Browsing by Author "Holditch-Davis, Diane"

Malawi has the highest preterm birth rate in the world and preterm birth contribute to more than one-third of the neonatal deaths annually. Malawi is also faced with limited resources, both human and material. The lack of incubators led to the adoption of Kangaroo Mother Care (KMC) as routine care for preterm infants. Families also provide support, physical and emotional during this entire period. Evidence from developed countries has shown that preterm birth contributes to maternal emotional distress (depressive, anxiety, and posttraumatic stress symptoms and maternal worry about child’s health) and fewer maternal and infant interactive behaviors. The majority of published research globally has also focused on early-preterm infants and little research has been done on late-preterm infants. Studies in Malawi have also largely focused on postpartum depression and no published literature could be located on mother-infant-interactions. The purpose of this study was to explore emotional distress and mother-infant interactions of mothers with early-preterm, late-preterm, and full-term infants in Malawi.

This mixed method study and three-part investigation was conducted at Queen Elizabeth Central Hospital. The first part of the investigation was translation and validation of the Perinatal PTSD Questionnaire and the Child Health Worry Scale as measures for posttraumatic stress symptoms and maternal worry about child’s health, respectively. I conducted a focus group discussion with Malawian nurse-midwives (N=8) to assess content of translations in relation to original. I also tested the instruments on mothers in the perinatal period (N=30; 10 mothers of early-preterm infants, 10 mothers of late-preterm infants, and 10 mothers of full-term infants). Validated instruments from first phase were used in the second phase of the study. The second phase of the investigation compared emotional distress and mother infant interactions among 85 mother-infant dyads (28 mothers with their early-preterm, 29 mothers with their late-preterm, and 28 mothers with their full-term infants). Baseline assessments were done following birth for the three groups and follow-up assessments were conducted for mothers of the preterm groups. I also recorded and coded videos of mothers and infants to assess mother-infant interactions. The third phase of the investigation was qualitative (N= 19; 7 mothers with early-preterm infants, 7 mothers with late-preterm infants, and 5 mothers of full-term infants) and explored maternal perceptions of sources of concerns and social support following birth of their infants. In-depth interviews were conducted at the end of the study.

Findings showed that mothers of early-preterm infants experienced higher levels of emotional distress than mothers of full-term infants, with mothers of late-preterm infants being intermediate between the two. Cesarean birth was also associated with more anxiety and depressive symptoms. Kangaroo Mother Care had minimal effects on the change of emotional distress in mothers of the preterm groups. However, KMC interruptions were associated with an increase in emotional distress. Minimal differences were seen in mother-infant interactions among the mothers and infants of the three groups. KMC had no impact on the interactive behaviors. Mothers’ concerns during infant hospitalization were personal and family factors; prenatal and perinatal experiences; infant illness, treatments, and appearance; concerns about the infant’s outcome; loss of parental role; health care workers and the healthcare system; infant care including breastfeeding concerns; and provision of KMC. Types of support received during the hospitalization included instrumental/tangible support, emotional support including spiritual support, and financial support. Mothers also preferred to have their own family as their caregivers during hospitalization.

Future studies need to focus on longitudinal methods to explore whether emotional distress experiences change over time and also to explore maternal and infant interactive behaviors as the babies mature. The Malawi healthcare system needs to provide support for mothers throughout the prenatal and perinatal period in order to lower maternal distress symptoms and promote positive mother-infant interactions.

Abstract

Background. Hypertensive disorders (chronic hypertension, preeclampsia/eclampsia, preeclampsia superimposed on chronic hypertension and gestational hypertension) are present in 6% to 8% of pregnancies in the United States. The number of women of childbearing age who will develop hypertension is increasing due to the obesity epidemic and the increasing maternal age at pregnancy. In the United States, 3 to 5% of pregnant women have chronic hypertension before pregnancy or are diagnosed in the first 20 weeks of pregnancy. Chronic hypertension contributes to pregnancy related hypertension and has negative effects on maternal and infant outcomes including preterm birth and small for gestational age infants. Prenatal care is one of the most important preventative public health measures used globally and in the United States because the goal is to detect potential complications during pregnancy and provide appropriate and timely interventions. However, not all pregnant women have access to early prenatal care and adequate prenatal care. The benefits of prenatal care for maternal and infant outcomes for women with hypertensive disorders during pregnancy have not been described. Therefore, the purpose of this dissertation was to examine the influence of chronic hypertension, pregnancy induced hypertension and prenatal care on pregnancy outcomes for women and their infants.

Methods. First, a secondary data analysis of the 2009-2011 Pregnancy Risks Assessment Monitoring System (PRAMS) dataset for North Carolina (Chapter 3) was conducted to understand the effects of chronic hypertension and prenatal care on maternal and infant outcomes in pregnant women. Second, to understand whether preterm infants born to women with hypertensive disorders of pregnancy differ from those of women without hypertensive disorders in terms of illness and development characteristics, a secondary data analysis of a study of maternally administered interventions for neonates was conducted in Chapter 4.

Results. In Chapter 3, the results indicated that women with chronic hypertension have higher risks for pregnancy induced hypertension, preterm birth, and small for gestational age infants. In addition, first trimester or adequate prenatal care did not improve pregnancy outcomes for women with chronic hypertension as it did for women without chronic hypertension. In Chapter 4, preterm infants of women with hypertensive disorders are more likely to be small for gestational age than preterm infants of women without hypertensive disorders.

Conclusion. Overall results showed that preterm infants of women with hypertensive disorders are small for gestational age when compared to preterm infants of women without hypertensive disorders. Also, prenatal care has no significant impact on improving pregnancy and birth outcomes of women with chronic hypertension.