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Weiland S, Jansen DEMC, Groen H, de Jong DR, Erwich JJHM, Berger MY, Hoek A, Peters LL. Does social need fulfillment moderate the association between socioeconomic status and health risk behaviours during pregnancy? Eur J Public Health 2024:ckae102. [PMID: 38894504 DOI: 10.1093/eurpub/ckae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Socioeconomic differences in health risk behaviours during pregnancy may be influenced by social relations. In this study, we aimed to investigate if social need fulfillment moderates the association between socioeconomic status (SES) and health risk behaviours (smoking and/or alcohol consumption) during pregnancy. We used baseline data from the Lifelines Cohort Study merged with data from the Lifelines Reproductive Origin of Adult Health and Disease (ROAHD) cohort. Education level was used to determine SES, categorized into low, middle, and high, with middle SES as the reference category. Social need fulfillment was taken as indicator for social relations and was measured with the validated Social Production Function Instrument for the Level of Well-being scale. The dependent variable was smoking and/or alcohol consumption during pregnancy. Univariable and multivariable logistic regression analysis was conducted to assess the association of SES and social need fulfillment with health risk behaviours and to test for effect modification. We included 1107 pregnant women. The results showed that women with a high SES had statistically significantly lower odds of health risk behaviours during pregnancy. The interaction effect between SES and social need fulfillment on health risk behaviours was not statistically significant, indicating that no moderation effect is present. The results indicate that social need fulfillment does not modify the effect of SES on health risk behaviours during pregnancy. However, in literature, social relations are identified as an important influence on health risk behaviours. More research is needed to identify which measure of social relations is the most relevant regarding the association with health risk behaviours.
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Affiliation(s)
- Stella Weiland
- 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
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, 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 (ICS), University of Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorien R de Jong
- 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
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lilian L Peters
- 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
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
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Wagijo MA, Crone M, Bruinsma-van Zwicht B, van Lith J, Billings D, Rijnders M. The Effect of CenteringPregnancy Group Antenatal Care on Maternal, Birth, and Neonatal Outcomes Among Low-Risk Women in the Netherlands: A Stepped-Wedge Cluster Randomized Trial. J Midwifery Womens Health 2024; 69:191-201. [PMID: 38339816 DOI: 10.1111/jmwh.13582] [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] [Revised: 08/10/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands. METHODS A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes. RESULTS Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group. CONCLUSION Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
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Affiliation(s)
- Mary-Ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | | | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Billings
- Group Care Global, Philadelphia, Pennsylvania
- University of South Carolina, Columbia, South Carolina
| | - Marlies Rijnders
- Department of Child Health, Dutch Organization of Applied Scientific Research, Leiden, The Netherlands
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Meireson E, De Rycke L, Bijnens EM, Dehaene I, De Bock S, Derom C, Roelens K. Birth outcomes of twins after multifetal pregnancy reduction compared with primary twins. Am J Obstet Gynecol MFM 2024; 6:101230. [PMID: 37984690 DOI: 10.1016/j.ajogmf.2023.101230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The introduction of assisted reproductive technology and the trend of increasing maternal age at conception have contributed to a significant rise in the incidence of multiple pregnancies. Multiple pregnancies bear several inherent risks for both mother and child. These risks increase with plurality and type of chorionicity. Multifetal pregnancy reduction is the selective abortion of ≥1 fetuses to improve the outcome of the remaining fetus(es) by decreasing the risk of premature birth and other complications. OBJECTIVE This study aimed to compare birth outcomes of trichorionic triplets reduced to twins with those of trichorionic triplets and primary dichorionic twins. The added value of this study is the comparison with an additional control group, namely primary dichorionic twins. STUDY DESIGN This was a retrospective cohort study. Data from January 1990 to November 2016 were collected from the East Flanders Prospective Twin Survey, one of the largest European multiple birth registries. A total of 85 trichorionic triplet pregnancies (170 neonates) undergoing multifetal pregnancy reduction to twins were compared with 5093 primary dichorionic twin pregnancies (10,186 neonates) and 104 expectantly managed trichorionic triplet pregnancies (309 neonates). The assessed outcomes were gestational age at delivery, birthweight, and small for gestational age. RESULTS Pregnancy reduction from triplets to twins was associated with higher birthweight (+365.44 g; 95% confidence interval, 222.75-508.14 g; P<.0001) and higher gestational age (1.7 weeks; 95% confidence interval, 0.93-2.46; P<.0001) compared with ongoing trichorionic triplets after adjustment for sex, parity, method of conception, birth year, and maternal age. A trend toward lower risk of small for gestational age was observed. Reduced triplets had, on average, lower birthweight (-263.12 g; 95% confidence interval, -371.80 to -154.44 g; P<.0001) and lower gestational age (-1.13 weeks; 95% confidence interval, -1.70 to -0.56; P=.0001) compared with primary twins. No statistically significant difference was observed between primary twins and reduced triplets that reached 32 weeks of gestation. CONCLUSION Multifetal pregnancy reduction from trichorionic triplets to twins significantly improved birth outcomes. This suggests that multifetal pregnancy reduction of trichorionic triplets to twins is medically justifiable. However, the birth outcomes of primary twins before 32 weeks of gestation are still better than those of reduced triplets. The process of multifetal pregnancy reduction includes at least 1 fetal death by definition, and thus prevention of higher-order pregnancies is preferable.
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Affiliation(s)
- Eline Meireson
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium (Ms Meireson and Dr Roelens); Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens).
| | - Laura De Rycke
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens)
| | - Esmée M Bijnens
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (Dr Bijnens); Department of Environmental Sciences, Open University of the Netherlands, Heerlen, The Netherlands (Dr Bijnens)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens)
| | - Sophie De Bock
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium (Dr De Bock)
| | - Catherine Derom
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens)
| | - Kristien Roelens
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium (Ms Meireson and Dr Roelens); Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens)
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Harriett LE, Eary RL, Prickett SA, Romero J, Maddrell RG, Keenan-Devlin LS, Borders AEB. Adaptation of Screening Tools for Social Determinants of Health in Pregnancy: A Pilot Project. Matern Child Health J 2023:10.1007/s10995-023-03732-2. [PMID: 37316688 DOI: 10.1007/s10995-023-03732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Social determinants of health (SDOH) and stress during pregnancy may contribute to adverse pregnancy outcomes. The objective of this in the field pilot project was to develop a comprehensive screening tool by combining existing validated screeners. Additionally, implement use of this tool within routine prenatal visits and assess feasibility. METHODS Pregnant patients accessing prenatal care at a single site of an urban Federally Qualified Health Center were recruited during prenatal visits to complete a Social Determinants of Health in Pregnancy Tool (SIPT). SIPT combines a series of questions from existing and well-validated tools and consists of five domains: (1) perceived stress, (2) relationship and family stress, (3) domestic violence, (4) substance abuse, and (5) financial stress. RESULTS Between April 2018 and March 2019, 135 pregnant participants completed SIPT. Ninety-one percent of patients scored positive on at least one screener, 54% to three or more screeners. CONCLUSIONS Despite guidelines to screen for SDOH during pregnancy there is no universal tool. Our pilot project demonstrated the concurrent use of adapted screening tools where participants reported at least one area of potential stress, and that linking to resources at the time of a visit is plausible. Future work should examine if screening and point of care linkages of services improves maternal child outcomes.
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Affiliation(s)
- Lauren E Harriett
- PCC Community Wellness Center, 115 North Parkside Avenue, Chicago, IL, 60644, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA.
| | - Sarah A Prickett
- Department of Family and Community Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., K Building, 2nd Floor, Suite 400F, Dallas, TX, 75390, USA
| | - Janedelie Romero
- Department of Obstetrics and Gynecology, NorthShore University Health System, Chicago, IL, USA
| | - Rebecca G Maddrell
- A.L. Burdick Family Medicine Center, 3 Erie Court Suite 6160, Oak Park, IL, 60302, USA
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System and Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Bardou M, Meunier-Beillard N, Godard-Marceau A, Deruelle P, Virtos C, Eckman-Lacroix A, Debras E, Schmitz T. Women and health professionals' perspectives on a conditional cash transfer programme to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomised controlled study. BMJ Open 2023; 13:e067066. [PMID: 36990483 PMCID: PMC10069550 DOI: 10.1136/bmjopen-2022-067066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Women of low socioeconomic status have been described as having suboptimal prenatal care, which in turn has been associated with poor pregnancy outcomes. Many types of conditional cash transfer (CCT) programmes have been developed, including programmes to improve prenatal care or smoking cessation during pregnancy, and their effects demonstrated. However, ethical critiques have included paternalism and lack of informed choice. Our objective was to determine if women and healthcare professionals (HPs) shared these concerns. DESIGN Prospective qualitative research. SETTING We included economically disadvantaged women, as defined by health insurance data, who participated in the French NAITRE randomised trial assessing a CCT programme during prenatal follow-up to improve pregnancy outcomes. The HP worked in some maternities participating in this trial. PARTICIPANTS 26 women, 14 who received CCT and 12 who did not, mostly unemployed (20/26), and - 7 HPs. INTERVENTIONS We conducted a multicentre cross-sectional qualitative study among women and HPs who participated in the NAITRE Study to assess their views on CCT. The women were interviewed after childbirth. RESULTS Women did not perceive CCT negatively. They did not mention feeling stigmatised. They described CCT as a significant source of aid for women with limited financial resources. HP described the CCT in less positive terms, for example, expressing concern about discussing cash transfer at their first medical consultation with women. Though they emphasised ethical concerns about the basis of the trial, they recognised the importance of evaluating CCT. CONCLUSIONS In France, a high-income country where prenatal follow-up is free, HPs were concerned that the CCT programme would change their relationship with patients and wondered if it was the best use of funding. However, women who received a cash incentive said they did not feel stigmatised and indicated that these payments helped them prepare for their baby's birth. TRIAL REGISTRATION NUMBER NCT02402855.
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Affiliation(s)
- Marc Bardou
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Aurélie Godard-Marceau
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive EA 481, Université Bourgogne Franche-Comté, Besancon, Franche-Comté, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynaecology, Strasbourg University Hospital, Starsbourg, France
| | - Claude Virtos
- Service de Gynécologie et Obstétruique, Centre Hospitalier de Dreux, Dreux, France
| | - Astrid Eckman-Lacroix
- Département de Gynécologie et d'Obstétrioque, Centre Hospitalier et Universitaire de Besançon, Besançon, France
| | - Elodie Debras
- Service de Gynécologie et obstrétrique, CHU de Bicêtre DAR, Le Kremlin-Bicetre, Île-de-France, France
| | - Thomas Schmitz
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
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Molenaar JM, van der Meer L, Bertens LCM, de Vries EF, Waelput AJM, Knight M, Steegers EAP, Kiefte-de Jong JC, Struijs JN. Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis. Eur J Public Health 2023; 33:25-34. [PMID: 36515418 PMCID: PMC10263266 DOI: 10.1093/eurpub/ckac170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. METHODS We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. RESULTS In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. CONCLUSIONS Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.
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Affiliation(s)
- J M Molenaar
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - L van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - E F de Vries
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - A J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Knight
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - J C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - J N Struijs
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
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Qiu Q, Dai S, Yan J. Health behaviors of late adolescents in China: Scale development and preliminary validation. Front Psychol 2022; 13:1004364. [PMID: 36438386 PMCID: PMC9692111 DOI: 10.3389/fpsyg.2022.1004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 06/27/2024] Open
Abstract
Health behaviors influence health and well-being, improve quality of life, and provide economic benefits. It is important to take advantage of health-related opportunities during adolescence. Staying healthy during adolescence also promotes the future well-being of individuals and that of the next generation. We aimed to develop a reliable and valid scale based on the General Senior High School Physical Education and Health Curriculum Standards (2017 edition) to evaluate Chinese late adolescents' health behavior. The scale was to help physical education teachers measure the health behavior level of senior high school students, improve physical education and health teaching, and promote Chinese adolescent health. Participants were recruited by convenience sampling from September to October 2019. For the first survey, we recruited 526 senior high school students (318 boys, 208 girls; Mage = 16.5), and the data were subjected to item analysis and exploratory factor analysis. For the second survey, we recruited 542 senior high school students (249 boys, 293 girls; Mage = 15.5), and the data were subjected to confirmatory factor analysis and internal consistency reliability analysis. After exploratory factor analysis, we extracted four factors with 23 items: exercise awareness and habits (five items), mastering and applying healthy behavior knowledge (10 items), emotional regulation (four items), and environment adaptation (four items). The Cronbach's alpha values for these factors ranged from 0.863 to 0.937. After confirmatory factor analysis, we achieved a satisfactory goodness-of-fit model (CMIN/DF = 2.92, RMR = 0.03, GFI = 0.93, CFI = 0.91, TLI = 0.92, RMSEA = 0.06). Internal consistency, test-retest reliability, and construct validity were all satisfactory. These results suggest that the Chinese version of the Health Behavior Scale is a reliable and valid instrument for assessing the health behavior of senior high school students. The findings have important implications for increasing adolescents' health literacy, promoting adolescents' health, and enhancing the well-being of late adolescents.
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Affiliation(s)
- Qian Qiu
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
- College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Shengting Dai
- School of Sports Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Jingfei Yan
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
- College of Physical Education and Health, East China Normal University, Shanghai, China
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Health Behaviors and Behavior Change during Pregnancy: Theory-Based Investigation of Predictors and Interrelations. SEXES 2022. [DOI: 10.3390/sexes3030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Preventing pregnancy complications and maternal deaths and helping women stay healthy before, during, and after pregnancy by means of sexual health and behavior is imperative. Previous research demonstrated that a lack of social support and perceived discrimination have adverse effects on pregnancy outcomes. These determinants may impact health behavior as an important mediator of pregnancy outcomes. To better understand this relation, the Compensatory Carry-Over Action Model (CCAM) was applied. The research question was: how do predictors of health behavior, specifically intention, planning, self-efficacy, social support, and discrimination, interrelate with different health behaviors during pregnancy? (2) Methods: By means of qualitative interviews with ten pregnant women (20–39 years, mean = 28.6) from different cultural backgrounds, the predictors of health behaviors and experiences with pregnancy, including racial discrimination, were investigated. (3) Results: Not all women changed their unhealthy behaviors even though their higher-level goal was to ensure their baby’s and their own health. This appeared partially due to lack of social support, racial discrimination, and unexpected pregnancy side effects. The women who previously performed health behaviors revealed a healthier pattern with maintaining or even expanding their health behaviors, while those performing no health behavior in the past reported more obstacles with a healthy lifestyle. (4) Conclusions: Pregnant women appear to be having difficulties translating good intentions into behavior. The reasons include lack of support, fear, and insecurity, which impact self-efficacy and planning. Improvements in health behaviors were facilitated by specific circumstances, such as working from home. Policy and practice should take these aspects into account and help mobilize support and overcome discrimination by means of more rights and support for pregnant women while also empowering the individuals.
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Guo Y, Kehoe P, Pimentel P, Rousseau J, Axelin A, Rahmani AM, Dutt N. Exercise and Stress in At-Risk Women during Pregnancy and Postpartum. MCN Am J Matern Child Nurs 2021; 46:217-222. [PMID: 34166239 DOI: 10.1097/nmc.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to understand the relationship between exercise and stress among socioeconomically at-risk women who participated in a home visitation service during pregnancy and postpartum. METHODS A mixed-methods design was used to support and supplement quantitative data using qualitative data. Convenience sampling was used to collect data from at-risk women via questionnaires and follow-up interviews. The Perceived Stress Scale was used to assess stress. Frequency and duration of exercise were assessed based on the American College of Obstetricians and Gynecologists exercise guidelines. Regression analyses examined the association between stress and exercise controlling for covariates. Content analysis was used to understand women's stress management experiences. RESULTS N = 114 women completed the questionnaire and a subgroup of 11 received follow-up interviews. Greater frequency of exercise was significantly associated with lower levels of stress. Approximately one-third of women reported experiencing significant stress. Talking to their husband or partner was the most used and exercise was the least used coping strategy. Many women recognized the importance of managing stress and benefits of exercise, but were hindered by barriers such as feeling tired, preventing them from exercising. CLINICAL IMPLICATIONS A personalized and safe exercise program has the potential to be a low-cost stress management strategy for women during pregnancy and postpartum.
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Op de Coul ELM, Peek D, van Weert YWM, Morré SA, Rours I, Hukkelhoven C, de Jonge A, van Benthem B, Pereboom M. Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis infections among pregnant women and male partners in Dutch midwifery practices: prevalence, risk factors, and perinatal outcomes. Reprod Health 2021; 18:132. [PMID: 34174905 PMCID: PMC8236142 DOI: 10.1186/s12978-021-01179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/11/2021] [Indexed: 11/11/2022] Open
Abstract
Background Antenatal screening for HIV, syphilis and HBV has been successfully implemented in The Netherlands, but data on other STI among pregnant women or male partners are limited. Our objectives: (i) to assess the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) among pregnant women and male partners, (ii) to identify risk factors for these STI during pregnancy, and (iii) to identify adverse perinatal outcomes (APO) associated with STI. Methods Cross-sectional study. Pregnant women aged ≤ 30 years (n = 548) and male partners (n = 425) were included at 30 midwifery practices during 2012–2016. Participants provided a self-collected vaginal swab (women) or urine sample (men) and completed a questionnaire. Perinatal data were derived from pregnancy cards. APO was defined as premature rupture of membranes, preterm delivery, low birthweight, stillbirth, neonatal conjunctival and respiratory infections. Data were analysed by logistic regression. Results STI were present in 2.4% of pregnant women (CT 1.8%, NG 0.4%, TV 0.4%), and in 2.2% of male partners (CT 2.2%, NG 0.2%, TV 0%). Of young women (≤ 20 years), 12.5% had a CT infection. Prevalent STI during pregnancy was associated with female young age (≤ 20 years vs ≥ 21 years) (adjusted OR 6.52, CI 95%: 1.11–38.33), male non-Western vs Western background (aOR 9.34, CI 2.34–37.21), and female with ≥ 2 sex partners < 12 months vs 0–1 (aOR 9.88, CI 2.08–46.91). APO was not associated with STI, but was associated with female low education (aOR 3.36, CI 1.12–10.09), complications with previous newborn (aOR 10.49, CI 3.21–34.25 vs no complications) and short duration (0–4 years) of relationship (aOR 2.75, CI 1.41–5.39 vs ≥ 5 years). Small-for-gestational-age was not associated with STI, but was associated with female low education (aOR 7.81, 2.01–30.27), female non-Western background (aOR 4.41, 1.74–11.17), and both parents smoking during pregnancy (aOR 2.94, 1.01–8.84 vs both non-smoking). Conclusions Prevalence of STI was low among pregnant women and male partners in midwifery practices, except for CT among young women. The study could not confirm previously observed associations between STI and APO, which is probably due to low prevalence of STI, small study sample, and presumed treatment for STI. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01179-8. Antenatal screening for HIV, syphilis and HBV has been successfully implemented in The Netherlands, but data on other STI among pregnant women or male partners are limited. Our objectives were: (i) to assess the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) among pregnant women and male partners, (ii) to identify risk factors for these STI during pregnancy, and (iii) to identify adverse perinatal outcomes (APO) associated with STI. Pregnant women aged ≤ 30 years and male partners were included at 30 midwifery practices. Women provided a vaginal swab, partners a urine sample; both completed a questionnaire. Perinatal data were derived from midwives. STI were present in 2.4% of pregnant women (CT 1.8%, NG 0.4%, TV 0.4%), and in 2.2% of male partners (CT 2.2%, NG 0.2%, TV 0%). Of women ≤ 20 years, 12.5% had a CT infection. Prevalent STI during pregnancy was associated with female young age, male non-Western background, and female with ≥ 2 sex partners < 12 months. APO was not associated with STI, but was associated with female low education, complications with previous newborn, and short duration of the relationship. Small-for-gestational-age was not associated with STI, but was associated with female low education, female non-Western background, and both parents smoking during pregnancy. Prevalence of STI was low among pregnant women and male partners in midwifery practices, except for CT among young women. The study could not confirm previously observed associations between STI and APO. Probably due to low prevalence of STI, small study sample, and presumed treatment for STI.
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Affiliation(s)
- Eline L M Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Demi Peek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Yolanda W M van Weert
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Ingrid Rours
- Kinderplein, Medical Centre for Quality of Life, Rotterdam, The Netherlands
| | | | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Birgit van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Monique Pereboom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, The Netherlands
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