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Ekin A, Gezer C, Taner CE, Ozeren M, Mat E, Solmaz U. Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes. J Obstet Gynaecol Res 2015; 41:1744-51. [PMID: 26183146 DOI: 10.1111/jog.12783] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/27/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes. MATERIAL AND METHODS Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as <6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories. RESULTS Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of <6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65). CONCLUSION Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.
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Affiliation(s)
- Atalay Ekin
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cenk Gezer
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cuneyt Eftal Taner
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozeren
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emre Mat
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ulas Solmaz
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Afeworki R, Smits J, Tolboom J, van der Ven A. Positive Effect of Large Birth Intervals on Early Childhood Hemoglobin Levels in Africa Is Limited to Girls: Cross-Sectional DHS Study. PLoS One 2015; 10:e0131897. [PMID: 26121362 PMCID: PMC4488302 DOI: 10.1371/journal.pone.0131897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 06/08/2015] [Indexed: 12/22/2022] Open
Abstract
Background Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Anemia in children, which is highly prevalent in Africa, is associated with an increased risk of morbidity and mortality. Birth spacing is advocated as a tool to reduce anemia in preschool African children, but the role of gender differences and contextual factors has been neglected. The present study aims to determine to what extent the length of preceding birth interval influences the hemoglobin levels of African preschool children in general, as well as for boys and girls separately, and which contextual factors thereby play a crucial role. Methods and Findings This cross-sectional study uses data from Demographic and Health Surveys (DHS) conducted between 2003 and 2011 in 20 African countries. All preschool children aged 6–59 months with a valid hemoglobin measurement and a preceding birth interval of 7–72 months as well as their corresponding multigravida mothers aged 21–49 years were included in the study. Hemoglobin levels of children and mothers were measured in g/l, while birth intervals were calculated as months difference between consecutive births. Multivariate analyses were done to examine the relationship between length of preceding birth interval and child hemoglobin levels, adjusted for factors at the individual, household, community, district, and country level. A positive linear relationship was observed between birth interval and the 49,260 included children’s hemoglobin level, whereby age and sex of the child, hemoglobin level of the mother, household wealth, mother’s education and urbanization of place of residence also showed positive associations. In the interaction models, the effect of a month increase in birth interval is associated with an average increase of 0.025 g/l in hemoglobin level (P = 0.001) in girls, while for boys the effect was not significant. In addition, for girls, the effect of length of preceding birth interval was highest in young mothers and mothers with higher hemoglobin levels, while for boys, the highest effect was noticed for those living in more highly educated regions. Finally, significantly higher hemoglobin levels of girls compared to boys were observed at birth but with increasing age, the sex difference in hemoglobin level gradually becomes smaller. Conclusions A longer birth interval has a modest positive effect on early childhood hemoglobin levels of girls, and this effect is strongest when their mothers are in their early twenties and have a high hemoglobin level. Remarkably, although the physiological iron requirement is higher for boys than girls, birth spacing has little influence on hemoglobin levels of preschool boys. We speculate that the preference for male offspring in large parts of Africa significantly influences nutritional patterns of African preschool boys and girls, and as such also determines the different effect of birth spacing. Finally, gender aspects should be considered in intervention programs that aim to improve anemia in African children.
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Affiliation(s)
- Robel Afeworki
- Nijmegen Institute for International Health, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Jeroen Smits
- Nijmegen Center for Economics, Institute for Management and Research, Radboud University, Nijmegen, The Netherlands
| | - Jules Tolboom
- Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andre van der Ven
- Nijmegen Institute for International Health, Radboud University Medical Centre, Nijmegen, The Netherlands
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Pasha O, Goudar SS, Patel A, Garces A, Esamai F, Chomba E, Moore JL, Kodkany BS, Saleem S, Derman RJ, Liechty EA, Hibberd PL, Hambidge K, Krebs NF, Carlo WA, McClure EM, Koso-Thomas M, Goldenberg RL. Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reprod Health 2015; 12 Suppl 2:S11. [PMID: 26063346 PMCID: PMC4464604 DOI: 10.1186/1742-4755-12-s2-s11] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background During the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period. Methods Using the NICHD Global Network for Women’s and Children’s Health Research’s multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries (India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42 post-partum. Results We gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years, parity of two or less, limited education and those who deliver at home were at highest risk for having unmet need. Conclusions Six weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites where early contraceptive adoption is common, there is substantial unmet need for family planning. This is consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes, especially amongst young women. Study registration Clinicaltrials.gov (ID# NCT01073475)
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Subramaniam A, Wetta LL, Owen J. Relationship between interpregnancy interval and cervical length in high-risk women. J Matern Fetal Neonatal Med 2015; 29:1205-8. [PMID: 25983138 DOI: 10.3109/14767058.2015.1045866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our objective was to evaluate the relationship between the interpregnancy interval (IPI) and next-pregnancy mid-trimester cervical length (CL) in women at high risk for recurrent spontaneous preterm birth (SPTB). METHODS Retrospective review identified high-risk women, defined as a prior SPTB <36 weeks, who began scheduled serial transvaginal sonographic CL screening at 16-18 weeks gestation between December 2008 and November 2010. All CL assessment ended by 22(6/7) weeks, and weekly 17-α hydroxyprogesterone caproate, 250 mg IM, was recommended to all patients. Details of the prior and current pregnancy were collected, and regression models were used to evaluate the relationship between IPI and CL shortening. RESULTS One hundred and eight women with singleton gestations and a qualifying SPTB underwent CL screening. The mean (SD) birth gestational age (GA) of the last pregnancy was 25 (10) weeks, the median IPI was 613 (range 49-6038) days, and the mean (SD) delivery GA in the current pregnancy was 36 (5.3) weeks. Linear regression found no significant relationship between the IPI and the GA of the current birth (p = 0.98). There was a weak significant relationship between IPI and shortest CL (p = 0.04). However, after controlling for the GA of the prior pregnancy, this relationship was non-significant (p = 0.13). CONCLUSIONS IPI does not predict next birth outcome or next-pregnancy mid-trimester CL in high-risk women managed with progesterone and ultrasound-indicated cerclage.
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Affiliation(s)
- Akila Subramaniam
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham, AL , USA
| | - Luisa L Wetta
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham, AL , USA
| | - John Owen
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Alabama at Birmingham , Birmingham, AL , USA
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Nelson AL. Prenatal contraceptive counseling and method provision after childbirth. Open Access J Contracept 2015; 6:53-63. [PMID: 29386923 PMCID: PMC5683142 DOI: 10.2147/oajc.s52925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Postpartum contraception is undergoing major changes, not only in timing, but also in content. Failure to provide immediate postpartum contraception contributes to the problems of unintended pregnancies and rapid repeat pregnancy because often the highest-risk women do not return for postpartum care. If they do attend that visit, they have often lost the insurance coverage that would enable them to use the most effective forms of birth control. Most of the issues surrounding early initiation of progestin-only methods and breastfeeding have been favorably resolved. In some cases, insurance coverage for delivery has been expanded to cover the costs of providing intrauterine devices and implants before the woman is discharged home. All of these new opportunities shift the burden of counseling about postpartum contraception onto the shoulders of the prenatal care provider. This article provides information about the advantages and disadvantages of providing immediate postpartum contraception with each of the eligible methods so clinicians can provide the needed counseling both during pregnancy and during hospitalization for delivery. It also provides guidance for initiation of bridging contraception, if needed, to initiate a method for a woman later in the postpartum period.
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Affiliation(s)
- Anita L Nelson
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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Discussions about intimate partner violence during prenatal care in the United States: the role of race/ethnicity and insurance status. Matern Child Health J 2015; 18:1413-22. [PMID: 24158506 DOI: 10.1007/s10995-013-1381-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Over 1.5 million women are physically, sexually, and emotionally abused by intimate partners in the U.S. each year. Despite the severe health consequences and costs associated with intimate partner violence (IPV), most health providers fail to assess patients for abuse. It was of interest to examine the occurrence of IPV discussions during prenatal care (PNC) visits among women who experienced IPV. This study analyzed data from the 2004-2008 National Pregnancy Risk Assessment Monitoring System which included 195,687 women who delivered a live birth in the U.S. IPV victimization was measured using four items that addressed physical abuse by a current or former husband/partner in the 12 months before or during pregnancy. Responses were categorized as preconception, prenatal, preconception and prenatal, and preconception and/or prenatal IPV. The outcome was IPV discussions by health providers during PNC. Separate logistic regression models provided odds ratios and 95% confidence intervals. Women who reported prenatal IPV were less likely to have IPV discussions during PNC (OR = 0.81, 95% CI = 0.70-0.94). Results were similar for women experiencing IPV during the prenatal and preconception periods. Among racial/ethnic minorities, women who experienced preconception IPV were less likely to have discussions about IPV during PNC. Further, Medicaid recipients who reported preconception and/or prenatal IPV were less likely to report IPV discussions (OR = 0.75, 95% CI = 0.69-0.82). This study underscores a public health problem and missed opportunity to connect battered victims to necessary services and care. It elucidates the state of current clinical practice and better informs policies on incorporating universal IPV screening.
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Contraceptive counseling and postpartum contraceptive use. Am J Obstet Gynecol 2015; 212:171.e1-8. [PMID: 25093946 DOI: 10.1016/j.ajog.2014.07.059] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. STUDY DESIGN The Pregnancy Risk Assessment Monitoring System 2004-2008 data were analyzed from Missouri, New York state, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). RESULTS The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65-2.67) and both time periods (AOR, 2.33; 95% CI, 1.87-2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR, 3.51; 95% CI, 2.18-5.66) and Medicaid insurance (AOR, 3.74; 95% CI, 1.98-7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44-2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. CONCLUSION The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most.
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Lilungulu A, Matovelo D, Kihunrwa A, Gumodoka B. Spectrum of maternal and perinatal outcomes among parturient women with preceding short inter-pregnancy interval at Bugando Medical Centre, Tanzania. Matern Health Neonatol Perinatol 2015; 1:1. [PMID: 27057319 PMCID: PMC4772750 DOI: 10.1186/s40748-014-0002-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Traditionally women with a short inter-pregnancy interval will not have sufficient time to recover and get ready for the subsequent pregnancy. This includes socio-economic, cultural, psychological and physical body preparedness. The present study aimed at comparing the maternal and perinatal outcomes among parturient women with preceding short and normal inter-pregnancy interval attending at Bugando Medical Centre (BMC). This was a prospective cohort study. It was done from November 2012 to April 2013. Multiple matching design approach was used to adjust for age variable during selection of participants. Chi-square test and Relative Risk (RR) were calculated to test for strength of association between variables. RESULTS Four hundred and fifty (450) women were recruited in this study in which 150 had a SIPI and 300 had a NIPI. The premature rupture of membrane (PROM) was higher [RR = 13.6; 95% CI 7.2 - 25.6] among SIPI women than in NIPI women [RR = 0.57; 95% CI 0.49-0.7]. Women with a SIPI were found to have a significantly higher risk for anemia (RR = 3.4) compared to those with a NIPI (RR = 0.08). SIPI women had a higher risk for failure of trial of vaginal birth after caesarean section (VBAC) (RR = 14.7; 95% CI 6.4 - 33.6) compared to NIPI (RR = 0.72; 95% CI 0.65-0.8). The risk of postpartum hemorrhage (PPH) was higher among SIPI women (RR = 5.8) compared to women of NIPI (RR = 0.83). Women with SIPI had higher risk for small for gestation age (SGA) babies (RR = 7.7; 95% CI 3.8-15.7), low birth weight (RR = 6.7; 95% CI 3.6-12.3), preterm delivery (RR = 9.78; 95% CI 4.9-19.5) and low Apgar score (RR = 6.9; 95% CI 0.7-0.8) compared to women in NIPI. CONCLUSION Higher risk for PROM, anemia, failure of trial of VBAC, PPH and preeclampsia were observed among women with SIPI. Babies born of mothers with a SIPI were significantly at higher risk for SGA, low birth weight, low Apgar score, preterm deliveries compared to women in NIPI. Birth spacing, creating more awareness of complications, on risks associated with SIPI and provision of folate supplements should be advocated.
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Affiliation(s)
- Athanase Lilungulu
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
| | - Dismas Matovelo
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
| | - Albert Kihunrwa
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
- />Department of Obstetrics & Gynecology, Bugando Medical Centre, P.O. BOX 1370, Mwanza, Tanzania
| | - Balthazar Gumodoka
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
- />Department of Obstetrics & Gynecology, Bugando Medical Centre, P.O. BOX 1370, Mwanza, Tanzania
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Clark EAS, Esplin S, Torres L, Turok D, Yoder BA, Varner MW, Winter S. Prevention of recurrent preterm birth: role of the neonatal follow-up program. Matern Child Health J 2014; 18:858-63. [PMID: 23817726 DOI: 10.1007/s10995-013-1311-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from US newborn intensive care units. We aimed to determine whether NFPs are a potentially effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight < 1,250 g) were evaluated. Nearly 1 in 5 women (19.8 %) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3 % were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4 % were aware of effective pharmacologic preventative strategies. Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.
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Affiliation(s)
- Erin A S Clark
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Suite 2B200, 30 N 1900 E, Salt Lake City, UT, USA,
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Abstract
INTRODUCTION Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. METHOD A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. CONCLUSION Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.
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Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Abstract
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Dania Mallick
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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DeFranco EA, Ehrlich S, Muglia LJ. Influence of interpregnancy interval on birth timing. BJOG 2014; 121:1633-40. [DOI: 10.1111/1471-0528.12891] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- EA DeFranco
- Center for Prevention of Preterm Birth; Perinatal Institute; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - S Ehrlich
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - LJ Muglia
- Center for Prevention of Preterm Birth; Perinatal Institute; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; University of Cincinnati College of Medicine; Cincinnati OH USA
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Cha S, Masho SW. Intimate partner violence and utilization of prenatal care in the United States. JOURNAL OF INTERPERSONAL VIOLENCE 2014; 29:911-927. [PMID: 24203982 DOI: 10.1177/0886260513505711] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over 1.5 million women are victims of physical, sexual, and emotional abuse by former or present intimate partners. Intimate partner violence (IPV) around pregnancy can lead to devastating health consequences to mothers and infants. While some research suggests that IPV negatively affects the utilization of health services like prenatal care (PNC), inconsistencies in the assessment of PNC utilization, timing of partner violence, and definitions of IPV yield conflicting results. The objective for the present study is to evaluate whether preconception IPV, prenatal IPV, or IPV in the preconception and/or prenatal period affects PNC utilization. This study analyzed the 2004-2008 national Pregnancy Risk Assessment Monitoring System (PRAMS), which included 202,367 women who delivered a live birth in the United States. IPV victimization was measured using four items that addressed physical abuse by a current or former husband/partner in the 12 months before (preconception) and during (prenatal) pregnancy. Responses were categorized as preconception, prenatal, and preconception and/or prenatal IPV. The outcome was PNC adequacy categorized as inadequate, intermediate, adequate, and adequate plus based on the Adequacy of Prenatal Care Utilization index. Separate logistic regression models provided crude and adjusted odds ratios and 95% confidence intervals (CI). Over 6% of women reported preconception and/or prenatal IPV and 26% had less than adequate PNC. Women who reported abuse before and/or during pregnancy were more likely to have inadequate PNC (odds ratio [OR] = 1.4, 95% CI = [1.3, 1.6]). Similarly, women who experienced preconception or prenatal IPV were 30% more likely to have inadequate PNC (OR = 1.3, 95% CI = [1.2, 1.5]; OR = 1.3, 95% CI = [1.1, 1.7], respectively). Adequate PNC is essential in improving pregnancy outcomes; however, women in abusive relationships may face ongoing challenges and difficulties with obtaining appropriate care. Findings underscore a critical problem and health providers are urged to screen and educate women about IPV during all preconception and prenatal visits.
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Affiliation(s)
- Susan Cha
- Virginia Commonwealth University, VA, Richmond, USA
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Giurgescu C, Engeland CG, Zenk SN, Kavanaugh K. Stress, Inflammation and Preterm Birth in African American Women. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kessous R, Sheiner E. Is there an association between short interval from previous cesarean section and adverse obstetric and prinatal outcome? J Matern Fetal Neonatal Med 2013; 26:1003-6. [DOI: 10.3109/14767058.2013.765854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhang YP, Liu XH, Gao SH, Wang JM, Gu YS, Zhang JY, Zhou X, Li QX. Risk factors for preterm birth in five Maternal and Child Health hospitals in Beijing. PLoS One 2012; 7:e52780. [PMID: 23300774 PMCID: PMC3531336 DOI: 10.1371/journal.pone.0052780] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preterm birth, the birth of an infant prior to 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Preterm infants are at greater risk of respiratory, gastrointestinal and neurological diseases. Despite significant research in developed countries, little is known about the causes of preterm birth in many developing countries, especially China. This study investigates the association between sciodemographic data, obstetric risk factor, and preterm birth in five Maternal and Child Health hospitals in Beijing, China. METHODS AND FINDINGS A case-control study was conducted on 1391 women with preterm birth (case group) and 1391 women with term delivery (control group), who were interviewed within 48 hours of delivery. Sixteen potential factors were investigated and statistical analysis was performed by univariate analysis and logistic regression analysis. Univariate analysis showed that 14 of the 16 factors were associated with preterm birth. Inter-pregnancy interval and inherited diseases were not risk factors. Logistic regression analysis showed that obesity (odds ratio (OR) = 3.030, 95% confidence interval (CI) 1.166-7.869), stressful life events (OR = 5.535, 95%CI 2.315-13.231), sexual activity (OR = 1.674, 95%CI 1.279-2.191), placenta previa (OR 13.577, 95%CI 2.563-71.912), gestational diabetes mellitus (OR = 3.441, 95%CI1.694-6.991), hypertensive disorder complicating pregnancy (OR = 6.034, 95%CI = 3.401-10.704), history of preterm birth (OR = 20.888, 95%CI 2.519-173.218) and reproductive abnormalities (OR = 3.049, 95%CI 1.010-9.206) were independent risk factors. Women who lived in towns and cities (OR = 0.603, 95%CI 0.430-0.846), had a balanced diet (OR = 0.533, 95%CI 0.421-0.675) and had a record of prenatal care (OR = 0.261, 95%CI 0.134-0.510) were less likely to have preterm birth. CONCLUSIONS Obesity, stressful life events, sexual activity, placenta previa, gestational diabetes mellitus, hypertensive disorder complicating pregnancy, history of preterm birth and reproductive abnormalities are independent risk factors to preterm birth. Identification of remedial factors may inform local health and education policy.
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Affiliation(s)
- Yun-Ping Zhang
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital, Haidian District, Beijing, China.
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68
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Bloch JR, Webb DA, Mathew L, Culhane JF. Pregnancy intention and contraceptive use at six months postpartum among women with recent preterm delivery. J Obstet Gynecol Neonatal Nurs 2012; 41:389-97. [PMID: 22834885 DOI: 10.1111/j.1552-6909.2012.01351.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe pregnancy intention and contraceptive use among women with a recent delivery that occurred at 35 weeks gestation or fewer and who were enrolled in a large-scale randomized control trial. DESIGN In this descriptive study we used data from assessments conducted at 6 months postpartum as part of a randomized controlled clinical trial, the Philadelphia Collaborative Preterm Prevention Project (PCPPP). PARTICIPANTS AND SETTING Participants were recruited following a preterm birth (PTB) in one of the 12 urban birth hospitals. All women enrolled in PCPPP, who completed their 6-month postpartum assessment, and who were sexually active at the time of that assessment (n = 566), were included in the analysis. METHODS Data were collected during face-to-face interviews. Study questionnaires included questions about participants' plans for the timing of subsequent pregnancies, contraceptive behaviors, and other health variables. RESULTS Nearly all of the participants (90.1%, n = 509) reported they did not want to get pregnant within one year of the index PTB. However, more than one half of these women (54.6%) reported contraceptive practices of low or moderate effectiveness. Most predictive of intending another pregnancy within the year was the death of the index PTB infant (odds ratio [OR]= 18.2,95% confidence interval [CI] [8.9, 37.0]). CONCLUSIONS Discordant pregnancy intention and contraceptive use were reported among this group of mothers of PTB infants who are at particularly high risk for a poor outcome of any subsequent pregnancy. The findings highlight the need for further investigation of the causes, correlates, and consequences of discordant pregnancy intentions and contraceptive practices.
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Affiliation(s)
- Joan Rosen Bloch
- College of Nursing and Health Professions and School of Public Health, Drexel University, Philadelphia, PA 19102, USA.
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69
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Abstract
Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% over the past 20 years, merely by reducing the number of unintended pregnancies. By preventing high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio--the risk of maternal death per 100,000 livebirths--by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfilment of unmet need for contraception. The benefits of modern contraceptives to women's health, including non-contraceptive benefits of specific methods, outweigh the risks. Contraception can also improve perinatal outcomes and child survival, mainly by lengthening interpregnancy intervals. In developing countries, the risk of prematurity and low birthweight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling.
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Affiliation(s)
- John Cleland
- London School of Hygiene and Tropical Medicine, London, UK.
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70
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Wendt A, Gibbs CM, Peters S, Hogue CJ. Impact of increasing inter-pregnancy interval on maternal and infant health. Paediatr Perinat Epidemiol 2012; 26 Suppl 1:239-58. [PMID: 22742614 PMCID: PMC4562277 DOI: 10.1111/j.1365-3016.2012.01285.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Short inter-pregnancy intervals (IPIs) have been associated with adverse maternal and infant health outcomes in the literature. However, many studies in this area have been lacking in quality and appropriate control for confounders known to be associated with both short IPIs and poor outcomes. The objective of this systematic review was to assess this relationship using more rigorous criteria, based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. We found too few higher-quality studies of the impact of IPIs (measured as the time between the birth of a previous child and conception of the next child) on maternal health to reach conclusions about maternal nutrition, morbidity or mortality. However, the evidence for infant effects justified meta-analyses. We found significant impacts of short IPIs for extreme preterm birth [<6 m adjusted odds ratio (aOR): 1.58 [95% confidence interval (CI) 1.40, 1.78], 6-11 m aOR: 1.23 [1.03, 1.46]], moderate preterm birth (<6 m aOR: 1.41 [1.20, 1.65], 6-11 m aOR: 1.09 [1.01, 1.18]), low birthweight (<6 m aOR: 1.44 [1.30, 1.61], 6-11 m aOR: 1.12 [1.08, 1.17]), stillbirth (aOR: 1.35 [1.07, 1.71] and early neonatal death (aOR: 1.29 [1.02, 1.64]) outcomes largely in high- and moderate-income countries. It is likely these effects would be greater in settings with poorer maternal health and nutrition. Future research in these settings is recommended. This is particularly important in developing countries, where often the pattern is to start childbearing at a young age, have all desired children quickly and then control fertility through permanent contraception, thereby contracting women's fertile years and potentially increasing their exposure to the ill effects of very short IPIs.
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Affiliation(s)
- Amanda Wendt
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, MS #1599-001-1BX, 1599 Clifton Road, NE, Atlanta, GA 30322, USA.
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Hogue CJ, Menon R, Dunlop AL, Kramer MR. Racial disparities in preterm birth rates and short inter-pregnancy interval: an overview. Acta Obstet Gynecol Scand 2011; 90:1317-24. [PMID: 21306339 PMCID: PMC5575735 DOI: 10.1111/j.1600-0412.2011.01081.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We seek to expand on a biopsychosocial framework underlying the etiology of excess preterm birth experienced by African-American women by exploring short inter-pregnancy intervals as a partial explanatory factor. DESIGN We conducted a qualitative analyses of published studies that met specified criteria for assessing the association of inter-pregnancy interval and preterm birth. METHODS We determine whether inter-pregnancy interval is associated with preterm birth, what the underlying causal mechanism may be, whether African-American women are more likely than Caucasian women to have short intervals, and whether achieving an optimal interval will result in reduced African-American-Caucasian gap in preterm births. MAIN OUTCOME MEASURES Crude and adjusted odds ratios for preterm birth, with the referent group being the interval closest to the 'ideal' of 18-23 months and the exposed group having intervals <12 months or some subset of that inter-pregnancy interval. Results. Inter-pregnancy interval less than six months increases preterm birth by about 40%. The mechanism may be through failure to replenish maternal nutritional stores. While there may not be an interaction between race and short inter-pregnancy interval, short intervals can explain about 4% of the African-American-Caucasian gap in preterm birth because African-American women are approximately 1.8 times as likely to have inter-pregnancy intervals of less than six months. Limited studies indicate that optimal intervals can be achieved through appropriate counseling and health care. CONCLUSIONS Excess risk for preterm birth may be reduced by up to 8% among African-Americans and up to 4% among Caucasians through increasing inter-pregnancy intervals to the optimal length of 18-23 months.
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Affiliation(s)
- Carol J Hogue
- Women's and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Files JA, Frey KA, David PS, Hunt KS, Noble BN, Mayer AP. Developing a reproductive life plan. J Midwifery Womens Health 2011. [PMID: 23181644 DOI: 10.1111/j.1542-2011.2011.00048.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this article is 2-fold: to emphasize the importance of a reproductive life plan and to define its key elements. We review the 2006 recommendations from the Centers for Disease Control and Prevention (CDC) regarding ways to improve the delivery of preconception health care to women in the United States, with particular focus on encouraging individual reproductive responsibility throughout the life span and on encouraging every woman to develop a reproductive life plan. We propose recommendations for the content of a reproductive life plan and explore ways to incorporate the guidelines from the CDC into clinical practice. By encouraging women to consider their plans for childbearing before they become pregnant, clinicians have the opportunity to influence behavior before pregnancy, which may decrease the incidence of unintended pregnancies and adverse pregnancy outcomes.
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Affiliation(s)
- Julia A Files
- Division of Women’s Health Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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Sundtoft I, Sommer S, Uldbjerg N. Cervical collagen concentration within 15 months after delivery. Am J Obstet Gynecol 2011; 205:59.e1-3. [PMID: 22088899 DOI: 10.1016/j.ajog.2011.03.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 02/25/2011] [Accepted: 03/17/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical collagen concentration decreases during pregnancy. The increased risk of preterm birth after a short interpregnancy interval may be explained by an incomplete remodeling of the cervix. The objective of this study was to describe the changes in cervical collagen concentration over 15 months after delivery. STUDY DESIGN The collagen concentrations were determined in cervical biopsy specimens that were obtained from 15 women at 3, 6, 9, 12, and 15 months after delivery. RESULTS The mean cervical collagen concentrations were 50%, 59%, 63%, 65%, and 65% of dry weight (SD, 4.2-6.5). This increase was statistically significant until month 9, but not between months 9 and 12. CONCLUSION Low collagen concentrations in the uterine cervix may contribute to the association between a short interpregnancy interval and preterm birth.
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Affiliation(s)
- Iben Sundtoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Manuck TA, Henry E, Gibson J, Varner MW, Porter TF, Jackson GM, Esplin MS. Pregnancy outcomes in a recurrent preterm birth prevention clinic. Am J Obstet Gynecol 2011; 204:320.e1-6. [PMID: 21345407 DOI: 10.1016/j.ajog.2011.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/04/2011] [Accepted: 01/11/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to compare rates of recurrent spontaneous preterm birth (PTB) and neonatal morbidity between women enrolled in a recurrent PTB prevention clinic compared to those receiving usual care. STUDY DESIGN This was a retrospective cohort study of women with a single, nonanomalous fetus and ≥1 spontaneous PTB <35 weeks. Women enrolled in a recurrent PTB prevention clinic were compared to those receiving usual care. The recurrent PTB prevention clinic was consultative and included 3 standardized visits. Usual-care patients were treated by their primary provider. The primary outcome was recurrent spontaneous PTB <37 weeks. RESULTS Seventy recurrent PTB prevention clinic and 153 usual-care patients were included. Both groups had similar pregnancy histories. Recurrent PTB prevention clinic patients had increased utilization of resources, had lower rates of recurrent spontaneous PTB (48.6% vs 63.4%, P = .04), delivered later (mean 36.1 vs 34.9 weeks, P = .02), and had lower rates of composite major neonatal morbidity (5.7% vs 16.3%, P = .03). CONCLUSION Women referred to a consultative recurrent PTB prevention clinic had reduced rates of recurrent spontaneous prematurity and major neonatal morbidity.
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Affiliation(s)
- Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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75
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Gooding JS, Cooper LG, Blaine AI, Franck LS, Howse JL, Berns SD. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact. Semin Perinatol 2011; 35:20-8. [PMID: 21255703 DOI: 10.1053/j.semperi.2010.10.004] [Citation(s) in RCA: 341] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and family support in the NICU. We examine the research and available evidence supporting FCC in the NICU and offer recommendations for increased dissemination and for future study.
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Affiliation(s)
- Judith S Gooding
- NICU Initiatives and Chapter Program Strategy, Chapter Program Support, March of Dimes Foundation, White Plains, NY 10605, USA.
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76
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Ratzon R, Sheiner E, Shoham-Vardi I. The role of prenatal care in recurrent preterm birth. Eur J Obstet Gynecol Reprod Biol 2010; 154:40-4. [PMID: 20869804 DOI: 10.1016/j.ejogrb.2010.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 07/21/2010] [Accepted: 08/24/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the independent role of prenatal care in preventing recurrent preterm delivery (<37 weeks gestation) and in reducing adverse pregnancy outcomes in recurrent preterm delivery. STUDY DESIGN A population-based retrospective cohort study. Participants were 1470 Bedouin women in Southern Israel who at their first delivery (parity 1) gave birth preterm (<37 weeks) and had a consecutive birth (parity 2) at Soroka University Medical Center, the only birth hospital in the area. Multiple gestations were excluded. RESULTS The incidence of recurrent preterm delivery was 24.6% (362/1470) and it was not associated with having had prenatal care in the second pregnancy. In a multivariable logistic analysis, young maternal age, pregnancy complications and fetal abnormalities in the second pregnancy, as well as previous miscarriages, short inter-pregnancy interval, and length of gestation in the first pregnancy were significantly associated with recurrence. The incidence of adverse pregnancy outcomes (perinatal mortality, small for gestational age, gestational age <34 weeks, Apgar ≤ 7) in recurrent preterm delivery was 44.8% (162/362). Lack of prenatal care was significantly associated with adverse pregnancy outcomes (odds ratio: 4.03; 95% confidence interval: 2.04-7.97) in a multivariable logistic analysis controlling for all variables significantly associated with adverse pregnancy outcomes at the univariate analysis. CONCLUSIONS Prenatal care may reduce the risk of adverse pregnancy outcomes in recurrent preterm delivery, even if recurrence cannot be prevented. It is therefore important that quality prenatal care is accessible to women who had a preterm delivery in the past.
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Affiliation(s)
- Ronit Ratzon
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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77
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Duvan Cİ, Gözdemir E, Kaygusuz I, Kamalak Z, Turhan NÖ. Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period. J Turk Ger Gynecol Assoc 2010; 11:141-4. [PMID: 24591920 DOI: 10.5152/jtgga.2010.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.
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Affiliation(s)
- Candan İltemir Duvan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Elif Gözdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Ikbal Kaygusuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Zeynep Kamalak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Nilgün Öztürk Turhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
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78
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Sannisto T, Kosunen E. Initiation of postpartum contraception: a survey among health centre physicians and nurses in Finland. Scand J Prim Health Care 2009; 27:244-9. [PMID: 19958065 PMCID: PMC3413917 DOI: 10.3109/02813430903234914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres. DESIGN A survey study with self-administered online questionnaires. SETTING All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005. SUBJECTS A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups. MAIN OUTCOME MEASURES Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses. RESULTS The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum. CONCLUSION Professionals' reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.
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Affiliation(s)
- Tuire Sannisto
- Medical School, Department of General Practice, University of Tampere, and Pirkanmaa Hospital District, Centre of General Practice, Tampere, Finland
| | - Elise Kosunen
- Medical School, Department of General Practice, University of Tampere, and Pirkanmaa Hospital District, Centre of General Practice, Tampere, Finland
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79
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Wise PH. Transforming preconceptional, prenatal, and interconceptional care into a comprehensive commitment to women's health. Womens Health Issues 2008; 18:S13-8. [PMID: 18951817 DOI: 10.1016/j.whi.2008.07.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 07/29/2008] [Indexed: 11/24/2022]
Abstract
Preconception and interconception care respond to the growing body of evidence that many of the most important determinants of birth outcomes may exist before pregnancy occurs. In this sense, the strategy of extending prenatal care into the preconception and interconception periods marks a useful step in reforming the public health approach to improving birth outcomes. However, although helpful in underscoring the continuity of risk that can ultimately find expression in adverse birth outcomes, the concern is that without greater critical attention these relatively new care constructs have the potential to undermine rather than strengthen a comprehensive system of women's health care.
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Affiliation(s)
- Paul H Wise
- Stanford University, Center for Policy, Outcomes and Prevention, Stanford, California 94304-6019, USA.
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80
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DeFranco EA, Lian M, Muglia LA, Schootman M. Area-level poverty and preterm birth risk: a population-based multilevel analysis. BMC Public Health 2008; 8:316. [PMID: 18793437 PMCID: PMC2564937 DOI: 10.1186/1471-2458-8-316] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 09/15/2008] [Indexed: 11/10/2022] Open
Abstract
Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. Results PTB < 35 weeks occurred in 24,490 pregnancies (3.9%). The rate of PTB < 35 weeks was 2.8% in counties within the lowest quartile of poverty and increased through the 4th quartile (4.9%), p < 0.0001. High county-level poverty was significantly associated with PTB risk. PTB risk (< 35 weeks) was increased for women who resided in counties within the highest quartile of poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adjOR 1.27 (95% CI 1.06, 1.52). Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.
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Affiliation(s)
- Emily A DeFranco
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St, Louis, Missouri, USA.
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Purisch SE, DeFranco EA, Muglia LJ, Odibo AO, Stamilio DM. Preterm birth in pregnancies complicated by major congenital malformations: a population-based study. Am J Obstet Gynecol 2008; 199:287.e1-8. [PMID: 18771986 DOI: 10.1016/j.ajog.2008.06.089] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/24/2008] [Accepted: 06/25/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to estimate and compare the relative risk of preterm birth (PTB) in pregnancies complicated by 1 or more of 8 major congenital malformations (MCMs). STUDY DESIGN This was a population-based cohort study of the birth database of the Missouri Department of Health (1989-1997) including 678,693 singleton live births. Outcomes included a binary composite variable of any MCM and the following 8 individual malformations: spina bifida, diaphragmatic hernia, renal agenesis, other urogenital anomaly, tracheoesophageal fistula/esophageal atresia, omphalocele/gastroschisis, cardiac defect, and cleft lip/palate. Chromosomal anomalies were excluded. Logistic regression analyses assessed the association between malformations and PTB. RESULTS The risk of PTB increased significantly and to varying degrees for each malformation. In pregnancies with any MCM, there was an increased prevalence (11.5%) and relative risk (adjusted odds ratio [(adj)OR] 3.2 [95% confidence interval (CI) 2.9 to 3.6]) of PTB at less than 35 weeks' gestation. The magnitude of risk increase was greatest at the earliest gestational ages: (adj)OR 4.8 (95% CI, 4.0 to 5.7) at less than 28 weeks. Pregnancies with multiple malformations were at highest risk for PTB: (adj)OR 8.0 [95% CI, 4.6 to 14.1]. CONCLUSION MCMs significantly increase PTB risk. The risk varies by malformation type and is higher with multiple malformations.
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Affiliation(s)
- Stephanie E Purisch
- Center for Preterm Birth Research, Washington University School of Medicine, St Louis, MO, USA
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