176
|
Tasa J, Holmberg V, Sainio S, Kankkunen P, Vehviläinen-Julkunen K. Maternal health care utilization and the obstetric outcomes of undocumented women in Finland - a retrospective register-based study. BMC Pregnancy Childbirth 2021; 21:191. [PMID: 33676438 PMCID: PMC7937309 DOI: 10.1186/s12884-021-03642-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, capital city of Finland, in addition to comparing the results with all pregnant women in Finland. Methods The study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N = 47,274 women) and with prenatal screening tests for infectious diseases (N = 51,447 [HIV, HBV], N = 51,446 [syphilis]). Results The majority (91%) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71%) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5% (3/59) tested positive for HIV, 3% (2/59) for HBV, and 2% (1/57) for syphilis. The prevalence of HIV (p-value < 0.001) and HBV (p-value = 0.007) was significantly higher amongst undocumented women compared with all pregnant women. Conclusions Undocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was significantly higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.
Collapse
|
177
|
Schindler-Ruwisch J, Palancia Esposito C. "Alexa, Am I pregnant?": A content analysis of a virtual assistant's responses to prenatal health questions during the COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2021; 104:460-463. [PMID: 33422368 PMCID: PMC7771908 DOI: 10.1016/j.pec.2020.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To elucidate whether Amazon's virtual assistant, Alexa, provides evidence-based support as a supplement to provider-facilitated prenatal care, during the COVID-19 pandemic. METHODS Using a conceptual content analysis approach, a query of 40 questions, relating to all phases of pregnancy, was collected from Alexa by two independent investigators, using two unique devices, over a one-week period between May 20, 2020 and May 27, 2020. Alexa's responses were matched to the evidence-based content from the American College of Obstetricians and Gynecologists (ACOG) and reviewed by a Certified Nurse Midwife for completeness and currency. RESULTS Of the 40 questions asked of Alexa, it was unable to answer 14 questions (35%). A total of 21 out of the 40 responses (52%) were not evidence-based and three COVID-specific questions (about 1%) were answered incorrectly or insufficiently. Four questions (10%) were answered accurately. CONCLUSION Alexa was largely unable to provide evidence-based answers to commonly asked pregnancy questions and, in many cases, supplied inaccurate, incomplete, or completely unrelated answers that could further confuse health consumers. PRACTICE IMPLICATIONS Ensuring that mobile health (mhealth) tools, such as Amazon Alexa, are evidence-based and credible in answering common prenatal questions has important implications for this pandemic and future consumer needs.
Collapse
|
178
|
McKechnie AC, Erickson K, Ambrose MB, Chen S, Miller SJ, Mathiason MA, Johnson KA, Leuthner SR. Development and testing of a self-report measure of preparing to parent in the context of a fetal anomaly diagnosis. PATIENT EDUCATION AND COUNSELING 2021; 104:666-670. [PMID: 32839046 PMCID: PMC7889754 DOI: 10.1016/j.pec.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To generate a self-report instrument to capture clinically relevant variations in expectant parents' caregiving development, specified by how they are preparing to parent an infant with a major congenital anomaly. METHODS Recent literature structured domains to guide item generation. Evaluations by experts and expectant parents led to a refined instrument for field testing. Psychometric testing included exploratory factor analysis, internal consistency, and test-retest reliability. RESULTS Samples included expert evaluators (n = 9), and expectant parent evaluators (n = 20) and expectant mother field testers (n = 67) with fetal anomaly diagnoses. Preparing to Parent-Act, Relate, Engage (PreP-ARE) resulted from a three factor solution that explained 71.8 % of the total variance, with global Cronbach's α = 0.72, and sub-scales 0.81, 0.65, 0.72 respectively. Cohen's weighted kappa indicated all items were acceptably reliable, with 14 of 19 items showing moderate (≥ 0.41) or good (≥ 0.61) reliability. Convergent validity was found between the maternal antenatal attachment and Act scales (r = 0.39, p = 0.001). CONCLUSION This empirically-based instrument was demonstrated to be valid and reliable, and has potential for studying this transitional time. PRACTICE IMPLICATIONS PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare.
Collapse
|
179
|
Hutchinson-Colas J, Sachdev D. COVID-19 and pregnancy care for incarcerated women. Case Rep Womens Health 2021; 30:e00296. [PMID: 33614418 PMCID: PMC7880836 DOI: 10.1016/j.crwh.2021.e00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
|
180
|
Hurst DJ, Schmuhl NB, Voils CI, Antony KM. Prenatal care experiences among pregnant women with obesity in Wisconsin, United States: a qualitative quality improvement assessment. BMC Pregnancy Childbirth 2021; 21:139. [PMID: 33588775 PMCID: PMC7885492 DOI: 10.1186/s12884-021-03629-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/18/2021] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women's interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology. METHODS We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States. RESULTS All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated "weight" and "BMI" as the most desirable terms for describing weight, while "large size" and "obesity" were rated least desirable. CONCLUSIONS Many pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term "high BMI" will be used in place of the term "obesity" to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.
Collapse
|
181
|
Rafie Z, Vakilian K, Zamanian M, Eghbali H. The Effect of Solution-Oriented Counseling on Coping Strategies in Mental Health Issues in Women with Gestational Diabetes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:983-991. [PMID: 33559816 DOI: 10.1007/s10488-021-01111-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the effectiveness of solution-oriented intervention in patients with gestational diabetes, stress and anxiety on using coping strategies. This study was a randomized clinical trial with a control group. The population consisted of 56 diabetic women under treatment with insulin, who obtained higher score in one of the psychological disorders using DASS-21 (Depression, anxiety, stress scale). The participants were randomly assigned in two interventional (n = 28) and control (n = 28) groups after signing the written informed consent forms. The solution-oriented interventional program was conducted in six 60-min sessions for 6 weeks. Immediately after the final session and 6-8 weeks after the first session of the intervention, both groups completed coping inventory for stressful situations. The analytical statistic of t-test, chi-square, and variance analysis with repeated measurements using SPSS were used to analyze the data. solution-oriented counseling increased the problem-solving coping strategy in the intervention group (P = 0.001); the scores obtained by the subjects in the interventional group after adjusting the score before the intervention increased 2.68 units immediately after the intervention, which was not statistically significant (p-value = 0.44). However, it increased 11.5 scores six weeks after the intervention, which was statistically significant (P = 0.00). But, emotional and avoidance coping strategies were not significantly different between the two groups. This technique can be easily trained to all clients, and since it is focused on finding various solutions for psychological problems by clients, it can be used to reduce stress and anxiety in other chronic diseases as well.IRCT code: The code of this clinical trial study is IRCT20200202046339N1.
Collapse
|
182
|
Guarnizo-Herreño CC, Wehby GL. Health of Infants Born to Venezuelan Refugees in Colombia. J Immigr Minor Health 2021; 23:222-231. [PMID: 33550477 DOI: 10.1007/s10903-020-01114-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
Little is known about the health of infants born Venezuelan refugee women in Colombia. Using birth certificate data, we compared birth weight, gestational age, and Apgar scores between births to Venezuelan refugee women and Colombian women in 2016-2018 using logistic regression. We also compared number of prenatal visits and health insurance coverage. Infants born to Venezuelan refugee women were more likely to be preterm (OR=1.14 [95%CI:1.07,1.23]), extremely preterm (OR=1.71 [95%CI:1.19,2.46]), low birth weight (OR=1.30 [95%CI:1.18,1.42]), and very low birth weight (OR =1.80 [95%CI:1.45,2.23]) than infants born to Colombian women. There were no differences in Apgar scores. Most Venezuelan refugee women had no health insurance, and number of prenatal visits was half that of Colombian women. Pregnant Venezuelan refugee women face health care barriers and have worse birth outcomes than Colombian women, highlighting the need to further address health care and other socioeconomic barriers for this vulnerable population.
Collapse
|
183
|
Racial Disparities in Prenatal Care Utilization and Infant Small for Gestational Age Among Active Duty US Military Women. Matern Child Health J 2021; 24:885-893. [PMID: 32356127 DOI: 10.1007/s10995-020-02941-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine racial disparities in prenatal care (PNC) utilization and infant small for gestational age (SGA) among active duty US military women, a population with equal access to health care and known socioeconomic status. METHODS Department of Defense Birth and Infant Health Research program data identified active duty women with singleton live births from January 2003 through August 2015. Administrative claims data were used to define PNC utilization and infant SGA, and log-binomial regression models estimated associations with race/ethnicity. To examine whether associations between maternal race/ethnicity and infant SGA were subject to effect measure modification, respective analyses were stratified by demographic and health characteristics. RESULTS Overall, 12.2% of non-Hispanic White women initiated PNC after the first trimester, compared with 14.8% of American Indian/Alaska Native, 15.1% of Asian/Pacific Islander, 14.2% of non-Hispanic Black, and 13.0% of Hispanic women. Infant SGA prevalence was 2.4% and 1.6% among non-Hispanic Black and White women, respectively (aRR 1.52, 95% CI 1.40-1.64). This disparity persisted across stratified analyses, particularly among non-Hispanic Black versus White women with a preeclampsia or hypertension diagnosis in pregnancy (RR 1.96, 95% CI 1.67-2.29) and those aged 35 + years at infant birth (RR 2.04, 95% CI 1.56-2.67). CONCLUSIONS FOR PRACTICE In multiple assessments of PNC utilization and infant SGA, non-Hispanic Black military women had consistently worse outcomes than their non-Hispanic White counterparts. This suggests that equal access to health care does not eliminate racial disparities in outcomes or utilization; additional research is needed to elucidate the underlying etiology of these disparities.
Collapse
|
184
|
Tamang ST, Dorji T, Yoezer S, Phuntsho T, Dorji P. Knowledge and understanding of obstetric danger signs among pregnant women attending the antenatal clinic at the National Referral Hospital in Thimphu, Bhutan: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:104. [PMID: 33530968 PMCID: PMC7852084 DOI: 10.1186/s12884-021-03580-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women's understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. METHODS This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan's largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as 'good' (≥80%), 'satisfactory' (60-79%) and 'poor' (< 60%). Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson's correlation coefficient. Association between knowledge score and participant characteristics was tested using t-tests (and Kruskal-Wallis test) for numeric variables. Socio-demographic and clinical characteristics associated with the level of knowledge ('good' versus 'satisfactory' and 'poor' combined) were assessed with odds ratios using a log-binomial regression model. All results with p < 0.05 were considered significant. RESULTS Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had 'good' knowledge, 245 (58.1%) had 'satisfactory' knowledge and 157 (37.2%) had 'poor' knowledge. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 women (20.3%) could not recall any danger signs. Most women were knowledgeable about pre-labour rupture of membranes (96.0%) while very few women were knowledgeable about spotting during pregnancy (19.9%). Both knowledge score and number of danger signs recalled had significant correlation with the period of gestation. Women with previous surgery on the reproductive tract had higher odds of having 'good' level of knowledge. CONCLUSIONS Most pregnant women had 'satisfactory' knowledge score with poor explicit recall of danger signs. However, women recognized obstetric emergencies and identified the appropriate action warranted.
Collapse
|
185
|
#metoo? The association between sexual violence history and parturients' gynecological health and mental well-being. Arch Gynecol Obstet 2021; 304:385-393. [PMID: 33527173 DOI: 10.1007/s00404-021-05977-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sexual violence is a global health problem. We aimed to evaluate the association between self-reported history of sexual violence and parturients' health behaviors, focusing on routine gynecological care, and mental well-being. METHODS This was a retrospective questionnaire-based study, including mothers of newborns delivered at the "Soroka" University Medical Center (SUMC). Participants were asked to complete three validated questionnaires, including: screening for sexual violence history (SES), post-traumatic stress disorder (PDS) and post-partum depression (EPDS). Additionally, a demographic, pregnancy and gynecological history data questionnaire was completed, and medical record summarized. Multiple analyses were performed, comparing background and outcome variables across the different SES severity levels. Multivariable regression models were constructed, while adjusting for confounding variables. RESULTS The study included 210 women. Of them, 26.3% (n = 57) reported unwanted sexual encounter, 23% (n = 50) reported coercion, 1.8% (n = 4) assault and attempted rape, and 1.4% (n = 3) reported rape. A significant association was found between sexual violence history and neglected gynecological care, positive EPDS screening, and reporting experiencing sexual trauma. Several multivariable regression models were constructed, to assess independent associations between sexual violence history and gynecological health-care characteristics, as well as EPDS score. Sexual violence history was found to be independently and significantly associated with a negative relationship with the gynecologist, avoidance of gynecological care, sub-optimal routine gynecological follow-up, and seeking a gynecologist for acute symptoms (adjusted OR = 0.356; 95% CI 0.169-0.749, adjusted OR = 0.369; 95% CI 0.170-0.804, adjusted OR = 2.255; 95% CI 1.187-4.283, and adjusted OR = 2.113; 95% CI 1.085-4.111, respectively), as well as with the risk of post-partum depression (adjusted OR = 4.46; 95% CI 2.03-9.81). All models adjusted for maternal age and ethnicity. CONCLUSION Sexual violence history is extremely common among post-partum women. It is independently associated with post-partum depression, neglected gynecological care, a negative relationship with the gynecologist, and with reporting of experiencing sexual trauma. Identifying populations at risk and taking active measures, may reduce distress and improve emotional well-being and family function.
Collapse
|
186
|
Harvey SM, Oakley LP, Gibbs SE, Mahakalanda S, Luck J, Yoon J. Impact of Medicaid expansion in Oregon on access to prenatal care. Prev Med 2021; 143:106360. [PMID: 33309874 DOI: 10.1016/j.ypmed.2020.106360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/30/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022]
Abstract
Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low-income women access to healthcare before and early in pregnancy. The aim of this study was to examine the effects of Oregon's Medicaid expansion on timely and adequate prenatal care. We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. Outcomes were receipt of first trimester prenatal care and receipt of adequate prenatal care. We also assessed Medicaid enrollment one month prior to pregnancy. We estimated the overall effect of Medicaid expansion on prenatal care utilization using probit regression models. Additionally, we assessed the impact of Medicaid expansion on prenatal care utilization via pre-pregnancy Medicaid enrollment using bivariate probit models. Overall, receipt of first trimester prenatal care increased post-expansion by 1.5 percentage points (p < 0.01) after expansion. Receipt of adequate prenatal care also increased significantly post-expansion with an incremental increase of 2.8 percentage points (p < 0.001). Pre-pregnancy Medicaid enrollment increased following Medicaid expansion (β = 0.55, p < 0.001) and was associated with both timely (β = 0.48, p < 0.001) and adequate receipt of prenatal care (β = 0.14, p < 0.001). Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy, which subsequently increased receipt of timely and adequate prenatal care. Our study provides evidence that expanding Medicaid has positive effects on women's use of healthcare.
Collapse
|
187
|
Silva CFM, Saunders C, Peres W, Folino B, Kamel T, dos Santos MS, Padilha P. Effect of ultra-processed foods consumption on glycemic control and gestational weight gain in pregnant with pregestational diabetes mellitus using carbohydrate counting. PeerJ 2021; 9:e10514. [PMID: 33585080 PMCID: PMC7860109 DOI: 10.7717/peerj.10514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
AIMS The aims were to evaluate the consumption of ultra-processed foods by pregnant women with pre-existing diabetes mellitus (DM) using the carbohydrate counting method, in addition to investigating the association with total gestational weight gain and glycemic control. METHODS A cohort study of adult Brazilian pregnant women with pre-existing DM. Dietary intake was evaluated adopting the NOVA classification to identify the reported consumption of ultra-processed foods. Weight was measured at all consultations and laboratory tests were evaluated at each gestational trimester. Multivariate linear regression was used in the analysis. RESULTS Pregnant women (n = 42) presented mean total gestational weight gain of 12.02 ± 4.8 kg, 65.8% of them with inadequate weight gain. Daily consumption of ultra-processed foods was 272.37 ± 170.55 kcal. The increase of every 1 kcal in the calorie intake from ultra-processed foods in the third trimester increased glycated hemoglobin by 0.007% (β = 0.007, p = 0.025), raised 1-h postprandial glucose by 0.14 mg/dL (β = 0.143, p = 0.011), and added 0.11 kg to total gestational weight gain (β = 0.11, p = 0.006). CONCLUSION Ultra-processed food consumption influenced glycemic control and total gestational weight gain in pregnant women with DM.
Collapse
|
188
|
Shen WC, Chen CH. Effects of non-supervised aerobic exercise on sleep quality and maternal-fetal attachment in pregnant women: A randomized controlled trial. Complement Ther Med 2021; 57:102671. [PMID: 33486048 DOI: 10.1016/j.ctim.2021.102671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/19/2020] [Accepted: 01/15/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study was designed to evaluate the effect in pregnant women of a non-supervised aerobic exercise intervention on sleep quality and maternal-fetal attachment. DESIGN Pretest-posttest randomized controlled trial. SETTING Prenatal clinic of a medical center in southern Taiwan. PARTICIPANTS One hundred and forty eligible, pregnant women were assigned systematically, at a random starting point, to either the experimental group (n = 70) or the control group (n = 70). INTERVENTION Participants in the experimental group received a 20-minute, low-impact aerobic exercise video on DVD and were instructed to exercise at home at least three times per week for a period of three months. Participants in the control group received routine prenatal care only. MAIN OUTCOME MEASURES The Pittsburgh Sleep Quality Index and Modified Maternal-Fetal Attachment Scale were used to assess outcome measures before the intervention and at four and 12-weeks post-intervention. RESULTS The paired-sample t-tests revealed a significant improvement in sleep quality in the experimental group at 4-weeks posttest, which persisted through 12-weeks posttest. In addition, the experimental group reported a significantly higher mean score for maternal-fetal attachment at 4-weeks posttest than the control group. CONCLUSION The results of this study indicate that performing aerobic exercise ameliorates the decline in sleep quality and improves maternal-fetal attachment in women who are pregnant. These findings may be used to encourage pregnant women to regularly perform low-impact aerobic exercise.
Collapse
|
189
|
Self-management education among women with pre-existing diabetes in pregnancy: A scoping review. Int J Nurs Stud 2021; 117:103883. [PMID: 33548591 DOI: 10.1016/j.ijnurstu.2021.103883] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Education is a cornerstone of self-management for adults with diabetes. Self-management is particularly important during pregnancy for women with type 1 and type 2 diabetes, as perinatal outcomes are affected by maternal glycemic control. To our knowledge, literature describing the provision of diabetes education and support during pregnancy for women with type 1 and type 2 diabetes has not been synthesized, nor examined within its context as a complex intervention. OBJECTIVES AND DESIGN This scoping review aims to synthesize the evidence regarding prenatal diabetes education and support for women with type 1 and type 2 diabetes and to apply the Medical Research Council framework for complex interventions where appropriate. DATA SOURCES AND METHODS We searched EMBASE, CINAHL, and MEDLINE from inception to February 2019 for primary studies focused on prenatal diabetes education among women with type 1 and type 2 diabetes. Two independent reviewers screened eligible studies against inclusion criteria. A narrative synthesis of the included studies was conducted. RESULTS Of 511 identified citations, 30 studies were included in the final review. Approximately 44% of the pooled sample were women with type 1 diabetes, 46% had gestational diabetes mellitus, and 10% had type 2 diabetes. Education focused on self-monitoring of blood glucose, attaining glycemic targets, and following a healthy diet. Many studies included educational elements that went beyond traditional didactic teaching and promoted self-management skills and self-management support. The majority of education was delivered via one-on-one outpatient appointments every one to three weeks. About half of the reviewed studies used a multidisciplinary team approach, with most including a combination of physicians, nurses, dietitians, and midwives. Application of the Medical Research Council framework revealed that most studies were limited in methods (i.e., randomization) and few examined process evaluation or intervention cost-effectiveness. CONCLUSION We identified a lack of studies centred on educational interventions for women with type 2 diabetes in pregnancy. As pregnancy for women with type 2 diabetes involves significant changes, including the transition from oral hypoglycemics to insulin therapy, often without exposure to diabetes-specific preconception care and counselling, future research may focus on optimizing preconception and prenatal education and support for this high-risk group. This is particularly relevant as the prevalence of type 2 diabetes is increasing worldwide. Future research ought to also design, implement and evaluate interventions in accordance with the Medical Research Council framework for complex interventions.
Collapse
|
190
|
Harville EW, Giarratano GP, Buekens P, Lang E, Wagman J. Congenital syphilis in East Baton Rouge parish, Louisiana: providers' and women's perspectives. BMC Infect Dis 2021; 21:64. [PMID: 33435889 PMCID: PMC7805072 DOI: 10.1186/s12879-020-05753-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Congenital syphilis is completely preventable through screening and treatment, but rates have been rising in the United States. Certain areas are at particularly high risk. We aimed to assess attitudes, knowledge, and barriers around effective prevention of congenital syphilis among health care providers and community women potentially at risk. Methods Two parallel studies were conducted: in-depth interviews with health care providers and focus groups with community women in the area of Baton Rouge, Louisiana. Each group was questioned about their experience in providing or seeking prenatal care, knowledge and attitudes about congenital syphilis, sources of information on testing and treatment, perceptions of risk, standards of and barriers to treatment. Results were transcribed into QSR NVivo V10, codes developed, and common themes identified and organized. Results Providers identified delays in testing and care, lack of follow-through with partner testing, and need for community connection for prevention, as major contributors to higher rates of congenital syphilis. Women identified difficulties in accessing Medicaid contributing to delayed start of prenatal care, lack of transportation for prenatal care, and lack of knowledge about testing and prevention for congenital syphilis. Conclusions Providers and community members were in broad agreement about factors contributing to higher rates of congenital syphilis, although some aspects were emphasized more by one group or another. Evidence-based interventions, likely at multiple levels, need to be tested and implemented to eliminate congenital syphilis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05753-6.
Collapse
|
191
|
Thomas J, Harraway J, Kirchhoffer D. Non-invasive prenatal testing: clinical utility and ethical concerns about recent advances. Med J Aust 2021; 214:168-170.e1. [PMID: 33423294 DOI: 10.5694/mja2.50928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
192
|
Vanneste C, Barlow P, Rozenberg S. Urgent Medical Aid and Associated Obstetric Mortality in Belgium. J Immigr Minor Health 2021; 22:307-313. [PMID: 31093822 DOI: 10.1007/s10903-019-00897-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most Belgian citizens are covered by comprehensive medical insurance (AMI). Due to recent and significant undocumented immigration, an increasing number of patients have no health coverage. They may, however, qualify for "Urgent Medical Aid" (AMU). Still, some patients have no health insurance of any kind (no coverage). This study, conducted in a hospital which cares for a large number of undocumented immigrants, looked at the proportion of women benefiting from either "AMI" or "AMU" and those who have "No coverage" and addressed obstetrical outcomes in each of the three groups. Design: retrospective observational study. We collected data of all singleton pregnancies and deliveries from the CHU St Pierre maternity ward, between 1.10.2015 and 31.3.2016. Women were classified, prospectively, by our social workers, as having access to AMI, AMU or having "No coverage". Demographic, obstetrical and perinatal data were systematically collected and validated on a day-to-day basis and comparisons were then made between the three groups of women. During the follow up period, 1.439 women had access to regular social security (AMI) (87%), 142 women (10%) to AMU and 38 (3%) had no coverage. Women who benefited from AMU were younger and their first prenatal consultation occurred later in the pregnancy than it did for women with AMI. There were no significant differences in obstetrical outcomes between the three groups of women. Urgent medical aid (AMU) confers a certain normalisation of obstetrical care to pregnant women who would otherwise have no access to health care coverage.
Collapse
|
193
|
Patton EW, Saia K, Stein MD. Integrated substance use and prenatal care delivery in the era of COVID-19. J Subst Abuse Treat 2021; 124:108273. [PMID: 33771277 PMCID: PMC7979279 DOI: 10.1016/j.jsat.2020.108273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.
Collapse
|
194
|
Can fasting plasma glucose replace oral glucose-tolerance test for diagnosis of gestational diabetes mellitus? Diabetol Int 2021; 12:277-285. [PMID: 34150436 DOI: 10.1007/s13340-020-00484-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Background and aims Gestational diabetes mellitus (GDM) has high prevalence worldwide. This study aimed to evaluate the fasting plasma glucose (FPG) cutoffs at first prenatal visit and at 24-28th of gestational weeks to avoid obtaining full oral glucose-tolerance test (OGTT) in the diagnosis of GDM. Methods This study was a cross-sectional study conducted in Tehran, Iran during October 2016 and November 2017. All pregnant women reporting for the first routine prenatal visit before 20th week of gestational age were included in this study. Participants without overt diabetes mellitus at first prenatal visit, underwent OGTT at 24-28th of gestational weeks. Results Totally 952 pregnant women with mean age of 26.4 ± 14.1 years took part in this study. The prevalence of GDM was 12.7% (mostly diagnosed based on the FPG alone). FPG cutoffs 75 and 80 mg/dL at first prenatal visit and at 24-28th of gestational weeks can rule out the GDM with high sensitivity and negative predictive value, respectively. FPG cutoffs 85 and 90 mg/dL at first prenatal visit and at 24-28th of gestational weeks had high capacity, excellent specificity and positive predictive value in diagnosing GDM, respectively. Conclusions Performing only the FPG and considering FPG cutoffs 75 and 80 mg/dL at first prenatal visit and at 24-28th of gestational weeks can be a useful tool predicting the incidence of GDM, respectively, and had similar diagnostic power.
Collapse
|
195
|
Bouya S, Rezaie Keikhaie L, Hosseini S, Rezaie Keikhaie K. The effect of yoga on uterine artery Doppler indices, maternal and fetal complications in pregnant women: A quasi-experimental study. J Ayurveda Integr Med 2021; 12:70-74. [PMID: 32950349 PMCID: PMC8039333 DOI: 10.1016/j.jaim.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Today, the effect of yoga has been examined on various physical and psychological dimensions of pregnant women. However, there are still sparse studies on the effect of yoga on the uterine artery indices as well as maternal and fetal complications. OBJECTIVE The aim was to determine the effect of yoga on uterine artery Doppler indices, maternal and fetal Complications. MATERIALS AND METHODS This quasi-experiential study was conducted, on 100 pregnant women. The participants were assigned to yoga and control groups. In the yoga group, the participants exercised yoga for 1 h. On the other hand, the control group received routine care. RESULTS The results showed that in the yoga group, the functional indices of the uterine artery (S/D, PI, RI, and DN) improved more significantly compared to the control (p = 0.01). The results also showed that in the yoga group, maternal complications (diabetes and preeclampsia), as well as fetal complications (SAG, IUGR), were significantly lower compared to the control (p = 0.01). CONCLUSION This study revealed the positive effects of yoga on improving fetal development indices and reducing maternal and fetal complications following pregnancy. It can be used as a Complementary therapy alongside other treatments for mothers.
Collapse
|
196
|
Gaur BPS, Vasudevan J, Pegu B. Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings. J Prev Med Public Health 2020; 54:81-84. [PMID: 33618503 PMCID: PMC7939754 DOI: 10.3961/jpmph.20.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.
Collapse
|
197
|
Real life outpatient biomarker use in management of hypertensive pregnancies in third trimester in a low resource SeTting: ROBUST study. Pregnancy Hypertens 2020; 23:97-103. [PMID: 33307400 DOI: 10.1016/j.preghy.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The utility of angiogenic biomarkers in a low resource outpatient setting is not well known. This study evaluates the clinical utility of angiogenic biomarkers, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) among patients at risk for preeclampsia in a low resource outpatient setting. STUDY DESIGN This was a prospective pilot study among high risk third trimester outpatients conducted in Bengaluru, India. Serum sFlt1/PlGF was measured between 28 and 37 weeks. Patients with high risk ratio were managed with close observation, intermediate risk had serum redrawn in one week, and those with low risk ratio received routine care. Delivery decisions were made based on local protocols. MAIN OUTCOME MEASURES Maternal complication rate, development of preeclampsia with severe features, and latency to delivery was examined by sFlt1/PlGF ratio. RESULTS The study included 50 patients. Compared to women with a low risk ratio, women with a high-risk ratio were more likely to have preeclampsia with severe features (90.91% vs 8.00%, p < 0.0001), a higher composite maternal complication rate (18.18% vs 0%, p = 0.04) and deliver at earlier gestational ages (32.57 [30.43, 34.71] vs 37.43 [36.86, 38.14] weeks, p = 0.0001). CONCLUSION Angiogenic factors may have utility in the low resource outpatient setting for women with a hypertensive disease. Low sFlt1/PlGF levels were associated with a longer latency to delivery and no maternal complications. This study confirms the broad clinical utility of biomarkers in the real world.
Collapse
|
198
|
Liese KL, Kapito E, Chirwa E, Liu L, Mei X, Norr KF, Patil CL. Impact of group prenatal care on key prenatal services and educational topics in Malawi and Tanzania. Int J Gynaecol Obstet 2020; 153:154-159. [PMID: 33098114 DOI: 10.1002/ijgo.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/10/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether group prenatal care (PNC) increased key services and educational topics women reported receiving, compared with individual PNC in Malawi and Tanzania. METHODS Data come from a previously published randomized trial (n=218) and were collected using self-report surveys. Late pregnancy surveys asked whether women received all seven services and all 13 topics during PNC. Controlling for sociodemographics, country, and PNC attendance, multivariate logistic regression used forward selection to produce a final model showing predictors of receipt of all key services and topics. RESULTS In multivariate logistic regression, women in group PNC were 2.49 times more likely to receive all seven services than those in individual care (95% confidence interval [CI] 1.78-3.48) and 5.25 times more likely to have received all 13 topics (95% CI 2.62-10.52). CONCLUSION This study provides strong evidence that group PNC meets the clinical standard of care for providing basic clinical services and perinatal education for pregnant women in sub-Saharan Africa. The greater number of basic PNC services and educational topics may provide one explanatory mechanism for how group PNC achieves its impact on maternal and neonatal outcomes. ClinicalTrials.gov: NCT03673709, NCT02999334.
Collapse
|
199
|
Abstract
BACKGROUND Trauma is the leading cause for nonpregnancy-linked maternal mortality in pregnant women, even though the exact incidence for accidents in pregnancy is unknown. Trauma management concepts applied for nonpregnant adult patients are just as valid for injured and severely injured pregnant women but in addition trauma management has to consider the unique physiological and pathophysiological conditions for a favorable maternal and fetal outcome. OBJECTIVE Overview of current data about the epidemiology, injury mechanisms, maternal and fetal outcome and recommendations on the management of injured pregnant women based on a systematic literature search. RESULTS Currently, there is no evidence indicating an association between maternal injury severity, the physiological condition and the fetal outcome. Practice guidelines for trauma management in pregnancy recommend prioritization of maternal treatment and resuscitation for optimal initial treatment of the fetus. The current recommendations for trauma room management in pregnancy, surgical treatment, including damage control surgery, are based on weak evidence. CONCLUSION The examination, stabilization and treatment of injured pregnant women has priority for fetal survival and outcome. The management of severe trauma in pregnancy requires a multidisciplinary expertise and team approach consisting of surgeons, anesthetists, radiologists, obstetricians and neonatologists, so that for a severely injured gravida, the decision for admission to designated trauma centers is already preclinically made. The principles of management and treatment of severely injured pregnant women should adhere to the treatment principles of nonpregnant trauma victims.
Collapse
|
200
|
Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. ENFERMERIA CLINICA 2020; 31:82-90. [PMID: 33277168 DOI: 10.1016/j.enfcli.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.
Collapse
|