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    Maternal thyroid function, postnatal depression, the intake and status of iodine, selenium, and iron in postpartum women and their infants : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science at Massey University, Manawatū, New Zealand
    (Massey University, 2021) Jin, Ying
    Background: Thyroid dysfunction is a common health issue in women, with a higher prevalence found in postpartum women. Postnatal depression (PND) is a maternal health issue which can exacerbate negative health effects on their newborns. Iodine, selenium, and iron are three essential nutrients for the synthesis of thyroid hormones. Historically, dietary insufficiency of iodine and selenium exist in New Zealand. To improve iodine status, the New Zealand government introduced mandatory fortification of bread with iodised salt (2009), and recommended iodine supplementation (150 µg/day) for all pregnant and breastfeeding women (2010). Mostly, the iron status of postpartum women in New Zealand is rarely medically examined, unless high levels of blood loss during childbirth are recorded. Objectives: The overall aim of this PhD thesis was to investigate maternal thyroid function, postnatal depression, and the intake and status of iodine, selenium and iron in mothers and infants during their first postpartum year. Method: This observational longitudinal cohort study was conducted in Palmerston North, New Zealand, from June 2016 to December 2017. Mother-infant pairs attended study visits at three, six and twelve months postpartum (3MPP, 6MPP, and 12MPP). Online questionnaires investigated maternal iodine knowledge, supplement use, mode of infant feeding, and sociodemographic characteristics. Weighed four-day dietary diary, with urine/blood/breastmilk samples, were taken to measure maternal iodine, selenium, and iron intake/status. Infant iodine and selenium concentrations were determined in spot urine samples. The Edinburgh Postnatal Depression Scale was used to screen for PND. At 6MPP, serum thyroid hormones [free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), thyroglobulin (Tg) and anti-Tg and thyroid peroxidase antibodies] and thyroid volume were measured. Results: At 3MPP, 87 breastfeeding mother-infant pairs were recruited, followed up at 6MPP (n = 78) and 12MPP (n = 71). At 6MPP, 18% of women had thyroid dysfunction. Median total thyroid volume was 6.1 mL. Median (p25, p75) Tg was 11.4 (8.6, 18.6) µg/L, above 10 µg/L. Median maternal plasma selenium was 105.8 (95.6, 115.3) µg/L; 23% (17/74) being below 95 µg/L; with 4% of women experiencing iron deficiency without anaemia. Women with marginally lower plasma selenium were 1.14% times more likely to have abnormal TSH concentrations. Over the first postpartum year, maternal median urinary iodine concentration (MUIC) was 82 (46, 157) µg/L, 85 (43, 134) µg/L, and 95 (51, 169) µg/L, all below 100 µg/L; median BMIC was 69 (52, 119) µg/L, 59 (39, 108) µg/L, and 35 (26, 54) µg/L, all below the recommended 75 µg/L. Median maternal iodine intake was 151 (99, 285) µg/day, with 58% below the Estimated Average Requirement (EAR). At 3MPP, 46% of women took iodine-containing supplements, this reduced to 11% at 6MPP, and 6% at 12MPP. Women who used iodine-containing supplements had significantly higher MUIC (111 vs 68 µg/L) and BMIC (84 vs 62 µg/L) than non-users (P < 0.001). Infants fed by women using iodine-containing supplements had a higher MUIC (150 vs 86 µg/L, P = 0.036) than those of non-users. Infant MUIC at 3MPP [115 (69, 182) µg/L] and 6MPP [120 (60, 196) µg/L] were below 125 µg/L (suggested cut-point for iodine adequacy in infants). Median maternal selenium intake was 62 (51, 85) µg/day and 56% had intakes below the EAR. Median infant selenium intakes at 3MPP and 6MPP were 9 and 8 µg/day. Median maternal urinary selenium concentrations were 22, 22, and 26 µg/L across three time points, respectively. The highest prevalence of minor depression was observed in women with mean plasma selenium at 106 µg/L. Conclusions: A high prevalence of thyroid dysfunction was observed in a cohort of postpartum women who were iodine deficient, with suboptimal selenium intake, but having mostly adequate iron status. Women with low plasma selenium were likely to experience thyroid dysfunction. Iodine deficiency of lactating women remains, particularly for those who did not use iodine-containing supplements. The low use of iodine-containing supplements is concerning during later breastfeeding. Maternal selenium intake/status was suboptimal. Relation between selenium status and risk of PND was inconclusive. Iodine/selenium intake and status of infants were suboptimal.
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    Knowledge, early recognition and acceptance : the journey to recovery from postnatal depression : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2006) Morton, Alice Mabel Ina
    The purpose of this qualitative study was to explore with women their experience of postnatal depression (PND), with a specific emphasis on what factors assisted and what factors hindered their recovery. Eight women who had suffered at some stage from PND took part in the study. Interviews were carried out using an in-depth interview technique with open-ended questions regarding their subjective experience, which were audio-taped and then transcribed. Using thematic analysis, the information obtained from the interviews was analysed and significant statements extracted. Patterns emerged and were clustered into three major themes: Knowledge, Early recognition and Acceptance. These three themes and the patterns within them were all closely entwined, each influencing the other and having a major effect on the woman's experience of PND and her recovery. Lack of knowledge was identified as a major hindrance to recovery, with women describing feelings of being in the dark, not knowing what was happening to them and feeling like a failure. This lack of knowledge was a barrier to seeking help, causing a delay in recognition and treatment which prolonged the illness and forced these women to suffer in silence. The opposite also applied where prior experience of PND enabled women to recognise the symptoms, seek help, receive treatment and recover more quickly. Postnatal depression is a common complication following childbirth. It can have devastating effects on the mother, the infant, the family and society. Recovery is not possible without knowledge about this condition, not only for the women themselves, but for society as a whole, including health professionals. Women in this study recognised that early recognition played a major role in their recovery, but also identified acceptance as a problem for themselves, health professionals and society, in delaying this process. As a result of this study, gaps within the New Zealand health service were identified, such as a lack of education about PND, parenting of a new baby and support services available in the community. Unrealistic expectations of mothers and the romantic media hype about childbirth and motherhood were also identified as an issue.
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    "Keep on, keeping on" : one man's phenomenological experience of postnatal depression : a study presented in partial fulfillment of the requirements for the degree of Master in Nursing at Massey University
    (Massey University, 2000) Moore, Elizabeth Frances
    Postnatal depression has been documented as a disease/illness exclusively linked to mothers. The dominance of biological and psychological perspectives of postnatal depression in women, have upheld the dichotomy which seems to make postnatal depression in men inexaminable. In response to the lack of research into men's experience this study offers a trilogy that firstly examines a father and then a mother's separate perspectives on postnatal depression. The third dimension of this study aims to present an integrated view from this couple of postnatal depression. In order to achieve this, this work describes one man's perspective of the phenomenon of postnatal depression employing Crotty's (1996) mainstream phenomenological approach. Although the biological and psychosocial approaches show that postnatal depression is a very real disorder in some women's lives following childbirth, the phenomenological approach has identified the equally real disequilibrium that occurs in some men's lives when living with postnatal depression. The findings provide a detailed account of the co-researchers distress as he seeks to understand the essence of his experience of postnatal depression and realize the reality of his life-world. Thus potential health risks are identified which warrant further investigation that have implications for men's health.
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    A case study for helping to prevent postnatal depression : towards a cultural tool for Maori women : a thesis presented for the Masters degree of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2005) Merritt, Marama
    Postnatal depression is a depressive illness that affects 10-20% of all women. However, in societies with strong kin-based support structures and where customs and rituals are integral to everyday life, there is a very low incidence of postnatal depression. Indeed, there is little mention of depression in pregnancy and motherhood within traditional Maori society. Today, through the impact of colonisation, Maori women live in a very different world to that of their ancestors. The dissolution of the whanau structure, the loss of Te Reo and customs, the increase of solo-parent families and families living in poverty, the effects of drug and alcohol abuse and the increase in family violence mean that Maori women are more likely to suffer from depressive and anxiety based illness than non-Maori. Despite this statistic, there has been very little research conducted around Maori women and maternal mental health. This research attempts to identify the key issues that affect Maori women during pregnancy and motherhood and which impact on their maternal mental health. It also provides a critical analysis of the efficacy of current maternal mental health services, treatment and tools in meeting the needs of Maori women. Finally, these insights provide the basis for recommendations to improve maternal mental health services for Maori women and principles to guide the development of a tool to help prevent postnatal depression in Maori women. Ultimately this research is about realigning our thinking about working with Maori women and maternal health. The focus is on providing services, tools and an environment that is collaborative and draws on a range of resources to help Maori mothers succeed in all areas of their life, validating the use of cultural rituals, customs and practices within service provision. There is also a need to conduct research that recognises the diverse circumstances and needs of Maori women and that draws on Kaupapa Maori epistemology and paradigms to inform the research. Finally, and perhaps most importantly, this research clearly illustrates the importance of strong whanau structures and systems and the need to provide a society that allows Maori women to benefit from the support of friends and family, regardless of how that 'whanau' is defined.
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    Exploring antenatal factors in postnatal depression : a thesis presented in partial fulfilfment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2000) Kelly, Carolyn
    Up to 20% of all new mothers may suffer from postnatal depression. This amounts to around 3,500 mothers each year in Auckland alone. The effects of postnatal depression are far reaching and can impact detrimentally on the lives of mothers and those close to them. To understand more about postnatal depression, British researchers Cooper, Murray, Hooper, and West (1996) developed a measure for identifying antenatally women who may be at risk of developing postnatal depression. The present study examined the predictive validity of Cooper et al.'s antenatal index in identifying mothers likely to develop postnatal depression in a New Zealand population. Ninety-eight Auckland mothers completed antenatal and postnatal questionnaires that included Cooper et al.'s predictive index, the GHQ-12 and the Edinburgh Postnatal Depression Scale. Results suggested that the predictive ability of Cooper et al.'s measure improved when including an antenatal measure of general wellbeing (the GHQ-12) into the regression equation. The results suggested that 60% of the variance in postnatal depression scores was attributed to the antenatal predictive index. The GHQ-12 added to the predictive ability by explaining an additional 19% of the variance in postnatal depression scores. Discriminant analysis showed that the percentage of cases correctly classified into depressed and non-depressed was 66% and the sensitivity, specificity and positive predictive value of the antenatal measures achieved comparable findings to that of Cooper et al. Recommendations for future research include using a different methodological approach and investigating the predictive power of the General Health Questionnaire further.
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    "The Madonna myth" : the ideology of motherhood and it's [sic] influence on women with postnatal depression : a thesis presented in partial fulfilment of the requirements of the degree of Master of Social Work at Massey University
    (Massey University, 2001) Fry, Kim Jacqueline
    This thesis explores whether societal myths surrounding motherhood can contribute to the development of Postnatal Depression (PND) for some women. It considers the social construction of motherhood and the transmission of powerful messages to women, both before and during motherhood. It examines what happens when the reality of motherhood does not meet the idealise images of motherhood. The research involved face to face interviews with six women who had experienced PND. The key findings were that there are two strong myths surrounding motherhood. Mothers and non-mothers keep these alive in society. The myths are firstly, that motherhood is a natural stage for women in heterosexual relationships and that therefore the act of mothering is instinctual. The second myth is that motherhood brings with it fulfilment and happiness for the individual woman. The research found that the reality of motherhood also contains losses of identity and feelings of guilt and failure. These feelings are compounded for women with PND. The findings give rise to recommendations including increasing education and information about PND for pregnant women, increasing support services for new mothers more open and honest discussion in society about the realities of motherhood and the need to value mothers and their contribution to society.