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Staniczek J, Manasar-Dyrbuś M, Rybak-Krzyszkowska M, Kondracka A, Orszulak D, Niziński K, Sadłocha M, Drosdzol-Cop A, Stojko R, Illa M. Systematic review and meta-analysis of the association between young maternal age and fetal abnormalities. Sci Rep 2024; 14:22562. [PMID: 39343828 PMCID: PMC11439902 DOI: 10.1038/s41598-024-74015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024] Open
Abstract
Fetal anomalies among young women and adolescents pose major public health concerns. This systematic review aims to elucidate the relationship between young maternal age and the incidence of fetal abnormalities. According to the systematic review and meta-analysis PRISMA protocol, cohort, cross-sectional and case-control studies were scrutinized to include 80,393,450 participants across diverse regions. The meta-analysis utilized Odds Ratios (OR) as the effect measure, adopting a random-effects model. The screening process involved 157 selected and verified manuscripts, which ultimately resulted in the final inclusion of 20 studied in the meta-analysis. The criterion for young maternal age was the age of ≤ 20 years. The meta-analysis revealed a pooled OR of 0.93 (95% CI: 0.82-1.05, p = 0.252), indicating no statistically significant association between young maternal age (≤ 20 years) and fetal anomalies. However, considerable heterogeneity (I² = 96.21%) was noted, prompting the use of a random-effects model to derive the reported results. The meta-analysis did not find statistically significant differences in the occurrence of congenital anomalies in fetuses of younger women than in overall population. Although due to significant heterogeneity of the analyzed studies, and a risk of bias, caution should be exercised when interpreting the results, further investigation may be warranted to understand the relationship between maternal age and risk of fetal anomalies. Nevertheless, the study shows significant differences, which diminish in collective analysis, suggests that factors beyond age may be influential. Specifically, the limited access to or quality of healthcare in certain regions could be a more critical factor than maternal age itself.
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Affiliation(s)
- Jakub Staniczek
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland.
| | - Maisa Manasar-Dyrbuś
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | | | - Adrianna Kondracka
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, 20-059, Poland
| | - Dominika Orszulak
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | - Kacper Niziński
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | - Marcin Sadłocha
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | - Agnieszka Drosdzol-Cop
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | - Rafał Stojko
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, 40-211, Poland
| | - Miriam Illa
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, 08028, Spain
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Smith JN, Guttmann A, Kopp A, Vandermorris A, Shouldice M, Harron KL. Association of maternal risk factors with infant maltreatment: an administrative data cohort study. Arch Dis Child 2023; 109:23-29. [PMID: 37758290 DOI: 10.1136/archdischild-2022-325239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada. DESIGN This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment. RESULTS Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years. CONCLUSION Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.
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Affiliation(s)
- Jennifer N Smith
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
| | - Astrid Guttmann
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Ashley Vandermorris
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Shouldice
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katie L Harron
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
- ICES, Toronto, Ontario, Canada
- UCL Great Ormond Street Institute of Child Health, London, UK
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy-Lacroix MÈ, Sharma S, Waterman E. Directive clinique n o 441 : Surveillance prénatale du bien-être fœtal. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:678-693.e3. [PMID: 37661123 DOI: 10.1016/j.jogc.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIF Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales. POPULATION CIBLE Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale. OPTIONS Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale. RéSULTATS: La reconnaissance précoce de toute décompensation fœtale potentielle permet d'intervenir de façon à favoriser l'adaptation fœtale pour maintenir le bien-être ou à accélérer l'accouchement. BéNéFICES, RISQUES ET COûTS: Chez les personnes enceintes ayant des facteurs de risque périnatal confirmés, la surveillance du bien-être fœtal contribue à réduire le risque d'issue défavorable. Compte tenu du taux élevé de faux positifs, la surveillance du bien-être fœtal peut augmenter le risque d'interventions inutiles, ce qui peut avoir des effets nuisibles, dont l'anxiété parentale, l'accouchement prématuré ou assisté et l'utilisation accrue des ressources de soins de santé. L'optimisation des protocoles de surveillance d'après des pratiques fondées sur des données probantes peut améliorer les issues périnatales et réduire les effets nuisibles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à janvier 2022, à partir de termes MeSH et de mots clés liés à la grossesse, à la surveillance fœtale, aux mouvements fœtaux, à la mortinaissance, aux complications de grossesse et à l'échographie fœtale. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les membres de l'équipe de soins qui prodiguent des soins ou donnent de l'information aux patientes en obstétrique, notamment les spécialistes en médecine fœto-maternelle, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières, les infirmières praticiennes et les radiologistes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Ojukwu EN, Okoye HU, Saewyc E. Social Correlates of HIV-Risky Behaviours among African Canadian Adolescents Living in British Columbia, Canada: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6031. [PMID: 37297635 PMCID: PMC10252849 DOI: 10.3390/ijerph20116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
Studies have linked HIV-risky behaviours among young people to several socio-contextual factors. However, the social factors that might increase African Canadian adolescents' exposure to HIV-risky behaviours, including unprotected sex and forced or multiple-sexual partnerships, have received little or no attention in the literature. Using data from the British Columbia Adolescent Health Surveys (2003-2018) and guided by intersectionality and socio-ecological frameworks, we examined the social determinants of HIV-risky behaviours (HRB) among African Canadian adolescents in British Columbia. We observed a general decline in HRB from 2008 to 2018. However, more than half (54.5%) of the 1042 who were sexually experienced in 2018 reported having 2 or more sexual partners, and nearly half reported condom-less sex. Our results demonstrate an important need to evaluate the impacts of several social factors on health outcomes for a unique, marginalized population.
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Martín-Payo R, Gonzalez-Mendez X, Carrasco-Santos S, Muñoz-Mancisidor A, Papin-Cano C, Fernandez-Alvarez MDM. Assessment of content, behavior change techniques, and quality of unintended pregnancy apps in Spain: Systematic search on app stores. Digit Health 2023; 9:20552076231173563. [PMID: 37197412 PMCID: PMC10184260 DOI: 10.1177/20552076231173563] [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: 04/02/2022] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Objective Unintended pregnancies are a public health problem that represents 48% of global pregnancies. Despite the proliferation of smartphones there is limited data on the app's features on unintended pregnancy. The purpose of this research was to identify free apps available in Spanish, in the iOS Store and Google Play, which can be recommended to prevent unintended pregnancies in adolescents. Methods A systematic search to identify apps was performed in the iOS App Store and in Google Play aiming to replicate the way a patient might access an "unintended pregnancy prevention" app. Additionally, the quality, using the Mobile Application Rating Scale, and content were assessed. Results A total of 4614 apps were identified, of which 8 were retrieved for assessment (0.17%). The mean for objective and subject quality was 3.39 (standard deviation (SD) = 0.694) and 1.84 (SD = 0.626), respectively. A total of 16 thematic categories were identified. The mean of topics covered in the apps was 5.38 (SD = 2.925) being those related to contraception the more frequent. Conclusion The results of the present study suggest that only a small percentage of free pregnancy prevention apps in Spanish should be recommended. The contents of the apps retrieved meet the potential necessities of adolescents.
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Affiliation(s)
- Rubén Martín-Payo
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
| | - Xana Gonzalez-Mendez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
| | - Sergio Carrasco-Santos
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
| | - Aranzazu Muñoz-Mancisidor
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
| | - Cristina Papin-Cano
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
| | - María del Mar Fernandez-Alvarez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Avilés, Spain
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Quality Appraisal of Nutritional Guidelines to Prevent, Diagnose, and Treat Malnutrition in All Its Forms during Pregnancy. Nutrients 2022; 14:nu14214579. [PMID: 36364841 PMCID: PMC9659219 DOI: 10.3390/nu14214579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
This work aimed to identify clinical practice guidelines (CPGs) that include recommendations for the prevention, diagnosis, and treatment of women’s malnutrition during pregnancy and to evaluate the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. We conducted a literature review using PubMed and different websites from January 2009 to February 2021. The quality of the CPGs was independently assessed by reviewers using the AGREE II instrument, which defines guidelines scoring >70% in the overall assessment as “high quality”. The analysis included 43 guidelines. Among the main findings, we identified that only half of the CPGs (51.1%) obtained a final “high quality” evaluation. AGREE II results varied widely across domains and categories. The two domains that obtained the highest scores were scope and purpose with 88.3% (range 39 to 100%) and clarity of presentation with 87.2% (range 25 to 100%). Among the “high quality” CPGs, the best scores were achieved by the three guidelines published by the National Institute of Health and Care Excellence (NICE) and the World Health Organization (WHO). Due to the importance of maternal nutrition in pregnancy, it is essential to join forces to improve the quality of the guidelines, especially in CPGs that do not meet the reference standards for quality.
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Lastinger J, Enengl S, Neururer S, Leitner H, Oppelt P, Stelzl P. Teenage Pregnancies in Austria - an Epidemiological Study on Prevalence and Perinatal Outcome. Geburtshilfe Frauenheilkd 2022; 83:212-219. [PMID: 36743456 PMCID: PMC9897896 DOI: 10.1055/a-1911-1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Even though teenage pregnancy rates have been declining in the last decades, their global prevalence is still high and shows country-specific discrepancies. Insufficient sexual education, poor availability of contraceptives and early marriage are some of the multifactorial causes for adolescent pregnancies. Very often teenage pregnancies are classified as high-risk pregnancies. Studies have found higher rates of peripartal complications, such as preterm birth, low birth weight or low fetal Apgar-Scores. The aim of this retrospective cohort study is to evaluate the prevalence of teenage pregnancies in Austria and to identify principal differences in maternal and neonatal outcome. Material and methods Data were collected from the Austrian Birth Registry between 01/2012 and 12/2020. A total of 751661 deliveries in Austria were documented. Obstetric, maternal and neonatal parameters were descriptively analyzed. Mothers were subclassified into two age groups: teenage mothers of 19 years and younger and adult mothers of 20 to 39 years of age. Results Newborns of teenage mothers were significantly smaller (49.98 ± 3.11 vs. 50.31 ± 3.16 cm, p < 0.001) and had a lower birth weight (3216 ± 564 vs. 3247 ± 576 g, p < 0.001) than newborns of adult mothers. The percentage of caesarean deliveries in the teenage group was significantly lower than in adult mothers (21.1 vs. 31.8%, p < 0.001). Newborns of teenage mothers had significantly higher rates of very low (< 4) and low (< 7) 5-minute Apgar scores (5-minute Apgar < 4: 0.75 vs. 0.54%, p = 0.004) (5-minute Apgar < 7: 1.77 vs. 1.37%, p = 0.001) and significantly lower arterial umbilical-cord pH (7.25 ± 0.08 vs. 7.26 ± 0.08, p < 0.001). Perinatal mortality was higher in the age group below 20 years (0.7 vs. 0.6%, p = 0.043). Conclusion The data of this study show significantly poorer outcomes in pregnancies of teenagers compared to adult women, even though the healthcare system in Austria is considered excellent. Future guideline recommendations should focus on important aspects of obstetric care in teenage mothers.
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Affiliation(s)
- Julia Lastinger
- 31197Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz,
Austria
| | - Sabine Enengl
- 31197Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz,
Austria
| | - Sabrina Neururer
- 31222Institut für klinische Epidemiologie der Tirol-Kliniken (IET), Landesinstitut für Integrierte Versorgung Tirol (LIV), Innsbruck, Austria
| | - Hermann Leitner
- 31222Institut für klinische Epidemiologie der Tirol-Kliniken (IET), Landesinstitut für Integrierte Versorgung Tirol (LIV), Innsbruck, Austria
| | - Peter Oppelt
- 31197Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz,
Austria
| | - Patrick Stelzl
- 31197Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz,
Austria,Korrespondenzadresse DDr. Patrick Stelzl 31197Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler
Universitätsklinikum, Johannes Kepler Universität LinzAltenberger Straße 694040
LinzAustria
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Jung J, Karwal EK, McDonald S, Turner T, Chou D, Vogel JP. Prevention and control of non-communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011. BMC Med 2022; 20:305. [PMID: 36123668 PMCID: PMC9487084 DOI: 10.1186/s12916-022-02508-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are a leading cause of maternal mortality and morbidity worldwide. The World Health Organization is developing new recommendations focusing on the management of NCDs for pregnant, intrapartum, and postnatal women. Thus, to support the development of new guidelines and recommendations, we aimed to determine the availability, focus, and scope of recommendations of current guidelines for the management of NCDs during pregnancy, intrapartum, and postnatal period. METHODS PubMed, Global Index Medicus, TRIP, and Guideline International Network databases were searched on 31 May 2021, to identify any NCD-related guidelines published between 2011 and 2021 with no language or country restrictions. Websites of 165 professional organizations were also searched. Characteristics of included guidelines were analyzed, and recommendations were extracted from guidelines of five high-priority NCD conditions (diabetes, chronic hypertension, respiratory conditions, hemoglobinopathies and sickle cell disease, and mental and substance use disorders). RESULTS From 6026 citations and 165 websites, 405 guidelines were included of which 132 (33%) were pregnancy-specific and 285 (88%) were developed in high-income countries. Among pregnancy-specific guidelines, the most common conditions for which recommendations were provided were gestational diabetes, circulatory diseases, thyroid disorders, and hypertensive disorders of pregnancy. For the five high-priority conditions, 47 guidelines were identified which provided 1834 recommendations, largely focused on antenatal care interventions (62%) such as early detection, screening tools, pharmacological treatment, and lifestyle education. Postnatal recommendations largely covered postnatal clinical assessments, lifestyle education, and breastfeeding. Health system recommendations largely covered multidisciplinary care teams and strengthening referral pathways. CONCLUSIONS This study provides a robust assessment of currently available guidelines and mapping of recommendations on NCD management within maternal health services, which will inform the scope of the World Health Organization's future guideline development activities. This study identified a need to develop guidelines that consider NCDs holistically, with an integrated approach to antenatal, intrapartum, and postnatal care, and that are relevant for resource-limited contexts. Any such guidelines should consider what interventions are most essential to improving outcomes for women with NCDs and their newborns, and how variations in quality of NCD-related care can be addressed.
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Affiliation(s)
- Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Eshreena K Karwal
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Doris Chou
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Berti C, Elahi S, Catalano P, Bhutta ZA, Krawinkel MB, Parisi F, Agostoni C, Cetin I, Hanson M. Obesity, Pregnancy and the Social Contract with Today's Adolescents. Nutrients 2022; 14:3550. [PMID: 36079808 PMCID: PMC9459961 DOI: 10.3390/nu14173550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/16/2022] Open
Abstract
Adolescent health and well-being are of great concern worldwide, and adolescents encounter particular challenges, vulnerabilities and constraints. The dual challenges of adolescent parenthood and obesity are of public health relevance because of the life-altering health and socioeconomic effects on both the parents and the offspring. Prevention and treatment strategies at the individual and population levels have not been successful in the long term, suggesting that adolescent pregnancy and obesity cannot be managed by more of the same. Here, we view adolescent obese pregnancy through the lens of the social contract with youth. The disruption of this contract is faced by today's adolescents, with work, social and economic dilemmas which perpetuate socioeconomic and health inequities across generations. The lack of employment, education and social opportunities, together with obesogenic settings, increase vulnerability and exposure to lifelong health risks, affecting their offspring's life chances too. To break such vicious circles of disadvantage and achieve sustainable solutions in real-world settings, strong efforts on the part of policymakers, healthcare providers and the community must be oriented towards guaranteeing equity and healthy nutrition and environments for today's adolescents. The involvement of adolescents themselves in developing such programs is paramount, not only so that they feel a sense of agency but also to better meet their real life needs.
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Affiliation(s)
- Cristiana Berti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Unit, 20122 Milan, Italy
| | | | - Patrick Catalano
- Mother Infant Research Institute, Tufts University School of Medicine, Boston 02111, MA, USA
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Michael B. Krawinkel
- Institute of Nutritional Sciences—International Nutrition, Justus-Liebig-University, 35392 Giessen, Germany
| | - Francesca Parisi
- Department of Woman, Mother and Neonate, “V. Buzzi” Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Unit, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, “V. Buzzi” Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy
- Department of Biomedical and Clinical Sciences, School of Medicine, University of Milan, 20154 Milan, Italy
| | - Mark Hanson
- Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton SO17 1BJ, UK
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11
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Karaca SY, Adıyeke M, İleri A, İleri H, Vural T, Özmüş DN, Şimşek E, Özeren M. Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers. J Pediatr Adolesc Gynecol 2022; 35:472-477. [PMID: 35031447 DOI: 10.1016/j.jpag.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. DESIGN Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). RESULTS SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR = 2.35; 95% CI, 1.3-4.78), induction of labor (OR = 1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10 g/dl (OR = 2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. CONCLUSIONS BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.
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Affiliation(s)
- Suna Yıldırım Karaca
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Stem Cell, Izmir, Turkey
| | - Mehmet Adıyeke
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Alper İleri
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Hande İleri
- Alsancak State Hospital, Department of Family Medicine, Izmir, Turkey.
| | - Tayfun Vural
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Doğay Nurtaç Özmüş
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Ecem Şimşek
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Mehmet Özeren
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
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12
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Grégoire-Briard F, Harrison MA, Webster R, Fleming N. Frequency of unscheduled visits to the Obstetrical Triage Assessment unit by pregnant adolescents in an urban Canadian Center compared to a matched cohort of pregnant women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1061-1066. [PMID: 35752406 DOI: 10.1016/j.jogc.2022.06.007] [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: 03/16/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People from marginalized and vulnerable populations present more frequently for unscheduled, emergency obstetrical services at labour and delivery triage units. Based on our clinical experience, pregnant adolescents visit the obstetrical triage assessment units (OTAU) more often than adults do. This study was designed to assess this phenomenon by quantifying and describing the frequency of unscheduled visits to the OTAU by pregnant adolescents (age <20 y) compared with a matched cohort of adult pregnant patients (age ≥20 y). METHODS A retrospective database review was performed for data on all adolescent patients that delivered at our institution at ≥20 weeks gestation between January 1, 2013, and December 31, 2017. Adolescent pregnant patients were matched in a 1:1 ratio with adult pregnant patients. Demographic and clinical characteristics as well as the number of visits to the OTAU were recorded. RESULTS A total of 160 adolescent pregnant patients visited the OTAU during the study period. The mean number of visits to the OTAU by adolescents was 2.77 ± 2.40 compared with 1.96 ± 1.80 visits in the adult cohort (P = 0.0001). Adolescents were 63% more likely than adults to access triage services (incidence rate ratio [IRR] 1.63; 95% CI 1.09-2.44, P = 0.017). Diagnosis of a mental health condition was the only identified risk factor for accessing OTAU, irrespective of age (IRR 1.64; 95% CI 1.05, 2.55, P = 0.029). CONCLUSIONS Adolescent pregnant patients tend to visit the OTAU on an unscheduled basis more often than do adult patients. The presence of a mental health condition was identified as an important predictor of unscheduled visits to OTAUs for adolescent patients.
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Affiliation(s)
- Florence Grégoire-Briard
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario
| | - Mary-Ann Harrison
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Richard Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nathalie Fleming
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario; University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Canada; Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
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13
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Cioffi CC, Schweer-Collins ML, Leve LD. Pregnancy and miscarriage predict suicide attempts but not substance use among dual-systems involved female adolescents. CHILDREN AND YOUTH SERVICES REVIEW 2022; 137:106494. [PMID: 37089705 PMCID: PMC10118061 DOI: 10.1016/j.childyouth.2022.106494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background To examine the associations between adolescent pregnancy and pregnancy outcomes on substance use and suicide attempts in a sample who is at greater risk for substance use and suicide attempts - those who have been involved with the uvenile justice and child welfare systems. Methods Using a prospective, longitudinal design, we examined the role of adolescent pregnancy outcomes on risk for suicide attempts and substance use among a sample of 166 female adolescents with juvenile justice system and child welfare involvement. Results Of participants, 36% (n = 60) reported at least one adolescent pregnancy with a total of 109 pregnancies reported. Adolescent pregnancy was associated with an increase in later suicide attempts (aOR = 1.68, 95% CI 1.06-2.72). Miscarriage was associated with a 2-fold increase in the likelihood of later suicide attempts, (aOR = 2.12, 95% CI 1.10-4.12). No participants who reported induced abortion (n = 13) reported suicide attempts. Adolescent pregnancy, miscarriage, and abortion were not significantly associated with later substance use (Ps > 0.05). Conclusions Healthcare professionals should conduct routine screening for suicidality in the months following a miscarriage, offer education to caregivers about how to support youth who experience pregnancy loss, provide additional social supports and familiarize themselves with local and virtual behavioral health resources to prevent suicide attempts among female adolescents who are at high risk and experience miscarriage.
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14
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Orr E, Ballantyne M, Gonzalez A, Jack SM. Mobilizing Forward: An Interpretive Description of Supporting Successful Neonatal Intensive Care Unit-To-Home Transitions for Adolescent Parents. QUALITATIVE HEALTH RESEARCH 2022; 32:831-846. [PMID: 35316117 PMCID: PMC9152603 DOI: 10.1177/10497323221079785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnancy and parenting in adolescence and the transition home following the hospitalization of an infant in the neonatal intensive care unit (NICU) are two relatively complex phenomena; and whilst each have been consistently explored within the relevant literature, little is understood about the care required when they intersect. Using interpretive description methodology to guide our exploration, we conducted semi-structured interviews with 23 expert providers caring for adolescent parents involved in NICU-to-home transitions to describe this process in their practice. Findings suggest that supporting successful NICU-to-home transitions for adolescent parents relied strongly on understanding the impact of the NICU experience, establishing therapeutic relationships and facilitating supportive partnerships between the NICU and parents as well as the NICU and supportive services post-discharge. Findings highlight the opportunity for more integrated models of care within the NICU and extending into the community to address the complex biopsychosocial care needs of this parent population.
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Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University Faculty of Applied Health
Science, St. Catharines, Ontario, Canada
| | - Marilyn Ballantyne
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Holland Bloorview Kids Rehabilitation
Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural
Neurosciences, McMaster University, Hamilton, Ontario, Canada
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15
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Wahab RJ, Jaddoe VWV, van Klaveren D, Vermeulen MJ, Reiss IKM, Steegers EAP, Gaillard R. Preconception and early-pregnancy risk prediction for birth complications: development of prediction models within a population-based prospective cohort. BMC Pregnancy Childbirth 2022; 22:165. [PMID: 35227240 PMCID: PMC8886786 DOI: 10.1186/s12884-022-04497-2] [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: 07/21/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Suboptimal maternal health already from preconception onwards is strongly linked to an increased risk of birth complications. To enable identification of women at risk of birth complications, we aimed to develop a prediction model for birth complications using maternal preconception socio-demographic, lifestyle, medical history and early-pregnancy clinical characteristics in a general population. Methods In a population-based prospective cohort study among 8340 women, we obtained information on 33 maternal characteristics at study enrolment in early-pregnancy. These characteristics covered the preconception period and first half of pregnancy (< 21 weeks gestation). Preterm birth was < 37 weeks gestation. Small-for-gestational-age (SGA) and large-for-gestational-age (LGA) at birth were gestational-age-adjusted birthweight in the lowest or highest decile, respectively. Because of their co-occurrence, preterm birth and SGA were combined into a composite outcome. Results The basic preconception model included easy obtainable maternal characteristics in the preconception period including age, ethnicity, parity, body mass index and smoking. This basic preconception model had an area under the receiver operating characteristics curve (AUC) of 0.63 (95% confidence interval (CI) 0.61 to 0.65) and 0.64 (95% CI 0.62 to 0.66) for preterm birth/SGA and LGA, respectively. Further extension to more complex models by adding maternal socio-demographic, lifestyle, medical history and early-pregnancy clinical characteristics led to small, statistically significant improved models. The full model for prediction of preterm birth/SGA had an AUC 0.66 (95% CI 0.64 to 0.67) with a sensitivity of 22% at a 90% specificity. The full model for prediction of LGA had an AUC of 0.67 (95% CI 0.65 to 0.69) with sensitivity of 28% at a 90% specificity. The developed models had a reasonable level of calibration within highly different socio-economic subsets of our population and predictive performance for various secondary maternal, delivery and neonatal complications was better than for primary outcomes. Conclusions Prediction of birth complications is limited when using maternal preconception and early-pregnancy characteristics, which can easily be obtained in clinical practice. Further improvement of the developed models and subsequent external validation is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04497-2.
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Affiliation(s)
- Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Making, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marijn J Vermeulen
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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16
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Dawson A, Assifi A, Turkmani S. Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines. Reprod Health 2022; 19:50. [PMID: 35193606 PMCID: PMC8862274 DOI: 10.1186/s12978-022-01356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. METHOD We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. FINDINGS One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. CONCLUSION This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.
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Affiliation(s)
- Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia.
| | - Anisa Assifi
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sabera Turkmani
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia
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17
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Dumont T. The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: A Needs Assessment From Program Directors. J Pediatr Adolesc Gynecol 2021; 34:787-792.e1. [PMID: 34119662 DOI: 10.1016/j.jpag.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a needs assessment to determine whether a mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is required and feasible. MATERIALS AND METHODS This was a comparative descriptive design in which the 16 ObGyn Residency Program Directors (PD) in Canada were asked to undergo a 20-minute structured phone interview. These interviews were recorded, and explored how PAG and Reproductive Endocrinology (RE) objectives are met in each program, the PD's awareness of PAG opportunities in North America, and the feasibility of a mandatory training experience. This project is Research Ethics Board (REB) approved. RESULTS Of 16 PDs, 12 gave consent and completed the phone interview. There is at least 1 PAG-trained ObGyn per institution, with a wide variety of clinical and academic experiences in PAG for residents between residency programs. There is much overlap among PAG and RE. All PDs interviewed believe that PAG training is important and should be mandatory; however, many feel that they lack the resources to implement a PAG mandatory training experience and that many barriers to such a curriculum exist. CONCLUSION PAG training experiences should be mandatory in all ObGyn training programs, according to participating PDs. PAG providers were identified at all the participating residency programs, and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents so the residents can become competent in the care of young women and children. PDs should be provided with the available PAG resources and resident elective opportunities.
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Affiliation(s)
- Tania Dumont
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada; Department of Surgery, Division of Gynecology, CHEO, Ottawa, Ontario, Canada; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
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18
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Harrison CL, Teede H, Khan N, Lim S, Chauhan A, Drakeley S, Moran L, Boyle J. Weight management across preconception, pregnancy, and postpartum: A systematic review and quality appraisal of international clinical practice guidelines. Obes Rev 2021; 22:e13310. [PMID: 34312965 DOI: 10.1111/obr.13310] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/02/2023]
Abstract
This systematic review and quality appraisal evaluated clinical practice guidelines (CPGs) for weight management and weight-related behaviors across preconception, pregnancy, and postpartum. CPGs published in English were identified from research and guideline-specific databases between 2010 and 2019. Recommendations were categorized into weight (body mass index screening, weight loss, weight gain prevention, and gestational weight gain), diet, food safety, physical activity, and behavioral strategies. Three independent appraisers assessed CPG quality using the Appraisal of Guidelines Research and Evaluation II instrument. Twenty-two CPGs were included across preconception (n = 2), pregnancy (n = 8), postpartum (n = 2), or a combination (n = 10). Overall, 45% of CPGs were appraised as poor quality, 32% as moderate, and 23% as high. Evaluation of body mass index and supplementation recommendations were most common across CPGs, alongside secondary weight management recommendations for women with obesity in fewer CPGs. Accompanying recommendations for diet, physical activity, and behavior were highly variable between guidelines. We report significant ambiguity in existing guidance and an absence of important considerations, including targeting weight gain prevention and limiting excess gestational weight gain. Results emphasize the need for development of robust, comprehensive, and high quality guidelines on healthy lifestyle and weight management across these formative reproductive life stages.
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Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Nadia Khan
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Ayushi Chauhan
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Sheila Drakeley
- School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
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19
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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20
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Rebić N, Gilbert K, Soon JA. "Now what?!" A practice tool for pharmacist-driven options counselling for unintended pregnancy. Can Pharm J (Ott) 2021; 154:248-255. [PMID: 34345317 PMCID: PMC8282911 DOI: 10.1177/17151635211018716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
| | | | - Judith A Soon
- Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
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21
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Millar HC, Lorber S, Vandermorris A, Thompson G, Thompson M, Allen L, Aggarwal A, Spitzer RF. "No, You Need to Explain What You Are Doing": Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma. J Pediatr Adolesc Gynecol 2021; 34:538-545. [PMID: 33535100 DOI: 10.1016/j.jpag.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To understand the pregnancy and childbirth experiences and preferences of adolescent mothers with a history of childhood trauma in order to develop trauma-informed care practice recommendations for this unique group. DESIGN Mixed methods convergent parallel design involving completion of the Adverse Childhood Experiences (ACE) questionnaire, a survey of care experiences and preferences during pregnancy and delivery, and a one-on-one interview. SETTING hHospital-based medical home program for pregnant and parenting adolescents. PARTICIPANTS Adolescent and young adult mothers aged 12-22 years, receiving care between June 2018 and June 2019. RESULTS A total of 29 adolescent mothers completed the questionnaire, out of a potential 38 in the program (76.3% participation). Five went on to complete an interview. The average age was 17.9 years (standard deviation 1.8 years). The mean ACE score was 5.1 out of 10, indicating childhood exposure to an average of 5 different types of potential trauma. A total of 19 participants (65.5%) reported being triggered during pregnancy or postpartum. Trauma memories were elicited during vaginal examinations in the clinic (27.6%) and in the hospital (27.6%), abdominal examinations (13.8%), measurement of vital signs (17.2%), and labor (17.2%). Ten participants (34.5%) felt that the providers delivering their baby knew how to help them cope with trauma memories. Themes that emerged included the following: acknowledgment of trauma by provider, avoiding re-telling of story, building a relationship with provider, choice and control in care, and providing coping strategies. CONCLUSION A majority of adolescent mothers in our sample experienced trauma memories during pregnancy and postpartum medical interactions. Priorities for trauma-informed care in this population are described.
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Affiliation(s)
- Heather C Millar
- Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
| | - Sharon Lorber
- Department of Paediatrics, Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Ashley Vandermorris
- Department of Paediatrics, Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gillian Thompson
- Department of Paediatrics, Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marysa Thompson
- Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Allen
- Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Health System, Toronto, Ontario, Canada
| | - Anjali Aggarwal
- Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Rachel F Spitzer
- Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Health System, Toronto, Ontario, Canada
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22
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Decker MJ, Pineda N, Gutmann-Gonzalez A, Brindis CD. Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers. BMC Pregnancy Childbirth 2021; 21:349. [PMID: 33934698 PMCID: PMC8091497 DOI: 10.1186/s12884-021-03831-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. METHODS Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. RESULTS Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices. CONCLUSION Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.
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Affiliation(s)
- Martha J. Decker
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, San Francisco, CA 94158 USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA 94158 USA
| | - Noelle Pineda
- Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305 USA
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA 94158 USA
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA 94158 USA
- Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143 USA
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23
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Olajubu AO, Omoloye GO, Olajubu TO, Olowokere AE. Stress and resilience among pregnant teenagers in Ile-Ife, Nigeria. Eur J Midwifery 2021; 5:9. [PMID: 33817566 PMCID: PMC8010909 DOI: 10.18332/ejm/134181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The period of pregnancy is associated with some level of physical, emotional and psychological stress which can be particularly heightened and have more deleterious impact when the expectant mother is a teenager who needs higher level of resilience to cope with the challenges linked with motherhood. This study aimed to assess the level of perceived pregnancy-related stress and its relationship with the level of resilience. METHODS An analytical cross-sectional study design was employed using a structured questionnaire and the study was conducted among 241 adolescents. Perceived stress and resilience were measured using Perceived Stress Scale, and Wagnild & Young Resilience Scale, respectively. Descriptive and inferential statistics were computed using percentages, means with standard deviations, Student's t-test, Pearson correlation, one-way analysis of variance (ANOVA) and multivariate logistic regression. RESULTS Majority of the respondents (194; 80.5%) were categorized as having moderate level of perceived pregnancy-related stress and 186 (77.2%) had low level of resilience. A significant inverse relationship was found between perceived pregnancy-related stress and resilience (r=-0.15, p=0.02). At multivariate level, three variables emerged as independent predictors of higher level of pregnancy-related stress: feeling of shame (OR=3.39; CI: 1.01-11.34), male partner's rejection of pregnancy (OR=3.43; CI: 1.45-8.12) and lack of parental involvement in care (OR= 3.56; CI: 1.65-7.71). CONCLUSIONS There is a significant inverse relationship between perceived pregnancyrelated stress and resilience among teenagers in Nigeria, with higher resilience among the older age groups and those who had support from significant others.
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Affiliation(s)
- Aanuoluwapo O Olajubu
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Grace O Omoloye
- Department of Nursing Services, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Adekemi E Olowokere
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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24
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Kola L, Abiona D, Adefolarin AO, Ben-Zeev D. Mobile Phone Use and Acceptability for the Delivery of Mental Health Information Among Perinatal Adolescents in Nigeria: Survey Study. JMIR Ment Health 2021; 8:e20314. [PMID: 33496678 PMCID: PMC7872837 DOI: 10.2196/20314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/20/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are several barriers that may hamper adolescent mothers' utilization of available health interventions for perinatal depression. Innovative treatment approaches are needed to increase adolescent mothers' access to mental health care for improved maternal and child health outcomes. Mobile phones have the potential to serve as important conduits to mental health care in Africa. However, mobile phone use patterns and needs among young mothers in Nigeria are not well documented. OBJECTIVE This study sought to determine the prevalence of mobile phone use among perinatal adolescents and report patterns of use, as well as to assess the openness of young mothers to mobile health (mHealth) mental health interventions. METHODS We surveyed 260 adolescent mothers (ages 16-19 years) in their perinatal or postnatal periods of pregnancies in 33 primary health care clinics in Ibadan, Oyo State, Nigeria in 2020. Respondents were included if they were pregnant with a gestation age of greater than or equal to 4 weeks, or had babies (which they had birthed) that were younger than 12 months. RESULTS The total study sample consisted of 260 adolescent mothers with a mean age of 18.4 (SD 0.88) years. The majority of the respondents (233/260, 89.6%) owned mobile phones (eg, keypad, keypad and internet, smartphones); 22 (8.5%) of the 260 mothers had access to phones that belonged to relatives who lived in the same household, while 5 (1.9%) had access only to public paid phones. Only 23% (54/233) of phone owners (which is 20.5% of the total study population) had smartphones. On average, respondents reported first using mobile phones at 15.5 (SD 2.06) years old. The majority of respondents (222/260, 85.4%) reported using their phones for an average of 45 minutes daily for calls to family members. Facebook was the social media platform that was most often used among respondents who had phones with internet access (122/146 minutes per day, 83.4%). The majority of the sample responded as being "interested" and "very interested" in the use of mobile phones for preventive interventions (250/260, 96.2%) and treatment (243/260, 93.5%) information on mental illness such as depression and "hearing voices." Half of the respondents (126/233, 50.4%) preferred to receive such information in the form of text messages. CONCLUSIONS Findings from this study suggest that the vast majority of perinatal adolescents in Nigeria own and use mobile phones and that they are interested in leveraging these devices for prevention, treatment, and informational campaigns focused on mental health. The use of smartphones in this population is relatively low, and health intervention through text messages were favored by the women.
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Affiliation(s)
- Lola Kola
- University of Ibadan, Ibadan, Nigeria
| | | | | | - Dror Ben-Zeev
- University of Washington Seattle, Seattle, WA, United States
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25
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Tyker A, Pudwell J, Schneiderman M, Hundal P, Thorne J, Jamieson MA. Prevalence of Chlamydia and Gonorrhea Among Pregnant Adolescents Screened in the Third Trimester Using a Urine PCR Test: A Retrospective Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1069-1075. [PMID: 33412301 DOI: 10.1016/j.jogc.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our study assessed the rate of new and recurrent Chlamydia trachomatis and Neisseria gonorrhoeae infections in the third trimester at an adolescent obstetrics clinic. METHOD Between October 2016 and June 2020, routine third-trimester screening for C. trachomatis and N. gonorrhoeae was implemented according to new Canadian recommendations. Urine nucleic acid amplification was performed. Patient records were reviewed retrospectively, and demographic data; pregnancy and delivery characteristics; and information on screening at presentation to care, third-trimester screening (33-38 weeks), and other STI testing was recorded. RESULTS A total of 115 adolescents (mean age 17.90 ± 1.43 y) with 125 pregnancies presented for care. Twenty-three pregnancies were excluded (12 transferred out and 11 experienced a pregnancy loss). At presentation, screening was performed in 100 of 102 pregnancies: 64 of 100 at <13 weeks, 32 of 100 at 13-27 weeks, and 4 of 100 at 28-30 weeks. Nine tested positive for C. trachomatis and none tested positive for N. gonorrhoeae. In the third trimester, there were 3 positive C. trachomatis tests, but all were indicated: test of cure was due for 1 patient, 1 patient had a new sexual partner, and 1 patient presented with symptoms. The remaining 89 of 102 pregnancies were screened (with no other indication) and none were positive for C. trachomatis or N. gonorrhoeae. Ten patients could not be sampled (5 missed, 4 pre-term deliveries, and 1 non-compliant with testing). CONCLUSION No cases of C. trachomatis or N. gonorrhoeae infection were identified on third-trimester screening in our study. Adolescent obstetrics providers implementing Canadian screening guidelines may want to monitor their screening results to determine whether their yield warrants universal implementation.
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Affiliation(s)
- Anna Tyker
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON
| | - Megan Schneiderman
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON
| | - Prabhpreet Hundal
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON
| | - Julie Thorne
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynecology, School of Medicine, Queen's University, Kingston, ON.
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26
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Paynter MJ, Bagg ML, Heggie C. Invisible women: correctional facilities for women across Canada and proximity to maternity services. Int J Prison Health 2020. [DOI: 10.1108/ijph-06-2020-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to describe the process to create an inventory of the facilities in Canada designated to incarcerate women and girls, health service responsibility by facility, facility proximity to hospitals with maternity services and residential programmes for mothers and children to stay together. This paper creates the inventory to support health researchers, prison rights advocates and policymakers to identify, analyse and respond to sex and gender differences in health and access to health services in prisons.
Design/methodology/approach
In spring 2019, this study conducted an environmental scan to create an inventory of every facility in Canada designated for the incarceration of girls and women, including remand/pretrial custody, immigration detention, youth facilities and for provincial and federal sentences.
Findings
There are 72 facilities in the inventory. In most, women are co-located with men. Responsibility for health varies by jurisdiction. Few sites have mother-child programmes. Distance to maternity services varies from 1 to 132 km.
Research limitations/implications
This paper did not include police lock-up, courthouse cells or involuntary psychiatric units in the inventory. Information is unavailable regarding trans and non-binary persons, a priority for future work. Access to maternity hospital services is but one critical question regarding reproductive care. Maintenance of the database is challenging.
Originality/value
Incarcerated women are an invisible population. The inventory is the first of its kind and is a useful tool to support sex and gender and health research across jurisdictions.
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27
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Millar HC, Keter AK, Musick BS, Apondi E, Wachira J, MacDonald KR, Spitzer RF, Braitstein P. Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: a retrospective cohort study. Reprod Health 2020; 17:191. [PMID: 33267899 PMCID: PMC7709285 DOI: 10.1186/s12978-020-01031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya. METHODS The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10-19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined. RESULTS There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning. CONCLUSIONS A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
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Affiliation(s)
- Heather C Millar
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya. .,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada. .,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada.
| | - Alfred K Keter
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya
| | - Beverly S Musick
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Moi Teaching and Referral Hospital, Nandi Road, Uasin Gishu County, PO Box 3-30100, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Behavioral Sciences, Moi University, College of Health Sciences, PO Box 4606, Eldoret, 30100, Kenya
| | - Katherine R MacDonald
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Riley Hospital 5900, Indianapolis, IN, 46202, USA
| | - Rachel F Spitzer
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada.,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Moi University, College of Health Sciences, School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
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28
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Talungchit P, Kwadkweang S, Limsiri P. Mother-role development program and postpartum health-service utilization by adolescent mothers: A randomized, controlled trial. J Obstet Gynaecol Res 2020; 47:653-660. [PMID: 33242918 DOI: 10.1111/jog.14576] [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: 04/09/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the impact of a mother-role development program on postpartum health-service utilization by adolescent mothers. METHODS A single center, parallel, randomized, controlled, open-label trial using a computer-generated sequence was conducted at Siriraj Hospital. In all, 120 teenage mothers who delivered February 2015-December 2016 were randomized into experimental and control groups. The experimental group participated in a 2-year, mother-role development program at the Young Family Clinic. The two groups' characteristics, pregnancy outcomes and postpartum follow-up details over the 2-year period were compared. The main outcome measure was the utilization of maternal healthcare services (MHS). RESULTS The teenage mothers were randomized into two groups of 60 participants each. Many were progressively lost to follow-up, leaving only 37 (experimental group, 19; control group, 18) for the intention-to-treat analysis. The results demonstrated a higher MHS utilization by the experimental group, but only at the 6-week postpartum follow-up. The usage of long-acting, reversible contraception (birth control implants and intrauterine devices) rose from 53.3% (immediate postpartum) to 95.5% (2 years postpartum). The two groups also had identical repeat pregnancy rates (6.67%; four participants in each), a marked decrease from 20% in a prior study. The breastfeeding rate was consistently higher among the mothers undertaking the mother-role development program. CONCLUSION The program increased both MHS utilization during the initial postpartum period and the breastfeeding duration. Access to immediate postpartum contraception and long-acting, reversible contraception was associated with a reduction in repeat teen pregnancies. Having a multidisciplinary team was key to the health-service improvements.
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Affiliation(s)
- Pattarawalai Talungchit
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Kwadkweang
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarawan Limsiri
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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29
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The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied. ANS Adv Nurs Sci 2020; 43:349-359. [PMID: 33136587 DOI: 10.1097/ans.0000000000000299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.
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30
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Koucky M, Kamel R, Vistejnova L, Kalis V, Ismail KM. A global perspective on management of bacterial infections in pregnancy: a systematic review of international guidelines. J Matern Fetal Neonatal Med 2020; 35:3751-3760. [PMID: 33115310 DOI: 10.1080/14767058.2020.1839879] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Maternal sepsis is a leading cause of maternal and neonatal mortality. Despite the availability of management protocols, there is disparity in case fatality rates for pregnancy-related sepsis compared to other maternity-related complications. The main aim of this systematic review was to assess concordance between international evidence-based guidelines for the prevention and management of childbirth-related bacterial infections. MATERIAL AND METHODS The PRISMA statement was followed during the conduct and reporting of this review. PubMed was searched electronically from 2009 to November 2019 for clinical guidelines covering the topic of childbirth-related infections and specific searches for relevant guidelines on the websites of the top five international professional bodies most commonly identified by our searches. We did not apply any language restrictions. Guidelines were included if they provided any information about the prevention or management of childbirth-related bacterial infections irrespective of whether the guideline stated a recommendation or not. Two independent reviewers undertook study selection, decisions about inclusion of selected guidelines and data extraction. Extracted information was synthesized under the following topics: Asymptomatic bacteriuria; group B streptococcal infection (GBS); preterm premature rupture of membranes (P-PROM); intrauterine infection; procedures; maternal sepsis; miscellaneous. Concordance was defined as absence of contradictory information between the different guidelines with regards to a specific topic, subtopic or recommendation. Quality of included guidelines was assessed against the AGREE II guideline reporting domains. RESULTS A total of 43 guidelines were selected of which 11 were excluded leaving 32 guidelines that fulfilled our inclusion criteria. None of the guidelines fulfilled all the quality assessment domains and 11 (34%) of the guidelines satisfied 1-2 of domains only. Two guidelines covered the topic of asymptomatic bacteriuria, nine for GBS, five for P-PROM and three covered each of intra-amniotic infections maternal sepsis, obstetric procedures and interventions topics. The remaining guidelines covered miscellaneous topics. CONCLUSIONS There was concordance between guidelines with regards to several aspects in the prophylaxis and treatment of bacteriological infections in pregnancy. Nevertheless, there were several areas of discordance, some of which reached the extent of contradictory information as in the case of antenatal screening for GBS.
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Affiliation(s)
- Michal Koucky
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital in Prague, Prague, Czech Republic
| | - Rasha Kamel
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Lucie Vistejnova
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Kalis
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - Khaled M Ismail
- Biomedical center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
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31
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Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research. ANS Adv Nurs Sci 2020; 43:202-213. [PMID: 32732605 DOI: 10.1097/ans.0000000000000321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.
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32
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Barbieri MM, Juliato CRT, Bahamondes L, Surita FG. ENG-releasing subdermal implants in postpartum teenagers - an open-label trial study protocol. Reprod Health 2020; 17:100. [PMID: 32576199 PMCID: PMC7310555 DOI: 10.1186/s12978-020-00952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Higher than expected adolescent pregnancy high rates continue globally, with repeated unplanned pregnancy (UP) in this age group is a public health problem. In Brazil, 16% of pregnancies occur in adolescents under 18 years old, with high maternal morbidity and mortality rates in this age group. Effective and safe contraception is required to reduce UP rates. The objective of our study is to evaluate acceptance of etonogestrel (ENG)-releasing subdermal contraceptive implant after childbirth, before discharge, as well as clinical performance up to one year after placement. Comparison between teenagers who opt for ENG-implant versus other contraceptive methods after childbirth will be also evaluated, specifically regarding UP, continuation and discontinuation rates and reasons, body composition, pelvic ultrasound characteristics and user satisfaction. Methods A non-randomized open-label trial will be conducted with teenagers after childbirth and followed up to one year at the Women’s Hospital, University of Campinas (UNICAMP), Campinas, Brazil. The study group will consist of patients who accepted to use ENG-implant and placed before discharge. The comparison group will include adolescents who choose to use other contraceptive methods at the first postpartum visit (42 ± 3 days after childbirth). All women will follow-up at 40–60 days postpartum, as well as, at 6 and 12 months post-enrollment. Patient satisfaction, contraceptive effectiveness, reasons of discontinuation, continuation rate and body composition will be evaluated. Transvaginal ultrasound and electric bio impedance tests will be performed at all follow-up appointments. A 5% significance level was assumed, as well as, a sampling error (absolute) for 10% prevalence. The sample size was calculated at n = 100, obtaining an estimate of 50 to 70 adolescents who would accept the method offered, according to the prevalence and sample error assumed. Discussion Long-acting reversible contraceptive (LARC) methods include subdermal implants and intrauterine contraceptives, are considered first line contraception for teenagers. Immediate postpartum use is a safe option, which significantly reduces rates of repeated UP and all the undesirable consequences inherent to this process. Trial registration This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 92869018.5.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC): http://www.ensaiosclinicos.gov.br/rg/RBR-4z7bc6, (number 2.901.752).
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Affiliation(s)
- M M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - C R T Juliato
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - L Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - F G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil.
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Pires AJ, de Matos MB, Scholl CC, Trettim JP, Coelho FT, da Cunha Coelho FM, Pinheiro KAT, Pinheiro RT, de Avila Quevedo L. Prevalence of mental health problems in preschoolers and the impact of maternal depression. Eur Child Adolesc Psychiatry 2020; 29:605-616. [PMID: 31392431 DOI: 10.1007/s00787-019-01381-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4-5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2-3 years old and 4-5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4-5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4-5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.
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Affiliation(s)
- Andressa Jacondino Pires
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Mariana Bonati de Matos
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Carolina Coelho Scholl
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | | | - Fernanda Teixeira Coelho
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | | | | | - Ricardo Tavares Pinheiro
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Luciana de Avila Quevedo
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Gonçalves Chaves Street, 373, Room 411, Building C, Pelotas, RS, 96015-560, Brazil.
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Infant and Maternal Outcomes for Women Who Experience Imprisonment in Ontario, Canada: A Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:462-472.e2. [DOI: 10.1016/j.jogc.2019.11.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022]
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Wong SPW, Twynstra J, Gilliland JA, Cook JL, Seabrook JA. Risk Factors and Birth Outcomes Associated with Teenage Pregnancy: A Canadian Sample. J Pediatr Adolesc Gynecol 2020; 33:153-159. [PMID: 31634579 DOI: 10.1016/j.jpag.2019.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/06/2019] [Accepted: 10/13/2019] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To examine the extent to which socioeconomic status, mental health, and substance use are associated with teenage pregnancies in Southwestern Ontario (SWO), and whether these pregnancies are at an elevated risk for adverse birth outcomes, after controlling for medical, behavioral, and socioeconomic status factors. DESIGN Retrospective cohort study using perinatal and neonatal databases. SETTING Tertiary care hospital in SWO. PARTICIPANTS Women residing in SWO who gave birth to singleton infants without congenital anomalies between 2009 and 2014. Teenage pregnancies (19 years of age or younger) were compared with pregnancies of women 20-34 years and 35 years or older. INTERVENTIONS None. MAIN OUTCOME MEASURES Low birth weight (LBW), very LBW, term LBW, preterm birth, very preterm birth, low and very low Apgar score, and fetal macrosomia. RESULTS Of 25,263 pregnant women, 1080 (4.3%) were 19 years of age or younger. Approximately 18% of teenage mothers lived in socioeconomically disadvantaged neighborhoods, compared with 11% of mothers aged 20-34 and 9% of women 35 years of age or older (P < .001). Teenage mothers had higher rates of depression during pregnancy (9.8%) than mothers 20-34 years (5.8%) and those 35 years of age or older (6.8%; P < .001). Young mothers self-reported higher tobacco, marijuana, and alcohol use during pregnancy than adult mothers (P < .001). Teenage pregnancy increased the risk of a low Apgar score (adjusted odds ratio, 1.56; 95% confidence interval, 1.21-2.02), but was not associated with other birth outcomes after adjusting for covariates. CONCLUSION Teenage pregnancy is associated with a higher risk of socioeconomic disadvantage, mental health problems, and substance use during pregnancy, but is largely unrelated to adverse birth outcomes in SWO.
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Affiliation(s)
- Stephanie P W Wong
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography, Western University, London, Ontario, Canada; Human Environments Analysis Laboratory, London, Ontario, Canada; Department of Paediatrics, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Children's Health Research Institute/Lawson Health Research Institute, London, Ontario, Canada; School of Health Studies, Western University, London, Ontario, Canada
| | - Jocelynn L Cook
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada; Human Environments Analysis Laboratory, London, Ontario, Canada; Department of Paediatrics, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Children's Health Research Institute/Lawson Health Research Institute, London, Ontario, Canada.
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Van Lieshout RJ, Savoy CD, Boyle MH, Georgiades K, Jack SM, Niccols A, Whitty H, Lipman EL. The Mental Health of Young Canadian Mothers. J Adolesc Health 2020; 66:464-469. [PMID: 32057608 DOI: 10.1016/j.jadohealth.2019.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Although many young mothers (aged <21 years) are exposed to multiple adversities that increase their risk for mental illness, prevalence data are largely limited self-report questionnaires estimating only the prevalence of postpartum depression. Gaining a greater understanding of the burden of a broader range of common mental illnesses affecting these young women has the potential to improve their health as well as the development and functioning of their children. METHODS The Young Mothers Health Study recruited 450 mothers aged <21 years and 100 comparison mothers (aged >20 years old at first delivery) living in urban and rural central-west Ontario. Age-matched young mothers were also compared with 15- to 17-year-old women without children (N = 630) from the 2014 Ontario Child Health Study. The prevalence of current mental disorders was assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. RESULTS Nearly 2 of 3 young mothers reported at least one mental health problem, and almost 40% had more than one. Young mothers were 2 to 4 times as likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder, or conduct disorder and were 2 to 4 times more likely to have more than one psychiatric problem than older comparison mothers or women aged 15-17 years. CONCLUSIONS Given the high rates of mental health problems and complex needs of young mothers in Canada and the possible adverse effects of maternal psychopathology on their children, further efforts should be directed at engaging and treating this high-risk group.
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Affiliation(s)
- Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Calan D Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Alison Niccols
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather Whitty
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Gureje O, Kola L, Oladeji BD, Abdulmalik J, Ayinde O, Zelkowitz P, Bennett I. Responding to the challenge of Adolescent Perinatal Depression (RAPiD): protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care. Trials 2020; 21:231. [PMID: 32106885 PMCID: PMC7047361 DOI: 10.1186/s13063-020-4086-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 01/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent pregnancy is a pressing public health issue globally, and particularly in low and middle-income countries. Depression occurring in the perinatal period is common among women and more so among adolescent mothers. Effective treatments for the condition have been demonstrated in adults but the needs of adolescents are often unique, making such treatments unlikely to meet those needs. METHOD/STUDY DESIGN A hybrid effectiveness-implementation research study is described in which a cluster randomized trial design is used to explore the effectiveness as well as the utility in routine practice of an intervention package specifically designed for adolescents with perinatal depression. Consenting pregnant adolescents (aged less than 20 years) who are newly registered for antenatal care are enrolled into the trial if their fetal gestational age is less than 36 weeks and they score 12 or more on the Edinburgh Postnatal Depression Scale (EPDS). The intervention package consists of structured sessions of behavior activation, problem-solving treatment, and parenting skills training, and is delivered by primary maternal health care providers, complemented by support provided by a "neighborhood mother" identified by the adolescent. Mothers in the control arm receive care as usual. The trial is conducted in clinics where the maternal providers are trained to deliver routine depression care with the use of the WHO Mental Health Gap Action Programme, intervention guide. Assessments are undertaken by trained blinded assessors at baseline, at childbirth, and at 3 and 6 months postpartum. The primary outcome, assessed at 6 months, is the level of maternal depression (measured with the EPDS). The secondary outcome is parenting skills (assessed with the Home Observation Measurement of the Environment, Infant-Toddler version), while tertiary outcomes include measures of disability, quality of life, mother-child bonding, as well as infants' nutritional and growth indices. DISCUSSION This, to the best of our knowledge, will be the first fully-powered trial of an intervention package specifically designed to address the unique needs of adolescents with perinatal depression. TRIAL REGISTRATION ISRCTN16775958. Registered on 30 April 2019.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | | | - Olatunde Ayinde
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Phyllis Zelkowitz
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Ian Bennett
- Departments of Family Medicine, Psychiatry and Behavioural Science, and Global Health, University of Washington, Seattle, WA, USA
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Malek KA, Abdul-Razak S, Abu Hassan H, Othman S. Managing adolescent pregnancy: The unique roles and challenges of private general practitioners in Malaysia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2019; 14:37-45. [PMID: 32175039 PMCID: PMC7067509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Managing adolescent pregnancy in the primary care setting is complex, as it requires doctors to navigate through a combination of medical, social, financial and legal needs. Objective: This study explores the perspectives of private general practitioners on their roles and challenges in managing adolescent pregnancy in Malaysia. METHODS Nineteen private general practitioners in Selangor and Kuala Lumpur participated in in-depth interviews in 2015. A topic guide was used for interview navigation. Participants were asked to discuss their experiences and approaches in managing pregnant adolescents. We used purposive sampling to recruit consenting private general practitioners who had experience in managing adolescent pregnancy. The verbatim transcripts of the audio-recorded interviews were analyzed using thematic analysis. Data reached saturation at the nineteenth in-depth interview. Results: Two themes emerged. Under the theme 'inadvertent advocator,' participants described their tasks with regards to building trust, calming angry parents and delivering comprehensive counseling and care related to the sexual and reproductive health of adolescents, including requests for abortions. Theme two, 'challenges of private general practitioners,' refers mainly to personal and religious conflicts arising from a request for an abortion and deficiencies in support and multidisciplinary integration within their practice settings. CONCLUSION General practitioners practicing in the private sector identify themselves as active players in supporting pregnant adolescents but face many challenges arising from the personal, religious, professional and community levels. Addressing these challenges is important for optimal care delivery to pregnant adolescents in this community.
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Affiliation(s)
- K A Malek
- MFamMed, FRACGP, MBChB Universiti Teknologi MARA Malaysia
| | - S Abdul-Razak
- MFamMed, MBChB Universiti Teknologi MARA, Selangor Malaysia
| | - H Abu Hassan
- MMed Fam Med (UKM), MBBS (Malaya) National Defence University Kuala Lumpur, Malaysia
| | - S Othman
- PHD, MFamMed, MBBS University of Malaya, Kuala Lumpur Malaysia
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Maternal Area of Residence, Socioeconomic Status, and Risk of Adverse Maternal and Birth Outcomes in Adolescent Mothers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1752-1759. [PMID: 31047831 DOI: 10.1016/j.jogc.2019.02.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Adolescent pregnancy is a significant public health issue in Canada. Current evidence highlights the individual role of social determinants of health such as maternal residence and socioeconomic status (SES) on teen pregnancy outcomes. This study evaluated the joint association between residence/SES and adverse adolescent pregnancy outcomes. METHODS This was a population-based retrospective cohort study of all singleton, live deliveries (2010-2015) from women aged 15 to 19 who were registered in the Alberta Perinatal Health Program. Information on maternal residence and SES was extracted from the Pampalon Material Deprivation Index data set. The study categorized mothers into four risk dyads: rural/high SES, rural/low SES, urban/high SES, and urban/low SES. Adjusted odds ratios (ORs) of adverse pregnancy outcomes were calculated in logistic regression models (Canadian Task Force Classification II-2). RESULTS A total of 9606 births from adolescent mothers were evaluated. Thirty percent of adolescent mothers were classified as urban/high SES; 27% were urban/low SES; 7% were rural/high SES; and 36% were placed in the rural/low SES category. Compared with urban/high SES mothers, rural/low SES mothers had increased odds of postpartum hemorrhage (OR 1.57; 95% confidence interval [CI] 1.41-1.74), operative vaginal delivery (OR 1.37; 95% CI 1.18-1.60), Caesarean section (OR 1.39; 95% CI 1.19-1.62), large for gestational age infants (OR 1.39; 95% CI 1.16-1.66), low birth weight (OR 1.11; 95% CI 1.07-1.65), and preterm birth (OR 1.48; 95% CI 1.17-1.87). CONCLUSION Rural pregnant adolescents of low SES have the highest odds for adverse pregnancy outcomes. Social determinants of health that affect adolescent pregnancies need further examination to identify high-risk subgroups and understand pathways to health disparities in this vulnerable population.
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Govender D, Naidoo S, Taylor M. Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal. Afr J Prim Health Care Fam Med 2019; 11:e1-e11. [PMID: 31038339 PMCID: PMC6489148 DOI: 10.4102/phcfm.v11i1.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes. AIM The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children. SETTING The study was conducted in a local district hospital in Ugu, KwaZulu-Natal. METHODS An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis. RESULTS Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers. CONCLUSION In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, Ugu District, South Africa; and, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban.
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Dut R, Al RA. A brief study on the knowledge and choice of contraception methods in married adolescent girls. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0091/ijamh-2018-0091.xml. [PMID: 30978171 DOI: 10.1515/ijamh-2018-0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The fertility rate is 0.25% for 15-19-year-old girls and 16% for 19-year-old girls who are mothers or pregnant with their first child. Fifty-two percent of married adolescents did not have affective contraception. To encourage using the right contraceptive methods in married adolescents, it is essential to examine the behaviors of this group, the level of contraceptive knowledge and the choices they make regarding contraceptive use. MATERIALS AND METHODS One hundred and ten married adolescent females, less than 20 years of age, who visited a gynecology and obstetrics clinic between January 2015 and October 2016 were enrolled in this prospective study. RESULTS Of them 96.4% were unemployed. At the time of the study, 70% of them were pregnant. Of these pregnancies, 46.4% was a first, 19.1% a second and 8.2% a third pregnancy. The abortion rate in this study was 18.3%, and stillbirth was 2.8%. The interval between pregnancies was 20.9 months. The unplanned pregnancy rate was 45.5% and 37.3% of these unplanned pregnancies resulted in at least one healthy child. The most common contraceptive method was the use of condoms (10.9%). Changes in contraceptive methods resulted in pregnancy in 66.7% of the cases. Although 20.9% of the husbands in the study used contraceptive methods, 40.9% of them felt that their husbands should be using contraception. Of the participants 43.5% received their knowledge regarding family planning and contraceptive methods from local health clinics. DISCUSSION Teen marriage, pregnancy and teen parents result in socio-economic and educational difficulties. It is essential to support the adolescent parents using affective contraceptive methods and adolescent-friendly health clinics.
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Affiliation(s)
- Raziye Dut
- Department of Pediatric, Istanbul Training and Research Hospital, Telsiz mah. Balıklı Kazlıçeşme Yolu Cd. No:1,34020 Zeytinburnu, İstanbul, Turkey
| | - Ragıp Atakan Al
- Department of Gynecology and Obstetrics, Ataturk University, Yakutiye Training and Research Hospital, Erzurum, Turkey
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Liu N, Farrugia MM, Vigod SN, Urquia ML, Ray JG. Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study. CMAJ 2019; 190:E95-E102. [PMID: 29378869 DOI: 10.1503/cmaj.170595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A teenage woman's sexual health practices may be influenced by her mother's experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters. METHODS We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters' data for induced abortions between age 12 years and their 20th birthday. We assessed each mother's history of induced abortion for the period from 4 years before her daughter's birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter's risk of having an induced abortion in relation to the mother's history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother- daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile. RESULTS A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%-10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%-4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86-2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69-1.85) with 1 maternal abortion, 2.04 (95% CI 1.91-2.18) with 2 maternal abortions, 2.39 (95% CI 2.19-2.62) with 3 maternal abortions and 2.54 (95% CI 2.33-2.77) with 4 or more maternal abortions, relative to none. INTERPRETATION We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion.
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Affiliation(s)
- Ning Liu
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - M Michèle Farrugia
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Marcelo L Urquia
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Joel G Ray
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man.
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Use of Audio Computer-Assisted Self-Interviews to Gather Information on Risk Behaviors in a Population of Pregnant Adolescents. J Pediatr 2018; 203:450-453. [PMID: 30244989 DOI: 10.1016/j.jpeds.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022]
Abstract
In a prospective study comparing the use of the Audio Computer-Assisted Self-Interview (ACASI) with a traditional clinical interview in 40 pregnant adolescents, there was significantly greater disclosure of violence with the ACASI method. Better identification of high-risk behaviors may help to optimize care and programing for pregnant adolescents.
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Abstract
Teenage pregnancy represents a global risk. In France, in 2016, 1.14% of pregnancies concerned 15-17 year olds. Rare in our societies, they are socially condemned. A medical-psychological-sociological literature review shows that, beyond the contraceptive failure or the accidental nature evoked, it is essential to spot high risk situations and focus on the meaning behind these teenage pregnancies.
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Affiliation(s)
- Marjolaine Prieto
- UFR sciences de la santé Simone-Veil, université de Versailles Saint-Quentin-en-Yvelines, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
| | - Laelia Benoit
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
| | - Marie-Rose Moro
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
| | - Rahmeth Radjack
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
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Prieto M, Radjack R, Moro MR, Benoit L. [Caregivers' feelings and practices faced with teenage pregnancies]. Soins Psychiatr 2018; 39:22-27. [PMID: 30473103 DOI: 10.1016/j.spsy.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Teenage pregnancy does not comply with social norms; perceived as a failure, it poses a challenge. How do caregivers support these young girls? Confronted with a variety of situations, they are particularly vigilant with regard to their representations and to literature data. At the same time, practices are based on a transferential relationship similar to a parent-child relationship. The care of a pregnant teenager requires specific adjustments.
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Affiliation(s)
- Marjolaine Prieto
- UFR sciences de la santé Simone-Veil, université de Versailles Saint-Quentin-en-Yvelines, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
| | - Rahmeth Radjack
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
| | - Marie-Rose Moro
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
| | - Laelia Benoit
- Maison de Solenn-MDA, hôpital Cochin, 97, boulevard Port-Royal, 75014 Paris, France
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Pregnancy in adolescents in the last 11 years. Reasons for consulting and risk factors. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Booth L, Wedgeworth M, Turner A. Integrating Optimal Screening, Intervention, and Referral for Postpartum Depression in Adolescents. Nurs Clin North Am 2018; 53:157-168. [DOI: 10.1016/j.cnur.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reyes-Muñoz E, Sandoval-Osuna NL, Reyes-Mayoral C, Ortega-González C, Martínez-Cruz N, Ramírez-Torres MA, Arce-Sánchez L, Lira-Plascencia J, Estrada-Gutiérrez G, Montoya-Estrada A. Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis. BMJ Open 2018; 8:e021617. [PMID: 29654051 PMCID: PMC5905784 DOI: 10.1136/bmjopen-2018-021617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN Retrospective cohort study. SETTING Level-three medical institution in Mexico City. PARTICIPANTS The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
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Affiliation(s)
- Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Norma Lidia Sandoval-Osuna
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Christian Reyes-Mayoral
- Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carlos Ortega-González
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María Aurora Ramírez-Torres
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Josefina Lira-Plascencia
- Research Unit in Adolescent Medicine, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutiérrez
- Direction of Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Exploring young mothers' experiences with postpartum contraception in Ottawa: results from a multimethods qualitative study. Contraception 2018; 97:434-438. [PMID: 29326036 DOI: 10.1016/j.contraception.2017.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Postpartum contraception plays a significant role in reducing subsequent pregnancy. However, young mothers in Ottawa, the capital of Canada, face various barriers when trying to access contraception after delivery. Through this project, we aimed to explore these barriers and understand the decision-making processes of young mothers surrounding postpartum contraception. STUDY DESIGN We conducted 10 semistructured in-depth interviews with young mothers living in Ottawa who had experienced a subsequent pregnancy within 24months of their first childbirth. In addition, we interviewed 10 key informants who work with teenage mothers. We audio-recorded and transcribed all interviews and analyzed them using inductive and deductive techniques. We used ATLAS.ti software to manage our data. RESULTS Both young mothers and key informants report that teen mothers in Ottawa often do not use postpartum contraception or inconsistently use their chosen contraceptive method. Many factors, including cost, personal beliefs, personal priorities and knowledge, influence young mothers' decision making surrounding contraception. CONCLUSIONS Our study suggests that when young mothers do not use postpartum contraception, the reasons are complex; for some, this is a choice, and for others, this is the result of systems-level, service delivery and information barriers. Supporting policies to ensure that a full range of contraceptive methods are available and affordable and developing educational programs in Ottawa that are sex-positive and nonjudgmental appear warranted. IMPLICATIONS Ensuring that a full method mix, including contraceptive implants, is available to and affordable for young mothers in Ottawa could meet significant needs. Addressing existing systems-level, service delivery and information barriers through supporting evidence-based policies and sex-positive and nonjudgmental educational programs appears warranted.
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Abstract
OBJECTIVE We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women. METHODS The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016. RESULTS The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02). CONCLUSIONS Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women.
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Affiliation(s)
- Shunji Suzuki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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