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Item Intergenerational effects of violence on women's perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam(BioMed Central Ltd, 2021-12) Do HP; Baker PRA; Van Vo T; Murray A; Murray L; Valdebenito S; Eisner M; Tran BX; Dunne MPBACKGROUND: Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. METHODS: A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. RESULTS: One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = - 1.3). CONCLUSION: These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women's previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.Item Vaccination in Aotearoa : the role of anticipated regret, temporal discounting and maternal mental health : a thesis presented in partial fulfilment of the requirements for the qualification of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2023) Kember, SarahBackground. Uptake of childhood vaccines in Aotearoa remains consistently lower than necessary for population immunity. Understanding drivers for vaccine hesitancy is a complex but essential exercise. New and expectant mothers are generally primary decision-makers about vaccination for their babies, yet the crucial timeframe for those decisions coincides with the highest risk period for perinatal anxiety and depression. Study aims. This study was designed to test the hypothesis that anxiety and depression in pregnancy and postnatally have an effect on vaccination rates, given research support for a link between psychological distress and decision-making challenges. Decision theory guided the study, specifically temporal discounting, and anticipated regret. Participants’ own perspectives about key influences on their decisions were also explored. Methods. The study was a cross-sectional survey of new and expectant New Zealand mothers, recruited via social media – N = 387 (quantitative); N = 411 (content analysis). Survey items included existing measures (EPDS, GAD-7, MCQ) alongside purpose-built items and open-ended questions. Possible confounds, ethnicity and socio-economic status, were identified from a literature search and statistically controlled. Results. Anticipated action regret (action and inaction) was strongly and significantly correlated with vaccination intention. However, the hypothesised relationships between temporal discounting and either perinatal depression or anxiety were not observed. Further, neither anticipated regret nor temporal discounting had the expected effects on vaccination intentions. The observed depression/intention relationship was negligible, and anxiety was moderately, statistically significantly, and (contrary to prediction) positively correlated with intention. The sixth hypothesis (partial mediation of the distress-intention relationship by temporal discounting and anticipated regret) was also unsupported. Content analysis of open-ended questions suggested six main categories of influence on vaccination intentions - beliefs (safety/risk, effectiveness); knowledge/experience; health protection; formal sources (health officials/professionals); social (whānau/family, others); and pragmatic. Latent themes - fear and confidence, underpinned each category. Most participants reported no change, unless a strengthening of their position, due to the COVID-19 pandemic. Conclusions. Overall, there was evidence of a strong relationship between anticipated regret and vaccination intentions. However, perinatal depression did not have an observable effect on intentions, and – contrary to predictions - perinatal anxiety increased, rather than decreased, intention to vaccinate. Although the hypotheses were not supported here, the findings nevertheless suggest that intention is impacted by predicted regret about the consequences of that decision. Furthermore, a role for anxiety or regret in vaccination decision-making was supported by analysis of participants’ self-reported key influences on their decision-making. In this sample, limited variance in levels of elevated levels of either depression or anxiety (most experiencing no to low symptoms) or vaccination intentions (most being pro-vaccination), potentially affected the results obtained. Further investigation of the role of emotion and perinatal distress relationship is justified.Item Dietary choices of New Zealand women during pregnancy and lactation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2020) Brown, Kimberley JaneBackground: A woman and her offspring’s health is affected by the maternal diet during pregnancy and lactation. Because of the importance of the diet, there is a large emphasis on women making optimal dietary choices, as recommended by specific guidelines, in pregnancy and lactation. Dietary recommendations are different from other life stages because of altered nutrient requirements and a heightened need for food safety practices. Currently, there is limited evidence available about dietary choices, food safety practices, and sources of nutrition information of New Zealand women during pregnancy and lactation. This information is important to inform strategies to improve the support that women receive during pregnancy and lactation as it identifies what recommendations are currently being effectively communicated. Aim: To investigate New Zealand women’s dietary choices, food safety practices, and sources of nutrition information during pregnancy and lactation. Methods: Women from New Zealand were invited to participate in this observational study between January and June 2019. Participants were required to be pregnant or within six months postpartum. Women completed a demographic, pregnancy food frequency, and food choice questionnaire during or retrospectively to their pregnancy. Postpartum women also completed a lactation food frequency and food choice questionnaire. Results: Women (n=458) consumed a range of foods from the four food groups (fruit and vegetables, breads and cereals, milk and milk products, and meat/meat alternatives/eggs). A large percentage reported adding or increasing, limiting, and avoiding foods. Cow’s milk, the most frequently daily consumed dairy product, was more commonly reported in pregnancy (93%) than lactation (64%). A range of fruit, vegetables, protein, and grain foods were consumed daily in pregnancy and lactation. The majority of women followed food safety recommendations in particular avoidance of alcohol (92%), raw milk products (86%), and raw/smoked/precooked fish/seafood (84%). Dietary information was acquired from a range of sources. The greatest dietary influences included midwives, New Zealand pregnancy and breastfeeding guidelines, and family/friends. Women also frequently reported receiving dietary advice from their lead maternal carer, handouts, the internet, and alternative health practitioners. During lactation, women received information from more potentially unreliable sources including family/ friends, the internet, and alternative health practitioners. Infant symptoms also frequently affected women’s food choices in lactation. Conclusion: Women implement significant dietary changes during pregnancy and lactation. Women are likely to add, remove, and limit food during pregnancy following the New Zealand pregnancy guidelines; advice from health professionals, the internet, magazines/books/newspapers; or because of food safety concerns. Lactating women are likely to make dietary changes because of infant symptoms or advice received from midwives, alternative health practitioners, family/ friends, and the internet.Item "I could cope so much better if I could just get a good night's sleep" : maternal sleep and mental health from early pregnancy to three years post birth : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand(Massey University, 2020) Ladyman, Clare IonaHealthy sleep is vital to health and wellbeing at all life stages. But for many women, achieving restorative and satisfying sleep consistently throughout pregnancy is challenging. Because vulnerability to experiencing depressive symptoms increases with poor sleep and poor sleep influences the development and trajectory of depressive symptoms, sleep is an important and modifiable factor in the prevention and treatment of depression. Pregnancy is also considered a key teachable life stage as mothers wish to be healthy in order to protect their unborn baby. Yet research investigating non-pharmacological sleep education interventions for preventing perinatal depression is scarce. This thesis comprises three studies that investigate the relationship between maternal sleep health and depression. It presents findings from a scoped review examining sleep health throughout pregnancy; a longitudinal analysis of depression trajectories from late pregnancy to three years post-birth and the association of different sleep dimensions to trajectory group membership; and, the development, implementation and efficacy of a sleep education pilot intervention designed to promote sleep health and reduce the likelihood of depressive symptoms throughout pregnancy. Findings from the scoped review showed that while sleep in pregnancy is highly variable from one woman to the next, significant changes to sleep throughout pregnancy were not indicated for women who were considered physically and mentally healthy. However, the results of the longitudinal analysis revealed that for a sub-group of women, poor sleep was significantly associated with clinically elevated and persistent depressive symptoms throughout the perinatal period and into their child’s preschool years, with the probability of experiencing depressive symptoms especially pronounced for Māori women. The Sleep HAPi pilot study found recruiting and retaining previously depressed women into a longitudinal perinatal sleep education study achievable and the study design highly acceptable to participants. Similar to the results of the scoped review, self-reported sleep duration, quality, timing, continuity and daytime sleepiness remained stable throughout pregnancy, and at intervention end none of the women in this study were experiencing clinically elevated depressive symptoms. Sleep HAPi women were compared to a control group from a previous study with no sleep education component; Sleep HAPi mothers had significantly better sleep initiation and experienced fewer depressive symptoms at intervention completion, though results require confirmation in a larger randomised control group study. Collectively, the findings from these studies highlight the strong relationship between sleep and maternal mental health. Sleep education interventions, such as Sleep HAPi, show promise for minimising depressive symptoms, and optimising sleep for pregnant women. These findings have important health care practice and policy implications and the potential to improve outcomes for mothers, children, families and society.Item Individual and cultural differences in experiences of baby/pregnancy brain : a thesis presented in partial fulfilment of the requirements for the Master of Arts in Psychology at Massey University, Wellington Campus, New Zealand(Massey University, 2019) Turner, TanyaRecent research has found that grey brain matter reduces during pregnancy. This loss is thought to result in a phenomena popularly known as ‘baby/pregnancy brain’ (BB). Research in this area has focused mainly on structural brain changes and quantifying deficits in cognitive function during pregnancy with relatively little attention given to the individual and subjective perceptions of cognitive change. Therefore, this thesis will review current findings regarding BB; and present the results of an online survey regarding BB from the perspective of mothers, midwives and friends/family of mothers. This study utilised a mixed qualitative and qualitative approach. The primary objective was to establish whether experiences of cognitive deficits are universal across New Zealand Māori and European cultures; and secondly, to present particular problems associated with BB and successful coping methods employed to accommodate/avoid BB. Due to the low response to the surveys, particularly by Māori, midwives and friends/family, the view on the influence of culture on BB experiences was severely compromised. As a result the focus of the research was changed to an analysis of the responses to the ‘mother’ survey, rather than focusing on group belief systems. This provided insight into how BB is perceived and experienced by mothers, their key coping methods and the possible elements which may have contributed to their accounts of BB. The mothers surveyed were generally able to cope successfully with the symptoms of BB. However, awareness of the benefits to wellbeing of social support, adequate rest and a healthy lifestyle should be encouraged more strongly in informal social and formal medical care contexts to combat social isolation, cognitive function deficits, anxiety and low moods. Importantly, there is a need to define BB more comprehensively, so that it may be better characterised in research and in discussions amongst/between medical staff and pregnant women.Item How women cope with pregnancy and early mothering after recovery from an eating disorder : a grounded theory of women's experience : a thesis presented in partial fulfillment for the degree of Master of Science in Nutrition at Massey University(Massey University, 2005) Gunn, CarolineThis study used a qualitative approach, specifically Grounded Theory to explore how women who have had an eating disorder earlier in their lives, subsequently "recovered", experienced pregnancy and mothering. Ten women with a previous eating disorder, who were now mothers, were interviewed. Also, eight women without a history of an eating disorder and of comparable body mass were also interviewed for reference purposes. The study aimed to gain an understanding of how a woman recovers from an eating disorder, what the experience of pregnancy is like for them, with an emphasis on weight gain and nutritional needs and how they managed breastfeeding and the introduction of solids. The Grounded Theory developed focused on the core category of "measuring up" and how this need to measure up, cuts across all the women's life stages. The eating disorder is seen as a coping strategy when the need to measure up first presents. As the women were able to access more constructive coping strategies they recovered. For many of the women, exercise became their alternate coping strategy for the need to "measure up". The "recovered" women were very motivated to, and did have healthy pregnancies. Most women wanted nutritional advice during their pregnancy but said they were not offered any by health professionals. Their pregnancies were characterised by predominantly very high weight gains (6/10), a couple of very low weight gains (2/10) with only two women gaining within recommended limits. Their infant's birth weights were above normal, the majority of women breastfed for 9 months and there was no reported difficulty with infant solids feeding. Some women with a previous eating disorder reported difficulty when their own children (girls) reached adolescence. There was considerable eating restraint within the reference group and these were characterised by low prepregnancy BMIs and low pregnancy weight gains. The implications of this research are that young people must be encouraged as early as possible to seek out more constructive coping strategies for feelings of negativity. The recovered women appeared to experience relatively trouble free pregnancies without undue weight gain anxiety and early infant feeding was not problematic. The study highlighted a need for an increased emphasis on nutritional guidance for all women prior to conception and during pregnancy, as there can be significant dysfunction with food and feeding, present in women without a history of an eating disorder.Item Dietary intakes and food sources of omega-6 and omega-3 polyunsaturated fatty acids in pregnant women living in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Human Nutrition at Massey University, Albany, New Zealand(Massey University, 2015) Eickstaedt, MicheleBackground/Aims: Adequate intakes of omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are required for fetal growth, brain development and to support a healthy pregnancy. This study aimed to investigate dietary intakes and food sources of n-6 and n-3 PUFAs in a cohort of New Zealand (NZ) pregnant women. Method: Pregnant women (n=596) in their third trimester of pregnancy from throughout NZ completed an online validated FFQ to assess PUFA intakes over the past three months. Individual and combined intakes of the main PUFAs (linoleic acid, LA; alpha linolenic acid, ALA; arachidonic acid, AA; eicosapentaenoic acid, EPA; docosahexaenoic acid, DHA) were compared with dietary recommendations using frequency summary statistics. Results: Estimated median [25th, 75th percentile] intakes were: 11,580 [8,840, 15,760]mg/d LA (recommended 10,000mg/d), 1,300 [790, 2,120]mg/d ALA (recommended 1,000mg/d), 90 [60, 110]mg/d AA (upper limit 800mg/d), 180 [90, 460]mg/d total n-3 LC-PUFA (EPA plus DHA) (recommended 500mg/d), 60 [30, 190]mg/d EPA (recommended 220mg/d, and 110 [50, 250]mg/d DHA (recommended 200mg/d), with 30.9% of participants consuming more than 200mg/d DHA. Participants taking PUFA supplements (19.6%) had median intakes of 370 [210, 530]mg/d DHA, with 79.5% meeting DHA recommendations. Participants taking PUFA supplements were 16.5 times more likely to meet recommendations for DHA compared to participants not taking supplements. For participants not taking PUFA supplements (80.4%), DHA intakes were 90 [50, 160]mg/d and only 19% met the recommendations. Across all women fish and seafood were the main contributors of DHA (84.8%) and EPA (82.1%) intakes, yet only 9.5% and 12.2% of women consumed canned fish or fresh/frozen fish respectively at least twice per week. Over half of participants reported intakes of poultry (63.1%) and beef (60.8%) at least twice per week. Red meats and poultry (36.8%) alongside eggs (23.3%) were important sources of AA intakes. Fats and oils largely contributed to LA (43.2%) and ALA (55.7%) intakes. Conclusion: The majority of pregnant women did not meet the recommended intakes for DHA, which may be in part due to low fish/seafood intakes. Women taking PUFA supplements were more likely to meet these recommendations. These findings highlight the need for nutrition advice on the benefits of consuming n-3 LC-PUFA rich foods such as fish/seafood during pregnancy.Item Eating habits and nutrition attitudes among pregnant Chinese women in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutritional Science at Massey University, Palmerston North, New Zealand(Massey University, 2014) Ma, JingjingImmigration to a Western country can lead to dietary changes among Chinese immigrants, which can cause poor diets and health problems. Chinese immigrants' eating habits might be influenced by both Western and traditional Chinese Medicine (TCM) nutrition recommendations. These two nutrition recommendations point out eating and nutrition during pregnancy is crucial for both maternal and fetal health, and they provide suggestions on eating habits during pregnancy. The population of Chinese women of reproductive age in New Zealand has increased dramatically. Since there is a lack of evidence about the eating habits and nutrition attitudes of pregnant Chinese women in New Zealand, the current study investigates pregnant Chinese women's eating habits, attitudes towards both Western and TCM nutrition, and possible relations to acculturation. Pregnant Chinese women in New Zealand were recruited mainly via a Chinese website, communities, churches, and the “snow-ball” model. The immigrants' eating habits, attitudes towards Western and TCM nutrition recommendations, and acculturation were measured by an online questionnaire. The questionnaire was completed by 84 pregnant Chinese women, with a median age of 30.0 (95% CI 29.0 - 30.6). The participants' acculturation score was comparatively low (1.98 ± 0.592) compared with the theoretical score range (1.0 to 5.0). Regarding New Zealand nutrition recommendations, some of the findings cause concerns: (1) most of the participants did not meet the recommended intake of vegetables, cereals, and dairy food during pregnancy; (2) although a large proportion of the participants had positive attitudes towards recommended supplements and food for pregnancy, they did not follow the recommendations in practice, especially for the iodine supplements and food rich in iodine (e.g., bread and breakfast cereals). However, it is positive to find that: (1) most of the participants always consumed folic acid supplements during the first trimester of pregnancy; (2) a majority of the participants thought it was important for them to limit fat, salt, and sugar intake and most of them seldom or never eat food high in fat, sugar, and salt. A majority of the participants had positive attitudes towards TCM, including: (1) balancing cold and hot (or yin and yang) foods and adjusting their diets according to seasons or body constitutions; (2) eating less greasy food, eating more light food, and eating more spleen and stomach strengthening food. However, only a small proportion of participants had positive attitudes towards foods with specific TCM features and did not consume these foods no matter whether they are recommended by TCM nutrition for pregnancy or not. Meanwhile, a considerable proportion of the participants reported neutral attitudes towards caring and learning about nutrition and most of the TCM nutrition recommendations. Acculturation was positively associated with meeting the New Zealand recommended intake from food groups, but was not positively associated with other eating habits. Acculturation was not related to most nutrition attitudes. It was only positively associated with attitudes towards Western nutrition recommendations for pregnant women and their attitudes towards TCM nutrition recommendation for healthy eating for adults. In addition, there was a positive correlation between attitudes towards Western nutrition and TCM nutrition (p < 0.05). The above findings of the current study provide useful information for health professionals who work with Chinese immigrants in New Zealand. In particular, health professionals should help immigrants to consume sufficient servings of foods and understand the importance of consuming iodine supplements during pregnancy. Additionally, it might be helpful for health professionals to be familiar with overall TCM nutrition recommendations.Item Trading off : a grounded theory on how Māori women negotiate drinking alcohol during pregnancy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand(Massey University, 2009) Stuart, KeriataThis study aimed to understand how Maori women negotiate decisions about alcohol and pregnancy. It was based in the recognition that Maori women?s decisions about drinking alcohol when pregnant are shaped by social and cultural expectations about gender roles, as well as their knowledge about alcohol and pregnancy. Maori attitudes to alcohol have also been influenced by colonisation and Maori responses to it. Alcohol use in pregnancy also exists in the context of potential impacts, including fetal alcohol spectrum disorder. There is little knowledge about how and why women may or may not drink during pregnancy. The research used grounded theory methods. Information was gathered through in-depth interviews with ten Maori women. The information they provided was analysed using constant comparative analysis, and a series of categories was generated. The grounded theory proposes that Maori women manage decisions about drinking alcohol when pregnant using a process of Trading off. Trading off is supported by three key processes: drawing on resources, rationalising, and taking control of the role. Maori women start by learning the rules about alcohol, get messages about alcohol and pregnancy, change their alcohol use while making role transitions, and use alcohol in the processes of fitting in where you are, releasing the pressure, and carrying on as normal. Trading off is an individual process, but exists in a complex social context. The process is fluid, conditional, and continues throughout pregnancy. The theory must be recognised as my interpretation, although I believe it is grounded in the data, accounts for the data, and offers a new, modifiable and potentially useful interpretation. While the body of theory that can be compared to the theory of Trading off is limited, the interpretation is consistent with several models of health behaviour, including Maori health models. This research has implications for future research, and for the development of programmes to support Maori women.