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Chu SHS, Krishnaswamy S, Cole S, Giles ML. Travel patterns and advice-seeking behaviour of pregnant women in the Australian context: A multicentre cross-sectional analysis. Aust N Z J Obstet Gynaecol 2022; 62:688-694. [PMID: 35383883 DOI: 10.1111/ajo.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Travel poses risks to pregnant women, but little data exist describing the travel habits of women during pregnancy or pre-travel recommendations given. AIMS To examine travel patterns of pregnant women including frequency of pre-travel consultation, and advice recalled. MATERIALS AND METHODS Cross-sectional analysis of post-partum women admitted to five Victorian maternity hospitals between 21 May 2019 and 22 April 2020 in Australia. RESULTS Forty-four percent (182/410) of women travelled during pregnancy, 32.9% (135/410) interstate and 19.5% (80/410) internationally. Fifty-five percent travelled for leisure (118/215) and 27% to visit friends/relatives (58/215). Overall, 68.1% (124/182) sought pre-travel advice, primarily from an obstetrician (60.5%, 75/124) or general practitioner (29.8%, 37/124). Only one woman attended a travel clinic. The most common reason for not seeking pre-travel advice was the belief that travel posed no risk (63.4%, 45/71). Pre-travel advice was sought least by those visiting friends/relatives (61.4%, 35/57). Women recalled recommendations regarding travel restrictions by gestational age and venous thromboembolism precautions, but not infectious disease prevention for those to whom it was relevant. Of international travellers, 48.8% (39/80) sought advice from the internet, one-third (13/39) as an alternative to seeing a healthcare provider. CONCLUSIONS Travel is common during pregnancy and women seek pre-travel advice from the healthcare provider they see most often during pregnancy. All pregnant women should be provided with consistent, evidence-based pre-travel advice regardless of whom they consult. Further work is needed to educate and provide resources to maternity care providers to optimise pre-travel counselling.
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Affiliation(s)
- Sandy H S Chu
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Sushena Krishnaswamy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Stephen Cole
- Institute of Obstetrics and Gynaecology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Groom HC, Smith N, Irving SA, Koppolu P, Vazquez-Benitez G, Kharbanda EO, Daley MF, Donahue JG, Getahun D, Jackson LA, Klein NP, McCarthy NL, Nordin JD, Panagiotakopoulos L, Naleway AL. Uptake and safety of hepatitis A vaccination during pregnancy: A Vaccine Safety Datalink study. Vaccine 2019; 37:6648-6655. [PMID: 31548013 DOI: 10.1016/j.vaccine.2019.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Infection with hepatitis A virus (HAV) during pregnancy, although uncommon, is associated with gestational complications and pre-term labor. Hepatitis A vaccine (HepA) is recommended for anyone at increased risk for contracting hepatitis A, including women at risk who are also pregnant. Limited data are available on the safety of maternal HepA vaccination. OBJECTIVES Assess the frequency of maternal HepA receipt and evaluate the potential association between maternal vaccination and pre-specified maternal and infant safety outcomes. METHODS A retrospective cohort of pregnancies in the Vaccine Safety Datalink (VSD) resulting in live births from 2004 through 2015 was included. Pregnancies with HepA exposure were compared to those with other vaccine exposures, and to those with no vaccine exposures. Risk factors for contracting hepatitis A were identified up to one-year prior to or during the pregnancy using ICD-9 codes. Maternal and fetal adverse events were evaluated according to maternal HepA exposure status. Adjusted odds ratio (OR) were used to describe the association. RESULTS Among 666,233 pregnancies in the study period, HepA was administered at a rate of 1.7 per 1000 (n = 1140), most commonly within the first six weeks of pregnancy. Less than 3% of those exposed to HepA during pregnancy had an ICD-confirmed risk factor. There were no significant associations between HepA exposure during pregnancy and gestational hypertension, gestational diabetes, pre-eclampsia/eclampsia, cesarean delivery, pre-term delivery, and low birthweight. There was a statistically significant association between HepA exposure during pregnancy and small-for-gestational age (SGA) infants (aOR 1.32, [95% CI 1.09, 1.60], p = 0.004). CONCLUSIONS The rate of maternal HepA vaccination was low and rarely due to documented risk factors for vaccination. HepA vaccination during pregnancy was not associated with an increased risk for a range of adverse events examined among pregnancies resulting in live births, but an identified association between maternal HepA and SGA infant outcomes, while likely due to unmeasured confounding, warrants further exploration.
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Affiliation(s)
- Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - James G Donahue
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Darios Getahun
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James D Nordin
- HealthPartners Institute, Minneapolis, MN, United States
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
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Kogutt BK, Sheffield JS, Whyne D, Maragakis LL, Andonian J, Flinn J, Sulmonte C, Dodson A, Romig M, Sauer L, Maloney R, Ferrell J, Vaught AJ, Golden WC, Garibaldi BT. Simulation of a Spontaneous Vaginal Delivery and Neonatal Resuscitation in a Biocontainment Unit. Health Secur 2019; 17:18-26. [PMID: 30779606 DOI: 10.1089/hs.2018.0090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery. We created and executed a multidisciplinary functional exercise with simulation to test the ability of the Johns Hopkins Hospital biocontainment unit (BCU) to manage a pregnant patient in labor with an unknown respiratory illness and to deliver and stabilize her neonate. The BCU Exercise and Drill Committee established drill objectives and executed the exercise in partnership with the Johns Hopkins Simulation Center in accordance with Homeland Security and Exercise Program guidelines. Exercise objectives were assessed by after-action reporting and objective measurements to detect contamination, using a fluorescent marker to simulate biohazardous fluids that would be encountered in a typical labor scenario. The immediate objectives of the drill were accomplished, with stabilization of the mother and successful delivery and resuscitation of her newborn. There was no evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise. Simulation optimizes teamwork, communication, and safety, which are integral to the multidisciplinary care of the maternal-fetal unit infected, or at risk of infection, with a high-consequence pathogen. Lessons learned from this drill regarding patient transportation, safety, and obstetric and neonatal considerations will inform future exercises and protocols and will assist other centers in preparing to care for pregnant patients under containment conditions.
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Affiliation(s)
- Benjamin K Kogutt
- Benjamin K. Kogutt, MD, is a Clinical Fellow, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne S Sheffield
- Jeanne S. Sheffield, MD, is Division Director, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dianne Whyne
- Dianne Whyne, RN, MS, is Director of Operations, Office of Critical Event Preparedness and Response, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa L Maragakis
- Lisa L. Maragakis, MD, MPH, is Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Senior Director of Infection Prevention, Johns Hopkins Health System, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Andonian
- Jennifer Andonian, MPH, is Program Manager, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jade Flinn
- Jade Flinn, RN, is a Nurse Educator, Johns Hopkins Biocontainment Unit, Office of Critical Event Preparedness and Response, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chris Sulmonte
- Chris Sulmonte, MHA, is Administrative Manager, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adam Dodson
- Adam Dodson, NRP, NCEE, is Lead Simulation Specialist, Johns Hopkins Simulation Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Romig
- Mark Romig, MD, is Assistant Professor, Division of Pulmonary and Critical Care Medicine, and Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lauren Sauer
- Lauren Sauer, MS, is Research Director, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert Maloney
- Robert Maloney, MS, is Senior Director, Office of Emergency Management for Johns Hopkins Health System, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Janis Ferrell
- Janis Ferrell, CT, is Perinatal/Perioperative Clinical Operations Supervisor, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arthur J Vaught
- Arthur J. Vaught, MD, is Assistant Professor, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, and Department of Surgery, Division of Surgical Critical Care, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - W Christopher Golden
- W. Christopher Golden, MD, is Medical Director, Johns Hopkins Hospital Newborn Nursery, Department of Pediatrics, Division of Neonatology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, is Director, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
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Kong LY, Libman MD, Yansouni CP. Travel-Related Infections Among Pregnant Travellers to the Tropics: An Overview. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:460-472. [PMID: 29307707 DOI: 10.1016/j.jogc.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
Infectious diseases acquired during travel pose a significant health risk to pregnant travellers, who are more susceptible to both acquiring certain infections and developing severe complications. A review of the literature focusing on recent evidence-based guidelines was conducted with attention to tropical infections in the pregnant patient. A summary meant to serve as a succinct reference for health care professionals caring for pregnant women is presented. Magnitude of risk, clinical features, management, and preventive strategies of major travel-acquired infections of pertinence to the pregnant traveller are summarized, including malaria, arboviral infections, foodborne infections, helminthic infections, and influenza. Tables with details on specific infections within each group and guidance for reducing travel-related health risks in the pregnant patient are presented.
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Affiliation(s)
- Ling Yuan Kong
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC.
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC
| | - Cedric P Yansouni
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC
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