Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
December 19, 2008
1. MCH Library Releases New Edition of Knowledge Path on
Spanish-Language Health Resources
2. Journal Focuses on Policy and Finance Issues for
Preconception and Interconception Care
3. Journal Examines Clinical Content of Preconception Care
4. Study Investigates Pregnancy Intervals and Perinatal
Outcomes Among Women Delaying the Initiation of Childbearing
5. Article Explores the Effects of Contact with Stillborn
Infants on Maternal Anxiety and Depression
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Readers: The next issue of MCH Alert will be published on January 9,
2009.
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1. MCH LIBRARY RELEASES NEW EDITION OF KNOWLEDGE PATH ON
SPANISH-LANGUAGE HEALTH RESOURCES
Spanish-Language Health Resources: Knowledge Path is an electronic
guide to health hotlines and helplines, Web sites, publications, and
databases for health professionals and consumers. The new edition of
the knowledge path, produced by the MCH Library, presents general
resources on a range of health topics. A list of resources that focus
on specific aspects of maternal and child health is also included. A
Spanish-language version of the 2008 edition is being developed. The
knowledge path is available at http://mchlibrary.info/KnowledgePaths/kp_spanish.html.
MCH Library knowledge paths on other topics are available at
http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library
welcomes feedback on the usefulness and value of these knowledge paths.
A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.
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2. JOURNAL FOCUSES ON POLICY AND FINANCE ISSUES FOR
PRECONCEPTION AND INTERCONCEPTION CARE
The supplement to the November-December 2008 issue of Women's Health
Issues offers articles related to the policy and finance context for
improving preconception health and health care. The supplement,
produced with support from the Centers for Disease Control and
Prevention's Preconception Health and Health Care Initiative, discusses
the impact of finance and policy on preconception health and heath
care, as well as the strategies that are being used to overcome the
challenge of implementing preconception care with limited resources and
inadequate health coverage for women. Invited papers from authors with
expertise in healthy policy and finance issues describe how women's
health and preconception care fit into the larger debates on health
reform and how the paradigm for women’s health must change. Other
invited papers discuss opportunities and challenges for using programs
such as Medicaid, Title X Family Planning, the Title V Maternal and
Child Health Services Block Grant, Healthy Start, and Community Health
Centers in improving preconception health and health care. Contributed
articles on health services research in this supplement characterize
the types of change occurring across the country. The supplement is
available at http://www.sciencedirect.com/science/issue/5192-2008-999819993.8998-751070.
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3. JOURNAL EXAMINES CLINICAL CONTENT OF PRECONCEPTION CARE
A supplement to the December 2008 issue of the American Journal of
Obstetrics and Gynecology contains a series of articles on strategies
for implementing preconception care recommendations. An introductory
article reviews the accomplishments of the first 4 years of the Centers
for Disease Control and Prevention's (CDC's) Workgroup on Preconception
Health and Health Care. Another article summarizes the workgroup's
methods for selecting and reviewing topics and provides a summary table
of recommendations for the routine care of all women of reproductive
age. Topics include immunizations as part of preconception care;
infectious diseases in preconception care; women with chronic medical
conditions; women with psychiatric conditions; alcohol, tobacco, and
illicit drug exposures; genetics and genomics; nutrition and dietary
supplements; environmental exposures; care of psychosocial stressors;
use of medications and supplements among women of reproductive age;
reproductive history; preconception care for special populations; and
preconception care for men. The supplement is available at http://www.ajog.org/issues/contents?issue_key=S0002-9378(08)X0011-0.
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4. STUDY INVESTIGATES PREGNANCY INTERVALS AND PERINATAL OUTCOMES AMONG
WOMEN DELAYING THE INITIATION OF CHILDBEARING
"Both a delayed initiation of childbearing until age 30 or older, and a
short IPI [interpregnancy interval] less than 6 months are independent
risk factors for adverse perinatal outcomes in the second pregnancy,"
state the authors of an article published in the December 2008 issue of
the Journal of Obstetrics and Gynaecology Research. Several studies
have demonstrated associations between both short and long IPIs
(difference between date of delivery of the second infant and that of
the first infant minus the gestational age of the second infant at time
of delivery) and increased rates of adverse outcomes. However, few have
examined the association between IPIs and adverse outcomes in the
context of the mother's age at the time of first delivery. Given the
increasing number of women delaying childbearing, the effect of IPIs on
pregnancy outcomes for pregnancies other than the first for these women
has both clinical and population health implications. The article
investigates the association between IPIs and perinatal outcomes in
second pregnancy among women delaying the initiation of childbearing
until age 30 or older.
The researchers conducted a retrospective cohort study using the
Missouri maternally linked cohort files for 1978-1997. Maternal age at
end of first pregnancy was categorized as ages 20-29, 30-34, and 35-50,
with delayed initiation of childbearing defined as waiting until age 30
or older until delivery of the first infant. IPIs were grouped into one
of seven categories: 0-5 months, 6-11 months, 12-17 months, 18-23
months, 24-59 months, 60-119 months, and more than 120 months. Crude
models were fitted without adjusting for confounders. The second set of
models examined maternal age and short IPI simultaneously, while the
third set of models included interaction terms. The final set included
significant interactions as well as other confounders (maternal
demographic characteristics, medical and obstetric risk factors).
The authors found that
- A significant trend toward increasing adverse outcomes as
maternal age at first delivery increased was observed for
very-low-birthweight infants (1,000-1,499 g), preterm infants (delivery
at less than 37 completed weeks of gestation), moderate preterm infants
(32-36 weeks), and extremely preterm infants (24-27 weeks). There was a
significant trend toward lower rates of small-for-gestational-age
infants (birthweight below the 10th percentile) as maternal age at
first delivery increased.
- Mothers with IPIs of less than 6 months and those with IPIs of
60-119 months had significantly higher rates of adverse outcomes in the
second pregnancy across all age groups.
- Most of the interactions were nonsignficant, with the exception
of extremely low birthweight (500-999 g) where the interaction of
maternal age 30-34 and a short IPI were significant. Controlling for
other potential confounders, the interaction term for extremely low
birthweight was no longer significant.
The authors conclude that "health care providers should encourage women
to space pregnancies adequately through use of effective family
planning methods to minimize some of the potential effects of closely
spaced pregnancies."
Nabukera SK, Wingate MS, Kirby RS, et al. 2008. Interpregnancy interval
and subsequent perinatal outcomes among women delaying initiation of
childbearing. Journal of Obstetrics and Gynaecology Research
34(6):941-947. Abstract available at http://www3.interscience.wiley.com/journal/120847997/abstract.
Readers: More information is available from the following MCH Library
resource:
- Preconception and Pregnancy: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html
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5. ARTICLE EXPLORES THE EFFECTS OF CONTACT WITH STILLBORN INFANTS ON
MATERNAL ANXIETY AND DEPRESSION
"Seeing and holding a stillborn baby are associated with fewer anxiety
and depressive symptoms among mothers of stillborn babies than not
doing so," write the authors of an article published in the December
2008 issue of Birth. In the mid-20th century, mothers of stillborn
infants rarely had the opportunity to see and hold their newborns.
Later in the century, many hospitals began to promote rituals through
which mothers could see and hold their stillborn infants, believing
that this process would facilitate healthy maternal grief responses.
Recently, this practice has been called into question. The goal of the
study described in this article was to determine the association
between seeing and holding a stillborn infant with maternal anxiety and
depression. The authors assessed both the mothers' probability of
seeing and holding their infants and the risk for symptoms of anxiety
and depression during a subsequent pregnancy and in the long term.
For the study, 2,292 women who reported a singleton stillbirth after 20
weeks' gestation and certainty about whether they were currently
pregnant completed interactive questionnaires that explored various
topics related to stillbirth. Anxiety and depression rates were
measured.
The authors found that
- The great majority of mothers saw (95%) and held (90%) their
stillborn infants, and few expressed regret that they did so.
- Almost 80% of mothers who did not see and hold their stillborn
infants expressed regret that they did not do so.
- Among participants, 42% and 62% reported symptoms of anxiety and
depression, respectively.
- Among mothers who did not see their stillborn infants, those who
never were given the opportunity and those who actively resisted tended
to have more anxiety symptoms than those who reported that they simply
did not wish to see the infant.
- Among mothers who saw their stillborn infants, those who reported
that they were given no other options or that the subject was not
discussed with them had fewer symptoms of depression than mothers who
reported having seen the infant because of their own wish to do so.
- Mothers who perceived that health professionals left the decision
to them by offering them the option to see and hold the infant when
they had no strong wishes of their own tended to have more symptoms of
depression than those who spontaneously wished to see their infant.
- Mothers who were pregnant at the time of the investigation and
who had seen and held their stillborn infants had fewer symptom of
depression but more symptoms of anxiety than their counterparts who had
not seen or held their stillborn infants. However, long-term results
suggest that the negative effects are transient.
The authors conclude that "since caregiver interaction may influence a
grieving mother's responses during the acute crisis, active management
that includes responsiveness, support, and a staff willing to
facilitate contact with a stillborn baby is necessary and may provide
long-term benefits to the mother."
Cacciatore J, Radestad I, Froen F. 2008. Effects of contact with
stillborn babies on maternal anxiety and depression. Birth
35(4):313-320. Abstract available at http://www3.interscience.wiley.com/journal/121523277/abstract.
Readers: More information is available from the following MCH Library
resource:
- Depression During and After Pregnancy: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_postpartum.html
Information is also available from the following resources on the
National Sudden and Unexpected Infant / Child Death and Pregnancy Loss
Resource Center Web site:
- Pregnancy Loss, Miscarriage, and Stillbirth at
http://www.sidscenter.org/PregnancyLoss.html
- Stillbirth (A-Z Topics) at
http://www.sidscenter.org/AZtopics/S.html#s15
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and
Child Health and Georgetown University. MCH Alert is produced by
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MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel
LIST ADMINISTRATOR: Beth DeFrancis Sun
MCH Alert
Maternal and Child Health Library
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