Gestational Weight Gain: Historical Evolution of a Contested Health Outcome.

The history of research on gestational weight gain (GWG) in the United States and United Kingdom provides a context for current clinical practice. We trace the evolution of research on GWG in scientific literature from the 19th century to the present and examine its implications for contemporary clinical and public health practice. Obstetricians, beginning in the late 1800s, recommended dieting during pregnancy in order to limit GWG to 20 lb or less, driven by a belief that excessive weight gain was a cause of toxemia. Beginning in the 1930s, a burgeoning focus on nutrition and health allowed a better understanding of the effect of GWG on the health of the fetus and the newborn. Increased awareness of disparities in infant mortality in the 1960s, followed by systematic review of the literature, produced further refinements in GWG recommendations in the 1970s, which continue today. Current research focuses on epigenetic influences over the life course and has emphasized individualized recommendations. The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted. IMPORTANCE: Gestational weight gain and its relationship to maternal, fetal, and infant health are areas of active inquiry. OBJECTIVE: We critically review evolution of scientific understanding of GWG from the 19th century to the present, and examine its implications for contemporary obstetric practice. EVIDENCE ACQUISITION: We reviewed all English-language medical studies related to GWG published through 1930s as well as widely cited influential works from 1940s through present time. RESULTS: During the past century, recommendations for GWG have reversed from emphasizing dieting during pregnancy to the importance of proper nutrition during pregnancy. Obstetricians' focus has also evolved from being exclusively on the newborn to include the health of mothers. Contemporary obstetric practice seeks to achieve a balance between mothers' and infants' risk of adverse outcomes. CONCLUSIONS: Historical and social contexts of the United States and the United Kingdom led to distinct GWG policies in the 2 countries. Changes in GWG recommendations over the past century reflect developments in the allied fields, such as epidemiology and nutrition, as much as progress in obstetrics and gynecology. RELEVANCE: The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted.

Las Matronas de la Beneficencia Municipal y su atención a las mujeres pobres de Málaga (1900-1956) / As Parteiras de Assistência Municipal e atenção às mulheres pobres de Málaga (1900-1956) / The Municipal Welfare Midwives and attention to the poor women of Malaga (1900-1956)

El objetivo de este estudio consiste en conocer las características del desarrollo profesional y la práctica clínica de las Matronas de la Beneficencia Municipal Malagueña en el período de 1900-1956. Material y Método: Se ha realizado un estudio histórico descriptivo. La recogida de información se ha realizado a través de fuentes primarias y secundarias. Resultados: El proceso para instalar las casas de socorro en la ciudad de Málaga, se inició en 1862 por orden del Gobernador Civil que urgió al Ayuntamiento para que las estableciese. Conclusiones: La incorporación de la Matrona al escenario sanitario permitió una cobertura durante el proceso reproductivo a las mujeres pobres de Málaga a través de la Beneficencia Municipal (AU)

The aim of this study was focused on knowing professional development characteristics and Clinical Practice of Midwives in the Municipal Charity of Malaga in 1900-1956. Method and Materials: This was descriptive and historic study. The collection of information has been made through primary and secondary sources. Results: The process to install the relief houses in the City of Malaga, started in 1862 by Order of the Civil Governor. Conclusions: The incorporation of the healthcare scenario allowed Midwives coverage during the reproductive process of poor women of Malaga through the Municipal Welfare (AU)

O objetivo deste estudo é compreender as características do desenvolvimento profissional e prática clínica das Parteiras Municipal de Assistência Malagueña no período 1900-1956. Material e Métodos: Foi realizado um estudo descritivo histórico. A coleta de informações foi realizada por meio de fontes primárias e secundárias. Resultados: O processo para a instalação de casas de socorro na cidade de Malaga, começou em 1862 por ordem do Governador Civil instou o Conselho da Cidade de estabelecer. Conclusões: A adição do cenário da saúde permitiu a cobertura matrona durante o processo reprodutivo de Málaga mulheres pobres através da Previdência Municipal (AU)

A rollercoaster of policy shifts: global trends and reproductive health policy in The Gambia.

Global trends influence strategies for health-care delivery in low- and middle-income countries. A drive towards uniformity in the design and delivery of healthcare interventions, rather than solid local adaptations, has come to dominate global health policies. This study is a participatory longitudinal study of how one country in West Africa, The Gambia, has responded to global health policy trends in maternal and reproductive health, based on the authors' experience working as a public health researcher within The Gambia over two decades. The paper demonstrates that though the health system is built largely upon the principles of a decentralised and governed primary care system, as delineated in the Alma-Ata Declaration, the more recent policies of The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the GAVI Alliance have had a major influence on local policies. Vertically designed health programmes have not been easily integrated with the existing system, and priorities have been shifted according to shifting donor streams. Local absorptive capacity has been undermined and inequalities exacerbated within the system. This paper problematises national actors' lack of ability to manoeuvre within this policy context. The authors' observations of the consequences in the field over time evoke many questions that warrant discussion, especially regarding the tension between local state autonomy and the donor-driven trend towards uniformity and top-down priority setting.

[The protection of infant life: from XVIII to XXI century (the input of physicians and scientists of the Research Center of Children Health of the Russian Academy of Medical Sciences)].

The article deals with issues of protection of infant life in the history of the research center of children health of the Russian academy of medical sciences which originates from the Emperor Moscow founding hospital established September 1 1763 according decree of Empress Catherine II. As long as infant mortality persisted at extremely high rate during centuries, the protection of life of children of early age considered as a strategic public purpose in Russia right until middle of XX century. The activity of farsighted and responsible rulers of Russia laid the foundation to public system of mother and child health care 250 years ago. The physicians and researchers of the Moscow founding hospital and such its successors as the Infant Protection Home, the Institute of protection of maternity and infancy and the academic institute of pediatrics made their own input into protection of infant life. Because of all that, children mortality at infant age decreased more than in 30 times. Billions of children lives were saved.

[The House of infant protection in Moscow].

The article deals with short (1918-1922) but exremely important time of reorganization and functioning of the House of infant protection in Moscow established by the initiative of the Department of mother and infant protection. It turned out, because of enthusiasm and professionalism of physicians and in spite of the most severe situation in the country, to organize the departments for healthy infants, to establish clinics for gravely sick little patients, laboratory diagnostic units and children consultation. The House of infant protection became the only practical research center in the Soviet Russia to study physiology and pathology of children of early age and to train physicians and medical nurses specialized in the area of early childhood. The importance of the House of infant protection which was at the origins of the Soviet system of protection of children health, is hard to overestimate. The House was a kind of experiment area to develop the institutions of public system of mother and child protection, to elaborate the Soviet pediatric science and schools of training and advanced training of research and practical specialists in this field of medicine.

An historical overview of the first two decades of striving towards Safe Motherhood.

The paper examines some of the progress and problems encountered during the first two decades of the Safe Motherhood Initiative. Sufficient statistics are cited to identify the immensity of the persisting problems associated with maternal death and morbidity before the study focuses on some of the endeavours designed to enable women to survive their natural function of giving birth. Varying attitudes and approaches that have characterised the initiatives launched in the past 20 years are reviewed and their changing emphases noted. The stress on treating the medical causes of maternal death in the early years have been complemented by increasing attention to social and political issues as time has elapsed. The advent of the Millennium Development Goals (MDGs) has impelled efforts to provide skilled attendance for all women during childbirth; the poor, socially disadvantaged and vulnerable being those most at risk. MDG 5, concerning maternal health, is perceived as pivotal in the context of global development. Maternal death when viewed from the human rights perspective is perceived as a social injustice rather than a health disadvantage and Safe Motherhood is currently considered increasingly as a basic human right. The study offers a synthesis of concepts and actions that are contributing to building Safe Motherhood across the globe in the 21st century. In considering the factors that inhibit the degree of safety associated with giving birth, global efforts that are tackling a persisting buffer zone are identified and continuous action urged in order to strive towards the targets set for 2015.