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van Tintelen AMG, Jansen DEMC, Bolt SH, Warmelink JC, Verhoeven CJ, Henrichs J. The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands. J Midwifery Womens Health 2024. [PMID: 38659281 DOI: 10.1111/jmwh.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/31/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. METHOD This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. RESULTS Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations. DISCUSSION Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.
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Affiliation(s)
- Amke M G van Tintelen
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Danielle E M C Jansen
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Sociology and Interuniversity Center for Social Science Theory and Methodology, University of Groningen, Groningen, the Netherlands
- University Center for Child and Adolescent Psychiatry, Accare, Groningen, the Netherlands
| | - Sophie H Bolt
- Research Department, Fiom, 's-Hertogenbosch, the Netherlands
| | - J Catja Warmelink
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Corine J Verhoeven
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Division of Midwifery School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jens Henrichs
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Camargo JT, Barral RL, Kerling EH, Saavedra L, Carlson SE, Gajewski BJ, Ramírez M. Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest. Matern Child Health J 2023; 27:1811-1822. [PMID: 37369811 PMCID: PMC11251489 DOI: 10.1007/s10995-023-03733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts. OBJECTIVES This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community. METHODS This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area. RESULTS FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education. CONCLUSIONS FOR PRACTICE Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.
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Affiliation(s)
- Juliana Teruel Camargo
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
- Minority Health and Health Disparities Population Lab, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Romina L Barral
- Division of Adolescent Medicine, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Elizabeth H Kerling
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lillian Saavedra
- JUNTOS Center for Advancing Latino Health, Department of Population Health, School of Medicine, University of Kansas Medical Center, 4125 Rainbow Blvd Mail Stop 1076, Kansas City, KS, 66160, USA
| | - Susan E Carlson
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Byron J Gajewski
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Mariana Ramírez
- JUNTOS Center for Advancing Latino Health, Department of Population Health, School of Medicine, University of Kansas Medical Center, 4125 Rainbow Blvd Mail Stop 1076, Kansas City, KS, 66160, USA.
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Paulson JL. Intimate Partner Violence and Perinatal Post-Traumatic Stress and Depression Symptoms: A Systematic Review of Findings in Longitudinal Studies. TRAUMA, VIOLENCE & ABUSE 2022; 23:733-747. [PMID: 33252020 DOI: 10.1177/1524838020976098] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The link between maternal violence exposure and adverse obstetric outcomes is well-documented, but less is understood about the relationship between intimate partner violence (IPV) exposure and perinatal post-traumatic stress symptoms(PTSS) and depression in women around the world. A systematic review was conducted to synthesize empirical literature on the associations between IPV (e.g., before pregnancy, during pregnancy, postpartum) and post-traumatic stress and depression symptoms in the perinatal period. This review acknowledged the effects of IPV exposure timing, timing of assessment, and IPV subtypes. Forty-seven longitudinal studies met inclusion criteria and were reviewed to determine the effects of IPV exposure on perinatal mental health. Findings suggested a strong relationship between IPV exposure and perinatal mental health. Results were more consistent between perinatal mental health and IPV sustained close to or during the perinatal period than for lifetime IPV exposure. In general, physical, sexual, and psychological IPV were independently associated with perinatal depression and PTSS. Findings underscore the importance of theoretically driven research and the development of treatment protocols for women worldwide.
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Fontein Kuipers YJ, Mestdagh E. The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study. Women Birth 2021; 35:70-79. [PMID: 33745823 DOI: 10.1016/j.wombi.2021.03.004] [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: 11/19/2020] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. BACKGROUND Women's experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. AIM To examine if pregnant migrant women's experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. METHODS A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. RESULTS Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability showed a mean score of 4.2 (±2.56). Women's experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: "Look beyond who you think I am and see and treat me for who I really am", "Ownership of truth and knowledge", "Don't punish me for being honest", "Projection of fear" and "Coping with labelling". CONCLUSION Pregnant migrant women's experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.
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Affiliation(s)
- Yvonne J Fontein Kuipers
- Rotterdam University of Applied Sciences, School of Midwifery, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands; Artesis Plantijn University of Applied Sciences, Department of Health & Social Care, Noorderplaats 2, 2000 Antwerp, Belgium; Antwerp University, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Eveline Mestdagh
- Artesis Plantijn University of Applied Sciences, Department of Health & Social Care, Noorderplaats 2, 2000 Antwerp, Belgium; Antwerp University, Universiteitsplein 1, 2610 Wilrijk, Belgium
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