Experiences related to health promotion behaviors in overweight pregnant women: a qualitative study

Exploring the factors behind socioeconomic inequalities in Antenatal Care (ANC) utilization across five South Asian natiaons: A decomposition approach

Maternal and child mortality rates remain a significant concern in South Asian countries, primarily due to limited access to maternal care services and socioeconomic disparities. While previous studies have examined the factors influencing the utilization of antenatal care (ANC) services in individual countries, there is a lack of comparative analysis across South Asian nations. This study aims to investigate the factors affecting ANC utilization among women aged 15-49 in Bangladesh, India, Nepal, Maldives, and Pakistan using the latest Demographic and Health Survey data. The study utilized a total weighted sample size of 262,531 women. Simple bivariate statistics and binary logistic regression were employed to identify potential factors influencing ANC utilization. Decomposition analysis and concentration curve (Lorenz curve) were used to assess inequality in ANC service utilization. The prevalence of ANC utilization varied across the countries, with Maldives having the highest (96.83%) and Bangladesh the lowest (47.01%). Women's and husbands' education, household wealth status, BMI, and urban residence were found to significantly influence maternal healthcare services utilization. Higher education levels, affluent wealth quintiles, and urban living were identified as significant contributors to socioeconomic disparities in accessing ANC services. This study highlights the crucial role of socioeconomic factors in the utilization of maternal healthcare services in South Asian countries. Governments should focus on improving healthcare infrastructure, addressing cultural barriers, and promoting education to address these disparities. Identifying context-specific causes of maternal healthcare utilization is essential to inform targeted interventions and policies aimed at improving access to ANC services and reducing maternal mortality rates.

Socioeconomic inequalities in utilizing maternal health care in five South Asian countries: A decomposition analysis

BACKGROUND

High maternal mortality rates still today remain a significant public health concern in South Asian countries. The majority of maternal deaths occur during pregnancy, and these deaths may typically be avoided by ensuring that women have access to reliable maternity care such as antenatal care (ANC) and facility delivery. The objectives of this research were to assess socioeconomic disparities in the utilization of health care services by mothers and to determine the factors influencing this utilization among women aged 15 to 49 in five South Asian countries.

METHODS

For this study, nationally representative data from the Demographic and Health Survey (DHS) were analyzed. This research included a total of 262,531 women between the ages of 15 and 49. To determine the likely causes of maternal health care utilization, simple bivariate statistics and binary logistic regression were applied, and decomposition analysis and the concentration curve were used to quantify disparity (Lorenz curve).

RESULTS

ANC and institutional delivery were both prevalent in 59.27% and 86.52% of cases, respectively. Among the five nations, Maldives has the greatest ANC (96.83%) and institutional delivery (99.39%), while Bangladesh has the lowest ANC (47.01%) and institutional delivery (49.81%). Women's and husbands' education, household wealth status, BMI, and urban residents are the most important factors influencing maternal health service utilization, whereas higher education level, affluent wealth quintiles, and place of residence are the major contributors to socioeconomic inequalities in access to maternal health care that favor the wealthy.

CONCLUSION

Maternal health care services must be utilized properly in order to promote optimal health and prevent maternal mortality. Several socioeconomic and sociodemographic variables of the individual population, as well as policy issues, all have an impact on maternal mortality. This research recommends for concerted action to enhance how successfully women use maternity care services.

The effect of pregnant women's status of receiving preconception care on pregnancy stress

In the study, we aimed to determine the effect of pregnant women's status of receiving preconception care on their pregnancy stress. This is a descriptive, correlational, and cross-sectional design study, we were conducted with the participation of 409 pregnant women between June-December 2019. The Pregnancy Stress Rating Scale total score mean was found to be 30.72 ± 20.26. Individuals who received medication and vitamins as part of preconceptional care had significantly higher scores (p < 0.05; p < 0.001) compared to those who did not receive them for total pregnancy stress, postpartum social support, infant health, and infant identity-care stress. Similarly, individuals who received medical treatment and regular checkups had significantly higher scores (p < 0.05) compared to those who did not for total pregnancy stress, postpartum social support, infant identity-care, body image and psychological state during pregnancy stress scores. In addition, individuals who maintained a healthy lifestyle had significantly higher scores (p < 0.05; p < 0.001) compared to others for infant health, infant identity-care, and psychological distress during pregnancy. It was determined that women who made preparations for their pregnancy experienced more stress related to their babies (baby's health, baby's identity and care), psychological status in pregnancy, prenatal and postnatal social support, and body image.

Health-promoting behaviors and intermediary social determinants of health in low and high-risk pregnant women: an unmatched case-control study

Background

High-risk pregnancies require increased health and care resources to reduce the severe perinatal consequences. The adoption of a health-promoting lifestyle and social determinants is an important strategy for achieving the desired outcomes of pregnancy. This study aimed to compare intermediate determinants of social health in low and high-risk pregnant women.

Methods

This unmatched case-control study was performed with a ratio of 1: 2 and 300 pregnant women including 200 healthy and 100 pregnant women with gestational hypertension were included using the available sampling technique. Data were collected using socio-demographic and obstetrics, Health-promoting behaviors, Self-efficacy, Perceived stress, and Social support questionnaires by the self-report method.

Results

There was no significant difference in the demographic characteristics between the two groups, except for the spouse's education status. The total score of health-promoting behaviors and social support in the healthy group was significantly higher than women with gestational hypertension. However, the perceived stress in women with gestational hypertension was significantly higher than in the healthy group. In the multivariate analysis, those women with high stress [AOR 1.13, 95% CI (1.08–1.18)] and whose Spouse’s Educational status was low [AOR 4.94, 95% CI (1.54–15.81)] had higher odds of gestational hypertension than women who haven’t respectively. The development of gestational hypertension was decreased by increasing the score of social support [AOR 0.96, 95% CI (0.93–0.98)]. The results showed that the two variables of social support (β=0.331) and self-efficacy (β=0.215) have the greatest impact on the score of health-promotion behaviors, respectively. Based on regression analysis, 21.2% of the health-promotion behaviors changes could be explained by three independent variables.

Conclusion

Women with gestational hypertension have unhealthier lifestyles. Having a high level of stress is a risk factor for gestational hypertension but Social support has a protective effect on it. Recognizing the risk factors of gestational hypertension could help the determination of high-risk cases and it is important to pay attention to women's psychosocial to create appropriate sources of social support and provide the necessary action to reduce stress.

Adolescent pregnancy outcomes at Queen Elizabeth Central Hospital, Malawi: a cross-sectional study

Malawi has a growing population with a high Maternal Mortality Ratio (MMR) of 439 per 100,000 live births to which adolescents contribute 25%. Current data suggests adolescent pregnancies in low resource settings are at an increased risk of both maternal and neonatal morbidity.

Objectives

This study assessed the pregnancy outcomes amongst adolescents while using women from the early adulthood (20 - 24-year-old) and advanced maternal age (35 years old and above) groups as reference.

Methods

This was a cross-sectional study, carried out at the Chatinkha maternity (labour) and post-natal wards at QECH, and included all adolescents (10 - 19 years old) and women between 20 - 24 years old (early adulthood) and 35 years old or older (advanced maternal age), presenting in labor, at any gestational age ≥ 28 weeks or with a birth weight of 1000 grams or above.

Results

The study found the prevalence of adolescent pregnancy to be 20.4% (N=5035) out of all the deliveries during the recruitment period. Sexually transmitted infections were proportionally higher in the adolescent group, with 12% testing HIV seroreactive and 10% syphilis seroreactive. Neonatal outcomes of birth asphyxia (3.5%), low birth weight (5%), prematurity (4.3%) and early neonatal death (4.3%) were not statistically different from the outcomes of the older age groups. The major causes of maternal morbidity were determined to be a high caesarean section rate of 31.9% and intrapartum diagnosis of urinary tract infection (7.4%), malaria (7.4%) and hypertensive disorders (14.5%).

Conclusions

Adolescents are a significant proportion of the pregnant population in Malawi. These adolescents are at increased risk of some pregnancy and peripartum complications when compared to women of older age groups. However, our study determined that these outcomes appear to be more likely related to the peripartum care received and not solely specific to maternal age.

Health promotion behaviours of pregnant women and spiritual well-being: Mediatory role of pregnancy stress, anxiety and coping ways

AIM

Little is known about the link between spiritual well-being and health promotion behaviours in pregnant women. The study aimed to explore the direct and indirect effects of spirituality on health promotion behaviours with the mediatory roles of pregnancy stress, anxiety and coping ways.

DESIGN

Cross-sectional.

METHODS

Two hundred women aged above 18 years completed Spiritual Well-Being scale (SWBS), State-Anxiety Inventory (SAI), Promoting Lifestyle Profile (HPLP), Prenatal Coping Inventory (Nu-PCI) and Revised Prenatal Distress Questionnaire (NuPDQ).

RESULTS

Spirituality directly and negatively affected the state anxiety (β = -.41; p < .001) and NuPDQ (β = -.36; p < .001). Health promotion behaviours were negatively related to state anxiety (β = -.36; p < .001) and positively to planning-preparation coping (β = .23; p = .001). Spirituality had a significant indirect effect on health promotion behaviours (β = .33; p < .001), mediated through its association with state anxiety and planning-preparation coping. Thus, health professionals are proposed to consult pregnant women on the benefits of spirituality for improving healthy behaviours.

Association between Perceived Social Support and Health-Promoting lifestyle in Pregnant Women: A Cross-Sectional Study

Introduction: Adopting health-promoting lifestyle might be affected by a variety of factors. The existing evidence suggests that social support can improve health by fulfilling physical and mental needs. This study aimed to investigate the association between social support and health-promoting lifestyle in Pregnancy. Methods: Using multistage cluster sampling method, this cross-sectional study was conducted on 360 pregnant women. Data were collected using three questionnaires, including a self-reported demographic and obstetric, health-promoting lifestyle profile and perceived social support questionnaires. Data were analyzed using a t-test, repeated measures ANOVA, and multivariate linear regression model with SPSS software ver. 21 with. Results: The mean (SD) of health-promoting behaviors was 135.21(20.03). Amongst the different dimensions of health-promoting behaviors, the highest mean was detected in spiritual growth 26.84 (4.90) and nutrition 26.17 (4.22), respectively. Meanwhile, the lowest scores were detected in sub-domains of stress management 19.80 (3.78) and physical activity 16.71(4.14), respectively. The mean (SD) of perceived social support was 60.31 (14.75), and 51.7% of the participants had intermediate social support. Results indicated a significant difference between the mean score of Health-Promoting Lifestyle at different levels of social support. There was a direct and significant association between the scores of social support and health-promoting behavior (r=0.36; P<0.001). Conclusion: Pregnant women with better perception of social support had a better performance in adopting health-promoting Lifestyle. However, the status of health behaviors and social support was not favorable. Thus, there is a need to intervene and design programs to help pregnant women and improve their health.

Prenatal care experiences among pregnant women with obesity in Wisconsin, United States: a qualitative quality improvement assessment

BACKGROUND

Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women's interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology.

METHODS

We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States.

RESULTS

All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated "weight" and "BMI" as the most desirable terms for describing weight, while "large size" and "obesity" were rated least desirable.

CONCLUSIONS

Many pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term "high BMI" will be used in place of the term "obesity" to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.

The association between social support and psychological factors with health-promoting behaviours in pregnant women: A cross-sectional study

INTRODUCTION

Health promotion is one of the most important aspects in pregnancy, and health-promoting behaviors are one of the major determinants of health under the influence of various factors. This study aimed to determine the association between social support and psychological factors with health-promoting behaviors in pregnant women.

MATERIALS AND METHODS

This cross-sectional was performed on 375 pregnant women when they had 24-28 weeks in Ilam, October 2018 to May 2019. Two-stage cluster sampling was performed after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were completed in self-report form. The collected data were analyzed by the descriptive and inferential tests with the SPSS software version 19.

RESULTS

The mean score of health-promoting behaviors was 139.87 (21.26) and self-healing and physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively. Linear regression analysis showed a significant difference between different level of stress, anxiety, depression, and social support with health-promoting behaviors (P < 0.001). The results showed that one-point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and 24.1% reduction of health-promoting behaviors, respectively, and one-point score increase in social support resulted in 40% increase in health-promoting behaviors (P < 0.001).

CONCLUSION

A negative association was found between psychological factors and a positive relationship with health-promoting behaviors. Although perceived moderate health promotion behaviors and perceived social support were moderate, they did not have a good status in terms of psychological factors. Given awareness of the issues under study in each region is essential and planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate behaviors through planned interventions are required.

Comparison of health-promoting behaviours, eating behaviour patterns and perceived social support in normal-weight and overweight pregnant women: An unmatched case-control study

Aim

The interventions based on adopting a healthy lifestyle during pregnancy have conflicting results. This study aimed to compare health-promoting, dietary patterns and social support in normal and overweight pregnant women.

Design

An unmatched case-control design was used.

Methods

A total of 360 pregnant women were selected using multistage cluster sampling and divided into two groups of normal and overweight cases. Data were collected using demographic and obstetrics characteristics, health-promoting lifestyle, perceived social support and eating behaviour questionnaires.

Results

The evaluation of the health-promoting behaviours and dietary patterns demonstrated a significant difference between the mean of total scores and their subdomains including self-actualization, nutrition, consumption of healthy and low-fat foods, fast food and sweets, as well as emotional eating and accidental planning. There was no significant difference between the two groups about social support.

Factors influencing the adoption of health promoting behaviors in overweight pregnant women: a qualitative study

Background

The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy.

Methods

This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control.

Results

The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness).

Conclusion

The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.