The effects of maternal prepregnancy body mass index and psychological factors on infant feeding behaviors

The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months with continued breastfeeding until at least 1 year of age. Three-quarters of women in the U.S. initiate breastfeeding but rates decline considerably by 6 and 12 months postpartum; furthermore, many women introduce complementary foods before the recommended age. Low breastfeeding rates and early introduction of foods may be explained, in part, by the rise in obesity among women of childbearing age. There is some evidence that women who enter pregnancy overweight and obese are more likely to not breastfeed, to breastfeed for a shorter duration and to introduce complementary foods earlier than women of normal body mass index (BMI). It is unclear why this association exists but possible reasons include obesity-related biological changes, psychological changes and mechanical difficulties. The purpose of this research was to determine the association between pregravid BMI and infant feeding behaviors and explore whether the relationship was mediated by psychological factors present during pregnancy (depressive symptoms, stress, anxiety, and self-esteem). Data came from the postpartum component of the Pregnancy, Infection, and Nutrition study. Pregnant women, recruited from the University of North Carolina hospitals between January 2001 and June 2005, were followed from pregnancy to postpartum. Using multivariable regression analysis, we found that women who entered pregnancy overweight or obese were less likely to adhere to current infant feeding recommendations. Specifically, overweight or obese women were less likely to initiate breastfeeding; more likely to breastfeed for shorter duration (any or exclusive); and more likely to introduce complementary foods before 4 months of age compared to women of normal BMI. We did not find evidence to support the hypothesis that the association between pregravid BMI and infant feeding was mediated by psychological factors. Our results showed a strong association between maternal pregravid BMI and infant feeding behaviors but, contrary to our expectations, we did not find evidence for a mediatory psychological pathway. This suggests that other factors may be more important in explaining the pregravid BMI-infant feeding relationship. Future studies need to explore why overweight and obese women are less likely to adhere to infant feeding guidelines

Effect of Body Image on Pregnancy Weight Gain

The majority of women gain more weight during pregnancy than what is recommended. Since gestational weight gain is related to short and long-term maternal health outcomes, it is important to identify women at greater risk of not adhering to guidelines. The objective of this study was to examine the relationship between body image and gestational weight gain. The Body Image Assessment for Obesity tool was used to measure ideal and current body sizes in 1,192 women participating in the Pregnancy, Infection and Nutrition Study. Descriptive and multivariable techniques were used to assess the effects of ideal body size and discrepancy score (current—ideal body sizes), which reflected the level of body dissatisfaction, on gestational weight gain. Women who preferred to be thinner had increased risk of excessive gain if they started the pregnancy at a BMI ≤26 kg/m2 but a decreased risk if they were overweight or obese. Comparing those who preferred thin body silhouettes to those who preferred average size silhouettes, low income women had increased risk of inadequate weight gain [RR = 1.76 (1.08, 2.88)] while those with lower education were at risk of excessive gain [RR = 1.11 (1.00, 1.22)]. Our results revealed that body image was associated with gestational weight gain but the relationship is complex. Identifying factors that affect whether certain women are at greater risk of gaining outside of guidelines may improve our ability to decrease pregnancy-related health problems

Eliciting harms data from trial participants: how perceptions of illness and treatment mediate recognition of relevant information to report

Background: There is no consensus on the ideal methodology for eliciting participant-reported harms, but question methods influence the extent and nature of data detected. This gives potential for measurement error and undermines meta-analyses of adverse effects. We undertook to identify barriers to accurate and complete reporting of harms data, by qualitatively exploring participants’ experiences of illness and treatment, and reporting behaviours; and compared the number and nature of data detected by three enquiry methods. Methods: Participants within antiretroviral/antimalarial interaction trials in South Africa and Tanzania were asked about medical history, treatments and/or adverse events by general enquiries followed by checklists. Those reporting differently between these two question methods were invited to an in-depth interview and focus group discussion. Health narratives were analysed to investigate accuracy and completeness of case record form data and to understand reasons for differential reporting between question methods. Outcomes were the number and nature of data by question method, themes from qualitative analyses and a theoretical interpretation of participants’ experiences. Results: We observed a cumulative increase in sensitivity of detection of all types of reports while progressing from general enquiry, through checklist, to in-depth interview. Questioning detail and terminology influenced participants’ recognition of health issues and treatments. Reporting patterns and vocabulary suggest influence from the relative importance that illnesses and treatments have for participants. Perceptions were often dichotomised (e.g. ‘street’ versus clinic treatments, symptoms experienced versus tests and examinations performed, chronic versus acute illness, persistent versus intermittent symptoms, activity- versus malaria-related symptoms) and this differentiation extended to ideas of relevance to report. South African participants displayed a ‘trial citizenship’, taking responsibility for the impact of their reporting on trial results, and even reaching reporting decisions by consensus. In contrast, Tanzanians perceived their role more as patients than participants; the locus of responsibility for knowing information relevant to the trial fell with trial staff as doctors rather than with themselves. Conclusions: Our observations of how reporting relates to participant perceptions inside and outside trials could help optimise how harms data are elicited. Questions reflecting the different ways that biomedically defined illness and treatment data are perceived by participants may help them understand relevance for reporting. We will theorise how these two disparate trial environments may have influenced how participants understood their role, as this could help researchers achieve empowered participation in similar trials

Protocol for a drugs exposure pregnancy registry for implementation in resource-limited settings

BACKGROUND: The absence of robust evidence of safety of medicines in pregnancy, particularly those for major diseases provided by public health programmes in developing countries, has resulted in cautious recommendations on their use. We describe a protocol for a Pregnancy Registry adapted to resource-limited settings aimed at providing evidence on the safety of medicines in pregnancy.METHODS/DESIGN:Sentinel health facilities are chosen where women come for prenatal care and are likely to come for delivery. Staff capacity is improved to provide better care during the pregnancy, to identify visible birth defects at delivery and refer infants with major anomalies for surgical or clinical evaluation and treatment. Consenting women are enrolled at their first antenatal visit and careful medical, obstetric and drug-exposure histories taken; medical record linkage is encouraged. Enrolled women are followed up prospectively and their histories are updated at each subsequent visit. The enrolled woman is encouraged to deliver at the facility, where she and her baby can be assessed.DISCUSSION:In addition to data pooling into a common WHO database, the WHO Pregnancy Registry has three important features: First is the inclusion of pregnant women coming for antenatal care, enabling comparison of birth outcomes of women who have been exposed to a medicine with those who have not. Second is its applicability to resource-poor settings regardless of drug or disease. Third is improvement of reproductive health care during pregnancies and at delivery. Facility delivery enables better health outcomes, timely evaluation and management of the newborn, and the collection of reliable clinical data. The Registry aims to improve maternal and neonatal care and also provide much needed information on the safety of medicines in pregnancy

Pregravid body mass index, psychological factors during pregnancy, and breastfeeding duration: is there a link?

Breastfeeding rates in the U.S. are low and one possible reason may be the high prevalence of overweight/obesity among women of childbearing age. This analysis examined the association between pregravid body mass index (BMI) and breastfeeding duration and explored whether depressive symptoms, perceived stress and anxiety during pregnancy mediated this relationship. Participants (n = 550) in the Pregnancy, Infection, and Nutrition Postpartum Study were recruited through prenatal clinics prior to 20 weeks gestation and followed to 12 months postpartum. Duration of any breastfeeding was categorized as: none, less than 4 months, 4 to 6 months, 7 to 12 months, and more than 12 months (referent). Exclusive breastfeeding was categorized as less than 1 month, 1 to less than 4 months, and 4 months or more (referent). Being overweight/obese before pregnancy (35.7% of 550) was inversely associated with the durations of any and exclusive breastfeeding. Women who entered pregnancy overweight or obese were more likely to not initiate breastfeeding [RRR =5.39 (95% CI: 2.41, 12.04)] and to breastfeed less than four months [RRR = 2.38 (1.33, 4.27)] compared to women of normal weight status. Among women who initiated breastfeeding, being overweight or obese versus normal weight was related to exclusively breastfeeding less than 1 month [RRR = 2.09 (1.24, 3.51)]. We did not find evidence to support mediation by depressive symptoms, perceived stress or anxiety during pregnancy. Future research needs to explore the reasons behind the association between overweight/obesity and breastfeeding duration

Maternal Obesity, Psychological Factors, and Breastfeeding Initiation

Maternal obesity has been associated with lower initiation of breastfeeding, but reasons for why this association exists have not been well studied. In this study, we examined associations among prepregnancy obesity, psychological factors during pregnancy, and breastfeeding initiation

Strengthening pharmacovigilance in South Africa

This report outlines findings and recommendations of a national pharmacovigilance workshop held in August 2012 in South Africa (SA). A survey of current pharmacovigilance activities, conducted in preparation for the meeting, identified multiple programmes collecting drug safety data in SA, with limited co-ordination at national level. The meeting resolved that existing pharmacovigilance programmes need to be strengthened and consolidated to ensure that important local safety issues are addressed, data can be pooled and compared and outputs shared more widely. Pharmacovigilance activities should inform treatment guidelines with the goal of improving patient care. A variety of pharmaco-epidemiological approaches should be employed, including nesting drug safety studies within existing sentinel cohorts and the creation of a pregnancy exposure registry. The attendees agreed on key principles that will inform a national pharmacovigilance plan and compiled a list of priority pharmacovigilance issues facing public health programmes in SA.

Pregravid Body Mass Index Is Associated with Early Introduction of Complementary Foods

To determine whether women who entered pregnancy overweight or obese were less likely to follow American Academy of Pediatrics (AAP) guidelines for introducing complementary foods to infants after four months of age. In addition, to explore whether psychological factors accounted for any of the effect of pregravid body mass index (BMI) on age of complementary food introduction

Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study

Background: The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. Methods: Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. Results: Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. Conclusions: Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics

Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence

South Africa has the world's largest antiretroviral treatment programme, which may contribute to the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according to HIV status, to determine the contribution of drugs used in management of HIV and its complications to ADR-related EU presentations, and identify factors associated with ADR-related EU presentation. Methods: We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and preventability