Exploring the Need for Additional Nutritional Support in Adolescent Pregnancies

There is significant evidence to suggest that pregnancy outcomes among adolescent pregnant women may be less favourable compared to those of adult women. Incidence of preterm delivery, low birthweight and babies who are small for their gestational age have been identified as outcomes of particular concern for this population. One school of thought regarding this issue suggests that nutrition in adolescent pregnancies may have a role to play in reducing these differences and improving outcomes for adolescent mothers and their babies, however this area is in need of further research. The primary aim of this thesis therefore is to address the research question "Is there a need for additional nutritional support in adolescent pregnancies?" This is a mixed methods study following a sequential explanatory design in which priority is given to the quantitative research phase. Following a systematic review of the academic literature, the program of research is carried out in two distinct phases and the findings from each integrated. The quantitative research phase utilises secondary data from the Born in Bradford cohort study to investigate differences in maternal and neonatal outcomes and dietary patterns between adolescents (age ≤19 years) and an adult control group (age 20-34 years). Differences in outcomes were assessed using logistic regression models and differences in dietary pattern assessed using a combination of principle component analysis and regression models. The qualitative research phase was informed by the results of the quantitative phase and sought the perspectives of youth support professionals on supporting healthy eating in adolescent pregnancies through semi-structured interviews. Interviews were transcribed and analysed thematically. Findings from the program of research as a whole were then integrated narratively. The results of the systematic literature review confirmed that the nutritional status of pregnant adolescents is likely to be poor. The quantitative analyses identified significant differences in outcomes between adolescent and adult women, particularly a higher odds of delivering babies who were very (<32 weeks gestation) or extremely (<28 weeks gestation) pre-term (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively), or at an extremely low birthweight (<1000g, aOR 4.13, 95% CI 1.41 to 12.11). 5 Results from the quantitative phase were used to inform the development of the qualitative interview guide following which the integration of findings from the program of research as a whole identified three overarching themes; social context, dietary pattern and need for support. Adolescent pregnant women were found to live in areas with higher levels of socio-economic deprivation, were more likely to be single parents and have unstable family backgrounds and housing insecurity. Adolescents were also found to consume higher levels of snack and processed foods, less fruit and vegetables, were likely to eat less regularly than older women and took fewer nutritional supplements. The need for additional social support, both in terms of the provision of services and facilitating young women to access existing services was also a key theme from the qualitative data. The overarching themes identified in this program of work suggest that there are differences in diet quality between pregnant adolescents and adult pregnant women and that this may impact upon the health of the pregnancy. This research highlights that while additional support for eating healthily during pregnancy is important for this population, a more holistic approach which encompasses the range of complex issues faced by adolescent pregnant women is likely to have a greater impact on overall pregnancy health. This work makes an original contribution to knowledge by investigating an important large British cohort with unique characteristics to answer questions which have not previously been investigated in this data set. It has identified issues for pregnant adolescents which have not previously been documented and included the perspectives of a key professional group whose views have not previously been included in this debate

Perspectives of youth-support professionals on encouraging healthy eating in adolescent pregnancies

Background. Nutrition during pregnancy has been identified as an important modifiable factor to reduce adverse outcomes in adolescent pregnancies. Young women are supported during their pregnancies by a variety of professionals with both clinical and non-clinical roles. Professionals with a non-clinical support role provide practical and emotional support for young women and often have longer lasting professional relationships with their clients. For this reason, this study aims to explore the perspectives of these professionals on how young women can be encouraged to improve their diet during pregnancy. Ethics. Ethical approval for this study was granted by Sheffield Hallam University Ethics Committee in July 2016. Methods. This exploratory, qualitative study recruited eight youth-support professionals to take part in semi-structured interviews. Recruitment and interviews were conducted by the lead author during February 2017, with project supervision and triangulation of data completed by the other two authors. Interviews were audio-recorded and transcribed. Interview transcripts were loaded into NVivo 11 software to facilitate analysis and emerging themes identified. Results. Five overarching themes were identified from the data: perceptions of dietary pattern; connection with baby; family and social stability; building relationships; and service availability. Youth-support professionals felt that young women encountered numerous complex barriers to eating healthily during pregnancy. Their lives are frequently chaotic and lack a stable partner and family relationships. They suggested that young women often needed specific practical support to make improvements, such as being accompanied to health appointments. There was also some concern that further cuts to services for this group would make it more difficult for vulnerable young women to access help. Conclusions. A higher level of consistent, holistic support delivered by joined-up networks of professionals is needed to help young women achieve healthier pregnancies. Further research is necessary to understand the context of young women’s lives, how this relates to their experiences of pregnancy, and what type of interventions or resources would have the biggest impact in supporting healthy behaviours

Inter-Generational Differences in Perinatal Health Behaviours: A Secondary Analysis of the Born in Bradford Cohort, Disentangling Ethnicity and Migration

Objectives There exists a body of research regarding ethnic differences in perinatal health whereas this is not the case concerning the role of migration status and acculturation in attenuating these differences. This study aims to investigate determinants of health during pregnancy up to one-year postpartum by migration status. Methods The study utilises data collected by the Born in Bradford cohort. The focus of analysis was migration status groupings, based on self-reported country of birth of participants and their parents and grandparents. Chi-Square, one-way ANOVA and correlation coefficients examined relationships between variables. Results Migrant women were less likely to smoke (native: 34.4%, 1st generation: 2.8%, 2nd generation: 8.6%) or to be obese (native: 25.5%, 1st generation: 17.4%, 2nd generation: 21.3%) compared to native women. Migrants were less physically active at 6 months (Mean (SD) minutes/week: native 265 (245), 1st generation 113 (162), 2nd generation 147 (182)) with larger increases in BMI over time compared to native women. Migrant women were more likely to be suffering psychological distress at baseline and 6 months postpartum and migrant families were more likely to live in areas of high socio-economic deprivation, despite higher levels of educational attainment. Conclusions for Practice This study ethnicity and migration identifies some important differences between ethnic groups with different migration histories, therefore indicating that healthcare professionals should consider eliciting full migration histories to improve care. The impact of these differences on perinatal outcomes is a priority for future research

Differences in dietary pattern by maternal age in the Born in Bradford cohort : A comparative analysis

Objective Explore associations between dietary patterns and maternal age Design Population based cohort study Setting Maternity department of a large hospital in northern England Sample Women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 (N = 5,083). Methods Survey data including maternal dietary patterns derived from food frequency questionnaire data using principal component analysis (PCA) were compared by maternal age using one-way ANOVA and chi-squared as appropriate. Main outcome measures Dietary pattern PCA scores, supplement use, familiarity and compliance with 5-a-day fruit and vegetable recommendations, consumption of cola, maternal BMI. Results Three distinct dietary patterns were derived from the data; snack and processed foods, meat and fish and grains and starches. Mean PCA score for snack and processed foods was higher among women aged ≤19 (0.6, CI 0.4 to 0.8) than women aged 20–34 (-0.02, CI -0.1 to 0.01) and those aged 35≥ (-0.3, CI -0.4 to -0.2). Women aged 35≥ had a significantly higher mean PCA score for the grains and starches dietary pattern (0.1, CI 0.03 to 0.3) compared to both the 20–34 years (-0.01, CI -0.05 to 0.02) and the ≤19 (-0.04, CI -0.2 to 0.1) groups. No differences were observed between groups in mean PCA scores for the meat and fish dietary pattern. Adolescent women also had higher intakes of sugar sweetened cola (0.9 cups per day, CI 0.7 to 1.1) and reported lower levels of fruit and vegetable and supplement intake. Women aged 35≥ had a higher mean BMI (28.0, CI 27.5 to 28.4) and higher prevalence of overweight (36.8%) and obesity (29.6%, p<0.001). Conclusions Significant differences were observed between age groups both in terms of diet quality and BMI. Interventions targeted by age group may be advantageous in improving maternal nutrition and contribute to healthy pregnancies

Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort

Explore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women. Population-based cohort study. Maternity department of a large hospital in Northern England. Primiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20-34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20-34 years were used as the reference group. Maternal and neonatal outcomes. The odds of extremely low birth weight (<1000 g) were significantly higher in the adolescent group (≤19 years) compared with the reference group (adjusted OR (aOR) 4.13, 95% CI 1.41 to 12.11). The odds of very (<32 weeks) and extremely (<28 weeks) preterm delivery were also higher in the adolescent group (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively).Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67). This study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Healthy Weight Services in England before, during and after pregnancy: a mixed methods approach

Abstract: Background: Maternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle. Methods: A mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data. Results: A total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas. Several themes were identified from qualitative data including “equity and variation in service provision”, “need for rigorous evaluation”, “facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, “barriers” encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and “the need for additional support”. Conclusions: There is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use

Cesarean birth rates among migrants in Europe: A systematic review

Background Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. Methods A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta-analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. Results From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from “Sub Saharan Africa” and the “South East Asia, Asia and Pacific” region than rates in the receiving country. Statistical significance was not found between other populations. Conclusions This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care

“Everything is revolved around me being heavy … it’s always, always spoken about.” Qualitative experiences of weight management during pregnancy in women with a BMI of 40kg/m 2 or above

Introduction: Maternal weight management services have been recognised as a good opportunity to influence lifestyle and dietary behaviour of mothers and families. Exploring women’s views of maternal weight management services is paramount to understand what constitutes the most suitable service. This study therefore explored experiences among women with a raised body mass index (BMI) of maternal weight management service provision and the barriers and facilitators to weight management during pregnancy. Method: Thirteen women with a BMI≥40kg/m² undertook semi-structured interviews around weight management experiences during pregnancy. Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was undertaken. Results: Four themes emerged. 1). "Understanding where I am at" showed current readiness and motivation of women varied, from being avoidant to being motivated to make changes. 2). "Getting information" revealed inconsistent information provision during pregnancy. Women particularly wanted practical advice. Some attempted to find this for themselves from friends or the internet, however this left some women feeling confused when different sources provided inconsistent advice. 3). "Difficulties I face" identified physical, emotional and financial barriers and the strategies some women used to overcome these. 4). "Encountering professionals–a mixed experience" demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals tread was demonstrated by women thinking that they had received inadequate information and yet too much focus was placed on their weight and the associated risks during pregnancy without practical solutions to their weight management challenges. Discussion: Women were empowered when practical advice was provided, not just the continual repetition of the risks of being obese during pregnancy. Antenatal weight management services need to be clear, sensitive and respectful. Services centred on individual women’s needs and on their current and previous experiences are required. The psychological and social contexts of weight management also need to be addressed

Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries

Background: Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. Methods: A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11-19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. Results: The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0-83.1) to be significantly below recommendations (p=0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39-84). Conclusions: This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe