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Objective: To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period., Design: Instrument modification and psychometric assessment., Setting: Online, community, and health care settings., Participants: Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2., Methods: In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively., Results: We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26., Conclusion: The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R subscales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2023 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To systematically review the scope and development of frameworks to promote health during the postpartum period., Data Sources: We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021., Study Selection: We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework., Data Extraction: We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice., Data Synthesis: The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear., Conclusion: The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Mothers with physical disabilities (MPDs) face the behavioral and psychosocial changes of the motherhood transition with fewer resources, additional barriers, and higher risks than nondisabled mothers. In this study we sought guidance from MPDs on adaptations needed to a health promotion toolkit for behavioral and psychosocial health that was originally developed for nondisabled, primarily low-income, women., Objective: To identify general themes for adaptations that would increase the suitability of the toolkit for MPDs., Methods: 11 MPDs were interviewed by videoconferencing in a mixed-methods study about their perspectives on improving relevance of the existing toolkit for this population. The toolkit contained three components: assessment scale, feedback template on assessment results, and a decision aid related to behavior change. Interviews were analyzed using qualitative content analysis., Results: Nine themes for improving suitability of the toolkit for MPDs were identified. Themes covered: Using non-judgment language; including strengths, not just risks; using exercise items applicable to persons with physical disabilities; being aware that functional ability was the key body image concern; considering motivational stages of behavioral change; providing choice in goal-setting for change; including suggestions for social support; identifying resources for health and adaptive parenting; and making health promotion resources available in alternative platforms (paper, electronic)., Conclusions: The MPDs' feedback revealed ways that our toolkit for behavioral and psychosocial health could be improved to be inclusive of MPDs. The participatory methods utilized here are also recommended in designing new or revising existing materials aimed at enhancing health promotion for people with disabilities., Competing Interests: Declaration of competing interest Lorraine Walker, Heather Becker, and Carolyn Phillips declare no conflicts of interest. Erin Andrews declares Consultant (2016 to present) on the Parents Empowering Parents: National Research Center for Parents with Disabilities and their Families Grant, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), (Copyright © 2020 Elsevier Inc. All rights reserved.)

Researchers may find it difficult to transition from conducting descriptive, mechanistic, and associational studies to developing interventions based on those findings because little guidance is available. In this article, we present the Obesity-Related Behavioral Intervention Trials (ORBIT) model and describe its applicability in designing behaviorally oriented interventions for women. Adapted from drug development research on the translation of basic laboratory research to clinical practice, the ORBIT model emphasizes the pre-efficacy testing phases of intervention development. Phase I is focused on the definition and refinement of the intervention and incorporates various study designs, including experimental, observational, qualitative, and adaptive design. Phase II involves the use of single-group proof-of-concept, feasibility, and preliminary efficacy studies to show the feasibility and capacity of the intervention to produce change in an intermediate endpoint. Phase III involves the use of randomized controlled trials to test the efficacy of the intervention. We illustrate how the ORBIT model could be applied in a hypothetical intervention to increase a woman's sense of control of her life before behavioral weight loss efforts in the postpartum period., (Published by Elsevier Inc.)

Objective: To examine occurrence of health care provider discussion of postpartum women's behavioral and psychosocial health, acceptability of screening, and access to a provider with whom to comfortably discuss sensitive topics., Design: Mail survey during the first postpartum year., Setting: Community dwelling., Participants: Postpartum women (N = 168) from diverse backgrounds., Methods: Using vital records, we drew a random sample that was stratified on race/ethnicity and income from a Southwestern U.S. community. Potential participants were mailed a questionnaire about health care and screening in the areas of depression, diet, physical activity, smoking, and alcohol use during the postpartum period., Results: Women reported that discussion of depression most often occurred (51%) during health care encounters, and discussion of weight least often occurred (14%). More than 94% of women indicated they would "welcome" or "not mind" screenings for depression, diet, physical activity, alcohol use, or smoking at health care visits. More than 90% welcomed screening during their infants' pediatric health care visits. Most (86%) reported that screening on an electronic device at their health care visits was acceptable. Most (84%) were interested in completing a screening at home on a Web site. Also, 58% of women without health insurance compared with 24% of those with insurance indicated that they lacked a health professional with whom they could comfortably discuss sensitive topics such as depression., Conclusion: Wide gaps exist in postpartum behavioral and psychosocial health care. Most women find a variety of screening settings and methods acceptable., (Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To test the association of behavioral and psychosocial health domains with contextual variables and perceived health in ethnically and economically diverse postpartum women., Design: Mail survey of a stratified random sample., Setting: Southwestern community in Texas., Participants: Non-Hispanic White, African American, and Hispanic women (N = 168)., Methods: A questionnaire was sent to a sample of 600 women. The adjusted response rate was 32.8%. The questionnaire covered behavioral (diet, physical activity, smoking, and alcohol use) and psychosocial (depression symptoms and body image) health, contextual variables (race/ethnicity, income, perceived stress, and social support), and perceived health. Hypotheses were tested using linear and logistic regression., Results: Body image, dietary behaviors, physical activity behaviors, and depression symptoms were all significantly correlated (Spearman ρ = -.15 to .47). Higher income was associated with increased odds of higher alcohol use (more than 1 drink on 1 to 4 days in a 14-day period). African American ethnicity was correlated with less healthy dietary behaviors and Hispanic ethnicity with less physical activity. In multivariable regressions, perceived stress was associated with less healthy dietary behaviors, increased odds of depression, and decreased odds of higher alcohol use, whereas social support was associated with less body image dissatisfaction, more physical activity, and decreased odds of depression. All behavioral and psychosocial domains were significantly correlated with perceived health, with higher alcohol use related to more favorable perceived health. In regressions analyses, perceived stress was a significant contextual predictor of perceived health., Conclusion: Stress and social support had more consistent relationships to behavioral and psychosocial variables than race/ethnicity and income level., (Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To assess Hispanic ethnicity, border residence, or their interaction for association with risk of high gestational weight gain (GWG) and related outcomes., Design: Retrospective analysis of 2009 birth data., Setting: Texas., Participants: Participants included 146,458 Hispanic and 104,399 non-Hispanic (NH) White women., Methods: We used adjusted odds ratios (AOR) in logistic regression analyses to test the association of Hispanic ethnicity, border residence, and their interaction with high GWG, cesarean birth, macrosomia, and breastfeeding status at discharge., Results: After adjusting for covariates, risk of inadequate or excessive GWG was not associated with being a border resident, but Hispanic women compared to NH White women had an increased risk of inadequate GWG (AOR = 1.21, 99% confidence interval [CI] [1.17, 1.26]) and decreased risk of excessive GWG (AOR = 0.77, 99% CI [0.74, 0.79]). Risk of cesarean birth was increased for border residents (AOR = 1.22, 99% CI [1.05, 1.42]), and this risk was increased further among border residents who were Hispanic (AOR = 1.52, 99% CI [1.30, 1.77])., Conclusion: We found strengths and vulnerabilities among Hispanic and border-residing women. Hispanic women were at lower risk of excessive GWG than NH White women. Border-residing Hispanic women were at greater risk of cesarean birth than other women., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To describe postpartum women's access, perceived skill, confidence, and use of Internet and mobile technologies; their views about receiving health information about postpartum weight and parenting; and whether these factors varied by race/ethnicity or income level., Design: Health survey of a stratified random sample., Setting: County in central Texas., Participants: One hundred forty-five (145) White/Anglo, African American, or Hispanic women of higher and lower income., Results: Overall, 122 (84.1%) of respondents had access to a computer with an Internet connection at home and made daily use of the following: the Internet 77.6%, e-mail 75.4%, cell phone 97.1%, and text messaging 66.7%. Significant racial/ethnic and income differences occurred in home Internet access, frequency of Internet and e-mail use, and perceived confidence or skill favoring White/Anglo women over ethnic minority women, and those of higher over lower income. Overall, 35.9% of women expressed "a lot" of interest in an Internet-based weight loss program, 38.9% in a weight loss program sent by mail, 44.8% in an Internet-based parenting advice, and 38.6% in parenting advice sent by mail. Women of higher and lower income differed significantly in their interest in three of the four types of health-promotion information and methods of delivery., Conclusion: Generally, women with lower income were more likely to express high interest in receiving health information related to parenting by mail than those of higher incomes, whereas women of higher incomes were more likely to express high interest in receiving weight loss and parenting information through the Internet., (© 2012 AWHONN, the Association of Women's Health, Obsteric and Neonatal Nurses.)

Objective: This study examined test-retest reliability, internal consistency, and construct and predictive validity of the Physical Activity and Nutrition Self-Efficacy (PANSE) scale, an 11-item instrument to assess weight-loss self-efficacy among postpartum women of lower income., Methods: Seventy-one women completed the PANSE scale and psychosocial measures at baseline and at 7 and 13 weeks of a pilot study of weight loss., Results: Test-retest reliability of PANSE scores was r = 0.55 (P < .01). Cronbach α was r = 0.89. Construct validity was supported by correlations with less-healthful behaviors (r = -0.33, P = .005), perceived stress (r = -0.24, P = .04), and decisional balance (r = 0.25, P = .03). PANSE change scores correlated with intervention group weight changes (r = -0.54, P < .01), although baseline scores did not. One factor emerged (loadings .80 to .57)., Conclusions and Implications: The PANSE scale demonstrated adequate reliability, internal consistency, construct validity, and moderate predictive validity. Replication is needed to confirm study findings., (Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the distribution of weight-related risks (weight retention and overweight/obese status) during the first postpartum year and determine if risk distributions differ by race/ethnicity, time, age, or parity., Design: Secondary analysis of a longitudinal data set from 1- to 3-days to 12-months postpartum., Setting: Initial recruitment was from a community hospital., Participants: Two hundred and forty-seven (White, African American, or Hispanic) low-income women., Results: At 1- to 3-days postpartum weight-related risks were distributed as follows: 6.1% no risk, 17.0% significant postpartum weight retention, 12.1% overweight/obese, and 64.8% both weight-related risks; at 12 months, the distribution was 32.4%, 8.9%, 16.6%, and 42.1%, respectively. Distributions differed by race/ethnicity at 6-months (χ² =16.1, p=.013) and 12-months postpartum (χ² =19.7, p=.003). Having both weight-related risks (vs. not) at 12 months was 3.1 (odds ratio [OR]) times more likely (95% confidence interval [CI], 1.6, 6.2) for African American and 2.4 (OR) times more likely (95% CI[1.3, 4.6]) for Hispanic than White women. Having two risks decreased significantly only between 1 to 3 days and 6 weeks (p = .000). Maternal parity, but not age, was associated with weight-related risk distributions on four of five time points., Conclusion: Despite changes in the weight-related risk distributions from 1- to 3-days to 6-weeks postpartum, the proportion of African American and Hispanic women with weight-related risk (especially having two weight-related risks) remains high at 12-months postpartum., (© 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

This article presents health disparities and social inequities that may underlie adverse outcomes for childbearing women and infants in the United States. It also presents Internet-accessible databases that nurses can use to assess maternal and infant health disparities at a national or state level. Such assessments are basic to planning programs to address gaps in health care and advocating for practice and policy changes to improve the health care of childbearing women and infants.

Objective: To identify risk factors for excessive or inadequate gestational weight gain and associated morbidities among Hispanic women in a U.S.-Mexico border state., Design: Case-control design., Setting: New Mexico., Participants: Hispanic women responding to the New Mexico Pregnancy Risk Assessment Monitoring System 2000 to 2003; 1,597 women in final excessive versus adequate gestational weight gain analyses and 1,351 in final inadequate versus adequate gestational weight gain analyses., Methods: Information from birth certificates and Pregnancy Risk Assessment Monitoring System questionnaires were use in logistic regression analyses to identify risk factors and associated events., Results: Prevalence of excessive gestational weight gain was 35.7%, while inadequate gestational weight gain was 30.4%. Among factors associated with increased risk of excessive gestational weight gain were overweight (odds ratio [OR]=2.87, 95% confidence interval [CI]=2.11, 3.90) or obese status (OR=1.82, 95% CI=1.38, 2.39), whereas residing in a U.S.-Mexico border county reduced such risk (OR=0.75, 95% CI=0.59, 0.97). Among risk factors for inadequate gestational weight gain were gestational diabetes (OR=1.58, 95% CI=1.05, 2.37) and inadequate prenatal care (OR=2.17, 95% CI=1.56, 3.02). After adjusting for confounders, inadequate gestational weight gain increased risk of low birth weight (OR=l.92, 95% CI=1.11, 3.29), while excessive gestational weight gain reduced this risk (OR=0.29, 95% CI=0.12, 0.68) but increased risk of macrosomia (OR=2.07, 95% CI=1.32, 3.25)., Conclusion: Prepregnant overweight and obese status were among factors associated with excessive gestational weight gain among Hispanic women, whereas inadequate prenatal care was among factors associated with increased risk of inadequate gestational weight gain.

Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.

Objective: To determine the current state of knowledge of nursing interventions that foster the process of becoming a mother., Data Sources: A literature search was conducted using CINAHL and PubMed electronic databases and other key references., Study Selection: Reports on nursing intervention research published in English that focused on a facet of maternal behavior in the process of becoming a mother during pregnancy or during the first 4 months following birth, or both, were included. Twenty eight reports were found., Data Extraction: Studies were reviewed, categorized, and analyzed and interventions synthesized to determine the current knowledge base for fostering becoming a mother. Categories included instructions for infant caregiving, building awareness of and responsiveness to infant interactive capabilities, promoting maternal-infant attachment, maternal/social role preparation, and interactive therapeutic nurse-client relationships., Data Synthesis: Interactive therapeutic nurse-client relationships and maternal/social role preparation had greater impact on variables indicating progress in becoming a mother than formal teaching. Instructions without nurse input were ineffective., Conclusions: Interactive reciprocal nursing interventions are the most effective in enhancing mother-infant interactions and maternal knowledge about infant care. Evidence is limited on how to foster the mother's feelings about herself in becoming a mother and attachment to her infant., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

Objective: To determine the trajectory of postpartum weight changes and to examine associations between weight change in the first 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables., Design: Prospective, longitudinal design., Setting: Community hospital and university research setting., Participants: 26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies., Main Outcome Measure: Body mass index measured weekly., Results: Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women., Conclusions: The trajectory of weight change was nonlinear with large initial weight losses during the first 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the first 6 weeks postpartum.

Objective: To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services., Data Sources: The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search., Study Selection: The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review., Data Extraction: Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost., Data Synthesis: On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention., Conclusions: Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum.

Objective: To test the relationships between psychosocial thriving (depressive symptoms, health-related lifestyle) and gestational weight gain and birth weight. To test the influences of ethnicity on the relationships between psychosocial thriving and gestational weight gain and birth weight., Design: Baseline data taken from the Austin New Mothers Study., Setting: A community hospital in Texas., Participants: 305 low-risk African American, Hispanic, and White women with full-term pregnancies, singleton births, and Medicaid coverage., Main Measures: Center for Epidemiologic Studies Depression Scale, Self Care Inventory, Food Habits Questionnaire, gestational weight gain, and birth weight., Results: Newborns of African American women had lower birth weights (3,240 g) than newborns of Hispanic (3,422 g) or White women (3,472 g), even though no ethnic differences were found among the mothers on psychosocial variables. Late in pregnancy, women had high levels and prevalence (> 70%) of depressive symptoms regardless of ethnicity, and 50% exceeded recommended gestational weight gains. In full regression models, psychosocial variables were not significant predictors of gestational weight gain or birth weight. Ethnicity also was not a significant moderator of weight outcomes., Conclusions: Psychosocial thriving late in pregnancy was unrelated to gestational weight gain or birth weight. Ethnicity did not moderate psychosocial-weight relationships. Although ethnic differences were not found on psychosocial variables, high levels of depressive symptoms and greater than recommended gestational weight gains were prevalent. These findings have implications for maternal health during and beyond pregnancy.