1
|
Vitner D, Barrett J, Katherine W, White SW, Newnham JP. Community-based, population-focused preterm birth prevention programs - a review. Arch Gynecol Obstet 2020; 302:1317-1328. [PMID: 32875346 DOI: 10.1007/s00404-020-05759-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality worldwide. Being born too early contributes to approximately 70% of neonatal mortality and approximately half of long-term neurodevelopmental disabilities. Various PTB prevention programs have been described going back more than 30 years, and some have described possible success in decreasing the rate of PTB. In addition, there are also PTB prenatal care clinics in many parts of the world, each with the singular goal of reducing the PTB rate in their region. Interventions can be directed at all women for primary prevention and reducing the risk of PTB or used to mitigate risk in women identified to be at increased risk. METHODS A Medline and ClinicalTrials.gov ( www.clinicaltrials.gov ) search was performed (1982-2018), using preterm birth prevention program as the primary medical subject heading, reporting randomized clinical trials, quasi-experimental trials, and analytic studies (including retrospective and prospective cohort studies). We also searched Google for preterm birth prevention programs and prenatal care clinics published on-line. RESULTS Some prevention programs have reported success in lowering rates of PTB, principally using historical controls although the majority were not followed by improved outcomes. CONCLUSION Increasing knowledge and the use of social media to enhance education should now enable greater effectiveness of new programs. Development of regional and national PTB prevention programs should now be considered.
Collapse
Affiliation(s)
- Dana Vitner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Alliance for the Prevention of Preterm Birth and Stillbirth, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wendy Katherine
- Alliance for the Prevention of Preterm Birth and Stillbirth, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
2
|
Mathibe-Neke JM, Rothberg A, Langley G. The perception of midwives regarding psychosocial risk assessment during antenatal care. Health SA 2014. [DOI: 10.4102/hsag.v19i1.742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The physiological and psychological changes caused by pregnancy may increase a woman’s vulnerability to depression, which may in turn have adverse effects on both maternal and foetal wellbeing. Inadequate psychosocial risk assessment of women by midwives may lead to lack of psychosocial support during pregnancy and childbirth. Pregnant women who lack psychosocial support may experience stress, anxiety and depression that could possibly affect foetal wellbeing.Objective: The objective of this study was to explore and describe the perception of psychosocial risk assessment and psychosocial care by midwives providing antenatal care to pregnant women.Method: An interpretive and descriptive qualitative approach was adopted. Three focus group interviews were conducted with midwives working in three Maternal Obstetric Units in Gauteng Province, using a semi-structured interview guide. The constant comparison data analysis approach was used.Results: Findings revealed that midwives are aware of and have encountered a high prevalence of psychosocial problems in pregnant women. Furthermore, they acknowledged the importance of psychosocial care for pregnant women although they stated that they were not equipped adequately to offer psychosocial assessment and psychosocial care.Conclusion: The findings provided a basis for incorporation of psychosocial care into routine antenatal care. Agtergrond: Die fisiologiese en psigologiese veranderings wat deur swangerskap veroorsaak word, kan ‘n vrou se kwetsbaarheid vir depressie verhoog. Dit kan op sy beurt negatiewe gevolge vir sowel die moeder as die fetus se welstand hê. As vroedvroue nie voldoende psigososiale riskio-assesserings op swanger vrouens doen nie, kan dit tot ‘n gebrek aan psigososiale ondersteuning tydens die swangerskap en geboorte lei. Swanger vrouens wat ‘n gebrek aan psigososiale ondersteuning het, kan stres, angs en depressie ervaar wat weer die fetus se welstand kan beïnvloed.Doelwit: Die doelwit van hierdie studie was om die persepsies van vroedvroue, wat voorgeboortesorg aan swanger vrouens bied, te ondersoek en te beskryf sover dit hulle persepsies oor psigososiale risiko-assessering en psigososiale aangaan.Metode: ’n Interpretatiewe en beskrywende kwalitatiewe benadering is gevolg. Drie fokusgroep-onderhoude is deur middel van ‘n gestruktureerde onderhoudsgids gevoer met verloskundiges wat in drie voorgeboorteklinieke in die Gauteng Provinsie werksaam is. ’n Benadering tot data-analise wat van voortdurende vergelyking gebruik maak, is gevolg.Resultate: Die studie het aan die lig gebring dat verloskundiges bewus is van psigososiale probleme onder swanger vroue en dat die prevalensie van sulke probleme onder swanger vroue hoog is. Vroedvroue erken die belang van psigososiale sorg aan swanger vroue alhoewel hulle nie toereikend toegerus is om psigososiale assessering en -sorg te verleen nie.Gevolgtrekking: Die bevindinge stel ’n basis daar vir die insluiting van psigososiale sorg in roetine voorgeboortesorg.
Collapse
|
3
|
Mann JR, Mannan J, Quiñones LA, Palmer AA, Torres M. Religion, spirituality, social support, and perceived stress in pregnant and postpartum Hispanic women. J Obstet Gynecol Neonatal Nurs 2010; 39:645-57. [PMID: 21039849 DOI: 10.1111/j.1552-6909.2010.01188.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the association between religion/spirituality and perceived stress in prenatal and postpartum Hispanic women. DESIGN Cross-sectional survey. SETTING An urban, publicly funded hospital in California. PARTICIPANTS Two hundred and forty-eight pregnant and postpartum Hispanic women between age 18 and 45 years. METHOD Patients presenting for prenatal or postpartum care or for the first infant visit were recruited to participate in the current study. PARTICIPANTS completed surveys consisting of questions about demographic characteristics, religiosity, spirituality, social support, and stress. RESULTS Most participants were unmarried, low-income women with low educational attainment. Ninety percent of women reported a religious affiliation, with more than one half (57.4%) listing their religious affiliation as "Catholic." Overall religiousness/spirituality was significantly associated with increased negative experiences of stress in women who selected English language instruments (Spearman's r=.341, p=.007); there was no such relationship in women who selected Spanish language instruments. Social support and greater relationship quality with a significant other were significantly associated with reduced perceived stress in Spanish reading and English reading women. CONCLUSIONS In this sample of pregnant and postpartum Latinas, religiousness/spirituality was not associated with reduced perceived stress and was in fact associated with increased perceived stress among women who selected English-language surveys. Additional research is needed to investigate this association. On the other hand, the current study reinforces the importance of social support and relationship quality for pregnant and postpartum women.
Collapse
Affiliation(s)
- Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SCSC 29203, MD, USA.
| | | | | | | | | |
Collapse
|
4
|
Ghosh JKC, Wilhelm MH, Dunkel-Schetter C, Lombardi CA, Ritz BR. Paternal support and preterm birth, and the moderation of effects of chronic stress: a study in Los Angeles county mothers. Arch Womens Ment Health 2010; 13:327-38. [PMID: 20066551 PMCID: PMC2896639 DOI: 10.1007/s00737-009-0135-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/30/2009] [Indexed: 11/29/2022]
Abstract
Maternal psychosocial stress is an important risk factor for preterm birth, but support interventions have largely been unsuccessful. The objective of this study is to assess how support during pregnancy influences preterm birth risk and possibly ameliorates the effects of chronic stress, life event stress, or pregnancy anxiety in pregnant women. We examined 1,027 singleton preterm births and 1,282 full-term normal weight controls from a population-based retrospective case-control study of Los Angeles County, California women giving birth in 2003, a mostly Latina population (both US-born and immigrant). We used logistic regression to assess whether support from the baby's father during pregnancy influences birth outcomes and effects of chronic stress, pregnancy anxiety, and life event stress. Adjusted odds of preterm birth decreased with better support (OR 0.73 [95%CI 0.52, 1.01]). Chronic stress (OR 1.46 [95%CI 1.11, 1.92]), low confidence of a normal birth (OR 1.57 [95% CI 1.17, 2.12]), and fearing for the baby's health (OR 1.67 [95%CI 1.30, 2.14]) increased preterm birth risk, but life events showed no association. Our data also suggested that paternal support may modify the effect of chronic stress on the risk of preterm birth, such that among mothers lacking support, those with moderate-to-high stress were at increased odds of delivering preterm (OR 2.15 [95%CI 0.92, 5.03]), but women with greater support had no increased risk with moderate-to-high chronic stress (OR 1.13 [95%CI 0.94, 1.35]). Paternal support may moderate the effects of chronic stress on the risk of preterm delivery.
Collapse
Affiliation(s)
- Jo Kay C. Ghosh
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
| | - Michelle H. Wilhelm
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
- Center for Occupational and Environmental Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
| | - Christine Dunkel-Schetter
- Department of Psychology, University of California, Los Angeles, 1285A Franz Hall, 405 Hilgard Ave, Los Angeles, CA 90095-1563 USA
| | - Christina A. Lombardi
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
- Center for Health Policy Research, University of California, Los Angeles, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024 USA
| | - Beate R. Ritz
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
- Center for Occupational and Environmental Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, CHS 71-254, Los Angeles, CA 90095-1772 USA
| |
Collapse
|
5
|
Zachariah R. Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Res Nurs Health 2009; 32:391-404. [PMID: 19434649 DOI: 10.1002/nur.20335] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prospective repeated measures were used to examine attachment, social support, life stress, anxiety, and psychological wellbeing among low-income women in early and late pregnancy and the relationships of these variables to prenatal, intrapartum, and neonatal complications. One hundred and eleven medically healthy, low-income, Medicaid-eligible women ages 18-35 years, between 14 and 22 weeks of pregnancy were recruited from prenatal clinics. Self-report questionnaires and hospital records were used to collect data. Discriminant analysis was performed. The most important discriminating factors for prenatal complications were state anxiety and total functional social support. The factors for neonatal complications were negative life events and the interaction of emotional support with negative life events.
Collapse
Affiliation(s)
- Rachel Zachariah
- College of Nursing, Wayne State University, 5557 Cass Ave., Detroit, MI 48202, USA
| |
Collapse
|
6
|
Affiliation(s)
- Bernadette Fogarty
- Pals in Pregnancy at University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | | |
Collapse
|
7
|
Caelli K, Downie J, Letendre A. Parents' experiences of midwife-managed care following the loss of a baby in a previous pregnancy. J Adv Nurs 2002; 39:127-36. [PMID: 12100656 DOI: 10.1046/j.1365-2648.2002.02252.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS OF THE STUDY This article reports on research that explored the impact of the Special Delivery Service, a midwife-managed intervention, developed as an addition to routine care to support and educate high-risk pregnant women and their partners subsequent to the death of a baby in a previous pregnancy. BACKGROUND Approximately 40,000 families suffer the trauma of a neonatal death* annually in the USA, while statistics for Canada and Australia give similar numbers relative to population. Since many more babies die than those accounted for in these statistics, through stillbirth, miscarriage and Sudden Infant Death Syndrome, more than the above-cited 2% of childbearing couples will face the trauma of the loss of a baby. RATIONALE The resultant threat that this situation may pose to the health of the mother has been extensively documented in the literature. However, despite the recent growth in knowledge about the impact of perinatal loss and bereavement, few interventions are specifically designed to support Australian and Canadian women and their partners during a pregnancy following the loss of a baby. METHODOLOGY This phenomenological study explored women's and their partners' experiences of grief and loss and the support offered to them through the Special Delivery Service programme. RESULTS & DISCUSSION In the face of funding and organizational changes to both the Australian and Canadian health care systems that have eliminated or reduced some services, this research reinforced the need for individualized, compassionate midwifery care and the urgent need for genuinely empathic and supportive health care services for these women and their partners. It also emphasized the need for couples to be informed and supported so that gender differences in grieving do not become a divisive element in the relationship. CONCLUSIONS The findings have implications for both nurses and midwives in their practice in countries where optimum care of this vulnerable population is not routinely available. The research supports midwife-managed models of care to ensure women and their families are appropriately supported in crisis. The findings provide insight also into the diverse grief response among couples and the difficulties experienced in a pregnancy following the loss of a baby.
Collapse
Affiliation(s)
- Kate Caelli
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
| | | | | |
Collapse
|
8
|
Abstract
This exploratory study investigates the role of social support in the initiation of prenatal care by analyzing data from interviews with 36 pregnant women at a public health facility in Tuscaloosa, Alabama. A systematic sample of U.S.-born women aged 19 to 34 who initiated care in each of the three trimesters was interviewed. After controlling for age and education, three variables were found to be associated with earlier estimated gestational age at the time of a woman's first prenatal visit: self-referral to care, more prenatal care advocates, and fewer children. There was no significant effect on the timing of entry to care associated with ethnicity, marital status, transportation availability, rural vs. urban residence, distance of residence from the clinic, or prior prenatal care at the public health facility. These results suggest that first-time mothers are likely to seek early care and that family and friends play a significant support role in encouraging women to begin care.
Collapse
Affiliation(s)
- C A Winston
- Department of Epidemiology, Emory University, USA.
| | | |
Collapse
|
9
|
Norbeck JS, DeJoseph JF, Smith RT. A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women. Soc Sci Med 1996; 43:947-54. [PMID: 8888464 DOI: 10.1016/0277-9536(96)00003-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Previous clinical trials of social support interventions to reduce low birthweight (LBW) have not fully capitalized on findings from social science research, and therefore have not used empirically-derived criteria to define a low social support population or to develop the intervention. To overcome limitations of previous studies, this randomized clinical trial tested the hypothesis that an empirically-derived social support intervention would reduce LBW among African American women. Based on prior work, African American women were identified as at-risk for LBW due to inadequate social support if they lacked support from their mothers or male partners. Focus groups were used in this study to develop a culturally-relevant intervention. Adult low-income African American pregnant women (n = 319) were tested for inadequate social support in mid-pregnancy. Of these, 114 (36%) low-support women were identified and randomly assigned to the intervention group (n = 56) or control group (n = 58). The intervention was designed to provide the support usually provided by the pregnant woman's mother or male partner. It consisted of four standardized face-to-face sessions at two week intervals and telephone contact in the intervening weeks. Birthweight was obtained blinded from charts or birth certificates, with 99% follow-up. The rate of LBW (below 2500 grams) was 9.1% in the intervention group compared to 22.4% in the control group (P < 0.05). Contrary to previous studies, this social support intervention was effective in reducing the rate of LBW. It is promising that this intervention was successful for African Americans because the rate of LBW is twice as high among African Americans than among Caucasians.
Collapse
Affiliation(s)
- J S Norbeck
- School of Nursing, University of California, San Francisco 94143-0604, USA
| | | | | |
Collapse
|
10
|
Abstract
During the last decade several programs were established to prevent the onset of preterm labor and facilitate its early identification and treatment. Although these prevention programs shared a similar goal, they varied in their primary outcome focus, target populations, study designs, and specific intervention components. Their initial reports were promising; however, subsequent evaluations of efforts in the United States produced mixed results. The current literature is suggestive of the benefits of programs to prevent preterm labor and delivery, but methodologic differences among them and deficiencies in the reported evaluations have rendered a final verdict equivocal. Many studies using historical or geographic controls found positive results, whereas randomized, controlled trials did not find a significant impact. Positive results were found in studies using low-risk populations, but investigations of high-risk patients noted little effect. Together with continued research on the factors that underlie the onset of labor, additional assessment of these programs and their individual intervention components appears to be necessary.
Collapse
|
11
|
Abstract
Both observational studies and nonrandomized controlled trials have found the presence of support during pregnancy to be associated with superior outcomes in terms of preventing abortion, extending the length of gestation, and reducing interventions in labor. However, randomized controlled trials of supportive interventions in pregnancy have not demonstrated any physical benefits from the interventions. It is also unlikely there are any significant adverse effects. Psychological benefits do appear to result from supportive interventions, including better enjoyment of the pregnancy and better postnatal status.
Collapse
Affiliation(s)
- R L Bryce
- Flinders Medical Centre, South Australia
| |
Collapse
|
12
|
Weingarten CT, Baker K, Manning W, Kutzner SK. Married mothers' perceptions of their premature or term infants and the quality of their relationships with their husbands. J Obstet Gynecol Neonatal Nurs 1990; 19:64-73. [PMID: 2299439 DOI: 10.1111/j.1552-6909.1990.tb02526.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Twenty-eight mothers of premature infants and 37 mothers of term infants were examined for their perceptions of their infants and of their relationships with their husbands at two to four postpartum days and at six to eight postpartum weeks. The mothers tended to perceive their infants positively, whether or not the infants were born prematurely. Preterm mothers who compared their infants to an average premature infant were more positive than term mothers who compared their infants to an average term infant. An association was not found in either group between mothers' perceptions of their infants and of the quality of their relationships with their husbands. However, mothers with negative perceptions of their infants also tended to have difficult marriages.
Collapse
|