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Vandermorris A, McKinnon B, Sall M, Witol A, Traoré M, Lamesse-Diedhiou F, Bassani DG. Adolescents' experiences with group antenatal care: Insights from a mixed-methods study in Senegal. Trop Med Int Health 2021; 26:1700-1708. [PMID: 34669987 DOI: 10.1111/tmi.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Group antenatal care (G-ANC) is an innovative model in which antenatal care is delivered to a group of 8-12 women of similar gestational age. Evidence from high-income countries suggests G-ANC is particularly effective for women from marginalised populations, including adolescents. The objective of this study was to examine the experiences of Senegalese adolescents engaged in group antenatal care. METHODS This convergent parallel mixed-methods study is derived from a larger effectiveness-implementation hybrid pilot study conducted in Kaolack district, Senegal. Quantitative data for adolescent participants were collected through baseline and postnatal surveys and descriptively analysed. One-on-one interviews and focus-group discussions were conducted with adolescent participants, and qualitative data were analysed using qualitative descriptive analysis. RESULTS Forty-five adolescents aged 15-19 participated in G-ANC, with a median age of 18 years. The majority (93.3%) were married, and 64.4% were nulliparous. Findings indicated similar levels of G-ANC participation for adolescent and adult women. The majority (93.1%) of participants who had previously attended individual ANC indicated they would prefer G-ANC to individual care for a future pregnancy. Qualitative findings indicated key facets of consideration relevant to G-ANC for adolescents include social connectedness, the influence of social norms and the opportunity for engagement in healthcare. CONCLUSIONS This study suggests that G-ANC has the potential to be an adolescent-responsive and culturally appropriate method of delivering antenatal care in Senegal.
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Affiliation(s)
- Ashley Vandermorris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Britt McKinnon
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohamadou Sall
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Adrian Witol
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahamadou Traoré
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Fatma Lamesse-Diedhiou
- Institut de Recherche et Formation en Population, Developpement et Sante ́de la Reproduction, Universite ́ Cheik Anta Diop, Dakar, Senegal
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Suresh R, Alam A, Karkossa Z. Using Peer Support to Strengthen Mental Health During the COVID-19 Pandemic: A Review. Front Psychiatry 2021; 12:714181. [PMID: 34322045 PMCID: PMC8310946 DOI: 10.3389/fpsyt.2021.714181] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The coronavirus (COVID-19) pandemic has had a significant impact on society's overall mental health. Measures such as mandated lockdowns and physical distancing have contributed to higher levels of anxiety, depression, and other metrics indicating worsening mental health. Peer support, which is peer-to-peer provided social and emotional support, is an underutilized and effective mental health resource that can potentially be used to ameliorate mental health during these times. Objective: This review aims to summarize the toll that this pandemic has had on society's mental health as found in peer-reviewed literature from October 2019 to March 2021, as well as suggest the utility of peer support to address these needs. Methods: References for this review were chosen through searches of PubMed, Web of Science, and Google Scholar for articles published between October 2019 and March 2021 that used the terms: "coronavirus," "COVID-19," "mental health," "anxiety," "depression," "isolation," "mental health resources," "peer support," "online mental health resources," and "healthcare workers." Articles resulting from these searches and relevant references cited in those articles were reviewed. Articles published in English, French and Italian were included. Results: This pandemic has ubiquitously worsened the mental health of populations across the world. Peer support has been demonstrated to yield generally positive effects on the mental health of a wide variety of recipients, and it can be provided through numerous accessible mediums. Conclusions: Peer support can overall be beneficial for improving mental health during the COVID-19 pandemic and may be an effective tool should similar events arise in the future, although the presence of a few conflicting studies suggests the need for additional research.
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Affiliation(s)
- Rahul Suresh
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, QC, Canada.,Peer Support Centre, McGill University, Montreal, QC, Canada
| | - Armaghan Alam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zoe Karkossa
- Peer Support Centre, McGill University, Montreal, QC, Canada
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Uzunov AV, Bohiltea RE, Munteanu O, Nemescu D, Cirstoiu MM. A retrospective study regarding the method of delivery of adolescents in a Romanian Hospital. Exp Ther Med 2020; 20:2444-2448. [PMID: 32765731 DOI: 10.3892/etm.2020.8835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022] Open
Abstract
Adolescent pregnancies are associated with a high number of risks for the newborn and mother. Hence, an increased number of emergency caesarean extractions are performed in this group of patients. The aim of this study was to analyze the pregnancy-related conditions, the way of delivery and the neonatal outcome of all the patients who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, a tertiary unit in Romania in a period of 5 years. An observational, retrospective study was performed on a group of 686 patients, aged 12 to 19 years, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, between January 1, 2014 and December 31, 2018. The pregnant women were divided into two age groups. In the first group were pregnant patients aged under 18 years, and in the second group pregnant adolescents between 18 and 19 years. Whether the patients underwent prenatal screening was analyzed. Furthermore, the age of the patients, the rate of caesarean extraction and vaginal birth and the obstetrical complications were evaluated and compared. The outcome of the newborns was assessed based on Apgar score at 1 min and birth weight. Regarding the results, 464 of the 686 patients did not undergo any medical visits during pregnancy. In total, 52.76% of the patients delivered by caesarean section. The most frequent indications for caesarean extraction, in both analyzed groups, were Cephalo-pelvic disproportion, fetal distress and uterine scar after caesarean section. The lack of specific protocols regarding the ante-, peri- and post-natal management of adolescents is probably the cause of the alarmingly increasing number of patients pertaining to the group who deliver by caesarean section.
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Affiliation(s)
- Ana Veronica Uzunov
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy Doctoral School, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Octavian Munteanu
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Rossouw L, Burger RP, Burger R. An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial. Matern Child Health J 2019; 23:633-640. [PMID: 30600521 DOI: 10.1007/s10995-018-2677-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.
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Affiliation(s)
- Laura Rossouw
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Rulof Petrus Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Ahmadi-Montecalvo H, Haile ZT, Umer A, Chertok IRA. Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005-2010. Matern Child Health J 2018; 20:2465-2473. [PMID: 27377420 DOI: 10.1007/s10995-016-2040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this study was to examine the association between prenatal smoking and small for gestational age (SGA) infants among adolescent women in West Virginia, taking into account sociodemographic and health-related factors. Methods Secondary data analysis was conducted using the 2005-2010 West Virginia Pregnancy Risk Assessment and Monitoring Systems weighted dataset. The study population using complete case analysis procedure consisted of 886 adolescent women ages 19 and younger who delivered a live singleton infant in West Virginia. Results The prevalence of smoking among adolescents during the last 3 months of pregnancy was 67 %. Nearly a quarter (22.0 %) of the adolescents gave birth to SGA infants. Results from the logistic regression analysis showed that after controlling for sociodemographic and health-related variables, adolescents who smoked during the last 3 months of pregnancy were more likely to have SGA infants than those who did not smoke during the last 3 months of pregnancy (OR = 1.86, 95 % CI 1.06-3.27, P = 0.0307). Conclusion This study highlights the importance of recognizing that prenatal smoking is an issue among West Virginia adolescents and the need for evidence-based, culturally, and developmentally appropriate interventions for this Appalachian population.
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Affiliation(s)
- Halima Ahmadi-Montecalvo
- Department of Social and Behavioral Sciences, Robert C. Byrd Health Sciences Center, West Virginia University School of Public Health, 1 Medical Center Drive, PO Box 9190, Morgantown, WV, 26505-9190, USA.
| | - Zelalem Teka Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, 43016, USA
| | - Amna Umer
- Department of Pediatrics, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9190, Morgantown, WV, 26505-9190, USA
| | - Ilana R Azulay Chertok
- Department of Nursing, College of Health Sciences and Professions, Ohio University, Athens, OH, 45701, USA
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Williams CM, Cprek S, Asaolu I, English B, Jewell T, Smith K, Robl J. Kentucky Health Access Nurturing Development Services Home Visiting Program Improves Maternal and Child Health. Matern Child Health J 2017; 21:1166-1174. [PMID: 28093688 DOI: 10.1007/s10995-016-2215-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Home visitation programs are one of the numerous efforts to help reduce the rates of preterm birth and low birth weight as well as offering other improvements in maternal and child health and development. The Kentucky Health Access Nurturing Development Services (HANDS) is a voluntary, home visiting program serving first-time, high-risk mothers. This study's objective was to evaluate the impact of HANDS on maternal and child health outcomes. METHODS HANDS administrative data, live birth certificate records and data from the Division of Child Protection and Safety were used in these analyses. We analyzed 2253 mothers who were referred to HANDS between July 2011 and June 2012 and received a minimum of one prenatal home visit (mean number of prenatal visits = 12.9) compared to a demographically similar group of women (n = 2253) who did not receive a visit. Chi square statistics and conditional logistic regression models were used to evaluate the impact of HANDS. RESULTS HANDS participants had lower rates of preterm delivery (OR 0.74, 95% CI 0.61-0.88) and low birth weight infants (OR 0.54, 95% CI 0.44-0.67). HANDS participants also were significantly less likely to have a substantiated report of child maltreatment compared to controls (OR 0.53, 95% CI 0.43-0.65). HANDS participants also had an increase in adequate prenatal care and a reduction in maternal complications during pregnancy. Of particular important, outcomes improved as the number of prenatal home visits increased: among women receiving 1-3 prenatal home visits was 12.1%, the rate among women receiving 4-6 prenatal home visits was 13.2%, while the rate of PTB among those receiving 7 or more prenatal home visits was 9.4%. CONCLUSIONS HANDS program participation appears to result in significant improvements in maternal and child health outcomes, most specifically for those receiving seven or more prenatal home visits. As a state-wide, large scale home visiting program, this has significant implications for the continued improvement of maternal and child health outcomes in Kentucky.
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Affiliation(s)
- Corrine M Williams
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA.
| | - Sarah Cprek
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA
| | - Ibitola Asaolu
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA
| | - Brenda English
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Tracey Jewell
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Kylen Smith
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Joyce Robl
- Kentucky Department for Public Health, Frankfort, KY, USA
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Khader YS, Batieha A, Al Fursan RK, Al-Hader R, Hijazi SS. Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0075/ijamh-2017-0075.xml. [PMID: 28782350 DOI: 10.1515/ijamh-2017-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022]
Abstract
Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged <20 years were more likely to deliver prematurely compared to women aged 20-35 years [odds ratio (OR)=1.5, 95% CI: 1.2, 1.9; p < 0.005)]. However, the two groups of women did not differ significantly in low birth weight delivery (OR = 1.2, 95% CI: 0.9, 1.5; p = 0.167) and neonatal mortality (OR = 1.2, 95% CI: 0.8, 1.3; p = 0.491) in the multivariate analysis. Conclusion Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.
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Affiliation(s)
- Yousef S Khader
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan, Phone: +962796802040
| | - Anwar Batieha
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Kareem Al Fursan
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rami Al-Hader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sa'ad S Hijazi
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Tibingana-Ahimbisibwe B, Katabira C, Mpalampa L, Harrison RA. The effectiveness of adolescent-specific prenatal interventions on improving attendance and reducing harm during and after birth: a systematic review. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0063/ijamh-2016-0063.xml. [PMID: 27542198 DOI: 10.1515/ijamh-2016-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adolescent pregnancy has been associated with poor pregnancy outcomes including pre-term birth (PTB), low birth weight (LBW) and perinatal death. OBJECTIVE To systematically review the effect of adolescent-specific interventions on reducing PTB, LBW, and perinatal death and increasing prenatal care attendance. SEARCH STRATEGY Possible studies for inclusion were identified by a comprehensive search of OvidSP MEDLINE (limits: humans, 1990-present), EMBASE (limits: humans, 1990-2015), Popline and Global Health Database from the World Health Organisation (WHO) and PubMed International scientific databases, and references of identified articles were searched from 1990 to present. SELECTION CRITERIA All types of controlled studies of prenatal interventions were exclusive to adolescents and at least one of the outcomes of interest. DATA COLLECTION AND ANALYSIS Investigators identified relevant studies and entered the data in a pro forma. Data were summarised as forest plots and narrative synthesis. MAIN RESULTS Twenty-two studies (three randomised controlled trials (RCTs), four prospective cohort studies, nine retrospective cohort studies, five case controls and one natural experiment) were included with all but one study being carried out in higher-income countries. Seven of the 16 studies reporting on PTB found a statistically significant reduction in PTB rates between adolescent-specific prenatal care (intervention) and non-age specific prenatal care odds ratio (OR) and 95% confidence intervals (CIs) ranged from OR: 0.15 (95% CI: 0.03-0.83) to OR: 0.59 (95% CI: 0.45-0.78). Nine of the 12 studies reported statistically significant higher mean prenatal attendance rates among the intervention group compared to controls (ranging from a mean number of visits of 14.3 vs. 10.7 p<0.001 to 10.8 vs. 7.6 visits p<0.001). The type and construct of the interventions, their implementation and local population differed sufficiently that a statistical synthesis was deemed inappropriate. CONCLUSION There is some evidence that adolescent-specific programs can increase prenatal attendance and reduce the risk of PTB and low birth rate but their effect on perinatal death is uncertain. There is a distinct lack of evidence of the effectiveness of these interventions for adolescents living in low-middle income countries, despite having the majority of adolescent pregnancies, and associated risk of harm. No high-quality intervention studies were identified. Robust, cluster-based RCTs are an urgent necessity to quantify the impact of these interventions and to identify factors contributing to their success.
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Affiliation(s)
| | | | | | - Roger A Harrison
- Centre for Epidemiology in the Institute for Population Health, The University of Manchester, Manchester, UK
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Sukhato K, Wongrathanandha C, Thakkinstian A, Dellow A, Horsuwansak P, Anothaisintawee T. Efficacy of additional psychosocial intervention in reducing low birth weight and preterm birth in teenage pregnancy: A systematic review and meta-analysis. J Adolesc 2015; 44:106-16. [PMID: 26265589 DOI: 10.1016/j.adolescence.2015.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/03/2015] [Accepted: 07/21/2015] [Indexed: 11/17/2022]
Abstract
This systematic review aimed to assess the efficacy of psychosocial interventions in reducing risk of low birth weight (LBW) and preterm birth (PTB) in teenage pregnancy. Relevant studies were identified from Medline, Scopus, CINAHL, and CENTRAL databases. Randomized controlled trials investigating effect of psychosocial interventions on risk of LBW and PTB, compared to routine antenatal care (ANC) were eligible. Relative risks (RR) of LBW and PTB were pooled using inverse variance method. Mean differences of birth weight (BW) between intervention and control groups were pooled using unstandardized mean difference (USMD). Five studies were included in the review. Compared with routine ANC, psychosocial interventions significantly reduced risk of LBW by 40% (95%CI: 8%,62%) but not for PTB (pooled RR = 0.67, 95%CI: 0.42,1.05). Mean BW of the intervention group was significantly higher than that of the control group with USMD of 200.63 g (95% CI: 21.02, 380.25). Results of our study suggest that psychosocial interventions significantly reduced risk of LBW in teenage pregnancy.
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Affiliation(s)
- Kanokporn Sukhato
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chathaya Wongrathanandha
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pornpot Horsuwansak
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Adolescent and Adult Clients in Prenatal Case Management: Differences in Problems and Interventions Used. Matern Child Health J 2015; 19:2673-81. [DOI: 10.1007/s10995-015-1789-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chiavarini M, Lanari D, Minelli L, Salmasi L. Socio-demographic determinants and access to prenatal care in Italy. BMC Health Serv Res 2014; 14:174. [PMID: 24735757 PMCID: PMC3991890 DOI: 10.1186/1472-6963-14-174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.
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Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Donatella Lanari
- Department of Economics, Statistics and Finance, University of Perugia, Perugia, Italy
| | - Liliana Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Luca Salmasi
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
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Shapiro GD, Fraser WD, Frasch MG, Séguin JR. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med 2013; 41:631-45. [PMID: 24216160 PMCID: PMC5179252 DOI: 10.1515/jpm-2012-0295] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/14/2013] [Indexed: 01/23/2023]
Abstract
AIMS Psychosocial stress during pregnancy (PSP) is a risk factor of growing interest in the etiology of preterm birth (PTB). This literature review assesses the published evidence concerning the association between PSP and PTB, highlighting established and hypothesized physiological pathways mediating this association. METHOD The PubMed and Web of Science databases were searched using the keywords "psychosocial stress", "pregnancy", "pregnancy stress", "preterm", "preterm birth", "gestational age", "anxiety", and "social support". After applying the exclusion criteria, the search produced 107 articles. RESULTS The association of PSP with PTB varied according to the dimensions and timing of PSP. Stronger associations were generally found in early pregnancy, and most studies demonstrating positive results found moderate effect sizes, with risk ratios between 1.2 and 2.1. Subjective perception of stress and pregnancy-related anxiety appeared to be the stress measures most closely associated with PTB. Potential physiological pathways identified included behavioral, infectious, neuroinflammatory, and neuroendocrine mechanisms. CONCLUSIONS Future research should examine the biological pathways of these different psychosocial stress dimensions and at multiple time points across pregnancy. Culture-independent characterization of the vaginal microbiome and noninvasive monitoring of cholinergic activity represent two exciting frontiers in this research.
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Affiliation(s)
- Gabriel D. Shapiro
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada; and CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
| | - William D. Fraser
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Martin G. Frasch
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada; and Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Jean R. Séguin
- Corresponding author: Jean R. Séguin, Department of Psychiatry Université de Montréal Centre de recherche de l’Hôpital Ste-Justine, Bloc 5, Local 1573 3175 Côte Ste-Catherine Montréal, QC Canada H3T 1C5, Tel.: +1-514-1-345-4931, ext. 4043, Fax: +1-514-345-2176,
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Alves JGB, Cisneiros RMR, Dutra LPF, Pinto RA. Perinatal characteristics among early (10-14 years old) and late (15-19 years old) pregnant adolescents. BMC Res Notes 2012; 5:531. [PMID: 23009715 PMCID: PMC3582532 DOI: 10.1186/1756-0500-5-531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy in adolescents is a worldwide health problem and has been mostly common in poor populations. It is not clear if socioeconomic or biological factors are the main determinants of perinatal adverse outcomes in pregnant adolescents. Adolescents under 15 years old may present a high growth rate which may contribute to impair fetal growth. Our aim is to compare perinatal characteristics among early (aged 10 to 14 years) and late (aged 15 to 19 years) pregnant adolescents. METHODS A cross-sectional study was performed using data from Pernambuco State 2009, obtained from DATASUS/SISNAC, a Brazilian Government, open-access public health database. Maternal and neonatal outcomes were compared between early (aged 10-14 years) and late (aged 15-19 years) pregnant adolescents. Family income was compared between early and late pregnant adolescents using a sample of 412 subjects evaluated at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during 2011. Statistical comparisons were made using the chi-square test was used with a significant level of 0.05; bivariate and multivariate analysis were performed. This project was approved by the Institutional Ethics Review Board. RESULTS Data from 31,209 pregnant adolescents were analyzed. 29,733 (95.2%) were aged 15 to 19 years and 1,476 (4.7%) were aged 10 to 14 years. There were significant differences with respect to marital status, education level and number of prenatal visits of mothers aged 10 to 14 years compared to 15 to 19 years. Of importance, early adolescents had a greater rate of neonates born premature and with low birth weight. Prematurity and low birth weight remained statistically significant after multivariate analysis. CONCLUSIONS Early aged adolescents may have an increased risk of prematurity and low birth weight. These findings highlight the potential role of biological factors in newborn outcomes in pregnant adolescents.
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Affiliation(s)
- João Guilherme Bezerra Alves
- Instituto de Medicina Integral Prof, Fernando Figueira (IMIP), Rua dos Coelhos 300, Boa Vista, Recife PE, ZIP: 50070-550, Brazil.
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15
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Abstract
OBJECTIVE To examine the relationship between child health and maternal relationship quality with a spouse/partner, self-rated health, depressive symptoms, and social support. METHODS In a cross-sectional study, structured interviews were completed with 595 mothers in 2002. Women were recruited from a random sample of households in low-income communities of Teresina, Piauí. Child health status was assessed with the Eisen Infant Health Rating Scale and a composite index of child fever, worms, or diarrhea in the past 2 weeks. Exposure variables included maternal relationship quality, self-rated health, depressive symptoms, and social support. Analyses included multivariable linear and logistic regression modeling, controlling for sociodemographics. RESULTS Both a high-quality partner relationship and good/excellent maternal self-rated health were significantly associated with higher scores on the Eisen Infant Health Rating Scale (â = 0.9; 95% confidence interval [CI]: 0.3-1.4 and β = 1.1; 95% CI: 0.7-1.6, respectively). Every 5-point increase in depressive symptoms was negatively associated with infant health scores (β = -0.3; 95% CI: -0.4 to -0.1) and with recent child wellness (lack of fever, diarrhea, or worms) (odds ratio = 0.9 95%; CI: 0.8-1.0). CONCLUSION Maternal factors, such as partner relationship quality and health status, may be important to child health and should be considered for inclusion in confirmatory longitudinal studies.
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Michele Issel L, Forrestal SG, Slaughter J, Wiencrot A, Handler A. A Review of Prenatal Home‐Visiting Effectiveness for Improving Birth Outcomes. J Obstet Gynecol Neonatal Nurs 2011; 40:157-65. [DOI: 10.1111/j.1552-6909.2011.01219.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zeck W, Wilkinson J, Obure J, Masenga G, Ulrich D, Oneko O. Comparison of obstetrical risk in adolescent primiparas at tertiary referral centres in Tanzania and Austria. J Matern Fetal Neonatal Med 2011; 23:1470-4. [PMID: 21067304 DOI: 10.3109/14767051003678077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Adolescent childbearing is most prevalent in Sub-Saharan Africa. Deliveries in adolescent primiparas at an Austrian and an East African tertiary referral centre were compared to reveal differences in obstetric outcome. METHODS A total of 186 primiparas delivering at an age of 17 or less between 1999 and 2005 at the Austrian centre were compared with 209 adolescent primiparas who delivered between 2005 and 2007 at the African centre. The type of delivery and complications were studied. RESULTS Adolescent primiparas accounted for 1.2% of the overall obstetric population at the Austrian centre, as compared with 2.3% at the East African centre (p<0.01). When comparing the adolescents' outcome at the Austrian centre with the outcome of 22-27 years old primiparas at the same institution, we noted that the rates of adverse obstetric outcomes were higher among the adult group. However, at the East African centre the opposite was observed. CONCLUSIONS In contrast to the results of Africa, data from Austria show that the obstetric outcome in adolescent pregnancies can be favourable. However, socioeconomic considerations have to be taken into account. Education and health knowledge seem critical for young females particularly in low-resource settings like East Africa.
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Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Tumaini University, Moshi, Tanzania, East Africa
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18
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Genetic Counselors’ Experiences with Adolescent Patients in Prenatal Genetic Counseling. J Genet Couns 2010; 20:178-91. [DOI: 10.1007/s10897-010-9338-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Rasheed S, Abdelmonem A, Amin M. Adolescent pregnancy in Upper Egypt. Int J Gynaecol Obstet 2010; 112:21-4. [DOI: 10.1016/j.ijgo.2010.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/31/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
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Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med 2010; 25:1186-92. [PMID: 20607434 PMCID: PMC2947642 DOI: 10.1007/s11606-010-1434-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 05/11/2010] [Accepted: 06/01/2010] [Indexed: 12/23/2022]
Abstract
INTRODUCTION U.S. Hispanic women suffer a disproportionate burden of cervical cancer, with incidence and mortality rates almost twice that of whites. Community health workers, or promotoras, are considered a potential strategy for eliminating such racial and ethnic health disparities. The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community. METHODS Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Sociodemographic characteristics, cervical cancer risk, previous screening history, cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge (on a 0-6 scale), self-efficacy (on a 0-5 scale), and receipt of Pap smear screening during the previous 6 months (dichotomous). Univariate analyses were performed using chi square, t-test, and the Mann-Whitney test. Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening. RESULTS There were no statistically significant differences between the two experimental groups at baseline. Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), cervical cancer knowledge (5.4 vs. 3.5, p-value<0.001), and self-efficacy (4.7 vs. 4.0, p-value 0.002). In multivariate analysis, cervical cancer knowledge (OR 1.68, 95% CI 1.10-2.81) and intervention group assignment (OR 6.74, 95% CI 1.77-25.66) were associated with receiving a Pap smear during the follow-up period. DISCUSSION Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.
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Zachariah R. Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Res Nurs Health 2009; 32:391-404. [PMID: 19434649 DOI: 10.1002/nur.20335] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prospective repeated measures were used to examine attachment, social support, life stress, anxiety, and psychological wellbeing among low-income women in early and late pregnancy and the relationships of these variables to prenatal, intrapartum, and neonatal complications. One hundred and eleven medically healthy, low-income, Medicaid-eligible women ages 18-35 years, between 14 and 22 weeks of pregnancy were recruited from prenatal clinics. Self-report questionnaires and hospital records were used to collect data. Discriminant analysis was performed. The most important discriminating factors for prenatal complications were state anxiety and total functional social support. The factors for neonatal complications were negative life events and the interaction of emotional support with negative life events.
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Affiliation(s)
- Rachel Zachariah
- College of Nursing, Wayne State University, 5557 Cass Ave., Detroit, MI 48202, USA
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Lee E, Mitchell-Herzfeld SD, Lowenfels AA, Greene R, Dorabawila V, DuMont KA. Reducing low birth weight through home visitation: a randomized controlled trial. Am J Prev Med 2009; 36:154-60. [PMID: 19135906 DOI: 10.1016/j.amepre.2008.09.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 07/18/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Poor birth outcomes increase the risk of infant mortality and morbidity, developmental delays, and child maltreatment. This study assessed the effectiveness of a prenatal home-visitation program in reducing adverse birth outcomes among socially disadvantaged pregnant women and adolescents. DESIGN As part of a larger RCT, this study examined the effects of home-visitation services on low birth weight (LBW) deliveries. SETTING/PARTICIPANTS Pregnant women and adolescents eligible for Healthy Families New York (HFNY) were recruited in three communities. Eligibility was based on socioeconomic factors such as poverty, teen pregnancy, and the risk of child maltreatment. Two thirds of the participants were black or Hispanic, and 90% were unmarried. INTERVENTION Pregnant women and adolescents were randomized to either an intervention group that received bi-weekly home-visitation services (n=236) or to a control group (n=265). Home visitors encouraged healthy prenatal behavior, offered social support, and provided a linkage to medical and other community services. Services were tailored to individual needs. MAIN OUTCOME MEASURE An LBW of <2500 grams on birth certificate files. Baseline and birth interviews were conducted from 2000 to 2002, and birth records were collected in 2007. Analyses were done from 2007 to 2008. RESULTS The risk of delivering an LBW baby was significantly lower for the HFNY group (5.1%) than for the control group (9.8%; AOR=0.43; 95% CI=0.21, 0.89). The risk was further reduced for mothers who were exposed to HFNY at a gestational age of <or=24 weeks (AOR=0.32; 95% CI=0.14, 0.74). CONCLUSIONS A prenatal home-visitation program with focus on social support, health education, and access to services holds promise for reducing LBW deliveries among at-risk women and adolescents.
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Affiliation(s)
- Eunju Lee
- Center for Human Services Research, School of Social Welfare, University at Albany, State University of New York, New York, USA.
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Zeck W, Walcher W, Tamussino K, Lang U. Adolescent primiparas: changes in obstetrical risk between 1983-1987 and 1999-2005. J Obstet Gynaecol Res 2008; 34:195-8. [PMID: 18412781 DOI: 10.1111/j.1447-0756.2007.00688.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Teenage pregnancies have always been considered at increased risk for obstetric complications. Deliveries in adolescent primiparas in the 5-year time periods 1983-1987 and 1999-2005 were compared against each other, the general population and against primiparas aged 20-29 years in order to reveal trends and differences in obstetric outcome. METHODS A total of 186 primiparas delivering at an age of 17 or less between October 1999 and October 2005 were compared with 353 adolescent primiparas delivered between 1983 and 1987. Type of delivery and complications such as low birthweight, pre-eclampsia, breech presentation and third stage complications were studied. RESULTS The percentage of adolescents in the overall obstetric population decreased. The cesarean section rate remained the same in the adolescents while increasing in the general population. Rates of low birthweight and operative vaginal delivery increased in the adolescent group and overall. Third stage complications (abnormally adherent or incomplete placentas) decreased in both groups. There were no intrauterine fetal deaths in adolescent pregnancies in either time period. Other obstetric variables were unchanged in the adolescent as well as in the general population between 1999 and 2005. When comparing the adolescents' outcome with the outcome of the 20-29-year-old primiparas between 1999 and 2005, it was noted that the rates of abstracted obstetric variables were higher in the population of the 20-29-year-olds. CONCLUSIONS The obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. We do not consider adolescence as an obstetrical risk. We suggest that adolescent pregnancy is more a public health issue than a clinical problem.
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Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
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Das S, Dhulkotia JS, Brook J, Amu O. The impact of a dedicated antenatal clinic on the obstetric and neonatal outcomes in adolescent pregnant women. J OBSTET GYNAECOL 2007; 27:464-6. [PMID: 17701790 DOI: 10.1080/01443610701406042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This retrospective observational study was designed to study the impact of a dedicated antenatal clinic service on obstetric and neonatal outcomes among teenage mothers in the maternity unit of a district general hospital in the UK. Outcomes were measured to investigate improvement in obstetric and neonatal outcomes before, and 12 months after the establishment of dedicated clinic for teenage pregnant women. Significant improvement in the birth weight was observed p = 0.01. A modest decrease in neonatal admission to special care unit by 6% was observed. Rate of spontaneous vaginal deliveries increased p = 0.0009. There was significant uptake of contraception and continuation of breast-feeding in this group of young women (p < 0.0001).
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Affiliation(s)
- S Das
- Department of Obstetrics and Gynaecology, Royal Oldham Hospital, Greater Manchester, UK.
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Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007; 36:368-73. [PMID: 17213208 DOI: 10.1093/ije/dyl284] [Citation(s) in RCA: 494] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. METHODS We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. RESULTS All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. CONCLUSIONS Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.
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Affiliation(s)
- Xi-Kuan Chen
- OMNI Research Group, Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada
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Affiliation(s)
- Suezanne T Orr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina 27858, USA.
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Abstract
We examine the effect of a large, comprehensive maternity and infant care (MIC) program on birthweight and infant mortality in an economically depressed urban population. The study is based on linked birth, infant death and program files for 1985-87 Cleveland and East Cleveland, Ohio, birth cohorts (N = 31,415). Taking into account differences in risk factors, Black MIC infants experienced lower neonatal and endogenous mortality, but White MIC infants had higher postneonatal and exogenous mortality than their same race, non-MIC counterparts. Birthweight distributions were also more favorable for Black than White clients. We discuss the policy implications of our findings.
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Affiliation(s)
- John Holian
- Cuyahoga Community College, Cleveland, OH 44130-5199, USA.
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Bowman EK, Palley HA. Improving adolescent pregnancy outcomes and maternal health:a case study of comprehensive case managed services. ACTA ACUST UNITED AC 2004; 18:15-42. [PMID: 15189799 DOI: 10.1300/j045v18n01_02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.
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Affiliation(s)
- Elizabeth K Bowman
- Army Research Laboratories, Aberdeen Proving Grounds, Aberdeen, MD, USA.
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Abstract
PURPOSE To review evidence regarding the role of paraprofessional support in improving maternal and infant outcomes in pregnant and parenting women. Although support provided by significant others (social support), by professionals, and by paraprofessionals are frequently considered together in literature reviews, this is inappropriate because the components of the support in each case differ. DATA SOURCES Data were limited to published studies. Searches of computerized databases (CINAHL, Medline, PsychLit, Social sciences abstracts, Social sciences citation, and Social work abstracts), hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched. STUDY SELECTION The studies included had statistically significant outcomes of paraprofessional support to pregnant and parenting women. Studies were published in 1985 or later, were conducted in the United States or Canada, and included maternal and/or infant outcomes. DATA EXTRACTION Data were extracted from each study concerning the theoretical framework, design, sample, measuring instruments, interventions, and outcomes. CONCLUSIONS Programs providing paraprofessional support to childbearing women are clearly providing an important service, but empirical evidence is not adequate to determine which specific paraprofessional program works for a specific population of women to achieve the best long-term outcomes for both women and children. Although proponents of paraprofessional support programs for pregnant and parenting women have reported some successes, more data are needed. Researchers should continue to conduct well-designed and controlled studies to compare outcomes from the three types of support. Nurses in practice should build on services provided by paraprofessionals in order to meet women's need for support and to achieve desired outcomes.
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Abstract
Home visiting may be a promising strategy to improve pregnancy outcomes, and home visiting by lay workers may be more accepted by pregnant women. Lay workers may impact on social and environmental risk factors as well as on health care utilization. As with any primary prevention strategy, these programs may be more successful if implemented with responsibility shared between the health care system and the community. This article reviews the state of the science related to lay home visiting during pregnancy in the United States. Using a variety of search terms, an exhaustive review of the literature was conducted using several large electronic databases. Studies of lay home visiting during pregnancy have documented mixed results. Many weaknesses exist in the studies available, including use of descriptive or quasi-experimental designs in most of the studies, absence of a clearly specified set of interventions, and lack of cost analysis. Gaps in our knowledge of the impact of lay home visitors on pregnancy outcomes persist.
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Campbell-Heider N, Tuttle J, Bidwell-Cerone S, Richeson GT, Collins SE. The Buffering Effects of Connectedness: Teen Club Intervention for Children of Substance Abusing Families. J Addict Nurs 2003. [DOI: 10.1080/jan.14.4.175.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Logsdon MC, Birkimer JC, Ratterman A, Cahill K, Cahill N. Social support in pregnant and parenting adolescents: research, critique, and recommendations. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2002; 15:75-83. [PMID: 12083755 DOI: 10.1111/j.1744-6171.2002.tb00328.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED ISSUE AND PURPOSE: Adolescent pregnancies continue to occur at an alarming rate in the United States, resulting in adverse outcomes for both the adolescent and her baby. Since social support has been shown to improve pregnancy and parenting outcomes, a critique of research in this area is presented. SOURCES Published literature. CONCLUSIONS Multisite research studies, which are longitudinal in design, are needed, with particular attention paid to variations in the need for social support by stage of adolescence.
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Cosey EJ, Bechtel GA. Family social support and prenatal care among unmarried African American teenage primiparas. J Community Health Nurs 2001; 18:107-14. [PMID: 11407179 DOI: 10.1207/s15327655jchn1802_04] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study determined the relation of family social support and the receipt of adequate prenatal care among 25 unmarried African American teenage primiparas residing in the home. The study also investigated the strength of the family social support system compared to nonfamily support systems. Using the Personal Resource Questionnaire, Part II to measure social support, participants were provided the questionnaire 1 to 2 days after birth, but immediately prior to leaving the hospital. Results of the study determined no significant difference in social support scores among those women who received either adequate or inadequate prenatal care, although the 17- to 18-year-old age group had higher support scores than the 15- to 16-year-old age group. However, findings from the study indicated that family social support between both groups was significantly greater than nonfamily support systems. Thus, interventions by community health nurses to involve family members in all aspects of birthing and parenting can be essential in promoting positive health outcomes.
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Affiliation(s)
- E J Cosey
- Department of Nursing, Southern University, USA
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Abstract
Recent advances are beginning to shed light on the mechanisms whereby adverse psychosocial factors can influence pregnancy outcome. High levels of maternal stress have been linked to endocrine disturbances, which in turn increases the risk of preterm labor considerably. These observations have been supported by experimental animal models. Birth weight is subject to considerable ethnic variation, and on its own is a nonspecific indicator of pregnancy outcome. The benefits of social and psychological intervention have been best documented in the intrapartum situation, whereas antenatal intervention is most likely to be of benefit when focused on improving socioeconomic conditions and access to healthcare providers.
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Affiliation(s)
- R L Tambyrajia
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore.
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Matthews S, Stansfeld S, Power C. Social support at age 33: the influence of gender, employment status and social class. Soc Sci Med 1999; 49:133-42. [PMID: 10414846 DOI: 10.1016/s0277-9536(99)00122-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper investigates the conceptualisation and operationalisation of social support and it's relationship to gender, employment status and social class. Clarification of these relationships is sought in order to better understand associations between social support and health. We used data from the 33-year survey of the 1958 British birth cohort study. Individual items and subscales of practical and emotional support were examined. In general, men had lower support than women and social classes IV and V had lower support than classes I and II. Emotional support, either from personal (for example, from friends or family), or combined with organisational sources of support (such as from a church or a financial institution), showed consistent gender and social class patterns. This suggests that emotional support is a robust concept across socio-demographic groups. Less consistent trends were found for practical support, in that socio-demographic trends depended on how practical support was measured. In particular, it depended on whether both personal and organisational sources of support were examined. Gender differences in social support were large and might therefore be expected to contribute to gender differences in health, whereas social class differences in social support were modest, suggesting a minor explanatory role for this factor in accounting for inequalities in health.
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Affiliation(s)
- S Matthews
- Institute of Child Health, Department of Epidemiology and Public Health, University College London, UK.
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Affiliation(s)
- J E Hupcey
- School of Nursing, College of Health and Human Development, Pennsylvania State University, Hershey, USA
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