Prenatal Intervention Research Articles

The Impacts of a Multifaceted Prenatal Intervention on Human Capital Accumulation in Early Life

We evaluate an intervention targeting early life nutrition and well-being for households in extreme poverty in Northern Nigeria. The intervention leads to large and sustained improvements in children’s anthropometric and health outcomes, including an 8 percent reduction in stunting 4 years, post-intervention. These impacts are partly driven by information-related channels. However, the certain and substantial flow of cash transfers is also key. They induce positive labor supply responses among women, and enables them to undertake productive investments in livestock. These provide protein rich diets for children, and generate higher household earnings streams long after the cash transfers expire. (JEL I12, I32, I38, J13, J16, J22, O12)

Fetal brain issues in congenital heart disease.

Following the improvements in the clinical management of patients with congenital heart disease (CHD) and their increased survival, neurodevelopmental outcome has become an emerging priority in pediatric cardiology. Large-scale efforts have been made to protect the brain during the postnatal, surgical, and postoperative period; however, the presence of brain immaturity and injury at birth suggests in utero and peripartum disturbances. Over the past decade, there has been considerable interest and investigations on fetal brain growth in the setting of CHD. Advancements in fetal brain imaging have identified abnormal brain development in fetuses with CHD from the macrostructural (brain volumes and cortical folding) down to the microstructural (biochemistry and water diffusivity) scale, with more severe forms of CHD showing worse disturbances and brain abnormalities starting as early as the first trimester. Anomalies in common genetic developmental pathways and diminished cerebral substrate delivery secondary to altered cardiovascular physiology are the forefront hypotheses, but other factors such as impaired placental function and maternal psychological stress have surfaced as important contributors to fetal brain immaturity in CHD. The characterization and timing of fetal brain disturbances and their associated mechanisms are important steps for determining preventative prenatal interventions, which may provide a stronger foundation for the developing brain during childhood.

Associations between Physiological Biomarkers and Psychosocial Measures of Pregnancy-Specific Anxiety and Depression with Support Intervention.

Stress and anxiety significantly impact the hypothalamic–pituitary axis, and in pregnancy, the subsequent maternal–fetal response can lead to poor outcomes. The objective of this study was to assess the association between psychosocial measures of pregnancy-specific anxiety and physiologic inflammatory responses. Specifically, to determine the effectiveness of the Mentors Offering Maternal Support (M-O-M-STM) program to reduce psychosocial anxiety and associated inflammatory response. In conjunction with measures of pregnancy-specific anxiety and depression, serum biomarkers (IL-2, IL-6, IL-10, IL1-B, TNF-α, CRH, CRP, and cortisol) were analyzed for each trimester throughout pregnancy. Results demonstrated that women receiving the M-O-M-STM intervention had longitudinally sustained lower TNF-α/IL-10 ratios than the control group, and it was significantly associated with psychosocial measures of anxiety, specifically for fears of labor and spouse/partner relationships. Additionally, the anxiety of spouse/partner relationships was significantly associated with IL-6/IL-10 ratios. The findings highlight the important counter-regulatory relationship between anti- and pro-inflammatory cytokines and provide insight into the distinct physiologic responses to pregnancy-specific anxiety with early prenatal intervention.

A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: a randomized, controlled pilot and feasibility trial

BackgroundDespite numerous benefits for both mom and baby, few infants are exclusively breastfed for the recommended first six months. Additionally, infants are given solids too early. Prenatal education increases rates of breastfeeding initiation and we hypothesize it can also improve exclusive breastfeeding rates and prevent the early introduction of solids. We conducted a randomized controlled pilot and feasibility trial to understand the feasibility and maternal acceptance of a prenatal behavioral lifestyle intervention (PBLI) delivered via group based phone counseling (GBPC) and its effectiveness on rates of exclusive breastfeeding up to six months postpartum. Secondary aims included rates of any breastfeeding up to six months, rates of early introduction of solids, and infant feeding progression.MethodsForty-one pregnant women were recruited from a Kansas City Metropolitan Obstetrics and Gynecology office and randomly assigned to a usual care group or a PBLI. Women in the PBLI participated in six GBPC sessions where they learned about breastfeeding and introducing solids. Feeding questionnaires to assess breastfeeding and introduction of solids were sent at two weeks, two months, four months, and six months postpartum. Structured interviews were also conducted after the intervention and at six months postpartum to assess maternal acceptance and intervention feasibility.ResultsParticipants overwhelmingly found the intervention acceptable and beneficial.Rates of exclusive breastfeeding and any breastfeeding did not differ between groups at any time point. No between group differences were found for early introduction of solids or infant feeding progression.ConclusionsMothers discontinue breastfeeding earlier than recommended despite high rates of initiation. A PBLI delivered via GBP is feasible, acceptable to participants, and showed positive impacts such as maternal empowerment for both breastfeeding and introducing solids. Future interventions should incorporate both prenatal and postpartum components.Trial registrationStudy protocols were approved by the University of Kansas Medical Center’s Human Subjects Committee (STUDY00140506) and registered at ClinicalTrials.gov on 02/22/2018 (NCT03442517, retrospectively registered). All participants gave written informed consent prior to data collection.

The emotional tone of child descriptions during pregnancy is associated with later parenting.

How parents think and feel about their young children has implications for the parent-child relationship. We examined prospective associations between prenatal descriptions of the unborn child's personality and later parenting behavior. Pregnant women (N = 120; mean age = 26.16, SD = 5.71) were recruited in their third trimester for a longitudinal study. The sample is demographically diverse and predominantly economically disadvantaged. During prenatal interviews, women described their unborn child's personality, from which positive and negative emotion words were coded. Parenting behavior was coded 12 months postpartum (n = 105 for longitudinal analyses). Use of positive and negative words was negatively correlated (r = -.34, p<.001). Greater use of positive words to describe the unborn child's personality was associated with higher observed sensitivity, warmth, and engagement during mother-infant interactions, whereas negative words were associated with higher interference and lower levels of sensitivity. Mothers who used anxiety- and/or anger-related words to describe their unborn child, relative to mothers who did not, demonstrated higher interference and lower warmth and sensitivity. Descriptions of a child's personality before the child is born were associated with postnatal parenting behavior. Prenatal interventions that address negative thoughts and feelings regarding the child may be beneficial for promoting positive parenting postnatally.

Testing the effects of a prenatal depression preventive intervention on parenting and young children\u2019s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

BackgroundPerinatal depression is a pervasive public health concern that disproportionately affects low-income women and can have negative impacts on parenting and child developmental outcomes. Few interventions focus on preventing perinatal depression. Previous studies suggest that Mothers and Babies is efficacious in preventing the worsening of depressive symptoms and the onset of postpartum depression. This manuscript presents the protocol of the EPIC study (Effects of a Prenatal Depression Preventive Intervention on parenting and young children’s Self-Regulation and Functioning) to test the effects of Mothers and Babies on parenting and child developmental outcomes through 54 months postpartum. EPIC is an observational study that builds on a completed cluster-randomized trial (CRT). Innovations of this study are direct observations of a subsample of mother-child dyads and the inclusion of fathers/caregivers’ variables as moderators of maternal mental health.MethodsFor this study, we plan to enroll 738 women with children under 30 months old, ≥18 years old, and who speak English or Spanish. Additionally, 429 fathers, partners, or other adult caregivers will be recruited through women participating in the study. Women will be recruited through the parent study (intervention and control participants) or through one of 10 home visiting programs in Illinois (control participants). Data collection will take place through maternal self-report at five time points (when the child is 30, 36, 42, 48, and 54 months), paternal self-report at three time points (when the child is 30, 42, and 54 months), and through mother-child observations at three time points (when the child is 36, 42, and 48 months). Outcome domains include maternal mental health, cognitive-behavioral and parenting skills, and child self-regulation and functioning. Moderators include the contributions of fathers/caregivers, race-ethnicity, and socioeconomic disadvantage. Power and sample size were calculated assuming a two-sided 5% type I error rate and assumed analyses on the individual level.DiscussionThis study has several key strengths and innovations, as well as great potential significance to influence the long-term trajectories of parenting and child development via prenatal intervention.Trial registrationThe study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT04296734) on March 5, 2020.

Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial

Background Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem. Aims This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups. Methods A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes. Results The results supported greater improvement in terms of perceived stress (Wald χ 2=26.94, p<0.001), fatigue (Wald χ 2=17.61, p<0.001), positive affect (Wald χ 2=9.03, p = 0.011), negative affect (Wald χ 2=11.37, p = 0.003), and mindfulness (Wald χ 2=24.97, p<0.001) in the intervention group than in the control group. Conclusions The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.

Feasibility of a Perinatal Mindfulness-Based Intervention Delivered Remotely Due to COVID-19

Mind–body interventions have shown promise for improving prenatal mental health. The purpose of this study was to investigate the feasibility of a prenatal mind-body intervention delivered remotely due to COVID-19 and preliminary efficacy with respect to mental health outcomes. This study used a simultaneous mixed methods approach (n = 27). Mixed methods data were collected to evaluate the feasibility and preliminary efficacy of the remotely delivered program (I.e., acceptability, practicality, demand, sustainability). Findings suggests that remote delivery of the Mindful Moms-to-Be program is acceptable. Half of the sample (45%) reported that they felt remote participation was more acceptable compared to in-person programming and approximately 1/3 reported that either format would be acceptable. Additionally, 36% of participants reported that remote participation did not impact their ability to participate and 46% reported that it increased their ability to participate. A majority (63%) of participants reported feeling moderately or extremely likely to sustain the habits learned in the program after birth. Finally, after participating in the program, participants reported statistically significant increases in resilience (t (26) = -3.89, p&lt;.01) and statistically significant decreases in stress (t (26) = 3.45, p&lt;.01), depression (t (26) = 4.04), and anxiety (t (26) = 4.23, p&lt;.01). Remotely delivered mind-body interventions may be feasible for pregnant individuals, increase demand, and potentially lead to sustainable changes in the postpartum period. Participation in Mindful Moms-to-Be may significantly mitigate negative mental health outcomes, including anxiety, during pregnancy.

Prenatal Yoga and Mental Health During the COVID-19 Pandemic: A Randomized-Control Trial.

Studies have demonstrated that new and expectant mothers experience increased levels of stress and anxiety during the COVID-19 pandemic. Though prenatal yoga is an effective mode of improving mental health during pregnancy, no research has evaluated its effect on mental health during times of extreme stress, such as a global pandemic. The purpose of this study was to determine the influence of a single session and a 10-week prenatal yoga intervention on the mental health of pregnant women during the COVID-19 pandemic. Women (n = 19; 28.52 ± 3.74 years; 20.94 ± 4.69 weeks gestation; BMI 29.33 ± 9.08) were randomized into a yoga or a non-yoga control group. There were no differences in demographic factors or depression/anxiety scores between groups at baseline. Baseline levels of anxiety and depression were high, with an average depression score of 8.10 ± 4.85 (scores > 8 represent possible depression) and an average anxiety score of 39.26 ± 12.99 (scores ≥ 39 represent a clinically significant anxiety). After just one session of yoga, women reported feeling less depressed (p = 0.028), tense (p < 0.001), and fatigued (p = 0.004). After 10 weeks, the yoga group had lower anxiety (p = 0.002), depression (p = 0.032), and total mood disturbance (p = 0.002) scores when compared to the control group. Yoga appears to benefit the mental health of expectant mothers, even in times of extreme stress. The findings of this study provide clinicians with valuable information regarding alternative exercise options for mental health during pregnancy during the COVID-19 pandemic.

High Familial Recurrence of Congenital Heart Defects in Laterality Defects Patients: An Evaluation of 184 Families

As a rare disease with genetic pathogenesis, observational study about familial CHD recurrence risk on CHD patients with laterality defects is lacking. This study aimed to investigate familial recurrence among families of patients with CHD and laterality defects, and compare them with CHD patients without laterality defects. A total of 184 patients with CHD and laterality defects treated in Cardiovascular Center, Children’s Hospital of Fudan University were observed from 2008 to 2019. A detailed family history was documented by trained staff using questionnaires, and information about the subtypes of CHD and laterality defects was also collected. In addition, positive family history information, including all three degrees relatives and all affected family members, was reconfirmed by trained medical staff through face-to-face interviews, telephone interviews, and letter return visits. Of the 184 included patients, 30 had at least one family member (from among three linear generations and distant relatives) with CHD. The familial recurrence rate of CHD in our cohort was 16.3% (30/184), which was higher than the 3.3% (67/2024) of patients with CHD without laterality defects. This result shows that the recurrence rate among the first-, second-, and third-degree relatives was 11.7% (11/94), 1.5% (3/204), and 3.1% (6/91) and that the recurrence rate among siblings (21.4%, 9/42) was higher than that among parents (3.8%, 2/52). The familial recurrence risk of CHD among patients with CHD and laterality defects is high, which is consistent with the previous study that reported a high familial recurrence of heterotaxy of 10%. First-degree relatives have a higher recurrence rate than second- and third-degree relatives, especially siblings. These findings have important significance for prenatal screening, intervention, and genetic counseling in the Chinese population, but may not be generalizable to other populations that may have different rates of familial and sporadic cases.

Extracellular Vesicles and Their miRNA Content in Amniotic and Tracheal Fluids of Fetuses with Severe Congenital Diaphragmatic Hernia Undergoing Fetal Intervention.

Infants with congenital diaphragmatic hernia (CDH) are at high risk of postnatal mortality due to lung hypoplasia and arterial pulmonary hypertension. In severe cases, prenatal intervention by fetal endoscopic tracheal occlusion (FETO) can improve survival by accelerating lung growth. However, postnatal mortality remains in the range of about 50% despite fetal treatment, and there is currently no clear explanation for this different clinical response to FETO. We evaluated the concentration of extracellular vesicles (EVs) and associated microRNA expression in amniotic and tracheal fluids of fetuses with CDH undergoing FETO, and we examined the association between molecular findings and postnatal survival. We observed a higher count of EVs in the amniotic fluid of non-survivors and in the tracheal fluid sampled in utero at the time of reversal of tracheal occlusion, suggesting a pro-inflammatory lung reactivity that is already established in utero and that could be associated with a worse postnatal clinical course. In addition, we observed differential regulation of four EV-enclosed miRNAs (miR-379-5p, miR-889-3p; miR-223-3p; miR-503-5p) in relation to postnatal survival, with target genes possibly involved in altered lung development. Future research should investigate molecular therapeutic agents targeting differentially regulated miRNAs to normalize their expression and potentially improve clinical outcomes.

Dietary Practices Among Pregnant Women in Rural Amhara, Ethiopia

ObjectivesMalnutrition affects 25% of women in Ethiopia. We are conducting a study to determine the impact of a prenatal nutrition intervention on maternal and infant health in Ethiopia. The objective of this formative study was to better describe dietary practices among pregnant women and community members in rural Ethiopia prior to initiation the parent study. MethodsThis formative study was conducted from October-November 2018 among pregnant women and community members in the rural Amhara region of Ethiopia, prior to the “Enhancing Nutrition and Antenatal Infection Treatment (ENAT)” study [ISRCTN15116516]. 28 in-depth interviews (IDIs) were conducted among 16 pregnant women and 12 community members. IDIs were recorded, transcribed, and translated. We used a grounded theory approach and inductive reasoning for content analysis of interview transcripts. ResultsFasting norms in the Ethiopian Orthodox religion had a significant impact on dietary behaviors which occurs for more than 200 days annually. Community members indicated that fasting during pregnancy is common and is also supported and encouraged by religious leaders and community members. Accordingly, women adhered to fasting restrictions during pregnancy, and many women maintained a vegan diet under direction of local religious leaders. Furthermore, many women reported restricting dietary intake in pregnancy to prevent growth of the fetus because of the concern for obstructed labor. A women’s diet depended on her husbands’/family earnings and household food preferences. Sharing of meals is a cultural norm; the husband is served first, with the remaining portions to the pregnant women/children. Pregnant women in the area also reported regular consumption of a locally brewed alcohol (“tella”), as it is believed to have lower alcohol levels. These findings demonstrate the impact of traditional and cultural beliefs on dietary decisions amongst pregnant women in this population. ConclusionsReduced food intake in pregnancy is common in this population, due to fasting, reduced appetite, and food restriction to avoid pregnancy complications. Context-specific interventions are needed, and this formative work will inform the future delivery and education regarding nutrition interventions in rural Ethiopia. Funding SourcesBill & Melinda Gates Foundation (OPP1184363).

A Role for the Pregravid Maternal Milieu in the Intergenerational Transmission of Obesity

ObjectivesMaternal obesity increases the risk for adverse pregnancy and offspring outcomes; however, with large heterogeneity. We hypothesize that in mothers with obesity, the heterogeneity of offspring adiposity is due to prolonged exposure to excess maternal substrates, namely glucose and triglycerides, which promote fetal fat accretion. The aims of this prospective observational study were to 1) examine the maternal metabolic milieu in pregnant women with metabolically unhealthy obesity, MUO and metabolically healthy obesity, MHO; and 2) identify if these maternal metabolic phenotypes in women with obesity influence infant adiposity. MethodsDuring early pregnancy, 51 women with obesity were classified to have MUO (n = 9) or MHO (n = 13) based on the presence of zero (MHO) or ≥ 2 (MUO) risk factors for metabolic syndrome (SBP > 130 or DBP > 85, HDL < 50 mg/dL, LDL ≥ 100 mg/dL, triglycerides ≥ 150 mg/dL, and glucose ≥ 100 mg/dL). Area under the pregnancy concentration curve (AUC) for glucose and triglycerides, gestational weight gain (GWG), fat accretion, and energy intake and expenditure from early (13–16 wks), mid (24–27 wks) to late (35–37 wks) pregnancy and infant fat mass were compared between groups. ResultsCompared to women with MHO, women with MUO were not different with respect to maternal BMI, GWG, fat accretion, energy and macronutrient intake, and energy expenditure. In both groups, maternal substrates changed similarly from ∼13 to ∼37 weeks of pregnancy, however MUO resulted in greater pregnancy AUC for glucose (+2169.7 ± 381.5 p < 0.001 mg/dL · day) and triglycerides (+12,210.5 ± 3916.1 mg/dL · day, p < 0.001). The offspring of women with MHO had significantly lower birth weight (–620.8 ± 204.6 g, p = 0.01), body fat percentage (–5.8 ± 2.1%, p = 0.02), and total fat mass (–268.8 ± 88.4 g, p = 0.01). ConclusionsDiffering obesity phenotypes in pregnancy may explain the heterogeneity of offspring adiposity. Metabolically unhealthy obesity resulted in a more prolonged exposure of fetal fat promoting substrates and increased adiposity at birth. This study identifies a population of women with obesity most in need of prenatal interventions and suggests that obesity phenotypes need to be considered when evaluating intervention effect on offspring outcomes. Funding SourcesR01DK099175.

Internet-based prenatal interventions for maternal health among pregnant women: A systematic review and meta-analysis

PurposeThis study investigated the effect of internet-based prenatal interventions among pregnant women. MethodsArticles regarding randomized controlled trials of internet-based prenatal education interventions were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, Cochrane Library, Embase, ERIC, and RISS on material published between 1985 and 2020. The inclusion criteria were peer-reviewed papers in English regarding randomized controlled trials of internet-based prenatal education interventions. The exclusion criteria were studies in which high-risk pregnant women participated, interventions that were conducted face-to-face or only involved telephone contact, and studies that reported outcomes related to the baby’s health. The quality of the included studies was evaluated using the Risk of Bias 2.0 methodology checklist. ResultsHeterogeneity testing suggested a homogeneous sample (I2 = 0%, p = .45). Meta-analysis through standardized mean differences showed that six studies had an effect on postpartum depression, with an effect size of −0.16 (95% CI, −0.26 to −0.05). Conclusion: This study demonstrated that internet-based prenatal interventions had an impact on maternal depression during the postpartum period. Therefore, antenatal care involving mobile-, web-, and internet-based materials may reduce maternal depressive symptoms.

The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations

It is the position of the Academy of Nutrition and Dietetics (Academy) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life; from 6 months until at least 12 months, breastfeeding should continue with the introduction of complementary foods. 1 Centers for Disease Control and Prevention, Department of Health and Human ServicesProposed data collection submitted for public comment and recommendations. https://www.federalregister.gov/documents/2020/05/15/2020-10412/proposed-data-collection-submitted-for-public-comment-and-recommendationsDate accessed: February 9, 2021 Google Scholar This position is similar statements from the World Health Organization (WHO) 2 World Health OrganizationPromoting proper feeding for infants and young children. http://www.who.int/nutrition/topics/infantfeeding/en/Date accessed: June 26, 2020 Google Scholar and the American Academy of Pediatrics (AAP). 3 Gartner L.M. Morton J. Lawrence R.A. et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115: 496-506https://doi.org/10.1542/peds.2004-2491 Crossref PubMed Scopus (2144) Google Scholar ,4 Section on BreastfeedingBreastfeeding and the use of human milk. Pediatrics. 2012; 129: e827-e841https://doi.org/10.1542/peds.2011-3552 Crossref PubMed Scopus (3197) Google Scholar Breastfeeding initiation rates have been increasing in the United States: from 35% of infants in 2000 to 82% in 2020. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar But disparities exist: 74% of non-Hispanic Black infants have been breastfed compared with 87% of non-Hispanic white infants. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar Income-eligible infants participating in the US Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is about 44.6% of all infants born in the United States, are 17% more likely to use infant formula than infants who are not WIC eligible. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar ,9 Gray K. Trippe C. Tadler C. Perry C. Johnson P. Betson D. National- and state-level estimates of WIC eligibility and WIC program reach in 2017 final report: volume I. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2017-Volume1.pdfDate accessed: March 19, 2021 Google Scholar Mothers participating in WIC differ from eligible nonparticipants who are more likely to have characteristics associated with increased breastfeeding. 7 Gregory E.F. Gross S.M. Nguyen T.Q. Butz A.M. Johnson S.B. WIC participation and breastfeeding at 3 months postpartum. Matern Child Health J. 2016; 20: 1735-1744https://doi.org/10.1007/s10995-016-1977-1 Crossref PubMed Scopus (12) Google Scholar Women of color and those living below the federal poverty level face barriers hindering breastfeeding initiation and duration. 8 Schreck P.K. Solem K. Wright T. Schulte C. Ronnisch K.J. Szpunar S. Both prenatal and postnatal interventions are needed to improve breastfeeding outcomes in a low-income population. Breastfeed Med. 2017; 12: 142-148https://doi.org/10.1089/bfm.2016.0131 Crossref PubMed Scopus (17) Google Scholar , 6 Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US)The Surgeon General's Call to Action to Support Breastfeeding. Office of the Surgeon General (US), Rockville, MD2011 Google Scholar , 10 US Dept of Agriculture, Food and Nutrition ServiceWIC food packages - maximum monthly allowances. https://www.fns.usda.gov/wic/wic-food-packages-maximum-monthly-allowancesDate accessed: February 9, 2021 Google Scholar , 11 Kim J.H. Fiese B.H. Donovan S.M. Breastfeeding is natural but not the cultural norm: a mixed-methods study of first-time breastfeeding, African American mothers participating in WIC. J Nutr Educ Behav. 2017; 49: S151-S161.e1https://doi.org/10.1016/j.jneb.2017.04.003 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Increased investments in WIC breastfeeding support helped reduce disparities in breastfeeding initiation and increased breastfeeding initiation rates by 30% between 1998 (42%) 12 US Department of Agriculture, Food and Nutrition ServiceWIC program and participants characteristics, 1998. https://www.fns.usda.gov/wic/wic-program-and-participants-characteristics-1998Date accessed: March 19, 2021 Google Scholar through 2018 (72%). 13 Kline N. Thorn B. Bellows D. Wroblewska K. Wilcox-Cook E. WIC participant and program characteristics 2018 final report. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICPC2018.pdfDate accessed: March 19, 2021 Google Scholar CorrigendumJournal of the Academy of Nutrition and DieteticsVol. 122Issue 8PreviewCorrigendum to: The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations Full-Text PDF

Novel scoring system for determining fetal candidacy for prenatal intervention for severe congenital lower urinary tract obstruction

ObjectivesTo evaluate a novel scoring system that combines several prenatal parameters for selecting ideal candidates for fetal intervention, and for predicting postnatal survival in patients with severe fetal lower urinary tract obstruction (LUTO). MethodsWe retrospectively reviewed all cases of severe LUTO evaluated for fetal intervention in a single large fetal center between January 2013 and December 2017. A scoring system for determining fetal candidacy for intervention was retrospectively developed based on postnatal outcomes. The proposed scoring system included fetal urinary biochemistry, renal ultrasound parameters, initial bladder volume, and degree of bladder refill. Relevant demographic characteristics, ultrasound reports and laboratory results were reviewed. Receiver operating characteristic (ROC) curves were used to select the cut-off values for initial bladder volume and degree of bladder refill and to evaluate the performance of the scoring system in predicting postnatal death. ResultsOf the 79 LUTO patients evaluated, 31 were eligible for the study. The overall 6-month postnatal survival was 64.5 % (20/31). A scoring system (0−8) was suggested with 2 points for unfavorable biochemistry, 4 points for ultrasound evidence of dysplastic kidneys, 1 point for inadequate initial bladder volume and 1 point for inadequate bladder refill. Scores>3 (N = 7) were associated with 0 % 6-month survival. The ROC curve for predicting postnatal mortality showed area under curve (AUC) of 0.82 (95 % CI 0.65−0.99). Subgroup analysis within subjects who underwent fetal intervention (N = 22) also confirmed the significance of the distribution of the scoring system between groups who survived and those who did not after adjustment for GA at delivery (p = 0.01). ConclusionWe propose a novel scoring system for antenatal evaluation of patients with severe LUTO which may be useful in selecting those candidates most appropriate for intervention and in counseling parents about predicted postnatal outcome.

A qualitative investigation of a prenatal yoga intervention to prevent excessive gestational weight gain: A thematic analysis of interviews

PurposeTo describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG). MethodsPregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis. ResultsTwelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga). ConclusionPrenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG.

Fetal abdominal tumors and cysts.

This article reviews the contemporary diagnosis and management of the most common abdominal neoplasms and cystic lesions diagnosed in the fetus. Fetal tumors discussed include teratomas (sacrococcygeal, cervical or mediastinal), mesoblastic nephroma, nephroblastoma (Wilms’ tumor), neuroblastoma, and hepatoblastoma. Fetal abdominal cystic lesions discussed include ovarian cyst, choledochal cyst, intestinal duplication cyst, mesenteric cyst, simple hepatic cyst, and meconium pseudocyst. We discuss the rare indications for fetal intervention or fetal surgery and other perinatal management, including prenatal interventions and fetal surgery for sacrococcygeal teratoma. The lesions reviewed are detected by widespread use of screening ultrasonography during pregnancy. Work-up for these abnormalities may include fetal MRI which enhances the diagnostic accuracy of abdominal tumors and cystic lesions and can aid in characterization of the lesion in relationship to surrounding anatomic structures. Accurate prenatal diagnosis of such lesions permits recommendations for optimal location and timing of delivery, and inclusion of appropriate caregivers and expertise to facilitate postnatal management. Perinatal management of the fetus with a neoplasm requires consideration of the optimal timing and mode of delivery, and pediatric oncology and surgical specialty care. The majority of tumors diagnosed antenatally have good prognosis with current multimodality treatment.

Awareness, acceptability, and intention to initiate HIV pre-exposure prophylaxis among pregnant women

ABSTRACT HIV prevention is critically important during pregnancy, however, pre-exposure prophylaxis (PrEP) is underutilized. We conducted a survey of pregnant and non-pregnant women in a high HIV prevalence community in Washington D.C. to evaluate determinants of PrEP initiation during pregnancy. 201 pregnant women and a reference population of 1103 non-pregnant women completed the survey. Among pregnant women, mean age was 26.9 years; the majority were Black with household-incomes below the federal poverty level. Despite low perceived risk of HIV acquisition and low prior awareness of PrEP, 10.5% of respondents planned to initiate PrEP during pregnancy. Pregnant women identified safety, efficacy, and social network and medical provider support as key factors in PrEP uptake intention. The belief that PrEP will “protect (their) baby from HIV” was associated with PrEP uptake intention during pregnancy. Concerns regarding maternal/fetal side effects, and safety in pregnancy or while breastfeeding were not identified as deterrents to uptake intention. When compared to a nonpregnant sample, there were no significant differences in uptake intention between the two samples. These findings support the need for prenatal educational interventions to promote HIV prevention during pregnancy, as well as interventions that center on the role of providers in the provision of PrEP.

Fatty acids in the placenta of appropiate- versus small-for-gestational-age infants at term birth

IntroductionFatty acids are essential nutrients for the fetus and are supplied by the mother through the placenta. Desaturase and elongase enzymes play an important role in modulating the fatty acid composition of body tissues. We aimed to compare the fatty acid profile and the estimated desaturase and elongase activities in the placenta of appropriate (AGA) versus small-for-gestational-age (SGA), and to determine their relationship with the offspring size at birth. MethodsThe placental fatty acid profile was analyzed by gas chromatography in 84 infants (45 AGA and 30 SGA) from a prenatal cohort study. The estimated desaturase and elongase activities were calculated from product-precursor fatty acid ratios. Results were associated with maternal (age, body mass index and weight gain during gestation) and neonatal (gestational age, sex, birth weight and birth length) parameters. ResultsDifferences in placental fatty acid composition between AGA and SGA infants rather than correlations thereof with neonatal parameters were observed. Placentas from SGA infants contained lower levels of omega-3 (ALA, EPA, DPA, and DHA) and high omega-6/omega-3 ratios (AA/DHA and LA/ALA), as well as low elongase (Elovl5) and high desaturase (D9Dn7 and D5Dn6) activity as compared to AGA infants (all p < 0.0001). DiscussionPlacentas of AGA and SGA infants differed in fatty acids profile as well as in estimated desaturase and elongase activities. A striking feature of SGA placentas was the low availability of omega-3. Hence, omega-3 fatty acid status deserves further attention, as a potential target of prenatal interventions.