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Hensel D, Helou NE, Zhang F, Stout MJ, Raghuraman N, Friedman H, Carter E, Odibo AO, Kelly JC. The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care. Am J Perinatol 2024; 41:884-890. [PMID: 35668653 DOI: 10.1055/s-0042-1748526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. STUDY DESIGN This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic-Clinic for Acceptance Recovery and Empowerment (CARE)-between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. RESULTS A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05-1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76-1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36-1.84). CONCLUSION In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. KEY POINTS · Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic..
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Affiliation(s)
- Drew Hensel
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nicole El Helou
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Fan Zhang
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony Carter
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Anthony O Odibo
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeannie C Kelly
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Hochberg A, Badeghiesh A, Baghlaf H, Tseva AT, Dahan MH. The effect of socioeconomic status on adverse obstetric and perinatal outcomes in women with polycystic ovary syndrome-An evaluation of a population database. Int J Gynaecol Obstet 2024; 165:275-281. [PMID: 37855037 DOI: 10.1002/ijgo.15201] [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: 08/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To evaluate the modifying effect of low socioeconomic status (SES) on polycystic ovary syndrome (PCOS) women's pregnancy and neonatal complications. METHODS A retrospective population-based cohort study including all women with an ICD-9 diagnosis of PCOS in the US between 2004 and 2014, who delivered in the third trimester or had a maternal death. SES was defined according to the total annual family income quartile for the entire population studied. We compared women in the lowest income quartile (<$39 000 annually) to those in the higher income quartiles combined (≥$39 000 annually). Pregnancy, delivery, and neonatal outcomes were compared between the two groups. RESULTS Overall, 9 096 788 women delivered between 2004 and 2014, of which 12 322 had a PCOS diagnosis and evidence of SES classification. Of these, 2117 (17.2%) were in the lowest SES group, and 10 205 (82.8%) were in the higher SES group. PCOS patients in the lowest SES group, compared to the higher SES group, were more likely to be younger, obese (body mass index ≥30 kg/m2 ), to have smoked tobacco during pregnancy, and to have chronic hypertension and pregestational diabetes mellitus (DM) (P < 0.05). In a multivariate logistic regression, women in the lowest SES group, compared to the higher SES group, had increased odds of pregnancy-induced hypertension (aOR 1.27, 95% CI: 1.12-1.46, P < 0.001), pre-eclampsia (aOR 1.37, 95% CI: 1.14-1.65, P < 0.001), and cesarean delivery (aOR 1.21, 95% CI: 1.09-1.34, P < 0.001), with other comparable pregnancy, delivery and neonatal outcomes. CONCLUSION In PCOS patients, low SES increases the risk for pregnancy-induced hypertension, pre-eclampsia and CD, highlighting the importance of diligent pregnancy follow-up and pre-eclampsia prevention in these patients.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Haitham Baghlaf
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Ayellet Tzur Tseva
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Kim HW. Perspectives on promoting healthy pregnancies. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:1-5. [PMID: 38650321 PMCID: PMC11073554 DOI: 10.4069/whn.2024.03.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Hae Won Kim
- The Research Institute of Nursing Science, SNU Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21, Seoul National University College of Nursing, Seoul, Korea
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Masilela LN, Modjadji P. Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1294. [PMID: 37628293 PMCID: PMC10453191 DOI: 10.3390/children10081294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers' nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80-100), good (60-79), average (40-59), and fair (0-39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers' nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers' nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12-3.29), child's age (6-11 months: AOR = 2.63, 95%CI: 1.53-4.53 and 12-23 months: AOR = 3.19, 95%CI: 1.41-7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15-0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.
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Affiliation(s)
- Lucy Nomsa Masilela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Alves AC, Souza RT, Mayrink J, Galvao RB, Costa ML, Feitosa FE, Rocha Filho EA, Leite DF, Tedesco RP, Santana DS, Fernandes KG, Miele MJ, Souza JP, Cecatti JG. Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study. BMC Pregnancy Childbirth 2023; 23:396. [PMID: 37248450 DOI: 10.1186/s12884-023-05692-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Resilience reflects coping with pregnancy-specific stress, including physiological adaptations of the maternal organism or factors arising from the socioeconomic context, such as low income, domestic violence, drug and alcohol use, lack of a support network and other vulnerability characteristics. Resilience is a dynamic characteristic that should be comparatively evaluated within a specific context; its association with perceived stress and social vulnerability during pregnancy is still not fully understood. This study aimed at exploring maternal resilience, perceived stress and social vulnerability during pregnancy and its associated factors and outcomes. METHODS Prospective multicenter cohort study of nulliparous women in Brazil determining resilience (Resilience Scale; RS) and stress (Perceived Stress Scale; PSS) at 28 weeks of gestation (± 1 week). Resilience and stress scores were compared according to sociodemographic characteristics related to maternal/perinatal outcomes and social vulnerability, defined as having low level of education, being adolescent, without a partner or ethnicity other than white. RESULTS We included 383 women who completed the RS and PSS instruments. Most women showed low resilience scores (median: 124.0; IQR 98-143). Women with a low resilience score (RS < 125) were more likely from the Northeast region, adolescents, other than whites, did not study or work, had a low level of education, low family income and received public antenatal care. Higher scores of perceived stress were shown in the Northeast, other than whites, at low levels of education, low annual family income and public antenatal care. Pregnant women with low resilience scores (n = 198) had higher perceived stress scores (median = 28) and at least one vulnerability criterion (n = 181; 91.4%). CONCLUSION Our results reinforce the role of resilience in protecting women from vulnerability and perceived stress. It may prevent complications and build a positive experience during pregnancy.
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Affiliation(s)
- Anic C Alves
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Rafael B Galvao
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | | | - Edilberto A Rocha Filho
- Department of Gynecology and Obstetrics, Medical Sciences School, Federal University of Pernambuco, Recife, PE, Brazil
| | - Débora F Leite
- Department of Gynecology and Obstetrics, Medical Sciences School, Federal University of Pernambuco, Recife, PE, Brazil
| | - Ricardo P Tedesco
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Danielly S Santana
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil
| | - Joao P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming, Cidade Universitária, Campinas, SP, Brazil.
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Lange AE, Mahlo-Nguyen J, Pierdant G, Allenberg H, Heckmann M, Ittermann T. Antenatal Care and Health Behavior of Pregnant Women—An Evaluation of the Survey of Neonates in Pomerania. CHILDREN 2023; 10:children10040678. [PMID: 37189927 DOI: 10.3390/children10040678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Background. The German maternity guidelines require regular medical checkup (MC) during pregnancy as a measure of prevention. Socioeconomic factors such as education, profession, income and origin, but also age and parity may influence the preventive and health behavior of pregnant women. The aim was to investigate the influence of these factors on the participation rate in MC of pregnant women. Method. The current analysis is based on the prospective population-based birth cohort study Survey of Neonates in Pomerania, which was conducted in Western Pomerania, Germany. The data of 4092 pregnant women from 2004 to 2008 were analyzed regarding the antenatal care and health behavior. Up to 12 MC were regularly offered; participation in 10 MC is defined as standard screening according to maternity guidelines. Results. Women participated in the first preventive MC on average in the 10th (±3.8 SD) week of pregnancy. 1343 (34.2%) women participated in standard screening and 2039 (51.9%) took a screening above standard. 547 (13.92%) women participated in less than the 10 standard MCs. In addition, about one-third of the pregnancies investigated in this study were unplanned. Bivariate analyses showed an association between better antenatal care behavior and higher maternal age, stabile partnerships and mother born in Germany, p < 0.05. On the contrary antenatal care below standard were more often found by women with unplanned pregnancies, less educational women and women with lower equivalent income, p < 0.001. Health behaviors also influenced antenatal care. Whereas the risk of antenatal care below standard increased by smoking during pregnancy (RRR 1.64; 95% CI 1.25, 2.14) and alcohol consumption (RRR 1.31; 95% CI 1.01, 1.69), supplementation intake was associated with decreased risk (iodine—RRR 0.66; 95% CI 0.53, 0.81; folic acid—RRR 0.56; 95% CI 0.44, 0.72). The health behavior of pregnant women also differs according to their social status. Higher maternal income was negatively correlated with smoking during pregnancy (OR 0.2; 95% CI 0.15, 0.24), but positively associated with alcohol consumption during pregnancy (OR 1.3; 95% CI 1.15, 1.48) and lower pre-pregnancy BMI (Coef. = 0.083, p < 0.001). Lower maternal education was positively correlated with smoking during pregnancy (OR 59.0; 95% CI 28.68, 121.23). Conclusions. Prenatal care according to maternity guidelines is well established with a high participation rate in MC during pregnancy of more than 85%. However, targeted preventive measures may address younger age, socioeconomic status and health-damaging behaviors (smoking, drinking) of the pregnant women because these factors were associated with antenatal care below standard.
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Affiliation(s)
- Anja Erika Lange
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Janine Mahlo-Nguyen
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Guillermo Pierdant
- Department of Obstetrics and Gynecology, University of Greifswald, 17475 Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, University of Greifswald, 17475 Greifswald, Germany
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Seabela ES, Modjadji P, Mokwena KE. Facilitators and barriers associated with breastfeeding among mothers attending primary healthcare facilities in Mpumalanga, South Africa. Front Nutr 2023; 10:1062817. [PMID: 36998907 PMCID: PMC10043338 DOI: 10.3389/fnut.2023.1062817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
IntroductionDespite the health benefits of breastfeeding for both the mother and the child, early cessation of breastfeeding remains a public health problem in South Africa, attributed to contextual barriers and facilitators. Within the context of Mpumalanga province, which is characterized by low breastfeeding rates and high infant mortality rates in children under 5 years, we explored the facilitators and barriers to breastfeeding among mothers attending the three primary health facilities in Ermelo.MethodsUsing a semi-structured interview guide suggested by the socio-ecological model, three focus group discussions and 12 in-depth interviews were conducted among mothers selected using a purposive sampling. Transcripts from audiotaped and transcribed verbatim interviews were assessed through thematic analysis using NVivo version 10.ResultsMothers were aged between 18 and 42 years and from poor sociodemographic backgrounds. At the individual level, mothers valued breastfeeding facilitated by their commitment, maintaining it, eating healthy foods, and having sufficient breast milk. However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. At the interpersonal level, the family was identified as the main form of support to breastfeeding mothers; however, family interference was also identified as a barrier. At the community level, mothers shared some family beliefs and practices but were still split between societal and cultural norms and traditional beliefs as facilitators or barriers to breastfeeding. At the organizational level, most mothers valued the support provided by healthcare workers on childcare and techniques for breastfeeding at the health facilities. They did however articulate concerns on the miscommunication some healthcare workers offered regarding breastfeeding, which negatively influenced their infant feeding practices.DiscussionIntervention efforts should focus on behaviour change to educate and equip mothers to overcome the barriers that are within their control. Such interventions should further focus on family-centered education and strengthening the proficiency of healthcare workers on advising breastfeeding mothers.
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Affiliation(s)
- Ethel Sekori Seabela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- *Correspondence: Perpetua Modjadji
| | - Kebogile Elizabeth Mokwena
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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Mohammadian F, Nejadifard MM, Tofighi S, Garrosi L, Molaei B. Adverse Maternal, Perinatal, and Neonatal Outcomes in Adolescent Pregnancies: A Case-Control Study. J Res Health Sci 2023; 23:e00570. [PMID: 37571941 PMCID: PMC10422142 DOI: 10.34172/jrhs.2023.105] [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: 01/12/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Despite the increase in the age of marriage, early marriage and subsequent adolescent pregnancy remain a serious problem in many regions and societies. Due to low evidence in this regard, this study was conducted to determine the health consequences of adolescent pregnancy. STUDY DESIGN This was a case-control study. METHODS The present study was performed on pregnant women who were referred to Ayatollah Mousavi hospital of Zanjan for delivery in 2021. Pregnant women with gestational age less than 19 years were considered as the case group and those with gestational age between 19-35 years as the control group. The pregnancy outcomes on the mother and the neonate were obtained through the researcher-made checklist. Chi-square test and student's t-test were used to compare variables between the two groups. RESULTS In this study, 169 adolescent and 258 adult mothers were compared as the case and control groups, respectively. The mean age of cases and controls was 17.41±1.22 and 30.66±6.46 years, respectively. Cesarean delivery (34.5% vs. 23.67%, P=0.017) and anemia during pregnancy (16.28% vs. 10.7%, P=0.005) were significantly higher in the control group, while mood disorder after delivery was significantly higher in the case group (11.24% vs. 5.84%, P=0.04). The Apgar score 5 minutes after birth and birth weight were significantly higher in mothers of the control group (P<0.05). CONCLUSION The results demonstrated that adolescent mothers are more prone to postpartum depression, and babies born to these mothers are more prone to low birth weight and a low Apgar score. Therefore, adolescent pregnancy should be managed as a high-risk pregnancy.
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Affiliation(s)
- Farnaz Mohammadian
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Monireh Moharram Nejadifard
- Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Shabnam Tofighi
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Lida Garrosi
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Behnaz Molaei
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Teixeira GA, Holanda NSO, Azevedo IG, Moura JR, de Carvalho JBL, Pereira SA. Factors Associated with Number of Prenatal Visits in Northeastern Brazil: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14912. [PMID: 36429631 PMCID: PMC9690730 DOI: 10.3390/ijerph192214912] [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: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study is to assess factors associated with the number of prenatal visits of women who delivered in a public maternity hospital in northeastern Brazil. This cross-sectional study focused on 380 puerperal women who gave birth at a public maternity hospital in northeastern Brazil. Prenatal and perinatal data were collected in the immediate postpartum period by interviewing mothers and using medical records. Chi-square/Fisher exact test compared the data, and a logistic regression model estimated the association between birth weight and number of prenatal visits. As a result, the sample was composed of 175 women with <37 weeks of gestational age and 205 women with ≥37 weeks of gestational age. Women with less than four prenatal visits were more likely to give birth to low birth weight (<2500 g) and preterm infants (<37 weeks of gestational age) than those with more than four prenatal visits (p = 0.001). The subjects with less than four prenatal visits had a 2.76-fold higher odds of giving birth to infants weighing less than 2500 g (p = 0.03; 95%CI = 1.05-7.30), without relation to maternal and gestational ages. In conclusion, women with less than four prenatal visits had higher odds of giving birth to low birth infants, independently of maternal and gestational ages, and were more likely to give birth to premature babies.
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Affiliation(s)
- Gracimary A. Teixeira
- Health Technical School, Federal University of Paraiba, João Pessoa 58051-900, PB, Brazil
| | - Norrara S. O. Holanda
- Health Sciences’ Faculty of Trairi, Federal University of Rio Grande do Norte (FACISA—UFRN), Santa Cruz 59200-000, RN, Brazil
| | - Ingrid G. Azevedo
- Department of Therapeutic Processes, Universidad Católica de Temuco, Temuco 4813302, La Araucania, Chile
| | - Julia R. Moura
- Department of Physical Therapy, Graduate Program of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal 59090-000, RN, Brazil
| | - Jovanka B. L. de Carvalho
- Graduate Program in Health and Society and Graduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil
| | - Silvana A. Pereira
- Department of Physical Therapy, Graduate Program of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal 59090-000, RN, Brazil
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Impact of preeclampsia/eclampsia on hemorrhagic and ischemic stroke risk: A 17 years follow-up nationwide cohort study. PLoS One 2022; 17:e0276206. [DOI: 10.1371/journal.pone.0276206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background and purposes
The long-term risk of stroke in women with preeclampsia/eclampsia is a concerning issue. In this study we further investigated different stroke subtypes and differentiated follow-up time intervals.
Methods
Between 2000 and 2017, 1,384,427 pregnant women were registered in the National Health Insurance Research Database in Taiwan. After excluding women with previous stroke history and exact matching with all confounders, 6,053 women with preeclampsia/eclampsia and 24,212 controls were included in the analysis sample.
Results
Over the 17-year follow-up, the adjusted hazard ratio (aHR) for stroke in women with preeclampsia/eclampsia was 2.05 (95% confidence interval, CI = 1.67–2.52, p<0.001). The 17 years overall aHR of both ischemic and hemorrhagic stroke were 1.98 and 3.45, respectively (p<0.001). The stroke subtypes, hemorrhagic and ischemic, had different time trend risks, and hemorrhagic stroke risks kept higher than that of ischemic stroke. The aHR of ischemic stroke reached a peak during 1–3 years after childbirth (aHR = 3.09). The aHR of hemorrhagic stroke reached a peak during 3–5 years (aHR = 7.49).
Conclusions
Stroke risk persisted even after decades, for both ischemic and hemorrhagic subtypes. Women with preeclampsia/eclampsia history should be aware of the long-term risk of stroke.
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Kaur A, Hornberger LK, Fruitman D, Ngwezi D, Eckersley LG. Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:359-366. [PMID: 35839119 DOI: 10.1002/uog.26030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Socioeconomic status (SES) and distance of residence from tertiary care may impact fetal detection of congenital heart disease (CHD), partly through reduced access to and quality of obstetric ultrasound screening. It is unknown whether SES and remoteness of residence (RoR) affect prenatal detection of CHD in jurisdictions with universal health coverage. We examined the impact of SES and RoR on the rate and timing of prenatal diagnosis of major CHD within the province of Alberta in Canada. METHODS In this retrospective study, we identified all fetuses and infants diagnosed with major CHD in Alberta, from 2008 to 2018, that underwent cardiac surgical intervention within the first year after birth, died preoperatively, were stillborn or underwent termination. Using maternal residence postal code and geocoding, Chan SES index quintile, geographic distance from a tertiary-care fetal cardiology center and the Canadian Index of Remoteness (IoR) were calculated. Outcome measures included rates of prenatal diagnosis and diagnosis after 22 weeks' gestation. Risk ratios (RR) were calculated using log-binomial regression and stratified by rural (≥ 100 km from tertiary care) or metropolitan (< 100 km from tertiary care) residence, adjusting for year of birth and the obstetric ultrasound screening view in which CHD would most likely be detected (four-chamber view; outflow-tract view; three-vessel or three-vessels-and-trachea or non-standard view; septal view). RESULTS Of 1405 fetuses/infants with major CHD, prenatal diagnosis occurred in 814 (57.9%). Residence ≥ 100 km from tertiary care (adjusted RR, 1.19; 95% CI, 1.05-1.34) and higher IoR (adjusted RR, 1.9; 95% CI, 1.1-3.3) were associated with missed prenatal diagnosis of major CHD. Similarly, residence ≥ 100 km from tertiary care (adjusted RR, 1.41; 95% CI, 1.22-1.62) and higher IoR (adjusted RR, 3.6; 95% CI, 2.2-8.2) were associated with prenatal diagnosis after 22 weeks. Although adjusted and unadjusted analyses showed no association between Chan SES index quintile and prenatal-diagnosis rate overall nor for residence in rural areas, in metropolitan regions, lower SES quintiles were associated with missed prenatal diagnosis (quintile 1: RR, 1.24; 95% CI, 1.02-1.50) and higher risk of diagnosis after 22 weeks' gestation (quintile 1: RR, 1.46; 95% CI, 1.10-1.93; quintile 2: RR, 1.66; 95% CI, 1.24-2.23). CONCLUSIONS Despite universal healthcare, rural residence in Alberta is associated with lower rate of prenatal diagnosis of major CHD and higher risk of late prenatal diagnosis (≥ 22 weeks). Within metropolitan regions, lower SES impacts negatively prenatal-diagnosis rate and timing. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Kaur
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - L K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - D Fruitman
- Division of Cardiology, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - D Ngwezi
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - L G Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
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12
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Nam JY, Oh SS, Park EC. The Association Between Adequate Prenatal Care and Severe Maternal Morbidity Among Teenage Pregnancies: A Population-Based Cohort Study. Front Public Health 2022; 10:782143. [PMID: 35712308 PMCID: PMC9192951 DOI: 10.3389/fpubh.2022.782143] [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: 09/23/2021] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to examine whether inadequate prenatal care affect the risk of severe maternal morbidity in teenage pregnancies. Methods We included 23,202 delivery cases among adolescent mothers aged between 13 and 19 years old with ≥ 37 weeks' gestational age. Data were derived from the National Health Insurance Service National Delivery Cohort in Korea between 2003 and 2018. We used a generalized estimating equation model while adjusting for numerous covariates to determine the adjusted relative risk (RR) associated with severe maternal morbidity. The main outcome measures were severe maternal morbidity and the Kessner Adequacy of Prenatal Care Index. Results Severe maternal morbidity occurred in 723 (3.1%) of the 23,202 investigated delivery cases. The risk of severe maternal morbidity was 1.8-fold higher among adolescent mothers who had received inadequate prenatal care (RR, 1.81, 95% confidence interval [CI], 1.39–2.37) and 1.6-fold higher among those who had received intermediate prenatal care (RR, 1.59, 95% CI, 1.33–1.87) compared to those with adequate prenatal care. Synergistic effects of inadequate prenatal care and maternal comorbidities affected severe maternal morbidity. Conclusion This study confirmed that inadequate prenatal care is associated with increased risk of severe maternal morbidity among pregnant teenagers. Notably, maternal comorbidity and inadequate prenatal care produced synergistic effects on severe maternal morbidity. Public health policy makers should focus on the development and implementation of programs to ensure that adequate prenatal care and financial/healthcare support is provided to teenage mothers during their pregnancies.
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Affiliation(s)
- Jin Young Nam
- Department of Healthcare Management, Eulji University, Seongnam, South Korea
| | - Sarah Soyeon Oh
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea
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Bruno SKB, Rocha HAL, Rocha SGMO, Araújo DABS, Campos JS, Silva ACE, Correia LL. Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study. BMC Pregnancy Childbirth 2021; 21:616. [PMID: 34496791 PMCID: PMC8427858 DOI: 10.1186/s12884-021-04088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent motherhood (AM) remains a public health problem, especially in low and middle income countries, where approximately 95% of these births occur. Evidence from studies with population representativeness about events associated with AM is limited. We assessed the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. METHODS A population-based cross-sectional study on maternal and child health of women aged 10 to 49 years, living in the state of Ceará, in northeastern Brazil was carried out to assess the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. The definition of adolescence used in the study was the one utilized by the WHO. In addition to the interview, data were double-checked according to the information in the government's pregnancy health booklet. Sample-adjusted logistic models to determine the association of socioeconomic factors and AM, as well as the association of AM with obstetric outcomes, with a causal approach to multivariate analyses, were used. RESULTS The prevalence of adolescent motherhood was 18.6%. Poverty and household crowding were associated with greater chances of AM (p values of 0.038 and < 0.001, respectively), as well as not being in a stable relationship (OR 2.26 (95%CI: 1.67, 3.07), p < 0.001). AM showed a greater chance of not using community health services (p < 0.001), had fewer prenatal consultations (β - 0.432 (95%CI: - 0.75, - 0.10)) and started prenatal care at a later date (β 0.38 (95%CI: 0.21, 0.55), p < 0.001)). AM are also less likely to be tested for HIV and more likely to have urinary tract infections. CONCLUSIONS Interventions aimed at socially-vulnerable adolescents are suggested. However, if pregnant, adolescents should receive proactive and differentiated prenatal care.
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Affiliation(s)
| | - Hermano Alexandre Lima Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA. .,Department of Maternal and Child Health, Federal University of Ceará, Rua Professor Costa Mendes, 1608 5 Andar, Fortaleza, Ceará, Brasil CEP: 60430-140, Brazil.
| | | | | | | | | | - Luciano Lima Correia
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
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14
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Barbosa de Andrade R, Pirkle CM, Sentell T, Bassani D, Rodrigues Domingues M, Câmara SMA. Adequacy of Prenatal Care in Northeast Brazil: Pilot Data Comparing Attainment of Standard Care Criteria for First-Time Adolescent and Adult Pregnant Women. Int J Womens Health 2020; 12:1023-1031. [PMID: 33204175 PMCID: PMC7667512 DOI: 10.2147/ijwh.s272743] [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: 07/18/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Adolescent pregnancy is a public health concern worldwide, particularly in low-income settings. Adolescent mothers face higher risks during pregnancy and delivery compared to adult mothers and yet, may also experience worse quality of obstetrical care. This study evaluates adherence to meeting Brazilian recommendations for prenatal care by comparing first-time adolescent versus adult mothers in a rural, low-income setting. Methods Using data from the Adolescence and Motherhood Research (AMOR) project, we evaluated adherence to national recommendations as documented in the prenatal cards of 39 adolescents (13-18 years) and 37 adults (23-28 years) from a low-income area in northeast Brazil. Recommendations included ≥6 prenatal consultations, gestational age ≤12 weeks at the first visit, participation in 3 educational activities, 2 serology for syphilis (VDRL) and HIV, 1 Toxoplasmosis serology, 2 urine tests, 2 blood glucose and 2 hemoglobin/hematocrit (Hb/Ht) exams. Chi-square tests were used to compare the proportions of adolescents and adults with a record of these procedures in the prenatal cards. Results Compared to adult women, the adolescent group had lower attainment of almost all recommended components of prenatal care compared to the adult group, with statistically significant differences for 2 blood glucose tests (46.2% vs 78.4%; p=0.004), 2 VDRL tests (30.8% vs 54.1%; p=0.040), 2 Hb/Ht exams (35.9% vs 83.8%; p<0.001), and at least 6 consultations (84.6% vs 100%; p=0.013). Conclusion Despite greater health risks of adolescent fertility, the prenatal cards of adolescent mothers presented a poorer record of adherence to recommendations for adequate prenatal care compared to adult mothers from a low-income setting of Brazil. Health policies for both health professionals and the target population are needed to ensure adequacy of prenatal care and appropriate risk reduction for this vulnerable population.
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Affiliation(s)
- Raísa Barbosa de Andrade
- Postgraduate Program in Public Health, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Diego Bassani
- Department of Paediatrics, Faculty of Medicine & Dalla Lana School of Public Health University of Toronto, Toronto, ON, Canada
| | | | - Saionara M A Câmara
- Postgraduate Program in Public Health, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil.,Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
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Lamichhane DK, Lee SY, Ahn K, Kim KW, Shin YH, Suh DI, Hong SJ, Kim HC. Quantile regression analysis of the socioeconomic inequalities in air pollution and birth weight. ENVIRONMENT INTERNATIONAL 2020; 142:105875. [PMID: 32590283 DOI: 10.1016/j.envint.2020.105875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/02/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND An association between maternal exposure to air pollution and the birth weight distribution has been reported, but the extent to which this relationship varies according to socioeconomic status (SES) is unknown. This study examined the relationship using the data from a Korean birth cohort. METHODS Data for singleton births in Seoul from 2007 to 2017 (n = 1739) were analyzed. Maternal exposures to particulate matter with an aerodynamic diameter <10 µm (PM10) and <2.5 µm (PM2.5), as well as to nitrogen dioxide (NO2) and ozone (O3) for each trimester and the entire pregnancy were estimated using residential address, gestational age, and the birth date. The associations between the interquartile range (IQR) increases in pollutant concentrations and the changes in birth weight were examined using linear regression and quantile regression models. The socioeconomic disparities in the associations were investigated using a derived SES variable based on the composite of parental education and occupation. This SES variable was then interacted with the air pollutant. RESULTS In the gestational age-adjusted models, particulate air pollutants (PM10 and PM2.5) and O3 were associated with birth weight decreases for the lower birth weight percentiles. For example, the decrease in mean birthweight per IQR increase in PM2.5 during second trimester was -21.1 g (95% confidence interval (CI) = -41.8, -0.4), whereas the quantile-specific associations were: 10th percentile -27.0 g (95% CI = -46.6, -7.3); 50th percentile -22.2 g (95% CI = -39.6, -4.8); and 90th percentile -22.9 g (95% CI = -45.5, -0.2). Particulate air pollutants and O3 showed a pattern of socioeconomic inequalities; the reduced birth weight was of greater magnitude for children from a low SES group. CONCLUSIONS Negative associations between particulate air pollutants and O3 and birth weight were consistently greater at the lower quantiles of the birth weight distribution, especially in lower SES group.
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Affiliation(s)
- Dirga Kumar Lamichhane
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
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Kemelbekov KS, Ayazbekov A, Nurkhasimova R, Kulbayeva S, Bolat K, Kurmanova AM, Yeskarayeva A, Sarbassova M. Features of Pregnancy, Childbirth and Postpartum Period of Young Mothers. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/8459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baş EK, Bülbül A, Uslu S, Baş V, Elitok GK, Zubarioğlu U. Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents. Med Sci Monit 2020; 26:e919922. [PMID: 32087083 PMCID: PMC7055197 DOI: 10.12659/msm.919922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents. Material/Methods A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded. Results Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%). Conclusions In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.
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Affiliation(s)
- Evrim Kiray Baş
- Department of Neonatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Bülbül
- Department of Neonatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Uslu
- Department of Neonatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Vedat Baş
- Department of Pediatrics, Istanbul Arel University, Istanbul, Turkey
| | - Gizem Kara Elitok
- Department of Pediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Umut Zubarioğlu
- Department of Neonatology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
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Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3124847. [PMID: 32051825 PMCID: PMC6995314 DOI: 10.1155/2020/3124847] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022]
Abstract
Introduction One of the major public health issues across the whole world these days is teenage pregnancy which is defined as being pregnant in the age ranging from 13–19 years. About 11% of all births which occurred worldwide accounted for girls aged 15 to 19 years. From these, 95% teenage deliveries occur in low- and middle-income countries. World health 2014 statistics show that complications during pregnancy and childbirth are the second cause of death for 15–19-year-old girls globally. The aim of this study was to determine adverse obstetrical and perinatal outcomes of teenage pregnancy among deliveries at Lemlem Karl General Hospital, Tigray, Ethiopia, 2018. Result This study result showed that 17.5% of the teenagers and 6.8% of the adults deliver low birth weight neonates. From the total teenage mothers, about thirty-five (11.3%) of them had developed pregnancy-induced hypertension, whereas about thirteen (4.2%) of adults develop pregnancy-induced hypertension. Regarding cesarean delivery, forty (12.9%) of those teenage mothers deliver by a cesarean section while 58 (18%) of the adult mothers deliver by cesarean delivery. Teenage pregnancy was significantly associated with adverse obstetric and perinatal outcomes, a cesarean delivery (AOR: 0.57; 95% CI, 0.36–0.90), episiotomy (AOR: 2.01; 95% CI, 1.25–3.39), and low birth weight (AOR: 2.22; 95% CI, 1.13–4.36), and premature delivery were 2.87 (1.49–5.52). This study shows that adverse obstetric and perinatal outcomes were significantly associated with teenagers than adult mothers. Therefore, giving health education on focused ANC is very important to bring change to the teenager at this study area.
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What Are the Maternal and Neonatal Outcomes of Adolescent Pregnancy in Women Referring to Ayatollah Mousavi Hospital in Zanjan? A Comparative Cross-sectional Study. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.52547/pcnm.9.3.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rexhepi M, Besimi F, Rufati N, Alili A, Bajrami S, Ismaili H. Hospital-Based Study of Maternal, Perinatal and Neonatal Outcomes in Adolescent Pregnancy Compared to Adult Women Pregnancy. Open Access Maced J Med Sci 2019; 7:760-766. [PMID: 30962834 PMCID: PMC6447330 DOI: 10.3889/oamjms.2019.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adolescent pregnancy, defined as a pregnancy in girls aged 10 to 19 years. Adolescent mothers are at high risk for maternal and neonatal complications. AIM To compare maternal, perinatal and neonatal outcomes in adolescents and adult women aged 20-24 years. MATERIAL AND METHODS This retrospective cohort study included all singleton pregnancies during a three-year period (January 2016-December 2018) who gave birth in a Clinical Hospital in Tetovo, Republic of Macedonia. After exclusion criteria, a total of 932 cases were reviewed and divided into two groups: one of the teenage mothers (< 19 years old) (115 women) and the other of adult mothers (20-24 years old) (817 women). RESULTS Of the total number of 5643 births, 128 (2.27%) were from adolescent pregnancies. Of them, nulliparous adolescent women were 115 (2.04%). Adolescents compare to adult mothers had a higher rate of urinary tract infections (33% vs. 22%), increased rate of maternal anemia (26% vs. 15%), preterm birth, small for gestational age newborns (25.2% vs. 17.1%), lower high school attendance (0 vs. 21.9%) and inadequate prenatal care. Spontaneous labour was more common in adolescents (73% vs 63.5%), while Caesarean sections were less common than in women aged 20-24 years (25.2% vs 33.5%). The rate of other perinatal outcomes was not significantly different between the 2 groups. CONCLUSIONS The results of the study showed that the frequencies of some maternal, perinatal and neonatal complications were considerably higher in adolescent mothers.
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Affiliation(s)
- Meral Rexhepi
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Florin Besimi
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Nagip Rufati
- Department of Gynecology and Obstetrics, Clinical Hospital, Tetovo, Republic of Macedonia
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Arian Alili
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Sani Bajrami
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
| | - Hysni Ismaili
- Faculty of Medical Sciences, University of Tetovo, Tetovo, Republic of Macedonia
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Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study. J Korean Med Sci 2019; 34:e8. [PMID: 30618515 PMCID: PMC6318447 DOI: 10.3346/jkms.2019.34.e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/11/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as "Obstetric Care Underserved Areas (OCUA)." However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
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Affiliation(s)
- Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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Jo S, Park S, Youn JH, Sohn BK, Choi HJ, Lee JY, Lee JY, Lee JY. The Mental Health Status and Intellectual Ability of Unwed Mothers Dwelling in Korean Shelter Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040637. [PMID: 29601524 PMCID: PMC5923679 DOI: 10.3390/ijerph15040637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
Although many unwed mothers have issues concerning mental health and intellectual ability, little research has focused on their mental and cognitive status. Due to the public stigma attached to unwed mothers in South Korea, they tend to conceal their status and are less likely to seek psychiatric and psychological help. In this context, this study aims to assess the current status of their mental health and intellectual characteristics. A total of 48 unwed mothers from two shelter homes in South Korea agreed to participate in the study. We compared the mental health status of these unwed mothers with that of the general female population. Unwed mothers were more likely than those of the general female population to have mood disorders, post traumatic stress disorder (PTSD), alcohol and nicotine use disorders, and attention-deficit hyperactivity disorder (ADHD). Among the 48 unwed mothers, 20 (41.7%) had an IQ of less than 70, and the mean IQ (78.31) was significantly lower than the normalized mean IQ of the general female population. This study confirmed that unwed mothers dwelling in Korean shelter homes are more likely than the general female population to have mental disorders.
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Affiliation(s)
- Suyeon Jo
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Soowon Park
- Department of Education, Sejong University, Seoul 05006, Korea.
| | - Jung Hae Youn
- Department of Art Therapy & Counseling Psychology, Cha University, Gyeonggi-do 11160, Korea.
| | - Bo Kyung Sohn
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul 01757, Korea.
| | - Hyo Jung Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Ji Yeon Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Jin Yong Lee
- Public Health Medical Service, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
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Park J, Min B, Shin H, Oh S, Song WH, Cho SY, Cho MC, Jeong H, Son H. A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2. J Sex Med 2018; 14:1142-1151. [PMID: 28859873 DOI: 10.1016/j.jsxm.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many studies on sexual attitudes and behavior have been performed to improve sexual health. AIM To evaluate changing trends in Korean female sexual life and attitudes in an internet-based survey at 10-year intervals. METHODS The survey was targeted toward 20- to 59-year-old women who were asked to complete the questionnaire only if they were sexually active. The survey contained 110 questions about demographic statistics, sexual life, and attitudes that were crafted based on the 2004 study. OUTCOMES Results of the 2004 study vs those of the 2014 study. RESULTS In total, 516 women participated in the study; the questionnaire response rate was 16.0%. The mean frequency of intercourse (FOI) per month was 3.46 ± 2.56 in 2014 vs 5.34 ± 3.84 in 2004. Women in their 20s and 30s in 2014 reported a lower mean FOI than those in 2004. There was no significant difference in the mean FOI in 2004 vs 2014 for women who in their 40s. Risk factors for lower FOI were being older, being single, and having dyspareunia. Most Korean women had positive attitudes toward sex (3.2 ± 0.6 of 5) and considered it as important (3.3 ± 0.7 of 5) as those surveyed in 2004. However, women 20 to 39 years old had less positive attitudes toward sex than in the past decade. Women in their 40s were more active and had more conversations with their partners. Of women using contraceptives, 63.8% were found to use less effective methods, such as intercourse withdrawal and the fertility awareness method. CLINICAL IMPLICATIONS Assessment of changing trends in Korean female sexual life, attitudes, and contraceptive methods could help to establish proper national sexual education programs and campaigns. STRENGTHS AND LIMITATIONS This study was not a cohort study, because subjects in the 2014 were not identical to those in the 2004 study. Nevertheless, we applied the same inclusion and exclusion criteria for this internet survey, a suitable tool to evaluate the sex life of women, which is often considered a sensitive and private issue in Asian culture. CONCLUSIONS Compared with the 2004 survey, young Korean women had fewer sexual relationships and had a less positive attitude toward sex. In addition, many women used less effective methods of contraception. Park J, Min B, Shin H, et al. A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2. J Sex Med 2017;14:1142-1151.
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Affiliation(s)
- Juhyun Park
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byunghun Min
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyojin Shin
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Medical Research Collaboration Center, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Won Hoon Song
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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Kim MK, Lee SM, Bae SH, Kim HJ, Lim NG, Yoon SJ, Lee JY, Jo MW. Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health 2018; 17:2. [PMID: 29304810 PMCID: PMC5756361 DOI: 10.1186/s12939-017-0715-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/26/2017] [Indexed: 01/12/2023] Open
Abstract
Background Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone’s social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Methods Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient (“low” SES) or a NHI beneficiary (“middle/high” SES). Results In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Conclusions Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.
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Affiliation(s)
- Min Kyoung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hee Bae
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Korea
| | - Nam Gu Lim
- Department of Medical Administration and Information, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. .,Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
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