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Geissler KH, Jeung C, Attanasio LB. Preventive Primary Care in the Postpartum Year: The Role of Medicaid Delivery System Reform. Am J Prev Med 2024:S0749-3797(24)00083-7. [PMID: 38484901 DOI: 10.1016/j.amepre.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Preventive and primary care in the postpartum year is critical for future health and may be increased by primary care focused delivery system reform including implementation of Medicaid Accountable Care Organizations (ACO). This study examined associations of Massachusetts Medicaid ACO implementation with preventive visits in the postpartum year. METHODS The Massachusetts All-Payer Claims Database was used to identify births to privately-insured or Medicaid ACO-eligible individuals from January 1, 2016 to February 28, 2019. Comparing these groups before and after implementation, a propensity score weighted difference-in-difference design was used to analyze associations of Medicaid ACO implementation with any preventive care visit and any primary care physician (PCP) preventive visit within one year postpartum, controlling for other characteristics. Analyses were performed in 2023 and 2024. RESULTS Of the 110,601 births in the study population, 35.5% had any preventive care visit and 23.0% had any preventive PCP visit in the year postpartum, with higher rates of preventive visits among privately-insured individuals. In adjusted difference-in-difference analyses, relative to the pre-period, there was a 2.7 percentage point (pp) decrease (95% confidence interval [CI]: -4.3pp, -1.2pp) and 3.5 pp decrease (95% CI: -4.9pp, -2.0pp) in use of any preventive visits and any PCP preventive visits, respectively, for Medicaid-insured versus privately-insured individuals after ACO implementation. CONCLUSIONS Implementation of Massachusetts Medicaid ACOs was associated with decreases in receipt of preventive visits and preventive PCP visits for Medicaid-insured individuals relative to privately-insured individuals. Medicaid ACOs should consider potential implications of primary care access in the postpartum year for health across the lifecourse.
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Affiliation(s)
- Kimberley H Geissler
- Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, MA
| | - Chanup Jeung
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, Albany, NY
| | - Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA.
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Ghisi GLDM, Banks L, Cotie LM, Pakosh M, Pollock C, Nerenberg K, Gagliardi A, Smith G, Colella TJ. Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review. CJC Open 2024; 6:182-194. [PMID: 38487070 PMCID: PMC10935684 DOI: 10.1016/j.cjco.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 03/17/2024] Open
Abstract
Background Several common pregnancy conditions significantly increase a woman's risk of future cardiovascular diseases (CVD). Patient education and interventions aimed at awareness and self-management of cardiovascular risk factors may help modify future cardiovascular risk. The aim of this systematic review was to examine education interventions for cardiovascular risk after pregnancy, clinical measures/scales, and knowledge outcomes in published qualitative and quantitative studies. Methods Five databases were searched (from inception to June 2023). Studies including interventions and validated and nonvalidated measures of awareness/knowledge of future cardiovascular risk among women after complications of pregnancy were considered. Quality was rated using the Mixed Methods Appraisal Tool. Results were analyzed using the Synthesis Without Meta-analysis reporting guideline. Characteristics of interventions were reported using the Template for Intervention Description and Replication. Fifteen studies were included; 3 were randomized controlled trials. Results In total, 1623 women had a recent or past diagnosis of hypertensive disorders of pregnancy, gestational diabetes mellitus, and/or premature birth. Of the 7 studies that used online surveys or questionnaires, 2 reported assessing psychometric properties of tools. Four studies used diverse educational interventions (pamphlets, information sheets, in-person group sessions, and an online platform with health coaching). Overall, women had a low level of knowledge about their future CVD risk. Interventions were effective in increasing this knowledge. Conclusions In conclusion, women have a low level of knowledge of risk of CVD after pregnancy complications. To increase this level of knowledge and self-management, this population has a strong need for psychometrically validated tailored education interventions.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Lisa M. Cotie
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, KITE, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Courtney Pollock
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna Gagliardi
- Toronto General Hospital Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Tracey J.F. Colella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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Srialluri N, Surapaneni A, Chang A, Mackeen AD, Paglia MJ, Grams ME. Preeclampsia and Long-term Kidney Outcomes: An Observational Cohort Study. Am J Kidney Dis 2023; 82:698-705. [PMID: 37516302 PMCID: PMC10818021 DOI: 10.1053/j.ajkd.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/04/2023] [Accepted: 04/22/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Preeclampsia is a pregnancy-related complication characterized by acute hypertension and end-organ dysfunction. We evaluated the long-term association between preeclampsia and the risk of developing chronic hypertension and kidney disease. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 27,800 adults with deliveries in the Geisinger Health System between 1996 and 2019. EXPOSURE Preeclampsia. OUTCOME Hypertension, reduced estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2), and albuminuria>300mg/g. ANALYTICAL APPROACH Propensity-score matching and Cox proportional hazards models to evaluate the association between preeclampsia and incident hypertension, reduced eGFR, and albuminuria. RESULTS Of 27,800 adults with pregnancies during the study period (mean age, 28 years; 3% Black race), 2,977 (10.7%) had at least 1 pregnancy complicated by preeclampsia. After matching for multiple characteristics, individuals with preeclampsia had a higher risk of developing chronic hypertension (HR, 1.77 [95% CI, 1.45-2.16]), eGFR<60mL/min/1.73m2 (HR, 3.23 [95% CI, 1.64-6.36]), albuminuria (HR, 3.60 [95% CI, 2.38-5.44]), and a subsequent episode of preeclampsia (HR, 24.76 [95% CI, 12.47-48.36]), compared with matched controls without preeclampsia. Overall, postpartum follow-up testing was low. In the first 6 months after delivery, 31% versus 14% of individuals with and without preeclampsia had serum creatinine tests, respectively, and testing for urine protein was the same in both groups, with only 26% having follow-up testing. LIMITATIONS Primarily White study population, observational study, reliance on ICD codes for medical diagnosis. CONCLUSIONS Individuals with a pregnancy complicated by preeclampsia had a higher risk of hypertension, reduced eGFR, and albuminuria compared with individuals without preeclampsia. PLAIN-LANGUAGE SUMMARY Preeclampsia is a significant contributor to perinatal and maternal morbidity and is marked by new-onset hypertension and end-organ damage, including acute kidney injury or proteinuria. To gain insight into the long-term kidney effects of the disease, we compared adults with deliveries complicated by preeclampsia with those without preeclampsia in the Geisinger Health System, while also assessing postpartum testing rates. Our results demonstrate that pregnant individuals with preeclampsia are at a heightened risk for future hypertension, reduced eGFR, and albuminuria, with overall low rates of postpartum testing among both individuals with and without preeclampsia. These findings underscore the need to consider preeclampsia as an important risk factor for the development of chronic kidney disease. Further studies are required to determine optimal postpreeclampsia monitoring strategies.
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Affiliation(s)
- Nityasree Srialluri
- Division of Nephrology, Department of Medicine, Johns Hopkins University Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Baltimore, Maryland.
| | - Aditya Surapaneni
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland; Division of Precision Medicine, Department of Medicine, New York University, New York, New York
| | - Alexander Chang
- Kidney Health Research Institute, Danville, Pennsylvania; Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - A Dhanya Mackeen
- Division of Maternal-Fetal Medicine, Women's Health Service Line, Danville, Pennsylvania
| | - Michael J Paglia
- Division of Maternal-Fetal Medicine, Women's Health Service Line, Danville, Pennsylvania
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland; Division of Precision Medicine, Department of Medicine, New York University, New York, New York
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Mpalatsouka I, Zachariou M, Kyprianidou M, Fakonti G, Giannakou K. Assessing awareness of long-term health risks among women with a history of preeclampsia: a cross-sectional study. Front Med (Lausanne) 2023; 10:1236314. [PMID: 38020133 PMCID: PMC10662303 DOI: 10.3389/fmed.2023.1236314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Pregnancy complications, such as hypertensive disorders, present a substantial global public health challenge, with significant long-term implications for maternal and offspring health. This cross-sectional study aims to determine the level of awareness regarding long-term health risks among women who experienced preeclampsia during pregnancy in Cyprus and Greece. The study participants included adult women with a history of preeclampsia, while women with normal pregnancies were used as the comparison group. Data collection took place between June 2021 and February 2022, utilizing an online, self-administered questionnaire. The study included 355 women, with 139 (39.2%) in the preeclampsia group and 216 (60.8%) in the comparison group. Findings revealed that more than half of the women with prior preeclampsia (55.4%) were not aware of hypertensive disorders that can occur during pregnancy before their diagnosis, and a similar percentage (45.2%) had not received information about the long-term health risks following their diagnosis. Remarkably, only 3 participants (4.7%) with a history of preeclampsia were aware of the risk of developing cardiovascular diseases. There were no statistically significant differences between the preeclampsia and the comparison group regarding their concerns about long-term health risks, frequency of health checks, perceptions of factors influencing cardiovascular disease development, and doctor communication about different health topics, except from hypertension or high blood pressure. The study underscores the low level of awareness of long-term health risks among women with prior preeclampsia in Cyprus and Greece. This emphasizes the importance of implementing public health programs aimed at promoting cardiovascular risk assessment and effective management, both for clinicians and women with have experienced preeclampsia.
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Affiliation(s)
| | | | | | | | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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Adamu AN, Callahan KL, Anderson PB. Awareness of Preeclampsia among Antenatal Clinic Attendees in Northwestern Nigeria. Avicenna J Med 2023; 13:111-116. [PMID: 37483992 PMCID: PMC10361257 DOI: 10.1055/s-0043-1770700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background Preeclampsia (PE) is among the five main causes of maternal mortality in low resource countries. This study was designed to assess PE awareness and its socioeconomic determinants among antenatal clinic attendees in northwestern Nigeria. Methods Two hundred twenty-one antenatal clinic attendees in northwestern Nigeria were selected through systematic random sampling for this quantitative study. Women who were 9 months pregnant and had consented to participate were included; those with chronic illnesses such as diabetes mellitus were excluded. Data on respondents' sociodemographic variables, and PE awareness were collected using a validated questionnaire. Associations between variables were tested using chi-square test and multiple regression analysis. Results Ninety-one percent of respondents were aged 20 to 40 years, 53.9% were multiparous, 27% had no or low level of formal education, and 52% had attended antenatal care (ANC) at least four times in the index pregnancy. Only 37% ( N = 83) were aware of PE. Women with formal education were 3.8 times more likely (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.4-10.3) to be aware of PE compared with those with no formal education ( p < 0.05). Also, women who experienced hypertension in their previous pregnancies were 2.8 times more likely (OR = 2.8, 95% CI = 1.37-5.71) to be aware of PE than those women who had not ( p < 0.05). Conclusion There was a low level of PE awareness among pregnant women in this study; being formally educated and having had hypertension in a previous pregnancy were positively associated with PE awareness. PE education should be part of ANC.
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Affiliation(s)
- Aisha N. Adamu
- Department of Obstetrics and Gynecology, Federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria
| | - Katie L. Callahan
- Department of Community Health Education and Recreation, University of Maine at Farmington, Farmington, Maine, United States
| | - Peter B. Anderson
- Contributing Faculty and College of Health Professions, Walden University, Minneapolis, Minnesota, United States
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Kassab M, Sabrah EF, Smadi A, Rayan A, Baqeas MH, R. AlOsta M, Othman EH, Hamadneh S. Cardiovascular Disease Risk Factors Awareness among Women with a History of Preeclampsia in Jordan. SAGE Open Nurs 2023; 9:23779608231207223. [PMID: 37954913 PMCID: PMC10638867 DOI: 10.1177/23779608231207223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/11/2023] [Accepted: 09/23/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Preeclampsia is a pregnancy-specific hypertensive disease that affects 3-5% of pregnant women all over the world and 1.3% of pregnancies among Jordanian women. Objectives This study aims to assess the cardiovascular disease risk factors awareness among women with a recent history of preeclampsia in Jordan and assess the role of healthcare providers in providing counseling about cardiovascular disease risk factors. Methods A descriptive cross-sectional design was used to recruit 180 women with a recent history of preeclampsia during the last 12 months. Data were obtained from patients' medical records and the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaires. Results The results revealed that 43.9% of women with a recent history of preeclampsia have hypertension, 6.7% have diabetes mellitus, 16.1% have dyslipidemia, 28.9% have a family history of cardiovascular disease, 66.1% are overweight or obese, and 7.2% are smokers. The mean total score of knowledge subscale was 5.5 (SD = 1.21) out of 8. Only 20% of the participants had good cardiovascular disease knowledge. The mean total score of risk perception was 15.47 (SD = 7.8). The mean score of perceived benefits and intention to change behaviors was 2.30 (SD = 0.62). The mean score of healthy eating intentions was 2.54 (SD = 0.81). Income, having diabetes mellitus, and receiving counseling about preeclampsia as cardiovascular disease risk factor were associated with some dimensions of cardiovascular disease risk factors awareness. Conclusion The prevalence of cardiovascular disease risk factors was relatively high among the study participants. The majority of participants had inadequate cardiovascular disease knowledge. In addition, the role of healthcare providers in providing counseling about cardiovascular disease and related risk factors, including PE was limited. Providing more counseling related to cardiovascular disease by nurses and doctors is essential to enhance women's cardiovascular disease knowledge and intention to change lifestyle.
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Affiliation(s)
- Manal Kassab
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Evan Fadel Sabrah
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Smadi
- Department of Adult Health care, Princess Salma Faculty of Nursing, Al al-BaytUniversity, Mafraq, Mafraq, Jordan
| | - Ahmad Rayan
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Manal Hassan Baqeas
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | | | - Elham H. Othman
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Shereen Hamadneh
- Department of Maternal and Child Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Nielsen LM, Hauge MG, Ersbøll AS, Johansen M, Linde JJ, Damm P, Nielsen KK. Women’s perceptions of cardiovascular risk after preeclampsia: a qualitative study. BMC Pregnancy Childbirth 2022; 22:832. [DOI: 10.1186/s12884-022-05179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Preeclampsia is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous preeclampsia are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks. We examined the experiences and perceptions of preeclampsia and the increased risk of cardiovascular disease (CVD) later in life among Danish women with previous preeclampsia and their attitudes towards CVD risk screening.
Methods
Ten individual semi-structured interviews were conducted with women with previous preeclampsia. Data were analysed using thematic analysis.
Results
We identified six themes: 1) Experiences and perceptions of being diagnosed with preeclampsia, 2) Awareness about increased risk of CVD later in life, 3) Knowledge as a precondition for action, 4) The perception of CVD risk as being modifiable, 5) Motivators for and barriers to a healthy lifestyle, and 6) Screening for CVD. Awareness of the severity of preeclampsia was limited prior to being diagnosed. Particularly among those with few or no symptoms, preeclampsia was perceived as a non-severe condition, which was further reinforced by the experience of having received very little information. Nonetheless, some women were shocked by the diagnosis and feared for the health of the offspring. Many women also experienced physical and psychological consequences of preeclampsia. Awareness of the increased risk of later CVD was lacking; yet, when informed, the women considered this to be essential knowledge to be able to act accordingly. The risk of future CVD was perceived to be partly modifiable with a healthy lifestyle, and the women expressed a need for counselling on appropriate lifestyle changes to reduce CVD risk. Other factors were also mentioned as imperative for lifestyle changes, including social support. The women were generally positive towards potential future screening for CVD because it could provide them with information about their health condition.
Conclusions
After preeclampsia, women experienced a lack of knowledge on preeclampsia and the increased risk of CVD later in life. Improved information and follow-up after preeclampsia, including guidance on CVD risk reduction and support from health professionals and family, are warranted.
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Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion. BMC Womens Health 2022; 22:427. [PMID: 36309668 PMCID: PMC9618195 DOI: 10.1186/s12905-022-02004-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. METHODS Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women's needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. RESULTS Women's primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. CONCLUSION Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.
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Adeosun F, Folayan O, Ojo T. Choosing cesarean section over natural birth: Challenges of decision making among pregnant women with pre-eclampsia in Ado-Ekiti. Pregnancy Hypertens 2022; 30:97-102. [PMID: 36130417 DOI: 10.1016/j.preghy.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although Caesarean section has greatly improved obstetric care throughout the world, there is a great aversion to caesarean section in developing countries. This study was carried out to examine the rate at which pregnant women with Pre-eclampsia decide to choose caesarean section over natural birth. STUDY DESIGN A descriptive study was conducted among a sample of 112 pregnant women with Pre-eclampsia, aged 18-40 years, whose gestation period has exceeded 20 weeks and are registered in the hospitals. The sample selection was purposive. MAIN OUTCOME MEASURES Data collection was done through self-administered structured questionnaire. Data analysis was presented using simple percentages. RESULTS 94% of respondents had no prior information about Pre-eclampsia and its associated complications. Pre-eclampsia has a prevalence rate of 12.3% among respondents in Ado-Ekiti as at the time this study was conducted. 38% of respondent favored caesarean section because they believed it is safer, less painful with little or no complications. If caesarean section is given as an only medical option for safe childbirth to respondents who preferred natural birth, 46.4% would opt for religious interventions while 10.7% would opt for traditional healthcare. CONCLUSIONS Respondents who preferred natural birth would not choose caesarean section because of fear, cultural belief, religious beliefs and the cost. Level of education, religion and employment status were found to influence respondents' decision to choose. Hence the need to encourage research in awareness creation, patient education and best ways to assist patients decide on mode of delivery and plan on how to finance treatment.
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Affiliation(s)
- Foluke Adeosun
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria.
| | - OpeOluwa Folayan
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria
| | - Tolulope Ojo
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria
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Beussink-Nelson L, Baldridge AS, Hibler E, Bello NA, Epps K, Cameron KA, Lloyd-Jones DM, Gooding HC, Catov JM, Rich-Edwards JW, Yee LM, Toledo P, Banayan JM, Khan SS. Knowledge and perception of cardiovascular disease risk in women of reproductive age. Am J Prev Cardiol 2022; 11:100364. [PMID: 35866048 PMCID: PMC9294042 DOI: 10.1016/j.ajpc.2022.100364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in American women, but general knowledge and perception of risk in this population remains poor. In this cross-sectional study of young women, significant gaps in knowledge and perception of CVD risk in individuals who have experienced an APO were identified along with general knowledge deficits related to pregnancy-related risk factors and CVD risk in young women. These findings provide primary data to support the need for development and delivery of educational content on CVD risk to young women, particularly during the peripartum period.
Objective Women who experience adverse pregnancy outcomes (APO) are at increased risk for cardiovascular disease (CVD); however, their knowledge of CVD risk is not well characterized. We aimed to evaluate knowledge and perception of CVD risk in young women and to determine whether these factors differ based on experience of an APO. Methods We conducted a cross-sectional study among women with a recent live birth at an urban medical center. Knowledge and perception of CVD risk were assessed through a self-administered online survey adapted from the American Heart Association Survey of Women's CVD Awareness. Results Of 5612 individuals contacted between 3/1/21 and 4/18/21, 714 completed the survey; the mean (SD) age was 34 (4) years and 25% reported an APO. While 62% of respondents identified CVD as the leading cause of death in women, there was no significant difference in CVD knowledge scores between participants who reported experiencing an APO and those who did not (6.9 vs 6.8 out of 10; p = 0.51). Participants who reported experiencing an APO had higher perception of personal risk for CVD (adjusted odds ratio, 2.64 [95% CI 1.83-3.80]) compared with participants who did not. Half of participants who experienced an APO reported perceiving average, or below average, risk for CVD and only 41 (22.5%) reported speaking with a healthcare professional about CVD within the past year. Conclusions Gaps remain in knowledge of CVD risk among young women, particularly after an APO. The peripartum period may represent a unique opportunity for targeted education when healthcare engagement is high.
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Rossiter C, Henry A, Roberts L, Brown MA, Gow M, Arnott C, Salisbury J, Ruhotas A, Hehir A, Denney-Wilson E. Optimising mothers' health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention. BMC Public Health 2022; 22:1259. [PMID: 35761317 PMCID: PMC9235190 DOI: 10.1186/s12889-022-13590-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder. Methods Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention’s effect on their capacity and motivation to pursue healthy lifestyles. Results Thirty-four women from all three trial arms participated at 10–12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention. Conclusions Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood. Trial registration The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13590-2.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Amanda Henry
- Discipline of Women's Health, Faculty of Medicine and Health, The University of New South Wales, Kensington, NSW, 1466, Australia. .,Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.
| | - Lynne Roberts
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.,St George and Sutherland Clinical School, The University of New South Wales, St George Hospital, Kogarah, NSW, 2217, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital and the University of NSW, Sydney, Australia
| | - Megan Gow
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, 2145, Australia
| | - Clare Arnott
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Justine Salisbury
- NSW Ministry of Health, 1 Reserve Road, St Leonards, NSW, 2065, Australia
| | - Annette Ruhotas
- Consumer and Community Involvement Representative, Sydney, Australia
| | - Angela Hehir
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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12
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Gholami K, Norouzkhani N, Kargar M, Ghasemirad H, Ashtiani AJ, Kiani S, Sajedi Far M, Dianati M, Salimi Y, Khalaji A, Honari S, Deravi N. Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review. Front Cardiovasc Med 2022; 9:886679. [PMID: 35795374 PMCID: PMC9252511 DOI: 10.3389/fcvm.2022.886679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP), including chronic hypertension, preeclampsia and gestational hypertension, is the cause of about 50,000 deaths out of 400,000 perinatal deaths. HDP is an effective risk factor in stroke, type 2 diabetes, and cardiovascular diseases like ischemic heart disease. There is a significant relation between HDP, lifestyle, and knowledge. Unfortunately, many studies showed that pregnant women have lack of knowledge about HDP. Therefore, the importance of educational interventions is, today, more acknowledged than before. Aim The goal of this systematic review was to investigate the effect of interventional educations on the knowledge of pregnant women about HDP. Methods A systematic review of the related articles was conducted. We included English randomized controlled trials published up to December 2021, including pregnant women as population, HDP as the outcome, and educational interventions as the intervention. Results After the process of study selection, six articles containing 819 pregnant women were included in this study. Educational pamphlets, mobile-based application, a mixture of pamphlets, pictographic magnet and videos, and a combination of PowerPoint and data show projectors and conversation were the educational interventions in these studies. Conclusions The positive effects of educational interventions on the knowledge of women with HTP were observed in all studies. The higher knowledge leads to HDP-related complications. Systematic Review Registration https://archive.org/details/osf-registrations-gcs5r-v1, identifier: doi: 10.17605/OSF.IO/GCS5R.
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Affiliation(s)
- Kosar Gholami
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Meraj Kargar
- Student Research Committee, Afzalipour Faculty of Medicine Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Ghasemirad
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Shamim Kiani
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Maryam Dianati
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Yasaman Salimi
- Student Research Committee, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sara Honari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Students Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Roth H, Morcos V, Roberts LM, Hanley L, Homer CSE, Henry A. Preferences of Australian healthcare providers regarding education on long-term health after hypertensive disorders of pregnancy: a qualitative study. BMJ Open 2022; 12:e055674. [PMID: 35618327 PMCID: PMC9137339 DOI: 10.1136/bmjopen-2021-055674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore Australian healthcare providers' (HCPs') preferred content, format and access to education regarding long-term health after hypertensive disorder of pregnancy (HDP), in order to guide the development of education programmes. DESIGN AND SETTING A qualitative study using a framework analysis was undertaken. Registered HCP who were practising in Australia and previously completed a survey about long-term health after HDP were invited to participate. PARTICIPANTS Twenty HCP were interviewed, including midwives, specialist obstetrician/gynaecologists, general practitioners with a diploma in obstetrics and gynaecology, and cardiologists. PRIMARY AND SECONDARY OUTCOME MEASURES Exploration of preferred content, format and distribution of educational material post-HDP. RESULTS Twenty HCP were interviewed in April to May 2020. Four main categories were identified. 'Obtaining evidence-based information for own learning' addressing own learning with preference for multi-disciplinary education, preferably endorsed or facilitated by professional organisations. 'Optimising the referral process from hospital to community health services' was about the need for structured long-term follow-up to transition from hospital to community health and align with HDP guidelines. 'Facilitating women's health literacy' addressed the need for evidence-based, print or web-based material to assist risk discussions with women. 'Seizing educational opportunities' addressed the responsibility of all HCP to identify education opportunities to initiate key health discussions with women. CONCLUSIONS HCP provided ideas on content, format and access of education regarding long-term health post-HDP within the parameters of the Australian healthcare context. This evidence will guide educational developments for HCP on post-HDP health to ensure they can better care for women and families.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Morcos
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Lisa Hanley
- Maternity Consumer, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Amanda Henry
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's Health, The George Institute for Global Health, Newtown, New South Wales, Australia
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Perceived determinants of physical activity among women with prior severe preeclampsia: a qualitative assessment. BMC Womens Health 2022; 22:133. [PMID: 35477462 PMCID: PMC9043879 DOI: 10.1186/s12905-022-01692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study was to (1) qualitatively identify the perceived determinants of physical activity among women who have experienced severe preeclampsia, and (2) examine whether these determinants are consistent with the overarching processes outlined in the integrated behavior change (IBC) model, a novel model that describes physical activity as being a result of motivational, volitional, and automatic processes.
Methods Patients (n = 35) of the Follow-Up PreEClampsia (FUPEC) Outpatient Clinic, Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were their perceived determinants of physical activity. Responses were analyzed using thematic analysis.
Results Thirteen themes emerged from the analysis. Six themes corresponded with motivational processes (future health, perceived ability, attitude, future reward or regret, physical appearance, and doing it for others), two with volitional processes (scheduling and planning), and two with automatic processes (affect and stress). Three themes were classified as environmental factors (time constraint, social support, and physical environment). Conclusions A range of facilitating and hindering factors were described by women with prior severe preeclampsia as the determinants of their physical activity. These factors corresponded well with the overarching motivational, volitional, and automatic processes described in the IBC model. In addition, motivational and environmental factors beyond the IBC model were described. Addressing these perceived determinants could enhance the efficacy of physical activity interventions in this population. Tweetable abstract: Motivational, volitional, automatic, and environmental factors drive physical activity in women with prior severe preeclampsia. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01692-3.
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Sakurai S, Shishido E, Horiuchi S. Experiences of women with hypertensive disorders of pregnancy: a scoping review. BMC Pregnancy Childbirth 2022; 22:146. [PMID: 35193516 PMCID: PMC8864783 DOI: 10.1186/s12884-022-04463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/08/2022] [Indexed: 12/25/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women’s health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions. Aims To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers. Methods A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist was used as a guide for the qualitative analysis. Content analysis and synthesis of findings were conducted using Nvivo12. Results Of the 1971 articles identified through database searching, 16 articles met the inclusion criteria. After data extraction, content analysis yielded six categories: ‘Life-threatening disorder’, ‘Coping with HDP’, ‘Concerns for baby and challenges of motherhood’, ‘Fear of recurrence and health problems’, ‘Necessity of social and spiritual support’, and ‘Positive and negative experiences in the healthcare context’. Women faced complex difficulties from the long treatment process while transitioning to motherhood. Conclusion Our findings revealed the perceptions and understanding of women regarding HDP as a life-threatening disorder to both mothers and their babies which mothers need to cope with. Recovery of physical condition and the long-term psychological effects of HDP on women should be given attention by mothers and HCP to reduce future health risks. Importantly, a lifelong follow-up system is recommended for women with HDP. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04463-y.
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Affiliation(s)
- Sachiko Sakurai
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan.
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan
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16
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Bovee EM, Gulati M, Maas AH. Novel Cardiovascular Biomarkers Associated with Increased Cardiovascular Risk in Women With Prior Preeclampsia/HELLP Syndrome: A Narrative Review. Eur Cardiol 2021; 16:e36. [PMID: 34721670 PMCID: PMC8546910 DOI: 10.15420/ecr.2021.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
Evidence has shown that women with a history of preeclampsia or haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome have an increased risk of cardiovascular disease later in life. Recommendations for screening, prevention and management after such pregnancies are not yet defined. The identification of promising non-traditional cardiovascular biomarkers might be useful to predict which women are at greatest risk. Many studies are inconsistent and an overview of the most promising biomarkers is currently lacking. This narrative review provides an update of the current literature on circulating cardiovascular biomarkers that may be associated with an increased cardiovascular disease risk in women after previous preeclampsia/HELLP syndrome. Fifty-six studies on 53 biomarkers were included. From the summary of evidence, soluble fms-like tyrosine kinase-1, placental growth factor, interleukin (IL)-6, IL-6/IL-10 ratio, high-sensitivity cardiac troponin I, activin A, soluble human leukocyte antigen G, pregnancy-associated plasma protein A and norepinephrine show potential and are interesting candidate biomarkers to further explore. These biomarkers might be potentially eligible for cardiovascular risk stratification after preeclampsia/HELLP syndrome and may contribute to the development of adequate strategies for prevention of hypertension and adverse events in this population.
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Affiliation(s)
| | | | - Angela Hem Maas
- Department of Cardiology, Radboud University Medical Center Nijmegen, the Netherlands
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17
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Roth H, Henry A, Roberts L, Hanley L, Homer CSE. Exploring education preferences of Australian women regarding long-term health after hypertensive disorders of pregnancy: a qualitative perspective. BMC Womens Health 2021; 21:384. [PMID: 34724948 PMCID: PMC8561910 DOI: 10.1186/s12905-021-01524-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnant women. Long-term health issues for these women include 2-3 times the risk of heart attacks, stroke and diabetes, starting within 10 years after pregnancy, making long-term health after HDP of major public health importance. Recent studies suggest this knowledge is not being transferred sufficiently to women and how best to transmit this information is not known. This study explored women's preferred content, format and access to education regarding long-term health after HDP. METHODS This was a qualitative study and framework analysis was undertaken. Women with a history of HDP who had participated in a survey on long-term health after HDP were invited to participate in this study. During telephone interviews women were asked about preferences and priorities concerning knowledge acquisition around long-term health after HDP. RESULTS Thirteen women were interviewed. They indicated that they wanted more detailed information about long-term and modifiable risk factors. Their preference was to receive risk counselling from their healthcare provider (HCP) early after giving birth along with evidence-based, print or web-based information to take home. All women suggested more structured postnatal follow-up, with automated reminders for key appointments. Automated reminders should detail rationale for follow-up, recommended tests and discussion topics to be addressed at the appointment. CONCLUSION Our findings show that most participants wanted information soon after birth with all women wanting information within 12 months post birth, complemented with detailed take-home evidence. Participants indicated preference for structured follow-up via their HCP with automated alerts about the appointment and recommended tests. This evidence can be used to guide the development of education programs for women on health after HDP which may enhance knowledge, preventive health management and more generally improve women's health trajectories.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- Department Women's and Children's Health, St George Hospital, Kogarah, Sydney, NSW, 2217, Australia
| | - Lynne Roberts
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- Department Women's and Children's Health, St George Hospital, Kogarah, Sydney, NSW, 2217, Australia
| | | | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Burnet Institute, Maternal, Child and Adolescent Health, Melbourne, VIC, Australia
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18
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Ruderman RS, Dahl EC, Williams BR, Davis K, Feinglass JM, Grobman WA, Kominiarek MA, Yee LM. Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals. ACTA ACUST UNITED AC 2021; 2:254-262. [PMID: 34318295 PMCID: PMC8310741 DOI: 10.1089/whr.2021.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Background: Recent paradigm shifts in postpartum care have conceptualized the “fourth trimester” as a critical transitional period requiring tailored, ongoing health care. However, this concept presents challenges for providers, especially in low-resource settings. Our objective was to understand providers' perspectives on challenges in postpartum care to highlight strategies for optimizing care. Methods: Focus groups were conducted using a semistructured interview guide to elicit perspectives on barriers and facilitators to postpartum care. Participants included physicians, nurses, and social workers who care for low-income postpartum individuals. Interviews explored the provider experience of postpartum care, with a focus on barriers experienced by patients and providers, and tools for maintaining engagement. Analysis was performed using the constant comparative method and framed by the Social Ecological Model. Results: Participants (N = 26) all acknowledged the importance of the “fourth trimester” but identified multiple barriers to providing optimal postpartum care. Challenges providers perceived for patients and those they perceived for themselves often overlapped, including difficulty with appointment scheduling, insurance limitations, lack of provider continuity, and knowledge gaps. Providers identified ease of referrals to specialists, access to tangible services (e.g., contraception), and enhanced care coordination (e.g., patient navigation) as potential facilitators of improved postpartum care. Conclusions: Obstetric providers recognize the importance of postpartum care yet highlighted significant systems- and patient-based barriers to achieving optimal care. The development and implementation of postpartum care delivery system redesign, such as the use of patient navigators to improve health care utilization and resource attainment, may enhance care during this critical time. Clinical Trial No.: NCT03922334.
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Affiliation(s)
- Rachel S Ruderman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma C Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney R Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe M Feinglass
- Division of General Internal Medicine and Geriatrics, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Seely EW, Celi AC, Chausmer J, Graves C, Kilpatrick S, Nicklas JM, Rosser ML, Rexrode KM, Stuart JJ, Tsigas E, Voelker J, Zelop C, Rich-Edwards JW. Cardiovascular Health After Preeclampsia: Patient and Provider Perspective. J Womens Health (Larchmt) 2021; 30:305-313. [PMID: 32986503 PMCID: PMC8020553 DOI: 10.1089/jwh.2020.8384] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. Methods: The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for risk reduction; and 4) next steps. Stakeholders included the Preeclampsia Foundation, patients, clinicians who had initiated CVD risk reduction programs for women with prior preeclampsia, researchers, and national task force members. Results: Participants agreed there is insufficient awareness and action to prevent CVD after preeclampsia. Patients suggested a clinician checklist to ensure communication of CVD risks, enhanced training for clinicians on the link between preeclampsia and CVD, and a post-delivery appointment with a clinician knowledgeable about this link. Clinical programs primarily served patients in the first postpartum year, bridging obstetrical and primary care. They recommended CVD risk modification with periodic blood pressure, weight, lipid and diabetes screening. Barriers included the paucity of programs designed for this population and gaps in insurance coverage after delivery. The American Heart Association, the American College of Obstetricians and Gynecologists, and the Preeclampsia Foundation have developed guidelines and materials for patients and providers to guide management of women with prior preeclampsia. Conclusions: Integrated efforts of patients, caregivers, researchers, and national organizations are needed to improve CVD prevention after preeclampsia. This meeting's recommendations can serve as a resource and catalyst for this effort.
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Affiliation(s)
- Ellen W. Seely
- Division of Endocrinology, Hypertension & Diabetes, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C. Celi
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaimie Chausmer
- Maternal Heart Health Clinic, Northside Hospital, Atlanta, Georgia, USA
| | - Cornelia Graves
- Collaborative Perinatal Cardiac Center, St. Thomas Health, Nashville, Tennessee, USA
| | - Sarah Kilpatrick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacinda M. Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary L. Rosser
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Kathryn M. Rexrode
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Stuart
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eleni Tsigas
- The Preeclampsia Foundation, Melbourne, Florida, USA
| | | | - Carolyn Zelop
- The Valley Hospital, Ridgewood, New Jersey, USA
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Janet W. Rich-Edwards
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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20
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Roth H, Homer CSE, LeMarquand G, Roberts LM, Hanley LI, Brown M, Henry A. Assessing Australian women's knowledge and knowledge preferences about long-term health after hypertensive disorders of pregnancy: a survey study. BMJ Open 2020; 10:e042920. [PMID: 33334841 PMCID: PMC7747529 DOI: 10.1136/bmjopen-2020-042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/02/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To (1) assess women's current knowledge regarding long-term cardiovascular health after hypertensive disorders of pregnancy (2) elicit women's preferred educational content and format regarding health after hypertensive disorders of pregnancy. DESIGN AND SETTING A custom-created online survey exploring Australian women's knowledge about long-term health after hypertensive disorders of pregnancy, distributed through consumer groups and social media. PARTICIPANTS 266 women with (n=174) or without (n=92) a history of hypertensive disorders of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Proportion of women identifying long-term health risks after hypertensive disorder of pregnancy using a 10-point risk knowledge score with 0-4 'low', 4.1-7.0 'moderate' and 7.1-10 'high'. (2) Exploration of preferred content, format and distribution of educational material post hypertensive disorder of pregnancy. RESULTS Knowledge scores about health after hypertensive disorder of pregnancy were moderate in groups with and without a history of the disorder. Knowledge was highest regarding risk of recurrent hypertensive disorders in a subsequent pregnancy, 'moderate' for chronic hypertension and heart attack, 'moderate' and 'low' regarding risk of heart disease and 'low' for diabetes and renal disease. Only 36% of all participants were aware that risks start within 10 years after the affected pregnancy. The majority of respondents with a history of hypertensive disorder of pregnancy (76%) preferred receiving information about long-term health 0-6 months post partum from a healthcare provider (80%), key organisations (60%), social media (47%) and brochures/flyers (43%). CONCLUSIONS Women's knowledge regarding health risks after hypertensive disorder of pregnancy was 'moderate', although with important disease-specific gaps such as increased risk of diabetes. Most women wanted to be informed about their long-term health from a healthcare provider.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Grace LeMarquand
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Sydney, New South Wales, Australia
| | - LIsa Hanley
- Maternity Consumer, Saint George Hospital, Sydney, New South Wales, Australia
| | - Mark Brown
- Renal Medicine, Saint George Hospital, Sydney, New South Wales, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Sydney, New South Wales, Australia
- The George Institute, Sydney, New South Wales, Australia
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Lewey J, Levine LD, Yang L, Triebwasser JE, Groeneveld PW. Patterns of Postpartum Ambulatory Care Follow-up Care Among Women With Hypertensive Disorders of Pregnancy. J Am Heart Assoc 2020; 9:e016357. [PMID: 32851901 PMCID: PMC7660757 DOI: 10.1161/jaha.120.016357] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow‐up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. Methods and Results We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits (P<0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6‐month follow‐up with any continuity provider compared with 47% of women without hypertension (P<0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow‐up (adjusted odds ratio, 1.16; 95% CI, 1.2–1.21). Factors associated with a lower likelihood of any follow‐up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Conclusions Rates of continuity care follow‐up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Lisa D Levine
- Department of Obstetrics & Gynecology Maternal and Child Health Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Lin Yang
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Jourdan E Triebwasser
- Department of Obstetrics & Gynecology Maternal and Child Health Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA
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22
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Dijkhuis TE, Bloem F, Kusters LAJ, Roos SM, Gordijn SJ, Holvast F, Prins JR. Investigating the current knowledge and needs concerning a follow-up for long-term cardiovascular risks in Dutch women with a preeclampsia history: a qualitative study. BMC Pregnancy Childbirth 2020; 20:486. [PMID: 32831032 PMCID: PMC7444252 DOI: 10.1186/s12884-020-03179-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing evidence that a history of preeclampsia is an important risk factor for future cardiovascular events. Awareness of this risk could provide opportunities for identification of women at risk, with opportunities for prevention and / or early intervention. A standardized follow-up has not yet been implemented in the north of the Netherlands. The objective of this qualitative study was to explore the opinions and wishes among women and physicians about the follow-up for women with a history of preeclampsia. METHODS Semi-structured interviews with 15 women and 14 physicians (5 obstetricians, 4 general practitioners, 3 vascular medicine specialists and 2 cardiologists) were performed and addressed topics about knowledge on CVR, current - and future follow-up. Women were approached through the HELLP foundation and their physicians. Physicians were approached by email. The interviews were recorded, typed and coded using ATLAS.ti software. A theoretical-driven thematic analysis was performed. RESULTS Women had some knowledge about the association between preeclampsia and the increased CVR, but missed information from their health care providers. Specialists were aware of the association, but the information and advice they provided to their patients was minimal and inconsistent according to themselves. Whereas some general practitioners regarded their own knowledge as limited. There was a clear desire among women for a more extensive follow-up with specific attention to both emotional and physical consequences of preeclampsia. Physicians indicated that they preferred to see a follow up program concerning the CVR at the general practitioner as part of the already existent cardiovascular risk management (CVRM) program. CONCLUSION Women and medical specialists consider it important to improve aftercare for women after a pregnancy complicated by preeclampsia. Introducing these women into the CVRM program at the general practitioner is regarded as a preferred first step. Further research is warranted to establish an evidence-based guideline for the follow-up of these women.
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Affiliation(s)
- Tessa E Dijkhuis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Femke Bloem
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lise A J Kusters
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sofie M Roos
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Floor Holvast
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelmer R Prins
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
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23
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Monk C, Webster RS, McNeil RB, Parker CB, Catov JM, Greenland P, Bairey-Merz CN, Silver RM, Simhan HN, Ehrenthal DB, Chung JH, Haas DM, Mercer BM, Parry S, Polito L, Reddy UM, Saade GR, Grobman WA. Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery. Arch Womens Ment Health 2020; 23:361-369. [PMID: 31256258 PMCID: PMC6935433 DOI: 10.1007/s00737-019-00970-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
Maternal stress is a risk factor for adverse pregnancy outcomes (APOs). This study evaluates the associations of prenatal stress and APOs with maternal stress years after pregnancy. The 10-item Perceived Stress Scale (PSS) (0-40 range) was completed in the first and third trimesters, and 2-7 years after delivery among a subsample (n = 4161) of nulliparous women enrolled at eight US medical centers between 2010 and 2013 in a prospective, observational cohort study. Demographics, medical history, and presence of APOs (gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preeclampsia (PE), and medically indicated or spontaneous preterm birth (miPTB, sPTB)) were obtained. The associations of prenatal PSS and the presence of APOs with PSS scores years after delivery were estimated using multivariable linear regression. Mean PSS scores were 12.5 (95% CI 12.3, 12.7) and 11.3 (95% CI 11.1, 11.5) in the first and third trimesters respectively and 14.9 (95% CI 14.7, 15.1) 2-7 years later, an average increase of 2.4 points (95% CI 2.2, 2.6) from the start of pregnancy. Regressing PSS scores after delivery on first-trimester PSS and PSS increase through pregnancy showed positive associations, with coefficients (95% CI) of 2.8 (2.7, 3.0) and 1.5 (1.3, 1.7) per 5-point change, respectively. Adding APO indicator variables separately showed higher PSS scores for women with HDP (0.7 [0.1, 1.3]), PE (1.3 [0.6, 2.1]), and miPTB (1.3 [0.2, 2.4]), but not those with GDM or sPTB. In this geographically and demographically diverse sample, prenatal stress and some APOs were positively associated with stress levels 2-7 years after pregnancy.ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Catherine Monk
- Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA.
| | - Rachel S. Webster
- Columbia University Vagelos College of Physicians and
Surgeons, New York, New York
| | | | | | - Janet M. Catov
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip Greenland
- Division of Cardiology, Department of Medicine,
Northwestern University, Chicago, Illinois
| | - C. Noel Bairey-Merz
- Division of Cardiology, Department of Medicine,
Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah
and Intermountain Healthcare, Salt Lake City, Utah
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of
California, Irvine, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of
Medicine, Indiana University, Indianapolis, Indiana
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - LuAnn Polito
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, University of Texas, Galveston, Texas
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
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24
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Fyfe TM, Lavoie JG, Payne GW, Banner D. Rhesus D factor (RhD) negative women's experiences with pregnancy: An interpretive description. Women Birth 2020; 33:e511-e518. [PMID: 32035799 DOI: 10.1016/j.wombi.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The development of rh immune globulin (RhIG) for the prevention of Rhesus D (RhD) alloimmunization has significantly decreased the incidence of RhD alloimmunization. Despite long-standing prevention, the experiences of RhD negative women with pregnancy is absent in the literature. AIM The purpose of this study was to explore the experiences of RhD negative women with pregnancy. METHODS Utilizing an Interpretive Description approach, semi-structured interviews were conducted with RhD negative women about their pregnancies. This study took place within the geographic context of northern British Columbia (BC). The analysis involved a two-cycle approach to identify themes within the data. FINDINGS Sixteen RhD negative women that live in northern BC participated in this study. The analysis identified that RhD negative women are uninformed and want to be involved in the decision-making process regarding the prevention of RhD alloimmunization. The themes that emerged from the interview data were communication, information-seeking behaviour, out of sight out of mind, choice and trust, and patient advocacy. DISCUSSION The participants in this study described lacking information regarding the prevention of RhD alloimmunization. They sought information to overcome the gaps in knowledge and a desire to be involved in the decision-making process. CONCLUSION RhD negative women want information and to be involved in the decision-making process in the prevention of RhD alloimmunization. Working with RhD negative women to develop decision-aids and/or other educational tools to aid in the decision-making process are warranted.
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Affiliation(s)
- Trina M Fyfe
- Health Sciences Librarian, Northern Medical Program, Faculty of Medicine, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada.
| | - Josée G Lavoie
- Dept of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, #715, 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Geoffrey W Payne
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
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25
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Band R, Hinton L, Tucker KL, Chappell LC, Crawford C, Franssen M, Greenfield S, Hodgkinson J, McCourt C, McManus RJ, Sandall J, Santos MD, Velardo C, Yardley L. Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy. Pilot Feasibility Stud 2019; 5:153. [PMID: 31890265 PMCID: PMC6925434 DOI: 10.1186/s40814-019-0537-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence. METHODS Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials. RESULTS The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring. CONCLUSIONS With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable.
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Affiliation(s)
- Rebecca Band
- Academic unit of psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Lucy C. Chappell
- Division of Women and Children’s Health, King’s College London, London, SE1 7EH UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Sheila Greenfield
- Institute of Applied Health, University of Birmingham, Birmingham, B15 2TT UK
| | - James Hodgkinson
- Institute of Applied Health, University of Birmingham, Birmingham, B15 2TT UK
| | - Christine McCourt
- Centre for Maternal and Child Health, School of Health Sciences, City University, London, EC1R IUW UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Jane Sandall
- Division of Women and Children’s Health, King’s College London, London, SE1 7EH UK
| | - Mauro Dala Santos
- Institute of Biomedical Engineering, Department of Engineering Science, Building, University of Oxford, Oxford, OX3 7DQ UK
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, Building, University of Oxford, Oxford, OX3 7DQ UK
| | - Lucy Yardley
- Academic unit of psychology, University of Southampton, Southampton, SO17 1BJ UK
- School of Psychological Science, University of Bristol, Bristol, UK
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26
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Roth H, LeMarquand G, Henry A, Homer C. Assessing Knowledge Gaps of Women and Healthcare Providers Concerning Cardiovascular Risk After Hypertensive Disorders of Pregnancy-A Scoping Review. Front Cardiovasc Med 2019; 6:178. [PMID: 31850374 PMCID: PMC6895842 DOI: 10.3389/fcvm.2019.00178] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background: A history of a Hypertensive Disorder of Pregnancy (HDP) at least doubles a woman's risk of cardiovascular disease (CVD). The risk increases within 10 years after HDP and continues for life, making long-term health after HDP of major public health importance. Understanding knowledge gaps in health care professionals and women regarding cardiovascular health after HDP is an important component in addressing these risks. Objectives: The primary aim was to examine what women and healthcare providers (HCP) know about cardiovascular risks after HDP. The secondary aims were to identify enablers and barriers to knowledge and action on knowledge. Methods: A scoping review was conducted. This was a narrative synthesis, using PRISMA-ScR guidelines, of English-language full text articles that included assessment of knowledge of women, and/or HCP, on long term cardiovascular risk after HDP. The databases Embase, Medline, Scopus, ProQuest, Cochrane, and PsycInfo were searched from 01 January 2005 to 31 May 2019. Results: Twelve studies were included, six addressing women's knowledge, five addressing HCP knowledge, and one addressing both. The studies included 402 women and 1,215 HCP from seven countries. Regarding women's knowledge, six of seven studies found women had limited or no knowledge about the link between HDP and CVD. Where women were aware of the link, the majority had sourced their own information, rather than obtaining it through their HCP. In five of six studies, HCP also mostly had limited knowledge about HDP-CVD links. Primary enablers for HCP acquisition of knowledge and counseling were the availability and knowledge of guidelines. Where comparisons between HCP groups were made, obstetricians had greater knowledge than family physicians, internal medical specialists, or midwives. Conclusion: There was a low level of knowledge amongst HCP and women about increased CVD risk after HDP. Where women had higher levels of knowledge, the information was often obtained informally rather than from HCP. There were variations in knowledge of HCP, with obstetricians generally more aware than other professions. Further country and context-specific research on current status of women's and HCP's knowledge is therefore necessary when creating educational strategies to address knowledge gaps after HDP.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Grace LeMarquand
- School of Women's and Children's Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia.,Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Caroline Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Burnet Institute, Maternal and Child Health, Melbourne, VIC, Australia
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27
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Kamravamanesh M, Kohan S, Rezavand N, Farajzadegan Z. A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research. Reprod Health 2018; 15:81. [PMID: 29776432 PMCID: PMC5960172 DOI: 10.1186/s12978-018-0521-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women’s life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. Methods This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. Discussion It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is effective, it could be included in the postpartum health care guidelines. Trial registration IRCT20170927036445N2 Registered 10 March 2018.
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Affiliation(s)
- Mastaneh Kamravamanesh
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Rezavand
- Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Ziba Farajzadegan
- Community medicine Department, Faculty of medicine, Isfahan University of Medical Sciences, Hezar Jereb St, Isfahan, Iran.
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28
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Hinton L, Tucker KL, Greenfield SM, Hodgkinson JA, Mackillop L, McCourt C, Carver T, Crawford C, Glogowska M, Locock L, Selwood M, Taylor KS, McManus RJ. Blood pressure self-monitoring in pregnancy (BuMP) feasibility study; a qualitative analysis of women's experiences of self-monitoring. BMC Pregnancy Childbirth 2017; 17:427. [PMID: 29258469 PMCID: PMC5735874 DOI: 10.1186/s12884-017-1592-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 11/23/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. Raised blood pressure (BP) affects 10% of pregnancies worldwide, of which almost half develop pre-eclampsia. The proportion of pregnant women who have risk factors for pre-eclampsia (such as pre-existing hypertension, obesity and advanced maternal age) is increasing. Pre-eclampsia can manifest itself before women experience symptoms and can develop between antenatal visits. Incentives to improve early detection of gestational hypertensive disorders are therefore strong and self-monitoring of blood pressure (SMBP) in pregnancy might be one means to achieve this, whilst improving women's involvement in antenatal care. The Blood Pressure Self-Monitoring in Pregnancy (BuMP) study aimed to evaluate the feasibility and acceptability of SMBP in pregnancy. METHODS To understand women's experiences of SMBP during pregnancy, we undertook a qualitative study embedded within the BuMP observational feasibility study. Women who were at higher risk of developing hypertension and/or pre-eclampsia were invited to take part in a study using SMBP and also invited to take part in an interview. Semi-structured interviews were conducted at the women's homes in Oxfordshire and Birmingham with women who were self-monitoring their BP as part of the BuMP feasibility study in 2014. Interviews were conducted by a qualitative researcher and transcribed verbatim. A framework approach was used for analysis. RESULTS Fifteen women agreed to be interviewed. Respondents reported general willingness to engage with monitoring their own BP, feeling that it could reduce anxiety around their health during pregnancy, particularly if they had previous experience of raised BP or pre-eclampsia. They felt able to incorporate self-monitoring into their weekly routines, although this was harder post-partum. Self-monitoring of BP made them more aware of the risks of hypertension and pre-eclampsia in pregnancy. Feelings of reassurance and empowerment were commonly reported by the women in our sample. CONCLUSIONS SMBP in pregnancy was both acceptable and feasible to women in this small pilot study.
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Affiliation(s)
- Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK. .,Oxford NIHR Biomedical Research Centre, The Joint Research Office, The Churchill Hospital, Block 60, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - James A Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lucy Mackillop
- Oxford University Hospitals NHS Trust, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Christine McCourt
- City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Trisha Carver
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Mary Selwood
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Woodstock Rd, Oxford, OX2 6GG, UK
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29
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Pregnancy with gestational hypertension or preeclampsia: A qualitative exploration of women's experiences. Midwifery 2017; 46:17-23. [PMID: 28110162 DOI: 10.1016/j.midw.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hypertension complicates 10% of pregnancies and involves specialised care of the woman and her baby, a longer stay in hospital, and an increased risk of physical and mental morbidity. There is limited research reporting the woman's perspective on her experience, how she coped with it psychologically, and whether the care she received influenced her experience. AIM To gain insight into women's experience of hypertension in pregnancy and to report on what mediating factors may help improve their experience. METHODS A qualitative descriptive study was undertaken. Data were collected through a semi-structured, face to face interview at 10-12 months postpartum. In total, 20 women who had experienced hypertension in their pregnancy were interviewed. Thematic analysis was used to analyse the data. FINDINGS Four main themes were identified. These were: Reacting to the diagnosis, Challenges of being a mother, Processing and accepting the situation, and Moving on from the experience. The mediating factors that improved the experience were Feeling safe and trusting the care providers, Having continuity of care and carer, and Valuing social support from partner, family and friends. CONCLUSION The diagnosis of hypertension in pregnancy has a significant impact on women. This affects their pregnancy and birth experience and their pathway to motherhood. The implications of the findings for midwifery practice include having access to multidisciplinary continuity models of care and facilitating the support for these women.
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Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia. J Perinatol 2016; 36:1079-1082. [PMID: 27583396 PMCID: PMC5480377 DOI: 10.1038/jp.2016.137] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/07/2016] [Accepted: 07/13/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine factors associated with lower 6-week postpartum follow-up rates and persistent hypertension among women with preeclampsia with severe features (PEC-S). STUDY DESIGN Planned secondary analysis of a retrospective cohort study of women with PEC-S. Outcomes were (1) attendance at the 6-week postpartum visit and (2) persistent hypertension. RESULTS One hundred ninety-three women were in the final cohort. The 6-week follow-up rate was 52.3%. Factors associated with lower follow-up were African-American race (OR 0.37 (0.18-0.77)) and <5 prenatal visits (OR 0.44 (0.20-0.97)). Women with diabetes and women with a cesarean had higher follow-up (OR 4.00 (1.09-14.66) and 2.61 (1.40-4.88), respectively). Among those with 6-week follow-up, 21% had persistent hypertension. Obese women, women diagnosed with PEC-S by severe range blood pressure (BP) and women discharged home on BP medication were more likely to have persistent hypertension (OR 3.50 7 (1.06-11.58), 3.58 (1.11-11.54) and 3.04 (1.12-8.23), respectively). CONCLUSION We identified a subgroup of women at higher risk for poor postpartum follow-up and those at risk for persistent hypertension.
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Skurnik G, Roche AT, Stuart JJ, Rich-Edwards J, Tsigas E, Levkoff SE, Seely EW. Improving the postpartum care of women with a recent history of preeclampsia: a focus group study. Hypertens Pregnancy 2016; 35:371-81. [PMID: 27043861 DOI: 10.3109/10641955.2016.1154967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women with prior preeclampsia are at increased risk of cardiovascular disease (CVD). This study investigated barriers and facilitators toward learning about this link and engaging in lifestyle modifications to reduce this risk. METHODS Four focus groups were held with 14 women within 6 months of a preeclamptic pregnancy. RESULTS Participants were unaware of the link between preeclampsia and CVD, suggested improvements to provider-patient communication, and discussed the benefits of social support and online tracking (weight, blood pressure) in making lifestyle modifications. CONCLUSIONS Solutions offered may improve efforts to modify lifestyle and communication between providers and women about this link.
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Affiliation(s)
- Geraldine Skurnik
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
| | - Andrea Teresa Roche
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
| | - Jennifer J Stuart
- b Connors Center for Women's Health and Gender Biology , Division of Women's Health, Brigham and Women's Hospital , Boston , MA , USA.,c Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Janet Rich-Edwards
- b Connors Center for Women's Health and Gender Biology , Division of Women's Health, Brigham and Women's Hospital , Boston , MA , USA.,c Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Eleni Tsigas
- d The Preeclampsia Foundation , Melbourne , FL , USA
| | - Sue E Levkoff
- e College of Social Work, University of South Carolina , Columbia , SC , USA
| | - Ellen W Seely
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
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Vata PK, Chauhan NM, Nallathambi A, Hussein F. Assessment of prevalence of preeclampsia from Dilla region of Ethiopia. BMC Res Notes 2015; 8:816. [PMID: 26704295 PMCID: PMC4690301 DOI: 10.1186/s13104-015-1821-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Preeclampsia is a multi-organ system disorder that occurs after the 20th week of gestation in pregnancy and is characterized by hypertension and proteinuria. In Africa more than 270,000 women die from maternal deaths, worldwide approximately 76,000 women and 500,000 babies die yearly due to preeclampsia. It affects about 8–10 % of all pregnancies. Studies have shown that up to 77 % women affected with preeclampsia lack knowledge about preeclampsia, and therefore cannot take preventative measures. The aim of study is to evaluate the outcomes and quality of care given to preeclamptic patients treated in Dilla University Referral Hospital. Methods The study is a retrospective, hospital based study. One hundred and seventy two records of women were retained for final study out of 7702 patients from January 2009 to December 2012. Results The incidence rate of preeclampsia in Dilla University Referral Hospital was found to be 2.23 %. The common mean ages found to be affected for preeclampsia were 19.2, 22.5 and 27.8 and 31.5 with a trend towards increasing severity with younger age population. Conclusion A guideline on the management and prevention of preeclampsia needs to be produced for Ehiopia.
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Affiliation(s)
| | - Nitin M Chauhan
- College of Natural and Computational Sciences, Dilla University, 419, Dilla, SNNPR, Ethiopia.
| | | | - Fentaw Hussein
- College of Health Sciences, Dilla University, 419, Dilla, SNNPR, Ethiopia
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Traylor J, Chandrasekaran S, Limaye M, Srinivas S, Durnwald CP. Risk perception of future cardiovascular disease in women diagnosed with a hypertensive disorder of pregnancy. J Matern Fetal Neonatal Med 2015; 29:2067-72. [PMID: 26371379 DOI: 10.3109/14767058.2015.1081591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate a woman's risk perception for future cardiovascular disease (CVD) after being diagnosed with a hypertensive disorder of pregnancy. METHODS A prospective cohort of women diagnosed with a hypertensive disorder of pregnancy (HDP) was studied. Each woman completed two surveys, one prior to hospital discharge and one 2 weeks later, designed to assess knowledge of and risk perception for future CVD based on their recent diagnosis of a HDP. Rates of postpartum depression were also assessed. RESULTS Of the 146 subjects included, 28% were diagnosed with preeclampsia with severe features, 52.1% with preeclampsia with mild features, and 19.9% had chronic hypertension. Women with severe features and those delivering preterm were more likely to report a perception of increased risk of both recurrent HDP in a future pregnancy (p = 0.004 and 0.005, respectively) and hypertension later in life (p = 0.01 and 0.03, respectively). Women delivering preterm were more likely to report an accurate perception of increased risk of myocardial infarction and stroke compared to those delivering at term (p = 0.006 and 0.002, respectively). CONCLUSIONS Disease severity and preterm delivery were associated with a higher likelihood of the perception of an increased risk for both recurrent HDP and hypertension in the future. Only preterm delivery was associated with a higher risk perception for stroke and myocardial infarction. Interventions targeted at improved health awareness in women diagnosed with HDP are warranted.
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Affiliation(s)
- Jessica Traylor
- a Department of Obstetrics and Gynecology , University of Pennsylvania , Philadelphia , PA , USA
| | - Suchitra Chandrasekaran
- a Department of Obstetrics and Gynecology , University of Pennsylvania , Philadelphia , PA , USA
| | - Meghana Limaye
- a Department of Obstetrics and Gynecology , University of Pennsylvania , Philadelphia , PA , USA
| | - Sindhu Srinivas
- a Department of Obstetrics and Gynecology , University of Pennsylvania , Philadelphia , PA , USA
| | - Celeste P Durnwald
- a Department of Obstetrics and Gynecology , University of Pennsylvania , Philadelphia , PA , USA
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Stepan H, Kuse-Föhl S, Klockenbusch W, Rath W, Schauf B, Walther T, Schlembach D. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75:900-914. [PMID: 28435172 PMCID: PMC5396549 DOI: 10.1055/s-0035-1557924] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Hypertensive pregnancy disorders contribute significantly to perinatal as well as maternal morbidity and mortality worldwide. Also in Germany these diseases are a major course for hospitalization during pregnancy, iatrogenic preterm birth and long-term cardiovascular morbidity. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. Recommendations: This guideline summarizes the state-of-art for classification, risk stratification, diagnostic, treatment of hypertensive pregnancy disorders.
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Affiliation(s)
- H. Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - S. Kuse-Föhl
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - W. Klockenbusch
- Universitätsklinikum Münster, Klinik und Poliklinik für Frauenheilkunde und
Geburtshilfe, Abt. für Geburtshilfe, Münster
| | - W. Rath
- Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH
Aachen, Aachen
| | - B. Schauf
- Frauenklinik Sozialstiftung Bamberg, Bamberg
| | - T. Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork,
Ireland
| | - D. Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
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Recognition by Women's Health Care Providers of Long-Term Cardiovascular Disease Risk After Preeclampsia. Obstet Gynecol 2015; 125:1287-1292. [PMID: 26000498 DOI: 10.1097/aog.0000000000000856] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess health care providers' knowledge regarding pregnancy outcome as a risk factor for cardiovascular disease and evaluate the variables associated with their responses to questions about routine surveillance for cardiovascular disease. METHODS A voluntary, anonymous survey of internal medicine and obstetric and gynecologic health care providers at an academic institution. Responses to a case-based and direct inquiry questionnaire were evaluated. RESULTS The overall response rate was 65% (173/265). When assessing cardiovascular risk, gynecologists compared with internists significantly more often requested a pregnancy history (44/49 [90%] compared with 56/75 [75%], P=.039) and more often attached importance to a history of preeclampsia (35/48 [73%] compared with 41/75 [55%], P=.028). When a history of preeclampsia was obtained, internists more often obtained a fasting glucose test (25/52 [48%] compared with 9/43 [20.9%], P=.009). A minority of health care providers recognized the importance of fetal growth restriction. Both health care provider groups demonstrated similar knowledge of general cardiovascular risk factors, screening tools, and interventions. Higher general cardiovascular knowledge was significantly associated with identification of pregnancy complications as cardiovascular risk factors (P=.001). CONCLUSION When assessing cardiovascular risk, internists were less likely than gynecologists to include a pregnancy history. However, once identified as at risk for cardiovascular disease, gynecologists were less likely than internists to obtain appropriate testing. Education concerning the link between certain pregnancy complications and future cardiovascular disease is needed. Areas of opportunity for education in both medical specialties are identified.
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Seely EW, Tsigas E, Rich-Edwards JW. Preeclampsia and future cardiovascular disease in women: How good are the data and how can we manage our patients? Semin Perinatol 2015; 39:276-83. [PMID: 26117165 DOI: 10.1053/j.semperi.2015.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Women with a history of preeclampsia have double the risk of future heart disease and stroke, and elevated risks of hypertension and diabetes. The American Heart Association (AHA) and the American College of Obstetrics and Gynecology now include preeclampsia as a risk factor for future cardiovascular disease (CVD) with the recommendation of obtaining a history of preeclampsia and improving lifestyle behaviors for women with such a history. Research has progressed from asking whether preeclampsia is associated with CVD to how preeclampsia is associated with CVD, and the implications for prevention of CVD among women with a history of preeclampsia. A history of preeclampsia "unmasks" future CVD risk; research is inconclusive whether it also causes vascular damage that leads to CVD. For women with prior preeclampsia, the AHA recommends CVD risk reduction actions similar to those for other "at risk" groups: cessation of cigarette smoking, physical activity, weight reduction if overweight or obese and counseling to follow a "DASH" like diet. The efficacy of these lifestyle modifications to lower risk of CVD in women with prior preeclampsia remains to be determined. Barriers exist to implementing lifestyle improvement measures in this population, including lack of awareness of both patients and clinicians of this link between preeclampsia and CVD. We review patient, provider, and systems level barriers and solutions to leverage this information to prevent CVD among women with a history of preeclampsia.
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Affiliation(s)
- Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115.
| | | | - Janet W Rich-Edwards
- The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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van Kesteren F, Visser S, Hermes W, Franx A, van Pampus MG, Poppel MNM, Tamsma JT, Mol BW, de Groot CJ. Prevention of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation. Hypertens Pregnancy 2015; 34:261-9. [PMID: 25815424 DOI: 10.3109/10641955.2015.1009544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyse preventive interventions of women with cardiovascular risk factors postpartum. METHODS 3.5 years postpartum, women with history of hypertension in pregnancy were invited for a questionnaire, 1 year after a cardiovascular risk assessment. RESULTS Two hundred and fifty-seven women completed the questionnaire. At risk factor analyses, 35% had hypertension, 37% abnormal lipid- or glucose levels, 63% BMI ≥ 25 and 19% smoked. One year later, 36% of women with hypertension used anti-hypertensives, 0% of women with abnormal laboratory findings used anti-cholesterol and 1% anti-diabetes medication, 31% of the obese women achieved BMI reduction (≥ 5%), 42% of the women who smoked, quit. CONCLUSION A minority improved their risk profile.
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Affiliation(s)
- Floortje van Kesteren
- Department of Obstetrics and Gynaecology, VU Medical Center , Amsterdam , The Netherlands
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Seely EW, Rich-Edwards J, Lui J, Nicklas JM, Saxena A, Tsigas E, Levkoff SE. Risk of future cardiovascular disease in women with prior preeclampsia: a focus group study. BMC Pregnancy Childbirth 2013; 13:240. [PMID: 24359495 PMCID: PMC3878371 DOI: 10.1186/1471-2393-13-240] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/16/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A history of preeclampsia is a risk factor for the future development of hypertension and cardiovascular disease (CVD). The objective of this study was to assess, in women with prior preeclampsia, the level of knowledge regarding the link between preeclampsia and CVD, motivators for and barriers to lifestyle change and interest in a lifestyle modification program to decrease CVD risk following a pregnancy complicated by preeclampsia. METHODS Twenty women with a history of preeclampsia participated in 5 phone-based focus groups. Focus groups were recorded, transcribed, and analyzed. Qualitative content analysis was used to identify common themes across focus groups. Consensus was reached on a representative set of themes describing the data. RESULTS Women with prior preeclampsia were in general unaware of the link between preeclampsia and future CVD but eager to learn about this link and motivated to achieve a healthy lifestyle. Major perceived barriers to lifestyle change were lack of time, cost of healthy foods and family responsibilities. Perceived facilitators included knowledge of the link between preeclampsia and CVD, a desire to stay healthy, and creating a healthy home for their children. Women with prior preeclampsia were interested in the idea of a web-based program focused on lifestyle strategies to decrease CVD risk in women. CONCLUSIONS Women with prior preeclampsia were eager to learn about the link between preeclampsia and CVD and to take steps to reduce CVD risk. A web-based program to help women with prior preeclampsia adopt a healthy lifestyle may be an appropriate strategy for this population.
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Affiliation(s)
- Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA.
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