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Edelman N, Whetham J, Cassell J, de Visser R, Mercer C, Jones C, Gersten A, Bremner S. Performance of a tool to identify different types of self-reported sexual risk among women attending a contraception and sexual health clinic: results of a cross-sectional survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:117-128. [PMID: 32499381 PMCID: PMC8053341 DOI: 10.1136/bmjsrh-2019-200482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic. METHODS Female patients aged 16-44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity. RESULTS The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%-60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%-91.8%) and specificity of 43.7% (95% CI 39.0%-48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%-86.0%) and specificity of 48.3% (95% CI 43.4%-53.1%). CONCLUSIONS The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
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Affiliation(s)
- Natalie Edelman
- School of Health Sciences, University of Brighton, Brighton & Hove, UK
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Jennifer Whetham
- Claude Nicol Centre, Brighton & Sussex University Hospitals Trust, Brighton and Hove, UK
| | - Jackie Cassell
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Catherine Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Christopher Jones
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Stephen Bremner
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
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Flynn AC, Kavanagh K, Smith AD, Poston L, White SL. The Impact of the COVID-19 Pandemic on Pregnancy Planning Behaviors. ACTA ACUST UNITED AC 2021; 2:71-77. [PMID: 33786533 PMCID: PMC8006747 DOI: 10.1089/whr.2021.0005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
Background: Our understanding of how the coronavirus disease 2019 (COVID-19) pandemic has impacted decision-making for women planning to conceive is unclear. We aimed to investigate how the COVID-19 pandemic has influenced pregnancy planning behaviors. Methods: An online questionnaire of closed- and open-ended questions was utilized to capture pregnancy planning behaviors and reported behavioral changes during the COVID-19 pandemic in women planning pregnancy between January and July 2020. Closed-ended questions were analyzed quantitatively, and thematic framework analysis was utilized for open-ended responses. Results: A total of 504 questionnaires were included for analysis. The majority of respondents lived in the United Kingdom. Ninety-two percent of the women were still planning a pregnancy but over half (n = 267) reported that COVID-19 had affected their plans, with 72% of these (n = 189) deliberately postponing pregnancy. Concerns were predominantly over changes in antenatal care, but also fear of adverse effects of the virus on mother and baby. From the thematic analysis (n = 37), lack of services to remove contraceptive devices and provide fertility treatment were also cited. In contrast, 27% (n = 71) reported bringing their pregnancy plans forward; common themes included recalibration of priorities and cancelled or changed plans. Conclusions: The COVID-19 pandemic influenced pregnancy-planning behaviors with many women reporting postponement of pregnancy. These alterations in behavior could impact the health and wellbeing of women planning pregnancy while having important implications for health care services worldwide. Continued provision of family planning and fertility services should be ensured to mitigate the effect of future outbreaks or pandemics.
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Affiliation(s)
- Angela C Flynn
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Andrea D Smith
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Sara L White
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
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Tanton C, McDonagh L, Cabecinha M, Clifton S, Geary R, Rait G, Saunders J, Cassell J, Bonell C, Mitchell KR, Mercer CH. How does the sexual, physical and mental health of young adults not in education, employment or training (NEET) compare to workers and students? BMC Public Health 2021; 21:412. [PMID: 33637055 PMCID: PMC7908525 DOI: 10.1186/s12889-021-10229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Syndemic theory highlights the potential for health problems to interact synergistically, compounding impact. Young adults not in education, employment or training (NEET) are more likely to experience disadvantage and poorer general health outcomes. However, there is little research on their sexual health, or the extent to which this clusters with mental and physical health outcomes. Methods Analysis of data from 16 to 24 year olds (1729 men, 2140 women) interviewed 2010–12 for Britain’s third National Survey of Sexual Attitudes and Lifestyles. Natsal-3 is a national probability sample survey using computer-assisted personal interviewing with computer-assisted self-interviewing. Participants were classified as workers, students or NEET. We used multivariable logistic regression to examine associations between being NEET (relative to worker or student) and risk behaviours and outcomes in physical, sexual and mental health domains. We then examined how risk behaviours and poor health outcomes cluster within and across domains. Results 15% men and 20% women were NEET; 36% men and 32% women were workers; and 49% men and 48% women were students. Young people who were NEET were more likely to report smoking and drug use (men) than other young people. There were few differences in sexual health, although NEETs were more likely to report condomless sex, and NEET women, unplanned pregnancy (past year). Risk behaviours clustered more within and across domains for NEET men. Among NEET women, poor health outcomes clustered across mental, physical and sexual health domains. Conclusions Harmful health behaviours (men) and poor health outcomes (women) clustered more in those who are NEET. This points to a possible syndemic effect of NEET status on general ill health, especially for women. Our paper is novel in highlighting that elevated risk pertains to sexual as well as mental and physical health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10229-6.
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Affiliation(s)
- Clare Tanton
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Lorraine McDonagh
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
| | - Rebecca Geary
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
| | - Jackie Cassell
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK.,Department of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Chris Bonell
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kirstin R Mitchell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
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Helfferich C, Gerstner D, Knittel T, Pflügler C, Schmidt F. Unintended conceptions leading to wanted pregnancies - an integral perspective on pregnancy acceptance from a mixed-methods study in Germany. EUR J CONTRACEP REPR 2021; 26:227-232. [PMID: 33596147 DOI: 10.1080/13625187.2020.1870951] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The study examines the differences within unintended first pregnancies in the life course of 20-44 year old women. Special attention is paid to response and pregnancy acceptance. Exploring determinants and dynamics, this study will contribute to a better understanding of 'happiness with an unintended pregnancy', as this is assumed to be indicative of fewer social problems and health risks. METHODS Retrospective survey data on first unintended pregnancies carried to term (n = 2,306) were analysed using bivariate analysis. Qualitative analysis of the narrations of such pregnancies (n = 59) used the technique of comparing cases. Standardised and qualitative data are available for first intended or aborted pregnancies as comparison groups. All data were collected from the cross-sectional mixed-methods study of 'Women's Lives: Family Planning in the Life Course' (2012-2018, Federal Centre of Health Education, Germany). RESULTS Two-fifth of the unintended pregnancies carried to term were '(very) welcome'. Pregnancy intention, contraceptive use, living conditions, and attitudes had a significant impact. Five pathways of acceptance - sooner or later, more easy or hard to achieve - were identified in the qualitative data. CONCLUSION Unintended pregnancies form a continuum ranging from readily accepted 'happy' pregnancies to pregnancies hard to accept. A new measure should also include postconception acceptance, besides preconception desire.
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Affiliation(s)
- Cornelia Helfferich
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Dominik Gerstner
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg, Germany
| | - Tilmann Knittel
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Carina Pflügler
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Franziska Schmidt
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
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Rowland BB, Rocca CH, Ralph LJ. Certainty and intention in pregnancy decision-making: An exploratory study. Contraception 2021; 103:80-85. [PMID: 33189708 PMCID: PMC8186868 DOI: 10.1016/j.contraception.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Abortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has examined decision certainty among people planning to continue a pregnancy. We examined whether women seeking abortion experience lower decision certainty than those planning to continue pregnancies and whether certainty differs by pregnancy intendedness. STUDY DESIGN We administered the decisional conflict scale (DCS) to pregnant women (n = 149) at 8 U.S. primary and reproductive health clinics. Using Poisson regression models adjusted for sociodemographic and pregnancy characteristics, we evaluated differences in DCS scores (<25/100 vs ≥25/100) by pregnancy decision and whether pregnancy intention modified the effect of pregnancy decision on certainty. RESULTS Over one-half (58%) of respondents planned to have an abortion, 32% to continue the pregnancy, and 10% were unsure. DCS scores were low overall (median 9.4/100; IQR: 1.6, 25.0), indicative of high certainty, and the percentage scoring ≥25/100, reflecting any uncertainty, did not differ by pregnancy decision (23% abortion vs 19% continuing, p = 0.55). In a multivariable model, there was no statistically significant interaction between pregnancy decision (abortion vs continuing pregnancy) and intention. However, the predicted percentage reporting any uncertainty among respondents with intended pregnancies was comparable among those decided on abortion (13%) and continuing the pregnancy (16%). Among those with unintended pregnancies, these figures were 25% among those decided on abortion vs 36% among those continuing. CONCLUSION Levels of certainty about a pregnancy decision were high and appeared to depend more on whether the pregnancy was intended or unintended than on the pregnancy decision itself. IMPLICATIONS Similar levels of uncertainty among individuals who decided to have an abortion versus continue a pregnancy challenge the narrative that abortion is a particularly difficult medical and personal decision. The prevalence of some uncertainty among respondents continuing pregnancies suggests voluntary options counseling may be useful for some patients in prenatal care settings.
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Affiliation(s)
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, Oakland, CA, USA
| | - Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, Oakland, CA, USA
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Rajendran A, Eudy AM, Balevic SJ, Clowse MEB. The importance of pregnancy planning in lupus pregnancies. Lupus 2021; 30:741-751. [PMID: 33509066 DOI: 10.1177/0961203321989803] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology's Reproductive Health Guideline 2020, and pregnancy and infant outcomes. METHODS Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. RESULTS Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06). CONCLUSION This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.
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Altiparmak S, Yilmaz AN, Aksoy Derya Y. The Turkish validity and reliability study of the London measure of unplanned pregnancy. J Obstet Gynaecol Res 2021; 47:1362-1370. [PMID: 33496061 DOI: 10.1111/jog.14678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aims to adapt the London Measure of Unplanned Pregnancy (LMUP) developed by Barrett et al. to Turkish by checking its validity and reliability. METHOD The sample of this methodological study consisted of 596 pregnant women who were referred to the antenatal outpatient clinics of a public hospital in eastern Turkey. Data were collected from those who agreed to participate in the study, by using a personal information form and the six-item LMUP. Data were analyzed using SPSS 25.0 and AMOS 24.0 statistical package programs, and statistically assessed using descriptive statistics such as number, percentage, mean and SD, language and content validity, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's α reliability coefficient, and test-retest analysis. RESULTS The EFA revealed that the Turkish version of the LMUP consisted of five items and one factor. The items' factor loadings were above 0.30, and explained 68.89% of the total variance. The CFA supported the one-factor structure of the scale, which was revealed by the EFA. As a result of the CFA, the fit indices were found to be very good. The Cronbach's α coefficient of the scale was determined as 0.90. CONCLUSION The Turkish version of the LMUP is a valid and reliable instrument to evaluate unplanned pregnancy.
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Affiliation(s)
- Sümeyye Altiparmak
- Research Assistant, Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
| | - Ayşe N Yilmaz
- Research Assistant, Department of Midwifery, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Yeşim Aksoy Derya
- Associate Professor, Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
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Memtsa M, Goodhart V, Ambler G, Brocklehurst P, Keeney E, Silverio S, Anastasiou Z, Round J, Khan N, Hall J, Barrett G, Bender-Atik R, Stephenson J, Jurkovic D. Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background
Early pregnancy complications are common and account for the largest proportion of emergency work in gynaecology. Although early pregnancy assessment units operate in most UK acute hospitals, recent National Institute of Health and Care Excellence guidance emphasised the need for more research to identify configurations that provide the optimal balance between cost-effectiveness, clinical effectiveness and service- and patient-centred outcomes [National Institute for Health and Care Excellence (NICE). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management. URL: http://guidance.nice.org.uk/CG154 (accessed 23 March 2016)].
Objectives
The primary aim was to test the hypothesis that the rate of hospital admissions for early pregnancy complications is lower in early pregnancy assessment units with high consultant presence than in units with low consultant presence. The key secondary objectives were to assess the effect of increased consultant presence on other clinical outcomes, to explore patient satisfaction with the quality of care and to make evidence-based recommendations about the future configuration of UK early pregnancy assessment units.
Design
The Variations in the organisations of Early Pregnancy Assessment Units in the UK and their effects on clinical, Service and PAtient-centred outcomes (VESPA) study employed a multimethods approach and included a prospective cohort study of women attending early pregnancy assessment units to measure clinical outcomes, an economic evaluation, a patient satisfaction survey, qualitative interviews with service users, an early pregnancy assessment unit staff survey and a hospital emergency care audit.
Setting
The study was conducted in 44 early pregnancy assessment units across the UK.
Participants
Participants were pregnant women (aged ≥ 16 years) attending the early pregnancy assessment units or other hospital emergency services because of suspected early pregnancy complications. Staff members directly involved in providing early pregnancy care completed the staff survey.
Main outcome measure
Emergency hospital admissions as a proportion of women attending the participating early pregnancy assessment units.
Methods
Data sources – demographic and routine clinical data were collected from all women attending the early pregnancy assessment units. For women who provided consent to complete the questionnaires, clinical data and questionnaires were linked using the women’s study number. Data analysis and results reporting – the relationships between clinical outcomes and consultant presence, unit volume and weekend opening hours were investigated using appropriate regression models. Qualitative interviews with women, and patient and staff satisfaction, health economic and workforce analyses were also undertaken, accounting for consultant presence, unit volume and weekend opening hours.
Results
We collected clinical data from 6606 women. There was no evidence of an association between admission rate and consultant presence (p = 0.497). Health economic evaluation and workforce analysis data strands indicated that lower-volume units with no consultant presence were associated with lower costs than their alternatives.
Limitations
The relatively low level of direct consultant involvement could explain the lack of significant impact on quality of care. We were also unable to estimate the potential impact of factors such as scanning practices, level of supervision, quality of ultrasound equipment and clinical care pathway protocols.
Conclusions
We have shown that consultant presence in the early pregnancy assessment unit has no significant impact on key outcomes, such as the proportion of women admitted to hospital as an emergency, pregnancy of unknown location rates, ratio of new to follow-up visits, negative laparoscopy rate and patient satisfaction. All data strands indicate that low-volume units run by senior or specialist nurses and supported by sonographers and consultants may represent the optimal early pregnancy assessment unit configuration.
Future work
Our results show that further research is needed to assess the potential impact of enhanced clinical and ultrasound training on the performance of all disciplines working in early pregnancy assessment units.
Trial registration
Current Controlled Trials ISRCTN10728897.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sergio Silverio
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, UK
| | | | - Jeff Round
- Institute of Health Economics, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nazim Khan
- Modelling and Analytical Systems Solutions Ltd, Edinburgh, UK
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | | | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Davor Jurkovic
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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Ranatunga IDJC, Jayaratne K. Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka. BMC Pregnancy Childbirth 2020; 20:667. [PMID: 33153469 PMCID: PMC7643445 DOI: 10.1186/s12884-020-03259-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unplanned pregnancy is a significant public health issue in both low- and high-income countries. The burden of unplanned pregnancy is reflected in women opting for pregnancy terminations and it can be detrimental to the women and her family as well as the health system and society. Solid data on the proportion of unplanned pregnancies are using more specific tools such as the London Measure of Unplanned Pregnancy (LMUP) needed to address the issue in Sri Lankan contexts. The objective was to describe the proportion of unplanned pregnancies, their determinants and the health outcomes of women delivering at Colombo North Teaching Hospital-Ragama (CNTH). METHODS A cross-sectional study was carried out among 494 consecutive pregnant women selected by non-probability consecutive sampling who were admitted for the confinement at CNTH. A pre-tested structured interviewer-administered questionnaire was used to collect data on antenatal women and intentionality measured by self-administered six-item LMUP. Maternal and newborn health outcomes were ascertained in each post-partum women before discharge. Data were analyzed with the Mann-Whitney U tests, Kruskal-Wallis tests and spearman rank correlation. We also evaluated the psychometric properties of the Sinhalese version of LMUP. RESULTS The response rate was 97.8 and 17.2% of pregnancies ending at birth were unplanned, 12.7% were ambivalent and 70.1% were planned. Associated factor profile of women with unplanned pregnancies includes; not married women (p = 0.001), educated up to the passing of GCE ordinary level by women (p < 0.001) and spouse (p < 0.001), primiparity (p = 0.002) and inadequate knowledge on emergency contraceptives (p = 0.037). Less planned pregnancies were also significantly associated with anemia (p = 0.004), low mood for last 2 weeks (p < 0.001), having a partner with problematic alcohol consumption (p < 0.001), presence of Gender-Based Violence (GBV) (p < 0.001), poor relationship satisfaction with partner (p < 0.001) and family (p < 0.001). Inadequate pre-pregnancy preparation and antenatal care were associated with an unplanned pregnancy. No differences were found in neonatal outcomes. Sinhalese version of the LMUP scale was found to be accepted, valid and reliable with the Cronbach's alpha of 0.936. CONCLUSIONS A sizeable proportion of pregnancies were unplanned. Teenage pregnancies, non-marital relationships and inadequate knowledge on emergency contraceptives, maternal anemia, low mood, and GBV were modifiable associated factors which could be prevented by evidence-based locally applicable approaches.
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Affiliation(s)
| | - Kapila Jayaratne
- Family Health Bureau, Ministry of Health, 231 De Saram Place, Colombo 10, Sri Lanka
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Malat J, Johns-Wolfe E, Smith T, Shields GS, Jacquez F, Slavich GM. Associations between lifetime stress exposure, race, and first-birth intendedness in the United States. J Health Psychol 2020; 27:765-777. [PMID: 33111552 DOI: 10.1177/1359105320963210] [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] [Indexed: 01/02/2023] Open
Abstract
This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.
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Arikawa S, Dumazert P, Messou E, Burgos-Soto J, Tiendrebeogo T, Zahui A, Horo A, Minga A, Becquet R. Childbearing desire and reproductive behaviors among women living with HIV: A cross-sectional study in Abidjan, Côte d'Ivoire. PLoS One 2020; 15:e0239859. [PMID: 33085671 PMCID: PMC7577483 DOI: 10.1371/journal.pone.0239859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Evidence on childbearing desire and reproductive behaviors in women living with HIV on antiretroviral therapy (ART) is scarce, particularly in West Africa. We investigated the prevalence and associated factors of childbearing desire in HIV-infected women in care in Abidjan, Côte d’Ivoire and explored whether such desires were translated into behaviors related to contraceptive use and communication with health personnel. Methods A cross-sectional survey was conducted in two HIV-care facilities in Abidjan, Côte d’Ivoire in 2015. Eligible women were non-pregnant, non-menopausal, aged 18–49 years and diagnosed as HIV-infected. The outcomes were childbearing desire, prevalence of modern contraceptive use, unmet needs for family planning and intention of the last pregnancy since HIV diagnosis. Women wishing to conceive immediately were asked whether they had discussed their desire with HIV healthcare workers. Logistic regression models were used to assess the associations between the outcomes and women’s characteristics. Results Of 1,631 women, 80% declared having childbearing desire. No association was found between women’s childbearing desire and ART status or its duration. In multivariate models, younger age, being in a stable relationship and having no or only one child were significantly associated with increased childbearing desire. Of the women wishing to conceive immediately (n = 713), only 43% reported having had fertility-related dialogue with healthcare provider. Among sexually active women wanting to avoid or delay pregnancy (n = 650), unmet needs for family planning was 40%. Regarding the last pregnancy since HIV diagnosis, one in three women reported not having wanted a baby at that time. Conclusions Pregnancy desire in women living with HIV in Abidjan was extremely high. Integration of safe conception strategies as well as improvement of contraceptive uptake among women in need of family planning are of utmost importance to ensure optimal conception and to avoid transmission of HIV to the male partner or to the forthcoming child.
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Affiliation(s)
- Shino Arikawa
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Patricia Dumazert
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre de Prise en charge de Recherche et de Formation (CePReF-Aconda-VS), Abidjan, Côte d'Ivoire
| | - Juan Burgos-Soto
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Thierry Tiendrebeogo
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
| | - Angèle Zahui
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Albert Minga
- Programme PAC-CI, ANRS site in Côte d’Ivoire, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d’Ivoire
| | - Renaud Becquet
- Inserm, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
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Lundsberg LS, Cutler AS, Stanwood NL, Yonkers KA, Gariepy AM. Association of Pregnancy Contexts with Depression and Low Social Support in Early Pregnancy. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:161-170. [PMID: 33047499 DOI: 10.1363/psrh.12155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/29/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Research into the relationship between pregnancy intention and perinatal depression or low social support is limited. Women's perspectives on pregnancy and their associations with perinatal depression could help in developing targeted efforts for screening and intervention. METHODS In 2014-2015, 161 women seeking pregnancy testing or abortion care at clinics in New Haven, Connecticut, were surveyed. They were asked about pregnancy context (intentions, planning, wantedness, desirability, timing and happiness), and the Edinburgh Depression Screen (EDS) and the Modified Kendler Social Support Index (MKSSI) were used to identify possible antenatal depression and low social support, respectively. Multivariable logistic regression analysis was employed to examine associations between pregnancy context and these outcomes. RESULTS On average, participants were 27 years old and at nine weeks' gestation. One-fifth reported a previous diagnosis of depression or anxiety, and 22% and 33% screened positive for depression (EDS scores of 13 or higher and 10 or higher, respectively); 52% received low social support (MKSSI score of 3.2 or less). Regression analysis found that pregnancies described as unintended, poorly timed or undesired were associated with depression at the higher cutoff (odds ratios, 3.2-4.5); all unfavorable pregnancy measures were associated with depression at the lower cutoff. Ambivalence regarding pregnancy timing, intention, wantedness and desirability was associated with increased odds of depression by either EDS score. Unplanned pregnancies and those about which the woman was ambivalent were associated with low social support. CONCLUSIONS Findings support the need to screen women for depression early in pregnancy and to integrate assessments of pregnancy context into the evaluation of potential risk factors.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Abigail S Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Kimberly A Yonkers
- Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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Vieira CS, Braga GC, Cruz Lugarinho PT, Stifani BM, Bettiol H, Barbieri MA, Cardoso VC, de Carvalho Cavalli R. Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study. Int J Gynaecol Obstet 2020; 151:237-243. [PMID: 32652559 DOI: 10.1002/ijgo.13305] [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: 01/13/2020] [Revised: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. METHODS A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. RESULTS The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. CONCLUSION Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Bianca Maria Stifani
- Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marco Antônio Barbieri
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Viviane Cunha Cardoso
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo de Carvalho Cavalli
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Contraception Practices Among Women on Opioid Agonist Therapy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:204-210. [PMID: 32980283 DOI: 10.1016/j.jogc.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Despite increased public awareness and use of opioid agonist therapy (OAT), there is little published data on contraception among women on methadone or buprenorphine/naloxone. This study aimed to characterize patterns of contraception use among this population. METHODS We conducted a cross-sectional survey between May 2014 and October 2015 at 6 medical clinics, pharmacies, and community organizations in British Columbia. Trained surveyors used the Canadian Sexual Health Survey (CSHS) to collect information on contraceptive practices and barriers to health care access. Descriptive analysis was performed on the subset of women on OAT who were at risk for unintended pregnancy. RESULTS Of the 133 survey respondents, 80 (60.2%) were at risk for unintended pregnancy. Among the 46 respondents with a recent pregnancy, 44 (95.7%) reported it as unintended. Of those at risk for unintended pregnancy, the most common contraceptive methods used were "no method," male condom, and depo-medroxyprogesterone at 28.8%, 16.3%, and 12.5%, respectively. Only 5% reported dual protection with a barrier and hormonal or intrauterine method. Barriers to contraception access included difficulty booking appointments with providers and cost, although 97% of all respondents reported feeling comfortable speaking with a physician about contraception. CONCLUSION We found that most respondents using OAT reported prior pregnancies that were unintended, and used less effective contraceptive methods. Health care professionals who provide addiction care are uniquely positioned to address their patients' concerns about contraception. Incorporating family planning discussions into OAT services may improve understanding and use of effective contraceptive methods. Addressing unmet contraceptive needs may enable women on OAT to achieve their reproductive goals.
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Hernandez ND, Chandler R, Nava N, Tamler I, Daley EM, Baldwin JA, Buhi ER, O’Rourke K, Romero-Daza N, Grilo S. Young adult US-born Latina women's thoughts, feelings and beliefs about unintended pregnancy. CULTURE, HEALTH & SEXUALITY 2020; 22:920-936. [PMID: 31382840 PMCID: PMC7002175 DOI: 10.1080/13691058.2019.1642517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Current measures of unintended pregnancy underestimate the co-occurring, complex set of social, cultural, economic and structural factors that influence how women interpret unintended pregnancy. The purpose of this study was to prospectively explore young adult US-born Latinas' thoughts, feelings and beliefs about pregnancy, specifically unintended pregnancies and the sociocultural factors identified as contributors to those beliefs. In-depth interviews (n = 20) were conducted with US-born, English-speaking Latinas aged 18-25 years in south Florida. Seventeen participants did not intend to get pregnant, while the remaining participants (n = 3) reported that their intentions kept changing. Participants' beliefs regarding their unintended pregnancy were influenced by social and economic hardship and cultural factors such as fatalism and familismo. Ideas and the meaning of pregnancy differed based on the woman's pregnancy resolution decision. Many women felt the term 'unintended pregnancy' placed blame on women and was stigmatising. When discussing pregnancy planning, most participants felt that women should not plan their pregnancies and doing so was going against fate. Findings suggest that salient influences such as culture and the social determinants related to unintended pregnancy should be incorporated into measurements examining unintended pregnancy.
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Affiliation(s)
- Natalie D. Hernandez
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Nancy Nava
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ilyssa Tamler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ellen M. Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Julie A. Baldwin
- Northern Arizona University, Department of Health Sciences, College of Health and Human Services, Flagstaff, AZ, USA
| | - Eric R. Buhi
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA
| | - Kathleen O’Rourke
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Stephanie Grilo
- Chronic Disease Epidemiology, Yale School of Public Heath, New Haven, CT, USA
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Huynh ST, Yokomichi H, Akiyama Y, Kojima R, Horiuchi S, Ooka T, Shinohara R, Yamagata Z. Prevalence of and factors associated with unplanned pregnancy among women in Koshu, Japan: cross-sectional evidence from Project Koshu, 2011-2016. BMC Pregnancy Childbirth 2020; 20:397. [PMID: 32646511 PMCID: PMC7346350 DOI: 10.1186/s12884-020-03088-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unplanned pregnancy is a public health issue with adverse consequences for maternal and neonatal health. In Japan, the prevalence of unplanned pregnancy was 46.2% in 2002. However, few studies have investigated this topic, and there is little recent data from Japan. We described and examined the prevalence and determinants of unplanned pregnancy among rural women in Japan from 2011 to 2016. Methods We used cross-sectional data from a community-based cohort study (Project Koshu). Data were collected from 2011 to 2016 via a self-report questionnaire included in the Maternal and Child Health Handbook of Japan. Pregnancy intention was measured as a binary variable (planned or unplanned). Univariate and multivariate logistic regression analyses were performed to examine factors associated with unplanned pregnancy, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). We conducted sensitivity analyses with different definitions of pregnancy intention to assess the robustness of the results. The significance level was set at 5%. Results Of the 932 participants (mean ± standard deviation age at baseline: 31.3 ± 5.2 years), 382 (41%) pregnancies were reported as unplanned. The multivariate analyses showed that maternal age (+ 1 year: OR = 0.94, 95% CI: 0.92–0.97, p < 0.001), ‘other’ family structure (OR = 2.76, 95% CI: 1.12–6.76, p = 0.03), three or more pregnancies (OR = 2.26, 95% CI: 1.66–3.08, p < 0.001), current smoking (OR = 2.60, 95% CI: 1.26–5.35, p = 0.01), balanced diet (OR = 0.62, 95% CI: 0.47–0.83, p < 0.001) and current depression (OR = 1.63, 95% CI: 1.24–2.16, p < 0.001) were strongly associated with unplanned pregnancy. These associations were consistent across definitions of pregnancy intention, supporting the robustness of our results. Conclusions The prevalence of unplanned pregnancy in the study population was high (41%). Risk factors for unplanned pregnancy were age, number of pregnancies, smoking, having a balanced diet and current depression. These results suggest greater efforts are needed to enhance sex education for young people, improve access to family planning services and provide comprehensive health care for high-risk women to help reduce unplanned pregnancies.
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Affiliation(s)
- Son Trung Huynh
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Sayaka Horiuchi
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.,Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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Toquinto SM, Berglas NF, McLemore MR, Delgado A, Roberts SCM. Pregnant Women's Acceptability of Alcohol, Tobacco, and Drug Use Screening and Willingness to Disclose Use in Prenatal Care. Womens Health Issues 2020; 30:345-352. [PMID: 32622582 DOI: 10.1016/j.whi.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Despite the prevalence of alcohol, tobacco, and other drug (ATOD) use screening as part of prenatal care, pregnant women's perspectives on screening are largely absent from research and clinical practice. This study examines pregnant women's acceptability of ATOD screening and willingness to disclose their ATOD use in prenatal care. METHODS Pregnant women completed a self-administered survey and structured interview at four prenatal care facilities in Louisiana and Maryland (N = 589). Participants reported the acceptability of screening and their willingness to honestly disclose their ATOD use to their provider. Data were analyzed through descriptive statistics, tests of proportions, simple regression models, and coding of open-ended responses. RESULTS Nearly all pregnant women found screening acceptable for alcohol (97%), tobacco (98%), and other drug use (97%) during prenatal care. The acceptability of alcohol use screening was higher among those who reported binge drinking (98% vs. 96%; p = .002) and risky alcohol consumption (99% vs. 96%; p = .018). The acceptability of screening for other drugs was higher among women reporting binge drinking (98% vs. 96%; p = .032) and other drug use (98% vs. 96%; p = .058). Almost all pregnant women indicated that they were willing to disclose their alcohol (99%), tobacco (99%), and other drug use (98%) to their provider. CONCLUSIONS Almost all women considered verbal screening for ATOD use during prenatal care acceptable and indicated that they were willing to honestly disclose their ATOD use. Verbal screening may allow for the opportunity to initiate safe, nonjudgmental conversations about women's substance use, risk, and goals for their ATOD use, pregnancy, and parenting.
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Affiliation(s)
- Signy M Toquinto
- MarinHealth Medical Center & Marin Community Clinics, Kentfield, California
| | - Nancy F Berglas
- Advancing New Standards In Reproductive Health, University of California, San Francisco, Oakland, California.
| | - Monica R McLemore
- Advancing New Standards In Reproductive Health, University of California, San Francisco, Oakland, California; School of Nursing, University of California, San Francisco, San Francisco, California
| | - Ana Delgado
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sarah C M Roberts
- Advancing New Standards In Reproductive Health, University of California, San Francisco, Oakland, California
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Barrett G, Nolan EM, Gürtin ZB, Stephenson J, Hall JA. London Measure of Unplanned Pregnancy and newer family forms: an update. J Epidemiol Community Health 2020; 74:765. [PMID: 32586985 DOI: 10.1136/jech-2020-214419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Geraldine Barrett
- UCL EGA Institute for Women's Health, University College London, London, UK
| | | | - Zeynep B Gürtin
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Jennifer Anne Hall
- UCL EGA Institute for Women's Health, University College London, London, UK
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Nkrumah I, North M, Kothe E, Chai TL, Pirotta S, Lim S, Hill B. The Relationship Between Pregnancy Intentions and Diet or Physical Activity Behaviors in the Preconception and Antenatal Periods: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2020; 65:660-680. [PMID: 32592533 DOI: 10.1111/jmwh.13112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Healthy preconception and antenatal diet and physical activity behaviors may optimize maternal and offspring outcomes. These behaviors are thought to be linked to pregnancy intentions. The aim of this study was to conduct a systematic review and meta-analysis to determine the association between women's pregnancy intentions and diet or physical activity behaviors in the preconception and antenatal periods. METHODS MEDLINE Complete, PsycINFO, CINAHL Complete, Global Health, Embase, and INFORMIT: Health Subset were searched in September 2018 for studies that evaluated relationships between pregnancy intentions and dietary and physical activity behaviors. Risk of bias was assessed, and random effects meta-analyses were conducted for dietary (food groups; energy and macronutrients; diet quality; and caffeine, iodine, and folate intake) and physical activity outcomes. RESULTS Of 2623 screened records, 19 eligible studies were identified. The overall risk of bias was moderate to high. Twelve studies measured diet and physical activity behaviors during preconception, 5 during pregnancy, and 2 across both periods. Eleven studies measured pregnancy intention retrospectively, and 8 prospectively measured pregnancy intention. The number of studies available for meta-analyses of individual dietary and physical activity outcomes ranged from 2 to 5. Pregnancy intentions were not associated with preconception fruit, vegetable, or caffeine intake or physical activity. Antenatally, women with intended pregnancies were more likely to report healthier diets, lower caffeine intake, and higher physical activity. Insufficient studies were available to conduct subgroup comparisons for prospective or retrospective assessment. DISCUSSION Pregnancy intentions were not associated with preconception diet or physical activity behaviors. In contrast, antenatally, women with intended pregnancies demonstrated better diet and physical activity behaviors. Given the small number of studies available for meta-analyses, further research is needed to consolidate our findings. Meanwhile, health professionals can assess women's pregnancy intentions during preconception and pregnancy and encourage a healthy lifestyle.
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Affiliation(s)
- Isaac Nkrumah
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Garden City University College, Kumasi, Ghana
| | - Madelon North
- School of Psychology, Deakin University, Geelong, Australia
| | - Emily Kothe
- School of Psychology, Deakin University, Geelong, Australia
| | - Tze Lin Chai
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie Pirotta
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Roe AH, McAllister A, Sammel MD, Schreiber CA. Pregnancy intentions and contraceptive uptake after miscarriage. Contraception 2020; 101:427-431. [PMID: 32199790 PMCID: PMC7430048 DOI: 10.1016/j.contraception.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors associated with contraceptive uptake among participants in a miscarriage management clinical trial. STUDY DESIGN We performed a secondary analysis of a multi-center, randomized controlled trial of medical management regimens for miscarriage between 5 and 12 completed weeks. Pregnancy intention was measured by patient report after miscarriage diagnosis. Participants were offered contraception in accordance with standard clinical care once their miscarriage was completed. We analyzed participants as a cohort and fit a multivariable model to describe demographic characteristics and pregnancy intentions independently associated with contraceptive uptake. RESULTS Of 244 participants with available contraceptive outcomes, 121 (50%) stated that this pregnancy was planned, and 218 (90%) stated that they had planned to continue the pregnancy to term. Ninety-seven participants (40%) initiated contraception: 33 (14%) selected a long-acting reversible method, 44 (18%) a short-acting reversible method, and 20 (8%) condoms or emergency contraception, while 147 (60%) declined contraception after miscarriage completion. In the multivariable model, unplanned pregnancy (aRR 2.13, 95% CI: 1.45-3.13) and lack of intention to continue the pregnancy (aRR 1.61, 95% CI: 1.18-2.20) were independently associated with contraceptive uptake. Of participants who declined contraception, 85 (57%) did so in order to conceive again. Nearly one-quarter of participants who declined contraception described the index pregnancy as unplanned, but after miscarriage planned to conceive a new pregnancy. CONCLUSION Patients with unplanned pregnancy who miscarried were twice as likely to initiate contraception as those with planned pregnancy, however pregnancy intentions sometimes changed after miscarriage. IMPLICATIONS Miscarriage management represents an important opportunity to clarify pregnancy goals and provide contraceptive counseling. Although unplanned pregnancy correlates with contraceptive uptake, we do not recommend using this clinically to predict contraceptive need. Future research should examine how best to measure pregnancy intention and its relationship to the experience of miscarriage.
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Affiliation(s)
- Andrea H Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States.
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, 13001 E. 17th Place, B119, Bldg 500, 3rd Floor West Wing, Aurora, CO 80045, United States
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
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Hill B, Hall J, Skouteris H, Currie S. Defining preconception: exploring the concept of a preconception population. BMC Pregnancy Childbirth 2020; 20:280. [PMID: 32381056 PMCID: PMC7206804 DOI: 10.1186/s12884-020-02973-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background Health prior to conception can significantly impact offspring health, however, a clear definition of the attributes of the preconception population is currently lacking. We aimed to use existing literature to explore the concept and attributes of a preconception population by: [1] identifying characteristics and research recruitment methods; and [2] generating an attribute-based working definition of a preconception population. Methods A rapid review of current literature using CINAHL and the subject heading ‘pre-pregnancy care’ was conducted (Stage 1). Data extracted included definitions of preconception, participant inclusion/exclusion criteria, participant characteristics, and recruitment methods. Stage 2 involved a wider search of relevant publications beyond peer-reviewed literature followed by a concept analysis of the phrase “preconception population” applying Walker and Avant’s framework (Stage 2). Results Twenty-three papers (19 studies) were included in Stage 1. “Preconception” was explicitly defined in one study. Twelve studies specified participants must be planning a pregnancy. Stage 2 included 33 publications. Four key perspectives for the concept of the preconception population were derived: [1] intentional; [2] potential; [3] public health; and [4] life course. Conclusions Adopting these perspectives may allow researchers to accurately define, identify and recruit preconception populations and to develop interventions that are appropriately broad or tailored depending on population needs. We hope the definitions will facilitate research with this population and will subsequently improve the wellbeing of preconception men and women, which is essential to ensuring the health of future generations.
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Affiliation(s)
- Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Victoria, 3168, Australia.
| | - Jennifer Hall
- EGA Institute for Women's Health, University College London, 74 Huntley St, London, WC1E 6AU, UK
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Victoria, 3168, Australia
| | - Sinéad Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.
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Lang AY, Harrison CL, Barrett G, Hall JA, Moran LJ, Boyle JA. Opportunities for enhancing pregnancy planning and preconception health behaviours of Australian women. Women Birth 2020; 34:e153-e161. [PMID: 32312651 DOI: 10.1016/j.wombi.2020.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
PROBLEM AND BACKGROUND The preconception period provides a significant opportunity to engage women in healthy behaviour change for improved maternal and child health outcomes. However, there is limited research exploring women's pregnancy planning in Australia. AIM This study investigated associations between pregnancy planning, socio-demographics and preconception health behaviours in Australian women. METHODS A retrospective cross-sectional survey of pregnant women ≥18-years-of-age recruited through a Victorian public maternity service and a national private health insurer. RESULTS Overall 317 women (30±4.7 years) participated (public: n=225, private: n=92). Planned pregnancies were reported by 74% of women and were independently associated with marital status (AOR=5.71 95% CI 1.92-17.00, p=0.002); having ≤2 children (AOR=3.75 95% CI 1.28-11.05, p=0.016); and having private health insurance (AOR=2.51 95% CI 1.08-5.81, p=0.03). Overall, women reported preconception: any folic-acid supplementation (59%), up-to-date cervical screening (68%), weight management attempts (75%), accessing information from health professionals (57%) and immunisation reviews (47%). Pregnancy planners were more likely to use folic-acid (AOR=17.13 95% CI 7.67-38.26, p<0.001), review immunisations (AOR=2.09 95% CI 1.07-4.10, p=0.03) and access information (AOR=3.24 95% CI 1.75-6.00, p<0.001) compared to non-planners. Women <25-years-of-age were less likely to access information (AOR=0.38 95% CI 0.16-0.89, p=0.03) and take folic-acid (AOR=0.23 95% CI 0.09-0.59, p=0.002) and were more likely to smoke 3-months preconception (AOR=6.68 95% CI 1.24-36.12, p=0.03). CONCLUSIONS Women with planned and unplanned pregnancies reported variable preconception health behaviour uptake and limited healthcare engagement. Opportunities exist to improve awareness and healthcare engagement for optimising preconception health and pregnancy planning benefits including collaborative health promotion. Population-based and targeted approaches reaching pregnancy planners and non-planners are required.
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Affiliation(s)
- Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51, Kanooka Grove, Clayton, Victoria, 3186, Australia.
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51, Kanooka Grove, Clayton, Victoria, 3186, Australia.
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, 74 Huntley Street, London, WC1E 6AU, United Kingdom.
| | - Jennifer A Hall
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, 74 Huntley Street, London, WC1E 6AU, United Kingdom.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51, Kanooka Grove, Clayton, Victoria, 3186, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51, Kanooka Grove, Clayton, Victoria, 3186, Australia.
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Rocca CH, Wilson MR, Jeon M, Foster DG. Stability of Retrospective Pregnancy Intention Reporting Among Women with Unwanted Pregnancies in the United States. Matern Child Health J 2020; 23:1547-1555. [PMID: 31236825 DOI: 10.1007/s10995-019-02782-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives Retrospective assessment of pregnancy intention may be unreliable as women's perceptions of a past conception can change over time. We compared the stability of retrospective pregnancy intention reporting over 5 years among women who sought and either received, or were denied, an abortion. Methods We recruited women from 30 abortion facilities across the United States in 2008-2010. Participants, some who received abortions and others who were denied care because they presented beyond facilities gestational limits, were followed prospectively for 5 years (n = 827). At enrollment and semiannually from year-2 to year-5, women completed the London Measure of Unplanned Pregnancy (LMUP), a six-item measure (scored 0-12), regarding the index pregnancy. We used multivariable mixed-effects models to assess the stability of retrospective reports of index pregnancy intendedness and compared trajectories by group, accounting for site and participant clustering. Our hypotheses were that intention would tend towards "more intended" over time among women denied abortions, who carried the pregnancies to term, and remain stable among women who received the abortion. Results Baseline LMUP scores were low (mean: 2.8) and similar by study group. Scores increased among women denied the abortion by year-2 (from 2.9 to 3.5; p < 0.001) and were steady through year-5. For women having near-limit abortions, reported intentions were steady between baseline (mean: 2.7) and year-2 (2.8), and declined thereafter through year-5 (to 2.5; p < 0.001). Conclusions Women somewhat shifted their perceptions of their intentions in correspondence with the pregnancy outcome. Retrospective estimates may underestimate the degree to which births result from unintended pregnancy.
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Affiliation(s)
- Corinne H Rocca
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 1330 Broadway, 11th Floor, Oakland, CA, 94612, USA.
| | - Mark R Wilson
- Graduate School of Education, University of California, Berkeley, 4415 Berkeley Way Building, Berkeley, CA, 94720, USA
| | - Minjeong Jeon
- Graduate School of Education and Information Studies, University of California, Los Angeles, Moore Hall 3141, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Diana G Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 1330 Broadway, 11th Floor, Oakland, CA, 94612, USA
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Ralph LJ, Foster DG, Rocca CH. Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:39-48. [PMID: 32189427 PMCID: PMC8126343 DOI: 10.1363/psrh.12134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 05/17/2023]
Abstract
CONTEXT Measurement of pregnancy intentions typically relies on retrospective reporting, an approach that may misrepresent the extent of unintended pregnancy. However, the degree of possible misreporting is unclear, as little research has compared prospective and retrospective reports of intention for the same pregnancies. METHODS Longitudinal data collected between 2010 and 2015 on 174 pregnancies were used to analyze the magnitude and direction of changes in intendedness (intended, ambivalent or unintended) between prospective and retrospective measurements of intendedness using versions of the London Measure of Unplanned Pregnancy (LMUP). Changes were assessed both continuously and categorically. Differences in the degree of change-by pregnancy outcome and participant characteristics-were examined using mixed-effects linear and logistic regression models. RESULTS Over two and one-half years of follow-up, 143 participants reported 174 pregnancies. Approximately half showed changes in intention between the prospective and retrospective assessments, with 38% of participants reporting increased intendedness and 10% decreased intendedness. Reported intendedness increased more among those who gave birth (mean change in continuous LMUP score, 2.2) than among those who obtained an abortion (0.7), as well as among individuals with a college degree (4.1) than among those with a high school diploma (1.2). Participants who reported recent depression or anxiety symptoms showed more stable intentions (0.02) than those who did not (2.1). CONCLUSIONS Retrospective measurement of pregnancy intentions may underestimate the frequency of unintended pregnancy, with such underestimation being greater among certain subgroups. Estimates based on retrospective reports thus may produce inaccurate impressions of intentionality. Further efforts to refine the measurement of pregnancy preferences are needed.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Whitley J, Wouk K, Bauer AE, Grewen K, Gottfredson NC, Meltzer-Brody S, Propper C, Mills-Koonce R, Pearson B, Stuebe A. Oxytocin during breastfeeding and maternal mood symptoms. Psychoneuroendocrinology 2020; 113:104581. [PMID: 31911347 PMCID: PMC8117182 DOI: 10.1016/j.psyneuen.2019.104581] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/21/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
This study aimed to quantify the relationship between postpartum depression and anxiety, oxytocin, and breastfeeding. We conducted a longitudinal prospective study of mother-infant dyads from the third trimester of pregnancy to 12 months postpartum. A sample of 222 women were recruited to complete the Beck Depression Inventory II and Spielberger State-Trait Anxiety Inventory-state subscale, participate in observed infant feeding sessions at 2 and 6 months postpartum, and provide venous blood samples during feeding. Maternal venous oxytocin levels in EDTA-treated plasma and saliva were determined by enzyme immunoassay with extraction and a composite measure of area under the curve (AUC) was used to define oxytocin across a breastfeeding session. Linear regression was used to estimate associations between postpartum depression and anxiety as predictors and oxytocin AUC during breastfeeding as the outcome at both 2 and 6 months postpartum. Mixed models accounting for correlations between repeated oxytocin measures were used to quantify the association between current depression and/or anxiety symptoms and oxytocin profiles during breastfeeding. We found no significant differences in oxytocin AUC across a feed between depressed or anxious women and asymptomatic women at either 2 or 6 months postpartum. Repeated measures analyses demonstrated no differences in oxytocin trajectories during breastfeeding by symptom group but possible differences by antidepressant use. Our study suggests that external factors may influence the relationship between oxytocin, maternal mood symptoms, and infant feeding.
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Affiliation(s)
- Julia Whitley
- University of North Carolina School of Medicine, United States.
| | - Kathryn Wouk
- Carolina Global Breastfeeding Institute, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna E Bauer
- Department of Psychiatry, UNC School of Medicine
| | - Karen Grewen
- Department of Psychiatry, UNC School of Medicine
| | | | | | - Cathi Propper
- Center for Developmental Science, University of North Carolina at Chapel Hill
| | - Roger Mills-Koonce
- Center for Developmental Science, University of North Carolina at Chapel Hill
| | | | - Alison Stuebe
- Department of Obstetrics and Gynecology, UNC School of Medicine
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76
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Rocca CH, Samari G, Foster DG, Gould H, Kimport K. Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma. Soc Sci Med 2020; 248:112704. [DOI: 10.1016/j.socscimed.2019.112704] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/23/2019] [Accepted: 11/26/2019] [Indexed: 01/26/2023]
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Maas VYF, Koster MPH, Ista E, Vanden Auweele KLH, de Bie RWA, de Smit DJ, Visser BC, van Vliet-Lachotzki EH, Franx A, Poels M. Study design of a stepped wedge cluster randomized controlled trial to evaluate the effect of a locally tailored approach for preconception care - the APROPOS-II study. BMC Public Health 2020; 20:235. [PMID: 32059663 PMCID: PMC7023687 DOI: 10.1186/s12889-020-8329-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background In a previous feasibility study (APROPOS) in a single municipality of the Netherlands, we showed that a locally tailored preconception care (PCC) approach has the potential to positively affect preconceptional lifestyle behaviours. Therefore, we designed a second study (APROPOS-II) to obtain a more robust body of evidence: a larger group of respondents, more municipalities, randomization, and a more comprehensive set of (clinical) outcomes. The aim of this study is to assess the effectiveness and the implementation process of a local PCC-approach on preconceptional lifestyle behaviours, health outcomes and the reach of PCC among prospective parents and healthcare providers. Methods This study is an effectiveness-implementation hybrid type 2 trial. This involves a stepped-wedge cluster randomized controlled trial design aiming to include over 2000 future parents from six municipalities in the Netherlands. The intervention has a dual-track approach, focusing on both the uptake of PCC among future parents and the provision of PCC by healthcare providers. The PCC-approach consists of 1) a social marketing strategy directed towards prospective parent(s) and 2) a local care pathway to improve interdisciplinary collaboration. Data will be collected before and after the introduction of the intervention through questionnaires and medical records in each of the participating municipalities. The primary outcome of this study is change in lifestyle behaviours (e.g. folic acid use, smoking and alcohol use). Secondary outcomes are pregnancy outcomes (e.g. miscarriage, preterm birth, gestational diabetes) and the uptake of PCC. Moreover, a process evaluation will be performed, providing information on the efficacy, feasibility, barriers and facilitators regarding the implementation of the intervention. Discussion The APROPOS-II study introduces a locally tailored PCC-approach in six municipalities in the Netherlands that will contribute to the body of evidence regarding the effectiveness of PCC and its implementation. If this intervention has a positive effect on lifestyle behaviour changes, leading to improved pregnancy outcomes and the future health of prospective parents and their offspring, it could subsequently be upscaled to (inter)national implementation. Trial registration Dutch Trial register: NL7784 (Registered June 6th, 2019).
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Affiliation(s)
- Veronique Y F Maas
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | | | - Renate W A de Bie
- Department of Obstetrics, Diakonessenhuis hospital, Utrecht, Bosboomstraat 1, 3582, KE, the Netherlands
| | - Denhard J de Smit
- MediClara Projects, Baambrugge, Prinses Beatrixstraat 7, 1396, KD, the Netherlands
| | - Bianca C Visser
- Geboorte Concortium Midden Nederland (GCMN), Utrecht, Oudlaan 4, 3515, GA, the Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Marjolein Poels
- Department of Obstetrics and Gynaecology, University Medical Centre Rotterdam, Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands. .,Research agency Care2Research, Amsterdam, Mattenbiesstraat 133, 1087, GC, the Netherlands.
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78
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Lundsberg LS, Pensak MJ, Gariepy AM. Is Periconceptional Substance Use Associated with Unintended Pregnancy? WOMEN'S HEALTH REPORTS 2020; 1:17-25. [PMID: 33786469 PMCID: PMC7784790 DOI: 10.1089/whr.2019.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: To evaluate the relationship between periconceptional (period before and/or after conception) substance use and unfavorable pregnancy contexts, including unintended pregnancy. Materials and Methods: This is a cross-sectional analysis of English- or Spanish-speaking women aged 16–44 years with pregnancies <24 weeks' gestation presenting to pregnancy testing clinics and enrolled between June 2014 and June 2015. Participants self-reported periconceptional substance use (tobacco, alcohol, marijuana, and other illicit substances during the 3 months before enrollment), and pregnancy “contexts,” including pregnancy intention, wantedness, planning, timing, desirability, and happiness. Multivariable logistic regression was performed adjusting for potential confounding variables. Results: We enrolled 123 women, averaging 27 ± 6 years, and mean gestational age 7.5 ± 3.0 weeks. Most participants were black, non-Hispanic (37%), or Hispanic (46%), and chose to complete the study in English (69%). Sixty-five percent participants reported use of one or more substances during prior 3 months: alcohol (54%), tobacco (31%), and marijuana (21%). In multivariate analysis, periconceptional alcohol use was associated with increased odds of unintended or ambivalent pregnancy and unwanted or mixed feelings regarding pregnancy (odds ratios [OR] = 3.29, 95% confidence interval [CI] 1.08–10.08 and OR = 2.81, 95% CI 1.07–7.36, respectively). Weekly or daily tobacco use was associated with unhappiness about pregnancy (OR = 7.56, 95% CI 1.65–34.51) and undesired or unsure pregnancy (OR = 4.00, 95% CI 1.14–14.06). Conclusions: Periconceptional alcohol or tobacco use demonstrates increased odds of specific unfavorable pregnancy contexts, including pregnancy described as undesired, unintended, unwanted, and unhappiness with pregnancy. Primary prevention of periconceptional substance use and the negative effects of alcohol and tobacco may be improved by increasing contraception access for women at risk for unfavorable pregnancy contexts.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Meredith J Pensak
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Perceptions and Behaviors Related to Contraceptive Use in the Postpartum Period Among Women With Pregestational Diabetes Mellitus. J Obstet Gynecol Neonatal Nurs 2020; 49:154-166. [PMID: 31951814 DOI: 10.1016/j.jogn.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe perceptions and behaviors related to contraception and preconception care and to test the association between these perceptions and contraceptive use in the postpartum period among women with pregestational diabetes mellitus. DESIGN Cross-sectional, descriptive survey. SETTING Three high-risk obstetric clinics in the Southeastern United States. PARTICIPANTS Fifty-five women who were 18 years or older with pregestational Type 1 or Type 2 diabetes mellitus. METHODS Between 4 and 8 weeks after birth, we used investigator-developed items and psychometrically validated scales to measure participants' perceptions and behaviors related to contraception and preconception care. We dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. We used multiple logistic regression to test the hypothesis that perceptions are associated with contraceptive use. RESULTS When data were collected 4 to 8 weeks after birth, almost half (49%, n = 27) of the participants had resumed sexual activity; however, most (95%, n = 52) did not want another pregnancy in the next 18 months. Fifty-six percent (n = 31) of participants used procedure/prescription contraception, and 44% (n = 24) used nonprescription/no method. Those who perceived contraception use and preconception care to be beneficial were more likely to use procedure/prescription contraception (adjusted odds ratio = 1.52; 95% confidence interval [1.07, 2.17]). CONCLUSION When caring for women in the postpartum period, providers should be mindful that women's perceptions of the benefits of contraception and preconception care may have implications for whether their use aligns with their reproductive goals and optimizes outcomes for future pregnancies.
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Parkes A, Waltenberger M, Mercer C, Johnson A, Wellings K, Mitchell K. Latent class analysis of sexual health markers among men and women participating in a British probability sample survey. BMC Public Health 2020; 20:14. [PMID: 31914970 PMCID: PMC6950902 DOI: 10.1186/s12889-019-7959-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite known associations between different aspects of sexual health, it is not clear how patterning of adverse sexual health varies across the general population. A better understanding should contribute towards more effective problem identification, prevention and treatment. We sought to identify different clusters of sexual health markers in a general population, along with their socio-demographic, health and lifestyle correlates. METHODS Data came from men (N = 5113) and women (N = 7019) aged 16-74 who reported partnered sexual activity in the past year in Britain's third National Survey of Sexual Attitudes and Lifestyles, undertaken in 2010-2012. Latent class analysis used 18 self-reported variables relating to adverse sexual health outcomes (STI and unplanned pregnancy, non-volitional sex, and sexual function problems). Correlates included socio-demographics, early debut, alcohol/drug use, depression, and satisfaction/distress with sex life. RESULTS Four classes were found for men (labelled Good Sexual Health 83%, Wary Risk-takers 4%, Unwary Risk-takers 4%, Sexual Function Problems 9%); six for women (Good Sexual Health 52%, Wary Risk-takers 2%, Unwary Risk-takers 7%, Low Interest 29%, Sexual Function Problems 7%, Highly Vulnerable 2%). Regardless of gender, Unwary Risk-takers reported lower STI/HIV risk perception and more condomless sex than Wary Risk-takers, but both were more likely to report STI diagnosis than Good Sexual Health classes. Highly Vulnerable women reported abortion, STIs and functional problems, and more sexual coercion than other women. Distinct socio-demographic profiles differentiated higher-risk classes from Good Sexual Health classes, with depression, alcohol/drug use, and early sexual debut widely-shared correlates of higher-risk classes. Females in higher-risk classes, and men with functional problems, evaluated their sex lives more negatively than those with Good Sexual Health. CONCLUSIONS A greater prevalence and diversity of poor sexual health appears to exist among women than men in Britain, with more consistent effects on women's subjective sexual well-being. Shared health and lifestyle characteristics of higher-risk groups suggest widespread benefits of upstream interventions. Several groups could benefit from tailored interventions: men and women who underestimate their STI/HIV risk exposure, women distressed by low interest in sex, and women experiencing multiple adverse outcomes. Distinctive socio-demographic profiles should assist with identification and targeting.
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Affiliation(s)
- Alison Parkes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK.
| | - Michael Waltenberger
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK
| | - Catherine Mercer
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, UK
| | - Anne Johnson
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Kirstin Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK
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Hultstrand JN, Tydén T, Målqvist M, Ragnar ME, Larsson M, Jonsson M. Foreign-born women’s lifestyle and health before and during early pregnancy in Sweden. EUR J CONTRACEP REPR 2020; 25:20-27. [DOI: 10.1080/13625187.2019.1706078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Gaudio M, Dozio N, Feher M, Scavini M, Caretto A, Joy M, Van Vlymer J, Hinton W, de Lusignan S. Trends in Factors Affecting Pregnancy Outcomes Among Women With Type 1 or Type 2 Diabetes of Childbearing Age (2004-2017). Front Endocrinol (Lausanne) 2020; 11:596633. [PMID: 33692751 PMCID: PMC7937966 DOI: 10.3389/fendo.2020.596633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
AIM To describe trends in modifiable and non-modifiable unfavorable factors affecting pregnancy outcomes, over time (years 2004-2017), in women with diabetes of childbearing age from an English primary care perspective. METHODS We identified women with diabetes aged 16-45 years from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network, an English primary care sentinel database. Repeated annual cross-sectional analyses (2004-2017) assessed the prevalence of unfavorable factors for pregnancy, such as obesity, poor glycaemic control, microalbuminuria, hypertension, use of medications for treating diabetes, and associated comorbidities not recommended for pregnancy. RESULTS We identified 3,218 women (61.5% with Type 2 diabetes) in 2004 and 6,657 (65.0% with Type 2 diabetes) in 2017. The proportion of women with ideal glycaemic control for conception (HbA1c<6.5%) increased over time, in patients with Type 1 diabetes from 9.0% (7.1%-11.0%) to 19.1% (17.2%-21.1%), and in those with Type 2 diabetes from 27.2% (24.6%-29.9%) to 35.4% (33.6%-37.1%). The proportion of women with Type 2 diabetes prescribed medications different from insulin and metformin rose from 22.3% (20.5%-24.2%) to 27.3% (26.0%-28.6%).In 2017, 14.0% (12.6%-15.4%) of women with Type 1 and 30.7% (29.3%-32.0%) with Type 2 diabetes were prescribed angiotensin-modulating antihypertensives or statins. We captured at least one unfavorable factor for pregnancy in 50.9% (48.8%-52.9%) of women with Type 1 diabetes and 70.7% (69.3%-72.0%) of women with Type 2 diabetes. Only one third of women with Type 1 diabetes (32.2%, 30.3%-34.0%) and a quarter of those with Type 2 diabetes (23.1%, 21.9%-24.4%) were prescribed hormonal contraception. Contraception was prescribed more frequently to women with unfavorable factors for pregnancy compared to those without, however, the difference was significant only for women with Type 1 diabetes. CONCLUSIONS Despite significant improvements in general diabetes care, the majority of women with Type 1 or Type 2 diabetes have unfavorable, although mostly modifiable, factors for the start of pregnancy. Good diabetes care for women of childbearing age should include taking into consideration a possible pregnancy.
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Affiliation(s)
- Mariangela Gaudio
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- International Medical Doctor Program, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicoletta Dozio
- International Medical Doctor Program, Vita-Salute San Raffaele University, Milan, Italy
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Feher
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- Nuffield Department of Primary Care Health Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Marina Scavini
- International Medical Doctor Program, Vita-Salute San Raffaele University, Milan, Italy
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Marina Scavini,
| | - Amelia Caretto
- International Medical Doctor Program, Vita-Salute San Raffaele University, Milan, Italy
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Mark Joy
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- Nuffield Department of Primary Care Health Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Jeremy Van Vlymer
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- Nuffield Department of Primary Care Health Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - William Hinton
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- Nuffield Department of Primary Care Health Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
- Nuffield Department of Primary Care Health Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, United Kingdom
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Nascimento NDC, Borges ALV, Fujimori E. Preconception health behaviors among women with planned pregnancies. Rev Bras Enferm 2019; 72:17-24. [PMID: 31851230 DOI: 10.1590/0034-7167-2017-0620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify determinants of preconception preparation among women with planned pregnancies. METHOD A cross-sectional study with a probabilistic sample of 264 women between 18 and 49 years of age who had or were undergoing planned pregnancies, and were users of two School Health Centers in the city of São Paulo. Analysis was conducted through univariate and multiple logistic regression of three variable blocks: 1) social and demographic characteristics; 2) sexual and reproductive characteristics; 3) preexisting health conditions. RESULTS Women with higher education, belonging to economic groups A and B, and older women with infertility were more likely to perform preconception training. CONCLUSION Preconception care has a strong social determination, as women with more favorable social profiles are more likely to perform it. Experience with infertility is also instrumental in the likelihood of preconception care.
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84
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Manze MG, Watnick D, Besthoff C, Romero D. Examining Women's and Men's Ideal Criteria Before Forming Families. JOURNAL OF FAMILY STUDIES 2019; 28:239-254. [PMID: 35299887 PMCID: PMC8923530 DOI: 10.1080/13229400.2019.1702079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/01/2019] [Indexed: 06/14/2023]
Abstract
In the United States, family formation decision-making is more complex than the predominant models that have been used to capture this phenomenon. Understanding the context in which a pregnancy occurs requires a more nuanced examination. In-depth interviews were conducted with 60 men and women, aged 18-35, who had children or were pregnant. Using grounded theory analysis, themes emerged that revealed participants' ideal criteria desired before pregnancy. We stratified by those who met and did not meet these criteria. Almost universally, participants shared ideal criteria: to graduate, gain financial stability, establish a relationship, and then become pregnant. Many participants did not accomplish these goals. Those who had not met their criteria had experienced traumatic childhoods and suffered economic concerns. For this group, having children prompted positive changes within their control, but financial stability remained limited. Efforts should focus on improving circumstances for all individuals to fulfill their criteria before pregnancy.
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Affiliation(s)
- Meredith G. Manze
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
| | - Dana Watnick
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
- Albert Einstein College of Medicine, Center for AIDS Research, New York, NY
| | | | - Diana Romero
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
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85
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Stuebe AM, Meltzer-Brody S, Propper C, Pearson B, Beiler P, Elam M, Walker C, Mills-Koonce R, Grewen K. The Mood, Mother, and Infant Study: Associations Between Maternal Mood in Pregnancy and Breastfeeding Outcome. Breastfeed Med 2019; 14:551-559. [PMID: 31424266 PMCID: PMC6791474 DOI: 10.1089/bfm.2019.0079] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: We sought to determine the role of depression and anxiety in breastfeeding cessation. Materials and Methods: Participants underwent a baseline visit with a structured clinical interview in the third trimester of pregnancy. Monthly phone interviews assessed current mood symptoms and infant feeding status. We assessed the association between baseline mood and infant feeding outcomes using Cox proportional hazards regression, adjusting for infant feeding intention and sociodemographic confounders. Results: We enrolled 222 mother-infant dyads in late pregnancy, of whom 206 completed assessments through 12 months postpartum. We enriched our study with symptomatic women by enrolling 87 women with current depression or anxiety (Current), 64 women with a history of depression or anxiety (Past), and 71 women with no psychiatric history (Never). In multivariable-adjusted analyses, baseline diagnosis was not associated with breastfeeding outcome, but baseline symptoms of depression (Beck Depression Inventory ≥11) or anxiety (Spielberger State Anxiety ≥40) were associated with earlier introduction of formula (depression: adj hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.01-2.30; anxiety: 1.70, 95% CI 1.01-2.87); and any cessation of breastfeeding (depression: adj HR 2.02, 95% CI 1.23-3.31; anxiety: 1.83, 95% CI 1.00-3.33), as were depression symptoms among women who were being treated with antidepressants, compared with untreated asymptomatic women (formula: adj HR 2.27, 95% CI 1.29-4.02; cessation: 2.32, 95% CI 1.17-4.61). History of childhood trauma (adj HR 1.34, 95% CI 1.12-1.61), disordered eating symptoms (adj HR 1.22, 95% CI 1.02-1.46), and poor sleep quality in pregnancy (adj HR 1.32, 95% CI 1.09-1.60) were independently associated with earlier introduction of formula. Conclusions: Baseline mood symptoms were independently associated with earlier formula introduction and cessation of breastfeeding. History of childhood trauma, disordered eating symptoms and poor sleep quality were associated with earlier formula introduction. Targeted support may enable women with these symptoms to achieve their feeding goals.
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Affiliation(s)
- Alison M Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cathi Propper
- Center for Developmental Science, Chapel Hill, North Carolina
| | - Brenda Pearson
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pamela Beiler
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mala Elam
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cheryl Walker
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Roger Mills-Koonce
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Grewen
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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86
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Manze MG, Watnick D, Romero D. A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study. Reprod Health 2019; 16:135. [PMID: 31488161 PMCID: PMC6729075 DOI: 10.1186/s12978-019-0793-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy. METHODS We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18-35, in the United States. Data were analyzed using grounded theory methodology. RESULTS Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that 'just happens.' The third group represented a blending of both notions. CONCLUSIONS Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined. These findings can be used to improve measurement, health services, and better direct public health resources.
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Affiliation(s)
- Meredith G. Manze
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
| | - Dana Watnick
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
- Center for AIDS Research, Albert Einstein College of Medicine, New York, NY USA
| | - Diana Romero
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
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87
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The Health and Social Service Needs of Pregnant Women Who Consider but Do Not Have Abortions. Womens Health Issues 2019; 29:364-369. [DOI: 10.1016/j.whi.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
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Hall JA, Stephenson J, Barrett G. On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure, Timing of Assessment, Women's Characteristics and Outcome of Pregnancy. Matern Child Health J 2019; 23:1177-1186. [PMID: 31218607 PMCID: PMC6658581 DOI: 10.1007/s10995-019-02748-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention. METHODS We compared the test-retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher's exact tests, and calculated odds ratios to estimate effect size. RESULTS The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51-0.66); the DHS had moderate reliability (0.56-0.58). The LMUP's stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p = 0.033), number of children (p = 0.048) and postnatal depression (p < 0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy. CONCLUSIONS FOR PRACTICE The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.
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Affiliation(s)
- J A Hall
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK.
| | - J Stephenson
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK
| | - G Barrett
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK
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89
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Jawad A, Patel D, Brima N, Stephenson J. Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100461. [PMID: 31494357 DOI: 10.1016/j.srhc.2019.100461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes the patterns of change in health behaviours that pregnant women adopt before and during pregnancy. STUDY DESIGN A cross-sectional survey of pregnant women asked questions about pregnancy planning, health knowledge, and health behaviour. Analysis was descriptive with associations examined using logistic regression models. MAIN OUTCOME MEASURES Health behaviours before and during pregnancy (smoking, alcohol consumption, and folic acid and multivitamin (supplement) intake), and recall of healthcare professional advice. RESULTS 1173 women completed the survey (mean age 32 ± 5 years, 68% white) of whom 73% indicated that their pregnancy was highly planned. 38% of women reported having never smoked, 45% quit smoking before becoming pregnant, and fewer (5%, 95% CI 3-6%) reported currently smoking. Current smokers reported reduced cigarette consumption compared to pre-pregnancy, and higher recall of health professional information. Nine percent (95% CI 5-8%) reported currently drinking, reducing the number of units consumed from 6 units weekly before pregnancy (IQR 2-10) to 1 unit weekly during pregnancy (IQR 1-2, p < 0.001). Most (62%) women were currently taking supplements, of whom 81% reported daily use. Women with more planned pregnancies had higher odds of adopting healthier behaviours of stopping smoking or drinking before pregnancy compared to those who stopped during pregnancy or continued the behaviour. CONCLUSIONS Most women adopted one or more healthy behaviours during pregnancy, with a small minority continuing to smoke or drink alcohol. For women who continued smoking in pregnancy and recalled information from health professionals, additional tailored approaches need to be explored.
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Affiliation(s)
- Aalaa Jawad
- Public Health Training Programme, Stewart House, London WC1B 5DN, United Kingdom.
| | - Dilisha Patel
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
| | | | - Judith Stephenson
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
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90
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Lang AY, Hall JA, Boyle JA, Harrison CL, Teede H, Moran LJ, Barrett G. Validation of the London Measure of Unplanned Pregnancy among pregnant Australian women. PLoS One 2019; 14:e0220774. [PMID: 31393966 PMCID: PMC6687283 DOI: 10.1371/journal.pone.0220774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/23/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction Globally, over half of pregnancies in developed countries are unplanned. Identifying and understanding the prevalence and complexity surrounding pregnancy preparation among Australian women is vital to enable sensitive, responsive approaches to addressing preconception and long-term health improvements for these women with varying motivation levels. Aim This study evaluated the reliability and validity of a comprehensive pregnancy planning/intention measure (London Measure of Unplanned Pregnancy) in a population of pregnant women (over 18 years of age) in Australia. Methods A psychometric evaluation, within a cross-sectional study comprising cognitive interviews (to assess comprehension and acceptability) and a field test. Pregnant women aged over 18 years were recruited in early pregnancy (approximately 12 weeks’ gestation). Reliability (internal consistency) was assessed using Cronbach’s alpha, corrected item-total correlations and inter-item correlations, and stability via a test-retest. Construct validity was assessed using principal components analysis and hypothesis testing. Results Six women participated in cognitive interviews and 317 in the field test. The London Measure of Unplanned Pregnancy was acceptable and well comprehended. Reliability testing demonstrated good internal consistency (alpha = 0.81, all corrected item-total correlations >0.20, all inter-item correlations positive) and excellent stability (weighted kappa = 0.92). Validity testing confirmed the unidimensional structure of the measure and all hypotheses were confirmed. Conclusions The London Measure of Unplanned Pregnancy is a valid and reliable measure of pregnancy planning/intention for the Australian population. Implementation of this measure into all maternity healthcare, research and policy settings will provide accurate population-level pregnancy planning estimates to inform, monitor and evaluate interventions to improve preconception health in Australia.
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Affiliation(s)
- Adina Y. Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer A. Hall
- Research Department of Reproductive Health, UCL EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL EGA Institute for Women’s Health, University College London, London, United Kingdom
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91
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Michie L, Cameron ST. Emergency contraception and impact on abortion rates. Best Pract Res Clin Obstet Gynaecol 2019; 63:111-119. [PMID: 31362908 DOI: 10.1016/j.bpobgyn.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.
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Affiliation(s)
- L Michie
- The Gatehouse, NHS Ayrshire and Arran, Ayrshire Central Hospital, United Kingdom.
| | - S T Cameron
- Chalmers Sexual and Reproductive Health Centre, NHS Lothian, 2 A Chalmers Street, Edinburgh, EH3 9ES, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh, United Kingdom.
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92
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Ayu IP, Rachmawati IN, Ungsianik T. Maternal age as a main factor influencing prenatal distress in Indonesian Primigravida. ENFERMERIA CLINICA 2019. [PMID: 31255447 DOI: 10.1016/j.enfcli.2019.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pregnancy is a maturation crisis, especially for primigravida, which affects both mother and fetus well-being. This study aimed to identify prenatal distress in primigravida and its relationship with maternal age, educational background, income level, gestational age, social support, previous traumatic experiences, satisfaction with paternal support, and pregnancy planning. METHODS This cross-sectional study involved 214 primigravidas in Serang City, Banten Province, Indonesia. Translated instruments, such as a socio-demographic questionnaire, PTSD Symptom Scale (PSS), the Multidimensional scale of perceived social support (MSPSS), London Measure of Unplanned Pregnancy Instrument (LMUP), Marital Adjustment Test (MAT), and Prenatal Distress Questionnaire (PDQ), were applied. RESULTS The results revealed that most respondents experienced severe distress (55.6%). Maternal age is the most dominant factor influencing prenatal distress in primigravida (OR=10.31; 95% CI: 4.7-22.6). CONCLUSIONS The younger the mother, the greater the extent of the psychosocial problems. A higher maternal age is assumed to be associated with greater adaptation to the changes occurring during pregnancy. Healthcare providers should be aware that pregnancy can lead to distress, especially in young primigravidas. Programs to maintain mental health during pregnancy should be implemented.
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Affiliation(s)
- Ike Puspasari Ayu
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia; Bachelor of Nursing Program, Institute of Health Sciences Faletehan, Serang, Banten, Indonesia
| | | | - Titin Ungsianik
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
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93
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Roberts SCM, Johns NE, Williams V, Wingo E, Upadhyay UD. Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion. BMC WOMENS HEALTH 2019; 19:78. [PMID: 31215464 PMCID: PMC6582555 DOI: 10.1186/s12905-019-0775-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/31/2019] [Indexed: 12/25/2022]
Abstract
Background To estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion. Methods Two hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015–2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana. Results 28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1–12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth. Conclusions For a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women’s ability to obtain abortions.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Nicole E Johns
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.,Present address: Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Valerie Williams
- Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, 3700 St. Charles Avenue, 5th floor, New Orleans, LA, 70115, USA
| | - Erin Wingo
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
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Cluster randomized trial of a patient-centered contraceptive decision support tool, My Birth Control. Am J Obstet Gynecol 2019; 220:565.e1-565.e12. [PMID: 30763545 DOI: 10.1016/j.ajog.2019.02.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research suggests the need for improvement in the patient-centeredness and comprehensiveness of contraceptive counseling. My Birth Control is a tablet-based decision support tool designed to improve women's experience of contraceptive counseling and to help them select contraceptive methods that are consistent with their values and preferences. OBJECTIVE The objective of this study was to evaluate the effect of My Birth Control on contraceptive continuation, experience of contraceptive care, and decision quality. STUDY DESIGN Using a cluster randomized design, randomized at the provider level, patient participants interested in starting or changing contraception interacted with My Birth Control before their family planning visit (intervention) or received usual care (control). A postvisit survey assessed experience of care method satisfaction, decision quality, and contraceptive knowledge. Surveys at 4 and 7 months assessed the primary outcome of contraceptive continuation, along with method use, satisfaction, and unintended pregnancy. Mixed-effects logistic regression models with multiple imputation for missing data were used to examine the effect of treatment assignment. RESULTS Twenty-eight providers participated and 758 patients enrolled between December 5, 2014, and February 5, 2016. Participants were racially/ethnically diverse; less than a quarter self-identified as white. No effect was found on 7-month continuation (56.6% and 59.6% for intervention and control group respectively, odds ratio, 0.89; 95% confidence interval, 0.65-1.22). However, assignment to the intervention group increased reporting of the greatest Interpersonal Quality of Family Planning score (66.0% vs 57.4%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), the greatest scores on the informed decision and uncertainty subscales of the Decisional Conflict Scale (50.5% vs 43.2%, odds ratio, 1.34; 95% confidence interval, 1.0-1.80 and 41.6% vs 33.3%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), and greater knowledge. CONCLUSION My Birth Control had no effect on contraceptive continuation. The intervention did enhance the experience of contraceptive counseling and informed decision making, as well as contraceptive knowledge., The intervention's effect on patient experience is important, particularly given the personal nature of contraceptive decision making and the social and historical context of family planning care.
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95
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Stephenson J, Vogel C, Hall J, Hutchinson J, Mann S, Duncan H, Woods-Townsend K, de Lusignan S, Poston L, Cade J, Godfrey K, Hanson M, Barrett G, Barker M, Conti G, Shannon G, Colbourn T. Preconception health in England: a proposal for annual reporting with core metrics. Lancet 2019; 393:2262-2271. [PMID: 31162084 DOI: 10.1016/s0140-6736(19)30954-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
There is growing interest in preconception health as a crucial period for influencing not only pregnancy outcomes, but also future maternal and child health, and prevention of long-term medical conditions. Successive national and international policy documents emphasise the need to improve preconception health, but resources and action have not followed through with these goals. We argue for a dual intervention strategy at both the public health level (eg, by improving the food environment) and at the individual level (eg, by better identification of those planning a pregnancy who would benefit from support to optimise health before conception) in order to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy. Existing strategies that target common risks factors, such as obesity and smoking, should recognise the preconception period as one that offers special opportunity for intervention, based on evidence from life-course epidemiology, developmental (embryo) programming around the time of conception, and maternal motivation. To describe and monitor preconception health in England, we propose an annual report card using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health.
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Affiliation(s)
- Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sue Mann
- Public Health England, London, UK
| | | | - Kathryn Woods-Townsend
- Southampton Education School, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners, London, UK
| | - Lucilla Poston
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas Hospital, London, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Keith Godfrey
- NIHR Southampton Biomedical Research Centre, MRC Lifecourse Epidemiology Unit (University of Southampton), University Hospital Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gabriella Conti
- Department of Economics and Department of Social Science, University College London, London, UK
| | - Geordan Shannon
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
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96
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Bukenya JN, Wanyenze RK, Barrett G, Hall J, Makumbi F, Guwatudde D. Contraceptive use, prevalence and predictors of pregnancy planning among female sex workers in Uganda: a cross sectional study. BMC Pregnancy Childbirth 2019; 19:121. [PMID: 30961542 PMCID: PMC6454679 DOI: 10.1186/s12884-019-2260-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Unintended pregnancies are associated with negative consequences to both mother and baby. Female Sex Workers (FSWs) are at high risk of unintended/unplanned pregnancies. However, prevalence of pregnancy planning and its predictors among FSWs has not been comprehensively investigated. This study was designed to determine contraceptive use, the prevalence, and predictors of pregnancy planning among FSWs in Uganda. METHODS In this cross-sectional study, 819 FSWs attending most at risk populations initiative (MARPI) clinics were recruited using systematic sampling and interviewed with a pretested questionnaire that included collection of data on pregnancy intention using the London Measure of Unplanned Pregnancy (LMUP). Data were analysed using STATA version 14.0. Multinomial logistic regression model was used to identify predictors of pregnancy planning, RESULTS: Of the 819 study participants, only 90 (11.0%) had planned pregnancies. Overall, 462 (56.4%) were hazardous alcohol users and 335 (40.9%) abused drugs; 172 (21.0%) had been raped in the last 2 years and 70 (40.7%) of these accessed emergency contraception post-rape. Dual contraception use (condom and other modern method) was 58.0%. Having a non-emotional partner as a man who impregnated the FSW compared to emotional partner was significantly associated with less planned relative to unplanned pregnancy, (aRR = 0.15 95%Cl =0.08, 0.30), so was lack of reported social support compared to support from friends, (aRR = 0.44; 95% CI = 0.22-0.87), keeping all factors constant in the model. Being raped (aRR = 0.51; 95% CI = 0.31-0.84) or abuse of substances (aRR = 0.65; 95% CI = 0.45-0.93) were significantly associated with lower ambivalence relative to unplanned pregnancy but not with planned relative to unplanned pregnancy. CONCLUSION Compared to women in the general population, pregnancy planning was low among FSWs amidst modest use of dual contraceptive. There is an urgent need to promote dual contraception among FSWs to prevent unplanned pregnancies especially with non-emotional partners, drug users, and post-rape.
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Affiliation(s)
- Justine Nnakate Bukenya
- School of Public Health, College of Health Sciences Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | - Fredrick Makumbi
- School of Public Health, College of Health Sciences Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David Guwatudde
- School of Public Health, College of Health Sciences Makerere University, P.O. Box 7072, Kampala, Uganda
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97
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Hill B, Kothe EJ, Currie S, Danby M, Lang AY, Bailey C, Moran LJ, Teede H, North M, Bruce LJ, Skouteris H. A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing. Prev Med Rep 2019; 14:100869. [PMID: 31011520 PMCID: PMC6465583 DOI: 10.1016/j.pmedr.2019.100869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to conduct a systematic mapping review of the literature that explored associations of pregnancy intentions with health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Six databases were searched (May 2017) for papers relating to pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing. The literature was mapped according to the preconception or pregnancy period; prospective or retrospective variable assessment; and reported lifestyle behaviours and psychological wellbeing outcomes. Of 19,430 retrieved records, 303 studies were eligible. Pregnancy intentions were considered during the preconception period in 103 studies (only 23 assessed prospectively), and during the pregnancy period in 208 studies (141 prospectively). Associations between pregnancy intention and preconception behaviours/psychological wellbeing were primarily reported for supplement use (n = 58) and were lacking for diet/exercise, and psychological factors. For behaviours/psychological wellbeing during pregnancy, associations with pregnancy intention were focused on prenatal care (n = 79), depression (n = 61), and smoking (n = 56) and were lacking for diet/exercise. Only 7 studies assessed pregnancy intentions with a validated tool. Despite a large body of literature, there were several methodological limitations identified, namely assessment of pregnancy intentions with non-validated measures and the reliance on retrospective assessment. Future primary studies are needed to fill gaps in our understanding regarding energy-balance-related behaviours. Future studies (including reviews/meta-analyses) should take care to address the noted limitations to provide a comprehensive and accurate understanding of the relationships between pregnancy intentions and health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Reliance on the assessment of pregnancy intentions with non-validated measures Reliance on retrospective assessment Studies on preconception pregnancy intentions and diet/exercise lacking
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Affiliation(s)
- Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia.,School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Emily J Kothe
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Sinéad Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, FK9 4LA, United Kingdom
| | - Meaghan Danby
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Madelon North
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Lauren J Bruce
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
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98
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Musgrave LM, Homer CSE, Kizirian NV, Gordon A. Addressing preconception behaviour change through mobile phone apps: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:86. [PMID: 30947750 PMCID: PMC6449990 DOI: 10.1186/s13643-019-0996-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Many of the adverse outcomes experienced by mothers and babies are directly related to the health of the woman prior to pregnancy. This preconception period is a unique window of opportunity when women are often more motivated to optimise health and change their lifestyle in preparation for pregnancy. Several risk factors in the preconception period can contribute to adverse perinatal outcomes. These risk factors can be divided into three broad areas: biomedical, social and environmental. Mobile phone applications as a behaviour change intervention have the potential to address these risks through supporting the provision of information, healthier lifestyles and informed decision-making. The aim of this systematic review is to assess the effectiveness of mobile phone applications in promoting behaviour change and improving long-term outcomes for mother and babies, in women of reproductive age. METHODS This review will include trials that assess any mobile phone application (app) that assist women of reproductive age to optimise health behaviours. Randomised controlled trials, quasi-randomised controlled trials and cluster-randomised trials will be included. The search strategy will use both MeSH and keyword combinations to search databases including the WHO Global Health Library, CINHAL, The Cochrane Library, Embase and MEDLINE for relevant studies. Retrieved citations will be screened independently by two authors to assess eligibility. Studies will be selected only if the intervention was commenced prior to pregnancy. Comparisons will be made including mobile phone applications versus text messaging-based communications or paper-based, face-to-face or telephone conversations and standard care or no specific intervention. The Cochrane Handbook for Systematic Reviews of Interventions will be utilised to assess the quality of included randomised studies. Primary and secondary outcomes will be compared and analysed. Results of the review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. DISCUSSION This systematic review is the first to assess the effects of preconception mobile phone app behaviour change and educational interventions in improving future pregnancy and maternal and child outcomes, in women of reproductive age. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017065903 .
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Affiliation(s)
- Loretta M. Musgrave
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
- Sydney Local Health District, Sydney, NSW Australia
| | - Caroline S. E. Homer
- Burnet Institute, Melbourne, VIC Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW Australia
| | - Nathalie V. Kizirian
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
| | - Adrienne Gordon
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, The Hub, Level 2, John Hopkins Drive, Camperdown, NSW 2006 Australia
- Sydney Local Health District, Sydney, NSW Australia
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99
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Long-term effects of unintended pregnancy on antiretroviral therapy outcomes among South African women living with HIV. AIDS 2019; 33:885-893. [PMID: 30649049 DOI: 10.1097/qad.0000000000002139] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Unintended pregnancies are common among women living with HIV, but there are no data on their long-term impact on treatment outcomes. In a cohort of women initiating antiretroviral therapy (ART) during pregnancy, we examined the association between the intendedness of the current pregnancy, measured antenatally, and elevated viral load up to 5 years postpartum. DESIGN Prospective study with enrolment at entry into antenatal care and follow-up at study visits separate from routine care. METHODS At enrolment women completed the London Measure of Unplanned Pregnancy. Mixed effects models examined the impact of the intendedness of the pregnancy (planned versus each of unplanned or ambivalent, respectively) on viral load 50 or more copies/ml across postpartum study visits. RESULTS Overall, 459 women were followed for a median of 43 months postpartum, contributing 2535 viral load measures (median per woman: 6). Ambivalent and unplanned pregnancy were commonly reported (20 and 60%, respectively), and the proportion of women with elevated viral load increased over time (16% at 6 weeks to 43% by 36-60 months postpartum). Compared with those reporting a planned pregnancy, elevated viral load was more common among women reporting an unplanned pregnancy (odds ratio: 2.87; 95% confidence interval: 1.46-5.64), with a trend towards a higher odds among those reporting ambivalence (odds ratio: 2.19; 95% confidence interval: 0.97-4.82); associations persisted after adjustment for a wide range of demographic, clinical and psychosocial factors. CONCLUSION These novel data suggest that unplanned pregnancy may be a prevalent and persistent predictor of poor ART outcomes among women initiating ART during pregnancy.
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100
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Lang AY, Harrison CL, Boyle JA. Preconception Lifestyle and Weight-Related Behaviors by Maternal Body Mass Index: A Cross-Sectional Study of Pregnant Women. Nutrients 2019; 11:nu11040759. [PMID: 30935152 PMCID: PMC6521092 DOI: 10.3390/nu11040759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 01/24/2023] Open
Abstract
Obesity is a rising global health challenge, particularly for reproductive-aged women. Our cross-sectional study of pregnant women (n = 223) examined associations between preconception body mass index (BMI) and socio-demographics, weight perceptions and lifestyle behaviors. Over half of women were overweight (33.2%) or obese (22.0%), 49.6% of which perceived their weight as normal. High proportions of women reported planning their pregnancies (70.0%) and were actively trying to lose or maintain their weight preconception (72.7%). Weight management approaches varied from reducing discretionary foods (63.7%) to professional support (8.1%). Obese women had significantly greater odds of reducing discretionary foods (odds ratio (OR) = 6.69 95% confidence interval (CI) 2.13–21.00, p = 0.001) and using structured diets (adjusted odds ratio (AOR) = 9.13 95% CI 2.90–28.81, p < 0.001) compared to normal-weight women. After adjusting for socio-demographics, compared to normal-weight women, overweight (AOR = 5.24 95% CI 2.19–12.56, p < 0.001) and obese (AOR = 2.85 95% CI 1.06–7.67, p = 0.04) women had significantly increased odds of exercising for weight management and significantly lower odds of taking folic-acid preconception (overweight: AOR = 0.40 95% CI 0.18–0.90, p = 0.01, obese: AOR = 0.38 95% CI 0.16–0.91, p = 0.03). Large proportions of women planning a pregnancy have an overweight/obese BMI, with associated suboptimal health behaviors and reduced health professional engagement preconception. Further research exploring women’s perspectives regarding preconception lifestyles is needed to inform effective preconception health promotion strategies.
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Affiliation(s)
- Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
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