RESUMEN
INTRODUCTION: Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population. MATERIAL AND METHODS: Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW. RESULTS: For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively. CONCLUSIONS: Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.
Asunto(s)
Personal Militar , Nacimiento Prematuro , Ansiedad/complicaciones , Ansiedad/epidemiología , Peso al Nacer , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Factores de RiesgoRESUMEN
OBJECTIVE: To determine the efficacy of the Mentors Offering Maternal Support (MOMS) program to reduce pregnancy-specific anxiety and depression and build self-esteem and resilience in military women. DESIGN: Randomized controlled trial with repeated measures. SETTING: Large military community in Texas. PARTICIPANTS: Pregnant women (N = 246) in a military sample defined as active duty or spouse of military personnel. METHODS: Participants were randomized in the first trimester to the MOMS program or normal prenatal care. Participants attended eight 1-hour sessions every other week during the first, second, and third trimesters of pregnancy. Pregnancy-specific anxiety, depression, self-esteem, and resilience were measured in each trimester. Linear mixed models were used to compare the two-group difference in slope for prenatal anxiety, depression, self-esteem, and resilience. RESULTS: The Prenatal Self-Evaluation Questionnaire was used to measure perinatal anxiety. Rates of prenatal anxiety on the Identification With a Motherhood Role (p = .049) scale and the Preparation for Labor (p = .017) scale were significantly reduced for participants in MOMS. Nulliparous participants showed significantly lower anxiety on the Acceptance of Pregnancy scale and significantly greater anxiety on the Preparation for Labor scale. Single participants had significantly greater anxiety on the Well-Being of Self and Baby in Labor scale, and participants with deployed husbands had significantly greater anxiety on the Identification With a Motherhood Role scale. CONCLUSION: Participation in the MOMS program reduced pregnancy-specific prenatal anxiety for the dimensions of Identification With a Motherhood Role and Preparation for Labor. Both dimensions of anxiety were previously found to be significantly associated with preterm birth and low birth weight. Military leaders have recognized the urgent need to support military families.
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Ansiedad , Depresión , Complicaciones del Embarazo , Adulto , Ansiedad/diagnóstico , Ansiedad/prevención & control , Depresión/diagnóstico , Depresión/prevención & control , Autoevaluación Diagnóstica , Eficiencia Organizacional , Femenino , Humanos , Personal Militar/psicología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/prevención & control , Complicaciones del Embarazo/psicología , Trimestres del Embarazo/psicología , Mujeres Embarazadas/psicología , Servicios Preventivos de Salud/métodos , Resiliencia Psicológica , Autoimagen , Apoyo Social , Encuestas y Cuestionarios , TexasRESUMEN
OBJECTIVE: To examine ways that women's experience of hospitalization with bed rest to prevent preterm birth impacts prenatal maternal development. METHOD: Interviews based on the Interview Schedules for Dimensions of Maternal Development in Psychosocial Adaptation to Pregnancy were conducted at a hospital in the southwestern United States with a convenience sample of 41 women during confinement to bed rest to prevent preterm birth. The interviews were recorded, and verbatim transcripts were submitted to thematic analysis. RESULTS: Five themes were mapped from the women's narratives: (1) acceptance of pregnancy, but with fears specific to elevated risks to self and baby; (2) heightened identification with motherhood and fatherhood protector roles; (3) renewal or deepening of mother-daughter closeness intensified by high-risk pregnancy; (4) enhanced couple support and collaboration; and (5) acceptance of responsibility to perform in remaining pregnant and preparing for labor, but willingness to accept help from doctors and nurses. CONCLUSIONS: This study of hospitalization to prevent preterm birth showed that women experience hospitalization as a burden to be endured to meet future goals, but that it also can facilitate prenatal maternal development in psychosocial adaptation to high risk pregnancy. Implications for research and practice are discussed.
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Actitud Frente a la Salud , Reposo en Cama/psicología , Emociones , Hospitalización , Madres/psicología , Embarazo de Alto Riesgo , Nacimiento Prematuro/prevención & control , Adolescente , Adulto , Familia/psicología , Femenino , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Embarazo , Nacimiento Prematuro/psicología , Riesgo , Sudoeste de Estados Unidos , Adulto JovenRESUMEN
Reviews panels on the prevention of preterm birth (PTB) conducted by the Office of the Surgeon General and the Eunice Kennedy Shriver National Institute of Child Health and Human Development made numerous novel recommendations for research on the assessment of risk factors for PTB and the development of personalized, specific interventions for the prevention of PTB. This paper discusses the particularly significant roles for nurses in assessment and intervention based on their education in pregnancy and in multiple health-related disciplines. General differences and specific anxiety assessment are presented based on the goals of research. An emphasis is placed on assessment of pregnancy-specific anxiety, and assessment and intervention methods that include the father/partner and couple using family system methodologies. The risks occurring with differences in partner intentions for pregnancy are discussed, and especially the benefits of male partner involvement and support. It is noted that interventions may need to be varied based on differences in gender, ethnic, cultural, and socioeconomic status. Differences in individual or group intervention psychotherapy approaches are considered. The special risks and needs of pregnant military couples, especially those with deployed partners are presented. Variations in anxiety are discussed in terms of implications for maternal/paternal fetal and child attachment from birth to adulthood. Discussion includes the considerable and varied parenting and financial strains that continue long after birth, with significant impact for parent-child mental and physical health, and the need for development of long-term interventions that include parental coping strategies and parental empowerment.
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Evaluación en Enfermería/métodos , Trabajo de Parto Prematuro/enfermería , Trabajo de Parto Prematuro/psicología , Adaptación Psicológica , Ansiedad/enfermería , Ansiedad/psicología , Educación/métodos , Terapia Familiar/métodos , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Terapia Conyugal/métodos , Personal Militar/psicología , Apego a Objetos , Trabajo de Parto Prematuro/prevención & control , Responsabilidad Parental/psicología , Poder Psicológico , Embarazo , Atención Prenatal/psicología , Factores de Riesgo , Factores Socioeconómicos , Teoría de SistemasRESUMEN
The first author recruited parent-adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they roleplayed, practiced resistance skills, and held parent-child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' self-control by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex.
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Conducta del Adolescente , Educación en Salud/métodos , Padres/educación , Embarazo en Adolescencia/prevención & control , Educación Sexual/métodos , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Lineales , Masculino , Relaciones Padres-Hijo , Padres/psicología , Embarazo , Embarazo en Adolescencia/psicología , Evaluación de Programas y Proyectos de Salud , Gestión de Riesgos/métodos , Enfermedades de Transmisión Sexual/psicología , Controles Informales de la Sociedad/métodos , TexasRESUMEN
The effect of military deployment and perceived availability and source of community support on women's acceptance of pregnancy were examined in each trimester of pregnancy at four military bases. The sample was 503 primigravida or multigravida women eligible for care in the military medical system. Military deployment and community support had a statistically significant effect on pregnancy acceptance. Gravidas with deployed husbands had higher conflict for accepting pregnancy than gravidas without deployed spouses. Community support had a significant positive effect on pregnancy acceptance. Women perceiving support predominantly from off-base versus on-base communities had significantly higher conflict with acceptance of pregnancy. Findings point to improved maternal acceptance of pregnancy with paternal presence and community support in the event of military deployment.
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Ansiedad de Separación/psicología , Actitud Frente a la Salud , Personal Militar/psicología , Complicaciones del Embarazo/psicología , Mujeres Embarazadas/psicología , Esposos/psicología , Adulto , Análisis de Varianza , Ansiedad de Separación/etiología , Ansiedad de Separación/prevención & control , Redes Comunitarias , Conflicto Psicológico , Femenino , Identidad de Género , Humanos , Modelos Lineales , Estudios Longitudinales , Conducta Materna/psicología , Investigación Metodológica en Enfermería , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/prevención & control , Trimestres del Embarazo/psicología , Autoimagen , Apoyo Social , Encuestas y Cuestionarios , TexasRESUMEN
In this study, the authors compared differences in sexual risk attitudes and intentions for three groups of youth (experimental program, n = 90; attention control, n = 80; and nonparticipant control, n = 634) aged 12-14 years. Two student groups participated with their parents in programs focused on strengthening family interaction and prevention of sexual risks, HIV, and adolescent pregnancy. Surveys assessed students' attitudes and intentions regarding early sexual and other health-risk behaviors, family interactions, and perceived parental disapproval of risk behaviors. The authors used general linear modeling to compare results. The experimental prevention program differentiated the total scores of the 3 groups (p < .05). A similar result was obtained for student intentions to avoid sex (p < .01). Pairwise comparisons showed the experimental program group scored higher than the nonparticipant group on total scores (p < .01) and on students' intention to avoid sex (p < .01). The results suggest this novel educational program involving both parents and students offers a promising approach to HIV and teen pregnancy prevention.
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Actitud , Intención , Relaciones Padres-Hijo , Embarazo en Adolescencia , Conducta Sexual/psicología , Encuestas y Cuestionarios , Adolescente , Niño , Femenino , Humanos , Masculino , Embarazo , Abstinencia Sexual , Enfermedades de Transmisión Sexual/prevención & controlRESUMEN
The Parent-Adolescent Relationship Education (PARE) Program, designed for parents and middle school students, focuses on strengthening family communication about sexual issues and behaviors to help prevent teen pregnancy, human immunodeficiency virus (HIV), and other sexually transmitted diseases (STDs). The program includes content about reproduction, STDs and Acquired Immune Deficiency Syndrome (AIDS), contraception, sex risks, and safe-sex behaviors. The course uses social learning and cognitive behavioral concepts to enhance decision-making, refusal, and resistance skills. A randomized treatment or control group design is used to assign parent-child dyads to an experimental education group (social learning) or an attention-control group (traditional didactic teaching). Three post-program maintenance or booster sessions are held at 6-month intervals and at times prior to peak teen conception periods to reinforce the knowledge and skills learned. Pre- and posttests for parents and students assess group differences in parental involvement and communication, contraception, sex attitudes and intentions, sex behaviors (initiation of sexual intercourse, frequency, number of partners, contraceptive practices, refusal skills), and the incidence of pregnancy.