associated with food enjoyment in children (B = 0.14 [95% confidence intervals = 0.02,0.27]) and responsiveness to food (B = 0.16 [0.03,0.29]), whereas a negative association with child food fussiness was observed (B = -0.19 [-0.33, -0.04]). Maternal perception about child overweight risk and child slowness in eating were negatively associated (B = -0.72 [-0.16 to -0.28]). Maternal concern and perception about child overweight risk were not associated with maternal feeding practices. In conclusion, maternal concern and perception about child overweight risk were found to be associated with food approach eating behavior traits but not with maternal feeding practices. Mothers who are concerned about child weight or perceive their children as overweight may need guidance and support to promote healthy eating behaviors among their children. Future cross-cultural studies are needed to understand the underlying mechanisms for the influence of maternal concern and perception about child overweight risk on maternal feeding practices, child eating behaviors, and weight status of children.

Maternal Worries During the COVID-19 Pandemic: A Cross-Sectional Study on Postpartum Women

Introduction:Since mothers often express higher levels of stress, anxiety and depression, it is important to evaluate the effect of Covid-19 on their mental health during pregnancy and postpartum.Objective:The aim of this study was to explore the concerns of mothers in the postpartum period amidst the Covid-19 pandemicMethods:This was a descriptive cross-sectional study on 600 postpartum mothers. The sample size was determined based on the households covered by the health centers. The selected mothers completed a demographic questionnaire and Cambridge Worry Scale (CWS).Results:The mean age of study participants was 28.9(6.3)and 364 (60.7%) mothers had excessive anxiety during pregnancy. The highest concern was related to the fear of congestion in the maternity ward with a mean of 2.48, and the lowest level of concern was related to the health status of the mother with a mean of 1.41.Conclusion:we recommend that the health sector adopt new methods of providing care to mothers. Implementation of tests for assessment of the mother's mental state during pregnancy by a midwife consultant is also recommended

Causes and Effects of COVID-19 Vaccine Hesitancy Among Pregnant Women and its Association with Adverse Maternal, Placental, and Perinatal Outcomes.

Populations identified to be severely affected by COVID-19, such as pregnant patients, require special consideration in vaccine counseling, access, and provider education. Maternal infection with COVID-19 poses a significant risk to the maternal-fetal dyad with known adverse placenta destruction [1-5]. Despite the widespread access and availability of vaccinations, vaccine hesitancy continues to persist and is highly prevalent in pregnant populations [6-9]. Addressing the multitude of social ecological factors surrounding vaccine hesitancy can aid in providing holistic counseling [10]. However, such factors are foremost shaped by maternal concern over possible fetal effects from vaccination. While changes in policy can help foster vaccine access and acceptance, increasing global provider education and incorporation of motivational interviewing skills are the first steps towards increasing maternal acceptance.

A systematic review of parental burnout and related factors among parents

BackgroundParenting is both a complex and stressful endeavor, so parents sometimes experience parenting burnout. The main objective of this study was to provide an overview of factors related to general parental burnout (PB) among parents with at least one child based on the Ecological Systems Theory (EST).MethodsPubMed, Web of Science, EBSCO, CNKI and WanFang were systematically searched for studies published from 2010 to July 2023 for peer-reviewed articles using keywords extracted from Medical Subject Headings such as “parenting”, “parental”, “burnout”, “psychological burnout”, “burn-out syndrome”. Studies were included if they described associations between factors and PB among parents of children aged 0-18 years old in the general population, and published in an English or Chinese language peer-reviewed journal. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was employed to assess the risk of bias of included studies.ResultsOf 2037 articles, 26 articles met the inclusion criteria. Based on the Ecological Systems Theory (EST), we found that microsystem-individual factors such as gender, educational level, income, parental personality, internalization of maternal parental motivation, unmitigated communion, self-compassion and concern for others, alexithymia, anxiety and depressive symptoms, parental perfectionism, resilience, low self-esteem and high need for control, mother's attachment style were identified as being associated with parenting burnout. Mesosystem-interpersonal factors involve parent-child relationship and marital satisfaction. The exosystem-organizational or community factors include the number of children in the household, neighborhood and the number of hours spent with children, child's illness, child's behavior problems and social support. The macrosystem-society/policy or culture factors are mainly personal values and cultural values.ConclusionsThis systematic review found several factors that have been investigated in relation to PB. However, the majority of the factors were reported by one or two studies often implementing a cross-sectional design. Nevertheless, we still recommend that health policymakers and administrators relieve parenting burnout among parents with children by adjusting these modifiable factors.

Maternal worry of children contracting COVID-19 predicts vaccine uptake in young children in Vermont

BackgroundYoung children, 6 months to 4 years of age, were the last population for whom the COVID-19 vaccines became available and remain the group with the lowest uptake. Scarce information exists on drivers of vaccine uptake in young children. The relationship between parental perceived risk of infection and child COVID-19 vaccination is unknown. ObjectiveExamine the association between perceived risk of infection and early childhood vaccination. MethodsIn June 2020, perinatal women in Vermont were enrolled in a longitudinal survey study assessing life changes during the pandemic. Surveys included worry of infection, Parents Attitude about Childhood Vaccines (PACV), intention to vaccinate children with the COVID-19 vaccine, and masking behaviors. Once vaccines became available, surveys also included child vaccination status. A demographic-adjusted stepwise logistic regression was conducted to assess the relationship of worry of infection and vaccine hesitancy on child vaccination status. Results85 women completed baseline and follow up surveys. Participants were highly adherent to adult COVID vaccines with 93 % at least partially vaccinated and only 3 % demonstrated general childhood vaccine hesitancy on the PACV. However, in this highly adherent population, only 61 % of young children are vaccinated. In univariate [OR = 7.35 95 % CI (2.70 to 20.02)] and demographic adjusted [OR = 6.03 95 % CI (1.30 to 27.90)] models, current worry about child infection was associated with higher odds of child vaccination. Previously established predictors, vaccine hesitancy [OR = 0.91 95 % CI (0.84 to 0.99)] and younger maternal age [OR = 1.33 95 % CI (1.07 to 1.65)] were again associated lower odds of child vaccination. ConclusionAmong vaccine adherent parents, worry of infection was a strong predictor of vaccine uptake. Continued efforts to articulate the potential morbidity of COVID in young children, along with established methods to address general vaccine hesitancy may aid in COVID vaccine uptake in this population.

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth.

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana.

Postpartum depression is a well-known maternal health care concern. For women using substances or experiencing underlying mental health conditions, incidence of postpartum depression is higher than that of the general population. The purpose of this study was to identify barriers and facilitators associated with seeking mental health care among women with substance use disorder or mental health concerns. Qualitative methods using interviews were conducted via the narrative inquiry approach. Women receiving care at a clinic in rural Montana and reporting substance use or mental health concerns were referred to the research team by the care manager. Participants were at least 18 years of age, English speaking, and pregnant or within 12 months postpartum at time of referral. Twenty-five women met inclusion criteria and were referred for potential study participation. Seven women were interviewed. Four themes on family history, stigmatization, lack of postpartum depression awareness, and isolation were identified. Our findings provide a better understanding of barriers and facilitators to seeking mental health care during pregnancy and postpartum among women living in rural areas with mental health concerns or perinatal substance use. An environment where opportunities for women to receive mental health care in a location that is free of stigma and judgment, while understanding the effects of familial trauma and limited or inconsistent social support, is essential to promote optimal outcomes.

Relation of Maternal Temperament, Body Dissatisfaction, and Concern About Child’s Weight to Maternal Child Feeding Practices: A Cross-Sectional Study

Child feeding practices are effective in children’s eating. This study examines the relation of maternal temperament, body dissatisfaction, and concern about child’s weight to child feeding practices. The sample comprised 3- to 6-year-old children and mothers. The Child Feeding Questionnaire, Nine Types Temperament Model, and Stunkard Figure Rating Scale were used. Correlation and regression were conducted. Parental perceived responsibilities and controlling increased as concerns about child’s weight increased. Type 1 and 3 temperaments seeking perfection and an admirable image, respectively, displayed more restriction. The findings demonstrate the need for considering temperament during interventions for child feeding practices as well as healthier body image.

Maternal Feeding Beliefs and Behaviors Relate to Infant Diet and Appetite.

Maternal feeding practices may be linked to infant obesogenic outcomes, but research to date has focused primarily on infant growth as an outcome of maternal feeding practices rather than exploring additional obesogenic outcomes like infant appetite and diet. Therefore, the current study examined the association between maternal feeding practices and beliefs and infant growth, diet, and appetite simultaneously at a critical timepoint for obesity risk development (i.e., 3-months-old). Thirty-two 3-month-old infants and their mothers participated in this cross-sectional study. Infant anthropometrics were collected by trained staff and mothers completed questionnaires regarding maternal feeding practices and beliefs and infant diet and appetite. The data were analyzed by Spearman correlations. Statistically significant correlations were identified between maternal feeding practices (e.g., using food to calm, concern about infant weight) and infant satiety, appetite, food responsiveness, slow eating, and kilocalories consumed. Infant weight-for-length was related to maternal concern about infant underweight and mother-infant social interaction during feeding. These findings highlight the importance of the mother-infant feeding relationship and how these associations may influence responsive feeding practices and infant weight-related outcomes.

Parental Worry About COVID-19 in Preschool Children's Mothers During the Pandemic Waves: The Role of Maternal Negative Feelings and Parenting Styles.

This cross-sectional study explores the relationship between maternal feelings, maternal parenting styles, and mothers' worry about COVID-19's detrimental consequences on preschool children's health and well-being. The study is among the first to concentrate on this reference specific group, whose characteristics might be particularly vulnerable to COVID-19's adversities. One hundred and four mothers of at least one preschool-age child completed an online questionnaire battery, which included the Parental Feelings Inventory, the Parenting Styles and Dimensions Questionnaire (PSDQ), and the parental worry about COVID-19 scale. Negative maternal feelings (i.e., anger, anxiety/sadness) were associated with authoritarian and indulgent parenting practices, especially verbal hostility, while maternal happiness was associated with more authoritative practices, especially warmth and support. The hierarchical multiple regression model explained about 42% of variance of the overall maternal worry about COVID-19 from maternal negative feelings and parenting styles, with maternal authoritative parenting and maternal anxiety/sadness as the significant predictors that uniquely explain maternal worry about COVID-19. These results are discussed in terms of positive and negative maternal worry, which partially reflect the differences between overprotective and authoritative parenting in early childhood.

The impact of the 2019/2020 Australian landscape fires on infant feeding and contaminants in breast milk in women with asthma

BackgroundThe 2019/2020 Australian landscape fires (bushfires) resulted in prolonged extreme air pollution; little is known about the effects on breastfeeding women and their infants. This study aimed to examine the impact of prolonged landscape fires on infant feeding methods and assess the concentration of polycyclic aromatic hydrocarbons (PAHs) and elements in breast milk samples.MethodsFrom May – December 2020, women with asthma, who were feeding their infants during the fires, were recruited from an existing cohort. Data on infant feeding and maternal concern during the fires were retrospectively collected. Breast milk samples were collected from a sample of women during the fire period and compared with samples collected outside of the fire period for levels of 16 PAHs (gas chromatography coupled with mass spectrometry), and 20 elements (inductively coupled plasma-mass spectrometry).ResultsOne-hundred-and-two women who were feeding infants completed the survey, and 77 provided 92 breast milk samples. Two women reported concern about the impact of fire events on their infant feeding method, while four reported the events influenced their decision. PAHs were detected in 34% of samples collected during, versus no samples collected outside, the fire period (cross-sectional analysis); specifically, fluoranthene (median concentration 0.015 mg/kg) and pyrene (median concentration 0.008 mg/kg) were detected. Women whose samples contained fluoranthene and pyrene were exposed to higher levels of fire-related fine particulate matter and more fire days, versus women whose samples had no detectable fluoranthene and pyrene. Calcium, potassium, magnesium, sodium, sulphur, and copper were detected in all samples. No samples contained chromium, lead, nickel, barium, or aluminium. No statistically significant difference was observed in the concentration of elements between samples collected during the fire period versus outside the fire period.ConclusionsFew women had concerns about the impact of fire events on infant feeding. Detection of fluoranthene and pyrene in breast milk samples was more likely during the 2019/2020 Australian fire period; however, levels detected were much lower than levels expected to be related to adverse health outcomes.

The effect of maternal empathy on infants' attachment security: Moderation by maternal emotion regulation and infant temperament.

This study examined the relationship between maternal empathy and infants' attachment security and tested the moderating effects of maternal emotion regulation and infant negative emotional temperament. Participants were sampled from 215 families whose infants were 6months old (T1) and from 170 families of the same cohort whose infantswere 14 months old (T2). At T1, mothers were measured for their empathy (empathic concern and perspective taking), emotion regulation (reappraisal and suppression), and infant negative emotional temperament (sadness, falling reactivity, fear, and distress to limitations). At T2, mothers were again measured for their emotion regulation, and infant attachment was measured using the Strange Situation Procedure. Maternal empathic concern (EC) and perspective taking (PT) were found to be positively related to infant attachment security, while maternal reappraisal and infant temperamental sadness moderated the relationship between maternal PT and infant attachment security. No significant moderation effects were found between maternal EC and infant attachment security. Simple slope results showed that for infants with higher maternal reappraisal or infant sadness, maternal PT could positively predict infant attachment security. These findings highlight the importance of how the individual characteristics of mothers and infants may interact with maternal empathy during the critical period of infant attachment formation.

Trauma-informed care for perinatal women during the COVID-19 pandemic: A survey of nurses and midwives in Turkey

ObjectivesThere is a paucity of evidence on the provision of trauma-informed care among nurses and midwives during the pandemic.Therefore, this online survey of Turkish nurses and midwives aimed to: describe reported maternal concerns and anxieties during the COVID-19 pandemic; and explore aspects of trauma-informed care for perinatal women during the COVID-19 pandemic (i.e., nurses’ and midwives’ knowledge, opinions, perceived competence, current practices, and implementation barriers). DesignA cross-sectional descriptive survey design. Setting and participantsA web-based survey conducted between June 2021 to December 2021. A total of 102 nurses and midwives comprised the final sample of this study. FindingsThe safety of COVID-19 vaccine was both the most common maternal concern (73%) and the most frequently noted maternal source of anxiety (79%) reported to nurses and midwives by perinatal women. Most nurses and midwives were knowledgeable of, held favorable opinion about, and perceived moderate competence in trauma-informed care. The most frequently provided practice was encouraging mothers to make use of their own social support system (82%). Time constrains and lack of resources were perceived as somewhat to significant barriers to providing trauma-informed care during the pandemic. ConclusionsAccess to correct information related to COVID-19 vaccination is necessary to reduce maternal anxiety. Since perinatal nurses and midwives had favorable opinions concerning implementing trauma-informed care, successful strategies for mitigating the implementation barriers are essential to facilitate the provision of trauma-informed care during the pandemic.

Abstract 15303: Maternal Features for Live Births in Fontan Patients

Introduction: As the population of women with congenital heart disease with prior Fontan palliation (PFPs) increases, doubling in size over the next 20 years, there will be a concordant need for multidisciplinary obstetrics care. There is an increased prevalence of miscarriage, maternal and fetal complications including arrhythmias, heart failure, premature birth, and neonatal death. We sought to review our single center experience in the context of an established cardio-obstetrics multidisciplinary team. Methods: Single-center retrospective cohort study of PFPs with live births who received care at our cardio-obstetrics clinic. A chart review was performed to identify maternal characteristics as well as fetal outcomes. Descriptive statistics were calculated using R Studio Statistical Software version 1.2.5033.Result: Ten women with PFPs and live births were identified. None had more than one live pregnancy. The average number of pregnancies was 2 (range 1-6). The mean gestational age was 31.2 weeks (range 23-37). Five patients were primigravida. Six of the pregnancies were planned and eight received preconception counseling. Baseline NYHA was 50% class I and 50% class II. The most common maternal comorbidity in patients with a live pregnancy was atrial arrhythmia, and the most common pre-pregnancy medication was warfarin. Prematurity, low birth weight, and associated comorbidities (see table 1) were common in this population. The average birthweight was 1,589g (range 460g-2210g). Indication for delivery was more commonly obstetric than maternal concern. No maternal strokes, thromboembolic events, cardiac arrests, maternal or infant deaths and rehospitalizations were noted. Conclusion: Maternal and fetal complications in mothers with PFP are common. A multidisciplinary approach in a specialized cardio-obstetrics clinic has the potential to improve outcomes. Larger cohort and long term outcomes are needed in this patient population.

Mother's Anxiety Level With Readiness Before Delivery at PMB Deli Serdang

Mother's readiness before delivery should be a priority for mothers and health workers in pregnancy services, because it can lead to excessive maternal worry in the face of childbirth. The purpose of this study was to analyze the relationship between the level of maternal anxiety before delivery which took place at the Independent Midwife Practice of Deli Serdang Regency. This study is an explanatory research. The population in this study were pregnant women in the third trimester with a sample of 60 respondents. The results obtained p value = 0.001 &lt;0.05, which means that there is a significant relationship between the level of maternal anxiety and readiness for delivery. Suggestions according to the results of the study are that it is considered necessary to provide education for pregnant women to reduce the level of maternal anxiety before childbirth. As well as motivating mothers to visit health services to get ante-natal services according to standards based on gestational age, especially before delivery, thereby reducing anxiety when facing childbirth.

Maternal postnatal depression and offspring depression at age 24 years in a UK-birth cohort: the mediating role of maternal nurturing behaviours concerning feeding, crying and sleeping.

Background: Maternal postnatal depression (PND) is a risk factor for offspring depression in adulthood. However, few longitudinal studies have examined the role of maternal nurturing parenting behaviours in the association between maternal PND and offspring depression in adulthood. Methods: We examined pathways from maternal PND measured using self-reported Edinburgh Postnatal Depression Scale at 8 weeks to offspring ICD-10 depression diagnosed using the Clinical Interview Schedule-Revised computerised assessment at 24 years through maternal-reported nurturing behaviours concerning feeding, sleeping and crying measured from pregnancy to age 3 years 6 months in 5,881 members of the UK-based birth cohort study, the Avon Longitudinal Study of Parents and Children. Results: The fully adjusted model revealed an indirect effect from PND to adult offspring depression through the combination of all parenting factors (probit regression coefficient [ B]=0.038, 95% confidence interval [CI] 0.005, 0.071); however, there was no evidence of a direct effect from early maternal PND to offspring depression once the indirect effect via parenting factors was accounted for ( B=0.009, 95%CI -0.075, 0.093). Specificity analyses revealed indirect effects through maternal worries about feeding ( B=0.019, 95%CI 0.003, 0.035, p=0.010) and maternal perceptions and responses to crying ( B=0.018, 95%CI 0.004, 0.032, p=0.012). Conclusions: The adverse impact of maternal PND on offspring depression in early adulthood was explained by maternal nurturing behaviours concerning feeding, crying and sleeping in early childhood. Residual confounding and measurement error likely limit reliable conclusions. If found causal, interventions providing support to reduce worries around maternal nurturing behaviours and treating depression could reduce adverse outcomes in adult offspring of depressed mothers.