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Nutritional status of infants at six months of age following maternal influenza immunization: A randomized placebo-controlled trial in rural Nepal.
Katz, J, Englund, JA, Steinhoff, MC, Khatry, SK, Shrestha, L, Kuypers, J, Mullany, LC, Chu, HY, LeClerq, SC, Kozuki, N, et al
Vaccine. 2017;(48 Pt B):6743-6750
Abstract
BACKGROUND Maternal influenza vaccination has increased birth weight in two randomized trials in South Asia but the impact on infant growth is unknown. METHODS A randomized placebo-controlled trial of year round maternal influenza immunization was conducted in two annual cohorts in Sarlahi District, southern plains of Nepal, from April 2011 through April 2014. Infants born to women enrolled in the trial had weight, length, and head circumference measured at birth and 6 months of age. The study was powered for the 3 primary trial outcomes but not for stunting and wasting at 6 months of age. RESULTS 3693 women received placebo or influenza vaccine between 17 and 34 weeks gestation, resulting in 3646 live births. About 72% of infants who survived had weight and length measurements between 150 and 210 days of age. Prevalence of stunting (<-2 Z scores length-for-age) was 14.8% in the placebo and 13.6% in the vaccine groups, respectively. Stunting < -3 Z scores was 3.2% versus 2.0% in placebo versus vaccine groups (RR: 0.64 (95% CI: 0.39, 1.04)). Wasting (< -2 Z scores weight for length) was 10.3% versus 11.0% for placebo versus vaccine groups. Severe wasting (< -3 Z scores weight for length) was 3.8% for placebo versus 2.6% for vaccine (RR: 0.69 (95% CI: 0.44, 1.07)). The impact of flu vaccine on wasting was greater in cohort 2 than in cohort 1, (RR: 0.66 (0.44, 0.99) for any wasting), and RR: 0.45 (0.19, 1.09) for severe wasting. This corresponded to a larger impact on birth weight and a better vaccine match with circulating viruses in cohort 2. CONCLUSIONS Although maternal immunization reduced low birth weight by 15%, only wasting at 6 months in the 2nd cohort was statistically significantly difference. However, the study was underpowered to detect reductions of public health importance. TRIAL REGISTRATION Clinicaltrials.gov (NCT01034254).
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An in-home intervention to improve nutrition, physical activity, and knowledge among low-income teen mothers and their children: results from a pilot study.
Davis, AM, Gallagher, K, Taylor, M, Canter, K, Gillette, MD, Wambach, K, Nelson, EL
Journal of developmental and behavioral pediatrics : JDBP. 2013;(8):609-15
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OBJECTIVE Teenage pregnancy is a major public health concern in the United States. In addition to other life stressors, adolescent mothers and their children are at risk for obesity and other negative health outcomes. The current study examines the impact of a brief in-home educational intervention designed to improve health knowledge and behavior in a sample of low-income adolescent mothers. METHOD Forty-six teen mothers received 6 in-home educational sessions focused on nutrition and physical activity, with baseline and follow-up knowledge and behavior assessments. RESULTS Results indicate significant improvements in mothers' health knowledge and physical activity pertaining to themselves and to their children, and also an unexpected increase in sedentary behaviors. CONCLUSION Results from this study indicate that knowledge-focused interventions may be an effective method to facilitate positive health behavioral change for teenage mothers.
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Two approaches to maternal depression screening during well child visits.
Olson, AL, Dietrich, AJ, Prazar, G, Hurley, J, Tuddenham, A, Hedberg, V, Naspinsky, DA
Journal of developmental and behavioral pediatrics : JDBP. 2005;(3):169-76
Abstract
The US Preventive Services Task Force (USPSTF) has recommended depression screening for adults. Screening mothers has special importance to pediatricians because of the impact of maternal depression on children. The two screening questions endorsed by the USPSTF may allow pediatricians to screen mothers during routine well child care. This study explores the feasibility and yield of interview- and paper-based pediatric screening for maternal depression during well child visits. A structured interview script was developed to inquire about maternal depression. It included the two-question screen and required less than 1 minute to administer. An alternative paper-based screen asked the two questions after a brief written introduction providing the rationale. Four community pediatric practices in New Hampshire and Maine were trained in both screening approaches and developed plans on how to respond to positive screens (either question positive). The 11 providers at these sites tested the two approaches on two different series of mothers at well child visits. The pediatricians also reported barriers to the screening inquiries, maternal responses, and subsequent clinician actions and referrals. The pediatricians screened 250 mothers via the scripted interview. In a second trial, 223 women had paper-based depression screening. Yields from the paper-based screen were 22.9% versus 5.7% for the interview-based screener. Pediatricians also took on the new role of discussion of possible depression in about two thirds of cases. Subsequently, 7.6% of all women with paper-based screening were referred to mental health versus 1.6% with the interview-based screening. With the interview, mothers of children younger than 1 year of age were less likely to screen positive than those with older children (1.9% vs. 8.5%, p = .04). With the paper-based screener, no age differences in positive screen rates occurred. While both approaches to screening were feasible in primary care, the yield from the two different approaches differed substantially. This finding deserves exploration in future studies. With either of these screening approaches, pediatricians could enhance their detection of mothers at risk of depression. The outcomes of pediatrician screening and the best approach to follow-up care still need to be determined.
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Mothers performing in-home measurement of milk intake during breastfeeding of their preterm infants: maternal reactions and feeding outcomes.
Hurst, NM, Meier, PP, Engstrom, JL, Myatt, A
Journal of human lactation : official journal of International Lactation Consultant Association. 2004;(2):178-87
Abstract
This study compares feeding outcomes and perceptions of mothers using in-home test weights and those who did not use test weights to manage breastfeeding of their preterm infants during the first month after hospital discharge. There were no significant differences in daily weight gain between the 2 groups during the study period. Maternal concerns cited in both groups were similar, namely, knowing how much milk infant is taking, infant gaining adequate weight, and infant getting enough milk. All women in the experimental group and two-thirds in the control group reported that in-home measurement of milk intake by test-weighing had been or would have been helpful. This prospective randomized study demonstrated that mothers of premature infants who performed in-home test-weighing procedures found the technique to be helpful and experienced no increased stress or lower achievement of breastfeeding goals when compared to mothers not performing test weighs.
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Effects of acupuncture and care interventions on the outcome of inflammatory symptoms of the breast in lactating women.
Kvist, LJ, Wilde Larsson, B, Hall-Lord, ML, Rydhstroem, H
International nursing review. 2004;(1):56-64
Abstract
OBJECTIVES To compare modes of care and treatment for lactating women with inflammatory symptoms of the breast, with special focus on the use of acupuncture. METHOD Eighty-eight mothers were randomized into three treatment groups. All three groups were given advice regarding emptying of the breasts and care in the form of comfort interventions. Acupuncture was included in the treatment regime for two of the groups. A severity index was created by adding together scores for signs and symptoms: breast tension, erythema and pain. FINDINGS Mothers in all groups expressed relative satisfaction with the breastfeeding situation despite considerable discomfort. There was no significant difference between the groups for the number of mothers requiring more than three contact days for recovery nor for their severity index scores on day 3. These findings must be interpreted with care but may suggest that care interventions play as great a part in the recovery of these women as acupuncture treatment or the use of oxytocin spray. Antibiotic therapy was used in 9% of the study population, which is in contrast to other studies. PROPOSED FUTURE ACTION Based on these results, a new study has been designed to test the hypothesis that acupuncture hastens recovery from inflammatory processes in the lactating breast and approximately 200 mothers will be randomized in a new expanded study.
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Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial.
Powell, C, Baker-Henningham, H, Walker, S, Gernay, J, Grantham-McGregor, S
BMJ (Clinical research ed.). 2004;(7457):89
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OBJECTIVES To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing. DESIGN Cluster randomised controlled trial. SETTING 18 clinics in three Jamaican parishes. PARTICIPANTS 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics. INTERVENTIONS Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials. MAIN OUTCOME MEASURES Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires. RESULTS Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development. CONCLUSION Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.
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Stages of change for weight management in postpartum women.
Krummel, DA, Semmens, E, Boury, J, Gordon, PM, Larkin, KT
Journal of the American Dietetic Association. 2004;(7):1102-8
Abstract
OBJECTIVE This study examined factors related to stages of change for weight-management behaviors in postpartum women. DESIGN Cross-sectional data, collected at baseline, are reported from the Mothers' Overweight Management Study (MOMS), a randomized, controlled trial conducted in postpartum women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Subjects/Setting Subjects were a sample of WIC recipients (N=151) older than 18 years of age with a child younger than 2 years. Statistical analysis The dependent variables were the stages of change for weight-management behaviors (losing weight, avoiding high-fat foods, eating a high-fiber diet, and exercising). Demographic, health, and psychosocial variables were examined as independent variables. One-way analysis of variance was used to compare means, and chi(2) was used for proportions. RESULTS Whereas 55% of women were in the action stage for weight loss, fewer women were in the action stage for the following weight management behaviors: avoiding high-fat foods (24%), increasing fiber (19%), and exercising three times per week (29%). Identifying pros for weight management was related to stages for losing weight, high-fat food avoidance, and exercise (F=13.4, P<.001; F=10.5, P<.001; F=3.7, P<.007, respectively). Self-efficacy for choosing a low-fat restaurant meal or using food labels was positively related to later stages for avoiding high-fat foods and increasing fiber intake (chi(2)=16.4, P=.003; chi(2)=11.7, P=.02). CONCLUSIONS Emphasizing the pros for weight-management behaviors, decreasing the cons for exercising, increasing confidence to select low-fat restaurant choices, and improving skills for using food labels are four strategies that nutrition professionals can use to help women become more ready to change behaviors for weight management.
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Maternal compliance with nutritional recommendations in an allergy preventive programme.
Schoetzau, A, Gehring, U, Franke, K, GrĂ¼bl, A, Koletzko, S, von Berg, A, Berdel, D, Reinhardt, D, Bauer, CP, Wichmann, HE, et al
Archives of disease in childhood. 2002;(3):180-4
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AIMS: To assess maternal compliance with nutritional recommendations in an allergy preventive programme, and identify factors influencing compliance behaviour. METHODS Randomised double-blind intervention study on the effect of infant formulas with reduced allergenicity in healthy, term newborns at risk of atopy. Maternal compliance with dietary recommendations concerning milk and solid food feeding was categorised. RESULTS A total of 2252 newborns were randomised to one of four study formulas. The drop out rate during the first year of life was 13.5% (n = 304). The rates of high, medium, and low compliance to milk feeding during weeks 1-16 were 83.4%, 4.0%, and 7.5%; the corresponding rates to solid food feeding during weeks 1-24 were 60.0%, 12.1%, and 22.9%. In 5.1% of subjects no nutritional information was available. Low compliance was more frequent among non-German parents, parents with a low level of education, young mothers, smoking mothers, and those who weaned their infant before the age of 2 months. CONCLUSIONS Evaluation of allergy preventive programmes should take into account non-compliance for assessing the preventive effectiveness on study outcome.
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Randomized study comparing the efficacy of a novel manual breast pump with a mini-electric breast pump in mothers of term infants.
Fewtrell, M, Lucas, P, Collier, S, Lucas, A
Journal of human lactation : official journal of International Lactation Consultant Association. 2001;(2):126-31
Abstract
The objective of this study was to compare the efficacy of a mini-electric pump (MEP) and a novel manual breast pump (MP) designed to operate more physiologically. Sixty term breastfeeding mothers used the MP and MEP in randomized order 8 weeks postpartum, expressing for 10 minutes from each breast. Milk volume, fat content, and pattern of milk flow were measured. Mothers rated pump characteristics by questionnaire. There was no significant difference in the milk volume or fat content when mothers used the pumps in randomized order. The MP was rated significantly better overall and more comfortable and pleasant to use. Significantly more mothers kept the MP than the MEP. Despite the greater complexity and expense of the MEP, the pumps showed similar efficacy. The MP was preferred by mothers. The novel, more physiological operation of the MP represents an advance in milk expression technology.
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The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate.
Turner, L, Jacobsen, C, Humenczuk, M, Singhal, VK, Moore, D, Bell, H
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. 2001;(5):519-24
Abstract
OBJECTIVE This prospective study examined the effect of lactation instruction and palatal obturation in decreasing time to feed, increasing intake, and on growth in eight breast milk bottle-fed newborn infants with cleft lip, cleft palate, or both. DESIGN An A, B1, C1, B2, and C2 reversal design was used with eight mothers. In A, baseline data on minutes fed by breast were recorded. In B1, baseline on minutes fed with a Haberman bottle was recorded. In C1, minutes fed following lactation education and palatal obturation were documented. Lactation education was information given to mothers to recognize infant feeding cues and to have infant-led feedings. The palatal obturator was a passive molding appliance. In B2, the obturator was removed and minutes fed noted. In C2, the obturator was returned and lactation support provided. Mothers kept feeding logs, satisfaction was assessed, and infant breast milk intake and flow rate were recorded during each study phase. Routine nutrition evaluation of weight, height, weight for height, and feed volume was completed by a registered dietitian during and following completion of the study. RESULTS Feeding times decreased with all infants, volume consumed increased with seven of eight infants, and flow rate increased with all infants. Mean feeding times during B1 and B2 phases (Haberman bottle only) were 34.4 and 32.3 minutes, respectively. Mean feeding times during C1 and C2 phases (obturation and lactation education) were 15.1 and 15.6 minutes. Volume of milk consumed during B1 and B2 feedings averaged 36.5 and 37 mL, compared with 67 mL and 76 mL during C1 and C2 phases. Growth as measured by height, weight gain, and weight for height during the study and the first 2 years of life compared favorably with that of children born without clefts. CONCLUSIONS The combined use of a palatal obturator and lactation education reduced feeding time and increased volume intake and was associated with good growth. Mothers who had desired to breast-feed elected to use the obturator to support high-volume intake, decrease infant fatigue, and provide breast milk for nutrition.