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Han HJ, Woo J, Wi WY, Cho KD, Koo M, Hong SJ, Jung YM, Kim HY, Ahn KH, Hong SC, Kim HJ, Oh MJ, Cho GJ. The impact of the COVID-19 pandemic on infant obesity: A nationwide retrospective cohort study. J Infect Public Health 2024; 17:795-799. [PMID: 38520760 DOI: 10.1016/j.jiph.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/19/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Lifestyle changes, such as those related to the COVID-19 pandemic, including alterations in physical activity and dietary habits, are known to affect pregnancy outcomes. In particular, suboptimal intrauterine conditions during pregnancy are known to influence not only fetal growth but also growth during infancy. However, research on the impact of the environmental changes caused by the COVID-19 pandemic on the growth of infants and children during their early years is lacking. To address this issue, this study evaluated the effect of the COVID-19 pandemic on obesity in infants. METHODS This retrospective cohort study used the data collected from the Korea National Health Insurance (KNHI) claims database. The data of 1985,678 women who delivered infants between 2015 and 2021 were collected. Women who delivered during the pandemic and those who delivered during the pre-pandemic period were matched in a 1:1 frequency-matched pair procedure for factors such as age, hypertension, diabetes mellitus, preeclampsia, gestational diabetes mellitus, mode of delivery, gestational age at delivery, offspring sex, and birth weight. Finally, 197,580 women were enrolled. The weight and head circumference of infants (4-6 months of age) of the COVID-19 pandemic group were compared with those of the pre-pandemic group. RESULTS The COVID-19 pandemic group infants exhibited significantly higher weight and prevalence of obesity at 4-6 months of age compared to infants in the pre-pandemic group. After adjustment for covariates, pandemic group infants had a higher risk of obesity (odds ratio: 1.54, 95% confidence interval: 1.51-1.57) compared to the pre-pandemic group infants. CONCLUSION The COVID-19 pandemic has had a notable impact on the weight of infants aged 4-6 months. This suggests that pandemic conditions may influence the growth of newborns, underscoring the importance of monitoring and assessing trends in the growth of infants born during such crises.
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Affiliation(s)
- Hye Jin Han
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Joohyun Woo
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Won Young Wi
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyu-Dong Cho
- Big Data Department, National Health Insurance Service, Gangwon-do, Republic of Korea
| | - Minji Koo
- Big Data Department, National Health Insurance Service, Gangwon-do, Republic of Korea
| | - Su Jung Hong
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Republic of Korea.
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Wolf ER, Richards A, Sabo RT, Woolf SH, Nelson BB, Krist AH. Neighborhood Predictors of Poor Prenatal Care and Well-Child Visit Attendance. Matern Child Health J 2024; 28:798-803. [PMID: 37991589 PMCID: PMC11001526 DOI: 10.1007/s10995-023-03844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Women and children continue to miss preventive visits. Which neighborhood factors predict inadequate prenatal care (PNC) and well-child visit (WCV) attendance remain unclear. DESCRIPTION In a retrospective case-control study at Virginia Commonwealth University Health System, mothers with less than 50% adherence or initiation after 5 months gestation were eligible as cases and those with ≥ 80% adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with ≥ 80% of adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio and matched on birth month. Covariates were derived from the 2018 American Community Survey. A hotspot was defined as a zip code tabulation area (ZCTA) with a proportion of controls less than 0.66. ZCTAs with fewer than 5 individuals were excluded. Weighted quantile regression was used to determine which covariates were most associated with inadequate attendance. ASSESSMENT We identified 38 and 35 ZCTAs for the PNC and WCV analyses, respectively. Five of 11 hotspots for WCV were also hotspots for PNC. Education and income predicted 51% and 34% of the variation in missed PNCs, respectively; language, education and transportation difficulties explained 33%, 29%, and 17% of the variation in missed WCVs, respectively. Higher proportions of Black residents lived in hotspots of inadequate PCV and WCV attendance. CONCLUSION Neighborhood-level factors performed well in predicting inadequate PCV and WCV attendance. The disproportionate impact impact of inadequate PCV and WCV in neighborhoods where higher proportions of Black people lived highlights the potential influence of systemic racism and segregation on healthcare utilization.
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Affiliation(s)
- Elizabeth R Wolf
- Children's Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA.
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Center on Society and Health, Richmond, VA, USA
| | - Bergen B Nelson
- Children's Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
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Jarlenski M, Cole E, McClure C, Sanders S, Smalls M, Méndez DD. Implementation and early effects of medicaid policy interventions to promote racial equity in pregnancy and early childhood outcomes in Pennsylvania: protocol for a mixed methods study. BMC Health Serv Res 2024; 24:498. [PMID: 38649983 PMCID: PMC11036682 DOI: 10.1186/s12913-024-10982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There are large racial inequities in pregnancy and early childhood health within state Medicaid programs in the United States. To date, few Medicaid policy interventions have explicitly focused on improving health in Black populations. Pennsylvania Medicaid has adopted two policy interventions to incentivize racial health equity in managed care (equity payment program) and obstetric service delivery (equity focused obstetric bundle). Our research team will conduct a mixed-methods study to investigate the implementation and early effects of these two policy interventions on pregnancy and infant health equity. METHODS Qualitative interviews will be conducted with Medicaid managed care administrators and obstetric and pediatric providers, and focus groups will be conducted among Medicaid beneficiaries. Quantitative data on healthcare utilization, healthcare quality, and health outcomes among pregnant and parenting people will be extracted from administrative Medicaid healthcare data. Primary outcomes are stakeholder perspectives on policy intervention implementation (qualitative) and timely prenatal care, pregnancy and birth outcomes, and well-child visits (quantitative). Template analysis methods will be applied to qualitative data. Quantitative analyses will use an interrupted time series design to examine changes over time in outcomes among Black people, relative to people of other races, before and after adoption of the Pennsylvania Medicaid equity-focused policy interventions. DISCUSSION Findings from this study are expected to advance knowledge about how Medicaid programs can best implement policy interventions to promote racial equity in pregnancy and early childhood health.
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA.
| | - Evan Cole
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Christine McClure
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Sarah Sanders
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Marquita Smalls
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Dara D Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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Abdolalipour S, Abbasalizadeh S, Mohammad-Alizadeh-Charandabi S, Abbasalizadeh F, Jahanfar S, Asghari Jafarabadi M, Abdollahi K, Mirghafourvadsnd M. Translation and measurement properties of pregnancy and childbirth questionnaire in Iranian postpartum women. BMC Health Serv Res 2024; 24:365. [PMID: 38519977 PMCID: PMC10958905 DOI: 10.1186/s12913-024-10689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/06/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Perceived care quality and patient satisfaction have been important care quality indicators in recent decades, and healthcare professionals have been influential on women's childbirth experience. This study investigated the measurement properties of the Persian version of the Pregnancy and Childbirth Questionnaire (PCQ), designed to measure mothers' satisfaction with the quality of healthcare services provided during pregnancy and childbirth. METHODS This is a cross-sectional methodological study. Instrument translation, face validity, content validity, structural validity, and reliability evaluation were performed to determine the measurement properties of the PCQ's Persian version. A backward-forward approach was employed for the translation process. Impact scores were selected based on the items' importance to measure face validity. Content validity index (CVI) and content validity ratio (CVR) were calculated to measure content validity, and exploratory and confirmatory factor analyses were used to measure structural validity. The cluster random sampling method was used, resulting in a sample of 250 eligible women referred to the health centers of Tabriz, Iran, who were 4 to 6 weeks after giving birth. Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC) using a test-retest approach were used to determine the questionnaire's reliability. RESULTS The impact scores of all items were above 1.5, which indicates a suitable face validity. The content validity was also favorable (CVR = 0.95, CVI = 0.90). Exploratory factor analysis on 25 items led to the removal of item 2 due to a factor loading of less than 0.3 and the extraction of three factors explaining 65.07% of the variances. The results of the sample adequacy size were significant (< 0.001, and Kaiser-Meyer-Olkin = 0.886). The model's validity was confirmed based on the confirmatory factor analysis fit indicators (i.e., RMSEA = 0.08, SRMR = 0.09, TLI = 0.91, CFI = 0.93, x2/df = 4.65). The tool's reliability was also confirmed (Cronbach's alpha = 0.88, and ICC (95% CI) = 0.93 (0.88 to 0.95)). CONCLUSION The validity and reliability of the PCQ's Persian version were suitable to measure the extent to which Iranian women are satisfied with the quality of prenatal and intrapartum care.
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Affiliation(s)
- Somayeh Abdolalipour
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Shamsi Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, USA
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, 3144, Melbourne, VIC, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 3800, Melbourne, VIC, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kosar Abdollahi
- Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvadsnd
- Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
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Goodfellow L, Care A, Curran C, Roberts D, Turner MA, Knight M, Zarko A. Preterm prelabour rupture of membranes before 23 weeks' gestation: prospective observational study. BMJ Med 2024; 3:e000729. [PMID: 38601318 PMCID: PMC11005708 DOI: 10.1136/bmjmed-2023-000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 04/12/2024]
Abstract
Objective To describe perinatal and maternal outcomes of preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation in a national cohort. Design Prospective observational study. Setting National population based cohort study with the UK Obstetric Surveillance System (UKOSS), a research infrastructure of all 194 obstetric units in the UK, 1 September 2019 to 28 February 2021. Participants 326 women with singleton and 38 with multiple pregnancies with PPROM between 16+0 and 22+6 weeks+days' gestation. Main outcome measures Perinatal outcomes of live birth, survival to discharge from hospital, and severe morbidity, defined as intraventricular haemorrhage grade 3 or 4, or requiring supplemental oxygen at 36 weeks' postmenstrual age, or both. Maternal outcomes were surgery for removal of the placenta, sepsis, admission to an intensive treatment unit, and death. Clinical data included rates of termination of pregnancy for medical reasons. Results Perinatal outcomes were calculated with all terminations of pregnancy for medical reasons excluded, and a worst-best range was calculated assuming that all terminations for medical reasons and those with missing data would have died (minimum value) or all would be liveborn (maximum value). For singleton pregnancies, the live birth rate was 44% (98/223), range 30-62% (98/326-201/326), perinatal survival to discharge from hospital was 26% (54/207), range 17-53% (54/326-173/326), and 18% (38/207), range 12-48% (38/326-157/326) of babies survived without severe morbidity. The rate of maternal sepsis was 12% (39/326) in singleton and 29% (11/38) in multiple pregnancies (P=0.004). Surgery for removal of the placenta was needed in 20% (65/326) and 16% (6/38) of singleton and twin pregnancies, respectively. Five women became severely unwell with sepsis; two died and another three required care in the intensive treatment unit. Conclusions In this study, 26% of women who had very early PPROM with expectant management had babies that survived to discharge from hospital. Morbidity and mortality rates were high for both mothers and neonates. Maternal sepsis is a considerable risk that needs more research. These data should be used in counselling families with PPROM before 23 weeks' gestation, and currently available guidelines should be updated accordingly.
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Affiliation(s)
- Laura Goodfellow
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Angharad Care
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ciara Curran
- Little Heartbeats Patient Support Group, Buxton, UK
| | | | - Mark A Turner
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Alfirevic Zarko
- Women's and Children's Health, University of Liverpool, Liverpool, UK
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Rogers AP, Fitzgerald L, Liebelt J, Barnett C. Medicare-funded reproductive genetic carrier screening in Australia has arrived: are we ready? Med J Aust 2024. [PMID: 38493786 DOI: 10.5694/mja2.52261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 03/19/2024]
Affiliation(s)
- Alice P Rogers
- SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, SA
- Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Lara Fitzgerald
- SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, SA
- Repromed (Adelaide Fertility Centre Pty Ltd), Adelaide, SA
| | - Jan Liebelt
- SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, SA
- Repromed (Adelaide Fertility Centre Pty Ltd), Adelaide, SA
| | - Christopher Barnett
- SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, SA
- Adelaide Medical School, University of Adelaide, Adelaide, SA
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Bruijns BA, Bourke M, Loh A, Tucker P. Movement behaviour education for parents in prenatal, postnatal, and pediatric care in Canada: A needs assessment. BMC Pediatr 2024; 24:164. [PMID: 38459485 PMCID: PMC10921676 DOI: 10.1186/s12887-024-04630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Parents/guardians can greatly influence their child's movement behaviours (i.e., physical activity, sedentary behaviour, and sleep). Yet, they have reported to lack sufficient background knowledge to foster healthy movement habits, and little is known about specific educational gaps. The aim of this study was to explore the educational background and needs regarding promoting healthy movement behaviours in early childhood among parents/guardians living in Canada. METHODS A cross-sectional study was conducted with parents/guardians living in Canada who had at least one child under the age of 5 years. Participants completed an online survey capturing their demographics, information they received about movement behaviours in early childhood during their prenatal/postnatal care or child's pediatrician appointments, where they sourced information about these topics, content areas they would like more information on, and preferred format for delivery. Descriptive statistics and frequencies were calculated for all outcome variables and logistic regression was used to explore if sociodemographic variables were associated with receiving movement behaviour-related education across care types. RESULTS Among the 576 parents/guardians who completed the survey, many reported no mention of any movement behaviour in their prenatal (49.4%), postnatal (29.6%), and pediatric care (37.2%). Physical activity was the most cited movement behaviour across care types, with 42.4%, 57.9%, and 54.8% of participants indicating this was discussed in their prenatal, postnatal, and pediatric care, respectively. Only 41.7% of parents/guardians reported asking their child's pediatrician about movement behaviours, while most relied on social media (70.9%), internet websites/news articles (68.7%), and family/friends (67.6%). The most sought-after movement behaviour topics included incorporating movement into traditionally sedentary activities (68.8%) and activity ideas to break up sitting time (65.0%), and participants expressed preference to receive more information via social media (63.2%), an online resource package (47.8%), or email (46.6%). CONCLUSIONS Given the noted inconsistencies in education relating to movement behaviours in maternal and pediatric care, this study highlights the opportunity for greater integration of this type of education across care types. Ensuring all parents/guardians receive evidence-based and consistent guidance on their child's movement behaviours will help ensure young children receive the best start to a healthy active life.
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Affiliation(s)
- Brianne A Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Aidan Loh
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
- Children's Health Research Institute, London, ON, Canada.
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Morrison J, Malik SMMR. Health equity in Somalia? An evaluation of the progress made from 2006 to 2019 in reducing inequities in maternal and newborn health. Int J Equity Health 2024; 23:46. [PMID: 38443921 PMCID: PMC10916226 DOI: 10.1186/s12939-023-02092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/29/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Every human being has the right to affordable, high-quality health services. However, mothers and children in wealthier households worldwide have better access to healthcare and lower mortality rates than those in lower-income ones. Despite Somalia's fragile health system and the under-5 mortality rate being among the highest worldwide, it has made progress in increasing reproductive, maternal, and child health care coverage. However, evidence suggests that not all groups have benefited equally. We analysed secondary 2006 and 2018-19 data to monitor disparities in reproductive, maternal, and child health care in Somalia. METHODS The study's variables of interest are the percentage of contraceptive prevalence through modern methods, adolescent fertility rate, prenatal care, the rate of births attended by midwives, the rate of births in a health care facility, the rate of early initiation of breastfeeding, stunting and wasting prevalence and care-seeking for children under-five. As the outcome variable, we analysed the under-five mortality rate. Using reliable data from secondary sources, we calculated the difference and ratio of the best and worst-performing groups for 2006 and 2018-19 in Somalia and measured the changes between the two. RESULTS Between 2006 and 2018-19, An increase in the difference between women with high and low incomes was noticed in terms of attended labours. Little change was noted regarding socioeconomic inequities in breastfeeding. The difference in the stunting prevalence between the highest and lowest income children decreased by 20.5 points, and the difference in the wasting prevalence of the highest and the lowest income children decreased by 9% points. Care-seeking increased by 31.1% points. Finally, although under-five mortality rates have decreased in the study period, a marked income slope remains. CONCLUSIONS The study's findings indicate that Somalia achieved significant progress in reducing malnutrition inequalities in children, a positive development that may have also contributed to the decrease in under-five mortality rate inequities also reported in this study. However, an increase in inequalities related to access to contraception and healthcare for mothers is shown, as well as for care-seeking for sick children under the age of five. To ensure that all mothers and children have equal access to healthcare, it is crucial to enhance efforts in providing essential quality healthcare services and distributing them fairly and equitably across Somalia.
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Ortelan N, de Almeida MF, Pinto Júnior EP, Bispo N, Fiaccone RL, Falcão IR, Rocha ADS, Ramos D, Paixão ES, de Cássia Ribeiro-Silva R, Rodrigues LC, Barreto ML, Ichihara MYT. Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort. BMC Public Health 2024; 24:713. [PMID: 38443875 PMCID: PMC10916064 DOI: 10.1186/s12889-024-18152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
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Affiliation(s)
- Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation. Edifício Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia, 41745-715, Brazil.
| | | | - Elzo Pereira Pinto Júnior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Nivea Bispo
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury T Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
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Vasilevski V, Graham K, McKay F, Dunn M, Wright M, Radelaar E, Vuillermin PJ, Sweet L. Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study. Women Birth 2024; 37:443-450. [PMID: 38246853 DOI: 10.1016/j.wombi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Women referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AIMS This study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. METHODS A qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FINDINGS Continuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. CONCLUSIONS Continuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.
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Affiliation(s)
- Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia.
| | - Kristen Graham
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia; College of Nursing and Health Sciences, Flinders University, Australia; National Centre for Epidemiology and Population Health, The Australian National University
| | - Fiona McKay
- School of Health and Social Development, Institute for Health Transformation, Deakin University, Victoria, Australia
| | - Matthew Dunn
- School of Health and Social Development, Institute for Health Transformation, Deakin University, Victoria, Australia
| | | | | | - Peter J Vuillermin
- Barwon Health, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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11
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Mallinson DC, Gillespie KH. Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010-2019. J Community Health 2024:10.1007/s10900-024-01338-5. [PMID: 38407757 DOI: 10.1007/s10900-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes-namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during 2010-2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach.
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Affiliation(s)
- David C Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way, STE 200, Madison, WI, 53705, USA.
| | - Kate H Gillespie
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, WI, 53705, USA
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12
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Ebinghaus M, Agricola CJ, Schmittinger J, Makarova N, Zyriax BC. Assessment of women's needs, wishes and preferences regarding interprofessional guidance on nutrition in pregnancy - a qualitative study. BMC Pregnancy Childbirth 2024; 24:154. [PMID: 38383376 PMCID: PMC10880225 DOI: 10.1186/s12884-024-06351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND A healthy nutrition in pregnancy supports maternal health and fetal development, decreasing the risk for adverse pregnancy outcomes. Guidance by prenatal care professionals can increase women's awareness regarding the importance of nutrition in pregnancy and thereby contribute to a reduced risk for adverse pregnancy outcomes. The aim of this study was to assess the needs, wishes and preferences of pregnant women regarding the interprofessional guidance on nutrition in pregnancy. METHODS Using a qualitative approach and a purposive maximum variation sampling strategy, 25 pregnant women were recruited to participate in six semi-structured, guideline-oriented online focus groups. In addition, two semi-structured, guideline-oriented interviews, with a midwife and an obstetrician, were conducted. The focus groups and interviews were audio-recorded and transcribed. Transcripts were analysed using a systematic deductive-inductive approach to qualitative content analysis according to Kuckartz. RESULTS Focus group participants covered diverse perspectives in terms of their age, different models of prenatal care as well as dietary forms from omnivorous to vegan. The majority of women perceived the guidance on nutrition during pregnancy as insufficient. Involved healthcare professionals, namely midwives and obstetricians, should provide more consistent information, especially to avoid uncertainties exacerbated by the internet and social media. There is a need for individual nutrition information regarding dietary supplements and the specifics of different dietary forms during pregnancy, such as a vegan diet. The majority of participants supported the integration of a free-of-charge professional nutrition counselling in prenatal care. Interviews with experts identified time pressure and the complexity of nutrition as a topic as the main obstacles in consultation settings. Both midwife and obstetrician emphasised the need for improved professional education on nutrition in pregnancy in their respective studies. CONCLUSION Professional guidance for pregnant women on nutrition and uncertainties going along with certain forms of diet during pregnancy could alleviate the burden and overwhelming amount of web-based information. Additionally, information adapted to the needs, wishes and preferences of pregnant women would improve prenatal care through a more personalised approach. The quality of nutrition guidance in pregnancy should be improved by the implementation of this topic in the education of involved healthcare professionals.
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Affiliation(s)
- Merle Ebinghaus
- Midwifery Science-Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Caroline Johanna Agricola
- Midwifery Science-Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Janne Schmittinger
- Midwifery Science-Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Nataliya Makarova
- Midwifery Science-Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science-Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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13
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Viswanathan AV, Berg KA, Bullington BW, Miller ES, Boozer M, Serna T, Bailit JL, Arora KS. Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study. Reprod Health 2024; 21:23. [PMID: 38355541 PMCID: PMC10865696 DOI: 10.1186/s12978-024-01752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. METHODS This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. RESULTS Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24-2.00), 42 days (aOR 1.51, 95% C.I 1.20-1.91), and 365 days (aOR 1.40, 95% C.I 1.11-1.75), compared to patients who had their first documented plan in the third trimester. CONCLUSIONS Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally.
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Affiliation(s)
- Ambika V Viswanathan
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Kristen A Berg
- Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Margaret Boozer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Tania Serna
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Jennifer L Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH, 44016, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA.
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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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15
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Fair FJ, Soltani H. A retrospective comparative study of antenatal healthy lifestyle service interventions for women with a raised body mass index. Women Birth 2024; 37:197-205. [PMID: 37679254 DOI: 10.1016/j.wombi.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Women with obesity are more likely to gain excessive gestational weight; with both obesity and excessive weight gain linked to adverse outcomes for mothers and their infant. Provision of antenatal healthy lifestyle services is currently variable, with uncertainty over the most effective gestational healthy lifestyle interventions. AIM To compare pregnancy and birth outcomes among women who experienced an antenatal health lifestyle service with a cohort who did not receive this service. METHODS A retrospective comparative cohort study was undertaken in women with a BMI ≥ 40 kg/m² attending maternity care in two NHS Trusts. One Trust provided an antenatal healthy lifestyle service, while the comparison Trust provided routine maternity care. Data was collected from medical records. FINDINGS No differences were observed between the antenatal healthy lifestyle service and comparison cohorts for average gestational weight gain [adjusted mean difference (aMD) - 0.70 kg (95%CI -2.33, 0.93)], rate of weight gain [aMD - 0.02 kg/week (95%CI -0.08, 0.04)] or weight gain in accordance with recommendations. The proportion of women breastfeeding at discharge was higher for the antenatal healthy lifestyle service than the comparison cohort (42.4% vs 29.8%). No other clinical outcomes were enhanced with the antenatal healthy lifestyle service. CONCLUSION Internal audit had suggested the antenatal healthy lifestyle service was successful at managing gestational weight gain in women with a BMI ≥ 40 kg/m². However, no benefit on gestational weight gain was evident once the service was evaluated against a comparison cohort with adequate adjustment for confounders. It is essential that future services are evaluated against a relevant comparison group.
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Affiliation(s)
- Frankie J Fair
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom.
| | - Hora Soltani
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom.
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Mobeen S, Fogel J, Harishankar K, Jacobs AJ. The COVID-19 Pandemic and Routine Prenatal Care: Use of Online Visits. Matern Child Health J 2024:10.1007/s10995-024-03904-8. [PMID: 38270717 DOI: 10.1007/s10995-024-03904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the prior year (PreCINT). METHODS A retrospective cohort study compared CINT (n = 2,195) to PreCINT (n = 2,395) at seven public hospitals in New York City. The primary outcome was total number of prenatal-care visits. Secondary outcomes were components of prenatal-care visits completion, timing of standard pregnancy screening tests, and adverse neonatal outcomes. RESULTS CINT patients had more total prenatal-care visits (B = 1.30, 95% CI:1.04, 1.56, p < 0.001), lower odds for initiation of prenatal care which was inadequate according to widely used criteria (OR:0.39, 95% CI:0.34, 0.45, p < 0.001), and lower gestational age at initial visit (B=-4.51, 95% CI:-5.10, -3.93, p < 0.001) than PreCINT patients. In-person visits did not differ between the two groups. PreCINT patients had no televisits, while CINT patients had a median of one televisit (Median = 1, p < 0.001). CINT patients had increased odds for group B Streptococcus screening (OR:1.27, 95% CI: 1.10, 1.48, p = 0.001), quadrivalent screening (OR:1.30, 95% CI:1.15, 1.48, p < 0.001), and anatomy sonogram (OR:2.30, 95% CI:2.04, 2.59, p < 0.001) but decreased odds for glucose challenge test screening (OR:0.81, 95% CI:0.72, 0.91, p < 0.001). Adverse neonatal outcome did not differ between CINT and PreCINT pregnancies. CONCLUSIONS FOR PRACTICE Despite the difficulties and perceived dangers of in-person visits during the COVID-19 pandemic, the COVID-19 pandemic had little negative impact upon the outpatient prenatal care received by patients in this hospital system.
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Affiliation(s)
- Sadia Mobeen
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA
- Department of Management, Marketing, and Entrepreneurship, Brooklyn College, Brooklyn, New York, USA
| | - Krupa Harishankar
- Department of Obstetrics and Gynecology, Elmhurst Hospital Center, Queens, New York, USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan J Jacobs
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA.
- Department of Obstetrics and Gynecology, Downstate Medical Center, Brooklyn, New York, USA.
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17
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Cole J, Bhatt A, Chapple AG, Buzhardt S, Sutton EF. Attitudes and barriers to breastfeeding among women at high-risk for not breastfeeding: a prospective observational study. BMC Pregnancy Childbirth 2024; 24:81. [PMID: 38267922 PMCID: PMC10807069 DOI: 10.1186/s12884-024-06264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Rates of breastfeeding are lower among minority and underserved populations in the United States. Our study objective was to assess pregnant persons attitudes and barriers to breastfeeding among a cohort at high risk for not breastfeeding. METHODS We disseminated the Iowa Infant Feeding Attitude Scale (IIFAS) to 100 pregnant persons at least 18 years of age attending a prenatal visit in a low-resource, academic practice in south-central Louisiana (Woman's Hospital). The IIFAS, as well as questions collecting information on breastfeeding experience and sociodemographic characteristics, were administered via interview. Medical records were reviewed to investigate associations between attitudes about breastfeeding in pregnancy and patient's feeding choices during the delivery hospital stay. Fisher exact tests and Wilcoxon rank-sum tests were used to assess associations between categorical and continuous variables respectively. RESULTS Of the 98 participants who completed the study, 8% were Hispanic, 63% were Black, 95% were Medicaid eligible, and 50% were unemployed. 59% (n = 58) went on to breastfeed/combination breast-formula feed (called "Any-Breastfeeding Group") during the delivery stay. Total IIFAS score during pregnancy was significantly higher among those who went on to breastfeed during delivery hospital stay (Any-Breastfeeding Group vs. Formula-Feeding-Only Group: 58.9 ± 5.5 vs. 53.7 ± 6.2 respectively, p < 0.001). In the group that went on to only formula feed (Formula-Feeding-Only Group), only 4% agreed breastfeeding was more convenient when surveyed during pregnancy, compared to 45% of the Any-Breastfeeding Group. 60% of Formula-Feeding-Only Group agreed formula is as healthy as breast milk. CONCLUSION The three major themes that coincided with favorability toward breastfeeding in the study, and can be addressed during prenatal counseling, are: mother-infant bonding, convenience, and health benefits. By identifying attitudes and barriers to breastfeeding for patients during pregnancy who went on to not breastfeed, directed educational opportunities can be developed to address these specific attitudes to ultimately increase breastfeeding initiation and continuation.
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Affiliation(s)
- Jessica Cole
- Department of Obstetrics and Gynecology, Louisiana State University Health and Sciences Center, Baton Rouge, LA, 70817, USA
| | - Ateshi Bhatt
- Woman's Hospital Research Center, Woman's Hospital, Baton Rouge, LA, 70817, USA
| | - Andrew G Chapple
- Department of Interdisciplinary Oncology, School of Medicine, Louisiana State University Health and Sciences Center, New Orleans, LA, 70112, USA
| | - Sarah Buzhardt
- Department of Obstetrics and Gynecology, Louisiana State University Health and Sciences Center, Baton Rouge, LA, 70817, USA
| | - Elizabeth F Sutton
- Woman's Hospital Research Center, Woman's Hospital, Baton Rouge, LA, 70817, USA.
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18
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Spinner C, Huber LRB. How Much is too Much? High Utilization of Prenatal Care and Its Impact on Primary Cesarean Birth Among Women in the United States. Matern Child Health J 2024:10.1007/s10995-023-03887-y. [PMID: 38261276 DOI: 10.1007/s10995-023-03887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Nationally, cesarean birth is one of the most performed surgical procedures, yet cesarean births have been linked to an increased risk of delivery complications. Prenatal care (PNC) and education are possible strategies to reduce the number of cesarean births. However, there is scant research assessing the impact of these strategies on safely reducing primary cesarean births. This study evaluates the association between the adequacy of PNC utilization and primary cesarean birth. METHODS The analysis used 2018 birth certificate data, and the sample included nulliparous women with no reported pregnancy or delivery complications (N = 729,140). Logistic regression was used to model the association between the adequacy of PNC utilization and delivery method, as well as identify other factors associated with the delivery method. RESULTS Among women with a primary cesarean birth, 36.2% had received adequate plus PNC. After adjustment, there was no significant association between women receiving inadequate, intermediate, or adequate PNC and primary cesarean birth. However, women who received adequate plus PNC had an increased odds of having a primary cesarean birth compared to women with no PNC (OR, 1.23; 95% CI, 1.18-1.28). DISCUSSION Findings from this study highlight the need to further understand the role of PNC and its potential impact on the delivery method. Within the patient-provider relationship, healthcare providers have the unique opportunity to provide education and inform patients of the risks and benefits of all delivery options. Thus, there is an increased opportunity to safely reduce primary cesarean births.
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Affiliation(s)
- Chelse Spinner
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, North Carolina, 28223, USA.
| | - Larissa R Brunner Huber
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, North Carolina, 28223, USA
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Lori JR, Kukula VA, Liu L, Apetorgbor VEA, Ghosh B, Awini E, Lockhart N, Amankwah G, Zielinski R, Moyer CA, Williams J. Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana. BMC Pregnancy Childbirth 2024; 24:37. [PMID: 38182969 PMCID: PMC10768124 DOI: 10.1186/s12884-023-06224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. METHODS A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. RESULTS Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. CONCLUSION While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. TRIAL REGISTRY Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).
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Affiliation(s)
- Jody R Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America.
| | - Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Liya Liu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | | | - Bidisha Ghosh
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Elizabeth Awini
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Nancy Lockhart
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Georgina Amankwah
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Ruth Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - John Williams
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
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20
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Rose M, Ritter D, Gupta N, Tolusso L, Horn P, Wakefield E, Glass J. Healthcare provider recognition of pregnancy related risks and management considerations in patients with tuberous sclerosis complex. Orphanet J Rare Dis 2024; 19:4. [PMID: 38166979 PMCID: PMC10763101 DOI: 10.1186/s13023-023-03015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) face an increased risk of maternal health complications and worsening disease manifestations during pregnancy. There are no established consensus guidelines that address the management of pregnancy in patients with TSC and healthcare providers rely on their individual experiences and preferences to derive treatment decisions. We sought to obtain provider opinion of pregnancy related maternal complications in patients with TSC, and the common evaluation and management strategies used to address these issues. METHODS We conducted a cross-sectional survey of healthcare providers with diverse areas of expertise related to the multisystem nature of involvement in TSC. Descriptive analyses were used to analyze our three primary variables: (1) provider recognition of maternal risks/complications; (2) provider recommendations before and during pregnancy; and (3) provider/clinic protocols. RESULTS We received responses from 87 providers from 11 countries, with 40.7% (n = 35) seeing > 30 TSC patients yearly. The majority of providers (n = 70, 88.6%) deemed that a patient with TSC needed expert care beyond the standard of care for a typical pregnancy, with over 25% of providers reporting that they have seen lymphangioleiomyomatosis (LAM) exacerbation, seizures, and preterm labor in pregnant patients with TSC. Providers who managed patients treated with mTOR inhibitors (mTORi) also agreed that mTORi use should be stopped prior to pregnancy (n = 45, 68.2%) but there was uncertainty about when to stop the mTORi (one month 28.9%, two months 11.1%, three months 42.2%, and 6-12 months 2.2%). Additionally, there were mixed opinions on restarting mTORi in response to disease progression during pregnancy. When asked about provider or clinic specific protocols, 71.6% (n = 53) of providers stated that they do not have a clear protocol for management decisions for patients with TSC before or during pregnancy. CONCLUSION Healthcare providers recognize that patients with TSC are at an increased risk for maternal health complications during pregnancy. However, there are wide inter-individual variances in practice, especially pertaining to decisions regarding mTORi use. There is a critical need to better understand the implications of pregnancy for patients with TSC, and to draft consensus recommendations to guide management decisions.
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Affiliation(s)
- Meredith Rose
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- Medical Genetics Clinic, Mary Bridge Children's/MultiCare Health System, Tacoma, USA.
| | - David Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, USA
- Medical Service, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Leandra Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Cincinnati Children's Fetal Care Center, Cincinnati, USA
| | - Paul Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Emily Wakefield
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Glass
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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Miramontes-Buiza L, Lona-Reyes JC, Pérez-Ramírez RO, Magallón-Picazo D, Cordero-Zamora A, Gómez-Ruiz LM, Cruz-Chávez TA. [Association of illicit drug use in pregnant women and congenital syphilis in a public hospital in Mexico]. Rev Argent Microbiol 2024; 56:69-73. [PMID: 37604752 DOI: 10.1016/j.ram.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/01/2023] [Accepted: 07/03/2023] [Indexed: 08/23/2023] Open
Abstract
We conducted a nested case-control study within a cohort with the aim of studying the association between illicit drug use and congenital syphilis (CS). Cases were diagnosed based on treponemal and non-treponemal tests conducted both in the mother and the newborn (NB). Multivariate analysis with logistic regression was performed. A total of 6171 births with a mean gestational age of 37.8 weeks were recorded and 62 CS events were diagnosed (incidence 10.5 events/1000 NB). Associated maternal factors were illicit drug use (OR 14.08, 95% CI 1.19-166.6), <5 prenatal visits (OR 2.9, 95% CI 1.12-7.53), more than two sexual partners (OR 3.76, 95% CI 1.62-8.71) and professional education level (OR 0.06, 95% CI 0.005-0.85). Among the mothers of the cases presented, the prevalence of illicit drug use was 22.6% and the most frequent drugs were methamphetamines and cannabis.
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Affiliation(s)
- Lucía Miramontes-Buiza
- Infectología Pediátrica, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
| | - Juan Carlos Lona-Reyes
- Infectología Pediátrica, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
| | - Rene Oswaldo Pérez-Ramírez
- Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México; Neonatología, Hospital Civil de Guadalajara «Dr. Juan I Menchaca», Guadalajara, Jalisco, México
| | - Diego Magallón-Picazo
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Araceli Cordero-Zamora
- Infectología Pediátrica, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
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Mei TL, Aligne CA, VanScott JL. A Visit to the Pediatrician as a Part of Comprehensive Prenatal Care? Matern Child Health J 2024; 28:76-82. [PMID: 37864772 PMCID: PMC10876718 DOI: 10.1007/s10995-023-03791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that expectant parents receive a preventive visit with a pediatrician in the prenatal period (a pediatric prenatal visit, or PPV). Discussing newborn health topics in the prenatal period tends to be more effective than immediately postpartum, and research suggests, for example, that the PPV increases timely childhood immunizations. However, only 22% of expectant parents have these visits, and there are significant disparities by race and income. METHODS A 2-min online survey with open-ended questions was emailed to 304 eligible obstetrics providers in Rochester, NY. Simple descriptive statistics and chisquare analysis were applied to survey responses. Responses were organized within the framework of knowledge, attitudes, and practices to identify barriers to guideline adherence resulting in chronic under-utilization of the PPV. RESULTS Ninety obstetric providers completed the survey. 66 reported awareness of the PPV, and 45 reported referring patients for a PPV. However, in open-ended questions, respondents expressed confusion between the PPV and a "meet and greet" visit with a pediatrician. Some respondents believed that the PPV is not covered by insurance, even though these visits are covered by Medicaid and marketplace insurance. Providers who had personally received one as a parent expressed positive attitudes. DISCUSSION These findings indicate that unfamiliarity with the PPV is one barrier to referral. Educating providers about the guideline recommendations, evidence base, and insurance coverage could overcome this barrier. Doing so could reduce disparities in utilization of the pediatric prenatal visit.
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Affiliation(s)
- Tiffany L Mei
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, USA
| | - C Andrew Aligne
- Department of Pediatrics, The Hoekelman Center, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue Box 777, Rochester, NY, 14642, USA.
| | - Jessica L VanScott
- Infectious Diseases Division, Center for Community Practice, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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23
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Tschirhart N, Jiraporncharoen W, Angkurawaranon C, Hashmi A, Hla S, Nosten S, McGready R, Ottersen T. Giving birth on the way to the clinic: undocumented migrant women's perceptions and experiences of maternal healthcare accessibility along the Thailand-Myanmar border. Reprod Health 2023; 20:178. [PMID: 38057915 DOI: 10.1186/s12978-023-01722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility. METHODS We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand-Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed. RESULTS Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain. CONCLUSIONS Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo-Norwegian Centre for Research Data (58542).
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Affiliation(s)
- Naomi Tschirhart
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand.
- Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand.
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth) Houston, Houston, TX, USA
| | | | - Suphak Nosten
- Borderland Health Foundation, Mae Sot, Tak, Thailand
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Thorvilson MJ, Carroll K, Kaemingk BD, Schaepe KS, Collura CA. The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study. Matern Health Neonatol Perinatol 2023; 9:15. [PMID: 38037157 PMCID: PMC10691151 DOI: 10.1186/s40748-023-00168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. METHODS This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists' discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. RESULTS In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus's presence, and (iii) fetal role in decision-making. CONCLUSION Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.
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Affiliation(s)
- Megan J Thorvilson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA.
| | - Katherine Carroll
- School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Bethany D Kaemingk
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Sanford Children's Hospital, Fargo, ND, USA
- Department of Pediatrics, University of North Dakota, Grand Forks, ND, USA
| | - Karen S Schaepe
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Christopher A Collura
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
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25
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Pai H, Tayade S, Sharma S, Pai A, Vaz RP, Lahariya C. Pre-Conceptional and Antenatal Care for Improved Newborn and Child Survival in India: A Review. Indian J Pediatr 2023; 90:10-19. [PMID: 37700121 DOI: 10.1007/s12098-023-04841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/23/2023] [Indexed: 09/14/2023]
Abstract
There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the concept of pre-conceptional care and its implementation status in India. The review documents the specific interventions that have been proven to effectively improve pregnancy outcome when provided as pre-conception care. Healthcare providers, particularly obstetricians/gynecologists and general physicians, should prioritize pre-conception care as an essential component of healthcare for women. However, the lack of continuum of care and program linkages are some of the key barriers in ensuring pre-conceptional and ante-natal care in India. Culturally and linguistically appropriate care should be provided to ensure that all women can access and understand the information and services needed to optimize their reproductive health and improve pregnancy outcomes. Prioritizing pre-conception and prenatal care, healthcare providers can improve maternal and fetal outcomes, reduce healthcare costs, and promote lifelong health for women and their families. The primary healthcare reforms being done in India can be and should be used to strengthen pre-conceptional and ante-natal care services and quality.
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Affiliation(s)
- Hrishikesh Pai
- National President, Federation of Obstetrics and Gynecological Societies of India (FOGSI), Mumbai, India
- Blooms Hospital, Mumbai, India
| | - Surekha Tayade
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha, 442102, India.
| | - Sakshi Sharma
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha, 442102, India
| | - Arnav Pai
- Department of Obstetrics and Gynecology, DY Patil Medical College, Mumbai, India
| | - Rodney P Vaz
- Foundation for People-centric Health Systems, Safdarjung Enclave, New Delhi, 110029, India
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, 110001, India
| | - Chandrakant Lahariya
- Foundation for People-centric Health Systems, Safdarjung Enclave, New Delhi, 110029, India
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Shakes P, Cashin A, Hurley J. Threat and adaptation: The maternal lived experience of continuing pregnancy after receiving a prenatal diagnosis of agenesis of the corpus callosum. Soc Sci Med 2023; 339:116391. [PMID: 37956619 DOI: 10.1016/j.socscimed.2023.116391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
One stated objective of prenatal screening and diagnosis is the preparation for delivering a baby with medical needs or disability, however, psychosocial outcomes of parents who received a prenatal diagnosis suggest that this objective is not yet realised. Preparation may be complicated by diagnostic and prognostic uncertainty. A prenatal diagnosis that includes significant uncertainty due to the heterogeneous presentations, classifications, causes and outcomes is agenesis of the corpus callosum. As a neuroanatomical anomaly identified in the second or third trimesters, the diagnosis is likely to cause distress for expectant mothers, yet there is limited guidance for holistic support. To begin to address the paucity of research, this hermeneutic phenomenological study sought to explore, and provide a telling of the maternal experience of continuing pregnancy after a prenatal diagnosis of agenesis of the corpus callosum. Through interviews and a series of online, asynchronous and facilitated focus groups, lived experiences during pregnancy from the time of diagnosis to birth were explored with 26 mothers who participated in this international study. Themes were constructed through reflexive thematic analysis to describe the experience of the lived phenomenon. The first theme, Under Threat, included subthemes of The Threat to the Life of the Baby and Threatened Image of the Expected Family. The second theme, Day to Day Toward Adaptation, included subthemes of Holding it Together and Falling Apart, and More Than Information, Searching for Meaning, Hope and Control. To realise the commonly stated objective of prenatal diagnosis, to support maternal preparation, healthcare professionals require awareness of the profound, yet individual experience of prenatal diagnosis to adequately respond and support mothers through their continued pregnancies. Healthcare services should be designed to flexibly respond in a woman- and family-centred manner to reduce the threat and support maternal adaptation after a prenatal diagnosis.
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Affiliation(s)
- Pieta Shakes
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - Andrew Cashin
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - John Hurley
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW, 2450, Australia.
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27
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Gonzales AM, Barcelo TI. Quality of prenatal care and maternal fetal attachment among primigravid mothers in the Philippines: A cross sectional study. Midwifery 2023; 127:103842. [PMID: 37871420 DOI: 10.1016/j.midw.2023.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The prenatal period is a proper chance for evaluating maternal-fetal attachment. AIM To determine the relationship between quality of prenatal care and maternal-fetal attachment among primigravida mothers during late pregnancy period. METHODS The study conducted a survey using a 46-item Quality of Prenatal Care Questionnaire and 24-item Maternal-Fetal Attachment Scale among 343 primigravida mothers in village health stations. Pearson correlation was used to correlate maternal-fetal attachment scores and quality of prenatal scores. Linear regression was used to determine relationships between variables. RESULTS Maternal-fetal attachment scores is correlated with: age ≤19 years (4.10 [95 % CI 1.81-6.39]), companion during visits (2.76 [95 % CI 0.34-5.18]), education (3.45 [95 % CI 0.93-5.97]). On multivariate analysis, the following were significantly associated with maternal-fetal attachment scores: information sharing (8.67 [95 % CI 4.74 - 12.60]), sufficient time (-2.34 [95 % CI -3.45 - -1.24]), support and respect (8.49 [95 % CI 4.54 - 12.45]), maternal age < 19 years (-3.78 [-5.81 to -1.75]), and unmarried (2.55 [95 % CI 0.70 - 4.41]). CONCLUSION The quality of prenatal care is correlated significantly with maternal-fetal attachment. Women valued the care given when it was individualized and the health workers were approachable in their ways and addressed their own particular needs. Combination of prenatal education and counselling tailored to address own particular emotional and social concerns of pregnant mothers are interventions that should be integrated in maternal care services.
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Affiliation(s)
- Artemio M Gonzales
- College of Arts, Sciences, and Technology, Occidental Mindoro State College, Occidental Mindoro, San Jose 5100, Philippines; Faculty of Management and Development Studies, University of the Philippines, Los Baños, Laguna 4030, Philippines.
| | - Teresita I Barcelo
- Faculty of Management and Development Studies, University of the Philippines, Los Baños, Laguna 4030, Philippines
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Rodriguez MI, Skye M, Acevedo AM, Swartz JJ, Caughey AB, McConnell KJ. Postpartum Expansion of Emergency Medicaid is Associated with Increased Receipt of Recommended Glycemic Screening and Care. J Immigr Minor Health 2023; 25:1221-1228. [PMID: 37280466 PMCID: PMC10698207 DOI: 10.1007/s10903-023-01504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
Oregon expanded Emergency Medicaid coverage to 60 days of postpartum care in 2018, facilitating ongoing care for conditions such as gestational diabetes. We linked Medicaid claims and birth certificates from 2010 to 2019 in Oregon and South Carolina, which did not expand postpartum care. We used a difference-in-difference design to measure the effects of postpartum care coverage among Emergency Medicaid recipients with gestational diabetes. Primary outcomes were receipt of recommended glucose tolerance testing and new diagnosis of Type 2 diabetes. Our sample included 2,270 live births among a predominantly multiparous, Latina population. Postpartum coverage was associated with a significant increase in receipt of a recommended glucose tolerance test (23.1 percentage points, 95% CI 16.9-29.3) and in diagnosis of Type 2 diabetes (4.6 percentage points, 95% CI 3.3-65.9). Expansion of postpartum coverage increased recommended screenings and care among Emergency Medicaid enrollees with pregnancies complicated by gestational diabetes.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Megan Skye
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Ann Martinez Acevedo
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Jonas J Swartz
- Department of Obstetrics and Gynecology, Duke University, Box 3084, Durham, NC, 27710, USA.
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
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Diezi AS, Vanetti M, Robert M, Schaad B, Baud D, Horsch A. Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners' perceptions and needs. BMC Pregnancy Childbirth 2023; 23:797. [PMID: 37978462 PMCID: PMC10655283 DOI: 10.1186/s12884-023-06105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Complications requiring medical interventions during childbirth are far from rare, even after uncomplicated pregnancies. It is often a challenge for maternity healthcare professionals to know how to prepare future parents for these eventualities without causing unnecessary anxiety. Studies on traumatic birth experiences have shown that feelings of loss of control, insufficient information, and lack of participation in medical decisions during childbirth are factors of difficult experiences. However, little is known about the information and communication needs of expectant parents about childbirth during the prenatal period. To gain a deeper understanding of the information and communication needs of first-time pregnant women and partners, we explored their perceptions and expectations for their upcoming childbirth, and the actions they initiated to prepare for it. METHODS Semi-structured interviews were conducted individually with first-time pregnant women and partners of pregnant women aged 18 years or older, with an uncomplicated pregnancy. Thematic analysis was used to identify themes and sub-themes. RESULTS Twenty expectant parents (15 pregnant women and five partners of pregnant women) were interviewed. Six themes were identified: Childbirth event; Childbirth experience; Childbirth environment; Organisation of care; Participation in decision making; Roles within the couple and transition to parenthood. CONCLUSIONS This study contributes to a better understanding of the information needs of future parents expecting their first child. Results highlighted that the notion of "childbirth risks" went beyond the prospect of complications during birth, but also encompassed concerns related to a feeling of loss of control over the event. Expectant parents showed an ambivalent attitude towards consulting risk information, believing it important to prepare for the unpredictability of childbirth, while avoiding information they considered too worrying. They expressed a desire to receive concrete, practical information, and needed to familiarise themselves in advance with the birth environment. Establishing a respectful relationship with the healthcare teams was also considered important. The findings suggest that information on childbirth should not be limited to the transmission of knowledge, but should primarily be based on the establishment of a relationship of trust with healthcare professionals, taking into account each person's individual values and expectations.
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Affiliation(s)
- Anne-Sylvie Diezi
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de La Corniche 10, 1011, Lausanne, Switzerland
- Communication Department, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Mélanie Vanetti
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de La Corniche 10, 1011, Lausanne, Switzerland
| | - Marie Robert
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de La Corniche 10, 1011, Lausanne, Switzerland
| | - Béatrice Schaad
- Communication Department, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Av. de Provence 82, 1007, Lausanne, Switzerland
| | - David Baud
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 10, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de La Corniche 10, 1011, Lausanne, Switzerland.
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 10, 1011, Lausanne, Switzerland.
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Afulani PA, Coleman-Phox K, Leon-Martinez D, Fung KZ, Martinez E, Garza MA, McCulloch CE, Kuppermann M. Psychometric assessment of the US person-centered prenatal and maternity care scales in a low-income predominantly Latinx population in California. BMC Womens Health 2023; 23:616. [PMID: 37978490 PMCID: PMC10656820 DOI: 10.1186/s12905-023-02721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States-the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales-in a low-income predominantly Latinx population in California. METHODS Data were collected from July 2020 to June 2023 from surveys of low-income pregnant and birthing people in Fresno, California, participating in the "Engaging Mothers and Babies; Reimagining Antenatal Care for Everyone" (EMBRACE) trial. Research staff administered the 26-item PCPC-US scale at 30-34 weeks' gestation (n = 315) and the 35-item PCMC-US scale at 10-14 weeks after birth (n = 286), using the language preferred by the participant (English or Spanish). We assessed construct, criterion, and known group validity and internal consistency of the scales. RESULTS 78% of respondents identified as Latinx. Factor analysis identified one dominant factor for each scale that accounted for over 60% of the cumulative variance, with most items loading at > 0.3. The items also loaded adequately on sub-scales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." Cronbach's alpha for the full scales were > 0.9 and between 0.70 and 0.87 for the sub-scales. Summative scores range from 0 to 100, with higher scores indicating higher person-centered care. Correlations with scores on scales measuring prenatal care quality and birth experience provided evidence for criterion validity, while associations with known predictors provided evidence for known-group validity. CONCLUSIONS The PCPC-US and PCMC-US scales, which were developed using a community-engaged process and found to have good psychometric properties in a largely high-income sample of Black women, were shown to also have good psychometric properties in a sample of low-income primarily Latinx women. Both scales provide valid and reliable tools to measure person-centered care experiences among minoritized communities to support efforts to reduce existing birth inequities.
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Affiliation(s)
- Patience A Afulani
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA.
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Daisy Leon-Martinez
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Kathy Z Fung
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Erica Martinez
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, USA
| | - Mary A Garza
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, USA
- Department of Public Health, College of Health and Human Services, California State University, Fresno, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
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Shaw-Churchill S, Phillips KP. The pandemic experiences of Ontario perinatal providers: a qualitative study. BMC Health Serv Res 2023; 23:1057. [PMID: 37794422 PMCID: PMC10552313 DOI: 10.1186/s12913-023-10079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences. METHODS Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes. RESULTS Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices). CONCLUSIONS Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.
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Affiliation(s)
- Sigourney Shaw-Churchill
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada.
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Julceus EF, Olatosi B, Hung P, Zhang J, Li X, Liu J. Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018-2021. BMC Pregnancy Childbirth 2023; 23:686. [PMID: 37741980 PMCID: PMC10517534 DOI: 10.1186/s12884-023-05983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals' decision of not admitting pregnant women's partner or support person, and pregnant women's fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race. METHODS We utilized 2018-2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic. RESULTS A total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 - June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20-1.33) and White women (OR 1.10, 95% CI 1.06-1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13-1.24) and White women (OR 1.09, 95% CI 1.04-1.13). CONCLUSIONS Compared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.
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Affiliation(s)
- Emmanuel Fabrice Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Sørensen ER, Rasmussen IS, Overbeck G, Siersma V, Appel CL, Wilson P. Uptake of signposting to web-based resources: pregnant women's use of a preventive web-based intervention. BMC Prim Care 2023; 24:189. [PMID: 37716967 PMCID: PMC10504765 DOI: 10.1186/s12875-023-02130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Signposting to web-based interventions is becoming increasingly popular in primary care. Most resources are focused on individuals with clinical problems, but less is known about the uptake of general practice (GP) signposted web-based interventions. GPs in Denmark are responsible for scheduled preventive care during pregnancy and the child's first five years. In the "Family Well-being in General Practice" trial the web-based intervention "Resilientchild.dk" is introduced at these consultations. Resilientchild.dk is designed to improve the capacity of parents to understand the mental state of themselves, their partners, and their children. In this study we assess the uptake and use of this web-based intervention. OBJECTIVE To describe participant and practice characteristics associated with the use of a web-based psychoeducational intervention. Eligible participants were pregnant women presenting at their first antenatal assessment, usually around 6-10 gestational weeks. METHODS The study was nested in a cluster randomised trial of resilientchild.dk. We conducted a relative importance analysis, which allows for determination of the variables most strongly associated with website use. To assess the direction and magnitude of the influences of the identified variables, we applied multinomial generalized linear mixed modelling. A practice random effect allows us to account for clustering of women within practices. RESULTS Parity and the absence of a nurse or midwife in the practice were important factors driving a decrease in the likelihood of using resilientchild.dk. Being a student or living outside the capital city were important factors driving an increase in the likelihood of using resilientchild.dk. CONCLUSION The data offer unique opportunities to assess the utilisation of a web-based mental health-promotion intervention following advice from a clinician. This study draws conclusions about which patients are likely to access similar resources and which practice characteristics encourage their use. TRIAL REGISTRATION Registered in clinicaltrials.gov, Trial number: NCT04129359 Date of registration: 16/10/2019 ( https://clinicaltrials.gov/ct2/show/NCT04129359 ).
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Affiliation(s)
- Emil Rønn Sørensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Ida Scheel Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Clara Lundmark Appel
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Huhn EA, Göbl CS, Fischer T, Todesco Bernasconi M, Kreft M, Kunze M, Vogt DR, Dölzlmüller E, Jaksch-Bogensperger H, Heldstab S, Eppel W, Husslein P, Ochsenbein Kölble N, Richter A, Bäz E, Winzeler B, Hoesli I. Sensitivity, specificity, and diagnostic accuracy of WHO 2013 criteria for diagnosis of gestational diabetes mellitus in low risk early pregnancies: international, prospective, multicentre cohort study. BMJ Med 2023; 2:e000330. [PMID: 37720695 PMCID: PMC10503330 DOI: 10.1136/bmjmed-2022-000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
Objective To evaluate the predictability of gestational diabetes mellitus wth a 75 g oral glucose tolerance test (OGTT) in early pregnancy, based on the 2013 criteria of the World Health Organization, and to test newly proposed cut-off values. Design International, prospective, multicentre cohort study. Setting Six university or cantonal departments in Austria, Germany, and Switzerland, from 1 May 2016 to 31 January 2019. Participants Low risk cohort of 829 participants aged 18-45 years with singleton pregnancies attending first trimester screening and consenting to have an early 75 g OGTT at 12-15 weeks of gestation. Participants and healthcare providers were blinded to the results. Main outcome measures Fasting, one hour, and two hour plasma glucose concentrations after an early 75 g OGTT (12-15 weeks of gestation) and a late 75 g OGTT (24-28 weeks of gestation). Results Of 636 participants, 74 (12%) developed gestational diabetes mellitus, according to World Health Organization 2013 criteria, at 24-28 weeks of gestation. Applying WHO 2013 criteria to the early OGTT with at least one abnormal value gave a low sensitivity of 0.35 (95% confidence interval 0.24 to 0.47), high specificity of 0.96 (0.95 to 0.98), positive predictive value of 0.57 (0.41 to 0.71), negative predictive value of 0.92 (0.89 to 0.94), positive likelihood ratio of 10.46 (6.21 to 17.63), negative likelihood ratio of 0.65 (0.55 to 0.78), and diagnostic odds ratio of 15.98 (8.38 to 30.47). Lowering the postload glucose values (75 g OGTT cut-off values of 5.1, 8.9, and 7.8 mmol/L) improved the detection rate (53%, 95% confidence interval 41% to 64%) and negative predictive value (0.94, 0.91 to 0.95), but decreased the specificity (0.91, 0.88 to 0.93) and positive predictive value (0.42, 0.32 to 0.53) at a false positive rate of 9% (positive likelihood ratio 5.59, 4.0 to 7.81; negative likelihood ratio 0.64, 0.52 to 0.77; and diagnostic odds ratio 10.07, 6.26 to 18.31). Conclusions The results of this prospective low risk cohort study indicated that the 75 g OGTT as a screening tool in early pregnancy is not sensitive enough when applying WHO 2013 criteria. Postload glucose values were higher in early pregnancy complicated by diabetes in pregnancy. Lowering the postload cut-off values identified a high risk group for later development of gestational diabetes mellitus or those who might benefit from earlier treatment. Results from randomised controlled trials showing a beneficial effect of early intervention are unclear. Trial registration ClinicalTrials.gov NCT02035059.
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Affiliation(s)
- Evelyn A Huhn
- Department of Feto-Maternal Medicine and Obstetrics, University Hospital Basel, Basel, Switzerland
- Department of Prenatal Diangosis and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian S Göbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fischer
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | | | - Martina Kreft
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - Mirjam Kunze
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - Deborah R Vogt
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Eva Dölzlmüller
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Heidi Jaksch-Bogensperger
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Sandra Heldstab
- Department of Obstetrics and Gynaecology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Wolfgang Eppel
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Peter Husslein
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | | | - Anne Richter
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - Elke Bäz
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - Bettina Winzeler
- Department of Endocrinology and Diabetology, University Hospital Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
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Dal Moro APM, Soecki G, de Fraga FS, Petterle RR, Rückl SZ. Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil. BMC Pregnancy Childbirth 2023; 23:632. [PMID: 37660013 PMCID: PMC10474709 DOI: 10.1186/s12884-023-05948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 08/22/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The fear of childbirth (FOC) harms maternal and fetal health, however it has been little studied in Brazil. This research aimed to determine the prevalence of FOC in a maternity hospital in southern Brazil and identify its associated factors. METHODS The Wijma Delivery Expectancy Questionnaire - W-DEQ(A) was used to assess the prevalence of FOC, and its relationship with sociodemographic variables, gestational history, aspects of the current pregnancy, knowledge about childbirth, anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Edinburgh Postnatal Depression Scale), and perception of social support (Multidimensional Scale of Perceived Social Support) was investigated. Questionnaires about the content of FOC and information sources regarding childbirth were also applied. RESULTS We interviewed 125 pregnant women between 28 and 36 weeks of pregnancy between July and September of 2021, and 12% of them scored ≥ 85 on the W-DEQ(A), indicating severe FOC. There was a significant correlation between FOC and anxiety symptoms (r = 0.50, p < 0.001), depressive symptoms (r = 0.34, p < 0.001), and poor social support (r = -0.23, p = 0.008). FOC was lower in pregnant women with complete elementary education when compared to those with higher education (p = 0.003), however, those with negative experiences in previous deliveries had more FOC than those who had had positive experiences (p = 0.001). More than 85% of them fear fetal distress. CONCLUSIONS FOC is a prevalent condition that impacts the mental health of pregnant women. Therefore, health professionals should recognize and address it during prenatal care to provide integral maternal-fetal care and improve the childbirth experience.
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Affiliation(s)
| | - Gabriella Soecki
- Medicine Student, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Sarah Zanghellini Rückl
- Departament of Psychiatry and Forensic Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
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Blondel B, Beuzelin M, Bonnet C, Moreau C. Pregnancy intention and preconception contraceptive behaviors and substandard prenatal care in France. J Gynecol Obstet Hum Reprod 2023; 52:102608. [PMID: 37245644 DOI: 10.1016/j.jogoh.2023.102608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Evaluate the association between a combined measure of time-based pregnancy intention and preconception contraceptive behavior and suboptimal prenatal care. POPULATION AND METHOD Women delivering a live birth in all maternity units during one week in March 2016 were interviewed in the postpartum ward (N = 13,132). Multinomial logistic regression models were used to assess the association between the indicator of pregnancy intention and substandard prenatal care (late initiation of care and less than the recommended number of prenatal visits (<60% recommended)). RESULTS 83.6% of women had timed pregnancies, 4.7% had mistimed pregnancies but discontinued contraception to conceive, 8.0% had mistimed pregnancies without discontinuing contraception to conceive and 3.7% had unwanted pregnancies. Women with timed pregnancies or mistimed pregnancies despite discontinuing contraception to conceive were more socially advantaged than those who had an unwanted pregnancy or a mistimed pregnancy without discontinuing contraception to conceive. 3.3% of women had a substandard number of prenatal visits and 2.5% had delayed prenatal care initiation. The adjusted odds ratios (aOR) of substandard prenatal visits were high among women with unwanted pregnancies (aOR=2.78; 95% confidence interval [1.91-4.05]) and women with mistimed pregnancies who had not discontinued contraception to conceive (aOR=1.69; [1.21-2.35]) compared to women with timed pregnancies. No difference was observed for women with mistimed pregnancies who discontinued contraception to conceive (aOR=1.22; [0.70-2.12]). CONCLUSION Using routinely collected information on preconception contraception allows a more nuanced assessment of pregnancy intentions that can help caregivers identify women at greater risk of substandard prenatal care.
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Affiliation(s)
- Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France.
| | - Maxime Beuzelin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Camille Bonnet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Primary Care and Prevention, Centre for Research in Epidemiology and Population Health (CESP), U1018, INSERM, 94805 Villejuif, France
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Beyuo TK, Lawrence ER, Oppong SA, Kobernik EK, Amoakoh-Coleman M, Grobbee DE, Browne JL, Bloemenkamp KWM. Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Pregnancy Hypertens 2023; 33:46-51. [PMID: 37586135 DOI: 10.1016/j.preghy.2023.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To explore how specific measures of antenatal care utilization are associated with outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. STUDY DESIGN Participants were adult pregnant women with preeclampsia or eclampsia at a tertiary hospital in Ghana. Antenatal care utilization measures included timing of first visit, total visits, facility and provider type, and referral status. Antenatal visits were characterized by former and current World Health Organization recommendations, and by gestational age-based adequacy. MAIN OUTCOME MEASURES Composites of maternal complications and poor neonatal outcomes. Multivariate logistic regressions identified associations with antenatal care factors. RESULTS Among 1176 participants, median number of antenatal visits was 5.0 (IQR 3.0-7.0), with 72.9% attending ≥4 visits, 19.4% attending ≥8 visits, and 54.9% attending adequate visits adjusted for gestational age. Care was most frequently provided in a government polyclinic (n = 522, 47.2%) and by a midwife (n = 704, 65.1%). Odds of the composite maternal complications were lower in women receiving antenatal care at a tertiary hospital (aOR 0.47, p = 0.01). Odds of poor neonatal outcomes were lower in women receiving antenatal care at a tertiary hospital (aOR 0.56, p < 0.001), by a specialist Obstetrician/Gynecologist (aOR 0.58, p < 0.001), and who attended ≥8 visits (aOR 0.67, p = 0.04). Referred women had twice the odds of a maternal complication (aOR 2.12, p = 0.007) and poor neonatal outcome (aOR 1.68, p = 0.002). CONCLUSIONS Fewer complications are seen after receiving antenatal care at tertiary facilities. Attending ≥8 visits reduced poor neonatal outcomes, but didn't impact maternal complications. Quality, not just quantity, of antenatal care is essential.
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Affiliation(s)
- Titus K Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA.
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana.
| | - Emily K Kobernik
- Department of Learning Health Sciences, University of Michigan, 1111 East Catherine Street, Ann Arbor, MI 48109 USA
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - K W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
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Lin K, Chern S, Sun J. Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries. World J Pediatr 2023; 19:835-850. [PMID: 36705781 DOI: 10.1007/s12519-022-00668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/30/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Closing the gap between child mortality in low- and middle-income countries (LMICs) and high-income countries is a priority set by the WHO in sustainable development goals (SDGs). We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs. METHODS The Demographic and Health Survey (DHS) was used to examine data from 26 countries to compare prenatal, postnatal, nutritional, and demographic factors across LMICs. Outcome of child death was classified into death before one month of age, between 1 to 11 months, between one to two years, between three to five years, and overall death before five years. Chi-square analyses identified differences in prenatal care, postnatal care, nutrition, and demographic factors between children who died and those who survived. Logistic regression identified factors that increased child mortality risk. RESULTS The majority of deaths occurred before the ages of one month and one year. Considerably poorer quality of prenatal care, postnatal care, and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s. High child mortality and poor quality of prenatal and postnatal care coincide with low income. Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries. The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk. Significant socio-demographic risk factors were associated with an increased mortality rate in children, including lack of education, maternal marital status, family wealth index, living rurally, and financial problems hindering access to healthcare. CONCLUSIONS Poor nutrition remains a vital factor across all LMICs, with numerous children being exposed to foods low in iron and vitamin A. Significantly, most deaths occur in neonates and infants, indicating an urgent need to address risk factors associated with early child death.
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Affiliation(s)
- Kelly Lin
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia
| | - Serena Chern
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia.
- Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, 4222, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Peahl AF, Turrentine M, Srinivas S, King T, Zahn CM. Routine Prenatal Care. Obstet Gynecol Clin North Am 2023; 50:439-455. [PMID: 37500209 DOI: 10.1016/j.ogc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs. Key aspects of recently developed prenatal care models include visit schedules based on needed services, telemedicine, home measurement of routine pregnancy parameters, and interventions that address social and structural drivers of health. Several barriers that affect the individual, provider, health system, and policy levels must be addressed to facilitate implementation of new prenatal care delivery models.
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Mark Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX 77030, USA
| | - Sindhu Srinivas
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Tekoa King
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Christopher M Zahn
- American College of Obstetricians and Gynecologists, 409 12th Street Southwest, Washington, DC 20024, USA
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Abstract
The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.
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Affiliation(s)
- Reshma Khan
- Shifa Free Clinic, 668 Marina Drive, Unit 4A, Charleston, SC 29492, USA.
| | - William Rayburn
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 1721 Atlantic Avenue, Sullivan's Island, SC 294482, USA
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Palaszewski D. Prenatal Care for the Obese and Severely Obese Pregnant Patient. Obstet Gynecol Clin North Am 2023; 50:525-534. [PMID: 37500214 DOI: 10.1016/j.ogc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing, and timing and mode of delivery.
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Voldner N, Eick F, Vangen S. 'Goodbye and good luck' Midwifery care to pregnant undocumented migrants in Norway: A qualitative study. Sex Reprod Healthc 2023; 37:100878. [PMID: 37369145 DOI: 10.1016/j.srhc.2023.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To explore community midwives' experiences caring for pregnant undocumented migrants seeking prenatal care in Norway. METHOD Due to the relatively limited previous research and number of pregnant undocumented migrants we used an explorative approach through qualitative method. Ten community midwives were interviewed after snowball sampling in Oslo, the capital of Norway. The main themes emerged through a qualitative analysis of the transcripts, and meaning units were extracted. RESULTS Midwives with no prior experience with pregnant undocumented migrants expressed uncertainty regarding the women's rights. In contrast, those midwives who had had prior experience with this group, developed their own solutions and enacted certain strategies to help them without any guidelines from their employer. All the midwives found it challenging to provide follow-up care to the undocumented migrants during pregnancy and postpartum. They also expressed concerns regarding increasing challenges creating clinical trusting relationships and restrictions and practices at public hospitals. CONCLUSIONS To ensure adequate perinatal care, it is needed to reassure pregnant undocumented migrants free and safe care at all stages in the birth giving process. Community midwives need professional support in establishing trusting clinical relationships with pregnant undocumented migrants to reduce maternal stress and facilitate continuity in perinatal care.
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Affiliation(s)
- Nanna Voldner
- Faculty of Health Studies, VID specialized university, Diakonveien 16, 0370 Oslo, Norway
| | - Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway.
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynaecology, Oslo University Hospital, Rikshospitalet, PO box 4950, Nydalen, 0424 Oslo, Norway
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Iwaya LH, Nordin A, Fritsch L, Børøsund E, Johansson M, Varsi C, Ängeby K. Early Labour App: Developing a practice-based mobile health application for digital early labour support. Int J Med Inform 2023; 177:105139. [PMID: 37406571 DOI: 10.1016/j.ijmedinf.2023.105139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pregnant women in early labour have felt excluded from professional care, and their partners have been restricted from being involved in the birthing process. Expectant parents must be better prepared to deal with fear and stress during early labour. There is a need for evidence-based information and digital applications that can empower couples during childbirth. OBJECTIVE To develop and identify requirements for a practice-based mobile health (mHealth) application for Digital Early Labour Support. METHODS This research started with creating an expert group composed of a multidisciplinary team capable of informing the app development process on evidence-based practices. In consultation with the expert group, the app was built using an agile development approach (i.e., Scrum) within a continuous software engineering setting (i.e., CI/CD, DevOps), also including user and security tests. RESULTS During the development of the Early Labour App, two main types of challenges emerged: (1) user challenges, related to understanding the users' needs and experience with the app, and (2) team challenges, related to the software development team in particular, and the necessary skills for translating an early labour intervention into a digital solution. This study reaffirms the importance of midwife support via blended care and the opportunity of complementing it with an app. The Early Labour App was easy to use, the women needed little to no help, and the partner's preparation was facilitated. The combination of the app together with blended care opens up awareness, thoughts and feelings about the method and provides good preparation for the birth. CONCLUSION We propose the creation of the Early Labour App, a mHealth app for early labour support. The preliminary tests conducted for the Early Labour App show that the app is mature, allowing it to be used in the project's Randomised Control Trial, which is already ongoing.
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Affiliation(s)
- Leonardo Horn Iwaya
- Department of Mathematics and Computer Science, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.
| | - Anna Nordin
- Department of Health Science, Faculty of Health, Science, and Technology, Karlstad University, Sweden; Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Lothar Fritsch
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Norway; Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Margareta Johansson
- Department of Women's and Children's Health, Faculty of Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Norway; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Karin Ängeby
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Berwick M, Louis-Jacques AF. Prenatal Counseling and Preparation for Breastfeeding. Obstet Gynecol Clin North Am 2023; 50:549-565. [PMID: 37500216 DOI: 10.1016/j.ogc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Breastfeeding is the gold standard of infant nutrition and current guidelines suggest exclusive breastfeeding for 6 months, with continued breastfeeding through 24 months or beyond. Obstetric care professionals can encourage and educate their patients about breastfeeding through the prenatal period when many expectant parents make decisions about their infant feeding choices. Education and support should extend through the postpartum period and include parents who may have concerns surrounding medical comorbidities, breast augmentation, or substance use disorders.
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Affiliation(s)
- Margarita Berwick
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA.
| | - Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA
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Stanhope KK, Goebel A, Simmonds M, Timi P, Das S, Immanuelle A, Jamieson DJ, Boulet SL. The impact of screening for social risks on OBGYN patients and providers: A systematic review of current evidence and key gaps. J Natl Med Assoc 2023; 115:405-420. [PMID: 37330393 PMCID: PMC10526693 DOI: 10.1016/j.jnma.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Increasingly, policymakers and professional organizations support screening for social assets and risks during clinical care. Scant evidence exists on how screening impacts patients, providers, or health systems. OBJECTIVE To systematically review published literature for evidence of the clinical utility of screening for social determinants of health in clinical obstetric and gynecologic (OBGYN) care. SEARCH STRATEGY We systematically searched Pubmed (March 2022, 5,302 identified) and identified additional articles using hand sorting (searching articles citing key articles (273 identified) and through bibliography review (20 identified)). SELECTION CRITERIA We included all articles that measured a quantitative outcome of systematic social determinants of health (SDOH) screening in an OBGYN clinical setting. Each identified citation was reviewed by two independent reviewers at both the title/abstract and full text stages. DATA COLLECTION AND ANALYSIS We identified 19 articles for inclusion and present the results using narrative synthesis. MAIN RESULTS The majority of articles reported on SDOH screening during prenatal care (16/19) and the most common SDOH was intimate partner violence (13/19 studies). Overall, patients had favorable attitudes towards SDOH screening (in 8/9 articles measuring attitudes), and referrals were common following positive screening (range 5.3%-63.6%). Only two articles presented data on the effects of SDOH screening on clinicians and none on health systems. Three articles present data on resolution of social needs, with inconsistent results. CONCLUSIONS Limited evidence exists on the benefits of SDOH screening in OBGYN clinical settings. Innovative studies leveraging existing data collection are needed to expand and improve SDOH screening.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States.
| | - Anna Goebel
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Monica Simmonds
- Center for Black Women's Wellness, 477 Windsor St SW, Atlanta, GA 30312, United States
| | - Patience Timi
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Sristi Das
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Asha Immanuelle
- Center for Black Women's Wellness, 477 Windsor St SW, Atlanta, GA 30312, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
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Bitnun A, Sauvé L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Paediatr Child Health 2023; 28:307-323. [PMID: 37484040 PMCID: PMC10362956 DOI: 10.1093/pch/pxad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Barbosa MCF, da Rocha NB, de Souza Gomes Rodrigues H, de Oliveira DSB, Fernandes LA, de Lima DC. Maternal Knowledge of Oral Health During Pregnancy and Childbirth. Matern Child Health J 2023:10.1007/s10995-023-03697-2. [PMID: 37394617 DOI: 10.1007/s10995-023-03697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This cohort study was to investigate maternal knowledge of the oral health of woman and children during pregnancy and after childbirth, and the associated factors. METHODS Groups of women participating in a public prenatal dental care programme in Brazil were assessed, in two different stages. In the first stage, pregnant women were assessed for their own oral health. In the second stage, after childbirth, women were assessed for the oral health of their child. The examiner assigned a maternal knowledge score to the questionnaires, considering the ideal alternatives within the context of oral health promotion as correct answers. Statistical analysis included the Kruskal-Wallis and multiple linear regression tests, considering a level of significance of P < 0.05. RESULTS Ninety-eight women were included in the study, with a mean age 26.27 years (SD 6.51). In the regression analysis, the maternal knowledge score was associated with the presence of myths about oral health (P < 0.01), the children first dental appointment in the first year of life (P = 0.07), the presence of a non-nutritious sucking habit (P < 0.01), considering dental treatment to be important during pregnancy (P < 0.01), and having been instructed on oral health during pregnancy (P < 0.01) and after the children birth (P = 0.02). CONCLUSION This study suggests that the women showed a regular score of knowledge about their oral health and that of their children, as they still believed in some myths about oral health and the risks of dental treatment during pregnancy. Women who received guidance on oral health in pregnancy and after birth showed higher knowledge of their oral health and that of their children, demonstrating the importance of carrying out health promotion actions during pregnancy and the first years of the child's life.
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Affiliation(s)
| | - Najara Barbosa da Rocha
- Department of Social and Preventive Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | | | | | - Daniela Coelho de Lima
- Dental School, Federal University of Alfenas (UNIFAL), Alfenas, MG, Brazil.
- Dental School, Federal University of Alfenas - UNIFAL, Rua Gabriel Monteiro da Silva, 700, Centro, Alfenas, MG, 37130-001, Brazil.
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Nagamine M, Matsumura K, Tsuchida A, Inadera H. Relationship between prenatal checkup status and low birth weight: a nationwide birth cohort-the Japan Environment and Children's Study. Ann Epidemiol 2023; 83:8-14. [PMID: 37094623 DOI: 10.1016/j.annepidem.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE We investigated the association between prenatal checkup status and low birth weight (LBW). We also sought to identify the background factors of pregnant women that influence their attendance at prenatal checkups and consider measures that might prove useful in reducing the LBW rate. METHODS Using data from a large nationwide birth cohort study, the Japan Environment and Children's Study (JECS), the sample comprised 91,916 unique mother-infant pairs with singleton live births. The outcome variable was cases of LBW, and the exposure variable was prenatal checkup status (number of visits missed). Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated by logistic regression analysis. RESULTS AORs (95% CIs) for cases of LBW were 1.57 (1.46-1.69) for 1 missed checkup, 2.40 (1.97-2.94) for 2 missed checkups, and 2.38 (1.46-3.88) for ≥3 missed checkups. A linear trend was also observed (P < .0001). Further analysis revealed that the main risk factors for missed checkups were divorced or widowed marital status, followed by negative attitude toward pregnancy, and single marital status, whereas protective factors were being employed and better mental health in mid-late pregnancy. CONCLUSIONS Our results suggest the importance of implementing various measures to promote regular attendance at prenatal checkups.
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Affiliation(s)
- Mitsue Nagamine
- Tokyo Tech Academy for Leadership (ToTAL)/Institute for Liberal Arts, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo, Japan; Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan.
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan
| | - Akiko Tsuchida
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan
| | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama, Toyama, Japan
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Atkins B, Kindinger L, Mahindra MP, Moatti Z, Siassakos D. Stillbirth: prevention and supportive bereavement care. BMJ Med 2023; 2:e000262. [PMID: 37564829 PMCID: PMC10410959 DOI: 10.1136/bmjmed-2022-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/26/2023] [Indexed: 08/12/2023]
Abstract
Around half of the two million stillbirths occurring worldwide each year are preventable. This review compiles the most up-to-date evidence to inform stillbirth prevention. Many general maternal health interventions also reduce the risk of stillbirth, for example, antenatal care attendance. This review focuses on specific aspects of care: glucose metabolism, targeted aspirin prophylaxis, clotting and immune disorders, sleep positions, fetal movement monitoring, and preconception and interconception health. In the past few years, covid-19 infection during pregnancy has emerged as a risk factor for stillbirth, particularly among women who were not vaccinated. Alongside prevention, efforts to address stillbirth must include provision of high quality, supportive, and compassionate bereavement care to improve parents' wellbeing. A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. Staff need support to be able to care for parents effectively, yet, studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. Action is urgently needed and is possible. Action must be taken with the evidence available now, in healthcare settings with high or low resources, to reduce stillbirths and improve training and care.
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Affiliation(s)
- Bethany Atkins
- Institute for Women's Health, University College London, London, UK
- National Institute for Health and Care Research, London, UK
| | - Lindsay Kindinger
- King Edward Memorial Hospital for Women Perth, Perth, WA, Australia
- Fiona Stanley Hospital, Perth, WA, Australia
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Mäkelä T, Saisto T, Salmela-Aro K, Miettinen J, Sintonen H, Rouhe H. Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study. BMC Pregnancy Childbirth 2023; 23:468. [PMID: 37349712 DOI: 10.1186/s12884-023-05790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples. METHODS In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument. RESULTS PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively). CONCLUSIONS PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.
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Affiliation(s)
- Tia Mäkelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland.
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland.
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
| | - Katariina Salmela-Aro
- Department of Educational Sciences, University of Helsinki, PO BOX 9, Helsinki, 00014, Finland
| | - Jenny Miettinen
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
- Espoo Health Care Center, City of Espoo, PO BOX 1, Espoo, 02070, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO BOX 20, Helsinki, 00014, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
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