UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item The Self Reported Health of US Women in the First Postpartum Year: NHANES 2007-2018(2021) Fahey, Jenifer Osorno; Shenassa, Edmond; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Most existing information about the health of US postpartum mothers comes from studies of morbidity and mortality. As a result, relatively little is known about the general well-being of postpartum mothers. Self-rated health (SRH), a single-item, 5-level ordinal measure has been widely used as an indicator of general health status in epidemiologic and population health research. There are no US population studies of maternal SRH in the postpartum period. Methods: An analytic sample of 6,266 women ages 20-44 was created from the 2007-2018 waves of the National Health and Nutrition Surveys. The 5-level SRH measure was dichotomized into “good” and “poor” levels and multivariate logistic regression analysis was used to characterize the relationship between postpartum status and SRH and to test whether parity, cigarette smoking, pregnancy, depression, sleep duration, tiredness/fatigue, obesity, history of c-section and breastfeeding status independently predict poor SRH in the sub-population of postpartum women (n=508). Results: There is a significant relationship between postpartum status and SRH that is moderated by pregnancy status. For women who are not pregnant, postpartum status is associated with lower odds of poor SRH (OR 0.52, 95% CI, 0.34-0.79) while for women who are pregnant, postpartum status is associated with increased odds of poor SRH (OR 2.34, 95% CI 0.81-6.78), an association that did not reach statistical significance at a p=0.05 level. Having a high school education (OR 0.35, 95% CI, 0.13-0.95) breastfeeding (OR 0.22, 95% CI 0.10-0.52) were associated with lower odds of poor SRH, while being Hispanic (OR 3.51, 95% CI 1.20-10.27), tired (OR 2.40, 95% CI 1.08-5.57) or obese (OR 2.72, 95% CI, 1.35-5.56) were associated with higher odds of maternal report of poor health. Discussion: Postpartum status is associated with better SRH. This is not the case; however, for women who are pregnant again in the first postpartum year suggesting that a short interpregnancy interval (IPI) is a threat to postpartum maternal well-being. Breastfeeding, on the other hand, is associated with a strong protective effect on maternal postpartum SRH. These results suggest a need for postpartum contraceptive and breastfeeding promotion efforts that focus on immediate impacts on maternal health. Maternal postpartum obesity and maternal tiredness also emerge as priority areas for maternal postpartum health promotion initiatives. Additional research on the postpartum experience of Hispanic mothers is warranted.Item Maternal postpartum nutrition exposures, breastfeeding, and infant weight(2020) Cassar-Uhl, Diana; Steinberg, Julia R; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Objective: This dissertation investigated relationships between postpartum maternal dietary intakes, breastfeeding exclusivity, intensity, and duration, reasons for weaning before 6 months, and infant weight at 6 months. Methods: Three aims examined 8 nutritional exposures: magnesium, added sugar, dairy, energy, glycemic load, and macronutrient distributions (percent of calories from carbohydrate, protein, and fat) among participants in the United States Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC)’s second Infant Feeding Practices Study (IFPS II). The first aim employed logistic regression to examine the association between intakes of dietary factors and exclusive breastfeeding at 3 months, partial breastfeeding at 3 months, and any breastfeeding at 6 months (n = 1099). The second aim used logistic regression to investigate the association between intakes of dietary factors and reasons for early weaning (n = 587). The third aim used multivariable linear regression to examine differences in infant weight and weight-for-age z-scores at 6 months by intakes of dietary exposures (n =186). Unadjusted models and models adjusted for relevant covariates were executed. Results: Those with consumption at or exceeding recommended daily intakes of magnesium, dairy, and energy were more likely to engage in recommended breastfeeding behaviors. Consuming a diet with a low average daily glycemic load was associated with not breastfeeding as recommended. Low average daily glycemic load was associated with a lower likelihood of citing “too much milk” as a reason to wean. No maternal intakes were associated with higher or lower weight or weight-for-age z-scores at 6 months. Conclusion: Findings support existing nutrition guidelines for women of childbearing age, and suggest that a higher daily intake of magnesium may be appropriate for lactating mothers. Average daily glycemic load may also be important, and should be studied further. Implications: This dissertation provides an exploration into specific maternal dietary intakes and important outcomes of infant feeding. It provides a foundation for future inquiries into the roles of magnesium and glycemic load in supporting breastfeeding.Item Breastfeeding Without Nursing: The Lived Experiences of Exclusive Pumpers(2020) Jardine, Fiona Mary; St Jean, Beth; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Worldwide, the overwhelming majority of parents initiate chest/breastfeeding at birth. Human milk is regarded as optimal nutrition for infants and the perfect version of milk for the first years of life; lactation also prevents disease in chest/breastfeeders. Most birth parents want to chest/breastfeed and it is seen as central to motherhood. Chest/breastfeeding is often challenging, resulting in early cessation. Exclusive pumping—that is, only expressing/pumping milk rather than nursing directly at the breast/chest—provides an alternative for those who cannot or do not want to nurse, while retaining most chest/breastfeeding benefits. Existing literature on EPing predominantly focuses on neonatal intensive care unit settings, milk composition, and quantitative data, such as secondary analyses of nationwide surveys. Despite the growing numbers of exclusive pumpers, there is little-to-no data concerning the lived experiences of exclusive pumpers, particularly pertaining to support needs and information provision. Through a retrospective, cross-sectional survey of over 2,000 exclusive pumpers and longitudinal follow-up with over 300 participants, the Breastfeeding Without Nursing study collected qualitative and quantitative data to explore their lived experiences, including: why some chest/breastfeeding exclusively pump; how they feel about it; and what information and support they need and where they find it. Themes within four domains—the circumstances surrounding exclusive pumping, affective experiences, information, and support—were identified through inductive thematic analysis. The findings of this analysis, combined with descriptive and statistical analysis of quantitative data, demonstrate that exclusive pumpers, in general, wanted to nurse at the breast, but as a result of a variety of socioecological influences, were unable to. This led to feelings of loss, grief, and anger, but also determination and pride. Participants needed earlier and better information, many having been incognizant of exclusive pumping despite receiving chest/breastfeeding education. Online support groups were vital sources of information and support; lactation consultants were often not regarded supportive or providing useful information. Having identified gaps in exclusive pumping information, education, and support, I suggest best practices and future research. Contributions to information science include recognizing the importance of education in overcoming incognizance and using a socioecological perspective to analyze the influences on information experience.Item Gestational Weight Gain, Infant Feeding Practices, and Infant Growth(2014) DiBari, Jessica Noelle; Shenassa, Edmond; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Suboptimal growth is apparent across generations. Gestational weight gain (GWG) and infant feeding have been linked to child growth trajectories. This study assessed the joint association of GWG and infant feeding with three growth outcomes: length, weight, and weight-for-length. I analyzed data from the Infant Feeding Practices Study II (2007), a nationally-based sample of mother/infant dyads followed from the third trimester of pregnancy through infancy (N=1939). GWG was defined as inadequate, adequate, and excessive. Predominant feeding categories were defined as ≥ 70% breast fed, ≥ 70% formula fed, and mixed fed. Linear multiple regression and mixed effect models were fit to achieve the study aims. At three months, compared to the adequate GWG group, the inadequate group were lighter (-0.24 lbs.; 95% CI: -0.36, -0.12) and shorter (-0.13 in.; 95% CI: -0.23, -0.03), while the excessive group was heavier (0.28 lbs.; CI: 0.19, 0.38) and longer (0.09 in.; 95% CI: 0.01, 0.17). At five months, compared to breastfed infants, formula fed infants were heavier (0.38 lbs.; 95% CI: 0.26, 0.50); and the association between feeding type and length was apparent at seven months, where formula fed were longer (0.24 in.; 95% CI: 0.10, 0.39). An association between feeding type and weight-for-length was evident at twelve months, where the ratio for formula fed was greater (0.03 lbs./in.; 95% CI: 0.03, 0.04). The weight gain trajectory of breastfed infants was lower than the other feeding groups. The length trajectories were highest among formula fed compared to breastfed and mixed fed infants. The interaction between GWG and feeding type was significant for weight (p<0.05) and marginally significant for length (p=0.06). My findings suggest existence of a difference in growth by GWG and feeding type. The weight trajectory of breastfed infants is steadier than that of other infants, highlighting the protective effect of breastfeeding on excessive weight gain. The growth rate for all feeding groups was fastest between 3-5 months, suggesting a critical window for growth during early infancy. Interventions targeting pregnancy and infancy can influence growth trajectories and contribute to a shift in intergenerational population growth trends.Item The Poetics of Bodily Being: The Lived Experience of Breastfeeding an Infant "Out of Reach" in the NICU(2013) Sampson-Kelly, Christy A.; Hultgren, Francine; Lieber, Joan; Special Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Babies born preterm (<37 weeks gestation) and at very low birth weight (VLBW, <1500 grams, 3.3 pounds) reside "out of reach" from their mothers in a neonatal intensive care unit (NICU) during the very beginnings of life. As the evidence of breast milk versus formula for infants within this vulnerable population is well established, multiple initiatives call for the provision of breast milk, and NICU professionals are subsequently making efforts to increase numbers of breastfed infants. However, there is a gap in the scholarly literature that brings forth mothers' voices relative to this unique breastfeeding experience. These voices are imperative to making a greater understanding of this phenomenon. This hermeneutic phenomenological study asks the question: What is the lived experience of providing breast milk for one's child who lives in a NICU? My exploration draws upon the writings of several philosophers including Levinas, Heidegger, Merleau-Ponty, Gadamer, and Derrida that relate to the phenomenon and discover how the phenomenon is made visible through them. The wondrous writings of poets are interlaced throughout my journeying, reverberating the deep meaning that lies beneath the surface of things. Max van Manen's depiction of hermeneutic phenomenology provides the methodological structure for the study, which is uncovered through the multiple, individual conversations with and journal entries of ten mothers who share this human experience. As meaning unfolds, breastfeeding emerges centrally, as a remedy and offering a way to transcend the dis-eases of self-blame, dis-place-ment, and dis-member-ment underwent as part of mothering in the NICU. Reflecting on these dis-eases, calls for the offering of pedagogical insights of more welcoming and less judgment in supporting mothers in doing the work of mothering, taking on a view of breast milk as more than pure resource, and the importance of nurturing the nurses. Attending to these stories may help NICU professionals to imagine an environed NICU, were mothers, too, are cared for in their journey to self-forgiveness, em-place-ment, and re-member-ment, amid the strange and wondrous terrain of their beginnings.