MOMS Intervention

The Mothers Offering Maternal Support (M-O-M-S) program was initially formed and piloted 12 years ago by Dr. Karen Weis, Professor and Brigadier General Endowed Chair of Nursing Research. Her research has shown benefits to the mothers; their comfort with pregnancy and improved health and the health of their newborn. Now at the University of the Incarnate Word, Weis and her team continue their program with military families and are transitioning the program to the general community. This early pregnancy MOMS-mentoring-MOMS program is proven to work.

If you are a community group, a non-profit, a medical practice, a health plan or an academic institution CARING for pregnant women—contact us for opportunities to work together! I will personally visit with you to collaborate!

Dr. Karen Weisweis@uiwtx.edu

Intervention Programming

A military family embracing each other at a parkFollowed 503 military women, active duty and wives of military members across pregnancy and explored impact of prenatal anxiety and family functioning on birth outcomes.

Study Methods

  • Convenience sample
  • Variables assessed in 1st, 2nd, and 3rd trimester
  • Measures
    • Prenatal-specific anxiety
    • Family functioning
    • Social support
  • Data collection began in September 2001

Results

Pregnancy-Specific Anxiety

  • Increased anxiety for Acceptance of pregnancy, Identification with a Motherhood Role, Preparation for Labor, and Well-Being predicted early gestational age
  • Increased anxiety for Preparation for Labor and Fears of Helplessness and Loss of Control in Labor predicted low birthweight

Family Functioning

  • Women’s perception of family adaptability had a statistically significant effect on ALL pregnancy-specific anxiety attributes
  • Women in families considered to be dysfunctional for adaptability and cohesion were 8 times more likely to experience hyperemesis

Community Support: Esteem-Building Support

  • Significant negative association with prenatal anxiety
  • Positive predictive relationship with community support in 1st and 2nd trimesters to infant birthweight
  • Women identifying an “ on-base” versus “off-base community of reference had significant decreases in prenatal anxiety

Deployment of Spouse/Partner

  • Military deployment of spouse (father of the baby) in 1st trimester
    • Statistically significant negative association with maternal acceptance of pregnancy
    • Predicted maternal role satisfaction and maternal-infant attachment at 6 months postpartum
    • Not predictive of maternal competence
    • Mothers had highest scores for symptoms of depression

*Father/Spouse often back home prior to delivery

Results Guided Intervention Development

  • Timing of intervention – must start in the first trimester
  • Support from a military-specific community
  • Focused intervention to pregnancy-specific anxiety
  • Absence of spouse/father of baby impacts self-esteem

A mother holding her baby as they read a toddler bookMentors Offering Maternal Support (M-O-M-S)

  • Begins in 1st trimester
  • Each session focused on specific dimensions of pregnancy anxiety
  • Mentors guide program and provide support
  • Program manual provides discussion points

M-O-M-S Pilot

  • 65 mothers in first trimester, randomized to control group (control group, n = 36; intervention group n=29), completed all aspects of study
  • All had deployed spouses
  • Study conducted at two bases having Special Operations missions and high deployment tempos

Measures

Variables and Measures
Variable Measure
Prenatal Maternal Anxiety PrenatalSelf-Evaluation Questionnaire –
PSEQ , 79 items, 7 scales (Lederman, 1996)
Perceived Community Support Social Support Index – SSI; 17 items
(McCubbin, Patterson, & Glynn, 1982)
Maternal Attachment Maternal Antenatal Attachment Scale
MAAS, 19 items (Conden, 1981)
Self-Esteem Rosenberg Self-Esteem Questionnaire
RSE, 10 items (Rosenberg, 1979)

Results

  • No statistically significant differences found between tx/control groups
  • *Women having greatest contact with spouses had higher scores for self-esteem
  • High satisfaction with program
  • Requested modifications to study manual
  • Participation continued after completing the 8 sessions (desired postpartum support)

References

Weis, K. L., & Ryan, T. W. (2012). Mentors offering maternal support: A support intervention for military mothers. Journal of Obstetric, Gynecologic & Neonatal Nursing, 41, 303-313.

Activation of M-O-M-S Intervention Programming

This M-O-M-S Intervention Program includes multiple sessions where the Moms and Mentors are in facilitated sessions. The research shows mentoring relationships and the supportive community leads to better outcomes for both mother and newborn.

A military member checking pregnant women using stethoscopeM-O-M-S Randomized Clinical Trial

  • Design: Randomized-controlled trial with repeated measures
  • Setting: San Antonio military community
  • Sample: n = 367 women in 1st trimester; Complete data across 3 trimesters for n = 246
  • Measurement: Prenatal anxiety, self-esteem, resilience and depression measured in each trimester

Measures

Variables and Measures
Variable Measure
Prenatal Maternal Anxiety Prenatal Self-Evaluation Questionnaire – PSEQ-SF, 53 items, 7 scales (Lederman & Weis, 2009)
Self-Esteem Rosenberg Self-Esteem Questionnaire – RSE, 10 items (Rosenberg, 1979)
Resilience Brief Resilience Scale – BRS, 6 items (Smith et al.,2008)
Depression Edinburgh Postnatal Depression Scale – EPDS, 10 items (Murray & Cox, 1990)

Demographics

  • Ages 19-42 (M= 28.72, SD= 5.00)
  • White/Caucasion (60%), Black, nonHispanic (29%), Hispanic (22%)
  • Married (91%)
  • Employed (63%)
  • College degree (42%)
  • First pregnancy (38%)
  • Active duty women (40%)
  • Deployed partner during pregnancy (9%)
  • Enlisted (73%)
  • Air Force (64%), Army (24%), Navy (9%)

Results

Women in M-O-M-S Intervention had:

  • Statistically significant decreases in anxiety related to Identification with a Motherhood Role (p = .049)
  • Statistically significant decreases in anxiety related to Preparation for Labor (p = .017)

Prenatal Anxiety: Identification with a Motherhood Role

Deployment was a significant predictor of anxiety related to Identification. Women with deployed partners during pregnancy had significantly greater anxiety for Identification with a Motherhood Role (p= .041).

Prenatal Anxiety: Preparation for Labor

Parity was a significant predictor of anxiety related to labor. Nulliparous women had significantly greater anxiety for Preparation for Labor (p= .0001).

References

Weis, K. L., Lederman, R. P., Walker, K. C., & Chan, W. (2017). Mentors offering maternal support reduces prenatal, pregnancy-specific anxiety in a sample of military women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(5), 669-685.

Pregnancy Anxiety and Birth Outcomes

Pregnancy Anxiety and Preterm Birth

  • Anxiety for acceptance of pregnancy
    • Each 1/10 increment of anxiety increased the odds by 37%
  • Anxiety for preparation of labor
    • Each 1/10 increment of anxiety increased the odds by 60%
  • Anxiety for fears of helplessness and loss of control in labor
    • Each 1/10 increment of anxiety increased the odds by 54%

Pregnancy Anxiety and Low Birthweight

  • Anxiety for well-being of self and baby
    • Each 1/10 increment of anxiety increased the odds by 83%
  • Active duty women were significantly more likely to have low birthweight infants

References

Weis, K. L., Walker, K. C., Chan, W., Yuan, T. T., & Lederman, R. P. (2020). Risk of preterm birth and
infant low birthweight in military women with increased pregnancy-specific anxiety. Military Medicine, 185, 678-685.

Preliminary Results for Multi-Site Randomized Clinical Trial (RCT)

Mentors Offering Maternal Support (M-O-M-S) Intervention to Determine Effect on Birth Outcomes

Multi-site RCT

  • Large military OB populations
    • Naval Medical Center San Diego – over 3,000 deliveries a year
    • Madigan Army Medical Center, Ft. Lewis-McCord, Washington – 2,700 deliveries a year
    • San Antonio Military Medical Center, 2,000 deliveries a year
  • Randomize 1,200 women -to assess intervention effects on birth outcomes
  • Data collection points at baseline, 16, 28, and 32 weeks; 1, 3, and 6 months postpartum

Current Demographics

  • San Antonio = 464; Madigan = 406; Naval Medical Ctr San Diego = 285
  • Ages 18-50 (M= 28.4, SD= 5.24)
  • Married (88%)
  • Employed (68%)
  • College degree (41%)
  • First pregnancy (48%)
  • Active duty women (41%)
  • Deployed partner during pregnancy (7%)
  • Enlisted (84%)
  • Air Force (23%), Army (42%), Navy (31%), Marine (4%)

Study Design

  • Recruited, consented, randomized in the first trimester of pregnancy
  • Randomized to MOMS group or prenatal care without the MOMS
  • MOMS participants attended 10 , 1-hr classes every-other-week
  • Completed questionnaires at baseline, 16, 24, 28, and 32 weeks and postpartum at 1, 3, and 6 montspostpartum.

Psychosocial Measures

  • Maternal Prenatal Stress and Anxiety (PSEQ)
  • Self Esteem (Rosenberg’s Self-Esteem Scale
  • Family Adaptability (FACES II)
  • Prenatal Depression (EPDS)
  • Perceived Support (SSI)
  • Military Family Commitment (FIC)
  • Resilience (BRS)
  • Postpartum Maternal Adaptation (PPSEQ) 

Results

Women in M-O-M-S Intervention had:
  • Statistically significant decreases in anxiety related to Preparation for Labor (p = .005)
  • Statistically significant decreases in anxiety related to Relationship with Spouse/Partner (p < .03)
Active Duty Women had:
  • Statistically significant increase in anxiety related to Preparation for Labor (p = .02)
Pregnancy-Specific Anxiety

Statistically significant increases in anxiety related to:

  • Acceptance (p <.001) (anxiety > for first-time Mom)
  • Identification of Motherhood (p < .001) (> for first-time Mom)
  • Preparation for Labor (p < .001) (anxiety > for first-time Mom)
  • Helplessness (p < .001) (anxiety > for first-time Mom)
  • Well-Being (p = .001) (anxiety > for first-time Mom)
  • Relationship with Mother (p = .001) (anxiety > for over 3 children)
  • Depressive Symptoms (p = .01) (Depressive symptoms > for 1-2 deliveries vs. zero or greater than 3).

Implications:

  • 14%-23% of women affected prenatally by anxiety/mood disorders
  • 11%-21.9% of women affected in postpartumperiod by anxiety/mood disorders
  • In 2015, American College of Obstetricians & Gynecologists (ACOG), recommended increasing perinatal screening and having treatment and referral plans
  • Must build capacity to care for women’s mental health care needs both pre-and post-natally

Intervention Articles By Dr. Karen Weis – Outcomes and what’s possible for Mentors-Offering-Maternal-Support (M-O-M-S)?

This study compared two groups of military wives, one group receiving standardized prenatal care and one group receiving a program designed to provide esteem-building support.

JOGNN – Scholarship for the Care of Women, Childbearing Families and Newborns - Jognn.org/

Abstract

Objective: To evaluate the effectiveness of the Mentors Offering Maternal Support (MOMS) program to promote maternal fetal attachment, maternal adaptation to pregnancy, self-esteem, and perceived community support in women within a military environment.

Design: A randomized, controlled, repeated measured pilot study compared two groups of pregnant military wives, a control group receiving standard prenatal care and an intervention group receiving a structured eight-session MOMS program.

Setting: The study was conducted at two Air Force installations in Florida having joint (Air Force, Army, and Navy) operations and high deployment requirements.

Participants: Sixty-five military wives in their first trimester of pregnancy (control group, n = 36 and intervention group, n = 29) completed all aspects of the study.

Methods: Women randomized to the MOMS program received eight structured classes starting in the first trimester of pregnancy and occurring every other week until the third trimester. Outcome measures were obtained in each trimester. The women in the control group received usual prenatal care.

Results: No statistically significant differences were found between the two groups for any of the outcome variables. The interaction of the amount of contact the women had with their deployed husbands and group assignment was statistically different for two variables, the Relationship with Husband Scale and the Rosenberg Self-Esteem Inventory.

JOGNN, 41, 303-314; 2012. DOI: 10.1111/j.1552-6909.2012.01346
Accepted December 2011

Abstract

Objective: To determine the efficacy of the Mentors Offering Maternal Support (MOMS) program to reduce pregnancy-specific anxiety and depression and build self-esteem and resilience in military women.

Design: Randomized controlled trial with repeated measures.

Setting: Large military community in Texas.

Participants: Pregnant women ( n = 246) in a military sample defined as active duty or spouse of military personnel.

Methods: Participants were randomized in the first trimester to the MOMS program or normal prenatal care. Participants attended eight 1-hour sessions every other week during the first, second, and third trimesters of pregnancy.

Pregnancy-specific anxiety, depression, self-esteem, and resilience were measured in each trimester. Linear mixed models were used to compare the two-group difference in slope for prenatal anxiety, depression, self-esteem, and resilience.

Results: The Prenatal Self-Evaluation Questionnaire was used to measure perinatal anxiety. Rates of prenatal anxiety on the Identification With a Motherhood Role ( p = .049) scale and the Preparation for Labor ( p = .017) scale were significantly reduced for participants in MOMS. Nulliparous participants showed significantly lower anxiety on the Acceptance of Pregnancy scale and significantly greater anxiety on the Preparation for Labor scale. Single participants had significantly greater anxiety on the Well-Being of Self and Baby in Labor scale, and participants with deployed husbands had significantly greater anxiety on the Identification With a Motherhood Role scale.

Conclusion: Participation in the MOMS program reduced pregnancy-specific prenatal anxiety for the dimensions of Identification With a Motherhood Role and Preparation for Labor. Both dimensions of anxiety were previously found to be significantly associated with preterm birth and low birth weight. Military leaders have recognized the urgent need to support military families.

JOGNN, 46, 669–685; 2017. http://dx.doi.org/10.1016/j.jogn.2017.07.003

Military Medicine 185 2020

Abstract

Introduction: Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population.

Material and Methods: Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW.

Results: For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively.

Conclusions: Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.