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Wallace ME, Vilda D, Dyer L, Johnson I, Funke L. Health care use and health consequences of geographic lack of access to abortion and maternity care. Birth 2024; 51:363-372. [PMID: 37968858 PMCID: PMC11093883 DOI: 10.1111/birt.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/05/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. METHODS We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. RESULTS In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). CONCLUSIONS Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.
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Affiliation(s)
- Maeve E Wallace
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Dovile Vilda
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lauren Dyer
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Iman Johnson
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Roth I, Tiedt M, Brintz C, Thompson-Lastad A, Ferguson G, Agha E, Holcomb J, Gardiner P, Leeman J. Determinants of implementation for group medical visits for patients with chronic pain: a systematic review. Implement Sci Commun 2024; 5:59. [PMID: 38783388 PMCID: PMC11112917 DOI: 10.1186/s43058-024-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain. METHODS The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research. RESULTS Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting. CONCLUSIONS Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain. TRIAL REGISTRATION This systematic review was registered with PROSPERO 2021 CRD42021231310 .
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Affiliation(s)
- Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Malik Tiedt
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Health Studies and Applied Educational Psychology, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Carrie Brintz
- Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ariana Thompson-Lastad
- Department of Family and Community Medicine, Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, USA
| | - Gayla Ferguson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Erum Agha
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Paula Gardiner
- Department of Family Medicine, Cambridge Health Alliance, University of Massachusetts Medical School, Boston, MA, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Forster DA, Matthews R, Hyde R, Fox D, Dyson K, Ryan T. Exploring the feasibility of conducting a randomised controlled trial of group-based pregnancy care and education: a pilot randomised controlled trial in Melbourne, Australia. Pilot Feasibility Stud 2024; 10:81. [PMID: 38769553 PMCID: PMC11103971 DOI: 10.1186/s40814-024-01501-8] [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: 07/31/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND In group-based pregnancy models, antenatal care and childbirth/parenting education are provided in groups of eight to 10 women, usually with two midwives, and six to eight sessions. Current evidence is inconclusive regarding potential benefit or harm. We aimed to explore the feasibility of implementing an adequately powered randomised controlled trial (RCT). METHODS A two-arm pilot RCT was conducted in a tertiary maternity hospital in Melbourne, Australia. Women were randomly allocated to either the intervention to receive group-based antenatal care and education (group care) or to usual care, which included hospital-based midwife, caseload midwifery, team midwifery, or GP shared care. Participants were English-speaking, primiparous, low risk, and < 24 weeks gestation at booking. DATA COLLECTION feasibility measures throughout pilot, baseline questionnaire at recruitment, clinical outcome data from the medical record, and a telephone-administered questionnaire 6 weeks postpartum. A focus group explored midwives' views. RESULTS Seventy-four women were recruited from May to June 2017 (group care = 40, usual care = 34). Study uptake was 35%. Women allocated to group care rated their overall pregnancy care more highly (88% good/very good vs 77% in usual care). There was no evidence of harm related to group care. Overarching themes from the midwives were that group care helped 'build connections' and 'empower women'. All midwives would work in the model again and believed it should be expanded. CONCLUSION Group care was acceptable to both women and midwives with no evidence of harm. The pilot demonstrated the feasibility of undertaking a large adequately powered RCT, important given the inconclusive evidence on clinical outcomes regarding the model, and its current relatively widespread implementation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000858695.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, 3086, Australia.
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Robyn Matthews
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, 3086, Australia
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC, 3052, Australia
| | - Rebecca Hyde
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, 3086, Australia
- School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC, 3052, Australia
| | - Deborah Fox
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Kaye Dyson
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC, 3052, Australia
| | - Trish Ryan
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC, 3052, Australia
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Maghalian M, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Ghanbari-Homaie S, Mirghafourvand M. Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol. Reprod Health 2024; 21:54. [PMID: 38637855 PMCID: PMC11025169 DOI: 10.1186/s12978-024-01792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women's experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes. METHODS/DESIGN The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women's understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data. DISCUSSION The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206 .
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Affiliation(s)
- Mahsa Maghalian
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Women's Reproductive Health Research Center, Department of Perinatology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Carandang RR, Epel E, Radin R, Lewis J, Ickovics J, Cunningham S. Association between mindful and practical eating skills and eating behaviors among racially diverse pregnant women in four selected clinical sites in the United States. Nutr Health 2024:2601060241246353. [PMID: 38584400 DOI: 10.1177/02601060241246353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background: Mindful eating is a promising strategy to address problematic eating behaviors; however, little is known about its applicability during pregnancy. No studies have examined the combined effects of mindful and practical eating skills on eating behaviors. Aim: We examined associations between mindful and practical eating skills and eating behaviors (nutritional intake and emotional eating) among pregnant women who received psychoeducation on healthy eating and pregnancies. Methods: Participants were racially-diverse pregnant women (14-42 years) from four clinical sites in Detroit, Michigan, and Nashville, Tennessee (N = 741). We conducted multiple linear regression to examine associations between mindful (hunger cues, satiety cues, mindful check-ins) and practical (food diary/journal, MyPlate method) eating skills and nutritional intake. We calculated residualized change scores to represent changes in the quality of nutritional intake from second to third trimester. We performed multiple logistic regression to examine associations between mindful and practical eating skills and emotional eating. Results: Women improved over time in eating behaviors (better nutrition, less emotional eating). Regular use of MyPlate was associated with better nutritional intake (unstandardized coefficient [B] = -0.61), but food diaries were not. We found a significant interaction in predicting emotional eating: For those regularly paying attention to hunger cues, some use of MyPlate (Adjusted Odds Ratio [AOR] = 0.39) and especially regular use of MyPlate (AOR = 0.13) reduced the likelihood of emotional eating during pregnancy. Conclusion: Enhancing both mindful and practical eating skills, such as paying attention to hunger cues, and using the MyPlate method, may facilitate pregnant women's ability to improve their eating behaviors.
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Affiliation(s)
- Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Rachel Radin
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Jessica Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jeannette Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Shayna Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
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Biringer A, Morson N, Walji S, Tregaskiss N, Merritt S, Makuwaza T, Forte M. Recreating the village: the patient experience with a hybrid model of Group Perinatal Care (GPPC) in an academic family health team. BMC Pregnancy Childbirth 2024; 24:227. [PMID: 38566095 PMCID: PMC10986064 DOI: 10.1186/s12884-024-06405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Group prenatal care (GPC) has been shown to have a positive impact on social support, patient knowledge and preparedness for birth. We developed an interprofessional hybrid model of care whereby the group perinatal care (GPPC) component was co-facilitated by midwives (MW) and family medicine residents (FMR) and alternating individual visits were provided by family physicians (FP's) within our academic family health team (FHT) In this qualitative study, we sought to explore the impact of this program and how it supports patients through pregnancy and the early newborn period. METHODS Qualitative study that was conducted using semi-structured telephone interviews with 18 participants who had completed GPPC in the Mount Sinai Academic Family Health Team in Toronto, Canada and delivered between November 2016 and October 2018. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by team members using grounded theory. RESULTS Four over-arching themes emerged from the data: (i) Participants highly valued information they received from multiple trusted sources, (ii) Participants felt well cared for by the collaborative and coordinated interprofessional team, (iii) The design of GPPC enabled a shared experience, allowing for increased support of the pregnant person, and (iv) GPPC facilitated a supportive transition into the community which positively impacted participants' emotional well- being. CONCLUSIONS The four constructs of social support (emotional, informational, instrumental and appraisal) were central to the value that participants found in GPPC. This support from the team of healthcare providers, peers and partners had a positive impact on participants' mental health and helped them face the challenges of their transition to parenthood.
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Affiliation(s)
- Anne Biringer
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Natalie Morson
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sakina Walji
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Tregaskiss
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
| | - Susannah Merritt
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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7
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Heberlein EC, Smith JC, LaBoy A, Britt J, Crockett A. Birth Outcomes for Medically High-Risk Pregnancies: Comparing Group to Individual Prenatal Care. Am J Perinatol 2024; 41:414-421. [PMID: 34710941 DOI: 10.1055/a-1682-2704] [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: 10/20/2022]
Abstract
OBJECTIVES Group prenatal care models were initially designed for women with medically low-risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birth weight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group versus individual prenatal care. STUDY DESIGN This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI > 45 kg/m2). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (one or more groups) or minimum threshold (five or more groups). RESULTS Participation in group prenatal care at either treatment exposure level was associated with a lower risk of neonatal intensive care unit (NICU) admissions (10.2 group vs. 13.8% individual care, odds ratio [OR] = 0.708, p < 0.001). Participating in the minimum threshold of groups (five or more sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR = 0.569, p < 0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR = 0.483, p < 0.001). No differences in birth weight were observed. CONCLUSION This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birth weight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups. KEY POINTS · This study compares outcomes for women who receive group versus individual prenatal care. · The study population was limited to women with diabetes, hypertension, and/or high BMI.. · Group participants did not have higher rates of preterm birth, low birth weight, or NICU admissions..
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Affiliation(s)
- Emily C Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Jessica C Smith
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Ana LaBoy
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Jessica Britt
- Department of Obstetrics and Gynecology, Prisma Health Upstate, Greenville, South Carolina
| | - Amy Crockett
- Department of Obstetrics and Gynecology, Prisma Health Upstate, Greenville, South Carolina
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Ware KS, Lee ASD, Rodriguez M, Williams CH. Perceptions to Overcoming Barriers to Prenatal Care in African American Women. Nurs Clin North Am 2024; 59:121-129. [PMID: 38272578 DOI: 10.1016/j.cnur.2023.11.010] [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] [Indexed: 01/27/2024]
Abstract
Pregnancy-related deaths affect African American women at a rate four to five times higher than White women. These deaths occur during pregnancy or up to 1 year after childbirth. Inadequate or delayed prenatal care is a factor associated with poor maternal health outcomes in African American women. Identifying factors that pose as facilitators and barriers to prenatal care is essential in developing interventions aimed at improving maternal health outcomes.
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Affiliation(s)
- Katilya S Ware
- Auburn University College of Nursing, 710 South Donahue Drive, Auburn, AL 36849, USA.
| | - Amy S D Lee
- Capstone College of Nursing 3006, Box 870358, Tuscaloosa, AL 35487, USA
| | - Mayra Rodriguez
- Edward Via College of Osteopathic Medicine Auburn, 910 South Donahue Drive, Auburn, AL 36832, USA
| | - Courtney H Williams
- Auburn University College of Nursing, 710 South Donahue Drive, Auburn, AL 36832, USA
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Wagijo MA, Crone M, Bruinsma-van Zwicht B, van Lith J, Billings D, Rijnders M. The Effect of CenteringPregnancy Group Antenatal Care on Maternal, Birth, and Neonatal Outcomes Among Low-Risk Women in the Netherlands: A Stepped-Wedge Cluster Randomized Trial. J Midwifery Womens Health 2024; 69:191-201. [PMID: 38339816 DOI: 10.1111/jmwh.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/10/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands. METHODS A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes. RESULTS Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group. CONCLUSION Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
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Affiliation(s)
- Mary-Ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | | | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Billings
- Group Care Global, Philadelphia, Pennsylvania
- University of South Carolina, Columbia, South Carolina
| | - Marlies Rijnders
- Department of Child Health, Dutch Organization of Applied Scientific Research, Leiden, The Netherlands
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Sadiku F, Bucinca H, Talrich F, Molliqaj V, Selmani E, McCourt C, Rijnders M, Little G, Goodman DC, Rising SS, Hoxha I. Maternal satisfaction with group care: a systematic review. AJOG GLOBAL REPORTS 2024; 4:100301. [PMID: 38318267 PMCID: PMC10839533 DOI: 10.1016/j.xagr.2023.100301] [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] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care. DATA SOURCES We searched CINAHL, Clinical Trials, The Cochrane Library, PubMed, Scopus, and Web of Science databases from the beginning of 2003 through June 2023. STUDY ELIGIBILITY CRITERIA We included studies that reported the association between overall maternal satisfaction and centering-based perinatal care where the control group was standard individual care. We included randomized and observational designs. METHODS Screening and independent data extraction were carried out by 4 researchers. We extracted data on study characteristics, population, design, intervention characteristics, satisfaction measurement, and outcome. Quality assessment was performed using the Cochrane tools for Clinical Trials (RoB2) and observational studies (ROBINS-I). We summarized the study, intervention, and satisfaction measurement characteristics. We presented the effect estimates of each study descriptively using a forest plot without performing an overall meta-analysis. Meta-analysis could not be performed because of variations in study designs and methods used to measure satisfaction. We presented studies reporting mean values and odds ratios in 2 separate plots. The presentation of studies in forest plots was organized by type of study design. RESULTS A total of 7685 women participated in the studies included in the review. We found that most studies (ie, 17/20) report higher satisfaction with group care than standard individual care. Some of the noted results are lower satisfaction with group care in both studies in Sweden and 1 of the 2 studies from Canada. Higher satisfaction was present in 14 of 15 studies reporting CenteringPregnancy, Group Antenatal Care (1 study), and Adapted CenteringPregnancy (1 study). Although indicative of higher maternal satisfaction, the results are often based on statistically insignificant effect estimates with wide confidence intervals derived from small sample sizes. CONCLUSION The evidence confirms higher maternal satisfaction with group care than with standard care. This likely reflects group care methodology, which combines clinical assessment, facilitated health promotion discussion, and community-building opportunities. This evidence will be helpful for the implementation of group care globally.
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Affiliation(s)
- Fitim Sadiku
- Action for Mother and Children, Prishtina, Kosovo (Mr Sadiku, Dr Bucinca, Mr Molliqaj, and Dr Hoxha)
- Evidence Synthesis Group, Prishtina, Kosovo (Mr Sadiku, Ms Selmani, and Dr Hoxha)
| | - Hana Bucinca
- Action for Mother and Children, Prishtina, Kosovo (Mr Sadiku, Dr Bucinca, Mr Molliqaj, and Dr Hoxha)
| | - Florence Talrich
- Vrije Universiteit Brussel, Brussel, Belgium (Ms Talrich)
- Universitair Ziekenhuis Brussel, Brussel, Belgium (Ms Talrich)
| | - Vlorian Molliqaj
- Action for Mother and Children, Prishtina, Kosovo (Mr Sadiku, Dr Bucinca, Mr Molliqaj, and Dr Hoxha)
| | - Erza Selmani
- Evidence Synthesis Group, Prishtina, Kosovo (Mr Sadiku, Ms Selmani, and Dr Hoxha)
| | | | - Marlies Rijnders
- The Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands (Dr Rijnders)
- Group Care Global, Philadelphia, PA (Dr Rijnders and Ms Rising)
| | - George Little
- Geisel School of Medicine at Dartmouth, Hanover, NH (Dr Little)
| | - David C. Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (Drs Goodman and Hoxha)
| | | | - Ilir Hoxha
- Action for Mother and Children, Prishtina, Kosovo (Mr Sadiku, Dr Bucinca, Mr Molliqaj, and Dr Hoxha)
- Evidence Synthesis Group, Prishtina, Kosovo (Mr Sadiku, Ms Selmani, and Dr Hoxha)
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (Drs Goodman and Hoxha)
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Nair NM, Makhanlall A, Roy S, Olola O, Altman E, Chaudhuri P, Wen X. Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy. J Womens Health (Larchmt) 2024; 33:239-253. [PMID: 38112533 PMCID: PMC10880298 DOI: 10.1089/jwh.2023.0179] [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] [Indexed: 12/21/2023] Open
Abstract
Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.
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Affiliation(s)
- Nisha M. Nair
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Amelia Makhanlall
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Shannon Roy
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Olabowale Olola
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elizabeth Altman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Preyashi Chaudhuri
- Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, New York, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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12
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Lima Figueiredo ER, do Socorro Carvalho Miranda C, Viana Campos AC, de Campos Gomes F, Câmara Rodrigues CN, de Melo-Neto JS. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Womens Health 2024; 24:84. [PMID: 38302949 PMCID: PMC10835861 DOI: 10.1186/s12905-024-02925-3] [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: 11/28/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.
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Affiliation(s)
- Eric Renato Lima Figueiredo
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | | | - Ana Cristina Viana Campos
- Laboratory and Observatory in Surveillance and Social Epidemiology, Federal University of the South and Southeast of Pará (Unifesspa), Marabá, PA, 68500-000, Brazil
| | | | - Cibele Nazaré Câmara Rodrigues
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil.
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13
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Gray HL, Rancourt D, Masho S, Stern M. Comparing Group Versus Individual Prenatal Care on Breastfeeding Practice and Motivational Factors. J Perinat Neonatal Nurs 2024:00005237-990000000-00029. [PMID: 38197803 DOI: 10.1097/jpn.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Although breastfeeding in the first 6 months postpartum benefits both infants and mothers, breastfeeding rates remain low. This study examined whether group prenatal care was associated with an increased breastfeeding initiation and duration compared with those receiving usual, individual prenatal care. A secondary aim was to investigate whether sociodemographic and motivational factors were associated with breastfeeding initiation and duration across prenatal care groups. METHODS Pregnant women in their third trimester (n = 211) from an innercity university medical center participated. Prenatal care type was identified from the medical chart, and data on breastfeeding duration at 1, 3, and 6 months postpartum were collected. Breastfeeding motivational factors were assessed with a survey. Logistic regressions and independent-samples t tests were used for data analyses. RESULTS After controlling for demographic factors, group prenatal care was associated with increased breastfeeding at 6 months postpartum (odds ratio = 2.66; P = .045) compared with individual care. Breastfeeding intention (P < .001), competence (P = .003), and autonomous motivation (P < .001) were significantly higher, while amotivation (P = .034) was significantly lower in group compared with individual prenatal care. CONCLUSIONS Breastfeeding persistence was higher among women receiving group prenatal care, potentially due to motivational factors. Future studies should investigate how breastfeeding motivational factors could be effectively targeted in prenatal care to increase breastfeeding persistence.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa (Dr Gray); Department of Psychology, University of South Florida, Tampa (Dr Rancourt); Virginia Commonwealth University, School of Medicine, Richmond (Dr Masho); and Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa (Dr Stern)
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14
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Park CH, Driver N, Richards RC, Ward P. The effects of CenteringPregnancy on maternal and infant health outcomes: a moderation analysis. J Public Health (Oxf) 2023; 45:e746-e754. [PMID: 37580870 DOI: 10.1093/pubmed/fdad146] [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: 08/11/2022] [Revised: 01/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND CenteringPregnancy (CP) has been expected to produce beneficial outcomes for women and their infants. However, previous studies paid little attention to testing variations in CP's effects across women from different demographic groups. This study aimed to test how multiple demographic factors (obesity, race, ethnicity, marital status and socioeconomic status) moderate CP's effects on health outcomes. METHODS This study employed a quasi-experimental design. De-identified hospital birth data were collected from 216 CP participants and 1159 non-CP participants. We estimated the average treatment effect of CP on outcome variables as a baseline. Then we estimated the average marginal effect of CP by adding each of the moderating variables in regression adjustment models. RESULTS CP produced salutary effects among those who were obese or overweight and unmarried as well as women with lower socioeconomic status. These salutary effects were also strengthened as maternal age increased. However, CP was ineffective for Hispanic/Latinx women. CONCLUSIONS CP produced more beneficial health outcomes for high-risk women such as obese, unmarried women and those with lower socioeconomic status. These are meaningful findings from a public health perspective.
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Affiliation(s)
- Chul H Park
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Nichola Driver
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Robert C Richards
- Clinton School of Public Service, University of Arkansas, 1200 President Clinton Avenue, Little Rock, AR 72201, USA
| | - Penny Ward
- Psychiatric Research Institute, University of Arkansas for Medical Sciences 4301 W. Markham St. Little Rock, AR 72205, USA
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15
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Carter EB, Thayer SM, Paul R, Barry VG, Iqbal SN, Ehrenberg S, Doering M, Mazzoni SE, Frolova AI, Kelly JC, Raghuraman N, Debbink MP. Diabetes Group Prenatal Care: A Systematic Review and Meta-analysis. Obstet Gynecol 2023:00006250-990000000-00958. [PMID: 37944148 PMCID: PMC11078888 DOI: 10.1097/aog.0000000000005442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To estimate the effect of diabetes group prenatal care on rates of preterm birth and large for gestational age (LGA) among patients with diabetes in pregnancy compared with individual diabetes prenatal care. DATA SOURCES We searched Ovid Medline (1946-), Embase.com (1947-), Scopus (1823-), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. METHODS OF STUDY SELECTION We searched electronic databases for randomized controlled trials (RCTs) and observational studies comparing diabetes group prenatal care with individual care among patients with type 2 diabetes mellitus or gestational diabetes mellitus (GDM). The primary outcomes were preterm birth before 37 weeks of gestation and LGA (birth weight at or above the 90th percentile). Secondary outcomes were small for gestational age, cesarean delivery, neonatal hypoglycemia, neonatal intensive care unit admission, breastfeeding at hospital discharge, long-acting reversible contraception (LARC) uptake, and 6-week postpartum visit attendance. Secondary outcomes, limited to the subgroup of patients with GDM, included rates of GDM requiring diabetes medication (A2GDM) and completion of postpartum oral glucose tolerance testing (OGTT). Heterogeneity was assessed with the Cochran Q test and I2 statistic. Random-effects models were used to calculate pooled relative risks (RRs) and weighted mean differences. TABULATION, INTEGRATION, AND RESULTS Eight studies met study criteria and were included in the final analysis: three RCTs and five observational studies. A total of 1,701 patients were included in the pooled studies: 770 (45.3%) in diabetes group prenatal care and 931 (54.7%) in individual care. Patients in diabetes group prenatal care had similar rates of preterm birth compared with patients in individual care (seven studies: pooled rates 9.5% diabetes group prenatal care vs 11.5% individual care, pooled RR 0.77, 95% CI, 0.59-1.01), which held for RCTs and observational studies. There was no difference between diabetes group prenatal care and individual care in rates of LGA overall (four studies: pooled rate 16.7% diabetes group prenatal care vs 20.2% individual care, pooled RR 0.93, 95% CI, 0.59-1.45) or by study type. Rates of other secondary outcomes were similar between diabetes group prenatal care and individual care, except patients in diabetes group prenatal care were more likely to receive postpartum LARC (three studies: pooled rates 46.1% diabetes group prenatal care vs 34.1% individual care, pooled RR 1.44, 95% CI, 1.09-1.91). When analysis was limited to patients with GDM, there were no differences in rates of A2GDM or postpartum visit attendance, but patients in diabetes group prenatal care were significantly more likely to complete postpartum OGTT (five studies: pooled rate 74.0% diabetes group prenatal care vs 49.4% individual care, pooled RR 1.58, 95% CI, 1.19-2.09). CONCLUSION Patients with type 2 diabetes and GDM who participate in diabetes group prenatal care have similar rates of preterm birth, LGA, and other pregnancy outcomes compared with those who participate in individual care; however, they are significantly more likely to receive postpartum LARC, and those with GDM are more likely to return for postpartum OGTT. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021279233.
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Affiliation(s)
- Ebony B Carter
- Division of Maternal Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, and the Becker Library, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Columbia, Maryland; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland Ohio; Harborview OB/GYN Generalists, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
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Doherty EA, Cartmell K, Griffin S, Heo M, Chen L, Britt JL, Crockett AH. Discrimination and Adverse Perinatal Health Outcomes: A Latent Class Analysis. Prev Chronic Dis 2023; 20:E96. [PMID: 37917614 PMCID: PMC10625434 DOI: 10.5888/pcd20.230094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION An intersectionality framework recognizes individuals as simultaneously inhabiting multiple intersecting social identities embedded within systems of disadvantage and privilege. Previous research links perceived discrimination with worsened health outcomes yet is limited by a focus on racial discrimination in isolation. We applied an intersectional approach to the study of discrimination to examine the association with adverse perinatal health outcomes. METHODS We analyzed data from a cohort of 2,286 pregnant participants (Black, n = 933; Hispanic, n = 471; White, n = 853; and Other, n = 29) from the Centering and Racial Disparities trial. Perceived discrimination was assessed via the Everyday Discrimination Scale (EDS) and perinatal health outcomes collected via electronic medical record review. Latent class analysis was used to identify subgroups of discrimination based on EDS item response and the rate of adverse perinatal health outcomes compared between subgroups using a Bolck, Croon and Hagenaars 3-step approach. RESULTS Four discrimination subgroups were identified: no discrimination, general discrimination, discrimination attributed to one or several social identities, and discrimination attributed to most or all social identities. Experiencing general discrimination was associated with postpartum depression symptoms when compared with experiencing no discrimination among Black (9% vs 5%, P = .04) and White participants (18% vs 9%, P = .01). White participants experiencing general discrimination gave birth to low birthweight infants at a higher rate than those experiencing no discrimination (11% vs 6%, P = .04). No significant subgroup differences were observed among Hispanic participants. CONCLUSION Perceived discrimination may play an influential role in shaping perinatal health. More research applying an intersectional lens to the study of discrimination and perinatal health outcomes is needed.
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Affiliation(s)
- Emily A Doherty
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
- Center of Rural Health, Oklahoma State University Center for Health Sciences, Department of Public Health Sciences, 1111 W 17th St, Tulsa, OK 74107
| | - Kathleen Cartmell
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Sarah Griffin
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Jessica L Britt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
| | - Amy H Crockett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
- University of South Carolina School of Medicine, Greenville, South Carolina
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17
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Malchi F, Abedi P, Iravani M, Maraghi E, Mohammadi E, Saadati N. The Effect of Group Prenatal Care on the Empowerment of Pregnant Adolescents: Randomised controlled trial. Sultan Qaboos Univ Med J 2023; 23:502-509. [PMID: 38090240 PMCID: PMC10712397 DOI: 10.18295/squmj.6.2023.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/19/2023] [Accepted: 04/19/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to evaluate the effect of group prenatal care (GPNC) on the empowerment of pregnant adolescents. Methods In this trial, 294 pregnant adolescents (aged 15-19 years) were randomly assigned into the GPNC (n = 147) and individual prenatal care (IPNC; n = 147) groups, where they received 5 sessions of GPNC (90-120 min) and IPNC, respectively, between the 16th and 40th weeks of pregnancy. The empowerment of participants in the two groups was measured using the Empowerment Scale for Pregnant Women. Data were analysed using various tests. Results The mean total score of pregnant women's empowerment in both groups after the intervention was 86.46 ± 4.95 and 81.89 ± 4.75, respectively (β = 6.11, 95% confidence interval: 4.89, 7.33; P <0.0001). Conclusion GPNC can improve pregnant adolescent empowerment. The current study's results can provide a foundation for implementing the GPNC model in Iran.
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Affiliation(s)
- Fatemeh Malchi
- Midwifery Department, Nursing and Midwifery School, Reproductive Health Promotion Research Center, Tarbiat Modares University, Tehran, Iran
| | - Parvin Abedi
- Midwifery Department, Nursing and Midwifery School, Reproductive Health Promotion Research Center, Tarbiat Modares University, Tehran, Iran
| | - Mina Iravani
- Midwifery Department, Nursing and Midwifery School, Reproductive Health Promotion Research Center, Tarbiat Modares University, Tehran, Iran
| | - Elham Maraghi
- Department of Biostatics and Epidemiology, Faculty of Public Health, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Najmieh Saadati
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wagijo MA, Crone M, Zwicht BBV, van Lith J, Billings DL, Rijnders M. Contributions of CenteringPregnancy to women's health behaviours, health literacy, and health care use in the Netherlands. Prev Med Rep 2023; 35:102244. [PMID: 37415970 PMCID: PMC10320596 DOI: 10.1016/j.pmedr.2023.102244] [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: 12/09/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023] Open
Abstract
The objective of this study was to assess the effects of CenteringPregnancy (CP) in the Netherlands on different health outcomes. A stepped wedged cluster randomized trial was used, including 2132 women of approximately 12 weeks of gestation, from thirteen primary care midwifery centres in and around Leiden, Netherlands. Data collection was done through self-administered questionnaires. Multilevel intention-to-treat analysis and propensity score matching for the entire group and separately for nulliparous- and multiparous women were employed. The main outcomes were: health behaviour, health literacy, psychological outcomes, health care use, and satisfaction with care. Women's participation in CP is associated with lower alcohol consumption after birth (OR = 0.59, 95 %CI 0.42-0.84), greater consistency with norms for healthy eating and physical activity (β = 0.19, 95 %CI 0.02-0.37), and higher knowledge about pregnancy (β = 0.05, 95 %CI 0.01-0.08). Compared to the control group, nulliparous women who participating in CP reported better compliance to the norm for healthy eating and physical activity (β = 0.28, 95 %CI0.06-0.51)) and multiparous CP participants consumed less alcohol after giving birth (OR = 0.42, 95 %CI 0.23-0.78). Health care use and satisfaction rates were significantly higher among CP participants. A non-significant trend toward lower smoking rates was documented among CP participants. Overall, the results of this study reveal a positive (postpartum) impact on fostering healthy behaviours among participants.
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Affiliation(s)
- Mary-ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Birgit Bruinsma-van Zwicht
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Deborah L. Billings
- Group Care Global, 6520 Wissahickon Ave., Philadelphia, PA 19119, USA
- University of South Carolina (Columbia, SC) / University of North Carolina, Chapel Hill, NC, USA
| | - Marlies Rijnders
- Department of Child Health, TNO, PO Box 22152301 CE, Leiden, The Netherlands
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Kolesova M, Sarantos S, Alvarez J, Torres A, Pateriya S, Penalver M. Accessibility to Obstetric Care in South Florida Based on Insurance: A Cross-Sectional Study. Cureus 2023; 15:e44781. [PMID: 37680257 PMCID: PMC10482546 DOI: 10.7759/cureus.44781] [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: 07/14/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Obstetrical research confirms that earlier onset prenatal care significantly improves pregnancy and birth outcomes. Initiating care in the second trimester or having less than 50% of recommended visits has been associated with an increased risk of prematurity, stillbirth, neonatal, and infant death. Studies have shown that women on public health insurance plans initiate prenatal care substantially later into pregnancy than those on private plans. The purpose of this study is to assess whether public health insurance limits Florida patients' access to obstetric care. Methods A cross-sectional study was conducted by collecting data on the four most populated zip codes for Medicaid in South Florida using HealthGrades.com. The following search parameters were used: "obstetric care", "four stars and up" and "10-mile distance". Each obstetrician was called three times to assess appointment availability for fictional nulliparous women at eight weeks of gestation requesting prenatal care. Accepted insurance types (Medicaid, Cigna, and United Health Group (UHG)), time to an appointment in business days, and self-pay rates were recorded. Practices with invalid contact information and retired obstetricians were excluded. Summary statistics, chi-squared analysis, and a two-way t-test were conducted for the primary outcome. Results Seventy-one out of 178 obstetricians were successfully contacted, of which 31 physicians accepted all three insurances, and 40 physicians did not accept at least one insurance. Of those, 97.2% accepted UnitedHealthcare, 98.6% accepted Cigna, and 45.1% accepted Medicaid. There was a statistically significant difference when comparing acceptance rates between UHC and Medicaid as well as Cigna and Medicaid (p<0.001). There was no statistically significant difference in acceptance rates in the direct comparison of the two private insurances, Cigna and UnitedHealthcare (p=0.559). The average number of days until the next available appointment was 12.7 (SD= 7.2) for UnitedHealthcare, 20.0 (SD=6.7) for Cigna, and 17.0 (SD=8.6) for Medicaid. There was a statistically significant trend between the type of insurance and the time to the earliest appointment (p=0.002). Conclusion This study demonstrated patients enrolled in Medicaid in South Florida have significantly less access to prenatal care than those with private insurance. This evidence shows that decreased access to care from Medicaid plans can possibly increase the risk of adverse outcomes associated with inadequate prenatal care. This information should be considered by policymakers when considering future Medicaid expansion.
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Affiliation(s)
- Maria Kolesova
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Sydney Sarantos
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Juan Alvarez
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Alfred Torres
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Soniya Pateriya
- Medical School, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Manuel Penalver
- Obstetrics and Gynecology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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21
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Hanson SJ, Lee K. Group Prenatal Care. Obstet Gynecol Clin North Am 2023; 50:457-472. [PMID: 37500210 DOI: 10.1016/j.ogc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Group prenatal care (GPC) is a novel model of health care delivery for pregnant patients. In GPC, a small group of patients of similar gestational age meet at scheduled intervals for both medical care and facilitated educational discussions. This care model encourages better communication and engages patients and providers in a supportive community. There is evidence that GPC leads to improved patient and provider satisfaction, health equity, and maternal and neonatal outcomes. Delivery of prenatal care in a group setting is a significant change from the traditional model and takes willingness, planning, and commitment for implementation and continued success.
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Affiliation(s)
- Sarah Jean Hanson
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Kirstein, 3rd Floor, Boston, MA 02215, USA; Department of Obstetrics and Gynaecology, Princess Marina Hospital, University of Botswana, Gaborone.
| | - Katherine Lee
- Harbor - UCLA Medical Center, University of California Los Angeles, 1000 West Carson Street, Torrance, CA 90502, USA
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22
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Lessard L, Oberholtzer C, Shaver A, Newel G, Middleton E, Kuppermann M, Fuchs J, Garza MA, Rand L, Capitman J. Using Community-Based Participatory Research to Design a Patient and Practitioner-Centered Group Prenatal Care Model. Health Promot Pract 2023; 24:895-902. [PMID: 35658722 DOI: 10.1177/15248399221098015] [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] [Indexed: 11/15/2022]
Abstract
In response to disproportionately high rates of infant mortality and preterm birth among women of color and women in poverty in Fresno County, California, community and academic partners coordinated a community-based participatory research (CBPR) project with local residents. Social isolation and stress, inaccessible prenatal care, and dissatisfaction with care experiences were identified as leading predictors of poor birth outcomes. The PRECEDE-PROCEED framework was used to lead the CBPR effort that resulted in the development of a model of group prenatal care, named Glow! Group Prenatal Care Program (Glow! Program). Group prenatal care (GPNC), which focuses on pregnancy health assessments, education, and peer support, has the potential to address the health and social priorities of women during pregnancy. As a result of the employed CBPR process and the extensive participation from stakeholders, this modified GPNC model responds to the unique needs of the at-risk community members, the agencies aiming to improve maternal-child health experiences and outcomes, and the prenatal care providers offering it to their patients. The methods from this study can be applied in the design and implementation of community-based health care interventions. Returning to community partners throughout the design, implementation, and evaluation phases underscored that health care interventions cannot be designed in silos, and require flexibility to respond to factors that promote improved maternal and infant outcomes, which affect the end goal for the intervention.
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Affiliation(s)
| | | | - Amber Shaver
- California State University Fresno, Fresno, CA, USA
| | - Gail Newel
- California State University Fresno, Fresno, CA, USA
| | | | | | - Jonathan Fuchs
- University of California San Francisco, San Francisco, CA, USA
| | - Mary A Garza
- California State University Fresno, Fresno, CA, USA
| | - Larry Rand
- University of California San Francisco, San Francisco, CA, USA
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23
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Moyett JM, Ramey-Collier K, Zambrano Guevara LM, MacDonald A, Kuller JA, Wheeler SM, Dotters-Katz SK. CenteringPregnancy: A Review of Implementation and Outcomes. Obstet Gynecol Surv 2023; 78:490-499. [PMID: 37594439 DOI: 10.1097/ogx.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Importance CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction. Objective The study aims to review the literature related to perinatal outcomes associated with CP, benefits and barriers to implementation, and utility of the model. Evidence An electronic-based search was performed in PubMed using the search terms "CenteringPregnancy" OR "Centering Pregnancy," revealing 221 articles. Results The CP model improves patient centeredness, efficiency, and equality in prenatal care. Challenges include administrative buy-in, limited resources, and financial support. Multisite retrospective studies of CP demonstrate improved maternal, neonatal, postpartum, and well-being outcomes, especially for participants from minority backgrounds; however, prospective studies had mixed results. CenteringPregnancy is feasibly implemented with high tenet fidelity in several low- and middle-income settings with improved perinatal outcomes compared with traditional care. Conclusions CenteringPregnancy is feasible to implement, largely accepted by communities, and shows positive qualitative and quantitative health outcomes. This body of literature supports CP as a potential tool for decreasing racial inequalities in prenatal access, quality of care, and maternal mortality. Further investigation is necessary to inform obstetric clinicians about the potential outcome differences that exist between group and traditional prenatal care.
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Affiliation(s)
- Julia M Moyett
- Medical Student, Duke University School of Medicine, Durham, NC
| | | | | | - Amy MacDonald
- Director, Group Care, Pomelo Care Affiliation, Bethesda, MD
| | | | | | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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24
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Leiferman JA, Lacy R, Walls J, Farewell CV, Dinger MK, Downs DS, Farrabi SS, Huberty JL, Paulson JF. My Baby, My Move+: feasibility of a community prenatal wellbeing intervention. Pilot Feasibility Stud 2023; 9:134. [PMID: 37507732 PMCID: PMC10375613 DOI: 10.1186/s40814-023-01368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (EGWG), insufficient prenatal physical activity and sleep, and poor psychological wellbeing independently increase risks for adverse maternal and infant outcomes. A novel approach to mitigate these risks is utilizing peer support in a community-based prenatal intervention. This study assessed the feasibility (acceptability, demand, implementation, and practicality) of a remotely delivered prenatal physical activity intervention called My Baby, My Move + (MBMM +) that aims to increase prenatal physical activity, enhance mood and sleep hygiene, and reduce EGWG. METHODS Participants were recruited through community organizations, local clinics, and social media platforms in the Fall of 2020 and Spring of 2021. Eligible pregnant women were randomized to either the MBMM + intervention or the control group. Each group met over Zoom for 16 sessions (twice weekly for 60 min over 8 weeks) to learn either behavioral change and wellbeing knowledge and skills (MBMM +) or knowledge and skills related to parenting (control group). Multiple methods of evaluation to better understand the feasibility of the intervention were conducted. RESULTS A total of 49 women (25 MBMM + intervention, 24 control) completed both pre- and post-survey assessments and were included in the analyses. A subsample of 19 (39%) intervention participants completed a combination of semi-structured interviews/surveys to assess acceptability, demand, implementation, and practicality. Participants expressed positive feedback regarding acceptability (satisfaction and intent to continue use) and were extremely likely or likely to recommend the program to a friend (demand). Implementation metrics were assessed by observation and feedback forms completed by peer leaders and demonstrated high-quality control. Findings suggest that the intervention was practical due to remote sessions and cost-effectiveness. CONCLUSION The MBMM + intervention was deemed to be a feasible intervention with high acceptability, demand, implementation, and practicality. These findings can be used to inform the scalability of the intervention and implementation of a larger efficacy trial. TRIAL REGISTRATION 19-1366, initial date is on January 23, 2020.
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Affiliation(s)
- Jenn A Leiferman
- Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA.
| | - Rachael Lacy
- Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Jessica Walls
- Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Charlotte V Farewell
- Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Mary K Dinger
- Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Danielle Symons Downs
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, PA, USA
- Department of Obstetrics and Gynecology, College of Medicine, The Pennsylvania State University, 266 Recreation Building University Park, State College, PA, 16802, USA
| | - Sarah S Farrabi
- Goldfarb School of Nursing at Barnes-Jewish College, 4483 Duncan Ave, St. Louis, MO, 63110, USA
- Center for Human Nutrition, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO, 63110, USA
| | - Jennifer L Huberty
- College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, USA
| | - James F Paulson
- Department of Psychology, Old Dominion University, 5115 Terminal Blvd, Norfolk, VA, 23529, USA
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25
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Kang J, Hwang S, Lee T, Ahn K, Seo DM, Choi SJ, Uh Y. Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution. BIOLOGY 2023; 12:816. [PMID: 37372101 DOI: 10.3390/biology12060816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Pre-eclampsia (PE) is a pregnancy-related disease, causing significant threats to both mothers and babies. Numerous studies have identified the association between PE and renal dysfunction. However, in clinical practice, kidney problems in pregnant women are often overlooked due to physiologic adaptations during pregnancy, including renal hyperfiltration. Recent studies have reported serum creatinine (SCr) level distribution based on gestational age (GA) and demonstrated that deviations from the expected patterns can predict adverse pregnancy outcomes, including PE. This study aimed to establish a PE prediction model using expert knowledge and by considering renal physiologic adaptation during pregnancy. This retrospective study included pregnant women who delivered at the Wonju Severance Christian Hospital. Input variables, such as age, gestational weeks, chronic diseases, and SCr levels, were used to establish the PE prediction model. By integrating SCr, GA, GA-specific SCr distribution, and quartile groups of GA-specific SCr (GAQ) were made. To provide generalized performance, a random sampling method was used. As a result, GAQ improved the predictive performance for any cases of PE and triple cases, including PE, preterm birth, and fetal growth restriction. We propose a prediction model for PE consolidating readily available clinical blood test information and pregnancy-related renal physiologic adaptations.
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Affiliation(s)
- Jieun Kang
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sangwon Hwang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Taesic Lee
- Division of Data-Mining and Computational Biology, Institute of Global Health Care and Development, Wonju 26426, Republic of Korea
- Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Kwangjin Ahn
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Dong Min Seo
- Department of Medical Information, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Seong Jin Choi
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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26
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Modde Epstein C, Houfek JF, Jones LP. Deep health: A qualitative, woman-centered perspective of health during pregnancy. Midwifery 2023; 120:103628. [PMID: 36870255 PMCID: PMC10111285 DOI: 10.1016/j.midw.2023.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To explore and define a woman-centered perspective on health during pregnancy. DESIGN Qualitative study using abductive thematic analysis of semi-structured interview data. SETTING & PARTICIPANTS Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy. FINDINGS Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.
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Affiliation(s)
- Crystal Modde Epstein
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States; School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States.
| | - Julia F Houfek
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States
| | - Lawrency P Jones
- School of Nursing, University of North Carolina Greensboro, 1007 Walker Avenue, Greensboro, NC 27412, United States
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27
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Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Care Providers' Perspectives on Quality Prenatal Care in High-risk Pregnancies: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:122-134. [PMID: 37114102 PMCID: PMC10126442 DOI: 10.30476/ijcbnm.2023.97603.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
Background A high-risk pregnancy (HRP) is adversely affects the health of the mother, baby, or both. Most prenatal care research, rather than quality concepts, focuses on the adequacy of prenatal care and describes the emotional-psychological experiences of women with HRP. The main purpose of this study was to explore the perspectives of healthcare professionals regarding the quality of prenatal care for women with HRP. Methods This qualitative study was conducted in three university hospitals and 12 comprehensive health centers in Ahvaz (Iran) from December 2020 to May 2021. In the present study, 10 midwives, 2 executive directors, and 7 specialists were purposefully selected with maximum diversity. In-depth semi-structured individual interviews were used to collect the data. Data were analyzed concurrently using Elo and Kinga's content analysis. The MAXQDA software version 10 was used for data analysis. Results During data analysis, the 6 main categories "infrastructure for care provision", "optimal clinical care", "organizing referrals", "preconception care", "risk assessment", and "family-centered care" and 14 subcategories were identified. Conclusion Our findings showed that professional groups focused on the technical aspects of caring. The findings from this study highlight several conditions that can affect the quality of prenatal care for women with HRP. Healthcare providers can use these factors to effectively manage HRPs, thereby improving pregnancy outcomes among women with HRPs.
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Affiliation(s)
- Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kobra Shojaei
- Fertility, Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Hinton L, Dumelow C, Hodgkinson J, Montgomery C, Martin A, Allen C, Tucker K, Green ME, Wilson H, McManus RJ, Chappell LC, Band R. 'Nesting networks': Women's experiences of social network support in high-risk pregnancy. Midwifery 2023; 120:103622. [PMID: 36893551 DOI: 10.1016/j.midw.2023.103622] [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: 07/26/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING England. PARTICIPANTS Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.
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Affiliation(s)
- L Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge.
| | - C Dumelow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - J Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - C Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - C Allen
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| | - K Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - H Wilson
- Department of Women and Children's Health, King's College London, London
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - L C Chappell
- Department of Women and Children's Health, King's College London, London
| | - R Band
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
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29
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Ahrne M, Byrskog U, Essén B, Andersson E, Small R, Schytt E. Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project. BMJ Open 2023; 13:e066000. [PMID: 36697050 PMCID: PMC9884917 DOI: 10.1136/bmjopen-2022-066000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures. DESIGN A quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study. SETTING Midwifery-led antenatal care clinic in a mid-sized Swedish town. PARTICIPANTS Pregnant Somali-born women (<25 gestational weeks); 64 women in gANC and 81 in sANC. INTERVENTION Language-supported gANC (2017-2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15-30 min individual appointments with their designated midwife. OUTCOMES Primary outcomes were women's overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week ≥35 and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes. RESULTS Recruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6-8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference -1.89; 95% CI -3.73 to -0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy. CONCLUSIONS This evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden ˂10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03879200).
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Affiliation(s)
- Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Birgitta Essén
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Erica Schytt
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Health and Caring sciences, Western Norway University of Applied Sciences, Bergen, Norway
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30
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Aderoba AK, Adu-Bonsaffoh K. Antenatal and Postnatal Care. Obstet Gynecol Clin North Am 2022; 49:665-692. [DOI: 10.1016/j.ogc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Wheeler SM, Jackson M, Massengale KEC, Ramey-Collier K, Østbye T, Corneli A, Bosworth H, Swamy G. EngagINg the COmmunity to Reduce Preterm birth via Adherence To an Individualized Prematurity Prevention Plan (INCORPorATe IP3): intervention development and future pilot study design. J Matern Fetal Neonatal Med 2022; 35:8559-8565. [PMID: 34663168 PMCID: PMC10509753 DOI: 10.1080/14767058.2021.1988565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Non-Hispanic Black birthing individuals are at increased risk of preterm birth compared to other racial and ethnic groups. In our clinical setting, we offer a tailored package of recommendations to reduce the risk of preterm birth known as an individualized prematurity prevention plan (IP3). Patient-centered, community engaged interventions that address patient-perceived barriers to preterm birth prevention are urgently needed. MATERIALS AND METHODS We engaged a group of stakeholders to develop a mutli-level (patient-centered and community-involved) intervention that will increase adherence to an individualized prematurity prevention plan (IP3) by addressing barriers identified during our prior qualitative studies. RESULTS The intervention includes trained doulas from a community-led, Black owned doula group. The doulas will moderate group prenatal social support sessions. In between the group sessions, participants will be encouraged to continue interacting with one another and the doulas using a private Facebook™ group page. We will pilot test the intervention in a cohort of pregnant, self-identified non-Hispanic Black patients with a history of prior preterm birth. CONCLUSION We present a novel, patient-centered, community engaged intervention to reduce preterm birth in high-risk non-Hispanic Black birthing individuals. If the intervention is feasible based on the pilot study findings, we anticipate conducting an appropriately powered study to determine whether the intervention achieves our goal of reducing preterm birth.
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Affiliation(s)
- Sarahn M. Wheeler
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Maya Jackson
- Mobilizing African American Mothers through Empowerment (MAAME), Inc., Durham, NC, USA
| | | | | | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Geeta Swamy
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
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Martens N, Crone MR, Hindori-Mohangoo A, Hindori M, Reis R, Hoxha IS, Abanga J, Matthews S, Berry L, van der Kleij RMJJ, van den Akker-van Marle ME, van Damme A, Talrich F, Beeckman K, Court CM, Rising SS, Billings DL, Rijnders M. Group Care in the first 1000 days: implementation and process evaluation of contextually adapted antenatal and postnatal group care targeting diverse vulnerable populations in high-, middle- and low-resource settings. Implement Sci Commun 2022; 3:125. [DOI: 10.1186/s43058-022-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/06/2022] [Indexed: 11/26/2022] Open
Abstract
Abstract
Background
Group care (GC) improves the quality of maternity care, stimulates women’s participation in their own care and facilitates growth of women’s social support networks. There is an urgent need to identify and disseminate the best mechanisms for implementing GC in ways that are feasible, context appropriate and sustainable. This protocol presents the aims and methods of an innovative implementation research project entitled Group Care in the first 1000 days (GC_1000), which addresses this need.
Aims
The aim of GC_1000 is to co-create and disseminate evidence-based implementation strategies and tools to support successful implementation and scale-up of GC in health systems throughout the world, with particular attention to the needs of ‘vulnerable’ populations.
Methods
By working through five inter-related work packages, each with specific tasks, objectives and deliverables, the global research team will systematically examine and document the implementation and scale-up processes of antenatal and postnatal GC in seven different countries. The GC_1000 project is grounded theoretically in the consolidated framework for implementation research (CFIR), while the process evaluation is guided by ‘Realistic Evaluation’ principles. Data are gathered across all research phases and analysis at each stage is synthesized to develop Context-Intervention-Mechanism-Outcome configurations.
Discussion
GC_1000 will generate evidence-based knowledge about the integration of complex interventions into diverse health care systems. The 4-year project also will pave the way for sustained implementation of GC, significantly benefitting populations with adverse pregnancy and birthing experiences as well as poor outcomes.
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Ahrne M, Byrskog U, Essén B, Andersson E, Small R, Schytt E. Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation. BMC Pregnancy Childbirth 2022; 22:721. [PMID: 36131237 PMCID: PMC9494829 DOI: 10.1186/s12884-022-05044-9] [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: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo (“mother” in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors. Methods A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8). Results Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC. Conclusions The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided. Trial registration The study was registered in ClinicalTrials.gov (Identifier: NCT03879200).
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Affiliation(s)
- Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Birgitta Essén
- Women's and Children's Health, IMCH, Uppsala University, Uppsala, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Erica Schytt
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Rodrigues DB, Backes MTS, Delziovo CR, Santos EKAD, Damiani PDR, Vieira VM. Complexity of high-risk pregnancy care in the health care network. Rev Gaucha Enferm 2022; 43:e20210155. [PMID: 35920482 DOI: 10.1590/1983-1447.2022.20210155.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To understand the complexity of high-risk care for pregnant women in the health care network. METHOD Qualitative study with theoretical framework of Edgar Morin's Complex Thought and Grounded Theory methodology, Strauss's version. Data collection by theoretical sampling, including twelve health professionals and seven women users of the care network in a municipality in the south of Brazil from July to October 2018. Analysis by open and axial coding and selective integration. RESULTS The phenomenon "Caring for high-risk pregnant women in the health care network", comprises four categories: Noticing autonomous decision making; Promoting care; Developing multiprofessional work; and Accessing the health care network. CONCLUSION Every high-risk pregnant woman should be seen as a singular and multidimensional being with comprehensive and continuous care, considering the complexity of local, regional, and global reality.
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Affiliation(s)
- Débora Batista Rodrigues
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Marli Terezinha Stein Backes
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | | | - Evangelia Kotzias Atherino Dos Santos
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Pattrícia da Rosa Damiani
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Vanessa Maria Vieira
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
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Descriptions of Maternal Mortality From Nurses Who Practice in Perinatal Settings. Nurs Womens Health 2022; 26:288-298. [PMID: 35690097 DOI: 10.1016/j.nwh.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/30/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore nurses' descriptions of maternal mortality when caring for women in the perinatal period in Indiana. DESIGN A qualitative descriptive approach was used to produce nurses' descriptions of maternal mortality. SETTING/PARTICIPANTS Convenience sample of 16 nurses recruited from the Indiana Section of the Association of Women's Health, Obstetric and Neonatal Nurses. MEASUREMENTS Semistructured phone interviews were conducted, and participants were asked to explain their experiences related to maternal mortality. This information, which was summarized using content analysis, provided data related to nurses' descriptions of maternal mortality when caring for women in the perinatal period. RESULTS Analysis revealed three main themes that explain nurses' descriptions of maternal mortality: When It Comes to Maternal Mortality: Out of Sight Is Out of Mind, Nurses Express Detachment From Their Role in Preventing Maternal Mortality, and Experience With Maternal Mortality or a Near-Miss Event Is a Turning Point for Nurses. CONCLUSION Nurses who have limited experience with maternal mortality and who approach the issue in a detached manner may miss opportunities to provide health education to women in the perinatal period. Nurses need education on substance use disorders in the perinatal period, guidance on how to support women in the postpartum period, and support for coping with death and dying in the perinatal period.
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Breastfeeding: The Basics, the History, and Barriers in the Modern Day. Obstet Gynecol Surv 2022; 77:423-432. [DOI: 10.1097/ogx.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wagijo MR, Crone MR, van Zwicht BS, van Lith JMM, Schindler Rising S, Rijnders MEB. CenteringPregnancy in the Netherlands: Who engages, who doesn't, and why. Birth 2022; 49:329-340. [PMID: 35092071 PMCID: PMC9306804 DOI: 10.1111/birt.12610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. METHODS Data from a stepped-wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. RESULTS A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%-53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. CONCLUSION A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.
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Affiliation(s)
| | | | | | - Jan M. M. van Lith
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
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Understanding and Reducing Persistent Racial Disparities in Preterm Birth: a Model of Stress-Induced Developmental Plasticity. Reprod Sci 2022; 29:2051-2059. [PMID: 35298790 DOI: 10.1007/s43032-022-00903-4] [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: 11/27/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal-fetal-placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
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Akseer N, Keats EC, Thurairajah P, Cousens S, Bétran AP, Oaks BM, Osrin D, Piwoz E, Gomo E, Ahmed F, Friis H, Belizán J, Dewey K, West K, Huybregts L, Zeng L, Dibley MJ, Zagre N, Christian P, Kolsteren PW, Kaestel P, Black RE, El Arifeen S, Ashorn U, Fawzi W, Bhutta ZA. Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs. EClinicalMedicine 2022; 45:101309. [PMID: 35243274 PMCID: PMC8885463 DOI: 10.1016/j.eclinm.2022.101309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries. METHODS This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals. FINDINGS Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group. INTERPRETATION The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations. FUNDING Bill and Melinda Gates Foundation (Grant No: OP1137750).
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily Catherine Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Pravheen Thurairajah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - David Osrin
- Institute for Global Health, University College London, United Kingdom
| | - Ellen Piwoz
- The Bill and Melinda Gates Foundation, United States
| | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Lingxia Zeng
- School of Public Health, Xi'an Jiaotong University Health Science Centre, China
| | | | - Noel Zagre
- UNICEF Regional Office for West and Central Africa, Senegal
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, United States
| | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
- Corresponding author at: Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
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The challenges and opportunities for implementing group antenatal care (‘Pregnancy Circles’) as part of standard NHS maternity care: A co-designed qualitative study. Midwifery 2022; 109:103333. [DOI: 10.1016/j.midw.2022.103333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/12/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022]
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Rodrigues L, Costa ML, Specian FC, Sim-Sim MMF, Surita FG. Quality of Life of Pregnant Women with Systemic Lupus Erythematosus. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:475-482. [PMID: 35176780 PMCID: PMC9948083 DOI: 10.1055/s-0042-1743092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation. METHODS An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental). RESULTS We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively. CONCLUSION The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.
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Affiliation(s)
- Larissa Rodrigues
- Departamento de Tocoginecologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Laura Costa
- Departamento de Tocoginecologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Rodrigues DB, Backes MTS, Delziovo CR, Santos EKAD, Damiani PDR, Vieira VM. Complexidade do cuidado da gestante de alto risco na rede de atenção à saúde. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210155.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Compreender a complexidade do cuidado da gestante de alto risco na rede de atenção à saúde. Método Estudo qualitativo com referencial teórico do Pensamento Complexo de Edgar Morin e metodológico da Teoria Fundamentada nos Dados, versão Straussiana. Coleta por amostragem teórica, participaram doze profissionais de saúde e sete mulheres usuárias da rede de atenção em um município do sul do Brasil no período de julho a outubro de 2018. Análise por codificação aberta, axial e integração seletiva. Resultados O fenômeno “Cuidando da gestante de alto risco na rede de atenção à saúde”, compreende quatro categorias: Percebendo a autonomia na tomada de decisões; Promovendo o cuidado; Desenvolvendo um trabalho multiprofissional e Acessando a rede de atenção à saúde. Conclusão Toda gestante de alto risco deve ser vista como um ser singular e multidimensional com cuidado integral e contínuo, que abrange a complexidade do real a nível local, regional e global.
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"You're a 'high-risk' customer": A qualitative study of women's experiences of receiving information from health professionals regarding health problems or complications in pregnancy. Women Birth 2021; 35:e477-e486. [PMID: 34974953 DOI: 10.1016/j.wombi.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Experiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women's perspectives on communicating with their healthcare providers about their concerns. AIM This study explored women's experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy. METHODS This was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data. FINDINGS Women had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach. CONCLUSION To improve women's experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women's need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.
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Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
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Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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Tesfalul MA, Feuer SK, Castillo E, Coleman-Phox K, O'Leary A, Kuppermann M. Patient and provider perspectives on preterm birth risk assessment and communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2814-2823. [PMID: 33892976 PMCID: PMC9005337 DOI: 10.1016/j.pec.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To describe and compare how obstetric patients and care providers view preterm birth risk assessment and communication. METHODS We conducted eight focus groups with obstetric patients (n = 35) and 16 qualitative interviews with obstetric providers. Grounded theory was used to identify and analyze themes. RESULTS Patients' knowledge about preterm birth varied greatly. Similar benefits and risks of preterm birth risk counseling were discussed by patients and providers with notable exceptions: patients cited preparedness as a benefit and providers cited maternal blame, patient alienation, and estimate uncertainty as potential risks. Most patients expressed a desire to know their personalized preterm birth risk during pregnancy. Providers differed in whether they offer universal versus selective, and quantitative versus qualitative, preterm birth risk counseling. Many providers expressed concern about discussing social and structural risk factors for preterm birth. CONCLUSION While many patients desired knowing their personalized preterm birth risk, prenatal care providers' disclosure practices vary because of uncertainty of estimates, concerns about negative consequences and challenges of addressing systemic inequities and social determinants of health. PRACTICE IMPLICATIONS Given the existing asymmetry of information about preterm birth risk, providers should consider patient preferences regarding and potential benefits and risks of such disclosure in their practice.
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Affiliation(s)
- Martha A Tesfalul
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
| | - Sky K Feuer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Esperanza Castillo
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Allison O'Leary
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
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Tucker CM, Felder TM, Dail RB, Lyndon A, Allen KC. Group Prenatal Care and Maternal Outcomes: A Scoping Review. MCN Am J Matern Child Nurs 2021; 46:314-322. [PMID: 34347633 DOI: 10.1097/nmc.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to examine the current state of literature on group prenatal care and its impact on maternal outcomes and racial disparities in adverse maternal outcomes. DESIGN We conducted a scoping review of literature published between January 2010 and December 2020 using the PRISMA-ScR reporting checklist. METHODS Eligible studies were identified using key words and MeSH terms in PubMed, CINAHL, and Web of Science. Inclusion criteria were studies that were (a) conducted in the United States; (b) published between January 2010 and December 2020; (c) in English; (d) focused on the primary investigation of group prenatal care and reporting on maternal comorbidity outcomes; and (e) an observational study or clinical trial. RESULTS Nine studies met inclusion criteria. They reported on outcomes of preeclampsia, gestational hypertension, gestational diabetes mellitus, final A1C among patients with gestational diabetes mellitus, and postpartum hemorrhage. None reported on racial disparities for minoritized populations. Among all reported maternal outcomes, results were mixed, providing inconclusive evidence. CLINICAL IMPLICATIONS Outcomes from group prenatal care focus more on neonatal outcomes than maternal outcomes. More studies are needed with stronger designs. Given pervasive racial disparities in U.S. maternal mortality, future studies should assess how group prenatal care participation may contribute to fewer experiences of racial discrimination and implicit bias for Black women in maternity care.
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Bruxvoort C. Emotional and Birth Outcomes Associated With Different Types of Prenatal Care for Women With Low Income. Nurs Womens Health 2021; 25:450-460. [PMID: 34756838 DOI: 10.1016/j.nwh.2021.10.001] [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: 12/22/2020] [Revised: 08/10/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
This article summarizes findings from the literature on the emotional and birth outcomes of women with low income receiving different types of prenatal care. This literature review included studies published between 2015 and 2020. The results indicated that women with low income have challenging experiences in traditional models of prenatal care. Evidence of improved birth outcomes with nontraditional prenatal care is mixed, but qualitative findings indicate that it is associated with better emotional outcomes for women with low income when compared to traditional prenatal care. Future research should investigate ways to improve the negative interpersonal and structural dimensions that can characterize prenatal care for women with low income.
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Ala SH, Husain S, Husain S. Reasons for presenting to antenatal care clinics in a sample of Pakistani women and their knowledge of WHO antenatal care package. Eur J Midwifery 2021; 5:43. [PMID: 34693217 PMCID: PMC8486015 DOI: 10.18332/ejm/140794] [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: 02/01/2021] [Revised: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision.
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Affiliation(s)
- Syed H Ala
- Department of Obstetrics and Gynecology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Samia Husain
- Department of Obstetrics and Gynecology, Aziz Medical Center, Karachi, Pakistan
| | - Saba Husain
- Department of Obstetrics and Gynecology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Vandermorris A, McKinnon B, Sall M, Witol A, Traoré M, Lamesse-Diedhiou F, Bassani DG. Adolescents' experiences with group antenatal care: Insights from a mixed-methods study in Senegal. Trop Med Int Health 2021; 26:1700-1708. [PMID: 34669987 DOI: 10.1111/tmi.13692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Group antenatal care (G-ANC) is an innovative model in which antenatal care is delivered to a group of 8-12 women of similar gestational age. Evidence from high-income countries suggests G-ANC is particularly effective for women from marginalised populations, including adolescents. The objective of this study was to examine the experiences of Senegalese adolescents engaged in group antenatal care. METHODS This convergent parallel mixed-methods study is derived from a larger effectiveness-implementation hybrid pilot study conducted in Kaolack district, Senegal. Quantitative data for adolescent participants were collected through baseline and postnatal surveys and descriptively analysed. One-on-one interviews and focus-group discussions were conducted with adolescent participants, and qualitative data were analysed using qualitative descriptive analysis. RESULTS Forty-five adolescents aged 15-19 participated in G-ANC, with a median age of 18 years. The majority (93.3%) were married, and 64.4% were nulliparous. Findings indicated similar levels of G-ANC participation for adolescent and adult women. The majority (93.1%) of participants who had previously attended individual ANC indicated they would prefer G-ANC to individual care for a future pregnancy. Qualitative findings indicated key facets of consideration relevant to G-ANC for adolescents include social connectedness, the influence of social norms and the opportunity for engagement in healthcare. CONCLUSIONS This study suggests that G-ANC has the potential to be an adolescent-responsive and culturally appropriate method of delivering antenatal care in Senegal.
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Affiliation(s)
- Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Britt McKinnon
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohamadou Sall
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Adrian Witol
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahamadou Traoré
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Fatma Lamesse-Diedhiou
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Lazar J, Boned-Rico L, Olander EK, McCourt C. A systematic review of providers' experiences of facilitating group antenatal care. Reprod Health 2021; 18:180. [PMID: 34493314 PMCID: PMC8425020 DOI: 10.1186/s12978-021-01200-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Group antenatal care is a rapidly expanding alternative antenatal care delivery model. Research has shown it to be a safe and effective care model for women, but less is known about the perspectives of the providers leading this care. This systematic review examined published literature that considered health care professionals’ experiences of facilitating group antenatal care. Methods Systematic searches were conducted in seven databases (Cinahl, Medline, Psychinfo, Embase, Ovid Emcare, Global Health and MIDRS) in April 2020. Qualitative or mixed methods studies with a significant qualitative component were eligible for inclusion if they included a focus on the experiences of health care providers who had facilitated group antenatal care. Prisma screening guidelines were followed and study quality was critically appraised by three independent reviewers. The findings were synthesised thematically. Results Nineteen papers from nine countries were included. Three main themes emerged within provider experiences of group antenatal care. The first theme, ‘Giving women the care providers feel they want and need’, addresses richer use of time, more personal care, more support, and continuity of care. The second theme, ‘Building skills and relationships’, highlights autonomy, role development and hierarchy dissolution. The final theme, ‘Value proposition of group antenatal care’, discusses provider investment and workload. Conclusions Health care providers’ experience of delivering group antenatal care was positive overall. Opportunities to deliver high-quality care that benefits women and allows providers to develop their professional role were appreciated. Questions about the providers’ perspectives on workload, task shifting, and the structural changes needed to support the sustainability of group antenatal care warrant further exploration. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01200-0. Receiving antenatal care in a group setting has been found to be safe and satisfying for women and is supported by international public health guidelines. However, questions remain about the experience of health care professionals tasked with providing this model, such as whether they like working in this model and whether they support its expansion. To answer these questions, the team searched for studies about the experiences of health care providers with group antenatal care, and only included those studies where providers themselves spoke about their own experiences of providing this kind of care. Our review demonstrated that midwives, doctors, nurses and community health workers mostly enjoyed facilitating group antenatal care. They particularly appreciated the ability to give women the kind of care they felt women want and need. Health care providers also experienced some changes in their professional roles, in relation to both the women they serve and their colleagues and organizations. In order to determine if group antenatal care models are a satisfying and sustainable option for health care professionals in the long term, more research is needed.
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