National Center for Education in Maternal and Child Health
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November 12, 2004
1. General Pediatric Faculty Report Need for Improved
Training in Developmental and Behavioral Pediatrics
2. Report Explores Economic Factors That Help Explain
Variation in Behaviors and Attitudes Associated with Weight Outcomes
3. Study Examines Effect of Maternal Weight on Labor
Progression
4. Authors Investigate Immigrant Mothers' Knowledge of
Parenting and Child Development
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1. GENERAL PEDIATRIC FACULTY REPORT NEED FOR IMPROVED TRAINING IN
DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
A Need for Faculty Development in Developmental and Behavioral
Pediatrics presents survey findings and recommendations for changes to
the current pediatric training and care systems to support better skill
acquisition among pediatric faculty members and trainees. The brief,
published by the Commonwealth Fund, draws data from a Web-based survey
e-mailed to nearly 1,700 members of the Ambulatory Pediatrics
Association in March and April 2004. The brief presents survey findings
on the quality of resident education in developmental and behavioral
pediatrics (DBP), the personal competency of generalist faculty in DBP,
interest in improving personal and teaching competencies, preferred
educational modality and duration, content areas for faculty
development in DBP, and incentives and barriers to participating in
faculty development in DBP. Information on the survey background and
methodology, a discussion of the findings, conclusions, and endnotes
are also presented. The brief is available at
http://www.cmwf.org/publications/publications_show.htm?doc_id=245576.
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2. REPORT EXPLORES ECONOMIC FACTORS THAT HELP EXPLAIN VARIATION IN
BEHAVIORS AND ATTITUDES ASSOCIATED WITH WEIGHT OUTCOMES
The Role of Economics in Eating Choices and Weight Outcomes examines
economic factors that help explain variation in behaviors and attitudes
associated with weight outcomes among U.S. adults. This report,
produced by the U.S. Department of Agriculture's Economic Research
Service, draws data from the 1994-96 Continuing Survey of Food Intakes
by Individuals and the 1994-96 Diet and Health Knowledge Survey. The
report includes a summary, data, and information on particular
behaviors and attitudes that affect an individual's risk for
overweight. The framework, findings, and conclusions of the economic
analysis are also presented. The appendix identifies risk for
overweight by an individual's gender, race/ethnicity, age, household
composition, income, level of education, and region. The report is
available at http://www.ers.usda.gov/publications/aib791.
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3. STUDY EXAMINES EFFECT OF MATERNAL WEIGHT ON LABOR PROGRESSION
"In our study, overweight and obese women had a significantly slower
labor from 4 to 10 cm, compared with that of normal-weight women,"
state the authors of an article published in the November 2004 issue of
Obstetrics and Gynecology. The authors note that prevalence of
overweight and obesity is increasing among women of childbearing age,
yet few studies have explored in depth the effect of maternal
overweight and obesity on labor progression. The article describes a
study to examine the effect of maternal overweight and obesity on the
pattern of labor progression after adjusting for potential confounders
in current obstetric practice.
Women in this study were participants in the Pregnancy, Infection, and
Nutrition Study (PINS), an ongoing, prospective cohort study to examine
the determinants of preterm birth. Between August 1995 and March 2002,
PINS recruited 3,625 women. Maternal prepregnancy body mass index
(BMI), the exposure of interest, was computed based on the following
Institute of Medicine weight-for-height categories: normal weight (BMI
19.8-26.0 kg/m2), overweight (BMI 26.1-29.0 kg/m2), and obese (BMI
greater than 29.0 kg/m2). Women were eligible for this analysis if they
met the following additional inclusion criteria: nulliparous, a
maternal prepregnancy BMI of 19.8 kg/m2 or higher, and a term delivery.
The final study sample included 612 women (297 normal weight, 115
overweight, and 200 obese). The median duration of labor by each
centimeter of cervical dilation was computed for each BMI category and
used as a measurement of labor progression.
The authors found that
* Compared with normal-weight women, both overweight and obese women
were admitted earlier (based on cervical dilation assessment) to labor
and delivery, more frequently reported no or irregular uterine
contractions, more frequently had their labor induced, and received
oxytocin more often.
* Primary emergent cesarean delivery rates were higher for overweight
and obese women compared with normal-weight women. The majority of
these deliveries were performed during the first stage of labor because
of an indication of dystocia and fetal distress.
* Overweight and obese women had a significantly longer median duration
of labor from 4 to 10 cm compared with normal-weight women (7.5, 7.9,
and 6.2 hours, respectively), after adjusting for maternal height, net
weight gain, labor induction, membrane rupture, the timing and use of
epidural analgesia, oxytocin use, and fetal size.
* Compared with normal-weight women, the general trend of a slower
labor from 4 to 6 cm persisted in overweight women, and the trend of a
slower labor before 7 cm persisted in obese women.
"Given that nearly one half of women of childbearing age are either
overweight or obese, it is critical to consider differences in labor
progression by maternal prepregnancy BMI before additional
interventions are performed," conclude the authors.
Vahratian A, Zhang J, Troendle JF, et al. 2004. Maternal prepregnancy
overweight and obesity and the pattern of labor progression in term
nulliparous women. Obstetrics and Gynecology 104(5, Part 1):943-951.
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4. AUTHORS INVESTIGATE IMMIGRANT MOTHERS' KNOWLEDGE OF PARENTING AND
CHILD DEVELOPMENT
"The gaps in [immigrant] parents' knowledge about normative child
development and the role of parents in their children's development
indicate that more needs to be done to educate parents," state the
authors of an article published in the November 2004 issue of
Pediatrics Electronic Pages. The authors note that approximately one in
five children in the United States lives with at least one parent who
was born outside the United States; however, little is understood about
parenting knowledge among immigrant families. The article examines
mothers’ substantive knowledge about child development and child
rearing.
The study sample included 114 mothers of 20-month-old children (38
Japanese immigrants, 36 South American immigrants, and 40 4th- and
5th-generation European Americans). All the mothers resided in the
Washington, DC, metropolitan area, were middle class and of similar
ages, and had comparable education levels. The mothers completed a
questionnaire to assess their knowledge of parental contributions to
children's psychological and social development, normal developmental
milestones, and health and safety guidelines.
The authors found that
* Immigrant mothers scored significantly lower on the parenting
knowledge evaluation than did European-American mothers.
* The majority of immigrant mothers did not know correct answers for
25% of the items, and their incorrect answers were mostly to questions
about normative child development and parent-child relationships during
infancy.
* Immigrant mothers did not differ significantly from European-American
mothers in their answers to questions concerning children's physical
health or safety.
"Considering parental knowledge level and cultural background
inevitably introduces a layer of complexity to the clinician's task,
but to eschew or negate such considerations risks access to vital
information about the child," conclude the authors.
Bornstein MH, Cote LR. 2004. "Who is sitting across from me?" Immigrant
mothers' knowledge of parenting and children's development. Pediatrics
Electronic Pages 114(5):e557-e564.
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MCH Alert © 2004 by
National Center for Education in Maternal and
Child Health and Georgetown University. MCH Alert is produced by
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and Child Health under its cooperative agreement (6U02 MC 00001) with
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EDITORS: Jolene
Bertness, Tracy Lopez
COPYEDITOR: Ruth
Barzel
National Center for
Education in Maternal and Child Health
Georgetown University
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