1
|
Critiquing the evolution of maternity care preferences research: A systematic mixed studies review. Midwifery 2022; 111:103386. [DOI: 10.1016/j.midw.2022.103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
|
2
|
Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2020; 255:1-12. [PMID: 33059307 DOI: 10.1016/j.ejogrb.2020.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
Collapse
|
3
|
de Guingand DL, Palmer KR, Bilardi JE, Ellery SJ. Acceptability of dietary or nutritional supplementation in pregnancy (ADONS) - Exploring the consumer's perspective on introducing creatine monohydrate as a pregnancy supplement. Midwifery 2019; 82:102599. [PMID: 31877396 DOI: 10.1016/j.midw.2019.102599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pre-clinical studies suggest maternal dietary creatine supplementation during pregnancy could protect babies against hypoxic intrapartum events, however creatine has not been used as a supplement in pregnancy. The aim of this study was to explore pregnant women and healthcare professional's general knowledge, behaviours, and attitudes toward nutritional supplements, and their thoughts on introducing creatine as a pregnancy supplement. METHODS Pregnant women (n = 42) and partners (n = 23), attending a tertiary care pregnancy service in Melbourne, Australia, participated in focus groups or semi-structured interviews. Health professionals (n = 100), completed a semi-structured online survey. Descriptive data were analyzed using SPSS 25.0 and qualitative data was managed using NVivo 22.0. RESULTS Use of branded nutritional supplements in pregnancy was commonplace and acceptable. All primary healthcare respondents discussed supplements with their patients at first consultation. Supplements consumed corresponded closely to those recommended. Women had good general awareness of commonly recommended nutritional supplements, however, were less aware of the rationale for supplement use. This aligned with health professional's perceptions. Women would consider taking creatine if recommended by their health professional. Health professionals would require detailed safety, beneficence, and efficacy information before recommending creatine supplementation. They would also be more likely to recommend a new supplement in higher-risk pregnancies, where benefits may outweigh any perceived side-effects. CONCLUSION There is high acceptance of current recommended nutritional supplements in pregnancy. Implementing creatine as a new supplement will require substantive empirical evidence and changes to clinical guidelines. Public awareness and education would also be essential to consumer acceptability of creatine.
Collapse
Affiliation(s)
- Deborah L de Guingand
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia.
| | - Kirsten R Palmer
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia; Department of Obstetrics & Gynaecology, Monash Health, Melbourne, Australia
| | - Jade E Bilardi
- Melbourne Sexual Health Centre, Central Clinical School, Monash University, Melbourne, Australia
| | - Stacey J Ellery
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| |
Collapse
|
4
|
Kiguen AX, Marramá M, Ruiz S, Estofan P, Venezuela RF, Mosmann JP, Monetti MS, Rivero V, Cuffini CG. Prevalence, risk factors and molecular characterization of Chlamydia trachomatis in pregnant women from Córdoba, Argentina: A prospective study. PLoS One 2019; 14:e0217245. [PMID: 31150440 PMCID: PMC6544222 DOI: 10.1371/journal.pone.0217245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Chlamydia trachomatis causes the most prevalent bacterial Sexual Transmitted Infection. In pregnant women, untreated chlamydial infections are associated with abortions, premature rupture of membranes, postpartum endometritis, low birth weight and transmission to the newborn. In Córdoba, Argentina, there is little knowledge about the prevalence of Chlamydia trachomatis in women in their third trimester of pregnancy, so, the aim of this study was to evaluate Chlamydia trachomatis prevalence and genotypes present in Cordovan pregnant women with different age and socioeconomic status. Methods and findings Design: prospective study. Settings: Women population from Cordoba city, Argentina. Population: Pregnant women having 35 to 37 weeks of gestation. Methods: Five hundred and nine cervical swabs were collected. Each sample was subjected to DNA extraction and PCR for Chlamydia trachomatis using primers NRO/NLO and CTP1/CTP2. Positives samples were sequenced to determine genotype. Main outcome measures: Demographic data of the patients were collected to detect a population at risk for this infection. Results A prevalence of 6.9% (35/509) for Chlamydia trachomatis infection was detected, with 32/295 and 3/214 from pregnant women with low or better economic resources respectively (p = 0,0001). Results showed a significantly increased rate of 11.6% (30/258) in women under 25 years compared with 2% (5/251) in patients over that age (p = 0,00003). Genotype E was the most prevalent. Conclusions With these results, we can say that pregnant women under 25 years old and low economic resources are one of the populations in which the screening programs of Chlamydia trachomatis should focus.
Collapse
Affiliation(s)
- Ana Ximena Kiguen
- Instituto de Virología Doctor José María Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- * E-mail:
| | - Marcela Marramá
- Dirección de Especialidades Médicas, Municipalidad de Córdoba, Córdoba, Argentina
| | - Susana Ruiz
- Laboratorios LACE Sociedad Anónima, Córdoba, Argentina
| | - Patricia Estofan
- Centro Integral de Ginecología, Obstetricia y Reproducción (CIGOR), Córdoba, Argentina
| | - Raúl Fernando Venezuela
- Instituto de Virología Doctor José María Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jessica Paola Mosmann
- Instituto de Virología Doctor José María Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marina Soledad Monetti
- Instituto de Virología Doctor José María Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Virginia Rivero
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Cecilia Gabriela Cuffini
- Instituto de Virología Doctor José María Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| |
Collapse
|
5
|
Medline A, Joseph Davey D, Klausner JD. Lost opportunity to save newborn lives: variable national antenatal screening policies for Neisseria gonorrhoeae and Chlamydia trachomatis. Int J STD AIDS 2016; 28:660-666. [PMID: 27440873 DOI: 10.1177/0956462416660483] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unfavorable pregnancy outcomes caused by Chlamydia trachomatis or Neisseria gonorrhoeae infection are well known. The first step in addressing antenatal C. trachomatis and N. gonorrhoeae infection is a national policy to screen all pregnant women for C. trachomatis and N. gonorrhoeae, regardless of symptoms. The aim of this study was to inform policy makers on the presence of antenatal screening recommendations for C. trachomatis and N. gonorrhoeae infection. We conducted a three-part study from June 2015 to February 2016. We analyzed English and French language information online on Ministry of Health websites regarding C. trachomatis and N. gonorrhoeae antenatal screening. We referenced both primary official country and regional policy documents. We contacted the Ministry of Health directly if the information on the national antenatal screening was outdated or unavailable. In parallel, we sent a survey to the regional representative from the World Health Organization to help collect country-level data. Fourteen countries have current policies for antenatal screening of C. trachomatis and/or N. gonorrhoeae infection: Australia, the Bahamas, Bulgaria, Canada, Estonia, Japan, Germany, Latvia, New Zealand, Democratic People's Republic of Korea, Romania, Sweden, the United Kingdom, and the United States. Australia, New Zealand, and Latvia and the United States restricted antenatal screening to women ≤25 years old and those of higher risk. Several countries responded that they had policies to treat pregnant women with symptoms. This is the currently recommended WHO guideline but is not the same as universal screening. North Korea had policies in place which were not implemented due to lack of personnel and/or supplies. National level policies to support routine screening for C. trachomatis and N. gonorrhoeae infection to prevent adverse pregnancy and newborn outcomes are uncommon.
Collapse
Affiliation(s)
- Alexandra Medline
- 1 Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dvora Joseph Davey
- 2 David Geffen School of Medicine, UCLA, Program in Global Health, Division of Infectious Disease, Los Angeles, CA, USA.,3 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- 2 David Geffen School of Medicine, UCLA, Program in Global Health, Division of Infectious Disease, Los Angeles, CA, USA
| |
Collapse
|
6
|
Ong JJ, Chen M, Hocking J, Fairley CK, Carter R, Bulfone L, Hsueh A. Chlamydia screening for pregnant women aged 16-25 years attending an antenatal service: a cost-effectiveness study. BJOG 2015; 123:1194-202. [PMID: 26307516 DOI: 10.1111/1471-0528.13567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determine the cost-effectiveness of screening all pregnant women aged 16-25 years for chlamydia compared with selective screening or no screening. DESIGN Cost effectiveness based on a decision model. SETTING Antenatal clinics in Australia. SAMPLE Pregnant women, aged 16-25 years. METHODS Using clinical data from a previous study, and outcomes data from the literature, we modelled the short-term perinatal (12-month time horizon) incremental direct costs and outcomes from a government (as the primary third-party funder) perspective for chlamydia screening. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and average cost-weights reported for hospitalisations classified according to the Australian refined diagnosis-related groups. MAIN OUTCOME MEASURES Direct costs of screening and managing chlamydia complications, number of chlamydia cases detected and treated, and the incremental cost-effectiveness ratios were estimated and subjected to sensitivity analyses. RESULTS Assuming a chlamydia prevalence rate of 3%, screening all antenatal women aged 16-25 years at their first antenatal visit compared with no screening was $34,931 per quality-adjusted life-years gained. Screening all women could result in cost savings when chlamydia prevalence was higher than 11%. The incremental cost-effectiveness ratios were most sensitive to the assumed prevalence of chlamydia, the probability of pelvic inflammatory disease, the utility weight of a positive chlamydia test and the cost of the chlamydia test and doctor's appointment. CONCLUSION From an Australian government perspective, chlamydia screening of all women aged 16-25 years old during one antenatal visit was likely to be cost-effective compared with no screening or selective screening, especially with increasing chlamydia prevalence. TWEETABLE ABSTRACT Chlamydia screening for all pregnant women aged 16-25 years during an antenatal visit is cost effective.
Collapse
Affiliation(s)
- J J Ong
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - M Chen
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School Monash University, Clayton, Victoria, Australia
| | - J Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School Monash University, Clayton, Victoria, Australia
| | - R Carter
- Deakin Health Economics, Strategic Research Centre-Population Health Deakin University, Burwood, Victoria, Australia
| | - L Bulfone
- Deakin Health Economics, Strategic Research Centre-Population Health Deakin University, Burwood, Victoria, Australia
| | - A Hsueh
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
7
|
Pereboom MTR, Spelten ER, Manniën J, Rours GIJG, Morré SA, Schellevis FG, Hutton EK. Knowledge and acceptability of Chlamydia trachomatis screening among pregnant women and their partners; a cross-sectional study. BMC Public Health 2014; 14:704. [PMID: 25011479 PMCID: PMC4105044 DOI: 10.1186/1471-2458-14-704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Chlamydia trachomatis infections in pregnancy can cause maternal disease, adverse pregnancy outcomes and neonatal disease, which is why chlamydia screening during pregnancy has been advocated. The effectiveness of a screening program depends on the knowledge of health care professionals, women and partners and the acceptability for screening of the target population. We assessed the knowledge of chlamydia infection among pregnant women and their partners in the Netherlands, their attitudes towards testing, and their experiences of being offered a chlamydia test. In addition, we evaluated the association between participants’ background characteristics and knowledge of chlamydia. Methods Pregnant women aged ≤ 30 years and their partners (regardless of their age) attending one of the participating primary midwifery care practices in the Netherlands were invited to participate. All participants completed a questionnaire, pregnant women provided a vaginal swab and partners provided a urine sample to test for C. trachomatis. Results In total, 383 pregnant women and 282 partners participated in the study of whom 1.9% women and 2.6% partners tested chlamydia positive. Participants had high levels of awareness (92.8%) of chlamydial infection. They were knowledgeable about the risk of chlamydia infection; median knowledge score was 9.0 out of 12.0. Lower knowledge scores were found among partners (p-value <0.001), younger aged (p-value 0.02), non-western origin (p-value <0.001), low educational level (p-value <0.001), and no history of sexually transmitted infections (p-value <0.001). In total, 78% of respondents indicated that when pregnant women are tested for chlamydia, their partners should also be tested; 54% believed that all women should routinely be tested. Pregnant women more often indicated than partners that testing partners for chlamydial infection was not necessary (p-value <0.001). The majority of pregnant women (56.2%) and partners (59.2%) felt satisfied by being offered the test during antenatal care. Conclusion Pregnant women and their partners were knowledgeable about chlamydial infection, found testing, both pregnant women and their partners, for chlamydia acceptable and not stigmatizing.
Collapse
Affiliation(s)
- Monique T R Pereboom
- Department of Midwifery Science, AVAG and the EMGO + Institute for Health and Care Research, VU University Medical Center, P,O, Box 7057, (Room D4,40), Amsterdam, 1007 MB, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
8
|
Raychaudhuri M. False positive chlamydia results in pregnancy: should we retest them? Sex Transm Infect 2013; 89:665. [PMID: 24243716 DOI: 10.1136/sextrans-2013-051304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
9
|
Abstract
This review considers the role of intracellular bacteria in adverse pregnancy outcomes, such as miscarriage, stillbirths, and preterm labour. The cause of miscarriage, stillbirth and preterm labour often remains unexplained. Intracellular bacteria that grow either poorly or not at all on media used routinely to detect human pathogens could be the aetiological agents of these obstetric conditions. For example, Listeria monocytogenes and Coxiella burnetti are intracellular bacteria that have a predilection for the fetomaternal unit and may induce fatal disease in the mother and/or fetus. Both are important foodborne or zoonotic pathogens in pregnancy. Preventive measures, diagnostic tools and treatment will be reviewed. Moreover, we will also address the importance in adverse pregnancy outcomes of other intracellular bacteria, including Brucella abortus and various members of the order Chlamydiales. Indeed, there is growing evidence that Chlamydia trachomatis, Chlamydia abortus and Chlamydia pneumoniae infections may also result in adverse pregnancy outcomes in humans and/or animals. Moreover, newly discovered Chlamydia-like organisms have recently emerged as new pathogens of both animals and humans. For example, Waddlia chondrophila, a Chlamydia-related bacterium isolated from aborted bovine fetuses, has also been implicated in human miscarriages. Future research should help us to better understand the pathophysiology of adverse pregnancy outcomes caused by intracellular bacteria and to determine the precise mode of transmission of newly identified bacteria, such as Waddlia and Parachlamydia. These emerging pathogens may represent the tip of the iceberg of a large number of as yet unknown intracellular pathogenic agents.
Collapse
Affiliation(s)
- D Baud
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | | |
Collapse
|