We found the there were no single health risk tool available when trialing an exercise intervention in obese pregnant women...consequently I developed a Pregnancy Symptoms Inventory where women could rate whether they had a particular symptom and how much it impacted on their activities of daily living. It has just been published in BMC Pregnacy and Childbirth and it's title is Development and Validation of a Pregnancy Symptoms Inventory.

I don't know what do you mean by global measure for maternal well-being, in developing countries we do anthropometric measurements, biochemical tests and also physical examination in Ante-natal, Natal and also post-natal period to measure maternal Health.

See Save the Children's State of the World Mother's 2012

See the attached

I'm not that well versed in these measures, but a lot of researchers use the Parenting Stress Index, you could check it out and see if it fits the bill

Yes, please clarify whether, by "global" you mean a measure that can be used in various parts of the world, or whether you mean the mother's "overall" well-being, and if so, in what part of the world? Thanks.

It is difficult to have one measure for maternal health if you take the W.H.O definition of Health. I think you can have a reasonable composite variable for global maternal health if consideration can be made of common antenatal complications (see indicators from WHO publications) such as anemia, hypertension etc; delivery complications, e.g. see near miss indicators; and postnatal complications eg, puerperal psychosis. Drawing such a composite variable may need considerations of the environment where it is going to be applied since some conditions are more relevant in one setting than the other.

I agree that it depends on what you are interested in measuring. Are you mainly concerned with measures of physicaland emotional health? In a cohort study on readmission, we selected ICD codes to define normal range at early discharge and reasons for readmission of mothers and newborns. In public health, we used the Edinbourgh Scale as a screen for signs of PPD. If you are interested in examing the links between the social determinants of health and maternal wellbeing you might want to consider a quality of life scale as a global measure of wellbeing -- Raphael, D. (2012). Health promotion and quality of life in Canada. Essensial readings. Toronto: Canadian Scholars Press.

If so, have you tried DSM foguidance on mood disorder measures? Psychiatrists may be in a better position to answer.

Edinburgh postnatal depression scale has been tested for validity and reliability in many different languages as far as i remember

I used the self-rated health measurement (SRH) which predicts morbitity and mortality and the use of health servicies in my studies of womens health after childbirth. Look for Schytt et al

I am not aware of any generic instruments measuring maternal well-being, but there are quite a few condition or disease-specific questionnaires for caregivers of children.

Please see the article titled "Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review."

http://link.springer.com.ezproxy2.library.usyd.edu.au/article/10.1007%2Fs11136-012-0343-z

You could also check out the online resource of POSITIVE HEALTH INDICATORS at http://www.uib.no/hemil/ressurser/positive-health-indicators. Here you can search for indicators of health as more than absence of disease.

I set up a Maternal Health clinic where I see women 6 months after pregnancies complicated by one or more of, what we call, pregnancy-related cardiovascular risk indicators (pre-eclampsia, gestational hypertension, abruption, IUGR, GDM, gestational impaired glucose tolerance, etc.). We have developed tools for abstracting the information and in addition to physical and biochemical testing, we determine if they have metabolic syndrome and calculate their risk for future cardiovascular disease. More information about this and the bits-and-pieces that we use can be found on our website (http://www.themothersprogram.ca/after-delivery/postpartum-health). Otherwise, there is no one measure of maternal well-being but a combination of these sorts of things, and including an assessment of mental health (like the Edinburgh Postpartum Depresssion test) should be considered.

I think this kind of factor is important for developed countries. But for the developing countries such factors are unimportant because normal quality factors are unavailable to would be mother.

Hi, I work for many years in Africa with MSF (doctors without borders) and in our MCH programmes maternal indicators were maternal mortality and neonatal mortality, then specifics for conditions, such as TT inmunisations, malaria prevention, appropiate pregnancy control, Fe levels, HIV screening and prevention of MTCT, etc. as somebody was advising before check WHO recommendations.

We found the there were no single health risk tool available when trialing an exercise intervention in obese pregnant women...consequently I developed a Pregnancy Symptoms Inventory where women could rate whether they had a particular symptom and how much it impacted on their activities of daily living. It has just been published in BMC Pregnacy and Childbirth and it's title is Development and Validation of a Pregnancy Symptoms Inventory.

This is all very helpful. I shared these responses with the researcher. From what I understand, the research is to validate a tool to be used in lieu of the Edinburgh, which is great, but a little awkward in terms of language for U.S. speakers of English. I'll make sure to share the outcome of this research when it is completed. Thanks!

The House of Representatives approved a resolution (H. Res. 1022) reflecting the House of Representatives’ commitment to reducing maternal mortality both at home and abroad. The resolution expresses the House of Representatives’ “commitment to promoting maternal health and child survival both at home and abroad through greater international investment and participation; and recognizes maternal health and child survival as fundamental to the well-being of families and societies, and to global development and prosperity.”

Reference

Women’s Policy Inc. House Approves Measure on Maternal Mortality. Available at:

http://www.womenspolicy.org/site/News2?id=8379

You could you the Raskin Covi Anxiety Depresssion scales as a general measure that are easy to use -but if you are interested in a population guide - premature births are an indicator to find areas of need as that is consistently related to lack of perinatal care.

The only truly global measure is the smile.

From maternal well being with respect to mental state (depression, anxiety and stress) standpoint, PSS (Perceived Stress SCale) by Sheldon Cohen has been validated and use in peripartum patients and used in a good number of peer-reveiwed publications on maternal well being in the OB literature. PSS can be used in both peripartum, as well as non-perpartum patients. PSS has been traslated into many different languages and also validated in a various subset of non-English speaking countries.

I am sending the reference of a paper on maternal wellbeing:

http://www.biomedcentral.com/1471-2431/10/19.

In this paper, a cohort of 791 mothers who had been followed since early pregnancy was mailed a questionnaire when the children were aged four to six years. The questionnaire included a screening tool for developmental problems, an assessment of the child's social competence, health care utilization and referrals, and maternal factors, including physical health, mental health, social support, parenting morale and sense of competence, and parenting support/resources.a questionnaire was used to assess maternal wellbeing.

I just finished a small qualitative exploratory study into pregnant women's perceptions of maternal wellness. I have been trying to understand how women define wellness. My initial analysis looks more like maternal well-being. The themes that emerged from the data were: environmental avoidance, emotional health, nutrition, delivery & recovery, exercise, loving gestures, and caring for self. These were women who had a high level of fitness prior to their second pregnancy. But their attitudes and behaviors do not match their prenatal behaviors. I will review the maternal wellbeing article for some insight. Thank you.

You might take a look at the Edinburgh Post Natal Depression Scale--available on the internet, 10 items. See if that meets your needs. There may also be some simple measures such as how the mother is doing with food intake, liquid intake, rest, pleasure, attending to their usual tasks, socializing with female friends and family members (sisters, mothers, cousins, aunts), responding to their baby and other children. These are fairly global, probably good enough measures, and can be adapted to many circumstances.

Dear researchers

these responses are very interesting but most focus on measures of maternal ill-health. I would also really like to hear more about anyone who has developed a measure or set of measures for wellbeing - positively!

Similarly here in Malaysia, no specific tools , as far as I am personally aware. However through the general assessment, interviews and physical assessment prenatally and postnatal , we will be able to find out if anything is not right.

Dear Grace

I agree that interviews before and after birth would be useful and some researchers have done such qualitative studies, so maybe a good task for a researcher or research team will be to analyse qualitative studies in order to pull out indicators and begin to develop a positive measure that can be used in more structured and large-scale studies.

Maternal well-being measurement is complicated as we discovered in a local study. Most postnatal women report high levels of satisfaction with the experience(s) which is not commensurate with the facilities, services or their health status. Therefore a universal measure of such would not be useful. We have a qualitative paper below if it may be useful for you.

http://www.ncbi.nlm.nih.gov/pubmed/22453705

Dear one

It would be good enough if one can do maternal well being measurement. As it was observed that per year in India 56,000 pregnant women died just because of pregnancy complications. Based on literature survey and single centre study I can say maternal nutrient deficiency may lead to IUGR or IUFD or neonatal morbidities. But as you asked on perinatal mood disorder i think folic acid might be having some role. and as i observed during survey because of pregnancy, pregnant women eat high fat diet rather than healthy food. It was reported that diet having high glycemic index may produce mood disorders. (particularly pastries, cakes, tea, coffee etc.)

There is no overall toolsspecifically for this as far as I am aware, however I believe to assess this a universally accepted classification should be used - we use the Ten Group Classification system which can be used not only to classify caesarean section but other outcomes such as maternal morbidity- one paper has described this using this system:

Homer CS, et al. A novel use of a classification system to audit severe maternal morbidity Midwifery 2010; 26(5): 532-6