Impact of Maternal Stress on Infant Stunting

Study Overview
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Brief Summary
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This study takes place in rural Mam-Mayan communities of Guatemala characterized by high rates of childhood stunting. It aims to characterize women's exposure to nutrition, infection and psychosocial stressors vs. resilience factors, to evaluate the cumulative impact of maternal-level factors (nutritional, infectious, psychosocial), social factors (autonomy, social support, domestic violence), and household factors (socioeconomic status, food security) on early infant growth, and to evaluate whether maternal cortisol may be a mediator in the vertical transmission of stress.

Detailed Description
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Grounded in participatory action research and a socio-ecological framework, this mixed-methods, observational study enrolled a longitudinal cohort of 155 women, seen during pregnancy (6-9 mo), early (0-6 wks) and later (4-6 mo) postpartum, and two cross-sectional cohorts (60 early, 56 later postpartum). Maternal and infant anthropometry was recorded, maternal fecal, urine and saliva samples were collected, and questionnaires were used to explore household factors (socioeconomic status, food security), social factors (autonomy, paternal/social support, domestic violence), and maternal-level factors (nutrition, infection, emotional distress). Analyses focused on (1) characterizing women's exposure to nutrition, infection and psychosocial stressors vs. resilience factors, (2) describing the maternal diurnal salivary cortisol rhythm in pregnancy and postpartum and explore its association with psychosocial variables, (3) assessing the cumulative impact of maternal-level factors (nutritional, infectious, psychosocial), social factors (autonomy, social support, domestic violence), and household factors (socioeconomic status, food security) on early infant growth, and (4) evaluating whether maternal cortisol may be a mediator in the vertical transmission of stress. In addition, Photovoice activities involved giving a camera to 23 women from study communities, who documented sources of stress vs. resilience for local women, and shared photo-elicited narratives through six group sessions.

Official Title
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Reducing Maternal Stress Due to Infection, Malnutrition and Psychosocial Conditions of Poverty: A New Paradigm for Tackling Infant Stunting

Conditions
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Maternal; Malnutrition, Infant Malnutrition, Physiological Stress, Emotional Stress, Life Stress, Domestic Violence, Infection, Breast Feeding, Mastitis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Woman from study communities Either pregnant or 0-6 wk postpartum or 4-6 mo postpartum Consenting to participate Exclusion Criteria: Twin pregnancy Not consenting to participate
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Longitudinal<br>155 women enrolled in 2nd or 3rd trimester of pregnancy, and seen again, with their infant, at 0-6 wk postpartum, and 4-6 mo postpartum | |
| Early Postpartum<br>60 women enrolled at 0-6 wk postpartum and seen once with their infant (cross-sectional) | |
| Later Postpartum<br>56 women enrolled at 0-6 wk postpartum and seen once with their infant (cross-sectional) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Infant stunting (Infant height-for-age score) | Infant height-for-age score measured at 0-6 wk | 0-6 wk | 
| Infant stunting (Infant height-for-age score) | Infant height-for-age score measured at 4-6 mo postpartum | 4-6 mo postpartum | 
| Change in infant HAZ per month | Change in infant HAZ score between 1st (0-6 wk) and 2nd (4-6 mo) visits | Change over time (between 0-6wk and 4-6mo) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Maternal Health, Guatemala, Indigenous Population, Stunting, Food Insecurity, Poverty, Social Support, Maternal Autonomy, Paternal Support, Cortisol Rhythm