School of Public Health
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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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 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.