Kathie Records

Interventions for Weight Management in Postpartum Women

OBJECTIVE To report the results of a comprehensive review of published intervention studies to identify the best evidence available for guiding weight management interventions in postpartum women. DATA SOURCES Electronic searches were conducted of three electronic databases: Cumulative Index to Nursing and Allied Health Literature; Medline; and the Science Citation Index, Expanded, in the Web of Science from 1994 to May 2007. Keyword searches were conducted using the terms obesity, obese, overweight, postpartum, pregnancy weight, and weight management in postpartum women. STUDY SELECTION Six studies were selected that met the inclusion criteria of testing interventions and one that reported preintervention planning and targeted a weight management intervention for postpartum women. DATA EXTRACTION All six interventions showed significant impact with diet and exercise or some combination on body composition in the targeted sample of women. DATA SYNTHESIS The strengths of previous studies include an emphasis on precision in outcome measures and experimental conditions; limitations were that the theoretical basis for the interventions was frequently omitted and limited attention given to the cultural, social, and contextual factors established in descriptive research. CONCLUSIONS Interventions need to target women early in their childbearing years to have the most significant long-term impact.

Lifetime physical and sexual abuse and the risk for depression symptoms in the first 8 months after birth

Despite the growing body of evidence on the significance of postpartum depression, little research has explored the contribution of lifetime or current abuse to postpartum depression. One hundred-thirty-nine women were assessed during their third trimester of pregnancy and followed for 2, 4, 6, and 8 months postpartum for abuse status and depression symptoms. Predictors of postpartum depression were also assessed. Few women reported current abuse experiences, although 37% reported having lifetime physical or sexual abuse or both. Women with a lifetime history of abuse were 3.6–8.4 times more likely to experience postpartum depression than their nonabused peers at each measurement time. This effect steadily increases during the first 6 months after birth and decreases at the 8th month. These findings extend recent reports of the chronicity of abuse and have implications for care providers. The standard of care for abuse assessments may need to be expanded to include consideration of lifetime physical and sexual abuse experiences of pregnant and postpartum women.

Reflections on Meeting Women's Childbirth Expectations

When care providers support their personal worth, use caring communication, facilitate consumer participation in decision making, seek optimal outcomes, and know the patient holistically, female patients feel that their dignity is respected. We compare womens expectations for dignified care in contemporary society with the expectations of women 40 years ago. Some progress has been made toward valuing womens voices and participation in decision making, the availability of interventions for optimal outcomes, and recognition of the importance of cultural competence. Continued work is needed to meet womens expectations for receiving individualized and tailored care, information about intervention effectiveness and risks, and support for the birth process that the family desires. A renewed focus on the recipient of care as a coparticipant in her birthing experiences may result in improved outcomes and resolution of tensions between childbearing women and sociopolitical forces and standards of care.

The relationship between abuse, sexually transmitted diseases, & group B streptococcus in childbearing women.

Purpose To examine the relationship between abuse, sexually transmitted diseases (STDs) and group B Streptococcus (GBS) infection among childbearing women using Selye’s (1978) stress response theory. Design and Methods Retrospective chart review (n = 205) from two different clinical sites in Washington State, using the Childbearing Health Questionnaire to guide data collection. The women in the sample had an average age of 26.4 years and represented Anglo (81.4%), Hispanic (12%), Native American (3.9%), and African American (2.5%) ethnic groups. Thirty-eight percent (n = 78) reported experiencing physical and/or sexual abuse during their lifetimes and 31% had been diagnosed with an STD. Results Abuse was significantly related to STDs, and ethnicity emerged as a significant variable for the Hispanic women participating in this study. Findings indicated that infection with group B Streptococcus was also related to abuse status (r = .60, p ≤ .002) and to presence of herpes simplex virus-2 (r = .468, p ≤ .01). Total prevalence of STDs was positively related to abuse (r = .78, p ≤ .000). Abused Hispanic women were more likely to be positive for STDs than were their nonabused counterparts (p ≤ .03). Clinical Implications The findings support previously published results that abuse is widespread in the United States and that abused women are at increased risk for STDs. These results highlight the need for regular screenings for abuse during healthcare, for abuse is a critical variable to consider when screening for STDs and GBS. STD screening typically occurs during the first prenatal visit and may need to be repeated for high-risk groups.

Promotoras' roles in integrative validity and treatment fidelity efforts in randomized controlled trials

Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts. This article describes a 48-week randomized controlled trial Madres para la Salud (Mothers for Health) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity. Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat, systemic and fat tissue inflammation, and depression symptoms. The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention, and a promotora model to incorporate initial and ongoing fidelity monitoring.

Overweight and obesity in postpartum Hispanic women.

Overweight and obesity vary in prevalence among particular groups, and are especially problematic for childbearing Hispanic women. The complex interaction between physical changes associated with pregnancy, role changes accompanying birth, and family and cultural values related to childbearing are superimposed upon the underlying mechanisms that create or perpetuate obesity. In this article we review biological and behavioral research on obesity in postpartum Hispanic women to identify critical components for intervention studies focused on weight management. Recommendations are offered for health care providers and researchers.

Comparative analysis of physiological adaptation of neonates of abused and nonabused mothers

The investigators examined: (a) the relationships between the mothers abuse status and the newborns stress responses, and (b) differences in newborn stress responses of abused and nonabused mothers before and after a phenylketonuria (PKU) heel stick. The t-tests show a trend toward statistical significance. Abuse had strong effect sizes on cortisol and oxygen levels at 25 minutes. Findings support further research on the impact that maternal stress resulting from abuse has on neonatal outcomes.

Cardiac Response Rate Variability in Physically Abused Women of Childbearing Age

Physical abuse directly affects maternal and fetal/infant health, with documented reports of higher rates of pregnancy termination, neonatal death, and lower birth weights. Although the Centers for Disease Control and Prevention recommend repeated interviews of women of childbearing age to screen for abuse, the paper-and-pencil instruments available for such screening are adversely affected by the hesitancy of women to disclose physical abuse. Biophysical measures of physiological stress adaptations may hold potential for identifying physically abused childbearing women. This pilot investigation used a Latin square design to assess the effects of physically abusive trauma on the cardiac rate response of three clinical groups and one control group of childbearing-age women. Participants were screened using the Child-bearing Health Questionnaire. Cardiac response rates were measured during a standardized orthostatic challenge using a Tanito cardiac rate response monitor. Forty participants participated with an average age of 27. Multiple analyses of variance revealed that there were significant differences between cardiac rate responses at the 5-min interval. Post hoc testing using Dunnett’s t indicated that only the abused pregnant women had significantly higher cardiac responses to orthostatic challenges; differences were apparent at the 5-min testing period. The findings suggest that physical abuse may alter the vasovagal response beyond the attenuation associated with pregnancy. These findings support further testing with larger samples to identify vasovagal changes in abused pregnant women.

Childbearing experiences of abused Hispanic women.

Previous research has documented that abused childbearing women have longer and more difficult labors than non-abused women. Prevalence of abuse differs depending on the ethnic group involved. Hispanic women experience higher rates of abuse and endure higher rates before reporting abuse than do Caucasian women. The purpose of this study was to explore the experience of childbearing for abused Hispanic women to provide guidance for clinical practice and further research. Cognitive dissonance theory guided the study. A sample of seven abused Hispanic women was recruited from a rural prenatal clinic. Criteria for selection of subjects included self-identification as Hispanic, less than 24 months postpartum, disclosure of abuse status, and willingness to be interviewed in English or Spanish. An acculturation scale and demographic form were completed. Interviews were conducted individually, and data were analyzed by using Van Kaams 12-step psychophenomenologic technique. Findings indicated that subjects experienced the normal responses associated with having a baby. However, the women also demonstrated a kindled neuroendocrine trauma response that was based on, and often similar to, their prior abuse experiences. The kindled emotional response was triggered by the normative events of childbearing. Understanding of the childbearing experiences of abused Hispanic women will facilitate the development of cultural-specific interventions that may ease the difficulties associated with birth for these women.

Comparison and evaluation of dietary quality between older and younger Mexican-American women.

OBJECTIVE To compare and evaluate the dietary quality of young and older sedentary Mexican-American women. Understanding key dietary concerns, while considering developmental transition periods and cultural relevance, can provide insight for developing appropriate nutrition interventions. DESIGN Cross-sectional dietary data were collected using unannounced 24 h diet recalls to assess nutrient intake adequacy (Estimated Average Requirement cut-point method) and dietary quality (Healthy Eating Index (HEI) 2010). SETTING Mujeres en Acción and Madres para la Salud, two community-based physical activity interventions. SUBJECTS Participants were 139 young (28 (sd 6) years) and 124 older (55 (sd 7) years) overweight/obese sedentary Mexican-American women (BMI=25·0-35·0 kg/m2) of low socio-economic status. RESULTS Older women consumed less Ca, Fe, folate, empty calories and energy from carbohydrate, but more fruit, vegetables, greens and beans, and fibre than younger women (all P<0·05). Over 60 % of all participants had an intake below recommendations for fibre, Ca, vitamin E, vitamin C and folate. Both groups had low total HEI-2010 scores (62 for older and 63 for younger women; NS), with 57 % of older and 48 % of younger women classified as having a poor diet. CONCLUSIONS Despite differences in nutrient requirements according to developmental transition periods (childbearing v. perimenopausal), overall, older and younger Mexican-American women generally had low-quality diets and may benefit from dietary quality improvement.