Vital statistics data were statistically analyzed to determine who is breastfeeding in central Kentucky and if factors differ between those in a WIC and non-WIC population. The sample consisted of 479 postpartum women aged 18-44 in central Kentucky. Participants in the study were analyzed as a whole, then divided by their participation in the WIC program (n=304) or non-participation in the WIC program (n=175). Variables recorded in the vital statistics form were analyzed. These variables included age, education level, marital status, and ethnicity of the mother, household income status, and gender, gestational age, and birth weight of the infant. In the population studied, education level, ethnicity, marital status, household income status, and gestational age of the infant were significantly different between mothers who initiated breastfeeding and those who did not. In the WIC population, mothers were more likely to initiate breastfeeding if they were of non-white ethnicity or if the infant was born at greater than 37 weeks gestation; whereas, in the non-WIC population, mothers were more likely to initiate breastfeeding if they had some college or a college degree or if they were not enrolled in Medicaid. WIC participants were significantly less likely to initiate breastfeeding than non-WIC participants.

Purpose: The purpose of this interpretive phenomenological study is to explore the lived experience of Haitian immigrant women living in Massachusetts with PPD. Specific Aims: Aim 1: To explore the lived experience of PPD among Haitian immigrant women. Aim 2: To explore how the experience of being Haitian influences Haitian immigrant women in their response to PPD. Framework: Leininger's Theory of Cultural Care (1988) guided the phenomenological approach and data collection. The Transcultural Care Decision & Action model contains three predictive modes for guiding nursing care judgments, decisions, or actions to provide care. Design: Interpretive phenomenology guided this qualitative study. Individual face-to-face interviews were conducted. The data from each interview were transcribed into a written document and analyzed using the Crist and Tanner five-step process. Results: This study yielded two themes; each theme has three dimensions. The first theme is “Feeling Disconnected” with three dimensions: (a) lack of support; (b) partner conflict; and, (c) nostalgia of Haiti. The second theme is “Feeling Reconnected” with three dimensions: (a) realization of needed help; (b) spirituality; and, (c) resilience. Conclusion: This study provides insight into the lived experience of Haitian women with PPD. Awareness of Haitian women’s actual experiences with PPD will help health care providers to identify and provide culturally appropriate care to this population.

Introdução: A prematuridade resulta de diferentes fatores inter-relacionados, que podem variar em diferentes culturas. Os avanços tecnológicos têm provido melhores condições de atendimento e sobrevida das crianças que nasceram prematuramente, porém, as causas desses nascimentos ainda são pouco conhecidas. Objetivo: Identificar fatores maternos e neonatais associados à prematuridade no município de Porto Alegre. Método: Estudo do tipo caso-controle de base populacional. Os casos foram recém-nascidos com menos de 37 semanas de gestação, e os controles foram os recém-nascidos com 37 semanas ou mais. Os dados provieram dos registros de nascimentos do município de Porto Alegre referentes ao ano de 2012 que constam no Sistema de Informações sobre Nascidos Vivos da Secretaria Municipal da Saúde. Foram alocados 767 casos e 1.534 controles, em um desenho de um caso para dois controles (1:2), mediante randomização simples. As variáveis estudadas foram alocadas em três blocos, representando diferentes níveis de hierarquia: variáveis sociodemográficas, história reprodutiva e fatores gestacionais e de nascimento. A análise de Regressão Logística Hierárquica multivariada foi utilizada. Resultados: No modelo final, foi encontrada associação estatisticamente significante ao nascimento prematuro para as seguintes variáveis: no Bloco 1, idade materna menor que 19 anos (OR=1,32; IC 95%: 1,02 – 1,71) e >34 anos (OR=1,39; IC 95%: 1,12 – 1,72) e escolaridade materna inadequada para a idade (OR=2,11; IC 95%: 1,22 – 3,65); no Bloco 2, nenhuma variável permaneceu associada à prematuridade; no Bloco 3, gravidez múltipla (OR=1,14; IC 95%: 1,01 – 1,29), cesariana (OR=1,15; IC 95%: 1,03 – 1,29), peso ao nascer menor a 2.500g (OR=4,04; IC 95%: 3,64 – 4,49), Índice de Apgar no 5° minuto de zero a três (OR=1,47; IC 95%: 1,12 – 1,91) e pré-natal inadequado (OR=1,18; IC 95%: 1,02 – 1,36). Conclusão: O aumento da prevalência da prematuridade é um evento que preocupa gestores de saúde em todo o país. Em razão da grande pluralidade da população brasileira, acredita-se que seja necessário o desenvolvimento de estudos populacionais regionalizados. Lembrando o importante papel da prematuridade na mortalidade infantil, é imprescindível que continuem as pesquisas com esta temática para elucidar as causas da prematuridade, a fim de auxiliar no planejamento de ações preventivas e no seu combate, assim diminuindo a mortalidade infantil. / Introduction: Premature birth results from different inter-related factors, which may vary in different cultures. Technological advances have provided better conditions of assistance to and survival of prematurely born children, but the causes of premature births are still little known. Objective: To identify maternal and neonatal factors associated with premature births in Porto Alegre. Method: population-based, case-control study. The cases involved children born before 37 weeks of pregnancy, and the group of controls consisted of children born at 37 weeks of pregnancy or later. Data were obtained from 2012 birth certificates of the city of Porto Alegre found in the Live Birth Registration System of the Department of Health. The study comprised 767 cases and 1534 controls in a one-to-two design through simple randomization. The studied variables were divided into three blocks standing for different hierarchical levels: social-demographic variables; reproduction-related data; and pregnancy and birth factors. Hierarchical Multiple Logistic Regression analysis was performed. Results: In the final model, there was statistically significant association between premature birth and the following variables: in Block 1, mother younger than 19 years (OR=1.32; IC 95%: 1.02 – 1.71) and older than 34 (OR=1.39; IC 95%: 1.12 – 1.72), and mother’s educational level lower than expected for age (OR=2.11; IC 95%: 1.22 – 3.65); in Block 2, no variable was associated with premature birth; in Block 3, multiple pregnancy (OR=1,14; IC 95%: 1.01 – 1.29), Caesarean operation (OR=1.15; IC 95%: 1.03 – 1.29), birth weight lower than 2500g (OR=4.04; IC 95%: 3.64 – 4.49), Apgar scores of 0-3 at five minutes (OR=1.47; IC 95%: 1.12 – 1.91) and inadequate prenatal care (OR=1.18; IC 95%: 1.02 – 1.36). Conclusion: Health managers from all over the country are concerned with the increased prevalence of premature births. The great plurality of Brazilian population may require the development of regionalized population studies. Considering the important role played by premature birth in child mortality, researches into this subject are fundamental to explain the causes of premature birth, thus contributing to both the planning of prevention actions and the fight for reduction of child mortality.

Available data from the quinquennial Infant Feeding Surveys (IFS) show that breastfeeding rates in Great Britain (GB) rose steadily between 1985 and 2010. However, the rates of breastfeeding continuation and exclusivity remain relatively low, and there is evidence that breastfeeding in public may still be considered unacceptable by many in GB. To date, no study has examined the reasons behind the increase in breastfeeding rates between 1985 and 2010, and the factors which influence women's practice of breastfeeding in public in GB remain under-researched. Therefore, this DPhil research aimed to investigate whether the increase in breastfeeding rates in the first six weeks after childbirth in GB between 1985 and 2010 were driven by changes in the distribution of population characteristics, or changes in the differences in breastfeeding behaviours between subgroups of women. It also aimed to investigate the factors which influenced the practice of breastfeeding in public in GB in 1995 to 2010. Data from the IFS surveys in 1985 to 2010 were analysed to, firstly, describe and summarise the distribution of selected explanatory factors among the childbearing population of GB from 1985 to 2010. This was followed by an estimation of the independent effects of these explanatory factors on breastfeeding initiation, breastfeeding continuation at one week and at six weeks, and breastfeeding in public, in each survey year. There was an assessment of the changes over time in the effects of each factor on breastfeeding initiation, and on breastfeeding continuation at one week and at six weeks. This was followed by an examination of the extent to which changes in the distribution of factors among the childbearing population contributed to the increase in breastfeeding rates in the first six weeks in GB between 1985 and 2010. This DPhil research found no evidence of changes in the effects of factors on breastfeeding in the first six weeks between 1985 and 2010. This suggests that breastfeeding behaviours had not improved over time. At the same time, there were increases in the distribution of those factors which positively influence breastfeeding, suggesting that the increase in breastfeeding rates in the first six weeks between 1985 and 2010 were indeed attributable to population changes rather than improved breastfeeding behaviours. Additionally, breastfeeding in public was seemingly most influenced by women's perceptions of the normality and acceptability of breastfeeding in GB. There is a clear need for more equitable interventions to target the needs and perceptions of those women in GB who remain characteristically less likely to breastfeed.

abstract: This mixed-methods research study examined the level of collective action that is occurring among non-governmental organizations (NGOs) working in maternal and child health in Haiti. This study takes the view that health, and by extension, maternal and child health, is a global public good; global public goods are most efficiently provided by the means of collective action. Therefore, to the extent that maternal and child health services are provided efficiently in Haiti, collective action should be occurring. This study utilized a semi-structured interview approach to gather both qualitative and quantitative data. A total of 17 participants who were managers or executives of NGOs working in maternal and child health in Haiti were interviewed. The interviews also gathered quantitative data that characterized types of cooperation that were occurring among NGOs. The qualitative data that were collected in these interviews were analyzed using thematic analysis, and quantitative data were analyzed using social network analysis. The findings concluded that while there is cooperation occurring among NGOs in Haiti, the cooperation levels are low, networks are not very dense and there is overall general consensus that more cooperation is needed / Dissertation/Thesis / Doctoral Dissertation Global Health 2017

Introdução: A prematuridade resulta de diferentes fatores inter-relacionados, que podem variar em diferentes culturas. Os avanços tecnológicos têm provido melhores condições de atendimento e sobrevida das crianças que nasceram prematuramente, porém, as causas desses nascimentos ainda são pouco conhecidas. Objetivo: Identificar fatores maternos e neonatais associados à prematuridade no município de Porto Alegre. Método: Estudo do tipo caso-controle de base populacional. Os casos foram recém-nascidos com menos de 37 semanas de gestação, e os controles foram os recém-nascidos com 37 semanas ou mais. Os dados provieram dos registros de nascimentos do município de Porto Alegre referentes ao ano de 2012 que constam no Sistema de Informações sobre Nascidos Vivos da Secretaria Municipal da Saúde. Foram alocados 767 casos e 1.534 controles, em um desenho de um caso para dois controles (1:2), mediante randomização simples. As variáveis estudadas foram alocadas em três blocos, representando diferentes níveis de hierarquia: variáveis sociodemográficas, história reprodutiva e fatores gestacionais e de nascimento. A análise de Regressão Logística Hierárquica multivariada foi utilizada. Resultados: No modelo final, foi encontrada associação estatisticamente significante ao nascimento prematuro para as seguintes variáveis: no Bloco 1, idade materna menor que 19 anos (OR=1,32; IC 95%: 1,02 – 1,71) e >34 anos (OR=1,39; IC 95%: 1,12 – 1,72) e escolaridade materna inadequada para a idade (OR=2,11; IC 95%: 1,22 – 3,65); no Bloco 2, nenhuma variável permaneceu associada à prematuridade; no Bloco 3, gravidez múltipla (OR=1,14; IC 95%: 1,01 – 1,29), cesariana (OR=1,15; IC 95%: 1,03 – 1,29), peso ao nascer menor a 2.500g (OR=4,04; IC 95%: 3,64 – 4,49), Índice de Apgar no 5° minuto de zero a três (OR=1,47; IC 95%: 1,12 – 1,91) e pré-natal inadequado (OR=1,18; IC 95%: 1,02 – 1,36). Conclusão: O aumento da prevalência da prematuridade é um evento que preocupa gestores de saúde em todo o país. Em razão da grande pluralidade da população brasileira, acredita-se que seja necessário o desenvolvimento de estudos populacionais regionalizados. Lembrando o importante papel da prematuridade na mortalidade infantil, é imprescindível que continuem as pesquisas com esta temática para elucidar as causas da prematuridade, a fim de auxiliar no planejamento de ações preventivas e no seu combate, assim diminuindo a mortalidade infantil. / Introduction: Premature birth results from different inter-related factors, which may vary in different cultures. Technological advances have provided better conditions of assistance to and survival of prematurely born children, but the causes of premature births are still little known. Objective: To identify maternal and neonatal factors associated with premature births in Porto Alegre. Method: population-based, case-control study. The cases involved children born before 37 weeks of pregnancy, and the group of controls consisted of children born at 37 weeks of pregnancy or later. Data were obtained from 2012 birth certificates of the city of Porto Alegre found in the Live Birth Registration System of the Department of Health. The study comprised 767 cases and 1534 controls in a one-to-two design through simple randomization. The studied variables were divided into three blocks standing for different hierarchical levels: social-demographic variables; reproduction-related data; and pregnancy and birth factors. Hierarchical Multiple Logistic Regression analysis was performed. Results: In the final model, there was statistically significant association between premature birth and the following variables: in Block 1, mother younger than 19 years (OR=1.32; IC 95%: 1.02 – 1.71) and older than 34 (OR=1.39; IC 95%: 1.12 – 1.72), and mother’s educational level lower than expected for age (OR=2.11; IC 95%: 1.22 – 3.65); in Block 2, no variable was associated with premature birth; in Block 3, multiple pregnancy (OR=1,14; IC 95%: 1.01 – 1.29), Caesarean operation (OR=1.15; IC 95%: 1.03 – 1.29), birth weight lower than 2500g (OR=4.04; IC 95%: 3.64 – 4.49), Apgar scores of 0-3 at five minutes (OR=1.47; IC 95%: 1.12 – 1.91) and inadequate prenatal care (OR=1.18; IC 95%: 1.02 – 1.36). Conclusion: Health managers from all over the country are concerned with the increased prevalence of premature births. The great plurality of Brazilian population may require the development of regionalized population studies. Considering the important role played by premature birth in child mortality, researches into this subject are fundamental to explain the causes of premature birth, thus contributing to both the planning of prevention actions and the fight for reduction of child mortality.

Para a promoção, proteção e apoio à amamentação, as instituições que aderem à Iniciativa Hospital Amigo da Criança (IHAC) adotam os chamados \"Dez passos para o sucesso do aleitamento materno\". O quarto passo da IHAC consiste em ajudar as mães a iniciar o aleitamento materno, na primeira meia hora após o nascimento, ainda na sala de parto. O presente estudo tem como objetivo analisar as práticas dos profissionais de saúde relacionadas à assistência às mulheres e aos recém-nascidos, durante a realização do contato precoce e amamentação, na primeira meia hora após o parto, no contexto de um Hospital Amigo da Criança. Trata-se de um estudo de abordagem qualitativa que permitiu a compreensão da subjetividade expressa nos discursos dos participantes, sem romper com o contexto onde eles estavam inseridos. A presente pesquisa foi realizada na maternidade da Santa Casa de Misericórdia, no município de Passos-MG. Participaram deste estudo 21 profissionais de saúde (médicos, enfermeiros, técnicos e auxiliares de enfermagem e psicóloga) que atuavam no Centro Obstétrico da Santa Casa e que concordaram em participar, após assinarem o Termo de Consentimento Livre e Esclarecido. O número de participantes foi determinado pela saturação dos dados. Os dados foram coletados no período de julho a outubro de 2013, por meio de observação, durante o momento do parto e pós-parto imediato, e de entrevistas semiestruturadas com os profissionais de saúde. Os dados foram analisados considerando-se os registros das observações e das falas dos entrevistados, através do método de interpretação de sentidos. A análise dos dados permitiu a identificação de unidades temáticas que convergiram para quatro categorias: a concepção e a prática do contato precoce pelos profissionais de saúde; contribuições da mulher no contato precoce e aleitamento materno na visão dos profissionais; fatores que implicam no processo do contato precoce e aleitamento materno, na sala de parto; e o modelo assistencial no processo do contato precoce e aleitamento materno, na sala de parto. Evidenciou-se que os participantes demonstraram conhecimento quanto à prática do contato pele a pele precoce e da amamentação na primeira meia hora pós-parto, no entanto, não foi verificada a efetivação desta prática pelos mesmos. Os participantes consideram a mulher como passiva na realização desta prática. Identificam fatores facilitadores e dificultadores para a realização do contato precoce, porém não utilizam as estratégias que poderiam facilitar a prática. O modelo assistencial é centrado em questões técnicas e biologicistas, e a assistência durante o período intraparto ocorre de maneira mecânica e fragmentada, seguindo-se as rotinas hospitalares sem a reflexão sobre o processo de trabalho, o que incide também na realização do 4º passo da IHAC. Considera-se necessário o maior envolvimento de todos os profissionais de saúde, de forma que reflitam sobre as vantagens e a reorganização da prática e da rotina hospitalar existente, com a finalidade de se concretizarem as ações preconizadas pelo contato precoce e amamentação, na primeira hora pós-parto, favorecendo assim a melhoria das taxas de aleitamento materno e, consequentemente, a melhoria da saúde materno-infantil / In order to get breastfeeding promotion, protection and support, institutions which adhere to the Baby Friendly Hospital Initiative (BFHI) adopt the so-called \"Ten steps for the breastfeeding success\". The fourth step of the BFHI consists in helping the mothers to begin the breastfeeding half an hour after the delivery, still in the delivery room. The objective of this study is to analyze the health professionals\' practices regarding the mothers\' and newborn babies\' assistance, during the early contact and breastfeeding in the first half hour after delivery according to the reality of Baby Friendly Hospital. It is a qualitative approach study, which allowed the comprehension of the participants\' speech subjectivity, without breaking with the context they were inserted. The study was conducted at Santa Casa de Misericórdia de Passos-MG. Twenty-one health professionals (doctors, nurses, nurse technicians and assistants, and a psychologist) who worked at the Obstetric Center at Santa Casa Hospital agreed to participate, after signing the Informed Consent Form. The number of participants was determined by the saturation of data. The data were collected from July to October/2013, through observation intrapartum and early postpartum, and semi-structured interviews with the health professionals. The data were analyzed considering the notes and the interviewees\' answers through the meaning interpretation method. The data analysis allowed the identification of thematic units which were converted into four categories: the conception and the early contact practice made by the health professional; the mother\'s contribution in the early contact and breastfeeding in the professionals\' point of view; facts that are relevant when it comes to the early contact and breastfeeding in the delivery room; and the assistance model in the process of early contact and breastfeeding in the delivery room. It was evident that the participants were aware of the practices of early skin-to-skin contact and the breastfeeding in the first half hour after delivery, however, the completion of this practice was not verified. The participants consider the mother as passive during the conduction of this practice. They found easy and difficult elements to conduct the early contact, but they did not use the strategies that could make the practice easier. The assistance method is centered in technical and biological issues, and the assistance during the intrapartum period happens in a fragmented and mechanical way, following the hospital routines without any reflections about the work process, which also includes the 4th step of BFHI. It is considered necessary most involvement of all the health professional, in such a way that they can reflect about the advantages and the practice reorganization and the existing hospital routine, with the aim at finishing the actions advocated by the early contact and the breastfeeding in the first half hour postpartum, favoring thus the rate improvement of breastfeeding and, as a result, the improvement of the mother-to-child health

As práticas alimentares da criança menor de um ano trazem inúmeras particularidades que transcendem o biológico e, portanto requerem ser analisadas nas dimensões culturais, psicológicas, sociais e econômicas. Desta forma, buscou-se compreender quais as representações sociais das mulheres/mães sobre as práticas alimentares das crianças menores de um ano. Tratase de uma pesquisa qualitativa, desenvolvida com 15 mulheres/mães de crianças menores de um ano e usuárias de um serviço da rede básica de saúde de Ribeirão Preto-SP. A coleta de dados foi através de entrevistas semi-estruturadas gravadas e transcritas na íntegra e registros de imagens do contexto social da alimentação da criança, fotografadas pelas mães. A coleta se deu após o consentimento livre e esclarecido, no domicílio dos sujeitos. O conteúdo foi categorizado com base na técnica de análise de conteúdo, modalidade temática, e as fotografias possibilitaram uma análise complementar. À luz das representações sociais na perspectiva socioantropológica, analisou-se como as mulheres, enquanto agentes do cuidado infantil, em especial da alimentação do filho, atuam nas diversas dimensões do \"espaço social alimentar\". Depreenderam-se quatro categorias temáticas: 1) O contexto de construção das práticas da alimentação infantil: a alimentação da família; 2) A alimentação da criança no primeiro ano de vida; 3) Pessoas tidas como referência para as práticas alimentares infantis e 4) A alimentação e a saúde da criança. A alimentação é a primeira socialização dos indivíduos, e a família é tradicionalmente o lócus no qual a aprendizagem social se dá, tendo os pais, particularmente as mães, a função de primeiros educadores alimentares. As mães fornecem os sentidos e ideologias que sustentam e determinam as decisões alimentares, desde o primeiro alimento recebido, o leite materno, até a introdução à comida da família. O comportamento alimentar da criança está delimitado por condicionantes fisiológicos, como as alternâncias de sensação de fome e saciedade, parâmetros esses manifestados pelas crianças, que guiam as condutas maternas na oferta do peito ao filho e na avaliação de sua capacidade como nutriz, evidenciando a necessidade de introduzir outro leite. Na alimentação complementar, o aspecto socioeconômico tem peso determinante na seleção dos alimentos, assim como o valor do alimento que deve ter vitaminas e que sustente a criança. A aceitação da comida, avaliada com base na quantidade ingerida, é entendida como uma preferência da criança, a qual guiará as condutas maternas futuras. Relacionam ainda a aceitação da comida como um comportamento esperado de uma criança saudável. O preparo dos alimentos infantis segue princípios que acreditam ser compatíveis com a fase de desenvolvimento da criança, sendo a textura e consistência valorizadas para evitar engasgos, e ao mesmo tempo encorpadas para garantir a sustância da criança. As práticas alimentares infantis se orientam por saberes que perpassam pela legitimidade do discurso científico e alcançam as subjetividades do conhecimento das mulheres do meio relacional, predominantemente de domínio feminino. A introdução precoce da comida da família, \"a mesma comida que a gente come, ele come\", é uma prática comum. Assim, as práticas alimentares demonstram estabelecer-se em um universo próprio que vai além do acesso à informação e das condições socioeconômicas, mas perpassam pelos desacordos existentes entre a prática declarada e a prática real, sendo guiadas pelas representações da comida como fonte de saciedade, evitando a fome, dando sustância e deixando a criança com o corpo forte e saudável. / The feeding practices of children under one year of age take on innumerable particularities that transcend the biological aspect, and, therefore, should be analyzed according to the cultural, psychological, social, and economic dimensions. Hence, the aim of this study was to understand what social representations that women/mothers have toward the feeding practices of children under one year of age. This is a qualitative study, developed with 15 women/mothers of children under one year of age, users of a public health service in the city of Ribeirão Preto, São Paulo State. Data collection was performed using semi-structured interviews, which were recorded and fully transcribed, in addition to photographs of the child\'s social context in feeding, provided by the mothers. This process took place after receiving consent from the participants at their households. The content was categorized based on content analysis technique, thematic mode, and the photographs allowed for a complementary analysis. Considering the social representations from the social-anthropologic perspective, the authors analyzed how women, as child care agents, particularly regarding their child\'s feeding practices, act in the various dimensions of the \"social feeding environment\". Four thematic categories emerged: 1) The context of constructing child feeding practices: feeding the family; 2) Child feeding in the first year of life; 3) People considered as a reference for child feeding practices, and 4) Child feeding and health. Eating is a person\'s first socialization experience, and the family is traditionally the location where social learning takes place. Therefore, parents, particularly mothers, have the role of being the first eating educators. Mothers provide the senses and ideologies that support and determine feeding decisions, from the first food provided, breast milk, to the introduction of food in the family. The child\'s eating behavior is limited by physiological conditionings, such as alternations between feelings of hunger and satiation. Children demonstrate these parameters, and guide the mother\'s act of offering her breast to her child and of evaluating her capacity of nursing, which may raise the need of introducing another milk. In complementary feeding, the socioeconomic aspect determines the selection of foods and the value assigned to the food that has the vitamins needed to feed the child. The acceptance of food, evaluated based on the amount consumed, is understood as the being a child\'s preference, and will guide the mother\'s behaviors in the future. Furthermore, there is an assumption that accepting food is a behavior expected in healthy children. The preparation of child food follows principles that believe to be compatible with the child\'s stage of development, in which texture and consistency are considered to avoid chocking, but are also made thick to assure child nourishment. Child feeding practices are guided by knowledge that skims over the legitimacy of scientific discourse and reaches the subjectivity of the knowledge of women in the relational environment, one that is mainly of feminine domain. The early introduction to family food, \"he eats the same food we eat\" is a common practice. Thus, feeding practices are established in their own universe, which goes beyond access to information and socioeconomic condition. However, they are also subject to the disagreement existing between the declared practice and the real practice, and are guided by the representations of food as a source of satiation, avoiding hunger, providing nourishment, and making the child strong and healthy.

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Introduction. Today women comprise 15% of the U.S. active-duty military, but are often overlooked in research of the Armed Forces. While some of the challenges faced by women are similar to men, they encounter unique stressors related to childcare while deployed, sexual harassment and assault, and gynecological needs. Women are also more likely than men to develop post-traumatic stress disorder (PTSD). Both stress and PTSD have been linked to the development of chronic hypertension and some adverse birth outcomes. We hypothesized that post-9/11/2001 era military women who deployed or who had indicators of PTSD would be at greater risk of developing a hypertensive disorder of pregnancy (HDP) than non-deployed or non-PTSD military women. Methods. We conducted a retrospective cohort study using a U.S. Department of Defense database comprised of all active-duty women who gave birth to their first, live-born singleton infant using Tricare from January 1, 2004 to December 31, 2008. The database included maternal and infant birth hospitalization records, maternal mental health visits, and post-9/11/2001 deployment information which included Post-Deployment Health Assessment (PDHA) and Reassessment (PDHRA) screening responses. HDP was defined with ICD-9-CM codes in the maternal birth hospitalization record. We evaluated the risk of HDP associated with overall deployment and timing of deployment ending compared to non-deployed women, in addition to cumulative months of deployment. We also conducted Classification Tree Analysis (CART) to determine appropriate cut-points for categorization of deployment variables among mothers who deployed: cumulative weeks of deployment, percent of study time spent deployed, and dwell time between two most recent pre-birth deployments. We explored effect modification by covariates postulated to potentially modify the relationship between deployment history and risk of HDP. New variables were defined and used in multivariable logistic regression models for each deployment measure. Women fit into four PTSD case-definition categories: confirmed (ICD-9-CM diagnosis), probable (possible plus endorsement of “high risk” items on the PDHA), possible (endorsement of ≥3 PTSD items on the PDHA), or none (no PTSD indicators). We compared mothers with PTSD to non-cases using multivariable logistic regression to quantify the risk of HDP, and repeated the analyses using a ≥2 PTSD item endorsement case-definition criteria. All logistic regression models were adjusted for known confounders and important covariates. Results. There were a total of 36,675 births, 13.4% of mothers experienced at least one HDP, and 35% of mothers deployed. No increased risk of HDP was observed for deployment overall (OR=1.02, 95% CI: 0.95-1.09), but black mothers who deployed were 13% more likely to develop an HDP (OR=1.13, 95% CI: 1.00-1.27). CART revealed an important cut-point for cumulative deployment length of ≥1 year, which was statistically significant among mothers <35 years old. Mothers with ≥1 year cumulative deployment were 17% more likely to have an HDP than mothers deployed <1 year (OR=1.17, 95% CI: 1.01-1.36). The prevalence of confirmed PTSD was 1.6% in the overall cohort. The prevalence of any PTSD among deployed mothers who completed a PDHA was 6.2%. Overall, PTSD was not significantly associated with HDP except among probable PTSD cases using the ≥2 item criteria (OR=1.30, 95% CI: 1.01-1.67) and among confirmed PTSD mothers identifying as “other” race (OR=6.62, 95% CI: 1.72-25.47). Conclusion. Results are suggestive of an elevated risk of HDP among the military population among women who deployed for a year or longer and for black mothers. Although PTSD did not clearly confer additional risk in the overall cohort, there is evidence to support further research using more thorough screening especially across racial/ethnic groups. Our study likely underestimated PTSD and possibly attenuated results since individuals may purposely report inaccurately on the PDHA in order to go home sooner after deployment. Future studies should include information related to deployment-specific experiences and screen all participants for evidence of PTSD.