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The quality of the mother–child relationship in the first year of life has far reaching implications across the life course (Bornstein in Annu Rev Psychol 65:121–158, 2014). Yet little is known about predictors of maternal bonding and emotional availability in early infancy. In this study we examined the extent to which postnatal bonding, maternal mental health, and substance use at 8-weeks postpartum predicted mother–infant bonding (self-report) and mother emotional availability (observational) at 12-months of age. Data were obtained from an Australian longitudinal cohort study of pregnancy (n = 308). Data were collected during pregnancy, at birth, and postnatally at 8-weeks and 12-months. The results show strong continuity between postnatal bonding at 8-weeks and 12-months. Early postpartum stress and depression were associated with bonding at 12-months; however, the effect did not persist after adjustment for bonding at 8-weeks. Tobacco use at 8-weeks, but no other indicators of mental health, predicted lower emotional availability scores at 12-months. Results suggest that the mother’s felt bond to her child is stable across the first year of life and that early bonding is a more robust indicator of bonding at 12-months than a mother’s mental health or substance use. These findings point to the importance of clinical and public health investments in establishing a strong bond between mother and child in the early postpartum period.

Background Teratogenicity of heavy prenatal alcohol exposure is established, but uncertainty remains regarding the impact of moderate alcohol exposure on cognitive deficits in infants. Separating in utero effects from environmental confounding is a challenge for observational studies; consideration of alcohol use by partners as well as mothers may help clarify this. This study examined associations between prenatal alcohol use by both mothers and their partners and infant cognitive developmental outcomes at 12-months. Methods Pregnant women (n = 1331) and their partners (n = 699) were recruited from antenatal clinics of three metropolitan public hospitals in Australia, and completed detailed interviews about alcohol consumptions throughout pregnancy. Infants were assessed with the Bayley Scales of Infant Development − Third edition (Bayley) at 12-months of age. Results Alcohol use during pregnancy was reported by 65.7% of mothers and 84.1% of partners. Using multiple methods to adjust for confounding factors, no evidence for impaired cognitive ability associated with alcohol use by mothers or their partners was observed. Children born to women who drank low-levels of alcohol had slightly higher Bayley cognitive scores than those born to abstaining women. There was some evidence for an interaction between sociodemographic factors and prenatal alcohol exposure on infant cognitive outcomes. Conclusion This finding corroborates existing evidence to suggest there are no detrimental effects to infant cognitive development at 12-months of age following low-level prenatal alcohol exposure. Future prospective studies involving families of a broad range of backgrounds would be informative to clarify interaction between alcohol exposure and environmental factors on developmental outcomes.

Introduction and Aims There is limited research regarding the effects of alcohol consumption by breastfeeding mothers on infant development. This study examined the frequency, correlates and outcomes of alcohol use during lactation. Design and Methods Data were from an Australian cohort study. Maternal demographics and substance use were assessed during pregnancy and at 8 weeks and 12 months postpartum. Breastfeeding duration, infant feeding, sleeping and development (Ages and Stages Questionnaire) were also assessed postpartum. Logistic regression and general linear model analyses examined characteristics of women who drank during breastfeeding, and the association between alcohol use during breastfeeding and infant outcomes. Results Alcohol use was reported by 60.7% and 69.6% of breastfeeding women at 8 weeks and 12 months postpartum, respectively. Breastfeeding women who consumed alcohol were more likely to be born in Australia or another English-speaking country, be tertiary educated and have higher household incomes. Most drank at low levels (≤14 standard drinks per week

Following publication of the original article [1], the authors opted to revise the first paragraph of the section “Characteristics associated with maternal drinking in pregnancy”. Below is the updated version.

Background Maternal alcohol consumption in pregnancy may have adverse effects on child gross motor (GM) development. There have been few human studies on this topic, particularly ones examining low exposure. This study examined the association between prenatal alcohol exposure (PAE) and infant GM development at 12-months of age. Methods Participants were 1324 women recruited from antenatal clinics in Sydney and Perth, Australia. Maternal and paternal alcohol use was assessed in pregnancy via interview; offspring GM development was measured at 12-months with the Bayley Scales of Infant Development (BSID-III). Results Any alcohol use in pregnancy was common: 56.1%, of pregnant women drank early in Trimester one (0–6 weeks), however this reduced to 27.9% on average thereafter and at predominantly low levels. However, infant BSID GM scale scores were not found to differ significantly as a function of PAE in the first 6-weeks (low, moderate, binge or heavy PAE), nor with low PAE across pregnancy. Conclusions We found no evidence to suggest that low PAE is associated with measurable impairment in infant GM development at 12-months. Further research is needed to examine potential PAE impacts on GM development in heavier exposure groups and through the childhood years when subtle GM deficits may be more detectable. Electronic supplementary material The online version of this article (10.1186/s12887-019-1516-5) contains supplementary material, which is available to authorized users.

Background Current estimates of the rates of alcohol-exposed pregnancies may underestimate prenatal alcohol exposure if alcohol consumption in early trimester 1, prior to awareness of pregnancy, is not considered. Extant literature describes predictors of alcohol consumption during pregnancy; however, alcohol consumption prior to awareness of pregnancy is a distinct behavior from consumption after becoming aware of pregnancy and thus may be associated with different predictors. The purpose of this study was therefore to examine prevalence and predictors of alcohol consumption by women prior to awareness of their pregnancy, and trajectories of change to alcohol use following pregnancy recognition. Methods Pregnant women (n = 1,403) were prospectively recruited from general antenatal clinics of 4 public hospitals in Australian metropolitan areas between 2008 and 2013. Women completed detailed interviews about alcohol use before and after recognition of pregnancy. Results Most women (n = 850, 60.6%) drank alcohol between conception and pregnancy recognition. Binge and heavy drinking were more prevalent than low-level drinking. The proportion of women who drank alcohol reduced to 18.3% (n = 257) after recognition of pregnancy. Of women who drank alcohol, 70.5% ceased drinking, 18.3% reduced consumption, and 11.1% made no reduction following awareness of pregnancy. Socioeconomic status (SES) was the strongest predictor of alcohol use, with drinkers more likely to be of high rather than low SES compared with abstainers (OR = 3.30, p

The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births (n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ‘low consumption’ (22%): low probability of any use; ‘within-guideline’ (70%): high probability of guideline adherence; and ‘decreasing heavy use’ (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = −143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted.

Introduction Very preterm babies can be difficult to monitor using standard external Doppler fetal heart tracings (eFHR). External fetal electrocardiogram (fECG) is a potential alternative. Methods This was a prospective observational pilot study of hospitalized patients at 24 to 28 weeks' gestation. A total of 30 women were traced for up to 2 hours using eFHR followed by up to 2 hours using fECG. The percentage of time the fetal heart rate was traced during the 2-hour window for each modality was calculated. Differences of ≥ 60, ≥ 80, and ≥ 90% total time traced were compared between modalities using McNemar's test. Differences were also assessed for each method between nonobese (body mass index [BMI]

Background Mother-infant bonding provides the foundation for secure attachment through the lifespan and organizes many facets of infant social-emotional development, including later parenting. Aims To describe maternal bonding to offspring across the pregnancy and postnatal periods, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal-offspring bond. Methods Data were drawn from a sample of 372 pregnant women participating in an Australian population-based longitudinal study of postnatal health and development. Participants completed maternal bonding questionnaires at each trimester and 8 weeks postnatal. Data were collected on a range of sociodemographic and psychosocial factors. Results Bonding increased significantly through pregnancy, in quality and intensity. Regression analyses indicated that stronger antenatal bonding at all time points (trimesters 1 through 3) predicted stronger postnatal bonding. Older maternal age, birth mother being born in a non-English speaking country, mother not working full time, being a first-time mother, breast-feeding problems, and baby's crying behavior all predicted poorer bonding at 8 weeks postpartum. Conclusion These novel findings have important implications for pregnant women and their infant offspring, and for health care professionals working in perinatal services. Importantly, interventions to strengthen maternal-fetal bonding would be beneficial during pregnancy to enhance postnatal bonding and infant health outcomes.

Objective To investigate the obesogenic influence of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on infant weight at birth and 12 months postpartum in an Australian general population sample. Methods Data on 1,305 pregnant women were collected on prepregnancy BMI and GWG through maternal interview, on infant weight at birth through hospital records, and on infant weight 12 months postbirth through direct measurement. Relationships between prepregnancy, gestational weight exposures, and infant weight outcomes were assessed with and without adjustment for potential confounding. Results We observed a 14 to 24 g increase in infant birth weight for every 1 kg increase in maternal weight (infant birth weight: β(BMI) = 0.014, p Conclusion In a general population sample, there is a significant but not substantial observed relationship between maternal prepregnancy BMI and GWG and infant weight outcomes, suggesting a minor role for these factors at a population level.

Bilateral risk-reducing salpingo-oophorectomy (RRSO) has been shown to significantly reduce the risk of ovarian cancer. This study assessed factors predicting uptake of RRSO. Women participating in a large multiple-case breast cancer family cohort study who were at increased risk for ovarian and fallopian tube cancer (i.e. BRCA1 or BRCA2 mutation carrier or family history including at least one first- or second-degree relative with ovarian or fallopian tube cancer), with no personal history of cancer and with at least one ovary in situ at cohort enrolment, were eligible for this study. Women who knew they did not carry the BRCA1 or BRCA2 mutation segregating in their family (true negatives) were excluded. Sociodemographic, biological and psychosocial factors, including cancer-specific anxiety, perceived ovarian cancer risk, optimism and social support, were assessed using self-administered questionnaires and interviews at cohort enrolment. RRSO uptake was self-reported every three years during systematic follow-up. Of 2,859 women, 571 were eligible. Mean age was 43.3 years; 62 women (10.9 %) had RRSO a median of two years after cohort entry. Factors predicting RRSO were: being parous (OR 3.3, p = 0.015); knowing one's mutation positive status (OR 2.9, p < 0.001) and having a mother and/or sister who died from ovarian cancer (OR 2.5, p = 0.013). Psychological variables measured at cohort entry were not associated with RRSO. These results suggest that women at high risk for ovarian cancer make decisions about RRSO based on risk and individual socio-demographic characteristics, rather than in response to psychological factors such as anxiety.

The objective of the study described here was to review the literature published in the UK in the last decade, about the relationship between self-help groups and professionals. The strengths and limits of the literature were to be identified and issues emerging from what has been published were to be discussed. The main source was a recently published bibliography on the subject. The setting was the current interest in voluntary groups as a source of care in the community. A wide variety of professionals are identified as being interested in working with self-help groups and their attitudes were found to be generally favourable and benefits of self-help groups are summarized. However, there is confusion about the possibility of partnership between organizations where there is an underlying tension. Attitudes and knowledge are the key to practice, which can include action when groups begin, referral, and support. An intellectual framework which defines the place of self-help groups is needed as well as ideas on practice. While there are many strengths to the published literature, a large number of limits are identified. More attention is needed, in particular, to the underlying tension between groups based on experiential knowledge and professionals with learned knowledge and greater clarity on definition is required. Compared to the extensive North American literature, relatively little has been published. Policies, tailored to different areas of need, require further thought, and more research and debate are needed, if a vital relationship is to be developed.

The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother’s felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.

The Triple B Pregnancy Cohort Study investigates the effects of parental alcohol, tobacco and other substance use on infant development and family functioning. The study (also known as: Bumps, Babies and Beyond), recruited two sub-samples: (i) a general antenatal clinic sample of pregnant women and their partners (n = 1534 women; 842 of their partners); and (ii) a smaller sample of pregnant women with diagnosed substance use disorders (SUD; n = 89 women only). Participants were recruited through public antenatal clinics attached to major hospitals and area health services in New South Wales (NSW) and Western Australia (WA). Of 4068 eligible women from the general antenatal clinics, 37.7% participated, with equivalent numbers for the SUD clinics being 198, 44.9%. There were 1453 and 65 live births from the two groups, respectively, with a total of 1414 and 65 mothers in the two groups, respectively. Data were also collected on 1264 (86.9%) of 1455 eligible partners of women recruited through the general antenatal clinics. The study collected repeated measures across pregnancy (trimesters 1, 2 and 3), and at 8 weeks and 12 months postnatally; retention at 12 months was 84.0% and 73.8% for mothers in the general antenatal and specialist SUD clinics, respectively. The data collected include demographic, parental, familial and infant factors, with a focus on parental substance use and mental health, parenting practices, familial functioning and infant development. Following pregnancy awareness, 42% of women consumed alcohol, 12% smoked tobacco and 4% used illicit drugs at some stage in pregnancy. Comprehensive assessments have been conducted with infants at 12 months to test numerous developmental domains, including cognitive, motor and language skills, along with measures of social and emotional functioning. Data access enquiries can be made to the principal investigator

This study prospectively investigated long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret 3 years post-surgery. Outcomes were compared to age- and risk-matched controls. Participants (N = 233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM + RRSO (30 controls). Women who underwent RRM and those who underwent RRM + RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.

Background. This paper describes the study design, recruitment, measurement, and initial recruitment outcomes of Australia's largest workplace intervention trial, the National Workplace Health Project. Methods. This was a cluster-randomized trial of socio-behavioral and environmental interventions focusing on key behaviors of physical activity, healthy food choices, cigarette smoking, and alcohol consumption, as well as motivational readiness for change. Twenty worksites were randomized separately for each intervention using a two-by-two factorial design. All participants underwent a health risk appraisal and measurements were made at baseline and at 1 and 2 years. Results. The overall response rate for the baseline survey was 73% with 61% attending the health risk appraisal. The sample was predominantly male, English-speaking, married, blue-collar workers. Overall, 12% reported unsafe alcohol consumption, 26% were current smokers, 44% were physically inactive, 74% ate at most one piece of fruit per day, and 26% ate at most one serving of vegetables per day. Intervention and control conditions were similar at baseline for the primary outcomes, except that a higher proportion of the sociobehavioral intervention condition was more physically active (59%) than the corresponding control condition (53%). Conclusions. This study will permit the rigorous evaluation of the efficacy of sociobehavioral and environ mental intervention approaches to workplace health promotion. Although participants were randomized by worksite, intervention and control conditions were similar at baseline; any differences in the primary out come variables will be controlled for in the analysis.

Self-help groups have been described as one of the great voluntary sector success stories in recent years. Yet it is not a co-ordinated development. People are rarely aware either of being part of a movement or of the concepts that underlie this special type of voluntary group when they set out on their self-help journey. This chapter sets out to explore what self-help groups are and do, and their benefits as members see them. Its sources come from the work of the Nottingham Self-Help Team over 12 years, and a recent research project in the Trent Region on self-help groups and professionals. The values and roles of the Team, and the definition it uses are summarized. The challenging nature of self-help and the question of support to self-help groups are discussed. Finally, the constraints which hold back the development of self-help are reviewed before reflecting on the extent to which self-help groups are a route to empowerment.

Seventy-six pregnancies in which hypertension complicated pregnancy before 28 weeks' gestation were studied: In 36, hemodynamics were characterized by increased cardiac output and low vascular resistance; in 32, hemodynamics were characterized by high resistance; in eight hemodynamics crossed 6ver from high output to high resistance during pregnancy. High-resistance hypertension was associated With a mean birth weight 1058 gm less than that in the low-resistance group ( p = 0.001). The reduction in birth weight was due to a 4-week difference in gestational age ( p = 0.001) and lower percentile weights for gestational age, 19th versus 39th ( p = 0.005). Infants in the crossover group had low percentile weights and a high rate of intrauterine fetal death.

In many manufacturing concerns the systems used to track production data are as numberous as the departments listed on the organization chart. The records of this multi-system technique seldom agree throughout the various departments. Generally, the root of this problem is (a) the disinterest on the part of non-data processing personnel in using a computerized tracking system themselves, and (b) the view that they cannot rely on a department outside their direct control (i.e. data processing) to do so for them.The implementation of one interactive system which uses a relational data base can transcend both. Use of the system would be uncomplicated enough that personnel in the various departments would feel at ease with it.The term "manufacturing" covers a large domain. The purpose of this paper is not to give one system that "as is" will cover all production phases of the entire spectrum of manufacturing concerns. The intent is to give a general enough approach that, if adapted to most areas and applied with enthusiasm, the result will be a unified and accurate set of data from which relevant information can be derived and sound decisions can be made.