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Background: Race and ethnicity influence the distribution and severity of hypertensive disorders of pregnancy (HDP) in the U.S. population, although the impact of prior infant loss on this relationship requires further investigation. Objectives: The aim of this study was to assess the relationship between history of infant loss and the risk of HDP by maternal race and ethnicity. Methods: For this large cross-sectional study, data were analyzed from the National Center for Health Statistics Vital Statistics Natality Birth Data, 2014–2017. The primary outcome was HDP, and the primary predictor was infant loss after prior live birth. Maternal race/ethnicity was the secondary predictor categorized as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Asian, or Other. Multiple logistic regression was used to assess the association between history of infant loss and HDP by race and ethnicity. Results: The 9,439,520 women included in this sample were 51% NHW, 15% NHB, 25% Hispanic, 6% Asian, and 3% Other with a mean age of 29.8 ± 5.3 years. In adjusted analyses, infant loss after prior live birth was significantly associated with an 11% odds of HDP (OR 1.11, 95% CI 1.08, 1.13). Stratified by race, NHB (OR 1.28; 95% CI 1.21, 1.36) women had significantly higher odds of HDP, and Hispanic (OR 0.84, 95% CI 0.79, 0.90) and Asian (OR 0.85, 95% CI 0.75, 0.97) women had significantly lower odds compared to NHW women. Within races, all women with infant loss after prior live birth had significantly higher odds of HDP (p< .001), except Other women (p= .632). Conclusions: Infant loss after prior live birth was significantly associated with higher odds of HDP among NHB women after adjusting for covariates. Further research is warranted to assess underlying mechanisms associated with higher odds of HDP in NHB women. [ABSTRACT FROM AUTHOR]

The developing field of motherhood studies has led scholars to re-examine the complex nature of maternal identity, yet only recently has attention turned to the figure of the childless mother--the woman who has experienced pregnancy and perhaps childbirth but who has no living children. The silence surrounding infant loss has greatly limited representa

Infant loss occurring prior to, during, or up to one year after birth, is a relatively common event that often affects mothers and fathers deeply. Although infant loss is most commonly characterised as a loss event, it can also be highly traumatic and lead to posttraumatic stress disorder (PTSD) with prevalence rates falling in the moderate-to-severe range compared to other traumatic events. Pre- and post-loss risk factors associated with PTSD following other types of trauma also predict PTSD following infant loss. Early identification of PTSD is extremely important, as the disorder is severely under-diagnosed in the parent population and may have a high number of adverse effects for the bereaved parent as well as his/her family, including children born subsequent to the loss. [ABSTRACT FROM AUTHOR]

Loss of a child from a multiple birth pregnancy is not uncommon yet the idiographic experience of parents who have lost a single twin from a multiple birth pregnancy is underexplored. This novel study sought to explore the experiences of mothers bereaved after loss of a twin from a multiple birth pregnancy, focusing on the dual challenges of parenting and grieving. Eighteen mothers at least 12 months post loss were recruited from a private UK based Facebook page dedicated to supporting parents after loss from a multiple birth. Eligible mothers completed an independent qualitative open-ended survey to explore maternal experiences of loss. Data were analysed using Thematic Analysis. Findings represented a sense of duality for participants, with mothers experiencing conflict between roles and identities as well as the nature of their loss. Key themes identified include 'Narrating a story of family and loss', 'Finding a place for the twins within the family' and 'A changing sense of self'. Findings fit with theoretical conceptualisations of bereavement that acknowledge retaining relationships with the deceased. Practically, suggestions for supporting mothers to identify stock answers to often asked questions about family make up were suggested. [ABSTRACT FROM AUTHOR]

Despite the high rate of infant mortality in Ghana, few studies have explored the maternal experience of infant loss and the perinatal grieving process. As part of a larger study that interviewed 153 mothers with a sick infant, this 1-year follow-up study reinterviewed eight mothers from the original cohort whose infant died since the study began. Mothers were queried about mental health, coping, and cultural issues related to the loss. Mothers were often discouraged from speaking or thinking about the death due to fear of psychological harm and impact on fertility. Primary coping mechanisms involved seeking support within the community and accepting the loss as God's will. Mothers desired more communication from health-care providers at the time of death. Despite the cultural norm of silent acceptance in the face of perinatal loss, intense maternal grief and desire to mourn may allow more opportunities for health-care workers to support bereaved mothers. [ABSTRACT FROM AUTHOR]

Background: Parents who experience a perinatal loss often leave the hospital with empty arms and no tangible mementos to validate the parenting experience. Opportunities to create parenting experiences with transitional objects exist following the infant's death.Purpose: This article offers suggestions for staff in units where infant loss is possible to best assist parents in optimal grieving through the offering of transitional bereavement objects.Methods/search Strategy: CINAHL Complete, MEDLINE, and the Cochrane Database of Systematic Reviews were searched using the following key words-perinatal bereavement, grief, perinatal loss, transitional objects, bereavement photography-and the search was limited to 5 years and the English language.Findings/results: Recommendations exist and are well supported by leading neonatal and perinatal nursing and medicine organizations for the use of transitional objects to facilitate healthy grieving when parents experience perinatal loss. Transitional objects are mementos that validate the meaning of parenthood-even if the physical act of parenting was brief. Nursing and medical staff have significant roles in guiding parents to a healthy state of bereavement and ultimately managing long-term grief.Implications For Practice: Transitional objects can be provided by staff that are low-cost or free, such as taking photographs for parents, or they can involve purchased products from perinatal bereavement programs. In the latter case, funding needs are a consideration for budgeting decisions.Implications For Research: Immediately following a loss, parents experience a brief sense of healing after receiving mementos of their infant. However, further research is needed to assess long-term effects of receiving transitional objects following perinatal loss. [ABSTRACT FROM AUTHOR]

Background: Haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) is a high-risk pregnancy condition that could be fatal to mother and/or baby. It is characterised, as the acronym indicates, by haemolysis, elevated liver enzymes and low blood platelets. Objective: This study explored women in Cape Town’s psychological experience of HELLP syndrome. Method: Six participants who previously experienced HELLP syndrome were interviewed. Using a grounded theory approach, themes emerged and a model illlustrating the psychological experience of HELLP syndrome was constructed. Results: The major themes that emerged were the perceived lack of information, a need to assign blame and a shift in focus. Themes of not knowing and trance and/or surreal experience underpin the cognitive aspects of the HELLP syndrome experience. Themes that expressed feelings of an inability to control, whirlwind and/or rapid pace and support acted together to bind the experience. Finally, emotions such as anger, ambivalence, disbelief, anxiety, guilt, loneliness and fear were present throughout the experience. Conclusion: This study developed an initial exploratory model representing the psychological experience of HELLP syndrome in a sample of South African women. Underlying this entire experience was a perceived lack of information which had a profound effect on numerous aspects of the experience ranging from where to locate blame to the varied emotions experienced. Agtergrond: Die HELLP sindroom is ‘n hoë-risiko swangerskap toestand wat kan dodelik vir moeder en/of baba wees. Dit word gekenmerk deur hemolise, verhoogde lewerensieme en lae bloedplaatjies. Doelwit: Hierdie studie het Suid-Afrikaanse vroue se sielkundige ervaring van die HELLP sindroom ondersoek. Metode: Ses deelnemers wat voorheen HELLP sindroom ervaar het is ondervra. Met die gebuik van gefundeerde teorie as ‘n teoretiese raamwerk en ontleding het temas na vore gekom en ‘n model wat die sielkundige ervaring van HELLP sindroom illustreer, is gebou. Resultate: Die vernaamste temas wat na vore gekom het was die oënskynlike gebrek aan inligting, ‘n behoefte om skuld toe te skryf en ‘n verskuiwing in fokus. Die tema van nie weet en beswyming en/of surrealistiese ervaring ondersteun die kognitiewe aspekte van die HELLP sindroom. Temas wat gevoelens van geen beheer, warrelwind en/of vinnige tempo en ondersteuning uitgesprek het, het saam opgetree om die ervaring te bind. Ten slotte, emosies soos woede, teenstrydigheid, ongeloof, angs, skuldgevoelens, eensaamheid en vrees was teenwoordig in die hele ervaring. Gevolgtrekking: Hierdie studie het van’n aanvanklike ondersoekende model van die sielkundige ervaring van HELLP sindroom tot ‘n steekproef van die Suid-Afrikaanse vroue ontwikkel. Onderliggend aan hierdie hele ervaring was ‘n oënskynlike gebrek aan inligting wat ‘n diepgaande uitwerking gehad het op talle aspekte van die ervaring wat gewissel het van waar om die blaam te plaas tot die uiteenlopende ervaarde emosies.

This article presents bereaved parents’ perceptions of their parents’ (the grandparents) reactions at the time of loss and in the pregnancy that follows. Data originated from two phenomenological studies conducted to understand bereaved parents’ experiences during their loss and subsequent pregnancy. However, this article reports a secondary thematic analysis focused on bereaved parents perceptions of the grandparents’ support (or lack of) at the time of loss and during the pregnancy following loss. Our findings illustrate some families found the means to share their grief at the time of loss in a constructive manner, while in others the intergenerational relationship was strained. Most important to parents was intergenerational acknowledgment of the ongoing relationship to the deceased child as an important, though absent family member, especially during the pregnancy that followed. Those supporting bereaved families can play an important role in helping intergenerational communication around perinatal loss and the subsequent pregnancy. [ABSTRACT FROM PUBLISHER]

Infanticide by males is common in mammalian species such as primates in which lactation lasts much longer than gestation. It frequently occurs in one-male groups following male takeovers and is likely a male reproductive strategy. Reported female countertactics include abrupt weaning of infants, dispersal, or paternity confusion. Here, we estimated costs of female countertactics in terms of weaning ages and interbirth intervals. We observed a population of white-headed leaf monkeys ( Trachypithecus leucocephalus) in Nongguan Nature Reserve, China (1995-2006) mainly composed of one-male groups. Takeovers ( N = 11) coincided with the peak conception period. Detailed data are presented for five takeovers (34 females, 29 infants, and 47 group-years) leading to six infant disappearances (42.9% of infant mortality). All presumed infanticides were in accordance with the sexual selection hypothesis. Following a takeover, females without infants or with old infants stayed with the new males, incurring no or low costs (via abrupt weaning). Females with young infants dispersing with the old males also experienced low costs. High costs (due to infant loss) were incurred by pregnant females and those with young infants who stayed with the new males indicating that paternity was not confused. Costs in terms of long interbirth intervals were also high for females leaving with the old males to later join the new males, despite infant survival. Female countertactics reflected female philopatry mediated by infant age. Presumably due to the seasonal timing of takeovers, most countertactics seemed successful given that 32.3% of females apparently incurred no costs and 41.2% incurred only low costs. [ABSTRACT FROM AUTHOR]

The evolution of social monogamy in larger mammals is difficult to explain because males usually do not invest much in direct offspring care and might achieve greater fitness by deserting a pregnant female to reproduce with additional females elsewhere. It has been hypothesized that socially monogamous males remain with the female year-round to protect their offspring from infanticide by new immigrant males. We investigated this idea by analyzing all cases of infant loss in a wild population of white-handed gibbons ( Hylobates lar; Primates), in which most groups were socially monogamous and some polyandrous (137.5 group years). We examined the influence of (a) male intruder pressure on male immigration rates and (b) the presence of a new male in the group on infant loss. We found no relation between intruder pressure and male immigration rates. Infant loss was lowest (4.5%) for stable monogamy (probable father stayed from conception through infancy) and intermediate (25.0%; p = 0.166) for stable polyandry. If a new male immigrated after conception, however, the infant was lost in all cases ( p < 0.01) independent of the presumed father's presence. Overall, 83.3% of infant losses were associated with the presence of a presumably unrelated male. Although the sample size is small, our results provide the first true support for the idea that the risk of infanticide is an important factor in the evolution of social monogamy in larger mammals. [ABSTRACT FROM AUTHOR]

Graphic representation of infant loss-mediated impact on emotionality and neuropeptide systems – what is known in women and rodents. Illustration by Carola Demarchi. [Display omitted] • The mother-child bond is the most enduring bond in life. • Losing a child is devastating, increasing the susceptibility for grief disorders. • We provide evidence for potential roles of OXT and CRF systems in grieving mothers. • These neuropeptide systems are involved in maternal behavior and stress response. • Future research is needed to understand the neurobiology of grief in motherhood. The bond between a mother and her child is the strongest bond in nature. Consequently, the loss of a child is one of the most stressful and traumatic life events that causes Prolonged Grief Disorder in up to 94 % of bereaved parents. While both parents are affected, mothers are of higher risk to develop mental health complications; yet, very little research has been done to understand the impact of the loss of a child, stillbirth and pregnancy loss on key neurobiological systems. The emotional impact of losing a child, e.g., Prolonged Grief Disorder, is likely accompanied by dysregulations in neural systems important for mental health. Among those are the neuropeptides contributing to attachment and stress processing. In this review, we present evidence for the involvement of the brain oxytocin (OXT) and corticotropin-releasing factor (CRF) systems, which both play a role in maternal behavior and the stress response, in the neurobiology of grief in mothers from a behavioral and molecular point of view. We will draw conclusions from reviewing relevant animal and human studies. However, the paucity of research on the tragic end to an integral bond in a female's life calls for the need and responsibility to conduct further studies on mothers experiencing the loss of a child both in the clinic and in appropriate animal models. [ABSTRACT FROM AUTHOR]

This paper describes approaches that may be used in consulting with the bereaved mother about engorgement and involution. The physical and emotional facets of this experience are intricately interwoven and lactation consultants should be aware that mothers may need a number of health care professionals to meet their needs. Suggestions for milk suppression, communication enhancement, and emotional support are offered. [ABSTRACT FROM PUBLISHER]

Mobile health (mHealth) short message system (SMS) interventions for maternal and child health (MCH) are being implemented globally. In many low- and middle-income settings in which these mHealth interventions are being rolled out, stillbirths and neonatal and infant deaths are common. It is important that mHealth solutions do not exacerbate emotional stress and pain by continuing with routine messaging for pregnancy or infant care when someone has experienced loss. In this brief viewpoint paper, we argue that SMS programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth, and infant loss. [ABSTRACT FROM AUTHOR]

Objective: To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss., Design: A qualitative, descriptive design with secondary data analysis., Setting: The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States., Participants: Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review., Methods: We used thematic analysis to analyze interview data., Results: Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death., Conclusion: Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Despite its prevalence worldwide, stillbirth is poorly understood and rarely discussed. Accordingly, ministers and other pastoral caregivers are seldom prepared to counsel and console parents suffering from this type of infant loss and to effectively design, propose, and lead ministries within their faith communities for this grieving population. This article addresses the immediate pastoral needs of bereaved parents and proposes first and second order responses that ministers and faith communities can employ to compassionately and effectively care for parents suffering from the trauma of stillbirth., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

This article presents secondary analysis of data from parents who, 50 to 70 years ago, birthed stillborn babies or babies with lethal anomalies and from adult children born after these losses. The stories reflect a time in history when parents were "protected" from seeing or holding their babies and mothers were unable to attend the funeral. There was no understanding by society or caregivers for parents' need to process the loss or resources to build memories. They provide a strong argument for health care providers to offer such resources to parents today and offer grief support.