Prenatal Development and Infancy Discussion

Prenatal Development and Infancy Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Prenatal Development and Infancy Discussion Prenatal Development and Infancy Discussion Read the articles assigned, you’ll have 3 articles to read on the topic of the week. You will post on 2 questions raised by each of the articles, but not answered by them. For each question, you’ll provide a brief explanation of what, in the article, made you think of it and why it’s important to answer. I really don’t want to see questions like “Why did they have mostly white babies in the study? I think this is important because we don’t know if all racial groups would respond in the same way.” If you have reason to believe, or expect, that babies from different racial/ethnic groups would behave differently, provide that reason, otherwise, don’t ask that type of question. If you’re reading a study about maternal post-partum depression, it should be clear that the researchers will be studying mothers, so it wouldn’t be a good idea to ask why they didn’t include fathers. The point of this exercise is to help you think about the studies you’re reading and really consider what they are and are not able to tell you. How do you know if a fetus has learned something? Can you really know? What about a 3 month old baby? How would you know if he or she has expectations about the way the world works? University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion knowledge_of_fetal_sex_in_jordan.pdf why_parents_should_not_be_told.pdf big_5_and_knowledge_of_fe International Journal of Nursing Practice 2009; 15: 105–111 RESEARCH PAPER Relationship between parental knowledge of fetal gender and newborns’ birthweight among Jordanian families Nemeh Al-Akour DNSc Assistant Professor in Maternal-Child Health Nursing, School of Nursing, Jordan University of Science and Technology (JUST), Irbid, Jordan Accepted for publication November 2008 Al-Akour N. International Journal of Nursing Practice 2009; 15: 105–111 Relationship between parental knowledge of fetal gender and newborns’ birthweight among Jordanian families The purpose of this study was to examine the relationship between women knowing the fetal gender and their newborns’ birthweight. Four-hundred and eighty-four post-partum mothers before discharge from the maternity unit participated in this study. We collected our data from the women by using two sources: a demographic data questionnaire and reviews of hospital records. v For this study, we considered normal birthweight as > 2500 and < 4000 g and low birthweight as < 2500 g. The findings of the study suggested that knowledge of fetal gender was significantly related to the mean birthweight of newborns. When the gender was known prenatally, the mean birthweight of male newborns was significantly higher than that of female newborns. Also knowledge of fetal gender was found to increase the probability of low birthweight among female newborns compared with male newborns. Identifying sociocultural factors that might be linked to the gender preference could improve mothers’ and their newborns’ well-beings. Nurses have to be aware of the consequences of gender preference such as low birthweight. Key words: birthweight, fetal gender, gender preference, Jordan, prenatal knowledge. INTRODUCTION Low birthweight (LBW) is an imporatnt health outcome measure.1 It continues to be a major determinant of infant mortality.1,2 Preference for male newborns and subsequent discrimination against female newborns in the area of prenatal health care might be an important area for analysis in developing countries such as Jordan.3,4 A recent study conducted in Jordan examined birthweight and found a significant difference between male and female Correspondence: Nemeh Al-Akour, School of Nursing, Jordan University of Science and Technology (JUST), PO Box (3030) Irbid 22110, Jordan. Email: [email protected] doi:10.1111/j.1440-172X.2009.01734.x newborns, with the mean birthweight (MBW) of female newborns being lower than that of male newborns.3 In countries where boys are preferred over girls, such as Jordan,3 identifying the relationship between prenatal knowledge of gender and birthweight might have important implications for the development of health-care services. Understanding health behaviors of pregnant women could enhance nurses’ knowledge about the phenomenon of gender preference from viewpoints of Jordanian women.University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion Furthermore, results of such studies might provide a foundation for the development of health-care systems to support such vulnerable populations. Specifically, initial steps could be made with Jordanian nurses that might help to assess necessary improvements in health © 2009 Blackwell Publishing Asia Pty Ltd 106 N Al-Akour care for pregnant women and infants. The current study seeks to provide such initial groundwork towards the development of population-specific, culturally sensitive health-care services. Literature review In 2005 a United Nations Children’s Fund (UNICEF) survey provided background information on neonate and infant health in Jordan.5 The percentage of infants with LBW was 12, neonatal and infant mortality rates were 17, and 17.35 deaths per 1000 live births, respectively. Female infant mortality was lower at 13.28 deaths per 1000 live births, compared with 20.04 per 1000 among male infants. According to the 2007 statistics from the Department of Statistics in Jordan the infant mortality rate was 16.76 per 1000 live births; however, neonatal and infant mortality in Jordan are lower considering it is a developing country.6 Furthermore, in a recent study involving Jordanian newborns Al-Tal and Bataineh found that the MBW of the newborns of 2256 mothers was 2812 g.7 Twenty-two per cent of the newborns weighed between 700 and 2499 g. These statistics represent initial efforts to obtain information regarding infant health in Jordan. Recent literature suggests that gender preference might be related to neonatal and infant health.3 In general, the literature on gender preference has been concerned with less developed countries, where the main preference observed was for sons, followed by a preference for an equal number of sons and daughters. For instance, Arnolds and Kuo provide a detailed study of 44 countries with demographic and health surveys in the period 1986– 1995.8 The authors found a prevalent preference for sons in 43 countries. In some nations, such as India and China, the majority of prenatal procedures were performed for gender selection, rather than the detection of fetal abnormalities. Dahl and Moretti examined the effects of gender composition on divorce, fertility-stopping rules, consensual union and polygamy in five developing countries: China, Vietnam, Mexico, Colombia and Kenya.9 The results of the Dahl and Moretti study revealed that all-girl mothers relative to all-boy mothers were more likely to be divorced, to have another child, to be in a consensual union and to be in a polygamous relationship.9 In addition, the birth of sons is typically celebrated more than that of daughters. Taken together these data suggest that the birth of sons within marriage might help to stabilize the union of the family by increasing the potential for women to © 2009 Blackwell Publishing Asia Pty Ltd remain married, reducing their probability of divorce and preventing the husband from entering into polygamous relationships. Information on gender preference in Jordan and other Arab countries is scarce.University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion However, Al-Qutob et al. examined the effect of the knowledge of prenatal fetal sex on birthweight in Amman, Jordan.3 The authors found that when the gender was known prenatally, the MBW of female newborns was lower than that of male newborns. In fact, this knowledge increased the risk of LBW newborns among female newborns as compared with that of male newborns by 27%. A qualitative study conducted by Khalaf and Callister searched cutural meanings of childbirth among Muslim women living in Jordan, and suggested that sons might be more valued than daughters.10 Given the lack of information regarding health-care services in developing countries such as Jordan, more data from a variety of samples might facilitate progress towards comprehensive health-care services. Specifically, more data regarding the relationship between prenatal knowledge of fetal gender and newborn birthweight will inform screening and intervention services in prenatal settings. AL-Qutob et al. examined this phenomenon in a relatively more developed area within Jordan, the capital of Amman.3 However, researchers should be aware that stark differences in lifestyles between relatively more developed cities and rural areas within developing countries such as Jordan might make the relevance of such studies specific to the location and populations studied. The current study will elaborate and extend upon the findings of AL-Qutob et al.3 by examining the relationship between prenatal knowledge of gender and newborn birthweight with a relatively rural population of Jordanian women living in the town of Irbid. METHODS Study population A cross-sectional design was used to examine the relationship of knowledge of fetal gender and newboens’ birthweight. The women who participated in this study and the basic methods used have been described by the author in a recent publication.11 A sample of post-partum mothers identified before discharge from the maternity units participated in this study during a 3-month period. Eligible women, aged 20–40 years with a singleton live-birth baby, had normal pregnancies as determined by obstetricians and were also judged to be free of chronic diseases. All the 484 women received prenatal care within the first Gender preference 107 4 months of pregnancy. A demographic questionnaire (the questionnaire and data are available from the author upon request) and hospital record reviews were used to obtain data used in this study. The questionnaire is a 27-item self-report instrument developed by the investigator to obtain information related to variations in maternal characteristics. The questionnaire, and the reviews of hospital records, were designed to determine: (i) descriptive information about maternal backgound, conception, pregnancy and prenatal care; and (ii) demographic data including marital status, family income, age, parity, gravida, occupation and employment status. For this study, normal birthweight was defined as > 2500 and < 4000 g12,13 and LBW as defined as < 2500 g.12,14–16 A pilot study was conducted with 60 women to ascertain whether or not there was a significant gender preference. Data collection A team of three trained nursing students and the primary researcher were responsible for identifying mothers who met the eligibility criteria for participation in this study. Four hundered and eighty-four mothers were recruited from a hospital in Irbid City, Jordan. University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion This hospital is the only public maternity hospital in the northern part of Jordan that provides health-care services free of charge for all women with governmental health insurance. Ethical approval for the study was obtained from the Ethical Research Committee at Jordan University of Science and Technology. The purpose of the study and instructions were reviewed with the mothers and a signed informed consent was obtained prior to participation in the study. Data analysis We used descriptive statistics to report the demographic data of maternal background and health status of newborns. anova and t-tests were used to compare the MBW of the newborns of pregnant women who knew the gender of their future children, and pregnant women who did not know the gender of their future children stratified by newborns’ gender. A c2 test was used to test the association between LBW newborns of pregnant women who knew the gender of their future children and pregnant women who did not know the gender of their future children stratified by newborns’ gender. We considered results as statistically significant when P-values were < 0.05. In this study, we used Statistical Package for Social Sciences (spss, version 13.0, SPSS Inc., Chicago, IL, USA) for all statistical analysis. RESULTS Table 1 presents the descriptive information about maternal background. Sixty-one per cent of the participants in the sample were 20–29 years of age. Forty-eight per cent and 43% of the mothers and fathers had ? 12 years of schooling, respectively. Sixty-eight per cent of the mothers were housewives and 32% were employed. More than half of the sample (51%) had a total family income of less than 300 Jordanian Dinars (JD) (which is considered below the poverty line in Jordan). Seventyfive per cent of the sample had more than one male sibling, and 81% had more than one female sibling. Seventy-three per cent of the mothers had given birth to more than three children. Forty-six per cent of the sample had been living in a village and 54% in a city. Sixty-eight per cent of the mothers and 69% of the fathers preferred boys, however, fathers reported nearly double the preference for girls (21%) than did mothers (12%). As to the obstetric history of the mothers, 364 mothers (75%) had the gender of their babies detected prenatally by ultrasound in their 16th weeks of gestation. Of these, 200 mothers (55%) knew their prospective babies were male and 164 (45%) knew they were female. One hundred and twenty mothers (25%) did not know the gender of their prospective babies. In this sample, 55% of the newborns were boys and 45% were girls. In this study, ª9% of the mothers had given birth to LBW babies. The results of the study showed that knowledge of fetal gender did significantly affect the MBW based on the gender. Table 2 shows that male fetuses prenatally known through ultrasound were 171 g significantly heavier than female fetuses whose gender was known through ultrasound (F = 5.174, P < 0.006); the MBW of male newborns was 3355.7 ? 490 and of female newborns was 3184.9 ? 515. The Scheffe post-hoc test revealed that when the gender was known prenatally, from the four groups (pregnant women of female offspring prenatally both known and unknown and pregnant women of male offspring prenatally both known and unknown) the MBW of female babies prenatally known were significantly the lowest among all the groups. No significant difference in MBW was found between male and female babies, when the parents had no prior knowledge of gender. In addition. the results indicate that knowledge of fetal gender might increase the risk of LBW among female newborns. The rate of LBW in female newborns prenatally known (5.7%) was significantly higher (P < 0.01) than that of male newborns prenatally known (3%). University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion These © 2009 Blackwell Publishing Asia Pty Ltd 108 N Al-Akour Table 1 Frequency and per cent of the sample by selected variables Variable Mother’s age 20–29 years 30–40 years Mother’s education ? 12 > 12 Father’s education ? 12 > 12 Mother’s occupation Working Housewives Family income JD/m < 300 300–500 > 500 Number of sons 0 ?1 Number of daughters 0 ?1 Gender of youngest child No child Male Female Mother’s prefernce No preference Boy Girl Father’s prefernce No prefernce Boy Girl N % 297 187 61 39 234 250 48 52 209 275 43 57 155 329 32 68 249 179 56 51 37 12 120 364 25 75 90 394 19 81 82 216 186 17 45 38 95 331 58 20 68 12 51 333 100 10 69 21 differences are in contrast to having no prior knowledge of the fetus’s gender where there was no significant difference in the proportion between both genders. Ancillary analyses Ancillary analyses were computed to identify relationships and differences between the main study variables and selected demographic variables. The review of the litera© 2009 Blackwell Publishing Asia Pty Ltd Variable Past history of LBW Yes No Parity 0 1–3 ?4 Mother’s height (cm) ? 155 > 155 Mother’s weight (KG) 50–60 > 60 Weigt gain (KG) ? 10 11–13 ? 14 Source of prenatal care Public Private Place of living Village City N % 36 448 7 93 82 50 352 17 10 73 47 437 10 90 61 423 13 87 192 167 125 40 34 26 294 190 61 39 224 260 46 54 ture suggested that factors such as consumption of essential nutrients during pregnanacy and source of prenatal care visits might be influenced by gender preferences, which might expose the pregnant women and the fetus to serious health risks. Moreover, family composition was found to influence MBW; number of girls in the family was significantly inversely related with the MBW newborns (r = -0.153, P < 0.01), whereas number of boys in Gender preference 109 Table 2 The mean birthweight (MBW) newborns by mother’s knowledge of fetal gender Sex Mother’s knowledge of fetal gender Known Male Female Unknown N MBW* ? SD N MBW ? SD 200 164 3355.7 ? 490 3184.9 ? 515 62 58 3278.7 ? 587 3191.4 ? 548 * P < 0.001. the family was significantly positively correlated with MBW newborns (r = -0.126, P < 0.01). Consumption of essential nutrients (carbohydrate and essential fatty acids, protiens, vitamins, iron, calcium) of pregnant women has significant influence on the MBW newborns’ birthweight (F = 3.127, P = 0.045). Source of prenatal care visits has influence on MBW; pregnant women using the services of a public facility for prenatal care had a MBW that was significantly lower than those using a private facility (t = 3.996, P = 0.001). In the current study, prenatal care use was found to have significant direct relationships to the MBW (r = 0.504, P < 0.01). Those women who had a recommended number of prenatal care visits had better positively effects on the MBW of their newborns. In other words, prenatal care use reduces LBW. DISCUSSION The MBW of the newborns sampled in the current study is consistent with findings of previous research in Jordan. Al-Qutob and colleagues indicated that the average birthweight of male newborns was 3303 g and that of female newborns was 3195 g.3 Furthermore, the authors found that, when the gender was known prenatally, the MBW of female newborns was lower than that of male newborns and this knowledge increases the risk of LBW among femle newborns as compared with that of male newborns by 27%. University Of New Hampshire PSYC 780 Prenatal Development and Infancy Discussion The current study is in a agreement with previous studies4,17 showing that socioeconomic and cultural factors might have influences on gender preference and produce variations in the quality of care among pregnant women. This includes factors such as health, nutrition and psycho- logical means, and these differences typically favour male newborns. The findings suggested that the number of boys and number of girls in the family, nutritional status of the mothers and source of prenatal care (public vs. private) were all factors that influence MBW. In addition, the findings of this study indicate that prenatal care decreases the incidence of LBW. However, literature in this area indicates that the effectiveness of prenatal care for preventing LBW is still a matter of controversy. For example, Lu et al. agreed that prenatal care decreases LBW.1 On the other side, Alexander and Korenbrot did not find that prenatal care visits significantly improved the outcomes of preganacy, and the authors reported there are small actions performed during the standard prenatal care visits that could be expected to decrease LBW.18 Mohsin et al. indicated that the relationship between newborns’ gender and LBW is still ambiguous.19 Literature showed that the fact that MBW of female newborns is lower than that of male newborns could be explained by the natural differences between the MBW of male and female newborns. However, female neonatal mortality is shown to be lower than male neonatal mortality.20,21 As such, the natural differences might contribute to some of the differences found in the current study. However, the findings reported here suggest that prenatal information regarding gender is critical, and female newborns whose gender was known prenatally were most likely to be LBW. Given this, the current study suggests that the outcomes are not due to gender alone, but rather gender and prenatal knowledge of gender. Previous research in Jordan found that 11% of the mothers had given birth to LBW babies,3,17 and Al-Tal and Bataineh found that 22% of the newborns were of LBW.7 In the current study a small number of newborns were of LBW, and perhaps future studies with larger samples are needed to examine the interactions of sex preference, socioeconomic and cultural factors, and birthweight. For example, the report of Department of Statistics stated that the north of Jordan had the lowest infant mortality rate compared with both the center and the south of Jordan.22 Such location-specific differences highlight the need for further analysis of the factors responsible for such differences. Given this, caution should be exercised when generalizing findings from one setting to another. Limitations The design restricts the authors’ capability to present causal interpretations. Prospective longitudinal research is © 2009 Blackwell Publishing Asia Pty Ltd 110 N Al-Akour essential to examine the magnitude of Jordanian mothers’ preferences for gender of newborns. Larger sample is necessary to investigate the relationships among gender preference, sociocultural factors and birthweight. Nursing implications and recommendations The findings of this study emph … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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