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.
BACKGROUND
The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together.


OBJECTIVE
To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother-infant dyads.


METHODS
Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored.


RESULTS
Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts.


CONCLUSIONS
The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother-infant dyad.
McGill University, Montreal, Quebec, Canada Tufts University, Boston, MA, USA.
Anne Marie
AM
Chomat
Tufts University, Boston, MA, USA Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
Noel W
NW
Solomons
McGill University, Montreal, Quebec, Canada.
Kristine G
KG
Koski
McGill University, Montreal, Quebec, Canada.
Hilary M
HM
Wren
Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
Marieke
M
Vossenaar
McGill University, Montreal, Quebec, Canada marilyn.scott@mcgill.ca.
Marilyn E
ME
Scott
D000328:Adult; D003430:Cross-Sectional Studies; D004032:Diet; D017579:Domestic Violence / Q000706:statistics & numerical data; D005260:Female; D005523:Food Supply; D006130:Growth Disorders / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007228:Infant Nutrition Disorders / Q000453:epidemiology; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology / Q000523:psychology; D008137:Longitudinal Studies; D039382:Maternal Nutritional Physiological Phenomena; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012424:Rural Population; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology; D011795:Surveys and Questionnaires
diet; domestic violence; local idioms of distress; maternal autonomy; microcephaly; paternal and social support; stunting; trust; underweight