Browsing by Author "Nerenberg, Kara"
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- ItemOpen AccessAge-period-cohort effects in pre-existing and pregnancy-associated diseases amongst primiparous women(2020-04-19) Metcalfe, Amy; Ahmed, Sofia B; Nerenberg, KaraAbstract Background The average age at first birth is steadily increasing in developed countries; however, demographic shifts in maternal age at childbearing have not occurred in isolation. While temporal increases in adverse pregnancy outcomes are typically attributed to increases in maternal age, little is known about how maternal health status has changed across maternal age, period of delivery, and birth cohort. Methods Natality files were used to identify primiparous women delivering liveborn, singleton infants in the USA in 1989, 1994, 1999, 2004, 2009, and 2014 (n = 6,857,185). Age-period-cohort models using the intrinsic estimator adjusted for temporal trends in smoking and gestational weight gain were used to quantify temporal changes in the rates of pre-existing (chronic hypertension, pre-existing diabetes) and pregnancy-associated (pregnancy-associated hypertension, gestational diabetes, eclampsia) diseases. Log-linear models were used to model the impact of temporal changes on preterm birth, small, and large for gestational age (SGA/LGA) births. Results Significant period effects resulted in temporal increases in the rate of chronic hypertension, pregnancy-associated hypertension, and gestational diabetes, and a significant decrease in the rate of eclampsia. These observed period effects were associated with a 10.6% increase in the rate of SGA and a 7.1% decrease in LGA. Had the rate of pre-existing and pregnancy-associated diseases remained static over this time period, the rate of preterm birth would have increased by 5.9%, but instead only increased by 4.4%. Conclusions Independent of changes in the incidence of pre-existing and pregnancy-associated diseases as women age, the obstetric population is becoming less healthy over time. This is important, as these changes have a direct negative impact on short-term obstetric outcomes and women’s long-term health.
- ItemOpen AccessBreastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis(2023-02-02) Scime, Natalie V.; Metcalfe, Amy; Nettel-Aguirre, Alberto; Nerenberg, Kara; Seow, Cynthia H.; Tough, Suzanne C.; Chaput, Kathleen H.Abstract Background Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters of breastfeeding difficulties experienced up to 6 weeks postpartum among mothers with chronic conditions and to examine associations between chronic condition types and breastfeeding difficulty clusters. Methods We analyzed 348 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study from Alberta, Canada. Data were collected through self-report questionnaires. We used latent class analysis to identify clusters of early breastfeeding difficulties and multinomial logistic regression to examine whether types of chronic conditions were associated with these clusters, adjusting for maternal and obstetric factors. Results We identified three clusters of breastfeeding difficulties. The “physiologically expected” cluster (51.1% of women) was characterized by leaking breasts and engorgement (reference outcome group); the “low milk production” cluster (15.4%) was discerned by low milk supply and infant weight concerns; and the “ineffective latch” cluster (33.5%) involved latch problems, sore nipples, and difficulty with positioning. Endocrine (adjusted relative risk ratio [RRR] 2.34, 95% CI 1.10–5.00), cardiovascular (adjusted RRR 2.75, 95% CI 1.01–7.81), and gastrointestinal (adjusted RRR 2.51, 95% CI 1.11–5.69) conditions were associated with the low milk production cluster, and gastrointestinal (adjusted RRR 2.44, 95% CI 1.25–4.77) conditions were additionally associated with the ineffective latch cluster. Conclusion Half of women with chronic conditions experienced clusters of breastfeeding difficulties corresponding either to low milk production or to ineffective latch in the first 6 weeks postpartum. Associations with chronic condition types suggest that connections between lactation physiology and disease pathophysiology should be considered when providing breastfeeding support.
- ItemOpen AccessExploring weight bias internalization in pregnancy(2022-07-29) Nagpal, Taniya S.; Salas, Ximena R.; Vallis, Michael; Piccinini-Vallis, Helena; Alberga, Angela S.; Bell, Rhonda C.; da Silva, Danilo F.; Davenport, Margie H.; Gaudet, Laura; Rodriguez, Angela C. I.; Liu, Rebecca H.; Myre, Maxine; Nerenberg, Kara; Nutter, Sarah; Russell-Mayhew, Shelly; Souza, Sara C. S.; Vilhan, Candace; Adamo, Kristi B.Abstract Background Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. Methods Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. Result 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2). Conclusions Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.
- ItemOpen AccessExploring weight bias internalization in pregnancy(BMC, 2022-07-29) Nagpal, Taniya S.; Ramos Salas, Ximena; Vallis, Michael; Piccinini-Vallis, Helena; Alberga, Angela S.; Bell, Rhonda C.; da Silva, Danilo F.; Davenport, Margie H.; Gaudet, Laura; Incollingo Rodriguez, Angela C.; Liu, Rebecca H.; Myre, Maxine; Nerenberg, Kara; Nutter, Sarah; Russell-Mayhew, Shelly; Souza, Sara C. S.; Vilhan, Candace; Adamo, Kristi B.Background: Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. Methods: Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. Result: 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2). Conclusions: Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.
- ItemOpen AccessLaboratory Use in Individuals with Early-Onset versus Usual-Onset of Diabetes: A Retrospective Cohort Study(2023-07) Sriskandarajah, Apishanthi; Butalia, Sonia; Metcalfe, Amy; Nerenberg, KaraBackground: The incidence and prevalence of diabetes is increasing in younger individuals and these individuals are at an increased risk of complications. Laboratory testing is used to screen and monitor for complications in people with diabetes, and there is concern that this is not being achieved as per clinical guidelines. The objective of this thesis was to describe the frequency and results of guideline recommended laboratory tests in individuals with early-onset (<40 years of age) and usual-onset diabetes (≥40 years of age), and to explore clinical and sociodemographic factors related to guideline concordance of frequency of testing and results. Methods: This observational, retrospective cohort study used population-based administrative and clinical databases in Alberta from 2018 to 2019. We included adults with incident diabetes (age ≥18 years) and stratified by age of onset (<40 years versus ≥40 years). Individuals were followed for a total of 365 days for glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR), and albumin to creatinine ratio (ACR) tests. Descriptive statistics were used to compare laboratory testing between early-onset and usual-onset groups. Multivariable logistic regression was used to assess factors related to guideline concordant testing frequency and above-target results. Results: Overall, the cohort included 23,643 individuals with incident diabetes (mean age 54.1 ± SD 15.4 years, 42.1% female). The early-onset group represented 18.9% of the cohort. A higher proportion of the early-onset group had lower frequency of testing for A1C, LDL-C, eGFR, and ACR tests and above-target test results for A1C and LDL-C compared to the usual-onset group. After adjustment of covariates (sex, socioeconomic status, rural residence, medication use), the early-onset group was more likely to have lower frequency of testing for A1C, LDL-C, and eGFR tests and above-target A1C and LDL-C levels compared to the usual-onset group. Sociodemographic and clinical factors were also associated with testing frequency and above-target test results. Conclusions: Despite a universal health care system, the early-onset group was not meeting clinical guidelines for testing frequency or targets. Future work is needed to inform tools and strategies to improve guideline recommended laboratory use in this group.
- ItemOpen AccessMindfulness-Based Cognitive Therapy for Treatment of Psychological Distress in Pregnancy: Is there an Effect on Maternal Autonomic Response to Acute Stress?(2017) Shay, Matthew Shawn; Tomfohr-Madsen, Lianne; Campbell, Tavis; Carlson, Linda; Nerenberg, KaraPregnancy is a time of increased physical and emotional stress for many women. Examination of cardiovascular response to acute stress can provide a non-invasive way of assessing autonomic nervous system function. Previous research suggests that the experience of heightened stress response in pregnancy is a risk factor for poor maternal and child health. Treatment of psychological distress with mindfulness-based cognitive therapy (MBCT) in non-pregnant populations can positively impact cardiovascular reactivity to stress. The current randomized controlled trial investigated MBCT for treatment of prenatal distress and examined whether MBCT was associated with changes in the physiological stress response. Women between 12-28 weeks gestation were recruited for participation in an 8-week MBCT intervention (N = 29) or assigned to treatment-as-usual (N = 32). Cardiovascular responses to a laboratory-based Stroop task and mental arithmetic stressors were measured by respiratory sinus arrhythmia (RSA), heart rate, and systolic and diastolic blood pressure) and assessed at pre-treatment, posttreatment, and three-months postpartum. MBCT participants experienced higher RSA at posttreatment for Stroop, mental arithmetic, and during the respective recovery periods, as well as greater RSA reactivity to both stressors at three-months follow-up. No changes in blood pressure or blood pressure reactivity were found. MBCT appeared to increase vagal activity posttreatment and vagal response to acute stress at three-months follow-up. Treatment of maternal distress with mindfulness-based interventions may have physiological health benefits.
- ItemOpen AccessSupporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study(2024-01-02) Sushko, Katelyn; Strachan, Patricia; Butt, Michelle; Nerenberg, Kara; Sherifali, DianaAbstract Introduction Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results The quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.
- ItemOpen AccessThe effect and safety of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in women: a protocol for systematic review and meta-analysis(2017-07-07) Dumanski, Sandra M; Ramesh, Sharanya; James, Matthew T; Metcalfe, Amy; Nerenberg, Kara; Seely, Ellen W; Robertson, Helen L; Ahmed, Sofia BAbstract Background The prevalence of menopause in women with or at risk of chronic kidney disease is increasing globally. Although international guidelines on menopause recommend the use of postmenopausal hormone therapy with or without selective estrogen receptor modulators for control of vasomotor symptoms, the effects of these treatments on kidney function and albuminuria are unclear. Furthermore, women with chronic kidney disease are at significantly increased risk of venous thromboembolism and malignancy, well-documented adverse effects of postmenopausal hormone therapy. Our study aims to establish the effect of these treatments on kidney function and albuminuria in women, as well as determine the safety of these treatments in the chronic kidney disease population. Methods We will conduct a systematic review and meta-analysis addressing the effect and safety of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in women. We plan to search for published (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), tables of contents of relevant journals) and unpublished (ongoing studies, conference proceedings) studies in all languages examining the effect of postmenopausal hormone therapy, including selective estrogen receptor modulators, on kidney function and albuminuria, as well as the risk of adverse outcomes of these treatments in women with chronic kidney disease. Two independent investigators will screen identified abstracts and select studies that examine the effect of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in the general population or adverse outcomes in the chronic kidney disease population. Data on study population, intervention, outcomes, as well as study quality and risk of bias will be independently extracted from each eligible study. Along with descriptive presentation of data, outcome measures will be presented as meta-analyses using a random effects model. Planned subgroup analyses will be completed, and meta-regression will be performed if significant heterogeneity is noted. Discussion By examining the effects of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney function and albuminuria, the results of this systematic review and meta-analysis will inform management of postmenopausal women in the general population. Furthermore, it will evaluate the safety, including the risks of known adverse outcomes of postmenopausal hormone therapy and selective estrogen receptor modulators, in the already vulnerable chronic kidney disease population. Systematic review registration PROSPERO CRD42016050651