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Qualitative studies of autistic people's pregnancy experiences have indicated sensory and communication related barriers to accessing adequate prenatal healthcare. However, quantitative work on the topic is scarce. This online survey study explored pregnancy experiences among 417 autistic and 524 non-autistic people. Compared with non-autistic people, autistic people reported heightened sensory and physical experiences during pregnancy and were more likely to experience prenatal depression and anxiety. Autistic people experienced lower satisfaction with prenatal healthcare, including having lower perceptions of their relationships with healthcare professionals and greater difficulties with antenatal classes. This study identifies key adjustments that can be made to prenatal healthcare, including sensory and communication adjustments. The findings highlight the need for greater autism understanding and awareness among professionals.

The present study examined genetic, prenatal, and postnatal environmental pathways in the intergenerational transmission of anxiety and depressive symptoms from parents to early adolescents (when these symptoms start to increase), while considering timing effects of exposure to parent anxiety and depressive symptoms postnatally. The sample was from the Early Growth and Development Study, including 561 adopted children (57% male, 55% White, 13% Black/African American, 11% Hispanic/Latine, 20% multiracial, 1% other; 407 provided data in early adolescence) and their birth (BP) and adoptive parents (AP). Using a trait-state-occasion model with eight assessments from child ages 9 months to 11 years, we partitioned trait-like AP anxiety and depressive symptoms from time-specific fluctuations of AP anxiety and depressive symptoms. Offspring anxiety and depressive symptoms were assessed at 11 years (while controlling for similar symptoms at 4.5 years). Results suggested that time-specific fluctuations of AP1 (mostly mothers) anxiety/depressive symptoms in infancy (9 months) were indirectly associated with offspring anxiety/depressive symptoms at 11 years via offspring anxiety/depressive symptoms at 4.5 years; time-specific fluctuations of AP1 anxiety/depressive symptoms at child age 11 years were concurrently associated with offspring anxiety/depressive symptoms at 11 years. AP2 (mostly fathers) anxiety/depressive symptoms were not associated with offspring symptoms. Genetic and prenatal influences measured by BP internalizing problems were not associated with offspring symptoms. Results suggested infancy and early adolescence as developmental periods when children are susceptible to influences of parent anxiety and depressive symptoms. Preventive interventions should consider time-specific fluctuations in parent anxiety and depressive symptoms during these developmental periods.

We investigated the longitudinal associations among maternal pre- and postnatal depression, maternal anxiety, and children's language and cognitive development followed from 15 to 61 months. Furthermore, we assessed the protective role of children's early print experiences with books against the adverse effect of maternal depression on language development. Data for mothers and children (51.7% boys, 95% White, N = 11,662) were from the Avon Longitudinal Study of Parents and Children. Prenatal maternal depression held an adverse association with child language ([beta] = -0.16, p = 0.002). Moreover, the risk was greater for girls than boys ([beta] = 0.19, p = 0.02). In addition, prenatal depression was significantly and negatively associated with child verbal intelligence quotient ([beta] = -0.11, p = 0.02) and performance intelligence quotient ([beta] = -0.12, p = 0.01). In contrast, postnatal depression or anxiety were not unique predictors of child outcomes. Importantly, children's early experiences with books, as measured by the reported frequency of parent-child shared reading, moderated the negative association between maternal depression and child language development ([beta] = 0.30, p < 0.001). Although modest in size, these findings inform models of child risk and resilience related to maternal psychopathology. The results also have implications for clinical programs as well as for prevention and intervention studies focusing on at-home early literacy.

We examine how increased Immigration and Customs Enforcement (ICE) activities impacted newborn health and prenatal care utilization in North Carolina around the time Section 287(g) of the Immigration and Nationality Act was first being implemented within the state. Focusing on administrative data between 2004 and 2006, we conduct difference-indifferences and triple-difference case-control regression analysis. Pregnancies were classified by levels of potential exposure to immigration enforcement depending on parental nativity and educational attainment. Contrast groups were foreign-born parents residing in nonadopting counties and all US-born non-Hispanic parents. The introduction of the program was estimated to decrease birth weight by 58.54 grams (95% confidence interval [CI], -83.52 to -33.54) with effects likely following from reduced intrauterine growth. These results are shown to coexist with a worsening in the timing of initiation and frequency of prenatal care received. Since birth outcomes influence health, education, and earnings trajectories, our findings suggest that the uptick in ICE activities can have large socioeconomic costs over US-born citizens.

Background: Though prenatal nutrition information is critical, it is not known whether information is shared equitably by patient race, financial security, or English proficiency. Purpose: To evaluate whether delivery or receipt of ChooseYourFish.org nutrition information in the first prenatal visit differed by patient demographics. Methods: Analysis of clinician-document electronic health record (EHR) or patient-reported surveys compared delivery and receipt of fish-related nutrition information in the first prenatal visit. Inferential statistics were used to compare delivery or receipt and race, ethnicity, payor, or interpreter use. Results: EHR analysis (n = 2,329) revealed Medicaid patients who used an interpreter were half as likely to have the fish nutrition message in their after-visit summary compared to those with Medicaid who did not use an interpreter (OR = 0.54, 95% CL: 0.35-0.84). The same was not true for non-Medicaid patients. Survey analysis (n = 52) showed respondents identifying as Black or African American were 25% less likely to report receiving the after-visit summary compared to respondents who identified as white (p < 0.01). Discussion: The results presented here illustrate how nutrition communication in the prenatal period can differ by patient race, financial security, and language. Translation to Health Education Practice: Culturally humble efforts to understand drivers of healthcare communication are needed to eliminate inequalities. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

The aim of this article is to review the psychometric properties of the psychological tests that are being used in the Nordic countries during pregnancy and the child's first two years of life. A systematic literature search was performed for 33 identified tests routinely used in health care, using specific review databases as well as PsycInfo, Embase and Medline. The trained authors conducted an overall assessment of quality for each test which was then verified by the editors. A total of 12% of the tests were rated at Level 1 'Low level of quality', 61% at Level 2 'Some evidence of Quality', 15% at level 3 'Good level of Quality' and 12% at Level 4 'High level of quality'. This indicates that the evidence for the psychometric properties is insufficient for many tests used in the Nordic countries for this purpose

Whether there is a relationship between oxytocin (OXT) use in labor and the risk of autism (ASD), and the nature of such relationship, is unclear. By integrating genetic and clinical data in a sample of 176 ASD participants, we tested the hypothesis that OXT is a marker for abnormal prenatal development which leads to impairments in the process of labor. OXT-exposed ASD had more obstetric complications (P = 0.031), earlier onset of symptoms (P = 0.027), poorer cognitive development (P = 0.011), higher mutation burden across neurodevelopment genes (P = 0.020; OR = 5.33) and lower transmission of polygenic risk for ASD (P = 0.0319), than non-exposed ASD. OXT seems to constitute a risk indicator rather than a risk factor for ASD, which is relevant for diagnostic and genetic counselling.

In 2004, the government of Punjab, Pakistan introduced a conditional cash assistance program for girls attending secondary schools. We exploit variations in exposure to the program across cohorts and regions to estimate the long run effects of the program on women's marriage and fertility decisions, maternal healthcare utilization and the health outcomes of their children. We find that each potential year of exposure to the program increases the probability of completing secondary school by 1.9 percent and decreases the probability of an early marriage by 3.5 percent. Exposure to the program also delays early childbirth and increases the likelihood of seeking prenatal care later in life. We also find evidence of inter-generational effects -- children of women exposed to the program are less likely to be underweight (-1.7 percent) or stunted (-1.9 percent) than the comparison sample. Evidence suggests assortative matching in the marriage market, increased health awareness and empowerment of educated women may be among the potential drivers of these results. These findings imply that programs aimed at promoting girls' education can lead to beneficial long run gains in multiple dimensions that should be factored in evaluating such policies.

The prevalence of autism is rising, a dynamic attributed to numerous explanations (e.g. better diagnostic practices, decreased stigma). As this neurodevelopmental disability increases in visibility, disparities in its diagnostic rate grow. Female and Black populations in the United States have historically lower prevalence, are diagnosed later, are more likely to have co-occurring intellectual disability, and experience exclusion from research. Autistic Black girls are effectively invisible in the literature. To combat this exclusion, this narrative review discusses intersectionality theory and how it may be used to provide integrated models that are inclusive toward diverse gender, ability, and racial/ethnic backgrounds. Systemic inequalities, including prenatal care and misdiagnosis, disproportionately negatively impact the quality of care available to female and Black autistic populations. The authors recommend that research include autistic populations with co-occurring intellectual disability, include a diagnostic evaluation as part of protocols, and clinically, universal screening and improved provider competence and confidence in working with diverse autistic populations.

This article concerns knowledge negotiations as an aspect of interactional power in three-way interaction between Arabic-speaking women, Swedish-speaking midwives and interpreters in Swedish antenatal care. The notion of epistemic stance is used to investigate how all three participants negotiate knowledge, and how this affects the ongoing consultation. The data consist of audio recordings of 33 consultations, involving five midwives. Using an interaction analytical approach, the study focuses on sequences where the pregnant woman makes her voice heard, possibly challenging the midwife or the Swedish antenatal care programme. Three different ways in which the epistemic stances of the participants unfold interactionally are analysed: (1) the midwife and the pregnant woman mutually adjusting their knowledge claims; (2) the pregnant woman unsuccessfully attempting to claim knowledge; and (3) participants jointly asserting the midwife's knowledge. Importantly, all three participants wield their interactional power through various ways of negotiating knowledge, which contrasts with the idea of the interpreter as fully neutral and detached. The knowledge claims of the pregnant women and the midwives in the data are also shown to be highly dependent on the interpreters' competence and performance.

Background: Women with intellectual and developmental disabilities face poorer reproductive and pregnancy outcomes partially due to health care inequity. Our objective was to conduct a scoping review of reproductive and pregnancy related health care among women with intellectual and developmental disabilities. Methods: We systematically reviewed three databases for keywords pertaining to pregnancy, reproductive health, and intellectual and developmental disabilities. Two reviewers screened abstracts and extracted full text. We synthesised included papers, identifying common themes. Results: Thirty-six papers met review criteria. Women with intellectual and developmental disabilities had lower fertility rates and were less likely to receive adequate sexual education compared to peers. While most women received prenatal care, uptake was lower and received later than women without intellectual and developmental disabilities. Conclusions: Pregnancy-related health care is often lacking for women with intellectual and developmental disabilities. There are gaps inhibiting our understanding which prevents action to reduce health disparities.

K-12 gifted and talented programs have struggled with racial, ethnic, socioeconomic, native language, and disability inequity since their inception. This inequity has been well documented in public schools since at least the 1970s and has been stubbornly persistent despite receiving substantial attention at conferences, in scholarly journals, and in K-12 schools. The purpose of this article is to outline why such inequity exists and why common efforts to combat it have been unsuccessful. In the end, poorly designed identification systems combined with larger issues of societal inequality and systemic, institutionalized racism are the most likely culprits. I end the article with a hierarchy of actions that could be taken--from low-hanging fruit to major societal changes--in order to combat inequity in gifted education and move the field forward.

Extensive research has established that fathers' engagement in parenting benefits children, but few studies have described how fathers contribute to child development even before birth. In this article, we consider both direct and indirect pathways through which expectant fathers shape child development during the prenatal period. Regarding direct pathways, we review work on expectant fathers' contributions to child development through genetic and epigenetic processes, as well as neuroendocrine mechanisms. Regarding indirect pathways, we outline ways in which expectant fathers indirectly influence child development through the couple relationship. In so doing, we seek to provide a foundation from which to formulate future lines of inquiry on the role of expectant fathers in child development. This research can inform clinical interventions and policies geared toward improving the early caregiving environment and child development.

We explored the association between caregiving for preschool children with developmental disabilities and maternal health and healthcare use using linked primary care and Born in Bradford birth cohort data. Adjusting for prenatal health, healthcare use and socioeconomic status, mothers who were caregivers were more likely than other mothers to have symptoms of psychological distress (odds ratio 1.24; 95% CI 1.01, 1.53), exhaustion (1.42; 1.12, 1.80) and possibly head and musculoskeletal pain (1.18; 0.97, 1.43). Despite the higher prevalence of symptoms, they did not access healthcare services more and may seek healthcare for psychological distress less often (0.64; 0.40, 1.02). In general, socioeconomic disadvantage was associated with worse health. Pakistani ethnicity (versus white British) and prenatal consultation were strongly associated with higher postnatal consultation rates. Prenatal ill health, healthcare use and socioeconomic status are important factors in the detection of postnatal ill health via primary care services. If caregiver burden and the risk of under-detecting (and thus under treating) caregiver ill health is not addressed during the preschool period health inequalities between caregivers and other mothers and their families may persist and grow. The health of mothers of young disabled children, in particular their unmet health needs, warrants attention in research and clinical practice.

Stunting is an important issue as it leads to many adverse consequences on children's health. Pakistan is in public health crisis due to higher stunting rates in children. World Health Organization entails the prevalence of stunting to be less than 2.5% in a healthy population, but every third child is stunted in Punjab (largest province of Pakistan by area and population). By using the Multiple Indicator Cluster Survey (MICS) Punjab, 2018 and employing multilevel logistic regression analyses, this study finds that children whose mothers are educated and have better access to drinking water and antenatal care have lower odds of stunting. Access to better and accessible health care, education especially of girls/women, and clean water can reduce stunting in children. The government needs to give special attention to these factors to help children grow healthy.

Background: While the Texas infant mortality rate (IMR) is below the Healthy People 2020 objective (5.7 per 1,000 live births), stark differences in IMR are seen across Texas communities. Health indicators for the state suggest important missed opportunities for improving maternal and infant outcomes. The Healthy Families initiative was a collaboration between a Texas state agency, community partners, and academic institutions to understand how evidence based interventions could be identified, adapted, and implemented to address community priorities and reduce disparities in pregnancy outcomes. Method: The Healthy Families initiative included two Texas counties, one with low utilization of prenatal care and one with persistent disparities in infant mortality. The model served to (1) identify community factors influencing IMR and maternal morbidity through stakeholder engagement and secondary data, (2) build community capacity to link pregnant women with existing and newly developed services, and (3) develop partnerships within the community and clinics to improve access to and sustainability of services. Results: A community-based participatory approach focused on stakeholder engagement was used to identify, design, and adapt strategies to address community-identified priorities. Conclusions: The Healthy Families initiative is a unique state-community-academic partnership aimed at improving pregnancy outcomes in vulnerable communities, with a focus on promotion of capacity building, maintenance, and sustainability of maternal and infant health programs

Purpose: Group prenatal care, which integrates medical care with patient education and empowerment in a group setting, has the potential to build social support among pregnant women and reduce the risk of postpartum depression (PPD). Past research on group care's effects on social support or PPD has produced inconsistent findings. Studies have tended to (1) examine direct effects on social support or PPD and (2) treat group care participation as a dichotomous variable. This study tests the hypothesis that group care has an indirect effect on PPD through its effect on social support. It uses both a dichotomous measure of group care participation and an ordinal measure of social contact with group members. Method: This study used survey data from 199 women at two Tennessee health care sites who participated in traditional care (TC)or Supportive Pregnancy Care (SPC), a new group program developed by March of Dimes. Path analysis was employed, estimating standardized path coefficients with propensity score weighted multilevel modeling. Results: The study found no evidence of an indirect relationship between SPC and PPD symptoms when modeling the dichotomous measure. Modeling the ordinal measure revealed more favorable PPD outcomes among women reporting high group member contact (compared with TC) and adverse outcomes among women reporting low group member contact. Conclusion: SPC may be useful for preventing PPD symptoms among women socially engaged with other group care patients. Given the adverse effect among women who do not engage with other group members, group facilitators should encourage women to interact outside of scheduled sessions.

Maternal health-seeking behavior (MHSB) is crucial for maternal health. However, little is known about MHSB in the Democratic Republic of the Congo (DRC). This study aims to evaluate the situation and socioeconomic associates of MHSB in the DRC. Based on the responses of 8,360 participants in a nationally representative survey, we adopted a K-modes cluster analysis algorithm to categorize women into three groups (i.e., infrequent service-users, partial service-users, and full service-users) according to their recent MHSB. Multinomial logistic regression was applied to identify the associated predictors of MHSB. The results show that most women (90.29%) did not receive integral maternal health services, including antenatal care, institutional delivery, and postnatal care. Compared with their counterparts, women who received higher maternal educational attainment, had good HIV-related knowledge, lived in urban regions, and lived in wealthier households were more likely to be partial service-users or full service-users. Women exposed to mass media at least once a week were more likely to be full service-users rather than infrequent service-users. The majority of participants who lived in Kasai and near provinces were infrequent service-users, indicating poor MHSB status in the region. Interventions to promote maternal health knowledge and awareness are highly recommended to improve MHSB in the DRC.

Despite the wide spread awareness regarding the need to improve maternal health, maternal mortality remains a great concern in Nigeria. Consequently, the importance of medical attention required in the care of pregnant women cannot be over emphasised. This study investigates the influence of barriers to attending antenatal care among pregnant women in Ibadan. Using a survey method, a total of 114 pregnant women were purposively selected from Akinyele Local Government Area of Ibadan.Data were analyzed using descriptive statistics, t- test and one way analysis of variance at 0.05 level of significance. Three hypotheses were tested. Results revealed that pregnant women who had more barriers (N = 54, mean = 4.5) were less likely to attend antenatal care than women who had fewer barriers (N = 60, mean = 5.6). Pregnant women who had no children (nulliparous) attended antenatal care more than pregnant women who have had at least one child (multiparous) (t (112) = 1.2 p< 0.05).Thus, barriers should be reduced by making antenatal care mobile and health care givers should be re- trained to develop more positive attitude towards better service delivery especially to pregnant women during antenatal period.

Hemolytic disease of the newborn (HDN) is a potentially fatal condition caused by a Rhesus (Rh) antigen incompatibility between a mother and fetus. As a result, determining the Rh status of expectant parents is a routine clinical assessment. Both the physiological and immunological basis of this condition are taught to undergraduate students. At the University of South Australia, some undergraduate immunology students find this topic challenging. The author designed, implemented, and assessed the impact of an interactive simulation to facilitate student learning of HDN. The students were actively engaged in determining the blood grouping and Rh status of an expectant mother and father and then determining the possibility of developing HDN. The simulation was found to take only 15 min to complete yet led to a significant increase in student performance in an end of semester exam question. Student perceived understanding was found to significantly improve following the introduction of the simulation, even though the content had been covered in a formal lecture. Student feedback was highly positive of this learning approach. In conclusion, short, interactive simulations can be used effectively to enhance student learning of challenging concepts.

Protecting an unborn baby from abuse and neglect presents particular challenges for professionals due to the uncertainties about appraising future harm and functioning of family relationships. This systematic narrative review synthesises studies of professional decision making by health and social care professionals regarding child protection of an unborn baby. Five bibliographic databases (ASSIA, CINAHL Plus, Ovid MEDLINE, PsycINFO, Social Care Online) were searched using an explicit and robust search; papers identified as relevant were appraised for quality and combined using a narrative synthesis based on the main themes in the papers. Ten papers met the inclusion criteria, including qualitative studies, surveys and randomised trials of the effectiveness of decision support tools. The papers identified the following case risk factors relating to risks to an unborn baby: alcohol abuse; ante-natal care; previous children in care; domestic violence; drug abuse; lack of education; employment issues; unrealistic expectations of the baby; housing issues; learning disability; feelings about pregnancy; low socio-economic status; mental illness; mother's childhood experiences; lack of parenting capacity; physical disability. There were several papers on developing risk assessment tools. A few papers focused on risk assessment and decision processes including engagement with pregnant women. There was some discussion of psychosocial supports for risks in pregnancy. There is useful published material on the range of risk factors, and more limited material on the development of assessment tools and on decision processes. The psychosocial supports that might be provided to the pregnant woman as decision options is an area for future research.

Objective: To provide an overview of college health centers' practices surrounding education, counseling and referral after a patient receives a positive pregnancy test. Participants: College health centers that participated in the annual ACHA Pap Test and STI Survey years 2008 to 2014. Methods: Descriptive analyses for items regarding all-options and limited counseling/education and types of referrals (adoption, abortion and prenatal care) provided to students. Chi-square statistics were calculated to examine trends over time and differences between demographic characteristics. Results: There were no significant differences across time but there were significant differences between regions of the US and if the institution was faith-based, though few had strong association values. Conclusions: The results indicate most college health centers are following best practices regarding counseling and education for a positive pregnancy test result. Understanding limitations for those institutions not in compliance require further exploration.

Birthing disparities in the United States are racialized and consistently show that Black women and Black birthing people face the highest risk. This article presents a historical context from which these disparities grew to acknowledge the roots of modern day institutionalized and systemic racism in maternal health care that undeniably effect the outcomes seen. The solution to eliminating the racial birthing disparities is multipronged. The authors share a racial concordant, integrated behavioral health model of perinatal care that promotes prioritizing culture-specific knowledge, traditions, and birthing practices that can be integrated in hospital and medical settings to buffer expecting Black families from obstetric oppression and violence. A call to action to standardize sanctuary birthing for Black families in our medical systems and the appointment of Black leadership to lead the charge is recommended.

According to the WHO data, preeclampsia develops during late pregnancy in 2-8% of women. Preeclampsia is a major cause of maternal and perinatal morbidity and mortality, therefore, the study of the morphological features of placental complex, taking into account gestational complications in postpartum women with severe preeclampsia is an important factor for finding the optimal treatment during pregnancy. The study was conducted on a placental complex (placenta, umbilical cord, fetal membranes) obtained from 24 pregnant women (10 pregnancies without complications, 14 with severe preeclampsia) of the first maternity home in Aktobe city. Paraffin histological sections were stained with hematoxylin-eosin and by using Van Gieson's stain. In the presence of severe preeclampsia, villi walls of separate blood vessels are sclerotic; sometimes vessels are dilated and filled with blood. Areas of eosinophilic accretions on the surface of the chorionic plate increased significantly, up to 15,9 ± 0,6%, areas of Langhans fibrinoid contacting terminal villi--up to 15,3 ± 1,2%. Rohr area on the basal lamina increased up to 21,1 ± 1,1%, along with increase in the number and area of decidual cells--up to 11,3 ± 1,14%. There was an increase in the number and area of terminal villi, up to 4,6 ± 0,45%. Arterial blood vessels of the umbilical cord lost annular invagination rolls into the lumen of the vessel. The study showed consolidation and infiltration of cellular elements of the fetal membranes. In response to strengthening of the destructive processes (inflammation, apoptosis), one could observe more pronounced compensatory and adaptive processes in the form of strengthening fibrinoid barriers aimed at eliminating defects of the fetoplacental barrier and at increasing the number of terminal villi, in the development of placental insufficiency.

Foetus developmental vulnerability in pre-school children of traumatized antenatal mothers in Cheptais and Mount Elgon Sub-Counties, Bungoma County, Kenya is a study meant to establish the effects of trauma of the mother on the unborn child who was born and now is in pre-school level of education. Through observation by the mother through neonate, infant and childhood stages of developmental milestones in relation to the same observation of non-traumatized mothers, children. Their conclusion is supported by the observation of the same children by their teachers in pre-schools. The sampling strategy involved non-probability where purposive and snow-ball observation, analysis and probability, sampling where multistage or cluster was the most appropriate for observation and units of analysis to make units of representative sample of Cheptais and Mount Elgon subcounties. Majority of the children born to traumatized mothers had developmental problems associated with disabilities as opposed to those mothers who resisted trauma; hence associating trauma with developmental problems.