Tailoring peripartum nursing care for women of advanced maternal age

Pregnancy Risk Perception and Associated Factors among Pregnant Women Attending Antenatal Care at Health Centers in Jabi Tehnan District, Amhara, Northwestern Ethiopia, 2021

Background

Pregnancy risk perception affects a pregnant woman's decision about health care services such as prenatal care, place of birth, choices about medical interventions, adherence to medical procedures, and recommendations. Therefore, the study is aimed at assessing pregnancy risk perception and associated factors among pregnant women attending antenatal care at health centers in Jabi Tehnan District.

Methods

An institutional-based cross-sectional study was conducted among 424 mothers attending ANC at health centers in the Jabi Tehnan District from April 1 to 30, 2021. Data was collected through a face-to-face interview using a structured questionnaire which was developed according to the health belief model. The logistic regression model was used using an adjusted odds ratio with 95% CI and pvalue < 0.05 to declare significance and associations.

Result

Four hundred twenty four (424) pregnant women were interviewed of which nearly half of the respondents 48% (43.2%, 52.7%) had good pregnancy risk perception. Women who had a history of obstetric complications (AOR: 95% CI = 3.44 : 1.73, 6.83), those who knew at least one pregnancy danger sign (AOR: 95% CI = 5.22, 2.46, 11.07), pregnant women who had a bad obstetric history (AOR: 95% CI = 2.23 : 1.13, 4.41), and knowing women who died due to pregnancy-related complications (AOR: 95% CI = 2.85 : 1.45, 5.60) were more likely to have good perception towards pregnancy risk compared to their counterparts.

Conclusion

Obstetric complications, awareness of pregnancy danger signs, bad obstetric history, and known women who died due to pregnancy-related complications were found to be significantly associated with pregnancy risk perception.

Does it get better with age? Women's experience of communication in maternity care

BACKGROUND

Communication with maternity care providers is one of the strongest predictors of the perceived quality of maternity care. There is evidence that older mothers experience better communication than younger mothers, but no evidence for why this occurs.

AIM

To identify differences between younger (<35 years) and older (35+ years) mother's perceived quality of communication and any apparent age-related differences.

METHODS

We analysed cross-sectional data from 2504 first-time mothers in the Having a Baby in Queensland Survey 2012. Binary logistic regression assessed associations between maternal age and perceived optimal communication (information, participation, and connection) from care providers during women's most recent pregnancy and birth. Multivariable logistic regression modelling determined the effect of potential confounders (model of care, mode of birth, maternal age, and risk perceptions) on associations between age and communication quality.

FINDINGS

After adjustment for confounders, older mothers were more likely to report experiencing optimal information (e.g., not receiving conflicting information) and connection with caregivers (e.g., comfortable asking questions) in both pregnancy and birth. There were no age-related differences in the perception of participation. Model of care and mode of birth were more influential than maternal age in predicting communication perceptions. Women who used midwifery or private obstetric models and had unassisted vaginal births were more likely to perceive optimal communication.

CONCLUSION

Given the benefits of communication on maternity care, redressing these age-related differences should be a focus of future communication training for care providers to ensure that women receive optimal communication, regardless of their age.

Factors affecting maternal confidence and satisfaction in older Japanese primiparae during postpartum hospital stay

The purpose of this study was to identify factors affecting maternal confidence and satisfaction in older Japanese primiparae during their postpartum hospital stay. Participants were Japanese primiparae (age ≥ 35) who delivered live singleton infants (n = 479). Questionnaires completed 1 day before discharge from hospital included the Postpartum Maternal Confidence Scale and the Postpartum Maternal Satisfaction Scale. Data were analysed using stepwise multiple regression for maternal confidence and stepwise logistic regression for maternal satisfaction, after controlling for delivery mode. Maternal confidence was negatively affected by feeling overwhelmed by postpartum routines, needing a longer time for feeding, and a pregnancy with complications. Satisfaction with the birth experience and a longer rooming-in period were related to greater maternal satisfaction. Lack of prior experiences with caring for babies and lack of communication with their partner about parenting role were also associated with lower confidence and satisfaction. These findings provide an important framework for nurses to teach and counsel older first-time mothers.

Advanced Aged Women's Needs for Pregnancy and Childbirth Care

PURPOSE

Advanced aged pregnancy may be related with health problems so that more aggressive health care is necessary for these women. This study aimed to provide the basic data for developing nursing intervention programs to enhance the health of pregnant women and their new-born babies and by identifying the advanced aged women's need for pregnancy and childbirth.

METHODS

It is the cross-sectional descriptive study to identify the advanced aged women's need on pregnancy and childbirth. Subjects were pregnant women 35 years or older and postpartum women. Total number of subjects was 95. Measurement tool is self-reporting survey that consisted of 67 items with four-point Likert scale, which was completed during October to November 2014.

RESULTS

Average score was 3.44 out of maximum 4 on the care need on pregnancy and childbirth. Average scores according to category were as follows: baby rearing and parental role, 3.55; preconception care, 3.49; delivery care, 3.47; postpartum care 3.42; and prenatal pregnancy, 3.39. The degree of needs on pregnancy and childbirth was different according to delivery experience (t=-2.49, p=.014).

CONCLUSION

Prenatal and postpartum nursing interventions were completed regardless of pregnant women's age until now; however, new nursing intervention programs are necessary to prevent the risk of advanced aged pregnancy, to provide the preconception care, and to increase the infant care and family support.

Association between adverse pregnancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia

Background

Gestational hypertension (GH) and Preeclampsia, (PE) are the most complicated amongst hypertensive disorders of pregnancy. The mechanism that links hypertension in pregnancy to adverse maternal outcomes is not fully understood though some relate this to endothelial dysfunction originating from an imbalanced angiogenic regulators and oxidative stress biomarkers. This study assessed the correlation between angiogenic regulators and oxidative stress biomarker levels with adverse pregnancy outcomes among GH and PE participants.

Methods

A cohort of pregnant women who received antenatal care at the Obstetrics and Gynaecology department of the Komfo Anokye Teaching Hospital (KATH) were followed. During their antenatal visits, 100 developed PE and 70 developed GE, of these, 50 PE and 50 GH gave informed consent. Their blood samples were taken at time of diagnosis and 48 h post-partum. 50 other aged-matched women who did not develop neither GH nor PE were selected as controls. Placental growth factor (PLGF), soluble fms-like tyrosine kinase 1 (sFlt-1) and 8-epi-prostaglandin F2alpha (8-epi-PGF2α) levels were estimated by ELISA and total antioxidant capacity (T-AOC) was measured spectrophotometrically. Graphpad Prism was used for data analysis.

Results

Median levels of sFlt-1, 8-epi-PGF2α and sFlt-1/PLGF were elevated among participants with PE co-existing with intrauterine fetal death (IUFD), placental abruptio, placental previa, HELLP syndrome and intrauterine growth restriction (IUGR) compared to PE without adverse outcomes (p = 0.041, p = 0.005, p = 0.0002). Levels of PLGF, T-AOC and PLGF/sFlt-1 were significantly reduced among participants with PE co-existing with IUFD, placental abruptio, placental previa, HELLP syndrome and IUGR compared to PE without adverse outcomes (p = 0.0013, p = 0.006, p < 0.0001). A significant negative correlation of IUGR (p = 0.0030; p < 0.0001), placental abruptio (p < 0.0001; p < 0.0001), IUFD (p < 0.0001; p < 0.0001), stillbirth (p = 0.0183 and p < 0.000), and postpartum haemorrhage (PPH) (p = 0.0420; p = 0.0044) were associated with both PLGF and T-AOC whilst a significant positive correlation of IUGR, placental abruptio (p < 0.0001; p < 0.0001), IUFD (p < 0.0001; p < 0.0001), stillbirth (p < 0.0001; p < 0.0001), and PPH (p = 0.0043; p = 0.0039) were observed with both sFlt-1 and 8-epi-PGF2α in PE.

Conclusions

Imbalance in the levels of angiogenic regulators and oxidative stress biomarkers correlates with adverse pregnancy outcomes among PE participants. Early identification of these imbalance would alert health care givers in anticipation of adverse pregnancy outcome and thus increased surveillance during pregnancy and parturition and measures to ameliorate the adverse outcome.

Experiences regarding maternal age-specific risks and prenatal testing of women of advanced maternal age in Japan

The number of pregnant women of advanced maternal age has increased worldwide. Women in this group have an increased chance of fetal abnormality. To explore Japanese women's experiences regarding maternal age-specific risks and prenatal testing, we conducted a descriptive qualitative study. Semi-structured interviews were conducted with 16 women aged 35 years or over who had given birth within the previous three months to a healthy, term infant. Thematic analysis of transcribed interview data was performed and three major themes were identified: inadequate understanding of genetic risks; insufficiently informed choice regarding prenatal testing; and need for more information from health professionals. Some participants were not aware of maternal age-specific risks to the fetus. Many took their cues from health professionals and did not raise the topic themselves, but would have considered prenatal testing if made aware of the risks. Nurses, midwives and other health professionals need to adequately inform pregnant women about the genetic risks to the fetus and offer testing at an appropriate stage early in the pregnancy.

Older maternal age and major depressive episodes in the first two years after birth: findings from the Parental Age and Transition to Parenthood Australia (PATPA) study

BACKGROUND

This study examines whether (1) older maternal age is associated with increased risk of depressive episodes between four months and two years after first birth and (2) the role of subsequent reproductive, social and child factors in vulnerability to later onset depression.

METHOD

592 women were recruited in the third trimester of pregnancy in three age-groups (≤ 30 years; 31-36 years,≥37 years); 434 (73%) completed all assessments at four months and two years after birth. Major Depression episodes (MDE) were assessed at four months and two years using the Mini International Neuropsychiatric Interview (MINI). Maternal (age, mode of conception, prior mood symptoms, health), child (temperament, health), reproductive (subsequent fertility treatment, pregnancy, birth, pregnancy loss) and social contextual variables (language background, paid work, practical support, life stresses) were assessed in pregnancy and postnatally using validated questionnaires and structured interview questions.

RESULTS

Maternal age was not related to prevalence or timing of MDE. Depression symptoms, poor child health, low practical support at four months and a non-English language background predicted episodes of depression between four months and two years, ps <0.05.

LIMITATIONS

Life history risks for depression were not considered, nor symptom profiles over time.

CONCLUSIONS

Findings indicate that despite a more complex reproductive context, older first time mothers are not more likely to report major depressive episodes in the first two years after birth. Prevalence for the whole sample was at the lower end of reported community ranges and was comparable early and later in the postpartum period. Screening for depression after childbirth should not be restricted to the early months.

Low-income, urban minority women's perceptions of self- and infant care during the postpartum period

OBJECTIVE

To describe low-income, urban, first-time mothers' perceptions about self-care and infant care during the first 6-months postpartum.

DESIGN

Naturalistic approach.

SETTING

Recruitment from community centers and churches.

PARTICIPANTS

Thirteen Hispanic and African American women who delivered their first infants within the past 6 months.

METHODS

Demographic and health information data were collected and analyzed using descriptive statistics. Semistructured interviews were conducted; data were coded and then clustered conceptually into categories.

RESULTS

Postpartum maternal self- and infant care issues included four categories: preparedness for discharge, confidence and satisfaction with mothering, concerns about infant care, and indifference to maternal self-care. Women were confident in caring for themselves and their infants and reported few unmet learning needs or health concerns. External sources of stress included finances, uncertain living arrangements, and relationship issues.

CONCLUSION

Health care providers who care for low-income postpartum women need to acknowledge the influence of external stressors that contribute to health outcomes in this population. It is vital that nurses collaborate with other health care providers to make certain that community connections are made for women who might need additional services beyond the postpartum check-up visit.

Characteristics of primiparous women of advanced age and their partners: a homogenous or heterogenous group?

BACKGROUND

Recent studies have reported that primiparous women of advanced maternal age (AMA) appear to constitute a heterogeneous group, emphasizing the need to revise stereotyped views. The aims of this study were the following: 1) to describe the sociodemographic and marital characteristics of Portuguese couples who experienced first childbirth at advanced maternal age (the AMA group) compared with their younger counterparts (the comparison group); 2) to compare the reproductive characteristics of both groups and identify distinct reproductive trajectories within the AMA group; and 3) to distinguish among different subgroups of couples within the AMA group, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics.

METHODS

The sample consisted of 250 couples. Both partners completed sociodemographic, marital, and reproductive health forms during pregnancy.

RESULTS

Despite being more highly educated, having a higher socioeconomic status, and having been employed longer, the AMA group displayed diverse conjugal configurations and reproductive trajectories over time. Within the AMA group, two subgroups were distinguished: couples who experienced infertility problems and couples who did not.

CONCLUSIONS

Couples who experience first childbirth at AMA constitute a heterogeneous group, which includes distinct subgroups with different psychosocial needs during the transition to parenthood. To revise stereotyped views of these couples, protective social policies should be improved, and health professionals should assume nonjudgmental attitudes and promote informed reproductive decisions. Psychoeducative programs concerning the transition to parenthood should take into account the distinct subgroups of couples who experience first childbirth at AMA.

Predictors of perception of pregnancy risk among nulliparous women

OBJECTIVE

To determine factors associated with perception of pregnancy risk using a conceptual framework based on a review of the relevant literature and the psychometric model of risk perception.

DESIGN

A correlational study.

SETTING

Ambulatory care and antepartum units of two tertiary hospitals and selected obstetricians' offices and prenatal classes in Winnipeg, Canada.

PARTICIPANTS

A convenience sample of nulliparous women in their third trimester with a singleton pregnancy.

METHODS

Between December 2009 and January 2011, the following questionnaires were completed by 159 nulliparous women: the Perception of Pregnancy Risk Questionnaire, the Pregnancy-related Anxiety scale, Knowledge of Maternal Age-related Risks of Childbearing Questionnaire, the SF-12v2 Health Status Survey, the Multidimensional Health Locus of Control, and the Prenatal Scoring Form. Pearson's r correlations and stepwise multivariable linear regression analyses were conducted to achieve the research objectives.

RESULTS

Of the eight proposed factors in the conceptual framework, five factors were significant predictors of perception of pregnancy risk, including pregnancy-related anxiety, maternal age, medical risk, perceived internal control, and gestational age, accounting for 47% to 49% of the variance in risk perception. An interaction between the pregnancy-related anxiety score and maternal age was found.

CONCLUSIONS

These results contribute to the literature on perception of pregnancy risk by identifying a new predictor (gestational age), supporting the role of previously known factors in the state of pregnancy, and proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. This knowledge may have implications for developing more effective risk communication models.

Advanced maternal age and risk perception: a qualitative study

Background

Advanced maternal age (AMA) is associated with several adverse pregnancy outcomes, hence these pregnancies are considered to be “high risk.” A review of the empirical literature suggests that it is not clear how women of AMA evaluate their pregnancy risk. This study aimed to address this gap by exploring the risk perception of pregnant women of AMA.

Methods

A qualitative descriptive study was undertaken to obtain a rich and detailed source of explanatory data regarding perceived pregnancy risk of 15 women of AMA. The sample was recruited from a variety of settings in Winnipeg, Canada. In-depth interviews were conducted with nulliparous women aged 35 years or older, in their third trimester, and with singleton pregnancies. Interviews were recorded and transcribed verbatim, and content analysis was used to identify themes and categories.

Results

Four main themes emerged: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals.

Conclusions

Several factors may influence women's perception of pregnancy risk including medical risk, psychological elements, characteristics of the risk, stage of pregnancy, and health care provider’s opinion. Understanding these influential factors may help health professionals who care for pregnant women of AMA to gain insight into their perspectives on pregnancy risk and improve the effectiveness of risk communication strategies with this group.

A 48-year-old woman primigravid via in vitro fertilization with severe bipolar depression and preeclampsia treated successfully with electroconvulsive therapy

Depression in pregnancy is difficult to treat due to potential adverse effects of medication on both the fetus and the mother. This is further complicated in older women, women with severe or treatment-resistant mental illness, and women with medical complications. Bipolar disorder can present with mania or depression and carries significant risk of impairment, including suicide. In addition, maternal depression adversely affects the development of the child. Depression during pregnancy is especially dangerous and can lead to suicide or infanticide. Treatment is critical. However, medication can present significant risks to the fetus. Therefore, conservative treatment is often the rule. However, especially severe cases require more aggressive approaches. Electroconvulsive therapy (ECT) is one relatively safe and effective option in these complex situations. This case describes a 48 year-old woman, pregnant via in vitro fertilization, with preeclampsia and severe treatment-resistant bipolar depression who responded well to ECT without significant adverse effects to herself or her child. This case highlights the effectiveness of ECT to treat maternal bipolar depression and is the only case, to our knowledge, of the use of ECT after in vitro fertilization in an older primigravid woman.

Lao Lai Zi—Becoming a Mother

Becoming a mother is a culturally significant value of transition for Chinese women. The purpose of this research was to explore the experiences of first-time mothers, 1 year after giving birth. Parse’s humanbecoming theory guided the research to illuminate the role transition experience. The research was conducted in a southern medical center in Taiwan using narrative inquiry with 10 first-time mothers over the age of 35. We explored the mothers’ experiences in the following areas: the pride and obstacles related to becoming a mother, the excitement and inconvenience in taking care of a baby, the struggling for energy and time in caring for the child, the worry about the child being unsociable, feeling grateful to God for the child, and realizing the inability to have another child. The findings of this research can provide nursing staff with a new perspective on the way first-time mothers experience their world, and it could enable them to offer better care.

A review of pregnancy in women over 35 years of age

The objective of the present paper is to review how pregnant women over 35 years have been described in previous research, and to review the risks associated with pregnancy in those of advanced maternal age. Computerized searches of the Cinahl, PubMed, Medic and Cochrane Library databases were undertaken. Research articles in scientific journals, relevant to the objective, and published in English between 2000 and 2008, were included. Data were extracted based on the aims, sample, authors, year and results.