Elizabeth G. Damato

Prenatal attachment and other correlates of postnatal maternal attachment to twins.

PURPOSETo determine the relationship of prenatal attachment and other selected perinatal contextual variables (method of delivery, maternal self-reported health, depression, infant birthweight, need for neonatal intensive care unit [NICU] admission) to postnatal attachment in mothers of twins. SUBJECTSTwo hundred fourteen women were initially recruited from a national mothers of twins support group for a study of maternal prenatal attachment. Of the 168 women who agreed to be contacted after delivery, 142 returned completed questionnaires (82.7% response rate), with 139 study-eligible women included in the analysis for this report. STUDY DESIGNCorrelational design with longitudinal follow-up at 1 month after expected delivery date. METHODSSelf-administered, mailed questionnaires completed by women with twin gestations prenatally and postnatally 1 month after their expected delivery dates. Descriptive analysis, correlations, and regression equations were performed. MAIN OUTCOME MEASURESThe Maternal Attachment Inventory. PRINCIPLE RESULTSA modest correlation was found between prenatal and postnatal attachment (r = 0.38, P < 0.001). Prenatal attachment and postpartum depression explained 26.1% of the variance in postnatal attachment (F = 5.06, P < 0.001). Depression, method of delivery, and need for admission to the NICU had moderator effects on the relationship between prenatal attachment and postnatal attachment. The addition of these interaction terms nominally increased the adjusted R2 to explain 27.9% to 29.6% of the variance in postnatal attachment. CONCLUSIONSAlthough the study findings support a modest relationship between prenatal and postnatal attachment in mothers of twins, maternal depression was also significant in explaining postnatal attachment. Postpartum depression, having a cesarean delivery, and the experience of a NICU admission for 1 or both twins further influenced the relationship between prenatal attachment and postnatal attachment. When fostering attachment in mothers of twins, nurses should assess for symptoms of depression and pay particular attention to those women who have an infant requiring a NICU admission.

Web Recruitment and Internet Use and Preferences Reported by Women With Postpartum Depression After Pregnancy Complications

Nearly one million women each year have pregnancy complications that cause antepartum and postpartum anxiety and depression. This exploratory study determined 1) feasibility of using social media to recruit women with depressive symptoms following high risk pregnancy, 2) womens barriers to treatment, 3) use of online resources for assistance with PPD, and 4) preferences for internet treatment. Among a national sample of 53 women, nearly 70% had major depression. Common barriers were lack of time and stigma. Over 90% of women would use the internet to learn coping strategies for PPD. Women expressed interest in web-based PPD treatment and identified desired characteristics of an intervention.

Predictors of Prenatal Attachment in Mothers of Twins

OBJECTIVES To explore the predictive relationship between prenatal attachment and selected demographic and biopsychosocial factors and to compare these predictors to those identified in previous research on maternal attachment in singleton pregnancies. DESIGN A predictive correlational descriptive design. SETTING Data were obtained via mailed surveys. PARTICIPANTS 214 women expecting twins were recruited from a national mother of twins support group. MAIN OUTCOME MEASURES Instruments included the Rosenberg Self-Esteem Scale, Norwood Social Support Apgar, Miller Prenatal Attachment Inventory, and a demographic data tool to collect data on perinatal factors of gestational age, infertility history, perceived risk status, fetal movement, and planning of pregnancy. RESULTS Women who were younger, with lower income, a history of infertility, greater self-esteem, who had experienced quickening, and were further along in their pregnancy reported greater prenatal attachment to their twins (Adjusted R2 = 19.4%, p < .001). Perceived risk, social support, and planning of pregnancy did not predict level of attachment. CONCLUSION Factors that influence attachment in women experiencing a twin pregnancy are complex, and much is still unknown. Development and testing of theory is needed to guide future research and practice.

Multiple Gestation: Side Effects of Antepartum Bed Rest

The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t =– 2.14,p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M=22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27)=15.68, p =.00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.

Explanation for Cessation of Breastfeeding in Mothers of Twins

This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother’s role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants’ behaviors, challenges presented by growth and development, and time commitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise.

Reducing the risk for preterm birth: evidence and implications for neonatal nurses.

The incidence of preterm birth has been slowly rising despite advances in obstetric health care. Neonatal nurses have ongoing contact with women who have had a preterm birth and, thus, who are at high risk to have another preterm birth. This article discusses current evidence about reducing risk for preterm birth. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimal health before conception. Quality prenatal care, as defined by the Institute of Medicine, consists of continuing risk assessment, health promotion, and interventions to modify medical and psychosocial risk. When these 3 components are consistently applied, they may confer some protection against preterm birth. Women at highest risk for preterm birth need to seek prenatal care from an expert in maternal-fetal medicine. Women also need to learn about the common, subtle signs of preterm labor so they can recognize symptoms and quickly seek treatment. Neonatal nurses can provide critical information and anticipatory guidance to women at risk for preterm birth so they can make sound decisions about future pregnancies.

Predictors of Serious Fall Injury in Hospitalized Patients

The purpose of this study was to identify predictors of falls that result in serious injury in hospitalized patients. The study involved secondary data analysis of 1,438 patient falls in a community hospital system between 2008 and 2010. The analysis included demographics, severity of illness, diagnosis-related group (surgical vs. medical), event type (bathroom, bed, chair, transfer, ambulating), risk factors identified by the Hendrich II fall risk assessment prior to the fall (confusion, depression, altered elimination, dizziness, antiepileptic or benzodiazepine medications), and contributing factors identified through an online event reporting system post-fall (incontinence, confusion, history of falls, alteration in mobility, and medication-related). Logistic regression results indicated that the overall model was a good fit and two predictors, age greater than 64 and male gender, were statistically reliable in predicting which patient falls would result in serious injury.

HIV exposure: neonatal considerations.

The presence of human immunodeficiency virus (HIV) in pregnant women puts infants at risk for exposure through placental infection and contact with contaminated maternal blood and genital secretions. Efforts to combat this inevitably fatal disease continue to focus on preventing transmission of the virus from a mother who has HIV to her newborn during the prenatal, intrapartum, and postnatal periods. Prophylaxis against transmission and vigilant assessment for indicators of infection are hallmarks of appropriate health care for infants exposed to HIV.

Growth Deficiency in Cystic Fibrosis Is Observable at Birth and Predictive of Early Pulmonary Function

Introduction: Cystic fibrosis (CF) is a complex disease that includes both pulmonary and gastrointestinal challenges, resulting in decreased weight. Pulmonary symptoms of CF are extremely variable. Greater body mass at an early age is associated with improved pulmonary function, but it is unknown at what age weight becomes predictive of pulmonary disease severity. The purpose of this study was to investigate the relationship between birth weight and pulmonary function in CF. Methods: Birth weight and pulmonary data were obtained. Linear regressions were used to examine the relationship between these two variables. A one-tailed t-test was used to compare birth weights between CF patients and the national average. Results: Birth weight was significantly lower in babies with CF and correlated with pulmonary disease at ages 6 and 10 years but not with age at which Pseudomonas aeruginosa colonization was observed. Discussion: These data suggest that CF growth deficiency has prenatal origins. Early nutritional intervention for babies with CF and a low birth weight is warranted to maximize pulmonary potential.

Maternal dietary supplementation with omega-3 polyunsaturated fatty acids confers neuroprotection to the newborn against hypoxia-induced dopamine dysfunction

Introduction Up to 84% of prematurely born infants suffer hypoxic, anoxic, and ischemic insults. Those infants with subsequent behavioral, motor or cognitive dysfunction represent 8–11% of all live births. Yet, no interventions employed during pregnancy attenuate risk of morbidity in those at-risk infants. Dietary supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFAs) has been shown to reduce stroke-induced neuropathology in rat models emulating this adverse clinical event. To extend those studies we sought to determine whether maternal dietary supplementation with ω-3 PUFAs would confer neuroprotection against hypoxia-induced neurochemical dysfunction in newborn rat pups exposed to repetitive hypoxic insults. Methods We provided pregnant rats with either a ω-3 PUFA enriched diet or else a standard rat chow diet. At postnatal day 7, pups were assigned randomly to either repetitive hypoxic insults or repetitive bursts of room air. On postnatal day 12, pups were sacrificed and brain dopamine levels characterized. Results Baseline brain dopamine levels did not differ between rat pups born to dams who received ω-3 PUFA enriched versus standard rat chow diets. Rat pups born to dams maintained on normal diets, who were exposed to five days of repetitive hypoxic insults, experienced a 57% reduction in striatal dopamine levels accompanied by significant apoptosis. In contrast, ω-3 PUFA-enriched newborn pups experienced no loss in striatal dopamine levels, and only minimal apoptosis. Conclusions Our findings suggest that it may be feasible to confer neuroprotection against hypoxia-induced dopamine dysfunction to newborns likely to experience hypoxic insults. This could significantly improve the outcomes of those 8–11% of newborns who would otherwise experience hypoxia-induced behavioral, motor and cognitive dysfunction.