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Püschl IC, de Wolff MG, Broberg L, Macklon N, Hegaard HK. Pregnant women's attitudes to and experiences with a smartphone-based self-test for prediction of pre-eclampsia: a qualitative descriptive study. BMJ Open 2023; 13:e065575. [PMID: 37221028 DOI: 10.1136/bmjopen-2022-065575] [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] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES To explore attitudes to and experiences using a smartphone-based self-test for prediction of pre-eclampsia among pregnant women. DESIGN A qualitative, descriptive study. SETTING An obstetrical care unit at a university hospital in Denmark. PARTICIPANTS Twenty women who had participated in the Salurate trial, a clinical trial testing the efficacy of a smartphone-based self-test for prediction of pre-eclampsia, were purposefully chosen for the study, using maximum variation sampling. DATA COLLECTION AND ANALYSIS Data were collected by semistructured, individual, face-to-face interviews conducted from 4 October 2018 to 8 November 2018. Data were transcribed verbatim and analysed by means of thematic analysis. RESULTS Qualitative thematic analysis resulted in the identification of three main themes: Raising awareness, self-testing has the potential to be an integrated part of pregnancy and trusting in technology. Two subthemes were identified under each main theme. CONCLUSIONS The smartphone-based self-test for prediction of pre-eclampsia has potential to be integrated into antenatal care, and women found it feasible to use. However, testing affected the participating women psychologically, leading to feelings of worry as well as safety. Therefore, if self-testing is implemented, it is important to take actions to handle adverse psychological side effects, including increasing knowledge on pre-eclampsia and having healthcare professionals ongoingly address the psychological state of women throughout pregnancy. In addition, it is essential to emphasise the importance of subjective bodily sensations during pregnancy, including fetal movements. Further studies on the experience of being labelled low risk versus high risk for pre-eclampsia are warranted since this was not investigated in this trial.
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Affiliation(s)
- Ida Catharina Püschl
- Department of Gyneacology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Mie Gaarskjaer de Wolff
- The Research Unit for Women's, Children's and Families' Health, Juliane Marie Centre, Kobenhavn, Denmark
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, Hvidovre, Denmark
| | - Lotte Broberg
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Kobenhavn, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Nick Macklon
- London Womens Clinic, London, UK
- Department of Gynecology and Obstetrics and ReproHealth Consortium, Zealand University Hospital Koge, Koge, Denmark
| | - Hanne Kristine Hegaard
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Kobenhavn, Denmark
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Nikčević AV, Sacchi C, Marino C, O’Gorman N, Poon LC, Nicolaides KH. Psychological Impact and Women's Evaluation of the First-Trimester Pre-Eclampsia Screening and Prevention: ASPRE Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5418. [PMID: 37048032 PMCID: PMC10094560 DOI: 10.3390/ijerph20075418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aims to extend the understanding of the psychological impact of the first-trimester pre-eclampsia (PE) screening on women identified as high risk for preterm PE. We examined the differences between low- vs. high-risk women throughout pregnancy in: symptoms of distress (anxiety, depression, physical and mental health, and worry), health behaviour changes, the experience of pregnancy, and attitudes towards PE screening. METHODS This study was nested within the ASPRE trial. Pregnant women were screened for preterm-PE risk status in the first trimester; the assessments were carried out before the screening, in the second and in the third trimester (n = 155 low-risk women and N = 82 high-risk women in the second trimester). RESULTS The high-risk-for-PE women exhibited more depressive symptoms compared to the low-risk women in the second but not in the third trimester. No differences were observed between the two groups in other distress symptoms or in the women's evaluation of their experience of pregnancy. The high-risk group reported greater health behaviour changes compared to the low-risk group, but this was moderated by depression levels. CONCLUSIONS Overall, pregnant women reported positive attitudes towards first-trimester PE screening, despite transient depressive symptoms. This study offers supportive evidence concerning the appropriateness of PE screening in ethical terms.
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Affiliation(s)
- Ana V. Nikčević
- Department of Psychology, Kingston University, London KT1 2EE, UK
| | - Chiara Sacchi
- Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy
| | - Claudia Marino
- Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy
| | - Neil O’Gorman
- Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Liona C. Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kypros H. Nicolaides
- Harris Birthright Research Centre of Fetal Medicine, King’s College Hospital, London SE5 8BB, UK
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Di Giacomo M, Piacenza M, Siciliani L, Turati G. The effect of co-payments on the take-up of prenatal tests. JOURNAL OF HEALTH ECONOMICS 2022; 81:102553. [PMID: 34808492 DOI: 10.1016/j.jhealeco.2021.102553] [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: 01/13/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Noninvasive prenatal screening tests help identify genetic disorders in a fetus, but their take-up remains low in several countries. Using a regression discontinuity design, we test the causal effect of a policy that eliminated co-payments for noninvasive screening tests in Italy. We identify the treatment effects by a discontinuity in women's eligibility for a free test based on their conception date. We find that the policy increases the probability of women's undergoing noninvasive screening tests by 5.5 percentage points, and the effect varies by socioeconomic status. We do not find evidence of substitution effects with more expensive and riskier invasive diagnostic tests. In addition, the increase in take-up does not affect pregnancy termination or newborn health. We find some evidence of positive effects on mothers' health behaviors during pregnancy as measured by reductions in mothers' weight gain and hospital admissions during pregnancy, but these are statistically significant only at the 10 percent level.
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Affiliation(s)
- Marina Di Giacomo
- University of Torino, Department of Economics, Social Sciences, Applied Mathematics and Statistics (ESOMAS).
| | - Massimiliano Piacenza
- University of Piemonte Orientale, Department of Economics and Business (DISEI), Novara, Italy.
| | - Luigi Siciliani
- University of York, Department of Economics and Related Studies, York, United Kingdom.
| | - Gilberto Turati
- Università Cattolica del Sacro Cuore, Department of Economics and Finance, Rome, Italy.
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Resta R. Birds of a Feather? Genetic Counseling, Genetic Testing, and Humanism. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036673. [PMID: 31548221 DOI: 10.1101/cshperspect.a036673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Humanism is a philosophy that emphasizes rational, scientific, and empiric analysis of the world we live in to improve the physical, social, and psychological life of humanity. Although individual genetic counselors may or may not identify as humanists, genetic counseling and genetic testing are primarily humanistic endeavors because they are situated in the context of humanistic medicine in the westernized world. Humanistic goals are also implicit and explicit in the profession and practice of genetic counselors. This review examines the relationship between humanism and genetic counseling, highlighting situations in which the two may be discordant, and suggests ways that genetic counselors can reconcile these discordances.
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Affiliation(s)
- Robert Resta
- Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington 98104, USA
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Biesecker BB. The Psychological Well-being of Pregnant Women Undergoing Prenatal Testing and Screening: A Narrative Literature Review. Hastings Cent Rep 2020; 49 Suppl 1:S53-S60. [PMID: 31268571 DOI: 10.1002/hast.1017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prenatal screening and testing are preference-based health care options. They are offered so that pregnant women and their partners can learn genetic information about the developing fetus. In this literature review, I summarize studies of women's and their partners' psychological responses to prenatal testing and screening. These studies investigate the experiences of pregnant women, largely in the United States, who have access to health care services. Although the results indicate that these women are receptive to prenatal testing and screening and seem to have limited negative psychological consequences, pregnant women without access to these services are not represented and may have different experiences. With that caveat in mind, based on the evidence, women generally do well psychologically as they manage the options that arise for them in the prenatal context.
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Crombag NMTH, Lamain-de Ruiter M, Kwee A, Schielen PCJI, Bensing JM, Visser GHA, Franx A, Koster MPH. Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women: a qualitative study. BMC Pregnancy Childbirth 2017; 17:12. [PMID: 28061818 PMCID: PMC5219667 DOI: 10.1186/s12884-016-1195-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/13/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation. METHOD Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers. RESULTS Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety. CONCLUSION Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.
| | - Marije Lamain-de Ruiter
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,The Netherlands Institute for Health Services Research Utrecht, Utrecht, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.,Department of obstetrics and gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Shiloh S, Drori E, Peleg S, Banai S, Finkelstein A. Mediation and moderation of the effects of watching the angiography screen on patients. PSYCHOL HEALTH MED 2016; 21:806-18. [PMID: 26740003 DOI: 10.1080/13548506.2015.1131997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients' personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.
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Affiliation(s)
- Shoshana Shiloh
- a The Gordon Faculty of Social Sciences, School of Psychological Sciences , Tel Aviv University , Tel Aviv , Israel
| | - Erga Drori
- a The Gordon Faculty of Social Sciences, School of Psychological Sciences , Tel Aviv University , Tel Aviv , Israel
| | - Shira Peleg
- a The Gordon Faculty of Social Sciences, School of Psychological Sciences , Tel Aviv University , Tel Aviv , Israel
| | - Shmuel Banai
- b Sackler Faculty of Medicine, Department of Cardiology, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Ariel Finkelstein
- b Sackler Faculty of Medicine, Department of Cardiology, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
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The relationship between frequency of obstetric ultrasound scans and birthplace preference – A case control study. Midwifery 2015; 31:31-6. [DOI: 10.1016/j.midw.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 04/07/2014] [Accepted: 05/04/2014] [Indexed: 11/24/2022]
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Harris J, Franck L, Green B, Michie S. The psychological impact of providing women with risk information for pre-eclampsia: A qualitative study. Midwifery 2014; 30:1187-95. [DOI: 10.1016/j.midw.2014.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/17/2014] [Accepted: 04/20/2014] [Indexed: 11/30/2022]
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Peterson WE, Sprague AE, Reszel J, Walker M, Fell DB, Perkins SL, Dunn SI, Johnson M. Women's perspectives of the fetal fibronectin testing process: a qualitative descriptive study. BMC Pregnancy Childbirth 2014; 14:190. [PMID: 24894630 PMCID: PMC4055372 DOI: 10.1186/1471-2393-14-190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/30/2014] [Indexed: 11/14/2022] Open
Abstract
Background In 2009 the Ontario Ministry of Health and Long Term Care funded the implementation of province-wide fetal fibronectin testing in Ontario hospitals. This paper reports results from the provincial evaluation that sought to describe the experience of fetal fibronectin testing from the perspective of women with symptoms of preterm labour. Methods A descriptive qualitative design was used, employing semi-structured telephone and face-to-face interviews with women who had fetal fibronectin testing. Results Five hospitals participated in recruiting women for the study and 17 women were interviewed. Women described their experiences of fetal fibronectin testing as an emotional process that moves from expecting, to feeling, to hoping for reassurance; and then to re-defining what is required to feel reassured. Women described feeling anxious while waiting for fetal fibronectin results. When test results were negative, women described feeling a sense of relief that their symptoms would not likely lead to an imminent preterm birth. Women with positive results expressed feeling reassured by the care decisions and quick action taken by the health care team. Conclusion Fetal fibronectin testing was acceptable and beneficial to these women with symptoms of preterm labour. Implications for practice and future research are suggested.
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Affiliation(s)
- Wendy E Peterson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Room 1118 F, Ottawa, Ontario K1H 8M5, Canada.
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Košec V, Nakić Radoš S, Gall V. Development and validation of the Prenatal Diagnostic Procedures Anxiety Scale. Prenat Diagn 2014; 34:770-7. [PMID: 24676886 DOI: 10.1002/pd.4365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/12/2014] [Accepted: 03/23/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES As there are currently no specific measures of anxiety due to prenatal diagnostic procedures, the aim of the study was to develop and validate a new measure called the Prenatal Diagnostic Procedure Anxiety Scale (PDPAS). METHODS Seventy-four pregnant women scheduled for amniocentesis and ultrasound completed the PDPAS, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale before undergoing the diagnostic procedure. Reliability, concurrent validity, factor structure, scale sensitivity, and specificity were analyzed. Differences between amniocentesis and ultrasound groups in the PDPAS score were analyzed with a t-test. RESULTS The final scale comprised 11 items and two subscales measuring 'fear of procedure' and 'fear of abnormal result'. Concurrent validity analysis showed that the PDPAS is an independent measure of anxiety. At a cut-off score of >11, sensitivity was 75.0% and specificity was 72.01% with moderate accuracy. Fear of procedure was higher in the amniocentesis group, whereas fear of abnormal result was equally present in both amniocentesis and ultrasound groups. CONCLUSION The PDPAS has good internal consistency and concurrent validity with satisfactory psychometric characteristics. As a short measure of situation-specific anxiety, it can be used as a screening tool in prenatal clinical settings.
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Affiliation(s)
- Vesna Košec
- Department of Obstetrics & Gynecology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
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Park FJ, Leung CH, Poon LC, Williams PF, Rothwell SJ, Hyett JA. Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy. Aust N Z J Obstet Gynaecol 2013; 53:532-9. [DOI: 10.1111/ajo.12126] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/05/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Felicity J. Park
- Department of High Risk Obstetrics; Royal Prince Alfred Hospital; Sydney NSW Australia
- Discipline of Obstetrics, Gynaecology and Neonatology; University of Sydney; Sydney NSW Australia
| | - Constance H.Y. Leung
- Discipline of Obstetrics, Gynaecology and Neonatology; University of Sydney; Sydney NSW Australia
| | - Leona C.Y. Poon
- Harris Birthright Research Centre for Fetal Medicine; King's College Hospital; London UK
- Department of Obstetrics and Gynaecology; St Mary's Hospital; London UK
| | - Paul F. Williams
- Discipline of Medicine; University of Sydney; Sydney NSW Australia
- Endocrinology Laboratory; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Samantha J. Rothwell
- Department of High Risk Obstetrics; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Jon A. Hyett
- Department of High Risk Obstetrics; Royal Prince Alfred Hospital; Sydney NSW Australia
- Discipline of Obstetrics, Gynaecology and Neonatology; University of Sydney; Sydney NSW Australia
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Malouf R. Why use systematic reviews in pregnancy, birth and infant psychology research? J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.749042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Reem Malouf
- a National Perinatal Epidemiology Unit , University of Oxford , Oxford , UK
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