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Partner Support and Impact on Birth Outcomes among Teen Pregnancies in the United States
Abstract
Despite hypothesized relationships between lack of partner support during a woman's pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.
In a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.
Even after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.
Having partner support or involvement during a teenager's pregnancy may reduce the likelihood of having a poor birth outcome.
... 19 Spousal support is also an important matter related to pregnancy outcomes, where lack thereof may cause pregnant women to develop a negative attitude regarding the health of their pregnancy and result in unfavorable pregnancy outcomes. 20,21 Women who reported at least one antenatal visit accompanied by their husband were more likely to deliver with a trained health worker than women who received antenatal care by themselves. 22 Teenage pregnancy class with the husband's assistance is a face-to-face learning tool for mothers and husbands. ...
... 29 Having support and a husband's involvement during teenage pregnancy may reduce the likelihood of a poor birth outcome. 20 Several previous studies have found a significant relationship between the husband's involvement and the use of antenatal and delivery cares. This statement means that pregnant women making use of pregnancy health care and delivery assistance by trained birth attendants is correlated with husband's involvement and family support. ...
... 19,30 Furthermore, spousal support is important in its connection to pregnancy outcomes, where lack thereof may cause pregnant women to develop a negative attitude regarding the health of their pregnancy and result in unfavorable pregnancy outcomes. 20,21 Husband assistance in pregnancy classes can be a positive step to improve the knowledge, attitudes, and behavior of husbands/partners about pregnancy, especially teenage pregnant women so that they can provide positive support during pregnancy until childbirth. With a good partner's understanding of pregnancy and positive support, teenage pregnant women can go through pregnancy safely without any anxiety about not being accepted and not supported. ...
Background
Teenage pregnancy is an international phenomenon without a definite solution to date. Globally, an estimated 16 million girls aged 15–19 give birth each year. Husbands need to play their assistance role in order to thwart the negative impact of the outcome of teenage pregnancy.
Research objective
To identify the effect of the development of Pregnancy Classes with the Husband’s Assistance on the Outcome of Teenage Pregnancy in the Dayak community, Central Kalimantan.
Research methods
This was a quasi-experimental study with the posttest-only non-equivalent control group design involving the husband’s assistance in pregnancy classes. The respondents were 60 individuals where 30 of them were given the pregnancy class assistance intervention while the other 30 were not given any intervention (control group).
Results and discussion
Pregnancy class with Assistance by the husband increases positive pregnancy outcomes 2.4 times compared to without the husband’s assistance. Family support increases positive pregnancy outcomes 2.5 times compared to pregnant women without support from the family. Pregnant women that are highly motivated regarding antenatal care are likely to have positive pregnancy outcomes 5.4 times greater than pregnant women with low motivation. Based on the analysis, then the variables that have no effect are the history of antenatal care, frequency of antenatal care, and support from health workers.
Conclusions
Pregnancy class with husband’s assistance affects positive outcomes of teenage pregnancy. Other factors with meaningful influence on pregnancy outcomes include family support and motivation to seek teenage antenatal care. Furthermore, other factors that have no influence include the teenager’s age, history of antenatal care, frequency of antenatal care, and support from health workers. An intervention is needed that involves the husband/partner in the form of active assistance.
... Thirty-one studies published from 11 countries and involving 59,670,142 adolescent mothers (age range: 10-19 years) were included in the review. The majority of studies were published in the U.S.(n=18) 16,[18][19][20][21][22][23][24][25][26][27][28]30,32,34,35,41,42 followed by Australia (n=2) 17,33 and Nigeria (n=2). 36,40 The most frequently evaluated SDOH in the individual studies was race [16][17][18][19][23][24][25][26][27][28][29][30]32,35,37,[39][40][41][42] while the most commonly reported maternal and birth outcomes were caesarean section 16,17,23,28,31,33,34,[37][38][39][40] and PTB, 16,17,19,20,[22][23][24][25][26]28,29,31,34,35,43 respectively. ...
... The majority of studies were published in the U.S.(n=18) 16,[18][19][20][21][22][23][24][25][26][27][28]30,32,34,35,41,42 followed by Australia (n=2) 17,33 and Nigeria (n=2). 36,40 The most frequently evaluated SDOH in the individual studies was race [16][17][18][19][23][24][25][26][27][28][29][30]32,35,37,[39][40][41][42] while the most commonly reported maternal and birth outcomes were caesarean section 16,17,23,28,31,33,34,[37][38][39][40] and PTB, 16,17,19,20,[22][23][24][25][26]28,29,31,34,35,43 respectively. The primary studies included 16 retrospective cohort studies, 16 ...
... Neighbourhood-level low SES was consistently linked with LBW in adolescent pregnancy despite the variability in the definition of SES. 24,28,35,41,44 Our findings are in line with the existing literature on socio-economic disparities in birth outcomes and highlight the influence of neighbourhood environment on adolescent pregnancy outcomes. 48 Low SES adolescents have also been reported to be at a greater risk of under nutrition before, during, and after pregnancy which may explain the high rate of LBW among this group. ...
Background
Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers.
Methods
Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes. Study selection, risk of bias appraisal, and data extraction of study characteristics were independently performed by two reviewers. Pooled odds ratios (pOR) with 95% confidence intervals (95% CI) were calculated to assess the association between SDOH and adverse birth outcomes.
Results
Thirty‐one studies met the inclusion criteria. The most frequently evaluated SDOH was race while the most commonly reported maternal and birth outcomes were caesarean section and preterm birth (PTB), respectively. The risk of bias of included studies was fair on the Newcastle‐Ottawa Scale. Meta‐analyses of retrospective cohort studies showed that, compared to White adolescent mothers, African American teens had increased odds of PTB (pOR 1.67; 95% CI 1.59, 1.75) and low birthweight (pOR 1.53; 95% CI 1.45, 1.62). Rural residence was consistently linked with PTB while low maternal socio‐economic (SES) and illiteracy were found to increase the risk of adolescent maternal mortality and LBW infants.
Conclusion
Social determinants of health contribute to the risk of adverse pregnancy outcomes in adolescent mothers. African American race, rural residence, inadequate education, and low SES are markers for poor pregnancy outcomes in adolescent mothers. Further research needs to be done to understand the underlying causal pathways to inequalities in adolescent pregnancy outcomes.
... Although the body of research examining the influence of paternal traits and behaviors on offspring development is extensive, the majority of studies focus on fathering at a single stage of the life course, typically from late infancy onward [2,3,6,7]. While some research has considered the role of father involvement during pregnancy on child outcomes [8], most of these studies explore whether paternal prenatal support predicts maternal wellbeing during and after pregnancy [8,9], infant mortality and/or preterm birth [10,11], or subsequent paternal involvement with the child [12]. These studies tend to overlook the possibility that, in addition to father involvement postnatally, paternal involvement prenatally and at the time of birth may predict developmental outcomes in children. ...
... A growing number of scholars are beginning to examine father involvement at an even earlier stage of development: the prenatal period [8,12]. Specifically, some researchers have started to emphasize the potential importance of father involvement and support of the mother during the pregnancy [8,11]. The majority of these studies, however, examine paternal prenatal involvement as a predictor of maternal wellbeing [8,9] and future paternal involvement [12]. ...
... The majority of these studies, however, examine paternal prenatal involvement as a predictor of maternal wellbeing [8,9] and future paternal involvement [12]. Additionally, a handful of studies have also considered whether paternal prenatal support predicts infant perinatal outcomes, such as infant mortality and prematurity [10,11]. Research examining paternal involvement and support during labor and delivery, moreover, tends to explore its impact on concurrent maternal mental health/distress [17], maternal satisfaction with the childbirth experience [18], and partner relationship quality [19]. ...
Background:
A long line of research has illustrated that fathers play an important role in the development of their children. Few studies, however, have examined the impact of paternal involvement at the earliest stages of life on developmental diagnoses in childhood.
Aims:
The present study extends this line of research by exploring the possibility that paternal involvement prenatally, postnatally, and at the time of birth may influence offspring risk for various diagnoses in childhood.
Study design:
A quasi-experimental, propensity score matching design was used to create treatment and control groups to assess the relationship between paternal involvement at each stage of development and developmental diagnoses.
Subjects:
Approximately 6000 children, and a subsample of fathers, who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B).
Outcome measures:
Activity, attention and learning, speech or language, and other diagnoses in early childhood, and overall number of diagnoses at 4years of age.
Results:
We find no consistent evidence that low paternal involvement prenatally or postnatally increases the risk of various developmental diagnoses by age 4. However, children whose fathers were absent at the time of their birth were at significantly greater risk of incurring various developmental diagnoses, as well as a significantly greater number of developmental diagnoses.
Conclusions:
The findings expand our understanding of exactly how early paternal influence begins and the specific dimensions of early father behaviors that are related to the risk of various developmental diagnoses. Ultimately, these results have important implications concerning father involvement during the earliest stages of the life course.
... The data collection tool was developed by reviewing the literature (13,(17)(18)(19)(28)(29)(30). A structured, intervieweradministered and checklist questionnaire were employed to collect the data through face-to-face interviews and observing charts. ...
... In this study, we found that women who had no husbandsupported pregnancy were more likely to have an adverse pregnancy outcome than those who had a husband supported pregnancy. This is supported by studies conducted in the United States (28), and Nepal (38). The possible explanation might be that those who had no husband-supported pregnancy have been shown to have effects on women's behaviors prenatally (39). ...
Background
In developing countries, adverse pregnancy outcomes are major public health issues. It is one of the leading causes of neonatal morbidity and mortality worldwide. Despite the fact that ending prenatal mortality and morbidity is one of the third Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of lifetime adverse pregnancy outcomes among antenatal care (ANC) booked women in Northwest Ethiopia.
Methods
An institutional-based cross-sectional study design was conducted in Northwest Ethiopia, between March 2021 and June 2021. A multi-stage stratified random sampling technique was employed to recruit participants. An interviewer-administered and checklist questionnaire were used to collect the data. The data were entered into Epi-data version 4.6 software and exported to Stata version 16 for analysis. The binary logistic regression model was fitted to identify an association between associated factors and the outcome variable. Variables with a p-value of < 0.05 in the multivariable logistic regression model were declared as statistically significant.
Results
In this study, the lifetime prevalence of adverse pregnancy outcome among study participants was 14.53% (95%CI: 11.61, 18.04). Road access to the health facilities (AOR = 2.62; 95% CI: 1.14, 6.02) and husband-supported pregnancy (AOR = 2.63; 95 CI: 1.46, 4.72) were significantly associated with adverse pregnancy outcomes.
Conclusions
More than one in 10 reproductive age women had adverse pregnancy outcome throughout their life. Road access to health facilities and husband-supported pregnancy were statistically significant factors for adverse events in pregnancy. Therefore, it is better to give more attention to expanding infrastructure like road accessibility and increasing husband-supported pregnancy to reduce adverse pregnancy outcomes.
... Among pregnant young women, emotional and informational supports from mothers and partners have the greatest stress buffering effect [25,26]. Women who receive support from their partners both during pregnancy and in the postpartum period have been shown to experience less anxiety, emotional distress, depressive symptoms and report greater maternal satisfaction [27]. ...
... Partner support has also been shown to contribute to improved birth outcomes. Shah et al. [25] found that pregnancy loss and low birth weight were lower in teenage mothers with more partner support. Women who receive support from their partners are more likely to initiate prenatal care earlier than women who do not receive support [29]. ...
Background
Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. The challenges they face may be exacerbated by lack of social support, putting them at risk of psychological disorders such as depression. Women who receive support from their partners both during pregnancy and postpartum experience less emotional distress and report greater maternal satisfaction. However, very little is known about the experiences of social support among pregnant adolescents and young women in tertiary institutions
Methods
Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the perceptions of pregnant students on the type of support that they need during pregnancy with particular focus on the role that their partners play (or do not play) in providing support during pregnancy and the puerperium. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis.
Results
The findings show that social support (emotional, instrumental, informational, and financial) were highlighted as an important resource to cope with stressors during pregnancy and post birth. Emotional support from male partner was the most important type of support needed as it entailed a sense of being loved and cared for. Social support was identified as important throughout the different phases of pregnancy and post birth, with different support needs expressed at each of these phases.
Conclusion
This study identified support needs of pregnant women in their transition to motherhood. Given the several challenges that they are faced with, pregnant students need all the available support including male partner support to enhance wellbeing as they try to cope with academic and pregnancy-related stressors.
... 37,41 For example, African American adolescents in supportive relationships and living in urban areas have decreased odds of adverse birth outcomes compared with African American mothers with no partner support. 22,95 Rural residence also compounds the risk of adverse birth outcomes among African American adolescent mothers. Compared with their urban counterparts, African American adolescent mothers living in rural areas face additional challenges in accessing maternity care services which can negatively impact their pregnancy outcomes. ...
... 22 Pregnant adolescents with poor social capital are likely to be of low SES and have a greater risk of adverse perinatal outcomes. 95 These associations emphasize that the "one-size-fits-all" approach to reduce inequities in adolescent perinatal health may not be effective. Instead, precision public health approaches that account for the intersection of multiple adversities affecting pregnant adolescents should aim to provide unique and customized interventions. ...
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
... La etnia y la edad materna al nacimiento, no considerados tradicionalmente como indicadores, pueden estar asociados con el contexto económico en ciertas comunidades y puede estar asociado con los resultados en desarrollo cognitivo (78). Aunque la adolescencia y el bajo estatus socioeconómico están asociados con peores indicadores perinatales (79,80), se ha observado también que el soporte de las adolescentes embarazadas en adultos de confianza mejora considerablemente estos indicadores (81). ...
... En nuestro análisis no hemos hallado que los niños con madres menores de 19 años presenten problemas en el crecimiento y el desarrollo, esto se condice con los hallazgos de Richards (101). Se ha observado que el soporte de las adolescentes embarazadas en adultos de confianza mejora considerablemente indicadores perinatales (81). Estos resultados podrían deberse entre otras cosas al acompañamiento familiar y del consultorio de adolescencia en el HMIRS (128). ...
... 3,4 One American study noted that fathers' support of breastfeeding (or lack of) was a significant factor in a mother's decision to breastfeed. 13 The aim of this study was to explore the attitudes of fathers in the setting of teenage pregnancy towards breastfeeding. ...
... Our study supports the findings of previous studies that in the setting of teenage pregnancy, the expectant fathers' support of breastfeeding (or lack of) will bea significant factor in the mother's decision-making process to breastfeed her infant. 3,4,13 Breastfeeding as a natural process emerged as both negative and positive themes in our study. Some fathers looked favourably upon breastfeeding, regarding it as a natural and convenient process. ...
... Studies addressing teenage pregnancy usually emphasise the role of the mother and significantly less data is available concerning fathers (Quinlivan and Condon [9] , 2005; Shah et al [10] , 2014). Furthermore, research addressing teenage pregnancy primarily explores the impact teenage pregnancy has on the birth and ongoing development of the child rather than considering the situation from the parent's perspective [9,[11][12][13][14] . ...
... Deave and Johnson [2] conducted a series of semi-structured interviews amongst first-time fathers and identified themes of apprehension, unpreparedness, fear, anxiety and the feeling of being a helpless bystander. Given partner support is a key feature to successful outcomes in teenage pregnancy, it is important father's fears and lack of preparedness for birth are resolved [10] . ...
... On the other hand, there was no relationship between women's marital status and PLTC 7,43 . Support from a partner during pregnancy might decrease the probability of adverse pregnancy outcomes 44 . This may be due to adequate maternal health service utilization. ...
Globally, potentially life-threatening maternal conditions (PLTCs) are significant public health threats. Ethiopia had the highest prevalence of PLTC (17.55%). However, there is limited evidence on the determinants that increase the occurrence of PLTC in Ethiopia. Therefore, this study aimed to identify determinants of the PLTC in Tigray, northern Ethiopia. A case‒control study was carried out between January 21 and April 20, 2024. Data were collected from 1027 participants (341 cases and 686 controls) through interviews and card reviews. Bivariate and multivariate logistic regression analyses were performed via SPSS version 24 to identify factors associated with the PLTC. In this study, variables such as having no formal education (AOR: 2.78; 95% CI 1.50–5.15), not in a marital union (AOR: 4.33; 95% CI 1.23–15.23), alcohol intake during pregnancy (AOR: 1.77; 95% CI 1.13–2.76), a history of stillbirth (AOR: 3.02; 95% CI 1.81–5.04), twin birth (AOR: 2.24; 95% CI 1.03–4.86), chronic hypertension (AOR: 11.37; 95% CI 3.71–34.88), prior cesarean section (CS) (AOR: 2.40; 95% CI 1.27–4.50), malaria during pregnancy (AOR: 4.10; 95% CI 1.25–13.45), not taking foliate (AOR: 4.10; 95% CI 1.25–13.45), induced labor (AOR: 7.33; 95% CI 4.31–12.47), and CS delivery (AOR: 2.39; 1.59–3.6) were increased risk of PLTC. However, completing recommended prenatal care visits (AOR: 0.59; 95% CI 0.41–0.86) was associated with lower odds of developing PLTC. Therefore, governmental and nongovernmental organizations, programmers, and healthcare providers should use the underlying evidence for the prevention and management of the PLTC.
... This might be linked to the reason that the women who had not to receive support during pregnancy make unfavourable surroundings for the mother due to lack of money, time, work load and decrease motivation for ANC visits, then which makes the mother cannot or less than recommended ANC follow up and stressful environment which leads the mother for different pregnancy-related complications including preterm delivery. Support may moderate the stress on pregnant women, which in turn may decrease a woman's chance of having a poor birth outcome [36]. ...
Background
Preterm delivery refers to childbirth that occurs before 37 full weeks’ gestation. Globally, around 13.4 million babies are born preterm annually, a million died due to its complications. Identifying its determinants is mandatory to decrease preterm birth and thereby neonatal deaths. Therefore, this study aimed to identify the determinants of preterm delivery among mothers who gave birth in hospitals in the Wolaita zone, southern Ethiopia.
Methods
A hospital-based unmatched case-control study design was conducted from March 29 to May 20, 2023, in the Wolaita zone, southern Ethiopia. Cases were women who gave birth after 28 weeks and before 37 completed weeks, and controls were women who gave birth at and after 37 and before 42 weeks of gestation from the first day of the last normal menstrual period. A consecutive sampling method was used. Data were collected by a structured interviewer-administered questionnaire. Data were coded and entered into Epi data 3.1 and analyzed by using SPSS version 25. Variables that had a P-value < 0.25 in the bivariate logistic regression analysis were entered into a multivariable logistic regression model. Finally, p-value < 0.05 was used to claim statistical significance.
Result
From a total of 405 eligible participants, 399 respondents (133 cases and 266 controls) participated in this study with a response rate of 98.52%. The result of the multivariable analysis shows that mothers who resided in rural areas [AOR = 2.78:95% CI (1.51–5.12)], not receiving support from their partner [AOR = 2.37:95% CI (1.24–4.51)], less than four antenatal care visits [AOR = 4.52:95%CI (2.38–8.57)], developed pregnancy-induced hypertension [AOR = 5.25:95%CI (2.27–12.14)] and exposed for intimate partner violence [AOR = 2.95:95%CI (1.105–7.85)], had statistically significant association with experiencing preterm delivery.
Conclusion and recommendation
Most of the determinants for preterm delivery have been proven modifiable. Thus, designing new strategies, providing comprehensive mobile clinic services to address hard-to-reach areas and Health care providers should give due attention to mothers with pregnancy-induced hypertension and exposure to intimate partner violence and increase the awareness of antenatal care follow-up and benefit of support during pregnancy to reduce preterm delivery.
... Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetrical events among the participants by 97% (aOR (95% CI) of 0.03 (0.02-0.06), p-value <0.001). The incomplete development of the maternal pelvis could determine an inability of the birth canal to allow the passage of the fetus and cause an increase in operative deliveries [40,41]. Cesarean delivery in our study was however protective of the adverse maternal outcomes because cesarean section can help optimize fetal outcomes when conducted timely before fetal compromise sets in [42]. ...
Introduction: Many female teenagers in low-resource settings conceive, of which half are unplanned and end in many deaths in sub-Saharan Africa, accounting for the majority of the cases. Teenage pregnancy is associated sometimes with poor maternal, newborn, and child deaths.
Objectives: The aim of the study was to determine the prevalence, maternal obstetric outcomes, and factors associated with poor maternal obstetric outcomes among teenage mothers delivering at Mbarara Regional Referral Hospital.
Methods: This was a cross-sectional study carried out in a maternity ward at Mbarara Regional Referral Hospital, where 9,200 mothers deliver annually. All the women coming in for the delivery of their babies were consecutively approached for inclusion in the study. The women were enrolled in the post-delivery ward after delivery and interviewed with pretested questionnaires to capture the sociodemographic, obstetric, and medical profiles of the mothers. Factors were significant if the p-value was <0.05.
Results: Out of the 327 participants, the majority were rural dwellers (68.5%), married (75.8%), attained primary education (69.4%), had not used contraception (89%), and had had a planned pregnancy (63.3%). The prevalence of adverse maternal obstetrical events was 59.9%. The HIV-positive rate was 4.9%, and about half of the participants had delivered by cesarean section (41.6%). The participants' mean age was 18.4 years and SD 1.1. The mean number of antenatal care contacts attended was 4.59 and SD 1.9. The adverse maternal outcomes included episiotomy (30.9%), perineal tear (18.7%), premature rupture of membranes (10.1%), placenta abruption (5.2%), and pre-eclampsia/eclampsia (4%). Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants by 97% (adjusted odds ratio (aOR) (95% CI) of 0.03 (0.02-0.06), p-value<0.001). Having a prior history of a miscarriage was significantly associated with the occurrence of adverse maternal obstetrical events among the participants (aOR (95% CI) of 6.55 (1.46-29.42), p-value0.014).
Conclusions: Slightly more than half of the teenage mothers had adverse maternal obstetrical outcomes, and a history of a miscarriage in previous pregnancies was significantly associated with adverse maternal obstetrical outcomes. Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants. Teenage mothers are at a high risk of adverse maternal obstetrical outcomes, and close antepartum and intrapartum surveillance is recommended.
... By accompanying the mother, it gives them a sense of reassurance and confidence to manage anxiety and the stress that comes with labor [10]. According to Shah et al. [11], there was a reduction in pregnancy loss and LBW pregnancies just with the presence of a partner. Alongside emotional aid, there is also tangible support. ...
A source of support during birth could be the solution to negative outcomes for the mother and her baby. To improve the birthing experience and increase positive birthing outcomes, sources of support during pregnancy should be evaluated and understood. The goal of this review was to synthesize the existing literature on how doulas might improve birth outcomes. This scoping review also aimed to shed light on the positive impact emotional support during childbirth can have on the health and well-being of mother and child. PubMed and EBSCOhost were used to identify articles using the search words with Boolean operators "doulas" AND "labor support" AND "birth outcomes" AND "pregnancy" AND "effects during labor." The eligibility criteria for article selection included primary studies investigating how doulas contributed to birth outcomes. The studies in this review indicated that doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections, premature deliveries, and length of labor. Moreover, the emotional support provided by doulas was seen to reduce anxiety and stress. Doula support, specifically in low-income women, was shown to improve breastfeeding success, with quicker lactogenesis and continued breastfeeding weeks after childbirth. Doulas can be a great resource for birthing mothers, and consideration should be given to using them more, as they may have a positive impact on the well-being of the mother and child. This study raised questions about the accessibility of doulas and how they may help mitigate health disparities among women from different socioeconomic levels.
... There are some findings in the literature showing that the relationship of the pregnant woman with her spouses is related to pregnancy anxiety, the results of the delivery, and perinatal distress. In the study by Shah et al., (2014), it was reported that possible negative postnatal results in pregnant women receiving support from their spouses during pregnancy were rare. Also, the study by Jonsdottir et al., (2017) stated that pregnant women who do not get along well with their spouses were 4 times more likely to experience perinatal distress. ...
Objective: To determine the effect of childbirth preparation education on the prenatal adaptation of pregnant women.
Methods: This study design was a quasi-experimental; one-group
pretest-posttest. This study was conducted with the participation of 42 pregnant women and their spouses. The educations were given in four sessions in a special area designed for childbirth preparation educations in a private hospital where the study was conducted. The data of the study were collected using the Pregnant Women Information Form and the Prenatal Self-Evaluation Questionnaire. Prenatal Self-Evaluation Questionnaire consists of seven subscales which are the well-being of pregnants’ and their infants, acceptance of pregnancy, acceptance of motherhood, fear of childbirth, relationship with her mother and relationship with her spouse. The Wilcoxon signed rank test statistics were used to analyze the difference between the pretest and posttest PSEQ scores.
Results: The concerns about the well-being of pregnants’ and their
infants (p<.05), acceptance of pregnancy (p<.05), acceptance of
motherhood (p<.05), fear of childbirth (p<.05), relationship with her
mother (p<.05), relationship with her spouse (p<.05) subscale and total adaptation score (p<.05) were significantly higher before the education compared with the after the education. However, there was no significant difference between pre and post-education scores regarding readiness for birth subscale (p>.05).
Conclusion: This study showed that childbirth preparation education
improves prenatal adaptation, acceptance of pregnancy and motherhood, relationship with her mother and relationship with her partner of pregnant women. In addition, it decreased fear of childbirth of pregnant women.
... These perceptions could influence birth outcomes either directly or indirectly via other protective behaviors (Weller, Eberstein and Bailey 1987;Kroelinger and Oths 2000;Shah et al. 2011;Shah, Gee and Theall 2014). ...
... Mothers who have no support during child bearing had ve times chance to develop adverse birth outcome when compared with mothers who have partner support. This study was in line with the study done in united states women with a supportive partner were 63% less likely to experience LBW and nearly two times less likely to have pregnancy loss compared to those with no partner support (30). This might be those who have paternal support may experience less stress and be more likely to enter prenatal care and they also may be more likely to indicate a desired pregnancy which may reduce their risk of poor birth outcomes. ...
Back ground The adverse birth outcomes can lead to higher rates of illness and infection for newborns, as well as long-term neurological and health problems. Hence, this study aims to identify determinants of adverse birth outcomes among mothers who gave birth in hospitals in the west shewa zone, Ethiopia.
Methods Unmatched case-control study was conducted among 591 mothers (146 cases and 445 controls) who gave birth at hospitals found in the west Shewa zone from March 2020 and July 2020. All cases during the data collection period and every 3rd control after cases were selected as a study population. The data were collected from the mothers, measurements from neonates. The questionnaire template was coded by using open source software for Computer-Assisted Personal Interviewing using census and survey processing system (CS-Pro) version 7.1. The collected data were exported to SPSS version 23 for analysis. Finally, presented and interpreted at P-value < 0.05 were considered as statistically significant in multivariable logistic regression.
Result: on multivariable analysis; urban residence (AOR=0.56, 95%, CI=0.36-0.88), lack of family support during child bearing (AOR=5.07, 95% ,CI: 3.01-8.54), pregnancy type(3.994 (AOR=3.4, 95% ,CI: 2.04-7.83,), short inter pregnancy interval (AOR=1.6, 95% CI: 1.99-2.48), not provided all initial newborn care (AOR=2.19, 95% CI: 1.39-3.41), less than four antenatal care visits (AOR=1.6, 95% CI: 1.02-2.61) and having current obstetric complication (AOR=2.7, 95% CI: 1.55-4.84) were significantly associated with adverse birth outcomes.
Conclusions: Residence, lack of family support during child bearing, Pregnancy type, short inter pregnancy interval, not provided first initial newborn care, having current obstetric complications, and Number of ANC visits were identified as determinants of adverse birth outcome. Therefore, improving family support, inter-pregnancy interval through family planning counselling and provision, providing all initial newborn cares, and having the recommended ANC follow-up was recommended.
... A significant difference was found between the risk group and the non-risk group concerning "characteristics related to pregnancy and spouse relationship", which is one of the factors of PPHAS (p<0.001). Paternal support and relationship may moderate or alleviate the stress on pregnant women, which in turn may decrease a woman's chance of having a poor birth outcome (21). A supportive partner may be a key factor in reducing the mother's stress during the prenatal period; thus, a weak marital relationship is the most stable predictor of anxiety, physically/emotionally abused and other health issues during pregnancy (15,22,23). ...
Objective: This study aims to compare women with risky pregnancy with women with non-risk pregnancies concerning pregnancy-related psychosocial adaptation.
Materials and Methods: This research has a descriptive, comparative and cross-sectional single-centre study. The data were collected from 253 pregnant women who applied to and were followed-up in the gynecology and obstetrics clinic of a university hospital in Izmir, Turkey. The Demographic Information Form and the Pregnancy Psychosocial Health Assessment Scale were used for data collection.
Results: Pregnant with-without risk of Psychosocial Health Assessment Questionnaire (PPHAS) total and subscale mean scores was compared and a statistically significant difference was observed between the two groups. The findings obtained in this study showed that the difference between PPHAS total and subscale mean rank total scores for risky and non-risky subjects was statistically significant (p<0.001). A statistically significant difference was found between the PPHAS score and the occupation, the place/region where the participant lived for the longest time, the family type, previous birth method, the frequency of pregnancy follow-up, the chronic disease presence, the pregnancy type (p<0.05).
Conclusion: There was a significant difference between psychosocial health between risky pregnancies and non-risky pregnancy who participated in this study. The psychosocial health level of the non-risk group was higher and psychosocial health was lower in risky pregnancies.
... Male teens of color contend with a documented increase in police surveillance and incarceration (Blankenship, del Rio Gonzalez, Keene, Groves, & Rosenberg, 2018), which have long-term consequences for family formation, multipartner fertility (parents who have children with more than one partner), and fathers' connections to children, families, and the broader community (Wildeman & Wang, 2017). Yet, paternal support and involvement are linked to better perinatal outcomes for teen mothers (Shah, Gee, & Theall, 2014) and socioemotional and academic outcomes for their children (Lewin et al., 2015), even when living apart (Howard, Lefever, Borkowski, & Whitman, 2006). Father involvement may also protect future generations, because fathers with stronger relationships with their own fathers are more likely to be involved fathers (Brown, Kogan, & Kim, 2018). ...
Although the teen birth rate in the United States continues to decline, births remain disproportionately high among disadvantaged teens and teens of color. The vulnerabilities and resilience of teen parents are described from a historical context, with recommendations for advancing primary care of these families. We endorse comprehensive primary care and clinical practices that capitalize on the strengths and resilience of these families while recognizing the social inequities that compromise their health and development. To strengthen the bonds among young mothers, fathers, and children, we recommend family-centered primary care services that are of a youth- and father-friendly, nonstigmatizing, strength-based, and trauma-informed nature.
... The only associated dimension of perceived social support with childbirth experience was support by significant others/ spouse, which has also been noted in previous studies ( Backstrom et al., 2017;Howarth et al., 2011;Sadeghiaval shahr et al., 2014;Shah et al., 2014 ). Support by spouse during pregnancy is accompanied by sense of respect, safety and self-esteem in mother and it is the most important source of social support. ...
Objective:
In recent years, the role of social support on different aspects of health especially pregnancy and childbirth has been emphasized. Social support facilitates individual access to necessary resources during stressful periods of life like pregnancy and childbirth. Present evidence of effects of social support on birth experience is inconsistent, Therefore, this study aimed to determine the correlation between perceived social support in pregnant women and their childbirth experience.
Design:
Analytic-cross sectional survey.
Setting:
Al-Zahra maternity hospital in Rasht, Iran.
Participants:
185 pregnant women who were in latent phase of labor entered the study and finally, 89.18% (n = 165) completed the study.
Measurements:
To measure perceived social support, the Multidimensional Scale of Perceived Social Support was used at latent phase of labor and to measure childbirth experience, the Childbirth Experience Questionnaire was used within 2 h after childbirth until the mother was discharged.
Results:
Mean score of perceived social support by significant others (4.18 ± 0.79) was higher than other dimensions of social support. Total mean score of childbirth experience was 58.13 ± 10.72 (score range: 22-88). Logistic regression results showed that support by significant others (P = 0.042, OR = 1.56), gestational age (P = 0.003, OR = 1.56) and mode of delivery (P = 0.004, OR = 0.33) are predictor variables of childbirth experience.
Key conclusions and implications for practice:
Perceived social support by significant others (spouse) during pregnancy has an important effect on woman`s childbirth experience. Therefore, providing training programs for family especially for spouse in order to increase maternal support during pregnancy is recommended, which can lead to a positive childbirth experience.
... Although teen parents rarely marry, paternal involvement remains important for children regardless of paternal age; research is limited but partner support contributed to positive birth outcomes for teen mothers (Shah, Gee, & Theall, 2014), pro-2013. Teen fathers' children fared worse on behavioral and cognitive measures at age 2 than children of older fathers but differences were attributed to young fathers' greater disadvantage (Mollborn & Lovegrove, 2011). ...
Background:
Although teen fathers are a vulnerable group of parents, they have received far less attention than teen mothers.
Purpose:
We conducted a systematic search of qualitative studies that examined their prenatal and postpartum experience to better understand teen fathers' concerns, strengths, and vulnerabilities.
Methods:
We searched nine electronic databases through September 2017; 29 studies represented in 30 articles met study criteria. All authors independently extracted data from each article. Coding decisions were reviewed weekly and differences were settled by consensus.
Results:
From pooling the results of 29 primary studies, we describe how a tenuous ground contributes to teen paternity and imperils young fathers' involvement with their children. In the best of circumstances, the ground begins to stabilize for teens who become involved parents despite significant challenges and hardships.
Clinical implications:
Our results contribute to the visibility of teen fathers and the social disparities that imperil fathering. We provide clinical guidance for strengthening the ground for teen fathers and their families, recognizing that clinicians often encounter challenges such as interpersonal factors and sociocultural conditions that systematically erode fathers' ties to their children, partners, professional caregivers, and institutions.
... Other researches support the importance of family support for pregnant women. Mothers with a supportive partner were 63% less likely to experience low birth weight and nearly 2 times less likely to have pregnancy loss compared to those with no partner support (Shah, Gee, & Theall, 2014). To be able to provide good support for pregnant women in the prevention of anemia, it is necessary to increase knowledge on the family about the importance of support pregnant women. ...
Background: Anemia during pregnancy is a major nutritional problem that can cause health problems for mothers and their fetus. Prevention of anemia has been done but many obstacles are perceived by pregnant women. Families need to provide support to improve the prevention behavior of anemia.Objective: This research aims to explore the effect of educational intervention on family support for pregnant women in preventing anemia.Methods: A quasi-experimental design was carried out on 60 pregnant women who had done pregnancy check ups at Community Health Centre and had received iron supplement, in which 30 women were in the experimental group and the rests were in the control group. This study was conducted from December 2016 to January 2017. Family support was measured using questionnaires before and after educational intervention.Results: After educational intervention, there was a significant change from the pretest score to the posttest score in the experimental group (p<0.05). There was an increase in the average score in the experimental group, 14.47 ± 2.89 becomes 16.83 ± 2.32.Conclusion: Educational interventions can increase family support for maternal behavior in preventing pregnancy anemia such as improving adherence to taking iron supplements and high intake of food containing iron.
... 24 Pendidikan ayah berpengaruh terhadap dukungan selama kehamilan yang dapat mengurangi kejadian berat bayi lahir rendah. 25 Pendidikan tinggi pada ayah, yang mana ayah merupakan kepala rumah tangga dapat memudahkan tenaga kesehatan untuk memberikan informasi kesehatan untuk keluarga, khususnya pada ibu hamil. 26,27 Dalam penelitian lain menemukan bahwa kekurangan dari faktor sosialekonomi dapat meningkatkan risiko pertumbuhan janin terhambat dan kelahiran prematur (output kehamilan). ...
Kehamilan merupakan periode fisiologis-spesifik yang mana selama periode ini, kebutuhan zat gizi meningkat. Sebanyak 50-70% ibu hamil mengalami mual dan muntah terus menerus, berdampak pada kurang maksimalnya pemberian asupan gizi bagi ibu dan bayi. Keberlanjutan kondisi ibu dapat menyebabkan ketidakseimbangan cairan di dalam tubuh yang berdampak pada status hidrasi ibu. Penelitian bertujuan menganalisis hubungan karakteristik, sosial-ekonomi, status gizi, asupan gizi dan air dengan status hidrasi. Penelitian ini merupakan penelitian cross-sectional, dilakukan di wilayah kerja Puskesmas Kecamatan Kebon Jeruk, Jakarta Barat. Subjek penelitian ini adalah ibu hamil trimester kedua, memeriksakan kehamilan di tempat penelitian berjumlah 107 subjek. Uji t-test independent dan chi-square digunakan untuk menganalisis data. Subjek dibagi ke dalam dua kelompok berdasarkan status hidrasi dari nilai osmolalitas urin; normal dan hipohidrasi. Nilai rerata osmolalitas urin pada kelompok hipohidrasi dan normal, adalah 838.78±172.35 mOsm/Kg dan 268.05±116.64 mOsm/Kg. Karakteristik subjek (umur, umur kehamilan, berat badan, tinggi badan, status gizi sebelum hamil, lingkar lengan atas, lingkar pinggang, lingkar panggul, tekanan darah) tidak terdapat perbedaan di antara dua kelompok (p≥0.05). Tidak terdapat hubungan tingkat pendidikan ayah dan ibu, pekerjaan ayah dan ibu, pengeluaran rumah tangga, dan pengetahuan ibu (p≥0.05). Terdapat perbedaan asupan energi, karbohidrat, dan zinc di dua kelompok (p<0.05), tetapi tidak menemukan perbedaan asupan (protein, lemak, kalsium, zat besi, asam folat) dan air di dua kelompok (p≥0.05). Namun demikian, ibu harus tetap memerhatikan asupan zat gizi dan air untuk mendukung tumbuh kembang janin.
... Furthermore, low birth weight (LBW) is associated with increased mortality as well as acute and long-term health problems [13][14][15]. In Europe the percentage of LBW ranged between 4 and 9% in 2010 [10]. ...
Background:
Prematurity and low birth weight are significant predictors of perinatal morbidity and mortality and are influenced by the overall health and socioeconomic status of the pregnant mother. Although Cyprus is characterized by the highest prematurity rate in Europe (13.1% in 2014), the relationship between maternal health and socioeconomic characteristics with prematurity and low birth weight has never been investigated. We aimed to investigate the association of maternal demographic, clinical and socioeconomic characteristics with premature delivery and low neonatal birth weight in Cyprus.
Methods:
In a case-control design, questionnaire data were collected from 348 women who gave birth prematurely (cases) and 349 women who gave birth at term (controls). Information was obtained on gestation duration and birth weight as well as maternal demographic, socioeconomic and clinical profiles, including parameters such as smoking, body mass index, alcohol consumption, presence of gestational diabetes and mental health factors.
Results:
Premature delivery was associated with greater maternal age (OR: 1.12, 95% CI: 1.06-1.18), absence of gestational diabetes (OR: 0.53, 95% CI: 0.30-0.97), long working hours (OR: 3.77, 95% CI: 2.08-6.84) and emotional stress (OR: 8.5, 95% CI: 3.03-23.89). Within the cases group, emotional stress was also associated with lower birth-weight (β: -323.68 (95% CI: -570.36, - 77.00).
Conclusions:
The findings of this study demonstrate the positive association of maternal psychological factors, working conditions as well as maternal age with prematurity and low birth weight in Cyprus. Additional, prospective, studies are needed in the country to further investigate these associations and inform public health intervention measures.
... Moreover, greater levels of social support improve quality of life as well as promoting physical and psychological well-being in women [27,28], but also in the product. For example, having a supportive partner may reduce the experience of low birth weight in the product or have a pregnancy loss [29]. On the contrary, low levels of social support predispose to higher risk of disease, increase other adverse results and mortality [30,31]. ...
Objectives
This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated.
Methods/Principal findings
A cross-sectional study enrolling women aged 18–25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%–49.3%), and 17.4% (95%CI: 13.1%– 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81–3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14–3.30) after controlling for confounders.
Conclusions
There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.
... Research suggests that among pregnant depressed women, perceived lack of support from partner increased the risk of earlier birth [24]. In contrast, support from partner during the pregnancy has been shown to be protective for low birthweight infants [40] including Black women [41]. Thus, research needs to focus on the role of the father of the baby on birth outcomes among Black women. ...
Background
While maternal depressive symptoms during pregnancy have been linked to preterm birth (PTB; birth before 37 completed weeks of gestation), little has been reported on potential buffering factors, particularly specific to Black women who are at much higher risk. We examined the association between depressive symptoms and PTB in pregnant Black women, with father of the baby (FOB) support as a potential buffering factor.
Methods
Data were obtained from the life-course influences on fetal environments study (2009–2011), a cohort of 1,410 Black women in metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to measure depressive symptoms. The 14-item social networks in adult relations questionnaire was used to assess the mother's relationship with the FOB. Logistic regression was used to explore the interaction between CES-D and FOB support with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care and BMI.
Results
The PTB rate in this cohort was 17.7%. Among women with FOB scale < 60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥ 23 (severe depressive symptoms) as compared to CES-D scores < 23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94; p < 0.001]. Among women with FOB scores ≥ 60 (more support), the odds of PTB in women with CES-D scores ≥ 23 did not significantly differ from the odds of PTB in women with CES-D scores < 23 (OR = 1.34; 95% CI: 0.74, 2.44; p = 0.3). After adjustment for covariates, among women with FOB scores < 60, the OR of PTB for women with CES-D scores ≥ 23 compared to < 23 was 2.79 (95% CI: 1.75, 4.45; p < 0.001). Among women with FOB scores ≥ 60, the odds of PTB in women with CES-D scores ≥ 23 was not statistically significantly different compared to the odds of PTB in women with CES-D scores < 23 (OR = 1.21; 95% CI: 0.62, 2.35; p = 0.6). The interaction term was statistically significant (p = 0.04).
Discussion/Conclusions
The adverse effect of depressive symptoms on risk of PTB may be buffered by factors such as a supportive relationship with the FOB.
... Lack of prenatal care in adolescents significantly increases the risk of preterm delivery and low birth weight (LBW) infants independently of the risk associated with their age [7,8] Teens are less likely to seek prenatal care for a variety of reasons, including fear of repercussions, the presence of an undesired pregnancy, or lack of access to appropriate resources [7,9]. ...
... Evidence also underscores the role of father involvement in children's health. Father involvement during pregnancy has been linked to a decreased risk of adverse birth outcomes, including infant morbidities and mortality (Alio et al. 2010;Shah et al. 2014) while father involvement during early childhood has been associated with stronger physical growth and less child malnourishment (Dearden et al. 2013;Jeong et al. 2016). ...
Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers’ involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0–4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011–2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and US-born Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.
... Other reasons could also lead to spontaneous abortions in adolescent pregnancies. Lack of a good nutritional status [21] and lack of partner support [22] may lead to spontaneous abortions. This urgently demands the need for awareness campaigns and support for contraception. ...
Background:
In Ghana, adolescents represent 22% of the total population. The rates of adolescent pregnancies are high. Of all births registered in the country in 2014, 30% were by adolescents, and 14% of adolescents aged between 15 and 19 years had begun childbearing. Pregnancies and deliveries of adolescents are accompanied by more risks as compared to older women. The aim of the study was to explore the long-term effects of adolescent pregnancies on subsequent pregnancies and births and on the socioeconomic status of the women.
Method:
A cross-sectional interviewer-performed survey of a purposive sample of 400 women in one community of Northern Ghana was conducted. Relationships between the age at first pregnancy and complications such as cesarean section, preterm or stillbirth and others were explored in 143 patients using the statistical program SPSS (Statistical Package for the Social Sciences).
Result:
Results show that adolescent women (<19 years at their first pregnancy) have an 80% higher risk for a cesarean section for the first and subsequent births as compared to older women (≥ 19 years). Furthermore, younger mothers have a 45% higher risk of stillbirths and a 30% increased risk of losing their baby within the first 6 weeks after birth. There was no difference in the socioeconomic status between the two age groups.
Conclusion:
Adolescent pregnancies are risk factors for the outcome of subsequent pregnancies of these mothers. This study, for the first time, shows that not only the first pregnancy and birth of very young women are negatively influenced by the early pregnancy but also subsequent pregnancies and births. While this study is of a purposive sample of women in one community, the clinical relevance of this study should not only be interesting for healthcare practitioners in Northern Ghana and other African regions but also for prevention campaigns in these regions.
... Different works have studied the impact of social support and self-efficacy and their relationship with maternal prenatal cares during pregnancy, type of delivery, and life quality (5,6). The results have indicated that perceived social support, especially from husband, has positive effects on different aspects of self-care activities in pregnant women (7)(8)(9). Concerning the importance of social support and husband's supportive role that can reduce pregnancy complications (10,11) on one hand, and considering this fact that one of the barriers to maternal prenatal cares in the participants was the lack of support by husbands on the other hand, it is of great importance to study this issue. A pregnant woman not only needs social support, but also she should perceive her ability to pregnancy, maternal prenatal cares, and the new condition (6). ...
Objective: Social support and perceived self-efficacy affect health-related behaviors and play an important role on mothers' adaptability with pregnancy. This paper aims to study the impact of educational interventions based on social support and perceived self-efficacy on maternal prenatal care.
Materials and methods: The present study is a before after experimental study in which 90 first-time pregnant women were randomly selected and divided into two 45- participants experimental and control groups. Data were collected from 21 January to 20 May 2016. Determining the validity and reliability of the questionnaire, we used the panel of experts and Cronbach's alpha. The data collected from the two groups were compared before and 3 months after intervention and were analyzed by SPSS 18.
Results: Unlike the control subjects, there was a significant difference in maternal prenatal cares before and after an educational intervention between the scores of social support and perceived self-efficacy in the experimental group (p < 0.05). Before intervention, the average score of the experimental group was 12.62 ± 2.63 that rose to 17.71 ± 1.56, three months after the educational intervention, which is statistically significant (p < 0.05). There was a direct and positive relation between self-efficacy and maternal prenatal cares (p = 0.000, r = 0.538). Social support and self-efficacy predicted the variance of maternal cares by 69.2%.
Conclusion: Developing an educational program based on social support and perceived self-efficacy on maternal prenatal cares is helpful and efficient. The health system, family and society are in charge of making facilities and opportunities to improve social support and perceived self-efficacy in pregnant women, resulting in improved maternal prenatal cares.
... The association between the lack of a partner support and teenage pregnancy might improve the likelihood of having a poor birth outcome. The support or involvement of a partner can affect maternal behaviour during either prenatal or perinatal periods [18]. The relationship between inadequate use of antenatal care and maternal death has already been established [19,20]. ...
Objectives
To assess a birth registry to explore maternal mortality and morbidity and their association with other factors.
Study Design
Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed.
Results
712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes.
Conclusions
The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.
... The dynamics of becoming pregnant at such an early age may create role strain and can lead to social and occupational difficulties (Morris & Levine Coley, 2004). These difficulties may be compounded by a lack of support from family, friends, and the baby's father, as well as preexisting lack of resources which can lead to poor mother and infant outcomes (Chedraui, 2008;Meltzer-Brody et al., 2013;Shah, Gee, & Theall, 2014). For example, adolescent mothers are more likely to deliver low birth weight babies, experience perinatal depression (PND), and eventually mistreat their own children thus perpetuating an intergenerational cycle of trauma (Cederbaum, Putnam-Hornstein, King, Gilbert, & Needell, 2013;Putnam-Hornstein, Cederbaum, King, Eastman, & Trickett, 2015). ...
This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample (N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.
... the need for involuntary establishment of paternity. Furthermore, roughly half of first pregnancies in the United States are unwanted or unexpected, which is associated with greater likelihood of pregnancy loss, delayed prenatal care, and low birthweight, and with lower likelihood of being breastfed (Bronte-Tinkew et al. 2009b;Korenman et al. 2002. Shah et al. 2014). Helping to prevent unwanted or unexpected pregnancies, especially in the context of unmarried noncohabiting couples, might increase voluntary establishment of paternity as well as improve birth outcomes and children's subsequent well-being. ...
The establishment of a legal father for children of unmarried parents reflects both high paternity confidence and male willingness to commit to paternal investment. Whether an unmarried man voluntarily acknowledges paternity after a child is born has important consequences for both the mother and child. This paper brings to bear a life history perspective on paternity establishment, noting that men face trade-offs between mating and parental effort and that women will adjust their investment in children based on expected male investment. I predict that paternity establishment will be more likely when the mother has high socioeconomic status, when maternal health is good, and when the child is male, low parity, or a singleton (versus multiple) birth. I further predict that establishment of paternity will be associated with increased maternal investment in offspring, resulting in healthier babies with higher birthweights who are more likely to be breastfed. These predictions are tested using data on 5.4 million births in the United States from 2009 through 2013. Overall the results are consistent with the hypothesis that the trade-offs men face between reproductive and parental investment influence whether men voluntarily acknowledge paternity when a child is born.
... It is found to minimize maternal depression (Kim et al. 2014;Logsdon et al. 2002) and decrease anxiety (Warren 2005), which acts as a proxy for positive physical health benefits. It is also found to reduce the likelihood of cognitive impairments in their infants (Shah et al. 2014), and prevent child abuse (Logsdon et al. 2002). Support, particularly from their spouse and/or their own mother, plays a crucial role in the transition to motherhood (Baheiraei et al. 2012), whereby new mothers are less likely to feel overwhelmed and have more time available for their infants. ...
Background Social support is highly valued and beneficial for women, especially after childbirth. The objective was to examine the differences of social support reported among teen, optimal age, and advanced age women, and to identify the characteristics associated with social support separately for each age group. Methods This was a cross-sectional analysis of the National Longitudinal Survey of Children and Youth. Primiparous women with infants were grouped into: teen (15–19 years), optimal age (20–34 years), and advanced age (35 years and older). The outcome was social support (Social Provisions Scale), and demographic, socio-economic, health, community, and infant characteristics were considered for stepwise linear regression, separately for the groups. Results Total of 455,022 mothers was analyzed. Teens had the lowest social support (Mean = 17.56) compared to other groups (Means = 19.07 and 19.05; p < 0.001). Teens’ volunteer involvement was associated with an increase in social support (Adjβ 2.77; 95%CI 0.86, 4.68), and depression was associated with a decrease (Adjβ −0.12; 95%CI −0.22, −0.02). Optimal age women’s support significantly increased with maternal age (Adjβ 0.07; 95%CI 0.02,0.12), working status (Adjβ 0.60; 95%CI 0.13,1.07), and with chronic condition(s) (Adjβ 0.59; 95%CI 0.16,1.02), while it decreased with depression (Adjβ −0.05; 95%CI −0.10, −0.01) and ever-immigrants (Adjβ −1.67; 95%CI −2.29, −1.04). Use of childcare was associated with increased support among women in advanced age group (Adjβ 1.58; 95%CI 0.12, 3.04). For all groups, social support was significantly associated with neighbourhood safety. Conclusion The characteristics associated with social support varied among the three age groups. The findings may help promote awareness of the essential needs to increase support, especially for teens.
... Lower father involvement during gestation and childbirth has been associated with multiple indicators of medical risk at birth, including low birth weight (Alio et al. 2010;Padilla and Reichman 2001), small for gestational age (Alio et al. 2010), preterm birth (Alio et al. 2011), and very preterm birth (Alio et al. 2011). A recent examination of teen pregnancies in the USA, for instance, indicated that a lack of father involvement during pregnancy corresponds to a 63% increase in the risk of low birth weight (Shah et al. 2014). Neonatal medical risk may also interfere with father involvement following the birth (Feeley et al. 2013), potentially by reducing the frequency of father-child interactions during the neonatal period (Franck and Spencer 2003) and/or by engendering interactions with medical staff that lead men to feel like the Bsecond parent^ (Hollywood and Hollywood 2011). ...
The current study examines the association between early father involvement and infant neurodevelopment, and whether neonatal medical risk moderates this association. Data from approximately 6000 fathers and their children were obtained from the Early Childhood Longitudinal Study: Birth Cohort (ECLS-B). Hierarchical regression was employed to analyze the data. The findings reveal that the association between early father involvement and infant neurodevelopment is contingent on both the timing of involvement (i.e., prenatal/perinatal or infancy) and offspring medical status at birth. The neurodevelopment of medically at-risk neonates was enhanced when fathers were involved during the gestational period and at the time of their birth. This relationship was not detected, however, in the case of infants who did not experience medical risks as neonates. Neonatal medical risk appears to be an important moderating factor in the link between father involvement during pregnancy and childbirth and infant neurodevelopment. Practitioners should continue to make efforts to involve fathers during gestation and childbirth. The findings of the present study suggest that doing so may protect against neurodevelopmental delays in neonates with medical risks.
... Shah et al. recently looked at the effect of partner support on birth outcomes in pregnant adolescents and, using a secondary analysis of survey data, found that teens with a supportive or involved partner were less likely to have adverse outcomes such as low birth weight or pregnancy loss [11]. Few studies have looked at the presence of a support person during the adolescent's pregnancy. ...
This study examined whether the presence of the father of the baby (FOB) at the first prenatal ultrasound study (US) visit of pregnant adolescents and young adults (AYA) is a marker for improved pregnancy outcomes. Charts of 400 pregnant AYA aged 14–22 years seen at an academic maternity hospital were assessed retrospectively for support persons brought to prenatal US visits. Logistic regression analysis was used to examine the association between FOB presence and gestational age and birth weight. Of 400 charts with support person recorded, 298 charts with first US visit data, singleton birth, and complete gestational data available were analyzed. FOB was present at 30.2% of visits, while the parent of the mother was present at 34.2% of visits. With FOB present, 3.3% of infants were born preterm (gestational age < 37 weeks) compared with 10.5% of infants with FOB absent ( p=0.04 ). Patients with FOB present also had significantly earlier gestational age at the first US visit (15 weeks) than those who did not (19 weeks; p=0.02 ). For AYA, the presence of FOB at initial prenatal US visits is a predictor of improved pregnancy outcome and likely represents increased support during the pregnancy.
The birth of a child brings many changes. Self-efficacy is a protective factor in finding and using own potential to cope with a new situation and even reduce the level of stress. The aim of the study was to identify factors influencing the level of self-efficacy and perceived stress in the early postpartum period.
Material and methods
The study was conducted among 110 women in the first days after giving birth. The Generalized Self-Efficacy Scale (GSES), Perceived Stress Scale (PSS-10) and an original questionnaire were used.
Results
The higher the level of self-efficacy, the lower the level of stress in mothers. Self-assessment of one’s ability to care for a child and the support of family in certain household activities has an impact on self-efficacy and perceived stress.
Conclusions
Research emphasizes the need to identify knowledge and support deficits among mothers of newborn children and to provide assistance to strengthen self-efficacy and reduce perceived stress.
Abstrak Ibu hamil mengalami periode transisi dengan perubahan fisik dan mental. Ibu dapat mengalami kecemasan dan kekhawatiran menjalani kehamilan, berdampak pada kesehatan diri dan janinnya. Perhatian dan kasih sayang suami diharapkan dapat membuat emosi ibu lebih stabil, bahagia sehingga meningkatkan perawatan kehamilan. Kebaruan dalam penelitian karena menganalisis upaya peningkatan kesehatan masa kehamilan melalui "Pos Penyusu". Tujuan penelitian untuk menganalisis perubahan dukungan suami dan kecemasan ibu hamil, setelah suami yang diberikan penyuluhan di Puskesmas Kasihan II Bantul Yogyakarta. Metode dalam penelitian ini, tahap pertama penyusunan poster (pos) dan tahap kedua penyuluhan kelas suami (penyusu). Sampel penelitian sejumlah 31 responden (ibu hamil dan suami), dipilih dengan tehnik accidental sampling, dengan kriteria melaksanakan pemeriksaan antenatal care rutin di Puskesmas Kasihan II Bantul Yogyakarta, bersedia menjadi responden dan tinggal di wilayah kecamatan Kasihan Bantul Yogyakarta. Pretest dilakukan pada 31 responden ibu hamil yang suaminya akan mengikuti penyuluhan dan posttest setelah 2 minggu pelaksanaan penyuluhan. Data diukur menggunakan kuesioner dukungan suami 21 item dan kecemasan prenatal 31 items. Data hasil pretest dan posttest dianalisis menggunakan wilcoxon test. Hasil penelitian poster dinyatakan valid oleh pakar. Data pretest dukungan suami baik 19 (61,3%) subyek, tidak cemas 7 (22,6%), dan data posttest dukungan suami baik 24 (77,4%) dan tidak cemas 18 (58,06%) subyek. Hasil uji saphiro-wilk data terdistribusi tidak normal, sehingga analisis menggunakan wilcoxon test, dihasilkan signifikansi dukungan suami 0,025 dan kecemasan 0,000. Kesimpulan bahwa poster dan penyuluhan suami (pos penyusu) terbukti signifikan mempengaruhi peningkatan dukungan suami dan penurunan kecemasan ibu hamil. Kata kunci: Dukungan suami; Kecemasan kehamilan; Poster. Abstract Pregnant women experience a transition period with physical and mental changes. Mothers can experience anxiety and worry about pregnancy, impacting their health and fetus. It is hoped that the husband's attention and affection can make the mother's emotions more stable and happy, thus improving pregnancy care. This is a novelty in research because it analyzes efforts to improve health during pregnancy through the "Sunny Post." The study aimed to analyze changes in husbands' support and anxiety of pregnant women after husbands were given counseling at the Kasihan II Bantul Health Center, Yogyakarta. The method in this study is the first stage of preparing posters (posts) and the second stage of class counseling for husbands (breastfeeders). The research sample was 31 respondents (pregnant women and husbands), selected using an accidental sampling technique, with the criteria of carrying out routine antenatal care checks at the Kasihan II Bantul Yogyakarta Community Health Center, willing to be respondents and living in the Kasihan Bantul sub-district area, Yogyakarta. The pretest was conducted on 31 pregnant female respondents whose husbands will attend counseling, and the posttest after two weeks of counseling. Data were measured using a husband support questionnaire with 21 items and prenatal anxiety with 31 items. Pretest and posttest data were analyzed using the Wilcoxon test. The results of the poster research were declared valid by experts. Pretest data on husband's support was suitable for 19 (61.3%) subjects; 7 (22.6%) were not anxious, and posttest data for husband's support was good for 24 (77.4%) and 18 (58.06%) subjects who were not worried. The results of the Shapiro-Wilk test data were not normally distributed, so the Wilcoxon test analysis resulted in a significance of husband's support of 0.025 and anxiety of 0.000. The conclusion is that posters and counseling for husbands (breastfeeding posts) have proven to significantly increase husbands' support and reduce anxiety for pregnant women.
Background: Preterm delivery refers to childbirth that occurs before 37 full weeks’ gestation. Globally, around 13.4 million babies are born preterm annually, a million died due to its complications. Identifying its determinants is mandatory to decrease preterm birth and thereby neonatal deaths. Therefore, this study aimed to identify the determinants of preterm delivery among mothers who gave birth in hospitals in the Wolaita zone, southern Ethiopia.
Methods: An Institutional-based unmatched case-control study design was conducted from March 29 to May 20, 2023, in the Wolaita zone, southern Ethiopia. Cases were women who gave birth after 28 weeks and before 37 completed weeks, and controls were women who gave birth at and after 37 and before 42 weeks of gestation from the first day of the last normal menstrual period. A consecutive sampling method was used. Data were collected by a structured interviewer-administered questionnaire. Data were coded and entered into Epi data 3.1 and analyzed by using SPSS version 25. Variables that had a P-value < 0.25 in the bivariate logistic regression analysis were entered into a multivariable logistic regression model. Finally, p-value < 0.05 was used to claim statistical significance.
Result: From a total of 405 eligible participants, 399 respondents (133 cases and 266 controls) participated in this study with a response rate of 98.52%. The result of the multivariable analysis shows that mothers who resided in rural areas [AOR=2.777:95% CI (1.507-5.118)], not receiving support from their partner [AOR=2.368:95% CI (1.243-4.514)], less than four antenatal care visits [AOR=4.520:95%CI (2.384-8.569)], developed pregnancy-induced hypertension [AOR=5.248:95%CI (2.270-12.135)] and exposed for intimate partner violence [AOR=2.945:95%CI (1.105-7.848)], had statistically significant association with experiencing preterm delivery.
Conclusion and Recommendation: Most of the determinants for preterm delivery have been proven modifiable. Thus, designing new strategies, providing policy for partner support during pregnancy and Health care providers should give due attention to mothers with pregnancy-induced hypertension and exposure to intimate partner violence and increase the awareness of antenatal care follow-up and support during pregnancy to reduce preterm delivery.
Purpose:
To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.
Method:
Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups.
Results:
Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared to the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload (P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = 0.018).
Conclusions:
Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.
Background
: In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage, changes to the marketplace, and contraceptive coverage, but its impact on birth trends are currently unknown, particularly adolescent births.
Objectives
: We sought to determine whether ACA implementation was associated with changes in adolescent births, and whether this differed by insurance type (Medicaid or Private insurance).
Methods
: We used revised 2009-2017 birth certificate data, restricting to resident women with a Medicaid or privately-paid singleton birth (N=27,748,028). Segmented regression analysis was used to examine births to adolescent mothers (12-19 years) before and after the ACA.
Results
: There were 27,748,028 singleton births (n=2,013,521 adolescent births) among U.S. residents between 2009-2017 in this analytic sample. Adjusted models revealed that the ACA was associated with a 23% significant decrease in odds of an adolescent birth (OR 0.78, 95%CI 0.77, 0.79) for Medicaid-funded births and 19% decrease (OR 0.81, 95%CI 0.79, 0.83) for privately insured births, with a further declining trend. Overall declines in adolescent births among the Medicaid population appear to be driven by states that chose to expand Medicaid.
Conclusion
: Beyond the declining secular trend already observed in adolescent pregnancy over the last 10 years, the ACA appears to have had a substantial impact on adolescent births, likely due to Medicaid expansion and increased access to affordable contraception. From a population health perspective, efforts to undo the ACA may have important consequences for maternal, infant, and family health in the U.S.
Introduction: Low-birth-weight (LBW) is a multifaceted public health problem and contributes to morbidity and mortality of children during perinatal, neonatal and early-childhood period. LBW is defined as a birth weight of an infant less than 2500g. There are several maternal and paternal factors which influence the growth of newborn babies in utero.
Background & objectives: Low birth weight is considered one of the most serious health problems in the world that puts tremendous pressure on the health care system and family. The aim of this study was to investigate the relationship between some maternal risk factors and low birth weight.
Methods: The present study was a cross- sectional study performed on 264 cases. The data gathering tool was a checklist with two parts to compare two groups in this research. The first part was related to the infant's characteristics (sex, weight, and gestational age of the newborn), and the second part related to maternal characteristics. Data were analyzed using SPSS software. Inferential statistics including Mann–Whitney u, chi-square, fisher exact test and logistic regression were used to investigate the relationship between the variables.
Results: In this study, the level of education was lower in mothers with term low birth weight neonates (p=0.024), also normal delivery was reported more frequently among mothers with low birth weight infants (p=0.0001). Also, the mean BMI and the weight at the beginning of pregnancy and overweight in mothers with term neonates and normal weight were greater (p=0.0001, in all). The first minute Apgar score and the fifth minute Apgar score were lower in mothers with low-birth term infants (p=0.002 and p=0.0001). Also distinguished that the gestational age (week) was lower in mothers with low-birth term infants (p=0.0001).
Conclusion: According to the results, increasing progress the pregnancy per week makes it possible to increase the normal weight of newborns by 3.11%.
Abstract Background: Adolescent mothers in the United States experience disproportionately lower rates of breastfeeding compared to older mothers. Evidence suggests that paternal support helps improve breastfeeding outcomes; however, support is difficult to quantify. Parental cohabitation is easy to identify and could be used to quantify paternal support. Research Aim: Our study is to investigate the association between parental cohabitation and breastfeeding initiation and duration among US adolescent mothers. Materials and Methods: Data from the 2011-2017 National Survey of Family Growth were used. Our study sample included primipara, adolescent mothers (aged 15-19 years) who gave birth to a singleton (n = 1,867). Multivariate logistic regression and Cox Proportional Hazards models were used to analyze the relationship between cohabitation and breastfeeding initiation and duration, respectively. All models were subsequently stratified by race/ethnicity due to evidence of effect modification. Results: After adjusting for all a priori confounders, cohabiting with the infant's father at birth was associated with increased odds of breastfeeding initiation compared to noncohabiting adolescent mothers (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.08-2.16). After stratifying by race/ethnicity, both Hispanic and non-Hispanic white adolescent mothers were more likely to initiate breastfeeding if cohabiting with the infant's father (ORHispanic: 1.9, 95% CI: 1.10-3.35; ORNon-Hispanic white: 1.7, 95% CI: 1.05-2.87). We found no evidence of an association between parental cohabitation and breastfeeding duration. Conclusions: Our study found evidence that cohabitation status at birth increases the odds of breastfeeding initiation in adolescent mothers. Practitioners should consider cohabitation status when working with adolescent mothers.
Background: Few studies investigated the association between the pregnancy intention to have a second child and antenatal depressive symptoms.The aim of this study was to explore the association between the pregnancy intention to have a second child by pregnant women’s own desires, pregnant women’s husband own desires, parents who want to grandchild desires, couple’s concordance desires and antenatal depressive symptoms.
Methods: A total of 306 participants who completed questionnaire were included in our analysis. Antenatal depressive symptom was assessed using the Chinese version of Edinburgh Postnatal Depression Scale. Logistic regression models were used to estimate the association between the pregnancy intention to have a second child by pregnant women’s own desires, pregnant women’s husband own desires, parents who want to grandchild desires and antenatal depressive symptoms.
Results: the prevalence of antenatal depressive symptoms was 36.3% among the second child pregnant women. Of the 306 participants, the proportion of the pregnancy intention to have a second child by pregnant women’s own desires, pregnant women’s husband desires, parents who want to grandchild desires and couple’s concordance desires was 8.5%, 8.5%, 10.8% and 72.2% respectively. Compared with the pregnancy intention by couple’s concordance desires, pregnant women’s own desires to have a second child had higher risk of antenatal depressive symptoms after adjustment for potential confounders (OR=4.560, 95%CI: 1.603,12.973). No association was found between the pregnancy intention to have a second child by pregnant women’s husband own desires, parents who want to grandchild desires and antenatal depressive symptoms after adjustment for confounders (OR=1.996, 95%CI:0.781,5.105; OR=0.744, 95%CI: 0.306,1.811, respectively).
Conclusion: These findings suggest the pregnancy intention to have a second child by pregnant women own’s desires may be a risk factors for antenatal depressive symptoms among two-child pregnant women. A qualitative study should be carried out to investigate the real reason for the intention by pregnant women’s own desires and antenatal depressive symptoms in the future, because of this study was a quantitative study. Key words: pregnancy intention; antenatal depressive symptoms; second child
Introduction: The postpartum period is a critical period for maternal and infant attachment formation and a stressful period for the mother due to physical and mental changes. The purpose of this study was to investigate the effect of couple-centered counseling on perceived spouse support and mother-infant attachment in parturient women referring to Urmia health centers in the years 2018-2019.
Methods: The randomized clinical trial study was conducted in 2018-2019 in Urmia city, Iran. A group of 108 nulliparous women randomly allocated in intervention (54) and control (54) groups. The intervention group received 6 sessions of intervention based on spouse intervention and the control group received routine care. Data collection tools were personal information form, Spousal Support Perceived Questionnaire, and Maternal Baglanma Olcegi Questionnaire. Kolmogorov-Smirnov test, independent t-test and paired t-test were used.
Results: Our results showed that the two groups were statistically similar in demographic features. According to the results, mean scores of perception of spouse support and attachment of mother and infant after counseling in intervention group were statistically significant compared with control group (P
Introduction
Although an array of maternal and child-centered risks have been researched, considerably less is known about the effects of paternal influences on child's birth outcomes and early development. This longitudinal study thus examined the effects of paternal influences (parental stress, partner support, childcare and nursing, and father–child interaction) from early pregnancy to 2 years postpartum on pregnancy outcomes and toddlerhood development, with a simultaneous consideration of maternal depression.
Methods
Pregnant women together with their partners were recruited from 2011 to 2016 at five selected hospitals in Taipei, Taiwan. In total, 440 families completed seven assessments from early pregnancy to 2 years postpartum. Self-reported data were analyzed using logistic regression and generalized estimating equation models.
Results
The increment in parental stress from early to late pregnancy was independently and significantly associated with higher risks of low birthweight (adjusted odds ratio [aOR] = 5.3, 95% confidence interval [CI] = 1.0–27.7). In the postpartum years, paternal poorer childcare and nursing (aOR = 1.7, 95% CI = 1.0–3.0) and father–child interaction (aOR = 1.8, 95% CI = 1.2–2.9) were significantly associated with increased risks of child's suspected developmental delay up to 2 years postpartum, particularly among children of nondepressed mothers’ children.
Limitations
Selecting both parents in metropolitan areas with higher socioeconomic status may compromise the generalizability of the study.
Conclusions
We suggested the essential role of longitudinal paternal influences from early pregnancy on birth outcomes and child's development during infancy and toddlerhood. Maternal depression remains critical to concern.
Background
We introduce and apply an elegant, contrastive genetic-epidemiological design – Maternal Half-Sibling Families with Discordant Fathers – to clarify cross-generational transmission of genetic risk to alcohol use disorder (AUD), drug abuse (DA) and major depression (MD).
Method
Using Swedish national registries, we identified 73 108 eligible pairs of reared together maternal half-siblings and selected those whose biological fathers were discordant for AUD, DA and MD, and had minimal contact with the affected father. We examined differences in outcome in half-siblings with an affected v. unaffected father.
Results
For AUD, DA and MD, the HR (95% confidence intervals) for the offspring of affected v. unaffected fathers were, respectively, 1.72 (1.61; 1.84), 1.55 (1.41; 1.70) and 1.51 (1.40; 1.64). Paternal DA and AUD, but not MD, predicted risk in offspring for attention deficit hyperactivity disorder, conduct disorder, and poor educational performance and attainment. Offspring of affected v. unaffected fathers had poorer pregnancy outcomes, with the effect strongest for DA and weakest for MD. A range of potential biases and confounders were examined and were not found to alter these findings substantially.
Conclusion
Reared together maternal half-siblings differ in their paternal genetic endowment, sharing the same mother, family, school and community. They can help clarify the nature of paternal genetic effects and produce results consistent with other designs. Paternal genetic risk for DA and AUD have effects on offspring educational achievement, child and adult psychopathology, and possibly prenatal development. The impact of paternal genetic risk for MD is narrower in scope.
Our study explored risk factors and birth outcomes of a community maternal and child outreach program for high poverty mothers in East and Central Harlem. We conducted a retrospective chart review of 75 mother–infant dyads, with singleton pregnancies, receiving antepartum and postpartum home visits. Inexperienced parenting was associated with increased odds of giving birth to an infant weighing <2,700 g compared to experienced parenting after adjustment for race/ethnicity and preeclampsia diagnosis (odds ratio (OR) 4.9, p = 0.04). Mothers had comparatively lower depression risk in the postpartum period compared to antepartum (p = 0.006).
The current study conducted interviews and focus groups with twenty-four diverse 16-25 year-old parents to elicit in-depth narratives about experiences related to parenting status. Parents were recruited from a case management program in the Southwestern United States supporting high school graduation and workforce employment (for mothers and fathers, respectively). Young parents disclosed experiences of shame, stigma, and discrimination associated with perceptions about their “fitness” to be a parent and moral judgment. Themes arose that revealed the positive, adaptive ways that participants coped with potentially deleterious experiences with a focus on their role as a parent and role model for their children. Our findings highlight positive meaning-making and resiliency of young parents when confronted with discrimination and systemic barriers, with many participants focusing on the benefits of parenthood within a unique developmental context. Further, implications for program development, provider trainings, and public policy and advocacy efforts for young parents are discussed.
U.S. pregnancy statistics for each of the 50 states and D.C. (births, abortions, miscarriages) for women aged 15-17, 18-19 and 15-19.
This longitudinal study investigated a new conceptualization of the effectiveness of social support attempts called social support effectiveness (SSE) that takes into account the quantity and quality of support attempts and the extent to which they meet the needs of recipients. SSE was assessed in a sample of 176 pregnant women with regard to their partners' social support behaviors. Potential antecedents of SSE were investigated, including individual and relationship variables. In addition, it was hypothesized that women who appraised their partner's support as more effective would have lower prenatal anxiety, both concurrently (in mid-pregnancy) and prospectively (in late preg- nancy). Factor analyses confirmed that all hypothesized aspects of SSE contributed to a unitary factor of SSE. Struc- tural equation modeling was used to test the proposed antecedents and consequences of SSE. Results revealed that women's ratings of the effectiveness of partner support were predicted by their interpersonal orientation (adult attachment, network orientation, kin individualism-collectivism, and social skills) and by characteristics of their relationships with their partners (relationship quality, emotional closeness and intimacy, and equity). Furthermore, women who perceived themselves to have more effective partner support reported less anxiety in mid-pregnancy and showed a reduction in anxiety from mid- to late pregnancy. Findings are discussed with regard to implications for advancing research on social support processes, especially within relationship contexts.
Maternal postpartum emotional distress is quite common and can pose significant risk to mothers and infants. The current study investigated mothers' relationships with their partners during pregnancy and tested the hypotheses that perception of prenatal partner support is a significant predictor of changes in maternal emotional distress from midpregnancy to postpartum, and contributes to maternal ratings of infant distress to novelty. Using a prospective longitudinal design, 272 adult pregnant women were interviewed regarding their partner support, relationship satisfaction, and interpersonal security (attachment style and willingness to seek out support), and they completed standardized measures of prenatal symptoms of depression and anxiety (distress). At 6 to 8 weeks' postpartum, mothers reported these symptoms again and completed measures of their infants' temperament. Structural equation modeling (SEM) was used to test direct and indirect contributions of partner support, relationship satisfaction, and interpersonal security to maternal and infant postpartum distress. Mothers who perceived stronger social support from their partners midpregnancy had lower emotional distress postpartum after controlling for their distress in early pregnancy, and their infants were reported to be less distressed in response to novelty. Partner support mediated the effects of mothers' interpersonal security and relationship satisfaction on maternal and infant outcomes. A high-quality, supportive partner relationship during pregnancy may contribute to improved maternal and infant well-being postpartum, indicating a potential role for partner relationships in mental health interventions, with possible benefits for infants as well.
Background
One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had.
Methods
We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995–1997, which was a matched multiple birth file (only twins were included in the current analysis). We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups.
Results
There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially) totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score <7, fetal mortality, neonatal mortality, and post-neonatal mortality were significantly increased in mothers whose partner's information was partly or (especially) totally missing.
Conclusions
Mothers whose partner's information was partly and (especially) totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.
Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.
This report presents 2006 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data.
Descriptive tabulations of data are presented and interpreted.
The U.S. infant mortality rate was 6.68 infant deaths per 1,000 live births in 2006, a 3 percent decline from 6.86 in 2005. Infant mortality rates ranged from 4.52 per 1,000 live births for Central and South American mothers to 13.35 for non-Hispanic black mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 states or the District of Columbia, were unmarried, or were born in multiple deliveries. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate was essentially unchanged in 2006 (4.46) from 2005 (4.54). The postneonatal mortality rate decreased 4 percent, from 2.32 in 2005 to 2.22 in 2006. Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. For example, more than half of all infant deaths in the United States in 2006 (54 percent) occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Still, infant mortality rates for late preterm infants (34-36 weeks of gestation) were three times those for term infants (37-41 weeks). The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--taken together accounted for 46 percent of all infant deaths. The percentage of infant deaths that were "preterm-related" was 36.1 percent in 2006. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.4 times higher and the rate for Puerto Rican mothers was 84 percent higher than for non-Hispanic white mothers.
To: 1) review the historical contexts and current profiles of father involvement in African American families; 2) identify barriers to, and supports of, involvement; 3) evaluate the effectiveness of father involvement programs; and 4) recommend directions for future research, programs, and public policies.
Review of observational and interventional studies on father involvement.
Several historical developments (slavery, declining employment for Black men and increasing workforce participation for Black women, and welfare policies that favored single mothers) led to father absence from African American families. Today, more than two thirds of Black infants are born to unmarried mothers. Even if unmarried fathers are actively involved initially, their involvement over time declines. We identified multiple barriers to, and supports of, father involvement at multiple levels. These levels include intrapersonal (eg, human capital, attitudes and beliefs about parenting), interpersonal (eg, the father's relationships with the mother and maternal grandmother), neighborhoods and communities (eg, high unemployment and incarceration rates), cultural or societal (eg, popular cultural perceptions of Black fathers as expendable and irresponsible, racial stratification and institutionalized racism), policy (eg, Earned Income Tax Credit, Temporary Assistance for Needy Families, child support enforcement), and life-course factors (eg, father involvement by the father's father). We found strong evidence of success for several intervention programs (eg, Reducing the Risk, Teen Outreach Program, and Children's Aid Society - Carrera Program) designed to prevent formation of father-absent families, but less is known about the effectiveness of programs to encourage greater father involvement because of a lack of rigorous research design and evaluation for most programs.
A multi-level, life-course approach is needed to strengthen the capacity of African American men to promote greater involvement in pregnancy and parenting as they become fathers.
To explore the association between paternal education and preterm birth, taking into account maternal social and economic factors. We analyzed data from a population-based cross-sectional postpartum survey, linked with birth certificates, of women who gave birth in California from 1999 through 2005 (n = 21,712). Women whose infants' fathers had not completed college had significantly higher odds of preterm birth than women whose infants' fathers were college graduates, even after adjusting for maternal education and family income [OR (95% CI) = 1.26 (1.01-1.58)]. The effect of paternal education was greater among unmarried women than among married women. Paternal education may represent an important indicator of risk for preterm birth, reflecting social and/or economic factors not measured by maternal education or family income. Researchers and policy makers committed to understanding and reducing socioeconomic disparities in birth outcomes should consider paternal as well as maternal socioeconomic factors in their analyses and policy decisions.
Maternal psychosocial stress is an important risk factor for preterm birth, but support interventions have largely been unsuccessful. The objective of this study is to assess how support during pregnancy influences preterm birth risk and possibly ameliorates the effects of chronic stress, life event stress, or pregnancy anxiety in pregnant women. We examined 1,027 singleton preterm births and 1,282 full-term normal weight controls from a population-based retrospective case-control study of Los Angeles County, California women giving birth in 2003, a mostly Latina population (both US-born and immigrant). We used logistic regression to assess whether support from the baby's father during pregnancy influences birth outcomes and effects of chronic stress, pregnancy anxiety, and life event stress. Adjusted odds of preterm birth decreased with better support (OR 0.73 [95%CI 0.52, 1.01]). Chronic stress (OR 1.46 [95%CI 1.11, 1.92]), low confidence of a normal birth (OR 1.57 [95% CI 1.17, 2.12]), and fearing for the baby's health (OR 1.67 [95%CI 1.30, 2.14]) increased preterm birth risk, but life events showed no association. Our data also suggested that paternal support may modify the effect of chronic stress on the risk of preterm birth, such that among mothers lacking support, those with moderate-to-high stress were at increased odds of delivering preterm (OR 2.15 [95%CI 0.92, 5.03]), but women with greater support had no increased risk with moderate-to-high chronic stress (OR 1.13 [95%CI 0.94, 1.35]). Paternal support may moderate the effects of chronic stress on the risk of preterm delivery.
This prospective study examined the effects of prenatal social support on maternal and infant health and well-being in a sample of low-income pregnant women (N = 129). Three aspects of support (amount received, quality of support received, and network resources) and four outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicated that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicated that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model.
This study explores if and how adolescents' pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum.
Adolescent girls who reported that they had "wanted a baby" (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy "just happened" (n = 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy.
Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child.
Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby.
Adolescent pregnancy occurs in all societies, but the level of teenage pregnancy and childbearing varies from country to country. A cross-country analysis of birth and abortion measures is valuable for understanding trends, for identifying countries that are exceptional and for seeing where further in-depth studies are needed to understand observed patterns.
Birth, abortion and population data were obtained from various sources, such as national vital statistics reports, official statistics, published national and international sources, and government statistical offices. Trend data on adolescent birthrates were compiled for 46 countries over the period 1970-1995. Abortion rates for a recent year were available for 33 of the 46 countries, and data on trends in abortion rates could be gathered for 25 of the 46 countries.
The level of adolescent pregnancy varies by a factor of almost 10 across the developed countries, from a very low rate in the Netherlands (12 pregnancies per 1,000 adolescents per year) to an extremely high rate in the Russian Federation (more than 100 per 1,000). Japan and most western European countries have very low or low pregnancy rates (under 40 per 1,000); moderate rates (40-69 per 1,000) occur in Australia, Canada, New Zealand and a number of European countries. A group of five countries--Belarus, Bulgaria, Romania, the Russian Federation and the United States--have pregnancy rates of 70 or more per 1,000. The adolescent birthrate has declined in the majority of industrialized countries over the past 25 years, and in some cases has been more than halved. Similarly, pregnancy rates in 12 of the 18 countries with accurate abortion reporting showed declines. Decreases in the adolescent abortion rate, however, were less prevalent.
The trend toward lower adolescent birthrates and pregnancy rates over the past 25 years is widespread and is occurring across the industrialized world, suggesting that the reasons for this general trend are broader than factors limited to any one country: increased importance of education, increased motivation of young people to achieve higher levels of education and training, and greater centrality of goals other than motherhood and family formation for young women.
Women who experience unwanted pregnancy are at a greater risk of complicated pregnancy outcomes, and their children are more likely to experience physical or psychological problems in infancy, than those women with wanted pregnancies. The objective of this research was to explain the impact of a partner on women's decisions to want or not want their pregnancies.
A primary study subsample of 349 clinical interviews of pregnant women comprised the quantitative portion of the analysis, with a secondary study subsample of 20 in-depth qualitative interviews of pregnant women complementing the statistical findings. Both samples included adult women (at least age 20 yr) of different ethnic groups who received Medicaid for their pregnancies and were in their first or early second trimester of pregnancy. Chi-square, t tests, and logistic regression were used for statistical analyses.
A partner's stability, status, feelings toward pregnancy, and level of dependability and support all had a significant influence on women's experiences of unwanted pregnancy. Variables including use of contraception (OR = 3.3), women's ethnicity (OR = 1.9), partner's feelings about pregnancy (OR = 2.0), amount of social support (OR = 1.2), and mother's instrumental support (OR = 0.85) all affected women's perceptions of wanting the pregnancy. These results were used to create a model of unwanted pregnancy, beginning before conception and ending with either termination of pregnancy or initiation of prenatal care.
The support and concern of a partner during pregnancy can have positive consequences for a mother's desire to carry out the pregnancy. To increase their commitment to the pregnancy and childbirth, partners should be included more in the prenatal care process.
Understanding women's reasons for having abortions can inform public debate and policy regarding abortion and unwanted pregnancy. Demographic changes over the last two decades highlight the need for a reassessment of why women decide to have abortions.
In 2004, a structured survey was completed by 1,209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. Bivariate analyses examined differences in the reasons for abortion across subgroups, and multivariate logistic regression models assessed associations between respondent characteristics and reported reasons.
The reasons most frequently cited were that having a child would interfere with a woman's education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%). Nearly four in 10 women said they had completed their childbearing, and almost one-third were not ready to have a child. Fewer than 1% said their parents' or partners' desire for them to have an abortion was the most important reason. Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents.
The decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons. The themes of responsibility to others and resource limitations, such as financial constraints and lack of partner support, recurred throughout the study.
CONTEXT. Mistimed and unwanted pregnancies that result in live births are commonly considered together as unintended pregnancies, but they may have different precursors and outcomes. METHODS: Data from 15 states participating in the 1998 Pregnancy Risk Assessment Monitoring System were used to calculate the prevalence of intended, mistimed and unwanted conceptions, by selected variables. Associations between unintendedness and women's behaviors and experiences before, during and after the pregnancy were assessed through unadjusted relative risks. RESULTS. The distribution of intended, mistimed and unwanted pregnancies differed on nearly every variable examined; risky behaviors and adverse experiences were more common among women with mistimed than intended pregnancies and were most common among those whose pregnancies were unwanted. The likelihood of having an unwanted rather than mistimed pregnancy was elevated for women 35 or older (relative risk, 2.3) and was reduced for those younger than 25 (0.8), the pattern was reversed for the likelihood of mistimed rather than intended pregnancy (0.5 vs. 1.7-2.7). Porous women had an increased risk of an unwanted pregnancy (2.1-4.0) but a decreased risk of a mistimed one(0.9). Women who smoked in the third trimester, received delayed or no prenatal care, did not breast-feed, were physically abused during pregnancy, said their partner had not wanted a pregnancy or had a low-birth-weight infant had an increased risk of unintended pregnancy; the size of the increase depended on whether the pregnancy was unwanted or mistimed. CONCLUSION: Clarifying the difference in risk between mistimed and unwanted pregnancies may help guide decisions regarding services to women and infants.
Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May
So much attention is placed on mothers when it comes to risk factors for adverse pregnancy outcomes that the possibility of risk from fathers is largely forgotten, yet they can have significant influence too.
Purpose: This study explores if and how adolescents’ pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum.Methods: Adolescent girls who reported that they had “wanted a baby” (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy “just happened” (n = 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy.Results: Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child.Conclusion: Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby.
The article examines the evidence that social support in pregnancy is associated with improved health of mothers and babies. Its starting point is the professional medical ideology and practice of antenatal care which, from a beginning that emphasized the ‘care’ and support element, has increasingly shifted in the last 30 years to assume the character of a technological surveillance programme. Different notions, measures and explanations of the possible effect of social support are considered, and the issue of the link between social support and reproductive health is located in the framework of the literature on social support and health more generally. Three main groups of studies are reviewed in terms of evidence for or against social support being good for the health of mothers and babies: observational studies describing mothers' own social networks and relationships in terms of different patterns of pregnancy outcome; intervention studies containing a support element but not carried out on the basis of random allocation of mothers to experimental and control groups; and randomized controlled trials of social interventions in pregnancy. It is concluded that these studies provide strong evidence in favour of the idea that socially supported mothers benefit from improved pregnancy outcomes.
The impact of men's attributions for pregnancy and expectations for coping with abortion on their partner's post-abortion adjustment was examined. Men's and women's attributions and coping expectations were assessed in a sample of 73 couples prior to obtaining a first-trimester abortion of an undesired pregnancy. Women's depression was assessed 30 minutes post-abortion. Partners did not differ in their coping expectations or attributions of the pregnancy to chance, situation, another person, or their own behavior, but men blamed the pregnancy more on their own character than did their partners. Male partner's coping expectancies affected women's adjustment only if the women themselves had low coping expectancies. Among women with low coping expectancies, those accompanied by partners who also had low coping expectancies were the most depressed. Men's attributions were unrelated to their partner's adjustment.
CONTEXT: Mistimed and unwanted pregnancies that result in live births are commonly considered together as unintended pregnancies, but they may have different precursors and outcomes
METHODS: Data from 15 states participating in the 1998 Pregnancy Risk Assessment Monitoring System were used to calculate the prevalence of intended, mistimed and unwanted conceptions, by selected variables. Associations between unintendedness and women's behaviors and experiences before, during and after the pregnancy were assessed through unadjusted relative risks.
RESULTS: The distribution of intended, mistimed and unwanted pregnancies differed on nearly every variable examined; risky behaviors and adverse experiences were more common among women with mistimed than intended pregnancies and were most common among those whose pregnancies were unwanted. The likelihood of having an unwanted rather than mistimed pregnancy was elevated for women 35 or older (relative risk, 2.3) and was reduced for those younger than 25 (0.8); the pattern was reversed for the likelihood of mistimed rather than intended pregnancy (0.5 vs. 1.7–2.7). Parous women had an increased risk of an unwanted pregnancy (2.1–4.0) but a decreased risk of a mistimed one (0.9). Women who smoked in the third trimester, received delayed or no prenatal care, did not breastfeed, were physically abused during pregnancy, said their partner had not wanted a pregnancy or had a low‐birth‐weight infant had an increased risk of unintended pregnancy; the size of the increase depended on whether the pregnancy was unwanted or mistimed
CONCLUSION: Clarifying the difference in risk between mistimed and unwanted pregnancies may help guide decisions regarding services to women and infants
This paper uses data from the baseline Fragile Families and Child Well-being Study to examine the level and effects of father-involvement on child's birth weight and mother's health behavior during pregnancy (prenatal care, drinking, drug use and smoking). The findings indicate that most fathers, including unwed fathers, are involved with their children at birth and have intentions to remain involved. The effects of father involvement on health and health behavior depend, however, on how the construct is measured. When measured as parent's relationship status (married, cohabiting, romantic or non-romantic), the effects of marriage are beneficial for all but one outcome, the effects of cohabitation are positive for prenatal care only, and the effects of romantic involvement are negative for child's birth weight. When measured as paternity acknowledgement, contributions during pregnancy and intentions to contribute, unmarried father involvement has no effect on child's birth weight, a strong effect on early prenatal care and a variable but overall positive effect on mother's health behaviors. Furthermore, the effects of father involvement do not vary systematically by fathers' earnings potential and psychosocial attributes. While these results support the notion that fathers can influence mothers to maintain or adopt healthy pregnancy behaviors, they do not indicate that father-involvement improves birth outcomes.
This report presents national estimates of sexual activity, contraceptive use, and births among males and females aged 15-19 in the United States in 2006-2010 from the National Survey of Family Growth (NSFG). For selected indicators, data are also presented from the 1988, 1995, and 2002 NSFG, and from the 1988 and 1995 National Survey of Adolescent Males, conducted by the Urban Institute.
Descriptive tables of numbers and percentages are presented and discussed. Data were collected through in-person interviews of the household population of males and females aged 15-44 in the United States, between July 2006 and June 2010. Interviews were conducted with 22,682 men and women, including 4,662 teenagers (2,284 females and 2,378 males). For both the teen subsample and the total sample, the response rate was 77%.
In 2006-2010, about 43% of never-married female teenagers (4.4 million), and about 42% of never-married male teenagers (4.5 million) had had sexual intercourse at least once. These levels of sexual experience have not changed significantly from 2002. Seventy-eight percent of females and 85% of males used a method of contraception at first sex according to 2006-2010 data, with the condom remaining the most popular method. Teenagers' contraceptive use has changed little since 2002, with a few exceptions: there was an increase among males in the use of condoms alone and in the use of a condom combined with a partner's hormonal contraceptive; and there was a significant increase in the percentage of female teenagers who used hormonal methods other than a birth-control pill, such as injectables and the contraceptive patch, at first sex. Six percent of female teenagers used a nonpill hormonal method at first sex.
We sought to assess the impact of paternal involvement on adverse birth outcomes in teenage mothers.
Using vital records data, we generated odds ratios (OR) and 95% confidence intervals (CI) to assess the association between paternal involvement and fetal outcomes in 192,747 teenage mothers. Paternal involvement status was based on presence/absence of paternal first and/or last name on the birth certificate.
Data were obtained from vital records data from singleton births in Florida between 1998 and 2007.
The study population consisted of 192,747 teenage mothers ≤ 20 years old with live single births in the State of Florida.
Low birth weight, very low birth weight, preterm birth, very preterm birth, small for gestational age (SGA), neonatal death, post-neonatal death, and infant death.
Risks of SGA (OR = 1.06; 95% CI: 1.03-1.10), low birth weight (OR = 1.19; 95% CI: 1.15-1.23), very low birth weight (OR = 1.53; 95% CI: 1.41-1.67), preterm birth (OR = 1.21; 95% CI: 1.17-1.25), and very preterm birth (OR = 1.49; 95% CI: 1.38-1.62) were elevated for mothers in the father-absent group. When results were stratified by race, black teenagers in the father-absent group had the highest risks of adverse birth outcomes when compared to white teenagers in the father-involved group.
Lack of paternal involvement is a risk factor for adverse birth outcomes among teenage mothers; risks are most pronounced among African-American teenagers. Our findings suggest that increased paternal involvement can have a positive impact on birth outcomes for teenage mothers, which may be important for decreasing the racial disparities in infant morbidities. More studies assessing the impact of greater paternal involvement on birth outcomes are needed.
We explore the psychosocial, demographic, and maternal characteristics across wanted, mistimed, and unwanted pregnancies.
Data from 1321 women from a prospective cohort study of pregnant women in Durham, NC, are analyzed. Psychosocial correlates were obtained through prenatal surveys; electronic medical records were used to ascertain maternal health and pregnancy outcomes.
Sixty-two percent of the women indicated an unintended pregnancy, with 44% (578) mistimed and 18% (245) unwanted. Only 38% of the pregnancies were characterized as wanted. Women with unwanted and with mistimed pregnancies were similar demographically, but they differed significantly on psychosocial profiles and maternal characteristics. Women with mistimed and with wanted pregnancies differed in demographics and psychosocial profiles. Wanted pregnancies had the healthiest, mistimed an intermediate, and unwanted the poorest psychosocial profile. Women with unwanted pregnancies had the highest depression, perceived stress, and negative paternal support scores (p<0.05) and the lowest self-efficacy, social support, and positive paternal support scores (p<0.05). In multivariate analyses, women with riskier psychosocial profiles had higher odds of being in the unwanted category. Controlling for psychosocial and demographic variables, perceived stress and positive paternal support remained significant predictors of belonging to the unwanted and mistimed groups.
Fully characterizing pregnancy intention and its relationship to psychosocial profiles may provide a basis for identifying women with highest risk during pregnancy and early motherhood. Women with unwanted and mistimed pregnancies may appear similar demographically but are different psychosocially. Women with unwanted pregnancies have multiple risk factors and would benefit from targeted interventions.
In the United States, Black infants have significantly worse birth outcomes than White infants. Over the past decades, public health efforts to address these disparities have focused primarily on increasing access to prenatal care, however, this has not led to closing the gap in birth outcomes. We propose a 12-point plan to reduce Black-White disparities in birth outcomes using a life-course approach. The first four points (increase access to interconception care, preconception care, quality prenatal care, and healthcare throughout the life course) address the needs of African American women for quality healthcare across the lifespan. The next four points (strengthen father involvement, systems integration, reproductive social capital, and community building) go beyond individual-level interventions to address enhancing family and community systems that may influence the health of pregnant women, families, and communities. The last four points (close the education gap, reduce poverty, support working mothers, and undo racism) move beyond the biomedical model to address the social and economic inequities that underlie much of health disparities. Closing the Black-White gap in birth outcomes requires a life course approach which addresses both early life disadvantages and cumulative allostatic load over the life course.
Background:
Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programs offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programs may include advice and counseling (about nutrition, rest, stress management, alcohol, and recreational drug use), tangible assistance (e.g., transportation to clinic appointments, household help), and emotional support. The programs may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or combination of lay and professional workers.
Objectives:
The primary objective was to assess effects of programs offering additional social support compared with routine care, for pregnant women believed at high risk for giving birth to babies that are either preterm or weigh less than 2500 gm, or both, at birth. Secondary objectives were to determine whether effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay woman).
Search strategy:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010).
Selection criteria:
Randomized trials of additional support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional support as some form of emotional support (e.g., counseling, reassurance, sympathetic listening) and information or advice or both, either in home visits or during clinic appointments, and could include tangible assistance (e.g., transportation to clinic appointments, assistance with care of other children at home).
Data collection and analysis:
Two review authors evaluated methodological quality. We performed double data entry.
Main results:
We included 17 trials (12,264 women). Programs offering additional social support for at-risk pregnant women were not associated with improvements in any perinatal outcomes, but there was a reduction in the likelihood of antenatal hospital admission (three trials; n = 737; RR 0.79, 95% CI 0.68 to 0.92) and caesarean birth (nine trials; n = 4522; RR 0.87, 95% CI 0.78 to 0.97).
Authors' conclusions:
Pregnant women need the support of caring family members, friends, and health professionals. While programs which offer additional support during pregnancy are unlikely to prevent the pregnancy from resulting in a low birthweight or preterm baby, they may be helpful in reducing the likelihood of antenatal hospital admission and caesarean birth.
This report describes how the continuous National Survey of Family Growth (NSFG) (begun in 2006) was designed, planned, and implemented. The NSFG is a continuous national survey of men and women 15-44 years of age designed to provide national estimates of factors affecting pregnancy and birth rates; men's and women's health; and parenting.
The survey used in-person, face-to-face interviews conducted by trained female interviewers. One person per household was interviewed from a national area probability sample. The data collection used computer-assisted personal interviewing (CAPI). Separate questionnaires were used for male and female respondents. The last section of the questionnaires used a self-administered technique called audio computer-assisted self-interviewing or ACASI. Each data collection period lasted 12 weeks-10 weeks for "Phase 1," the main data collection protocol, and 2 weeks for "Phase 2," an intensive attempt to locate and interview nonrespondents.
Each year, about 5,000 persons were interviewed in about 33 areas, called primary sampling units (PSUs). Over a 4-year period, 110 PSUs will be used. This report gives an overview of the procedures used in the conduct of the continuous NSFG. A later report will describe response rates and other results of the data collection, but the early fieldwork has gone well.
A systematic review of the risks of a low birthweight (LBW), preterm, and small-for-gestational-age births in relation to paternal factors was performed. Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of identified articles were searched for English-language studies. Study qualities were assessed according to a predefined checklist. Thirty-six studies of low-to-moderate risk of bias were reviewed for various paternal factors: age, height, weight, birthweight, occupation, education, and alcohol use. Extreme paternal age was associated with higher risk for LBW. Among infants who were born to tall fathers, birthweight was approximately 125-150 g higher compared with infants who were born to short fathers. Paternal LBW was associated with lower birthweight of the offspring. In conclusion, paternal characteristics including age, height, and birthweight are associated with LBW. Paternal occupational exposure and low levels of education may be associated with LBW; however, further studies are needed.
This paper presents information on the role and significance of social support for the occurrence of health and birth problems among adolescent mothers and their babies. Pregnant teenagers (N = 268) were interviewed during the course of pregnancy and again approximately four weeks after delivery, and hospital records were abstracted. The significance of family support, friend support, and partner support, assessed during the pregnancy, were examined in relation to infant and mother outcomes assessed at or after the birth. Infant outcome was indexed by birth weight, with gestational age controlled; mother outcome in terms of psychological adaptation was indexed by depressive symptomatology among adolescent mothers. Socioeconomic background was found to influence relationships between social support and both infant and mother outcomes.
Pregnancy in adolescence is associated with an excess risk of poor outcomes, including low birth weight and prematurity. Whether this association simply reflects the deleterious sociodemographic environment of most pregnant teenagers or whether biologic immaturity is also causally implicated is not known.
To determine whether a young age confers an intrinsic risk of adverse outcomes of pregnancy, we performed stratified analyses of 134,088 white girls and women, 13 to 24 years old, in Utah who delivered singleton, first-born children between 1970 and 1990. Relative risk for subgroups of this study population was examined to eliminate the confounding influence of marital status, educational level, and the adequacy of prenatal care. The adjusted relative risk for the entire study group was calculated as the weighted average of the stratum-specific risks.
Among white married mothers with educational levels appropriate for their ages who received adequate prenatal care, younger teenage mothers (13 to 17 years of age) had a significantly higher risk (P < 0.001) than mothers who were 20 to 24 years of age of delivering an infant who had low birth weight (relative risk, 1.7; 95 percent confidence interval, 1.5 to 2.0), who was delivered prematurely (relative risk, 1.9; 95 percent confidence interval, 1.7 to 2.1), or who was small for gestational age (relative risk, 1.3; 95 percent confidence interval, 1.2 to 1.4). Older teenage mothers (18 or 19 years of age) also had a significant increase in these risks. Even though sociodemographic variables associated with teenage pregnancy increase the risk of adverse outcomes, the relative risk remained significantly elevated for both younger and older teenage mothers after adjustment for marital status, level of education, and adequacy of prenatal care.
In a study of mothers 13 to 24 years old who had the characteristics of most white, middle-class Americans, a younger age conferred an increased risk of adverse pregnancy outcomes that was independent of important confounding sociodemographic factors.
To compare the trends and obstetric outcomes of pregnancy in teenage women with those of adult women.
We analyzed a 19-year (1975-1993) computerized perinatal data base with data on 69,096 births collected prospectively from a single inner-city tertiary medical center.
Of all the births, 1875, (2.7%) were to teenagers 12-15 years old and 17,359 (25.3%) were to teenagers 16-19 years old. Over the study period, the number and proportion of births to teenagers of both age groups declined (P < .001 in both cases). The proportions of teenagers 12-15 and 16-19 years old were highest among blacks (4.1% and 28.1%, respectively), followed by Hispanics (2.4%, 24.7%) and whites (1.6%, 23.1%). More than 95% of teenagers had no private health insurance coverage (staff), significantly higher than the 81.6% of mothers aged 20 years or older (P < .001). More than 8.1% of teenagers 12-15 years old had two or fewer prenatal care visits, significantly higher than 6.8% for teenagers 16-19 years old and 7.1% for adults (P < .001). The average gestational age and birth weight were significantly lower for teenagers 12-15 years old compared with those 16-19 years old and adults. Patients 16-19 years of age had longer gestational age and higher birth weight than the adults. The proportion of primary cesarean deliveries among teenagers 12-15 years old was 11.6%, significantly higher than 9.4% for those 16-19 years old and 10.2% for adults (P < .001).
On average, females 16-19 years old had better obstetric outcomes than adults, whereas obstetric outcomes for those 12-15 years old were worse than for adults. Therefore, all teenagers should not be grouped together when their obstetric outcomes are compared with those of adults.
We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth retardation. Included in the review are all reports on the direct effects of stressors or psychological distress; the indirect effects of stressors or distress through health behaviours such as smoking; and the direct and buffering effects of social support. Although an important stimulus for recent stress research has been the attempt to explain racial and social class differences in birth outcome, the recent data show that stressful life events during pregnancy, though more common in disadvantaged groups, do not increase the risk of preterm birth. In contrast, intimate social support from a partner or family member appears to improve fetal growth, even for women with little life stress. Questions unanswered by the research to date are whether elevated levels of depressive symptoms affect pregnancy outcome, either directly or by encouraging negative health behaviours, and whether chronic (vs. acute) stressors are harmful. Additional research is also needed to determine whether psychosocial factors interact with specific clinical conditions to promote adverse pregnancy outcomes. Focusing on intimate support and how it benefits pregnancy outcome could lead to the design of more effective interventions.
Unintended pregnancies can have serious health, social, and economic consequences. Such pregnancies may be unwanted (a baby is not wanted at any time) or mistimed, yet wanted (a baby is wanted eventually). Intended pregnancies are those conceived when desired. Reproductive health survey respondents' understanding of these concepts and validity of survey results may be affected by question order and wording. Using a randomized crossover design, National Survey of Family Growth (NSFG) and Demographic and Health Survey (DHS) intendedness questions were asked in a 1993 survey of Arizona women aged 18-44 years. Of 2,352 ever-pregnant respondents, 25% gave discordant responses to DHS and NSFG questions about the most recent pregnancy. Age, marital status, household income, education, parity, time since pregnancy, and outcome of pregnancy were significantly predictive of discordant responses. DHS and NSFG questions yielded similar prevalence estimates of intendedness and wantedness; but young, unmarried respondents gave more "mistimed" responses on whichever question was asked later. Classifying pregnancies as intended, mistimed, or unwanted may be a problem for women who have not decided on lifetime reproductive preferences. Approaches to improving survey validity include addressing ambivalence, clarifying the definition of "unwanted," and, for young, unmarried women, not attempting to classify unintended pregnancies as mistimed or unwanted.
The relationship among young age, biologic immaturity (as indexed by low gynecologic age), and the causes of preterm delivery (idiopathic preterm labor [PTL], premature rupture of the membranes [PROM], and medical indications) were investigated among 605 primigravidas from the Camden Study.
The sample consisted of 366 young adolescents < 16 years at the time of their last menstrual period (LMP) and 239 older women, 18-29 years at LMP (controls). The young adolescents were significantly shorter, thinner, had younger ages at menarche, and over a third (36.3%) were of low gynecologic age, i.e., their chronologic age was 2 or fewer years more than their age at menarche.
Adjusting for ethnicity, cigarettes smoked/day, weight gain rate, height, fetal sex, gestational diabetes mellitus, and pregnancy-induced hypertension, young adolescents overall had a nearly 75% increased risk of PTL (adjusted odds ratio [AOR] = 1.74, 95% confidence interval [95% CI]: 1.07-2.84), and preterm delivery with PTL (AOR = 2.08, 95% CI: 1.08-4.00). There was a modest decreased risk of preterm delivery among young gravidas attributable to other causes, such as PROM or medical indications (AOR = 0.70, 95% CI: 0.28-1.75). This increased risk of PTL and preterm delivery with PTL was principally attributable to biologic immaturity. Young age with low gynecologic age was associated with a twofold risk of PTL (AOR = 2.15, 95% CI: 1.19-3.89) and preterm delivery with PTL (AOR = 2.64, 95% CI: 1.23-5.65), while the risk associated with young age and higher gynecologic age was only increased moderately.
Young adolescents, and especially those of low gynecologic age, appear prone to PTL and are at increased risk for preterm delivery through this pathway.
The purpose of this study was to describe the incidence of abuse among pregnant teens in the three developmental stages of adolescence and to determine if abuse was related to pregnancy planning, high school participation, substance use during pregnancy, pregnancy complications, and infant birth weight.
Prospective survey.
A total of 559 pregnant adolescents between the ages of 13 and 19 were interviewed. Abuse was measured by the Abuse Assessment Screen. Substance use was measured by self-report. Birth weights were obtained from hospital records.
Abuse was reported by 37% of the adolescents. In every age group, the incidence of low birth weight was higher in those who had been abused.
The high rates of abuse reported by both adolescent and adult women in this study emphasize the need for nurses in every setting to incorporate routine screening for abuse into their nursing assessments.
In a longitudinal study of the effects of early childhood maltreatment, 92 adolescents who had become parents while under 20 years of age were compared to 297 adolescents who had not become parents during their teenage years. Preschool and school-age physical abuse alone and in combination with neglect were found to have significant relationships with teenage parenthood. Low self-esteem, as evaluated by elementary school teachers, was related to both early maltreatment and teenage parenthood. Sexual abuse, based on retrospective reports of the adolescents, had a significant but weaker relationship to teenage parenthood. The implications of these findings and the findings that high school dropout, assaultive behavior, and drug use are also related to teenage parenthood are discussed.
Many studies have explored maternal and infant factors as risks for infant mortality, but little attention is given to paternal factors. In Georgia, listing a father's name on the birth certificate is optional for married couples and possible after paternal acknowledgment for unmarried couples. The authors evaluated father's name reporting as a paternity measure and risk for infant mortality. Using the linked 1989-1990 birth and death certificates of singleton Georgia infants to calculate relative risks (RRs), infant mortality rates for 38,943 infants with no father's names listed were compared to rates for 178,100 with father's names listed. Compared with the rate for married women listing names, the death rates were higher for unmarried mothers not listing fathers (relative risk, RR = 2.5; 95% CI 2.3-2.7), unmarried mothers listing fathers (RR = 1.4; 95% CI 1.3-1.6), and married women not listing fathers (RR = 2.3; 95% CI 1.6-3.1). Increased risks remained after stratifying by maternal race, age, adequacy of prenatal care and medical risks; and congenital malformations, birthweight, gestational age, and small-for-gestational age. Using logistic regression to examine for effect modification and to adjust for these factors together, the adjusted relative risks for death varied across different groups without fathers' names, regardless of marital status. For example, it remained statistically higher for infants with no father listed and without effect-modifying conditions such as low birthweight (estimated RR = 2.0; 95% CI 1.6-2.4). Although these findings suggest paternal involvement, as measured by listing fathers' names, is protective against low birthweight and infant mortality, further evaluation is needed.
The purpose of this study was to examine the perceived positive consequences of teenage childbearing among female adolescents, and to determine whether perceived consequences of teenage childbearing are associated with other attitudes and sexual risk behaviors.
The sample consisted of 584 female students attending three urban high schools in Los Angeles, California. The respondents' mean age was 15.8 years, and 72% were Hispanic/Latina. Respondents completed a paper-and-pencil survey assessing their attitudes and risk behaviors relevant to teenage pregnancy. Multiple regression and logistic regression analyses were used to examine the associations between perceived consequences of teenage childbearing and demographic variables, educational variables, parental characteristics, psychosocial variables, attitudes, and sexual behavior.
Higher scores on a scale of perceived positive consequences of teenage childbearing were associated with increased risk of sexual intercourse and unprotected sexual intercourse. Higher scores on this scale were found among girls who were Latinas, were non-U.S. natives, had low levels of expected educational attainment, had low parental monitoring, had good communication with parents, and wished to have many children.
Potential strategies for preventing adolescent pregnancy include educating girls about the difficulties of teenage childbearing, countering their positive illusions about the expected benefits, and teaching them more adaptive ways to meet their emotional needs.
To study the effect on birthweight of maternal smoking, and its modification by study period, maternal age and paternal smoking.
A retrospective questionnaire based national survey comprising a random sample (n=34,799) of all mothers giving birth in Norway 1970-91. Variables studied were parental smoking during pregnancy, birthweight, maternal age and infant's year of birth.
The overall difference in mean birthweight between non-smoking and smoking mothers was 197 g. The difference in birthweight between non-smoking and smoking mothers increased with maternal age from 182 g (<20 years of age) to 232 g (35+ years of age). There was no significant effect of paternal smoking on birthweight when the mother was a non-smoker. When the mother was a smoker and the father was a non-smoker, the birthweight, adjusted for maternal age, was reduced by 153 g (p<0.005). However, when both parents smoked, the birthweight, adjusted for maternal age, was reduced by 201 g (p<0.0005). Even though the prevalence of paternal smoking decreased by 38% during the study period, there was no significant increase in overall mean birthweight. IMPLICATION AND RELEVANCE OF RESULTS: The negative effect of maternal smoking on birthweight appears to increase with maternal age. For a non-smoking pregnant woman to live with a smoking partner has little, if any, effect on birthweight. The negative effect of paternal smoking was only observed when the mother was smoking and might reflect two possible mechanisms: (1) that a smoking mother has a greater cigarette consumption when the partner also smokes, and (2) that a smoking mother is less concerned about passive smoking than a non-smoking mother.
Low birth weight is a primary cause of infant mortality and morbidity. Results of previous studies suggest that social support may be related to higher birth weight through fetal growth processes, although the findings have been inconsistent. The purpose of this investigation was to test a model of the association between a latent prenatal social support factor and fetal growth while taking into account relations between sociodemographic and obstetric risk factors and birth weight.
A prospective study was conducted among 247 women with a singleton, intrauterine pregnancy receiving care in two university-affiliated prenatal clinics. Measures of support included support from family, support from the baby's father, and general functional support. Sociodemographic characteristics were also assessed. Birth outcome and obstetric risk information were abstracted from patients' medical charts after delivery.
Structural equation modeling analyses showed that a latent social support factor significantly predicted fetal growth (birth weight adjusted for length of gestation) with infant sex, obstetric risk, and ethnicity in the model. Marital status and education were indirectly related to fetal growth through social support. The final model with social support and other variables accounted for 31% of the variance in fetal growth.
These findings suggest that prenatal social support is associated with infant birth weight through processes involving fetal growth rather than those involving timing of delivery. Biological and behavioral factors may contribute to the association between support and fetal growth, although these mechanisms need to be further explored. These results pave the way for additional research on fetal growth mechanisms and provide a basis for support intervention research.
This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.
Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.
This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.
The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.
It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.
Researchers have questioned why some children and adolescents are more resilient than others in the face of adversity and have identified several protective factors. The present paper focuses on one of these variables, namely, support from caring adults in the community. We present a brief review of this component of the resiliency literature along with a discussion of some of the issues and challenges raised by the findings. It is suggested that the evidence is substantial enough and the possible rewards associated with exploiting these findings considerable enough to warrant mounting wide-scale community-based efforts to assist vulnerable youth.
To determine whether first and second births among teenagers are associated with increased risk of adverse perinatal outcomes after confounding variables have been taken into account.
Population based retrospective cohort study using routine discharge data for 1992-8.
Scotland.
Stillbirth, preterm delivery, emergency caesarean section, and small for gestational age baby among non-smoking mothers aged 15-19 and 20-29.
The 110 233 eligible deliveries were stratified into first and second births. Among first births, the only significant difference in adverse outcomes by age group was for emergency caesarean section, which was less likely among younger mothers (odds ratio 0.5, 95% confidence interval 0.5 to 0.6). Second births in women aged 15-19 were associated with an increased risk of moderate (1.6, 1.2 to 2.1) and extreme prematurity (2.5, 1.5 to 4.3) and stillbirth (2.6, 1.3 to 5.3) but a reduced risk of emergency caesarean section (0.7, 0.5 to 1.0).
First teenage births are not independently associated with an increased risk of adverse pregnancy outcome and are at decreased risk of delivery by emergency caesarean section. However, second teenage births are associated with an almost threefold risk of preterm delivery and stillbirth.
To examine the prevalence and correlates of wanting to become pregnant among a sample of 462 sexually active nonpregnant African American adolescent females.
Multivariate logistic regression was used to calculate adjusted odds ratios, their 95% confidence intervals, and respective P values.
Significant correlates with pregnancy desire included having a male partner who desired pregnancy, having a boyfriend at least 5 years older, having low self-esteem, perceiving greater perceived barriers to condom use, and perceiving low family support.
Pregnancy prevention programs designed for economically disadvantaged African American adolescent females should address these correlates of their pregnancy desire.
Despite expansions in the public insurance coverage of pregnant women, concerns over poor birth outcomes remain. Poor birth outcomes occur among publicly and privately insured women, however, thereby imposing excess costs on employers and their insurers. Data from a large sample of privately insured for 1996 are used to examine these outcomes and costs. Almost one-fourth (24.3 percent) of the infants in our matched sample of 12,020 deliveries was premature or had other problems at birth. Costs for these infants accounted for 82 percent of the total 14,600. We found that these relative costs had increased over time due perhaps to the increased technology and intensity of services used to save infant lives. We also found that factors other than maternal and infant complications affected cost variations. For example, employers located in the Northeast, hiring older mothers, and in unionized sectors have higher prenatal, delivery, and infant costs.
Mistimed and unwanted pregnancies that result in live births are commonly considered together as unintended pregnancies, but they may have different precursors and outcomes.
Data from 15 states participating in the 1998 Pregnancy Risk Assessment Monitoring System were used to calculate the prevalence of intended, mistimed and unwanted conceptions, by selected variables. Associations between unintendedness and women's behaviors and experiences before, during and after the pregnancy were assessed through unadjusted relative risks.
The distribution of intended, mistimed and unwanted pregnancies differed on nearly every variable examined; risky behaviors and adverse experiences were more common among women with mistimed than intended pregnancies and were most common among those whose pregnancies were unwanted. The likelihood of having an unwanted rather than mistimed pregnancy was elevated for women 35 or older (relative risk, 2.3) and was reduced for those younger than 25 (0.8); the pattern was reversed for the likelihood of mistimed rather than intended pregnancy (0.5 vs. 1.7-2.7). Parous women had an increased risk of an unwanted pregnancy (2.1-4.0) but a decreased risk of a mistimed one (0.9). Women who smoked in the third trimester, received delayed or no prenatal care, did not breast-feed, were physically abused during pregnancy, said their partner had not wanted a pregnancy or had a low-birth-weight infant had an increased risk of unintended pregnancy; the size of the increase depended on whether the pregnancy was unwanted or mistimed.
Clarifying the difference in risk between mistimed and unwanted pregnancies may help guide decisions regarding services to women and infants.
To evaluate and characterize the racial/ethnic differences in obstetric outcomes of early and late teenagers in California.
A data-set linking birth and death certificates with maternal and neonatal hospital discharge records in California was utilized to identify nulliparous women (11 to 29 years of age) who delivered between January 1,1992 and December 31,1997. Pregnancy outcomes of early (11-15 year) and late (16-19 year) teenagers were compared to those of a control group of women aged 20-29.
Early (n = 31 232) and late teens (n = 271 470) demonstrated greater neonatal and infant mortality and major neonatal morbidities (delivery < 37 weeks of gestation and birthweight < 2500 g) when compared to pregnancies in the older control women (n = 662 752). Ethnicity adversely affected outcome with African-Americans of all ages having worse outcomes than whites. The higher rate of adverse obstetric outcomes among the teenage pregnancies occurred despite a lower cesarean section rate and was consistent across all ethnic groups.
When compared to women aged 20-29, all teen pregnancies were associated with higher rates of poor obstetric outcomes. Other factors besides teen pregnancy appear to be responsible for poor outcomes in certain ethnic groups.
The aim of this study is to investigate both maternal and paternal contributions in the familial aggregation of small for gestational age.
Nested case-control study.
Metropolitan area of Haguenau, France.
Data were drawn from a French population-based maternity registry. After selection, 256 cases born either small for gestational age or average for gestational age were included.
Controlling for known pregnancy-related risk factors, logistic regression models were used to determine the risk of the child being small for gestational age, given that the mother, father or both were small for gestational age, and to examine interactions between maternal small for gestational age and pregnancy risk factors.
Specifically, we investigate to what extent having either or both parents born small for gestational age increases the risk of small for gestational age in their offspring, after controlling for the established risk factors of small for gestational age and maternal and paternal characteristics. We also explore the extent to which the intergenerational predictors of small for gestational age may modify the effect of current pregnancy-related risk factors.
The risk of a small for gestational age offspring was 4.7 times greater for mothers and 3.5 times greater for fathers who were small for gestational age, compared with average for gestational age counterparts. Furthermore, the risk of a small for gestational age offspring was 16.3 times greater when both parents were small for gestational age. No significant interactions between maternal small for gestational age and maternal smoking, hypertension or parity were observed.
These results indicate that small for gestational age in both mother and father significantly influences the risk of their offspring being small for gestational age. While previous research has indicated that the birth outcome of the mother is an important determinant of the birth outcome of her offspring, these data indicate that the birth outcome of the father plays an equally critical role in determining fetal growth, strongly suggesting a genetic component in the familial aggregation of small for gestational age.