Mothers Of Singletons Research Articles

Parenting Stress, Social Support, and Mother‐Child Interactions in Families of Multiple and Singleton Preterm Toddlers

The study investigated family support as a buffer of stress in 153 mothers and preterm toddlers. Data were collected regarding maternal depressive symptoms, parenting stress, and family support; infant health; and videotaped mother-child interactions. Although more parenting stress related to less optimal child play, only information support functioned as a protective factor. Information support predicted positive play under high, but not low, maternal stress. Mothers of multiples reported more parenting stress than mothers of singletons.

Introducing Solid Foods

Introducing solids foods to infants before 6 months has been associated with adverse long-term health outcomes. Studies and surveys frequently use maternal report to identify the age when infants start solid foods. To address the accuracy of maternal report at 1 year postpartum regarding introduction of solid foods. Between 2008 and 2009, the authors enrolled mothers of healthy term singletons at an urban Boston hospital within 72 hours of giving birth. We called mothers monthly for 6 months and asked if they had given their baby solid foods in the previous month. At 1 year, we contacted mothers again and asked when they first gave solid foods; answers at 1 year were compared with the data collected monthly. The authors analyzed data on 157 women, all of whom had, according to monthly responses, started solid foods before 6 months. At 1 year, only 14% (22/157) of reports matched data recorded monthly. Although 100% of women introduced solids before 6 months, at 1 year, 41.4% reported starting solids at 6 months. Among women who started feeding solids before 6 months, most did not give an accurate response at 1 year. Most said they started giving solids later than they did. Maternal report may not be the best way to collect such data, and health outcomes based on such data may be biased toward the null.

High twinning rate in Candido Godoi: a new role for p53 in human fertility

Cândido Godói (CG) is a small town in South Brazil, which has the highest prevalence of twin births in Brazil. Recently, a number of studies have shown that p53 plays an important role in reproduction through blastocyst implantation and intra utero embryo survival. Thus, gene polymorphisms in the p53 pathway were investigated in this population. Single nucleotide polymorphisms from five genes in the p53 pathway were investigated, as well as background characteristics of 42 mothers of twins (cases) and 101 mothers of singletons (controls), all residents from CG. Mothers of twins have higher number of pregnancies and higher frequencies of P72 allele at TP53 and T allele at MDM4 genes compared with controls. Logistic regression shows that both TP53 and number of pregnancies maintained their association with twinning (P =0.004 and P =0.002, respectively), with TP53 having a higher odds ratio than number of pregnancies (2.73 versus 1.70, respectively). No interactive effect between TP53 and MDM4 (P =0.966) is observed. As expected, mothers of twins have three times more cases of cancer in their first-degree relatives than control mothers (P =0.011). Our results suggest that the P72 allele of TP53 is a strong risk factor for twinning in CG, while the number of pregnancies and the T allele at MDM4 may represent weaker risk factors. These two alleles are associated with infertility, but the anti-apoptotic effect of low levels of p53 in general, and of the P72 allele in particular, may play a role after implantation, enhancing the chance for a double pregnancy to succeed to term.

Dog Ownership during Pregnancy, Maternal Activity, and Obesity: A Cross-Sectional Study

The Avon Longitudinal Study of Parents and Children (ALSPAC) is an observational study of 14273 UK pregnant singleton mothers in 1990/1991. We examined outcomes of self report of strenuous activity (hours per week) at 18 and 32 weeks of gestation, hours spent in leisure-time physical activities and types, and pre-pregnancy body mass index (BMI); overweight status was defined as pre-pregnancy BMI≥25 and obesity BMI≥30. Pet ownership and activity data were reported for 11,466 mothers. Twenty-five percent of mothers owned at least one dog. There was a positive relationship between participation in activity at least once a week and dog ownership (at 18 weeks, Odds ratio 1.27, 95% confidence interval 1.11–1.44, P<0.001). Dog owners were 50% more likely to achieve the recommended 3 hours activity per week, equivalent to 30 minutes per day, most days of the week (1.53, 1.35–1.72, P<0.001). Dog owners were also more likely to participate in brisk walking activity than those who did not have a dog (compared to no brisk walking 2–6 hrs per week 1.43, 1.23 to 1.67, P<0.001; 7+ hrs per week 1.80, 1.43 to 2.27, P<0.001). However, no association was found with any other types of activities and there was no association between dog ownership and weight status. During the time period studied, pregnant women who had dogs were more active, through walking, than those who did not own dogs. As walking is a low-risk exercise, participation of pregnant women in dog walking activities may be a useful context to investigate as part of a broader strategy to improve activity levels in pregnant women.

Postnatal depression and associated parenting indicators among Vietnamese women

AbstractIntroductionPostnatal depression is a serious mental health problem. In low‐income countries, there has been only limited research investigating the direct link between childrearing attitude and maternal mood. The present study sought to determine the prevalence of probable depressive state among mothers in Vietnam, and to examine its risk factors with respect to social support and maternal childrearing attitude.MethodsA questionnaire survey was conducted in 299 consecutive mothers who visited Tu Du Obstetrical and Gynecological Hospital, a tertiary hospital, for regular check‐up between one and three months postpartum. The questionnaire was administered by trained pediatricians in October through December 2007. Depression was assessed using a two‐question case‐finding instrument for depression.ResultsSixty‐eight of the 294 (23.1%) mothers of singletons were assessed as having probable depressive state. Parental and familial conflict and recent moving was strongly associated with probable depressive state. In terms of childrearing attitude, the following factors increased risk of probable depressive state of mothers; lack of confidence (adjusted odds ratio = 2.74, 95% confidence interval: 1.40–5.38), and less relaxed feeing (adjusted odds ratio = 2.85, 95% confidence interval: 1.21–6.71) after controlling for subjective health.DiscussionMothers who felt unconfident and were less relaxed in childrearing were more likely to report a probable depressive state. Social support factors may have played a role in the depression. A brief screening tool for depression is useful to identify mothers in need of additional support in childrearing.

Recurrence of prolonged and post-term gestational age across generations: maternal and paternal contribution

To estimate intergenerational recurrence risk of prolonged and post-term gestational age. Population-based cohort study. Norway, 1967-2006. Intergenerational data from the Medical Birth Registry of Norway of singleton mothers and fathers giving birth to singleton children: 478 627 mother-child units and 353 164 father-child units. A combined mother-father-child file including 295 455 trios was also used. Relative risks were obtained from contingency tables and relative risk modelling. Gestational age ≥41 weeks (≥287 days), ≥42 weeks (≥294 days) and ≥43 weeks (≥301 days) of gestation in the second generation. A post-term mother (≥42 weeks) had a 49% increased risk of giving birth to a child at ≥42 weeks (relative risk [RR] 1.49, 95% CI 1.47-1.51) and a post-term father had a 23% increased risk of fathering a child at ≥42 weeks (RR 1.23, 95%CI 1.20-1.25). The RRs for delivery at ≥41 weeks were 1.29 (1.28-1.30) and 1.14 (1.13-1.16) for mother and father, respectively, and for ≥43 weeks 1.55 (1.50-1.59) and 1.22 (1.17-1.27). The RR of a pregnancy at ≥42 weeks in the second generation was 1.76 (1.68-1.84) if both mother and father were born post-term. Adjustment for maternal age in both generations, fetal sex in the second generation, parity, and maternal and paternal birthweight did not influence the risk estimates. There is a familial factor related to recurrence of prolonged pregnancy across generations and both mother and father seem to contribute.

Personal Growth in Mothers: Examination of the Suitability of the Posttraumatic Growth Inventory as a Measurement Tool

The validity of the Posttraumatic Growth Inventory for the experience of motherhood was examined in three separate studies, conducted in Israel between 2008 and 2010. Study 1 (n = 150) compared the answers of new first-time mothers to an open-ended question regarding changes following childbirth with the Posttraumatic Growth Inventory dimensions. Study 2 replicated this procedure using a more diverse sample (n = 157) to confirm the usefulness of the Posttraumatic Growth Inventory among various sub-groups of mothers (first-time and non-first-time mothers, mothers of twins and singletons, mothers of pre-term and full-term infants). Study 3 (n = 152 mothers and their own mothers) sought to corroborate mothers' scores on the Posttraumatic Growth Inventory by means of their own mothers' reports of their daughters' growth following childbirth. This study also examined the applicability of the Posttraumatic Growth Inventory's five factor structure—new possibilities, relating to others, personal strength, spiritual change, and appreciation of life—to the population of mothers. The findings indicated that the Posttraumatic Growth Inventory is indeed an effective instrument for the measurement of mothers' perceived positive changes following childbirth, and can be used for this purpose at least for several years after the birth.

Social determiants of parent-child interaction in the UK

<h3>Background</h3> Research has shown that activities such as play and reading are beneficial for the development of a child. This study examined the social and demographic characteristics of mothers who...

Recorded Pregnancy Histories of the Mothers of Singletons and the Mothers of Twins: A Longitudinal Comparison

A population-based record linkage case cohort of 239,995 births, to 119,214 women, born in Western Australia from 1980 to 2001 inclusive, was used to measure the recording of selected indicators of maternal health (current and prior) during pregnancy. We compared records of women with singleton pregnancies with that in twin pregnancies Mothers of first- and second-born singletons (n = 117,647) were compared with women with a first-born singleton followed by twins (n = 1,567). Binary indicators were used to calculate population prevalence of medical conditions, pregnancy complications and birth outcomes. Infant outcomes included stillbirth, low birthweight, preterm birth and birth defects. Women with twins were significantly older and taller, with similar rates of medical conditions and pregnancy complications during first singleton pregnancies compared with women with two consecutive singletons. However, during their second pregnancy, women with twins had significantly higher rates of essential hypertension, pre-eclampsia, threatened abortion, premature rupture of the membranes and ante partum hemorrhage with abruption than women with singletons. For both groups, maternal conditions in the first pregnancy were underreported in the second pregnancy, including diabetes, epilepsy, asthma, chronic renal dysfunction and essential hypertension. At the second birth, twins were 3 times more likely to be stillborn, 17 times more likely to be low birthweight and 4 times more likely to be delivered preterm compared with singletons. This research demonstrates the importance for epidemiologists and others, of having access to a complete maternal medical history for analyses of risks associated with maternal, infant and childhood morbidity.

054 Another Hispanic paradox? The health benefits of Hispanic communities for non-Hispanic mothers and infant

Background and ObjectivesIn the US, Hispanic mothers have rates of infant mortality and low birthweight that are comparable to non-Hispanic White mothers despite being more likely to live in socio-economically...

Risk Factors and Outcomes Associated With First-Trimester Fetal Growth Restriction

ABSTRACT Exposure of the fetus to an adverse environment may result in developmental adaptations that lead to fetal growth restriction. It has been suggested that fetal growth restriction may increase the risk of metabolic and cardiovascular diseases and other adverse outcomes in adulthood. Previous studies have shown that first trimester fetal growth restriction increased the risks of low birth weight and small size for gestational age. The effects of maternal lifestyle habits and physical characteristics on first trimester growth and postnatal outcomes are not known. This population-based prospective cohort study investigated the associations of first trimester growth restriction with adverse birth outcomes and postnatal outcomes in early childhood. The effect of several maternal physical characteristics and lifestyle habits on postnatal outcomes was also investigated. A self-administered questionnaire was completed by the mothers at enrollment. First trimester fetal growth in singleton mothers was assessed sonographically by measuring fetal crown rump length between the gestational age of 10 weeks 0 days and 13 weeks 6 days, and then performing follow-up growth scans in the second and third trimesters. The primary birth outcomes examined were preterm birth, low birth weight, and small size for gestational age at birth. Postnatal outcomes were studied up to the age of 2 years. Multivariate analysis showed that maternal age was positively associated with fetal crown rump length; the difference was 0.79 mm (95% confidence interval [CI]: 0.41–1.18) per 1 standard deviation (4.68 maternal years of age) increase. Both diastolic blood pressure and the hematocrit were negatively associated with first trimester crown to rump growth (shorter length) (differences, −0.40 mm; 95% CI: −0.74 to −0.06, and −0.52 mm; 95% CI: −0.90 to −0.14 per standard deviation increase, respectively). Mothers who smoked and did not use folic acid supplements had shorter crown rump lengths than nonsmoking mothers who used folic acid supplements; the difference was 3.84 mm; 95% CI: −5.71 to −1.98. In comparison to normal first trimester growth, restricted first trimester growth was associated with increased risks of prematurity (4.0% vs. 7.2%; adjusted odds ratio [OR]: 2.12; 95% CI: 1.24–3.61), small size for the gestational age at birth (4.0% vs.10.6%; OR: 2.64; 95% CI: 1.64–4.25), and low birth weight (3.5% vs. 7.5%; OR: 2.42; 95% CI: 1.41–4.16). Over the first 2 years of postnatal growth, each standard deviation decrease in first trimester fetal crown rump length was associated with an accelerated growth rate in weight and height; the increase in the standard deviation score was 0.139 per 2 years; 95% CI: 0.097 to 0.181. These findings demonstrate that first trimester fetal growth is independently associated with a number of maternal physical characteristics and lifestyle habits. Early fetal growth restriction is also associated with an increased risk of adverse birth outcomes and accelerated growth rates in early childhood.

Are Race and Ethnicity Risk Factors for Breech Presentation?

To investigate race and ethnicity as risk factors for breech presentation. Case-control study using a population-based birth certificate registry that included linkage to Medicaid/Women, Infants, & Children (WIC) eligibility data for a socioeconomic proxy variable. Florida, USA. 912,107 mothers of singletons born in Florida 1999 to 2003. Maternal race and ethnicity were evaluated as risk factors for breech presentation using logistic regression. The dependent variable was birth presentation. Covariates were variable measures that have been repeatedly identified as risk factors for breech presentation in the literature and are known to be highly accurate birth certificate variable measures. White women were 69% more likely to have a breech baby (adjusted odds ratio [OR]=1.69, 95% confidence interval [CI] 1.63, 1.76) than Black women. Higher socioeconomic status was a risk factor in the bivariate analyses, but not in the adjusted analysis. Prematurity, nulliparity, female infant, and advancing maternal age were risk factors in the final model. The final model accounted for <5% of the total variance (Max Rescaled R(2)=4.18%), and thus was poorly fit (Hosmer and Lemeshow goodness of fit <0.0001). White women were at increased risk of having a breech baby. However, important variables appear to be missing from the model.

Effect of Maternal Egg Consumption on Breast Milk Ovalbumin Concentration

Palmer D, Gold M, Makridess M. Clin Exp Allergy. 2008;38(7):1186–1191PURPOSE OF THE STUDY. To assess human milk ovalbumin concentrations after daily maternal ingestion of 1 cooked egg for a 3-week period.STUDY POPULATION. There were 32 mothers of singleton, breastfed, egg-sensitive infants with moderate-to-severe eczema. Egg sensitivity was identified by a positive skin-prick test result. Eczema was evaluated by using a standardized scoring system.METHODS. Families had an initial home visit by an experienced dietitian, which involved collection of demographic and dietary information. All women and children were asked to follow an egg-free diet from day 1 through the duration of the trial. Adherence to the egg-free diet was assessed via detailed dietary intake records for both mothers and children on days 1 to 3, 10 to 12, and 21 to 23. Mothers were randomly allocated to receive identical-appearing egg-free muffins or muffins containing 1 (55 g) whole egg. Each mother was given a 3-week supply of frozen muffins corresponding to her randomization group and consumed 1 muffin per day on days 3 through 23. Atopic dermatitis assessments were performed for each child at the commencement and completion of the trial. The mothers completed the Infant's Dermatitis Quality of Life Index 3 times during the trial. On days 3, 12, and 23, the mothers manually expressed 5 mL of breast milk into sterile containers before and 2, 4, and 6 hours after eating the test muffin. Breast milk samples were stored in the home freezer and collected on day 24. The breast milk samples were queried for ovalbumin concentration by using a sandwich enzyme-linked immunosorbent assay method. Breast milk ovalbumin concentrations (nanograms per milliliter) were plotted against time, and the resulting curve was used to determine peak ovalbumin concentrations and total ovalbumin excretions (nanograms per milliliter per hour). Independent-sample t tests, Mann-Whitney U tests, and Pearson's χ2 tests were used to investigate differences between the diet groups.RESULTS. Women in the egg group had higher ovalbumin concentrations in breast milk than did the control group at all time points. Within each dietary group, the frequency of ovalbumin detection, peak ovalbumin concentration, and total ovalbumin excretion did not differ at days 3, 12, and 23. Ovalbumin was not detected in the breast milk of 25% of the women in the egg group. Infant eczema symptom scores were significantly reduced with time for both groups.CONCLUSIONS. Human milk ovalbumin is related to maternal dietary egg intake. Comparable detection of ovalbumin across time suggests that ovalbumin does not accumulate in human milk. One quarter of the women had no ovalbumin detected in their breast milk on any of the study days, which suggests that some women either do not excrete ovalbumin in their breast milk when challenged with 1 egg or have delayed excretion beyond 6 hours. Maternal dietary avoidance of well-cooked egg may not be necessary for all breastfed infants with egg sensitivity and eczema.REVIEWERS COMMENTS. For breastfed infants with food allergy, strict avoidance of the offending food proteins for both mother and child is frequently recommended. Total dietary avoidance of egg is difficult for patients to achieve. Additional study is needed to substantiate or to refute the preliminary observation that regular maternal ingestion of a small quantity of well-cooked egg did not markedly exacerbate eczema symptoms in egg-sensitive breastfed infants.

Reasons Why Women Do Not Initiate Breastfeeding: A Southeastern State Study

Despite the increase in breastfeeding initiation and duration in the United States, only five states have met the three Healthy People 2010 breastfeeding objectives. Our objectives are to study women's self-reported reasons for not initiating breastfeeding and to determine whether these reasons vary by race/ethnicity, and other maternal and hospital support characteristics. Data are from the 2000-2003 Arkansas Pregnancy Risk Assessment Monitoring System, restricting the sample to women who did not initiate breastfeeding (unweighted n=2,917). Reasons for not initiating breastfeeding are characterized as individual reasons, household responsibilities, and circumstances. Analyses include the chi(2) test and multiple logistic regression. About 38% of Arkansas mothers of live singletons did not initiate breastfeeding. There was a greater representation of non-Hispanic Blacks among those who did not initiate breastfeeding (32%) than among those who initiated breastfeeding (9.9%). Among those who never breastfed, individual reasons were most frequently cited for noninitiation (63.0%). After adjusting for covariates, Hispanics had three times the odds of citing circumstances than Whites (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.31-7.18). Women who indicated that the hospital staff did not teach them how to breastfeed had more than two times greater odds of citing individual reasons (OR, 2.25; 95% CI, 1.30-3.91) or reasons related to household responsibilities (OR, 2.27; 95% CI, 1.19-4.36) as compared with women who indicated they were taught. Findings suggest the need for targeting breastfeeding interventions to different subgroups of women. In addition, there are implications for policy particularly regarding breastfeeding support in hospitals.

Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms

The purpose of the study was to assess the relationship between multiple births and maternal depressive symptoms measured 9 months after delivery. Data were derived from the Early Childhood Longitudinal Study-Birth Cohort, a longitudinal study of a nationally representative sample of children born in 2001. Depressive symptoms were measured at 9 months by using an abbreviated version of the Center for Epidemiologic Studies Depression Scale. Logistic regression analyses were conducted to study the association between multiple births and maternal depressive symptoms, with adjustment for demographic and household socioeconomic characteristics and maternal history of mental health problems. A total of 8069 mothers were included for analyses. The prevalence of moderate/severe depressive symptoms at 9 months after delivery was estimated to be 16.0% and 19.0% among mothers of singletons and multiple births, respectively. Only 27.0% of women who had moderate/severe depressive symptoms reported talking about emotional or psychological problems with a mental health specialist or a general medical provider within the 12 months before the interview. The proportions of women with depressive symptoms who were receiving mental health services did not vary according to plurality status. Mothers of multiple births had 43% greater odds of having moderate/severe, 9-month postpartum, depressive symptoms, compared with mothers of singletons. Greater attention is needed in pediatric settings to address maternal depression in families with multiple births.

Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study

Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated. We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a questionnaire. The effects of parity and child-related factors were assessed at T2. At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P < 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F = 5.20, P < 0.05 and F = 3.93, P < 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F = 10.01, P < 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F = 4.15, P < 0.05) and social dysfunction than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F = 4.29, P < 0.05) and anxiety (F = 5.40, P < 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F = 6.66, P < 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F = 3.34, P < 0.05). Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.

Twin births, sex of children and maternal risk of endometrial cancer: A cohort study in Norway

To explore whether twin births and sex of children influenced maternal risk of endometrial cancer, possibly with effect modification by age. Population-based prospective study. A total of 1,094,017 parous Norwegian women aged 30-74 years, including 3,356 endometrial cancer cases. Among the 27,158 mothers of twins, 101 cases occurred. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated in Poisson regression analyses of person-years at risk. Women ever having experienced a twin birth had an overall higher risk of endometrial cancer than women with singleton births only (IRR=1.26, 95% CI=1.03-1.53). Women with twin boys appeared to be the main contributor to the overall elevated risk (IRR=1.57, 95% CI=1.15-2.14). The risk estimates for women with twin girls or sex-nonconcordant twins were close to unity (IRR of 1.09 and 1.12, respectively). However, age-specific analyses revealed an elevated risk also in women with twin girls, but only before age 55 years (IRR=1.92, 95% CI=1.27-2.89); a lower risk was seen at older ages (IRR=0.41, 95% CI=0.19-0.92). The risk estimates for twin boys and sex-nonconcordant twins were consistently observed across age groups. The effect modification by age was statistically significant (p=0.0024). No association was found with sex of children in singleton mothers. Mothers of twin boys had a significantly higher risk of endometrial cancer than women with singleton births only, whereas women with twin girls had an elevated risk before age 55 years. No significant association was seen with sex-noncordant twins, neither overall nor within age groups.

Maternally Reported Food Allergies and Other Food-Related Health Problems in Infants: Characteristics and Associated Factors

Our goal was to identify the frequency, demographics, and diagnostic characteristics associated with maternally reported food allergies and other food-related health problems among infants aged < or = 1 year. We analyzed data from the 2005-2007 Infant Feeding Practices Study II, a longitudinal survey of 2441 US mothers of healthy singletons from pregnancy through their infant's first year. Doctor diagnosis and symptoms-based criteria were used to identify a probable-food-allergic group from maternal reports of infant health problems with food. More than one fifth of the 2441 mothers reported that their infant had a food-related problem; 6% (n = 143) had a probable food allergy, and 15% (n = 359) had other food-related problems. Forty percent of the infants with a food-related health problem were evaluated by a doctor. Gastrointestinal symptoms were more commonly reported in early infancy compared with skin-related symptoms, which were reported in later infancy, and 27% received medical treatment for the symptoms. Characteristics associated with increased incidence of probable food allergy included family histories of food allergy and type 1 diabetes, gestational diabetes, living in rural or urban areas, being black, and being male. Among all infants with a food-related health problem, the majority experienced their first problem by 6 months of age. Foods recognized to be major allergens were most commonly reported as the source of an allergy. Food-related problems occurred at a high frequency in the first year of life. A better understanding of the demographics, family history, disease manifestations, and diagnoses may provide insight into public health efforts to minimize or prevent food allergies in infancy and to help differentiate food-allergic problems from nonallergic food problems in this age group.

Infant Feeding Practices Study II: Study Methods

Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child care arrangements. In addition, mothers' dietary intake was measured prenatally and postnatally. The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500,000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at approximately 4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. A sample of 4902 pregnant women began the study, and approximately 2000 continued through their infant's first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding.

Mothers' Marital Adaptation Following the Birth of Twins or Singletons: Empirical Evidence and Practical Insights

Parenting twins is typically portrayed as more stressful than is parenting single children and, therefore, more of a strain on the marital relationship. With this in mind, the present study examined the contribution of infant characteristics and mother's internal resources (attachment style) and external resources (maternal and paternal grandmothers' perceived support) to their marital adaptation during the first month following delivery, comparing mothers of twins (n = 88) with mothers of singletons (n = 82). The findings indicate that both internal and external resources contribute to the marital adaptation of the two groups, even beyond the contribution of specific circumstances. Thus, it seems that the birth of twins and the birth of a single child are normative life events that have more in common than previously acknowledged. The implications for the focus of social work interventions, particularly in the case of the birth of twins, are discussed.