Racial/Ethnic Differences in Self-Reported and Biologic Measures of Chronic Stress in Pregnancy Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. A multicenter study of diet quality on birth weight and gestational age in infants of HIV-infected women. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. Prevalence of prenatal zinc deficiency and its association with socio-demographic, dietary and health care related factors in Rural Sidama, Southern Ethiopia: A cross-sectional study Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. The relationship between food security and quality of life among pregnant women The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study Could prenatal food insecurity influence neonatal abstinence syndrome severity? Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors
Objective : Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes . The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black ( NHB ) and non-Hispanic white ( NHW ) pregnant women . Study Design : NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospect i ve cohort study . Equal numbers of women were recruited with public vs private insurance in each racial group .  Self-reported stress  was measured and blood sample s collected in the second and third trimesters were analyzed for serum Epstein – Barr virus antibody , C-reactive protein ( CRP ) , corticotropin-releasing hormone ( CRH ) and adenocorticotropic hormone ( ACTH ) . Results : One hundred and twelve women were enrolled . NHW women reported more buffers against stress ( P=0.04 ) and neighborhood satisfaction ( P=0.02 ) . NHB women reported more discrimination ( P<0.001 ) , food insecurity ( P=0.04 ) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters . Conclusion : Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics . Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes RATIONALE Food insecurity has emerged as an important , and potentially modifiable , risk factor for  depression . Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa . OBJECTIVE To estimate the association between food insufficiency and depression symptom severity , and to determine the extent to which any observed associations were modified by social support . METHODS AND RESULTS We conducted a secondary analysis of population -based , longitudinal data collected from 1238 pregnant women during a three-year cluster-r and omized trial of a home visiting intervention in Cape Town , South Africa . Surveys were conducted at baseline , 6 months , 18 months , and 36 months ( 85 % retention ) . A vali date d , single-item food insufficiency measure inquired about the number of days of hunger in the past week . Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale . In multivariable regression models with cluster-correlated robust estimates of variance , lagged food insufficiency had a strong and statistically significant association with depression symptom severity ( β = 0.70 ; 95 % CI , 0.46 - 0.94 ) , suggesting a 6.5 % relative difference in depression symptom severity per day of hunger . In stratified analyses , food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support . Using quantile regression , we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity . Estimates from fixed-effects regression models and fixed-effects quantile regression models , accounting for unobserved confounding by time-invariant characteristics , were similar . CONCLUSIONS Food insufficiency was associated with depression symptom severity , particularly for women in the upper end of the conditional depression distribution . Instrumental social support buffered women against the adverse impacts of food insufficiency We determined factors associated with diet quality and assessed the relationship between diet quality , birth weight , and gestational age in a prospect i ve national multicenter cohort study . We evaluated diet quality with the Healthy Eating Index ( HEI , scale 0 - 100 ) in the third trimester of pregnancy with three 24-hr multiple-pass dietary recalls in 266 HIV+ women enrolled in the Pediatric HIV/AIDS Cohort Study . Covariates included demographics , food security , pre-pregnancy body mass index , HIV disease severity , substance use , and antiretroviral exposures . A two-stage multivariate process using classification and regression trees ( CART ) followed by multiple regression described HEI tendencies , controlled possible confounding effects , and examined the association of HEI with birth weight and gestational age . To assess the stability of the CART solution , both the HEI 2005 and 2010 were evaluated . The mean HEI scores were 56.1 and 47.5 for the 2005 and 2010 HEI , respectively . The first-stage CART analysis examined the relationship between HEI and covariates . Non-US born versus US-born mothers had higher HEI scores ( 15-point difference , R2 = 0.28 ) . There was a secondary partition due to alcohol/cigarette/illicit drug usage ( 3.5-point difference , R2 = 0.03 ) among US-born women . For the second-stage CART adjusted multiple regression , birth weight z-score was positively related to HEI 2005 and 2010 ( partial r 's > 0.13 , P 's ≤ 0.0398 ) , but not gestational age ( r = 0.00 ) . We conclude that diet quality among HIV+ women is associated with higher birth weight . Despite the influence of a large cultural effect and poor prenatal behaviors , interventions to improve diet  in HIV+ women may help to increase birth weight Household food insecurity has been associated with several negative health outcomes , yet little is known about the prevalence and correlates of household food insecurity during pregnancy . This study was conducted as part of the Pregnancy , Infection , and Nutrition prospect i ve cohort study to identify risk factors of preterm birth . The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes < or= 400 % of poverty . Descriptive statistics and logistic regression were used to identify socioeconomic , demographic , and psychosocial predictors of household food insecurity . Among 606 pregnant women , 75 % were from fully food-secure , 15 % from marginally food-secure , and 10 % from food-insecure households . Women from marginally food-secure and food-insecure households had significantly less income , less education , and were older than women from fully food-secure households . In bivariate analysis , all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity . Socioeconomic and demographic predictors for household food insecurity were income , black race , and age . After controlling for socioeconomic and demographic variables , psychosocial indicators of perceived stress , trait anxiety , and depressive symptoms , and a locus of control attributed to chance were positively associated with any household food insecurity . Conversely , self-esteem and mastery were inversely associated with any household food insecurity . Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women ; however , the direction of causation between psychosocial indicators and food insecurity can not be determined in these data Background Several studies witnessed that prenatal zinc deficiency ( ZD ) predisposes to diverse pregnancy complications . However , scientific evidence s on the determinants of prenatal ZD are scanty and inconclusive . The purpose of the present study was to assess the prevalence and determinants of prenatal ZD in Sidama zone , Southern Ethiopia . Methods A community based , cross-sectional study was conducted in Sidama zone in January and February 2011 . R and omly selected 700 pregnant women were included in the study . Data on potential determinants of ZD were gathered using a structured question naire . Serum zinc concentration  was measured using Atomic Absorption Spectrometry . Statistical analysis was done using logistic regression and linear regression . Results The mean serum zinc concentration was 52.4 ( + /-9.9 ) μg/dl ( 95 % CI : 51.6 - 53.1 μg/dl ) . About 53.0 % ( 95 % CI : 49.3 - 56.7 % ) of the subjects were zinc deficient . The majority of the explained variability of serum zinc was due to dietary factors like household food insecurity level , dietary diversity and consumption of animal source foods . The risk of ZD was 1.65 ( 95 % CI : 1.02 - 2.67 ) times higher among women from maize staple diet category compared to  Enset staple diet category . Compared to pregnant women aged 15 - 24 years , those aged 25 - 34 and 35 - 49 years had 1.57 ( 95 % CI : 1.04 - 2.34 ) and 2.18 ( 95 % CI : 1.25 - 3.63 ) times higher risk of ZD , respectively . Women devoid of self income had 1.74 ( 95 % CI : 1.11 - 2.74 ) time increased risk than their counterparts . Maternal education was positively associated to zinc status . Gr and multiparas were 1.74 ( 95 % CI : 1.09 - 3.23 ) times more likely to be zinc deficient than nulliparas . Frequency of coffee intake was negatively association to serum zinc level . Positive association was noted between serum zinc and hemoglobin concentrations . Altitude , history of iron supplementation , maternal workload , physical access to health service , antenatal care and nutrition education were not associated to zinc status . Conclusion ZD is of public health concern in the area . The problem must be combated through a combination of short , medium and long-term strategies . This includes the use of household based phytate reduction food processing techniques , agricultural based approaches and livelihood promotion strategies Background This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam . Son preference and traditional confinement practice s were explored as well as factors such as poverty , parity , family and intimate partner relationships and infant health . Methods A cross-sectional study was conducted in twelve r and omly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province , Vietnam . Mother-infant dyads one to six months postpartum were invited to participate . Question naires from 431 mothers ( urban n = 216 ; rural n = 215 ) assessed demographic and family characteristics , traditional confinement practice s , son preference , infant health and social capital . The Edinburgh Postnatal Depression Scale ( EPDS ) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing . Data were analysed using general linear models . Results Using an EPDS cut-off of 12/13 , 18.1 % ( n = 78 , 95 % CI 14.6 - 22.1 ) of women had depressive symptoms ( 20.4 % urban ; 15.8 % rural ) . Contrary to predictions , infant gender and traditional confinement were unrelated to depressive symptoms . Poverty , food insecurity , being frightened of family members , and intimate partner violence increased both depressive symptoms and lowered wellbeing . The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one ’s husb and , husb and ’s unemployment , breastfeeding difficulties , infant diarrhoea , and cognitive social capital were associated with higher EPDS scores . The second model had accounted for 22 % of the variance in WHO5 score . Living in Hue city , low education , poor maternal competence and a negative family response to the baby lowered maternal wellbeing . Conclusions Traditional confinement practice s and son preference were not linked to depressive symptoms among mothers , but were correlates of family relationships and wellbeing . Poverty , food insecurity , violence , infant ill health , and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam BACKGROUND Household food insecurity is positively associated with weight among women . The association between household food insecurity and pregnancy-related  weight gain and complications is not well understood . OBJECTIVE To identify whether an independent association exists between household food insecurity and pregnancy-related complications . DESIGN Data from the Pregnancy , Infection , and Nutrition prospect i ve cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes < or = 400 % of the income/poverty ratio , recruited between January 2001 and June 2005 and followed through pregnancy . MAIN OUTCOME MEASURES Self-reported pregravid body mass index , gestational weight gain , second trimester anemia , pregnancy-induced hypertension , and gestational diabetes mellitus . STATISTICAL ANALYSES PERFORMED Multivariate linear , multinomial logistic , and logistic regression analyses . RESULTS Among 810 pregnant women , 76 % were from fully food secure , 14 % were from marginally food secure , and 10 % were from food insecure households . In adjusted models , living in a food insecure household was significantly associated with severe pregravid obesity ( adjusted odds ratio 2.97 , 95 % confidence intervals [ CIs ] 1.44 to 6.14 ) , higher gestational weight gain ( adjusted beta coefficient 1.87 , 95 % CI 0.13 to 3.62 ) , and with a higher adequacy of weight gain ratio ( adjusted beta .27 , 95 % CI 0.07 to 0.50 ) . Marginal food security was significantly associated with gestational diabetes mellitus ( adjusted odds ratio 2.76 , 95 % CI 1.00 to 7.66 ) . CONCLUSIONS This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications Background Household food insecurity through influencing the quality and sufficiency of nutrition can have considerable effects on individuals ’ health . Previous studies have shown the relationship between household food insecurity and quality of life among adults , infants , and people of minority ethnicity . However , no studies have been conducted on household food insecurity and quality of life among pregnant women . This study aim ed to investigate the effect of food insecurity on quality of life among pregnant women in Qazvin city , Iran . Methods This cross-sectional study was conducted between May 2017 and November 2017 on 394 pregnant women . A r and om cluster sampling method was used to select eight urban health and medical centers from four geographical regions of Qazvin city , Iran . In the selected centers , pregnant women were recruited using eligibility inclusion criteria . Data was collected using the  SF-36 Health-related Quality of Life , Household Food Insecurity Access Scale  and a  demographic question  naire for recording the women ’s gestational and demographic information through interviews . Descriptive and inferential statistics including Chi-square test , one-way analysis of variance with Bonferroni post-hoc test and multiple linear regression were used for data analysis . P < 0.05 was considered statistically significant . Results Food insecurity was reported in 43.9 % of the pregnant women . Overall pregnant women ’s quality of life had the highest score ( Mean ± SD ) in the domain of ‘ social performance ’ ( 76.4 ± 21 ) and the lowest one in the domain of ‘ role limitation due to physical reasons ’ ( 60.5 ± 43 ) . Pregnant women with food insecurity had the lowest score in role limitation due to physical reasons domain of quality of life ( 68.6 ± 40.4 , 61.3 ± 45.5 & 51.3 ± 47.7 respectively for mild , moderate and sever food insecurity ) . The results of multiple linear regression showed that one unit reduction of household food security significantly decreased the total quality of life score by 5.2 score ( 95 % CI : -9.7 , − 0.7 ) among the mild food insecure group , 10.8 score ( 95 % CI : -17.1 , − 4.6 ) among the moderate food insecure group and 14.1 score ( 95 % CI : -19.7 , − 8.5 ) among the sever food insecure group . Conclusions Screening of the household food security status during the primary prenatal care can identify high-risk pregnant women to improve the quantity and quality of their diet . Moreover multi-level actions including policy-making , supplying re sources , and providing appropriate services are needed to ensure that pregnant women have access to high- quality foods Background Depression during pregnancy has far-reaching adverse consequences on mothers , children and the whole family . The magnitude and determinants of prenatal depressive symptoms in low-re source countries are not well established . This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition , intimate partner violence and social support among pregnant women in rural Ethiopia . Methods This study is based on the baseline data from a large prospect i ve , community-based , birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016 . A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation .  Depressed mood was assessed using the Patient Health Question naire ( PHQ-9 ) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms . Data collection was conducted electronically on h and held tablets and su bmi tted to a secured server via an internet connection . Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software . Result The community based prevalence of depressive symptoms during pregnancy was 10.8 % ( 95%Confidence Interval ( CI ) : 9.92–11.70 ) . Adjusting for confounding variables , moderate household food insecurity ( OR 1.74 ; 95 % CI : 1.31–2.32 ) , severe household food insecurity ( OR 7.90 ; 95 % CI : 5.87–10.62 ) , anaemia ( OR = 1.30 ; 95 % CI : 1.04–1.61 ) and intimate partner violence ( OR 3.08 ; 95 % CI : 2.23–4.25 ) were significantly associated with prenatal depressive symptoms . On the other h and , good social support from friends , families and husb and reduced the risk of prenatal depressive symptoms by 39 % ( OR 0.61 ; 95 % CI : 0.50–0.76 ) . Conclusion Prenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia . In this community based study , household food insecurity , anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms . Good maternal social support from friends , families and spouse was rather protective . The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy . Policies aim ed at reducing household food insecurity , maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression BACKGROUND AND AIMS In general population s , prenatal food insecurity negatively affects maternal and infant health . Our aim was to estimate and test the association between prenatal food insecurity and  neonatal abstinence syndrome ( NAS ) severity . DESIGN / SETTING Single-site prospect i ve cohort design . Women receiving opioid agonist treatment with methadone or buprenorphine  were interviewed ( including demographics and food insecurity ) during the third trimester at the combined obstetric/opioid use disorder treatment clinic at Boston Medical Center ( BMC ) in Boston , MA , USA , a large urban safety-net hospital . During postnatal hospitalization , infants were assessed and treated per hospital NAS protocol . Maternal clinic and infant hospitalization data were abstract ed from medical records . PARTICIPANTS Women ( n = 75 ; aged ≥ 18 years ; fluent English ; singleton pregnancy ; intending to deliver at BMC and maintain parental custody ) receiving care in the specialized clinic were study eligible ( 2013 - 15 ) . Women who delivered infants < 36 weeks gestational age or required prolonged newborn intensive care unit stay were excluded from analyses . PRIMARY MEASUREMENTS Predictors : vali date d two- question Hunger Vital Sign ™ food insecurity screener ; outcomes : extent of NAS pharmacological treatment and length of hospital stay ( LOS ) for NAS . FINDINGS Of the mother-infant dyads , 61 ( 81 % ) infants were treated pharmacologically for NAS . Mean hospital LOS was 19.9 ( st and ard deviation = 9.4 ) days . Maternal food insecurity ( n = 43 , 57.3 % ) was associated with infant NAS pharmacological treatment in logistic regression analyses individually adjusted for prenatal : maternal depression [ adjusted odds ratios ( aOR ) = 3.69 ( 95 % confidence intervals ( CI ) = 1.02 - 13.43 , P = 0.05 ) ] and methadone agonist treatment [ aOR = 4.17 ( 95 % CI = 1.05 - 16.50 , P = 0.04 ) ] . Associations of food insecurity and LOS were inconclusive regardless of covariate control ( P > 0.05 ) . CONCLUSION Among women receiving opioid agonist treatment  , prenatal food insecurity appears to be associated with increased risk for neonatal abstinence syndrome pharmacological treatment Background The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-re source setting in South Africa , and who present with a risk of depression during pregnancy . Methods This is a secondary analysis of a r and omised controlled trial among 384 women living in Khayelitsha , a low income setting in South Africa , recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale , were at least 18 years of age , less than 29 weeks pregnant and spoke isiXhosa . Participants were followed up at 8 months gestation , 3 and 12 months postpartum . Latent trajectories of depressive symptoms were identified using growth mixture modelling , based on the Hamilton Depression Rating Scale ( HDRS ) . There were no differences in HDRS scores between the control and intervention arms , so all participants were assessed together . Health , social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms , using univariate logistic regression . Results Two trajectories were identified : antenatal only ( 91.4 % ) , with moderate to severe symptoms at baseline which later subside ; and antenatal and postnatal ( 8.6 % ) , with severe depressive symptoms during pregnancy and later in the postpartum period , which subside temporarily to moderate levels at 3 months postpartum . Predictors for the antenatal and postnatal trajectory include severe food insecurity , intimate partner violence , lower social support , greater functional impairment , problematic drinking and suicide risk . Conclusions A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period , and can be differentiated from those who show a natural remission . Identification and referral strategies should be developed with these findings in mind , especially given the limited mental health re sources in low-income setting
Food insecurity ( FI ) occurs when people lack secure access to sufficient amounts of safe and nutritious food .
FI has been associated with negative effects on human health , including during the prenatal and neonatal periods .
The objective of this study is to evaluate the consequences of FI for pregnant women ’s and newborns ’ health .