[Show abstract][Hide abstract] ABSTRACT: Maternal depressive symptoms are negatively associated with early child growth in developing countries; however, few studies have examined this relation in developed countries or used a longitudinal design with data past the second year of the child's life. We investigated if and when early maternal depressive symptoms affect average growth in young children up to age 6 in a nationally representative sample of US children.
[Show abstract][Hide abstract] ABSTRACT: Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized.
Women's health issues : official publication of the Jacobs Institute of Women's Health. 05/2014;
[Show abstract][Hide abstract] ABSTRACT: Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009-2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57-1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51-0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26-0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05-2.89) or diabetes (aOR 2.79, 95 % CI 1.20-6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92-3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16-2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.
Maternal and Child Health Journal 04/2014; · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized.
Data are from vital statistics and the 2005 Los Angeles Mommy and Baby (LAMB) survey, a population-based study of women delivering a live birth in Los Angeles County, California (n = 1,214). Multivariable logistic regression assessed the relation of unintended birth with acculturation variables adjusting for background and psychosocial characteristics. Multinomial models assessed these relations for women with an unintended birth who did and did not use contraception.
Forty-one percent of women reported an unintended birth. Being a long-term immigrant and U.S.-born were positively associated with unintended birth compared with shorter term immigrants, but the adjusted relation was significant only for U.S.-born women (odds ratio [OR], 2.01; 95% CI, 1.19–3.39). Women reporting an unintended birth were younger, unmarried, and higher parity. If using contraception, the odds of unintended birth were increased for cohabiting women, those with high education, and those with greater stress during pregnancy. When not using contraception and reporting an unintended birth, women also have no usual place for health care, have depressive symptoms during pregnancy, and are dissatisfied with partner support.
Women's background and psychosocial characteristics were central to explaining unintended birth among immigrant women but less so for U.S.-born Mexican mothers. Interventions to improve birth intentions should not only target effective contraception, but also important social determinants.
[Show abstract][Hide abstract] ABSTRACT: The number of births in the United States declined by 1% between 2010 and 2011, to a total of 3 953 593. The general fertility rate also declined by 1% to 63.2 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 2% in 2011 (to 1894.5 births per 1000 women). The teenage birth rate fell to another historic low in 2011, 31.3 births per 1000 women. Birth rates also declined for women aged 20 to 29 years, but the rates increased for women aged 35 to 39 and 40 to 44 years. The percentage of all births to unmarried women declined slightly to 40.7% in 2011, from 40.8% in 2010. In 2011, the cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year in 2011 to 11.72%; the low birth weight rate declined slightly to 8.10%. The infant mortality rate was 6.05 infant deaths per 1000 live births in 2011, which was not significantly lower than the rate of 6.15 deaths in 2010. Life expectancy at birth was 78.7 years in 2011, which was unchanged from 2010. Crude death rates for children aged 1 to 19 years did not change significantly between 2010 and 2011. Unintentional injuries and homicide were the first and second leading causes of death, respectively, in this age group. These 2 causes of death jointly accounted for 47.0% of all deaths of children and adolescents in 2011.
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to examine whether maternal depressive symptoms at 9 months postpartum adversely affect growth in preschool- and school-aged children.
We used data from the US nationally representative Early Childhood Longitudinal Study, Birth Cohort. We fit multivariable logistic regression models to study maternal depressive symptoms at 9 months postpartum (using the Center for Epidemiologic Studies Depression Scale) in relation to child growth outcomes, ≤10% height-for-age, ≤10% weight-for-height, and ≤10% weight-for-age at 4 and 5 years.
At 9 months, 24% of mothers reported mild depressive symptoms and 17% moderate/severe symptoms. After adjustment for household, maternal, and child factors, children of mothers with moderate to severe levels of depressive symptoms at 9 months' postpartum had a 40% increased odds of being ≤10% in height-for-age at age 4 (odds ratio = 1.40, 95% confidence interval: 1.04-1.89) and 48% increased odds of being ≤10% in height-for-age at age 5 (odds ratio = 1.48, 95% confidence interval: 1.03-2.13) compared with children of women with few or no depressive symptoms. There was no statistically significant association between maternal depressive symptoms and children being ≤10% in weight-for-height and weight-for-age at 4 or 5 years.
Maternal depressive symptoms during infancy may affect physical growth in early childhood. Prevention, early detection, and treatment of maternal depressive symptoms during the first year postpartum may prevent childhood height-for-age ≤10th percentile among preschool- and school-aged children.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to examine relations between state-level school policies and childhood obesity for youth ages 10-17 years. Secondary analysis of the 2003-2006 School Nutrition Environment State Policy Classification System, 2003-2007 Physical Education Related State Policy Classification System, and 2003 and 2007 National Surveys of Children's Health was performed. Eleven nutrition and 5 physical education (PE) domains were examined for elementary (ES), middle (MS), and high school (HS) children. Logistic regression models examined the association of policies on obesity prevalence in 2007 as well as change scores for the policy assessments. Scores for 5 of 11 nutrition domains and 4 of 5 PE domains increased between 2003 and 2006-2007. Controlling for individual, family and neighborhood factors, nutrition policies were positively associated with the odds of 2007 obesity in 3 ES and 2 MS domains and negatively associated with 1 HS domain. Adjusted positive associations also were observed between 2 ES and 1 MS PE policy domains and 2007 obesity. Controlling for covariates, nutrition policy change scores showed positive associations between increases in 1 ES and 1MS domain, and negative associations with 1 ES and 1 HS domain and 2007 obesity. PE policy change scores showed positive adjusted associations between increases in 2 ES, 2 MS and 1 HS domains and 2007 obesity. The findings indicate that state-level school health policies are associated with childhood obesity after adjusting for related factors, suggesting that states with higher obesity levels have responded with greater institution of policies.
Maternal and Child Health Journal 04/2012; 16 Suppl 1:S111-8. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite increasing recognition of the importance of oral health to overall health, dental care utilization remains low in the US. Given the established link between maternal oral health and child oral health, this study examined factors related to preventive dental care utilization at two critical time points, before and during pregnancy. Data were obtained from a sample of 6,171 women who delivered a live birth during 2004-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System postpartum survey. Multinomial logistic analyses examined associations between predisposing and enabling factors with dental cleaning before and during pregnancy. Women with less than a high school education or a history of physical abuse and non-Hispanic black and Hispanic women were less likely to report teeth cleaning before and during pregnancy. Having no insurance at the start of pregnancy was associated with significantly lower risk of teeth cleaning before pregnancy and both before and during pregnancy. Receipt of oral health counseling during pregnancy was positively related to teeth cleaning during pregnancy. Dental cleaning is associated with insurance, oral health counseling and maternal factors such as race, ethnicity, education and history of physical abuse. Better integration of oral health into prenatal health care, particularly among ethnic and racial minority groups, may be beneficial to maternal and infant well-being. Oral health promotion, disease prevention and health care should be a part of the local, state and national health policy agendas.
Maternal and Child Health Journal 02/2012; · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The number of births in the United States decreased by 3% between 2008 and 2009 to 4 130 665 births. The general fertility rate also declined 3% to 66.7 per 1000 women. The teenage birth rate fell 6% to 39.1 per 1000. Birth rates also declined for women 20 to 39 years and for all 5-year groups, but the rate for women 40 to 44 years continued to rise. The percentage of all births to unmarried women increased to 41.0% in 2009, up from 40.6% in 2008. In 2009, 32.9% of all births occurred by cesarean delivery, continuing its rise. The 2009 preterm birth rate declined for the third year in a row to 12.18%. The low-birth-weight rate was unchanged in 2009 at 8.16%. Both twin and triplet and higher order birth rates increased. The infant mortality rate was 6.42 infant deaths per 1000 live births in 2009. The rate is significantly lower than the rate of 6.61 in 2008. Linked birth and infant death data from 2007 showed that non-Hispanic black infants continued to have much higher mortality rates than non-Hispanic white and Hispanic infants. Life expectancy at birth was 78.2 years in 2009. Crude death rates for children and adolescents aged 1 to 19 years decreased by 6.5% between 2008 and 2009. Unintentional injuries and homicide, the first and second leading causes of death jointly accounted for 48.6% of all deaths to children and adolescents in 2009.
[Show abstract][Hide abstract] ABSTRACT: The primary aim of this study was to examine whether incarceration during pregnancy is associated with infant birthweight. Our second objective was to illustrate the sensitivity of the relationship between infant birthweight and exposure to prison during pregnancy to the method used to measure and model this exposure. The data consisted of delivery records of 360 infants born between January 1, 2002 and December 31, 2004 to pregnant women incarcerated in Texas state prisons. Weighted linear regression, adjusting for potential confounders, was used to model infant birth weight as a function of: (1) the number of weeks of pregnancy spent incarcerated (Method A) and (2) the gestational age at admission to prison (Method B), respectively. These two exposure measures were modeled as continuous variables with and without linear spline transformation. The association between incarceration during pregnancy and infant birthweight appears strongest among infants born to women incarcerated during the first trimester and very weak to non-existent among infants born to women incarcerated after the first trimester. With Method A, but not Method B, linear spline transformation had a distinct effect on the shape of the relationship between exposure and outcome. The association between exposure to prison during pregnancy and infant birth weight appears to be positive only among women incarcerated during the first trimester of pregnancy and the relation is sensitive to the method used to measure and model exposure to prison during pregnancy.
Maternal and Child Health Journal 05/2011; 15(4):478-86. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective of the study was to explore factors associated with early childhood obesity and assess whether having a foreign born mother is protective against childhood obesity. Data sources include 9 months and 4 years parent interviews and direct assessments of possessive children's weight and height (4 years) or length (9 months) from the Early Childhood Longitudinal Study-Birth Cohort. Subjects were children with anthropometric measures who lived with their mothers (n = 9,700 at 9 months and 8,200 at 4 years). Overweight is defined as a weight-for-length ratio at or above the 95th percentile at 9 months; obesity is defined as a body mass index at or above the 95th percentile at 4 years. The prevalence of overweight/obesity was 15.4% at 9 months and 18.0% at 4 years. After adjustment for potential confounders, having a foreign-born mother was not associated with the odds of overweight at 9 months or 4 years. At 9 months and 4 years, low birth weight, pre-pregnancy weight and weight gain during pregnancy were protective of overweight. In addition to these factors, at 4 years, excessive weight gain in the first 9 months was the strongest predictors for obesity. Living in a safe neighborhood and ever having breastfed were protective against obesity. Having a foreign born mother is not protective of early childhood obesity. A focus on health of women prior to conception and on women's and infants' health in the perinatal period are key to addressing childhood obesity.
Maternal and Child Health Journal 04/2011; 15(3):310-23. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The number of births in the United States decreased between 2007 and 2008 (preliminary estimate: 4 251 095). Birth rates declined among all women aged 15 to 39 years; the decrease among teenagers reverses the increases seen in the previous 2 years. The total fertility rate decreased 2% in 2008 to 2085.5 births per 1000 women. The proportion of all births to unmarried women increased to 40.6% in 2008, up from 39.7% in 2007. The 2008 preterm birth rate was 12.3%, a decline of 3% from 2007. In 2008, 32.3% of all births occurred by cesarean delivery, up nearly 2% from 2007. Twin and triplet birth rates were unchanged. The infant mortality rate was 6.59 infant deaths per 1000 live births in 2008 (significantly lower than the rate of 6.75 in 2007). Life expectancy at birth was 77.8 years in 2008. Crude death rates for children aged 1 to 19 years decreased by 5.5% between 2007 and 2008. Unintentional injuries and homicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 51.2% of all deaths of children and adolescents in 2008. This annual article is a long-standing feature in Pediatrics and provides a summary of the most current vital statistics data for the United States. We also include a special feature this year on the differences in cesarean-delivery rates according to race and Hispanic origin.
[Show abstract][Hide abstract] ABSTRACT: Our objective was to examine how social and psychosocial factors may influence the risk of preterm birth. The design of the study was a hybrid retrospective and prospective cohort. African-American women residing in Baltimore, Maryland, were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution prenatal clinics (n=384) or enrolled post-partum if they delivered at Johns Hopkins Medical Institution with late, none or intermittent prenatal care (N=459). Preterm birth was defined as less than 37 weeks completed gestation. Interview data were collected on 832 enrolled women delivering singletons between March 2001 and July 2004. The preterm birth rate was 16.4%. In both unadjusted and adjusted models, exposure to racism over a woman's lifetime had no effect on risk of preterm birth in our sample. However, we found evidence of a three-way interaction between reported lifetime experiences of racism, depressive symptoms during pregnancy and stress during pregnancy on preterm birth risk. Racism scores above the median (more racism) were associated with an increased risk of preterm birth in three subgroups with the effect moderated by depressive symptoms and stress. Social and psychosocial factors may operate in a complex manner related to risk of preterm birth.
Paediatric and Perinatal Epidemiology 11/2010; 24(6):546-54. · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The number of births in the United States increased between 2006 and 2007 (preliminary estimate of 4,317,119) and is the highest ever recorded. Birth rates increased among all age groups (15 to 44 years); the increase among teenagers is contrary to a long-term pattern of decline during 1991-2005. The total fertility rate increased 1% in 2007 to 2122.5 births per 1000 women. This rate was above replacement level for the second consecutive year. The proportion of all births to unmarried women increased to 39.7% in 2007, up from 38.5% in 2006, with increases noted for all race and Hispanic-origin groups and within each age group of 15 years and older. In 2007, 31.8% of all births occurred by cesarean delivery, up 2% from 2006. Increases in cesarean delivery were noted for most age groups and for non-Hispanic white, non-Hispanic black, and Hispanic women. Multiple-birth rates, which rose rapidly over the last several decades, did not increase during 2005-2006. The 2007 preterm birth rate was 12.7%, a decline of 1% from 2006. The low-birth-weight rate also declined in 2007 to 8.2%. The infant mortality rate was 6.77 infant deaths per 1000 live births in 2007, which is not significantly different from the 2006 rate. Non-Hispanic black infants continued to have much higher rates than non-Hispanic white and Hispanic infants. States in the southeastern United States had the highest infant and fetal mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. Life expectancy at birth reached a record high of 77.9 years in 2007. Crude death rates for children aged 1 to 19 years decreased by 2.5% between 2006 and 2007. Unintentional injuries and homicide were the first and second leading causes of death, respectively, accounting for 53.7% of all deaths to children and adolescents in 2007.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine sociodemographic, psychosocial, and health belief factors that explain the association between maternal drug use and little or no prenatal care.
A cohort of 812 low-income women who delivered at Johns Hopkins Hospital were administered a postpartum survey. Drug use was determined by self-report, medical record, and toxicologic screens. Medical records were abstracted to determine little or no prenatal care, as defined by </= 1 visit.
Adjustments for sociodemographic characteristics and cocaine and opiate use were predictive of little or no prenatal care. The effect of cocaine was explained by psychosocial and health belief factors: external locus of control, fear of being reported to police, and disbelief in the efficacy of care. Opiate use remained strongly related to little or no care in fully adjusted models (odds ratio, 3.16; P < .001).
Different outreach and education strategies may be necessary to enroll cocaine- vs opiate-using women into prenatal care.
American journal of obstetrics and gynecology 02/2009; 200(4):412.e1-10. · 3.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed women's motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling.
Journal of Human Lactation 02/2009; 25(2):173-81. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neighborhood characteristics have been proposed to influence birth outcomes through psychosocial and behavioral pathways, yet empirical evidence is lacking. Using data from an urban, low-income sample, this study examined the impact of the neighborhood environment on birthweight and evaluated mediation by psychosocial and behavioral factors. The sample included 726 women who delivered a live birth at Johns Hopkins Hospital in Baltimore, Maryland, USA between 1995 and 1996. Census-tract data were used to create a principal component index of neighborhood risk based on racial and economic stratification (% Black, % poverty), social disorder (violent crime rate), and physical deterioration (% boarded-up housing) (alpha=0.82). Information on sociodemographic, psychosocial, and behavioral factors was gathered from a postpartum interview and medical records. Random intercept multilevel models were used to estimate neighborhood effects and assess potential mediation. Controlling for sociodemographic characteristics, a standard deviation increase in neighborhood risk conferred a 76g birthweight decrement. This represents an approximate 300g difference between the best and worst neighborhoods. Although stress (daily hassles), perceived locus-of-control, and social support were related to birthweight, their adjustment reduced the neighborhood coefficient by only 12%. In contrast, the neighborhood effect was reduced by an additional 30% and was no longer statistically significant after adjustment for the behavioral factors of smoking, drug use, and delayed prenatal care. These findings suggest that neighborhood factors may influence birthweight by shaping maternal behavioral risks. Thus, neighborhood level interventions should be considered to address multiple maternal and infant health risks. Future studies should examine more direct measures of neighborhood stress, such as perceived neighborhood disorder, and evaluate alternative mechanisms by which neighborhood factors influence behavior (e.g., social norms and access to goods and services).
Social Science [?] Medicine 12/2008; 68(1):100-10. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Unintended pregnancy may influence the timing of PNC access. Despite large numbers of Latina births, research addressing determinants of health behaviors during pregnancy among Latinas remains sparse. A population-based survey modeled after PRAMS, the Los Angeles Mommy and Baby Survey (LAMB), addresses determinants of unintended pregnancy as well as timely prenatal care. This study included 1214 Mexican women, 18-40 years old, who delivered live births in Los Angeles County in 2005. Unintended pregnancy included mistimed or unwanted births. PNC entry was categorized as timely (=<3 months) or late entry (>3 months). Logistic regression models estimated the effect of unintended pregnancy on delayed entry into PNC. US-Born women had the largest percentage of unintended births (48.3%). Among immigrants, there was an increasing trend with greater length of time in the US (p<0.05). Unintended pregnancy was also associated with high parity, younger age, lower income, lower education and not having a usual place for health care. Depression (OR= 2.10; CI: 1.66-2.66), lack of partner support (OR= 2.90; CI: 2.05-4.10), and greater stress (OR= 1.35; CI: 1.24-1.48) were psychosocial determinants. Unintended pregnancy was associated with delayed prenatal care entry (OR= 1.87; CI: 1.24-2.81) even after controlling for socio-demographic characteristics (AOR= 1.65; CI: 1.06-2.56). This association was reduced and no longer significant after adjustment for depression (AOR= 1.57; CI: 0.99-2.48) and lack of partner support (AOR= 1.54; CI: 0.97-2.44). The association of unintended pregnancy with timely entry into prenatal care among Mexican moms appears to be mediated through psychosocial determinants of use of care.
136st APHA Annual Meeting and Exposition 2008; 10/2008
[Show abstract][Hide abstract] ABSTRACT: The health and developmental outcomes of very low-birthweight infants are unpredictable over the first year of life. This uncertainty may have meaningful consequences for parents' quality of life. The objective of this study was to explore the quality of life of caregivers of these infants.
Primary caregivers of very low-birthweight infants, 12 to 18 months old, who had been cared for in an inner-city hospital were enrolled in the study. Primary caregivers of full-term infants of the same age served as a comparison group. During a telephone survey, participants answered questions about their quality of life, mental and physical health, living arrangements, and child's health.
Eighty-three caregivers of very low-birthweight infants and 84 caregivers of full-term infants were enrolled in the study. Demographic characteristics of the caregivers were similar between the groups. Forty-five percent of caregivers of very low-birthweight infants reported that their child had an ongoing medical problem compared with 23 percent of caregivers of full-term infants. Both groups of caregivers reported significant physical and mental health problems. Caregivers of very low-birthweight infants reported higher quality of life than did caregivers of full-term infants, but the difference did not reach statistical significance.
Although very low-birthweight infants had poorer health and required significantly more health care resources than full-term infants, caregivers' quality of life did not differ between the two groups. Caregivers of both groups of infants reported substantial mental and physical health problems but perceived good quality of life. These data will aid parents, physicians, and policy makers as they struggle to make decisions concerning care of high-risk, costly, very low-birthweight infants.
[Show abstract][Hide abstract] ABSTRACT: Depressive symptoms are known to affect functioning in early pregnancy. We estimated the effect of a change in depressive symptoms status on health-related quality of life (HRQoL) throughout pregnancy and after delivery.
Longitudinal study of 200 women. The independent variable was depressive symptoms, defined as a Center for Epidemiologic Studies Depression (CES-D) score of > or =16. The dependent variable was HRQoL from 8 domains of the Medical Outcomes Study (SF-36) Short Form. Women were categorized based on the change in CES-D score: (1) never depressed, (2) became well, (3) became depressed and (4) always depressed. A random effects model was used to (1) estimate the effect of a change in depressive symptomatology from the first to the second trimester on HRQOL in the second trimester and (2) estimate the change in depressive symptomatology from the second to the third trimester on HRQoL in the third trimester and after delivery, adjusting for covariates. Intra-individual correlations were accounted for using generalized estimating equations (GEE).
The proportion of women with depressive symptoms was 15%, 14%, and 30% in the first, second and third trimesters, respectively, and 9% after delivery. Women who became depressed had scores in the social domains that were 10-23 points and 19-31 points lower in the second and third trimesters, respectively, compared to women with no depressive symptoms. Women who became well had scores that were 3-31 points lower, compared to women with no depressive symptoms.
Alterations in depressive symptomatology have a substantial effect on functioning during pregnancy and after delivery.
Maternal and Child Health Journal 10/2008; 13(5):577-87. · 2.24 Impact Factor