Objectives Indigenous women continue to experience rates of stillbirth, preterm birth and low birth weight, two to three times higher than other women in high-income countries. The reasons for disparities are complex and multifactorial. We aimed to assess the extent to which adverse birth outcomes are associated with maternal cannabis use and exposure to stressful events and social health issues during pregnancy. Design/setting Cross-sectional, population-based survey of women giving birth to Aboriginal babies in South Australia, July 2011–June 2013. Data include: maternal cannabis use, exposure to stressful events/social health issues, infant birth weight and gestation. Participants 344 eligible women with a mean age of 25 years (range 15–43 years), enrolled in the study. Participants were representative in relation to maternal age, infant birth weight and gestation. Results 1 in 5 women (20.5%) used cannabis during pregnancy, and 52% smoked cigarettes. Compared with mothers not using cannabis or cigarettes, mothers using cannabis had babies on average 565 g lighter (95% CI −762 to −367), and were more likely to have infants with a low birth weight (OR=6.5, 95% CI 3.0 to 14.3), and small for gestational age (OR=3.8, 95% CI 1.9 to 7.6). Controlling for education and other social characteristics, including stressful events/social health issues did not alter the conclusion that mothers using cannabis experience a higher risk of negative birth outcomes (adjusted OR for odds of low birth weight 3.9, 95% CI 1.4 to 11.2). Conclusions The findings provide a compelling case for stronger efforts to address the clustering of risk for adverse outcomes in Aboriginal and Torres Strait Islander communities, and point to the need for antenatal care to address broader social determinants of adverse perinatal outcomes. Integrated responses—collaboratively developed with Aboriginal communities and organisations—that focus on constellations of risk factors, and a holistic approach to addressing social determinants of adverse birth outcomes, are required.
Intimate partner violence is commonly experienced by women and associated with poor mental health outcomes. Evidence regarding the patterns of IPV across time, and the associated long term course of depressive symptoms is lacking. The current study aimed to (a) identify patterns of physical and emotional IPV experienced by women over the 10 years since having their first child, and (b) identify trajectories depressive symptoms across the 10-year period for each pattern of IPV exposure. Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal study of 1507 mothers and their first born child. Data was collected during pregnancy and at one, four, and ten years postpartum. Using Latent Class Analysis, four distinct classes of IPV were identified: (1) Minimal IPV, (2) Early IPV exposure, (3) Increasing IPV, and (4) Persistent IPV. Latent growth modelling revealed that all classes characterised by some IPV exposure experienced elevated trajectories of depressive symptoms in comparison to the minimal IPV class. Those experiencing increasing and persistent IPV experienced the most severe course of depressive symptoms.
ABSTRACT: Objective: To identify profiles and predictors of maternal-reported infant sleep problems across the first postnatal year. Methods: Survey data examining maternal mental and physical health, intimate partner violence (IPV), and infant sleep problems and night waking were gathered from a cohort of 1,460 nulliparous women at 15 weeks' gestation and when their infants were 3, 6, 9, and 12 months old. Results: Latent class analysis revealed 5 profiles of infant sleep problems, including those who had few problems (24.7%), persistent moderate problems (27.3%), increased problems at 6 months (10.8%), increased problems at 9 months (17.8%), and persistent severe problems (19.4%). Persistent severe infant sleep problems were associated with prepartum and postpartum maternal depression (adjusted odds ratio [AOR] 2.13, 95% confidence interval [CI] 1.35–3.34, p < 0.01; AOR 2.52, 95% CI 1.64–3.87, p < 0.001, respectively), poorer prepartum and postpartum perception of health (adjusted mean difference [AMD] 23.48, 95% CI 24.9 to 22.1, p < 0.01; AMD 23.78, 95% CI 25.2 to 22.4, p < 0.001, respectively), increased postpartum anxiety (AOR 2.22, 95% CI 1.26–3.90, p < 0.01), and increased prevalence of IPV in the first year postpartum (AOR 1.86, 95% CI 1.20–2.87, p < 0.01). Conclusion: Poorer prepartum and postpartum maternal mental and physical health, and IPV, were associated with maternal report of persistent severe infant sleep problems. Women experiencing prenatal physical and mental health difficulties may benefit from advice on managing infant sleep and settling. Health professionals working with unsettled infants must be equipped to enquire about and respond appropriately to disclosures of IPV.
To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery and more common in women who had an operative vaginal birth compared with women who had a spontaneous vaginal birth for their first newborn, and whether postpartum fecal incontinence is more common in women who report intimate-partner violence.This was a multicenter, prospective, nulliparous pregnancy cohort (n=1,507) using standardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3, 6, 9, and 12 months postpartum.Approximately 17% reported fecal incontinence at some point in the first 12 months postpartum, with 12.8% reporting fecal incontinence beyond the first 3 months postpartum. Fecal incontinence at 4 to 12 months postpartum was significantly more common among women who had experienced emotional violence, physical violence, or both in the first 12 months postpartum (18.8% compared with 11.5%, adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.05-2.50). Compared with spontaneous vaginal birth, cesarean delivery (13.1% compared with 11.3%, adjusted OR 0.99, 95% CI 0.65-1.53), and operative vaginal birth (15.0% compared with 11.3%, adjusted OR 1.33, 95% CI 0.86-2.07) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum.Understanding causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence. This has implications for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery. In this nulliparous cohort, method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum.II.
Around 6 % of births in Australia are to Aboriginal and Torres Strait Islander families. Aboriginal and Torres Strait Islander women are 2–3 times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia. Population-based study of mothers of Aboriginal babies born in South Australia, July 2011 to June 2013. Mothers completed a structured questionnaire at a mean of 7 months postpartum. The questionnaire included measures of stressful events and social health issues during pregnancy and maternal psychological distress assessed using the Kessler-5 scale. Three hundred forty-four women took part in the study, with a mean age of 25 years (range 15–43). Over half (56.1 %) experienced three or more social health issues during pregnancy; one in four (27 %) experienced 5–12 issues. The six most commonly reported issues were: being upset by family arguments (55 %), housing problems (43 %), family member/friend passing away (41 %), being scared by others people's behavior (31 %), being pestered for money (31 %) and having to leave home because of family arguments (27 %). More than a third of women reporting three or more social health issues in pregnancy experienced high/very high postpartum psychological distress (35.6 % versus 11.1 % of women reporting no issues in pregnancy, Adjusted Odds Ratio = 5.4, 95 % confidence interval 1.9–14.9). The findings highlight unacceptably high rates of social health issues affecting Aboriginal women and families during pregnancy and high levels of associated postpartum psychological distress. In order to improve Aboriginal maternal and child health outcomes, there is an urgent need to combine high quality clinical care with a public health approach that gives priority to addressing modifiable social risk factors for poor health outcomes.
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