Clinical trial NCT02755012: Impact of Maternal Stress on Infant Stunting
Official title: Reducing Maternal Stress Due to Infection, Malnutrition and Psychosocial Conditions of Poverty: A New Paradigm for Tackling Infant Stunting
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Maternal; Malnutrition
Infant Malnutrition
Physiological Stress
Emotional Stress
Life Stress
Domestic Violence
Infection
Breast Feeding
Mastitis
Keywords: Maternal Health
Guatemala
Indigenous Population
Stunting
Food Insecurity
Poverty
Social Support
Maternal Autonomy
Paternal Support
Cortisol Rhythm
Lead sponsor: McGill University
Sponsor class: OTHER
Collaborators: name: Center for Studies of Sensory Impairment, Aging and Metabolism
First posted: 2016-04-28
Enrollment: 271
Sex: FEMALE
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Indigenous Mam-Mayan women living in 8 rural hamlets (or communities) in the municipality of San Juan Ostuncalco, in the department of Quetzaltenango, Guatemala.

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Infant stunting (Infant height-for-age score)
timeFrame: 0-6 wk
measure: Infant stunting (Infant height-for-age score)
timeFrame: 4-6 mo postpartum
measure: Change in infant HAZ per month
timeFrame: Change over time (between 0-6wk and 4-6mo)
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: McGill University
name: Anne Marie Chomat, MD, PhD, MPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Chomat AM, Solomons NW, Koski KG, Wren HM, Vossenaar M, Scott ME. Quantitative Methodologies Reveal a Diversity of Nutrition, Infection/Illness, and Psychosocial Stressors During Pregnancy and Lactation in Rural Mam-Mayan Mother-Infant Dyads From the Western Highlands of Guatemala. Food Nutr Bull. 2015 Dec;36(4):415-40. doi: 10.1177/0379572115610944. Epub 2015 Oct 19.
citation: Solomons NW, Vossenaar M, Chomat AM, Doak CM, Koski KG, Scott ME. Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala. Public Health Nutr. 2015 Jul;18(10):1737-45. doi: 10.1017/S136898001400264X.
citation: Wren HM, Solomons NW, Chomat AM, Scott ME, Koski KG. Cultural determinants of optimal breastfeeding practices among indigenous Mam-Mayan women in the Western Highlands of Guatemala. J Hum Lact. 2015 Feb;31(1):172-84. doi: 10.1177/0890334414560194.