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Markowitz MA, Lundsberg LS, Gariepy AM. A Multidimensional and Longitudinal Exploratory Study of the Stability of Pregnancy Contexts in the United States. Womens Health Rep (New Rochelle) 2024; 5:211-222. [PMID: 38516649 PMCID: PMC10956533 DOI: 10.1089/whr.2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/23/2024]
Abstract
Objective Evaluate the longitudinal stability of six pregnancy contexts, including intention, in a diverse cohort of individuals experiencing delivery, abortion, or miscarriage. Methods We enrolled individuals 16-44 years of age with pregnancies <24 weeks gestation in this longitudinal study between June 2014 and June 2015 in four US urban clinics. We assessed six pregnancy contexts (intention, wantedness, planning, timing, desirability, and happiness) at enrollment and 3-month follow-up. We constructed three-level categorical measures for each context defined as favorable, ambivalent, or unfavorable. We used Wilcoxon sign tests to evaluate changes in paired observations between pregnancy context measures over time and by pregnancy outcome. Results Among 121 participants at median gestational age of 7 weeks and 3 days, we found intention, wantedness, planning, timing, and happiness remained unchanged from enrollment in early pregnancy to 3-month follow-up. Individuals demonstrated changes in desirability; pregnancy assessments shifted toward less desirable from enrollment to follow-up (p = 0.01) (i.e., desired to ambivalent, or ambivalent to undesired). Among participants choosing delivery (57%), assessments shifted toward more favorable planning (i.e., unplanned to ambivalent, or ambivalent to planned) (p < 0.01), and less favorable desirability (i.e., desired to ambivalent or ambivalent to undesired) (p < 0.01) at follow-up. Among participants choosing abortion (28%), assessments shifted toward more unfavorable planning (i.e., planned to ambivalent, or ambivalent to unplanned) at follow-up (p < 0.01). Conclusion In multidimensional, longitudinal assessment, pregnant participants' perspectives on five of six pregnancy contexts remained unchanged between enrollment and 3-month follow-up; only desirability shifted. Pregnancy planning perspectives differed by pregnancy outcome.Human Research Subjects Protection Program: 1310012926.
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Affiliation(s)
- Melissa A. Markowitz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lisbet S. Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aileen M. Gariepy
- Department of Obstetrics and Gynecology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
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Wohrer F, Ngo H, DiDomenico J, Ma X, Roberts MH, Bakhireva LN. Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy. Front Hum Neurosci 2024; 18:1323297. [PMID: 38445095 PMCID: PMC10912531 DOI: 10.3389/fnhum.2024.1323297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH). Methods Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH. Results Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all p's < 0.05). Conclusion These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.
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Affiliation(s)
- Fiona Wohrer
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Helen Ngo
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jared DiDomenico
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Xingya Ma
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Melissa H. Roberts
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Nickels L, Yan W. Nonhormonal Male Contraceptive Development-Strategies for Progress. Pharmacol Rev 2023; 76:37-48. [PMID: 38101934 PMCID: PMC10759220 DOI: 10.1124/pharmrev.122.000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.
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Affiliation(s)
- Logan Nickels
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
| | - Wei Yan
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
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Pei Y, Chen Q, Zhang Y, He C, Wang J, Tang J, Hou H, Zhu Z, Zhang X, Wang W. Factors associated with the mental health status of pregnant women in China: A latent class analysis. Front Public Health 2023; 10:1017410. [PMID: 36703830 PMCID: PMC9871834 DOI: 10.3389/fpubh.2022.1017410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Prenatal mental health is a neglected public health issue that places pregnant women at a higher risk for mental disorders. The purpose of this study was to investigate the influencing factors of prenatal mental disorders and provide a scientific basis to guide and promote the mental health of pregnant women. Methods The study sample comprised 973 women in their first pregnancy, who were in their second trimester and third trimester, who underwent obstetric outpatient checkups at the Maternal and Child Health Hospital in Huai'an, who were recruited in the survey that was conducted from July to December 2017. The Chinese mental health scale (CMHS) was used to assess the mental health of pregnant women. The present study uses the chi-square test to compare the rates of class with different demographic variables, a latent class analysis to identify psychological symptoms, and multiple logistic regression analysis to examine whether the demographics predicted class membership. Results The chi-square test results showed that participants who reported feeling different in the perinatal period (χ2 = 6.35, P = 0.04), having marital satisfaction (χ2 = 15.8, P < 0.001), with an in-law relationship (χ2 = 29.43, P < 0.001), with a friend relationship (χ2 = 24.81, P < 0.001), with basic diseases (χ2 = 8.04, P = 0.02), and taking birth control pills (χ2 = 8.97, P = 0.01) have different probabilities of being classified. Three latent classes were identified: the high symptoms group (6.89%), the moderate symptoms group (20.56%), and the low symptoms group (72.56%). Pregnant women in the third trimester [odds ratio (OR) = 1.83, 95% confidence interval (CI): 1.04-3.25, P = 0.04], with a poor in-law relationship (OR = 2.82, 95% CI:1.45-5.51, P = 0.002), with a bad friend relationship (OR = 3.17, 95% CI: 1.31-7.71, P = 0.01), and who had basic diseases (OR = 1.70, 95% CI: 1.00-2.90, P = 0.04) tended to be classified under the high symptoms group than under the low symptoms group. Pregnant women with a bad friend relationship (OR = 2.15, 95% CI: 1.08-4.28, P = 0.03) and taking birth control pills (OR = 1.51, 95% CI: 1.08-2.11, P = 0.02) were more likely to be placed under the moderate symptoms group than under the low symptoms group. Conclusions A pregnant woman's mental health status factors include feeling different in the perinatal period, those with marital satisfaction, those with an in-law relationship, those with a friend relationship, those with basic diseases, and those taking birth control pills. To ensure a smooth progress of pregnancy and promote the physical and mental health of pregnant women, psychological screening and psychological intervention measures should be strengthened.
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Affiliation(s)
- Yifei Pei
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qian Chen
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ying Zhang
- Huai'an Center for Disease Control and Prevention, Huai'an, Jiangsu, China
| | - Chenlu He
- Wuxi No.5 People's Hospital, Wuxi, Jiangsu, China
| | - Jingjing Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Tang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hao Hou
- School of Public Health, Wuhan University, Wuhan, China
| | - Ziqing Zhu
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Xunbao Zhang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China,*Correspondence: Xunbao Zhang ✉
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China,Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China,Wei Wang ✉
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Ortega-García JA, Sánchez-Sauco MF, Zafra-Rodríguez JA, Cabrera-Rivera LT, Díaz-Martínez F, Llegus-Santiago EM, Delgado-Marín JL, Orenes-Piñero E, Kloosterman N, Bach A, Ojeda-Sánchez C, Ramis R. Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention. Digit Health 2023; 9:20552076231177146. [PMID: 37284011 PMCID: PMC10240876 DOI: 10.1177/20552076231177146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives To compare the environmental health results in women trying to get pregnant or pregnant using a mobile health application (Green Page) through healthcare professionals or self-completed by women, and to explore the relationship between the subjective well-being of these women with their lifestyles and environmental factors. Methods A descriptive study with mixed methods was conducted in 2018. A mobile health survey was used in two phases. Phase 1 was a cross-sectional study through professionals (n = 1100) followed by phase 2, a convenience sampling through women's self-reporting (n = 3425). A personalized report was downloadable with health recommendations for the well-being of the mother and child. Results Of the 3205 participants (mean age = 33 years, SD = 0.2 years), 1840 were planning a pregnancy and 1365 were pregnant. One in five pregnant women had a low level of happiness. Globally, subjective well-being and happiness were found to be negatively associated with lack of contact with nature, sedentary lifestyle, excess weight, environmental exposure, and older age in pregnancy. Precisely 45%, 60%, and 14% of women were exposed to tobacco, alcohol, and illegal drugs, respectively. The women self-reported levels of risk factors higher than when the tool was used by or through professionals. Conclusions The use of mobile health interventions focused on environmental health during planning or pregnancy periods could help improve the quality of healthcare and foster greater involvement of women in their self-care process, thus promoting empowerment, healthier environments, and lifestyles. Ensuring equity of access and data protection are global challenges to be addressed.
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Affiliation(s)
- Juan Antonio Ortega-García
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - Miguel Felipe Sánchez-Sauco
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - José Alberto Zafra-Rodríguez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- TICARUM, University of Murcia, Murcia, Spain
| | - Laura Teresa Cabrera-Rivera
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Environmental Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
- International Exchange Program for Minority Student, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Francisco Díaz-Martínez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - Eduardo Manuel Llegus-Santiago
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Environmental Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
- International Exchange Program for Minority Student, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Juan Luis Delgado-Marín
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen Arrixaca, Fetal Medicine Unit Murcia, IMIB Arrixaca, Región de Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Departament of Biochemistry and Molecular Biology, University of Murcia, Murcia, Spain
| | - Nicole Kloosterman
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- MUSC Health University Medical Center, Charleston, SC, USA
| | - Albert Bach
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Environment and Human Health Laboratory (EH2 Lab), Forest Science and Technology Center of Catalonia, Solsona, Spain
| | - Carlos Ojeda-Sánchez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Preventive Medicine, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Rebecca Ramis
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute and Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública−CIBERESP), Madrid, Spain
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Souza Leite Vieira A, Nascimento SL, Souza Silva L, Mendes Pedroso Chainça T, Costa Machado H, Surita FG. Self-reported exercise or physical activity level: what matters to a better quality of life in the third trimester of pregnancy? Women Health 2022; 62:799-808. [PMID: 36404410 DOI: 10.1080/03630242.2022.2146833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the relationship of self-reported exercise, physical activity (PA) level, and Quality of Life (QoL) among women in their third trimester of pregnancy and verified which factors are associated with physical exercise (PE) and QoL. A cross-sectional study was performed with women who have been pregnant for at least 28 weeks and who can engage in PE. Data on self-reported exercise, sociodemographic characteristics, PA level, and QoL were collected through the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Quality of Life Questionnaire BREF version (WHOQOL-BREF). Frequencies, bivariate analyses, and logistic and linear regression were performed. Among 405 pregnant women, 103 (25.43 percent) reported practicing PE. The self-reported PE was associated with better scores in the physical and environmental domains of the WHOQOL-BREF. Several IPAQ variables and the WHOQOL-BREF environmental score were associated with self-reported exercise. The majority classified as "active" by the IPAQ was due to employment and not the PE practice. A correct conceptual approach to PA and PE during antenatal care has a different impact on health and QoL during pregnancy.
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Affiliation(s)
- André Souza Leite Vieira
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Sao Paulo, Brazil
| | | | - Luana Souza Silva
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Sao Paulo, Brazil
| | | | - Helymar Costa Machado
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Sao Paulo, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Sao Paulo, Brazil
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Boutib A, Chergaoui S, Marfak A, Hilali A, Youlyouz-Marfak I. Quality of Life During Pregnancy from 2011 to 2021: Systematic Review. Int J Womens Health 2022; 14:975-1005. [PMID: 35941917 PMCID: PMC9356752 DOI: 10.2147/ijwh.s361643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Health-related quality of life (HRQoL) has emerged as a key concern in patient care. It has become one of the major objectives of clinical trials. Our study aims to describe the quality of life (QoL) during uncomplicated pregnancy and to assess its associated factors. Patients and Methods The search of articles was carried out using the online database of PUBMED and Web of Science with a limit of time between 2011 and 2021. Data were retrieved by two independent reviewers. Results 721 publications responding to keywords were identified, of which 73 articles on the topic were selected. The main countries that have published on this subject are Australia (n = 10) and China (n = 7). Twenty-three articles deal with QoL for pathological pregnancies. All the pathologies studied have a negative impact on the HRQoL of pregnant women, and its improvement depends on the type of treatment. Obesity, low back, and pelvic girdle pain, and hyperemesis gravidarum were the frequent pathologies during pregnancy. Socio-demographic characteristics related to improved well-being (favorable economic status, social support). Similarly, better sleep quality and moderate physical exercise were linked to an increased QoL. Physical and psychological factors were associated with a lower QoL. Conclusion The HRQoL refers to patients’ subjective evaluation of physical, mental, and social components of well-being. Optimizing the QoL during pregnancy necessitates a deeper understanding of their issues as well as counseling which provides support wherever needed.
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Affiliation(s)
- Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Abdelghafour Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- National School of Public Health, Rabat, Morocco
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- Correspondence: Ibtissam Youlyouz-Marfak, Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco, Tel +212 6 61 60 43 58, Fax +212 5 23 40 01 87, Email
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8
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Laine C. Contraceptive Counseling: An Essential Component of Preventive Health Care. Ann Intern Med 2022; 175:1043-1044. [PMID: 35605237 DOI: 10.7326/m22-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Schiavoni KH, Lawrence J, Xue J, Kotelchuck M, Boudreau AA. Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents. Acad Pediatr 2022; 22:296-304. [PMID: 34758402 DOI: 10.1016/j.acap.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Long acting reversible contraceptives (LARCs) are recommended as highly effective for adolescents. Although the uptake of LARCs has increased, overall use remains low due to barriers for both providers and patients. We evaluate whether pediatric medical home transformation, including implant placement in pediatrics, may increase LARC use or decrease adolescent pregnancy rates. METHODS Retrospective interrupted time-series analysis of adolescents ages 11 to 19 years at 2 pediatric practices in academically affiliated community health centers during 2005-2015. The intervention practice underwent medical home transformation including team-based care with family planning and health coaching, youth-friendly policies, and contraceptive implant placement. The control practice continued usual care. Differential changes in population event rates were evaluated using a segmented longitudinal regression model. RESULTS The study population included 4946 adolescent females at the intervention practice and 1992 at the control practice. Following practice transformation, LARC use increased significantly more at the intervention practice compared to the control (1.73 versus 0.28 events per 1000 patients quarterly P = 0.004). Pregnancy rate declined at both practices without temporal correlation to the LARC intervention. During the medical home transformation period, the intervention practice showed a greater decline in pregnancy rate, though this difference did not reach statistical significance (2.01 versus 0.81 events per 1000 patients quarterly P = 0.090). CONCLUSIONS Adolescents had higher LARC use where implant placement was offered within the pediatric practice as part of medical home transformation. Although LARC did not impact pregnancy rate, the process of practice transformation may have accelerated its decline through heightened adolescent health focus.
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Affiliation(s)
- Katherine H Schiavoni
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Mass General Brigham, Population Health Management (KH Schiavoni), Somerville, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass.
| | - Jourdyn Lawrence
- Harvard T. H. Chan School of Public Heath, Department of Social and Behavioral Sciences (J Lawrence), Boston, Mass
| | - Jiayin Xue
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Milton Kotelchuck
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Alexy Arauz Boudreau
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
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Wilson R, Campos A, Sandhu M, Sniffen S, Jones R, Tackett H, Berry E, Louis-Jacques A. Can the Healthy Start Risk Screen Predict Perinatal Depressive Symptoms among High-Risk Women? Children (Basel) 2022; 9. [PMID: 35204899 DOI: 10.3390/children9020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Early detection of depression in at-risk populations is critical for ensuring better maternal and child health outcomes. This study assessed whether Healthy Start Prenatal Risk Screening (HSPRS) could predict depressive symptoms in women enrolled in a Healthy Start (HS) program in under-resourced, high-risk communities of Hillsborough County. METHODS Data from HS participants were included for those who were evaluated using the HSPRS and the Edinburgh Postnatal Depression Scale (EPDS). A correlation analysis determined if the HSPRS score was associated with a positive EPDS screen, and HSPRS questions related to the participants psychosocial environment were assessed individually to determine their predictive potential. The crude odds ratio (OR) and adjusted OR (controlling for sociodemographic covariates) were calculated for each question of interest. RESULTS A total of 736 women were included, with 122 (16.5%) scoring 14 or greater on the EPDS, indicating probable depression risk. There were significant differences between women at risk for depression compared to those not at risk regarding maternal age (p-value = 0.03) and marital status (p-value = 0.01). There were no significant differences in education, ethnicity, or race. The total HSPRS score had a weak yet significant correlation with the EPDS score (r = 0.14, p-value = 0.0001), and seven individual HSPRS questions were significantly associated with risk for perinatal depression. Conclusions for Practice: By focusing on responses to key HSPRS questions rather than the overall score, women may receive access to much needed services more quickly, thereby reducing the risk for poorer maternal and developmental outcomes. SIGNIFICANCE A young maternal age and single marital status have been identified as risk factors for perinatal depression. Additionally, women from racial/ethnic minority groups or low-income populations are more likely to experience depression. Thus, in communities where women exhibit many pre-identified risk factors for perinatal depression, the ability to quickly identify those at the highest risk is imperative. This work indicates that among medically and socially high-risk mothers enrolled in a HS program, the overall HSPRS score was not as predictive of perinatal depression as individual responses to key questions. Attention to these responses could result in women receiving much needed services quicker.
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Zhang X, Liang X, Cao W. Evaluation of Cardiac Function of Pregnant Women with High Blood Pressure during Gestation Period and Coupling of Hearts with Peripheral Vessels by Ultrasonic Cardiogram under Artificial Intelligence Algorithm. Comput Math Methods Med 2022; 2022:5019153. [PMID: 35126627 PMCID: PMC8813232 DOI: 10.1155/2022/5019153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/11/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
The research was aimed at analyzing the value of the optimized eXtreme Gradient Boosting (XGBoost) algorithm-based ultrasound cardiogram images in the diagnosis of pregnant hypertension patients. A total of 145 pregnant women (85 cases suffered from hypertension disease during pregnancy and 60 other normal women were healthy) were selected as the reference to the comparison and analysis of ultrasound cardiac function parameter, common carotid artery parameter, and the coupling relationship between hearts and cervical vessels of pregnant hypertension patients. The results demonstrated ultrasound cardiac function parameter of pregnant hypertension patients as follows. The maximum volume of the left atrium (LAVmax) was 35.65 mm, left ventricular end-systolic volume (LVESV) was 31.07 mm, and left ventricular end-diastolic volume (LVEDV) was 88.73 mm. All the above indexes were obviously higher than those of the normal control group (P < 0.05). Besides, intima-media thickness (IMT) of common carotid artery (465.84 μm), pulse wave velocity (PWV) (8.09 m/s), pressure of turning point 1 from isovolumic contraction phase to ejection phase (PT1) (126.5 mmHg), arterial enhancement pressure (AP) (6.14 mmHg), and arterial pressure enhancement index (8.58%) were all significantly higher than those of the normal control group (P < 0.05). In addition, the correlation between the coupling (E/A) of hearts and carotid artery of pregnant hypertension patients and PWV was not obvious (r = -0.08432, P > 0.05). The results of the research indicated that intima-media inside carotid artery of pregnant hypertension patients thickened obviously, and it became less elastic compared with that of normal healthy pregnant women. What is more, cardiac morphological changes were manifested mainly as the enlargement of the left atrial chamber and the thickening of the interventricular septum. Volume load and blood flow velocity both increased, and left ventricular diastolic function was damaged. XGBoost algorithm-based ultrasound cardiogram images could improve the diagnostic effects of hypertension during pregnancy effectively.
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Affiliation(s)
- Xia Zhang
- Department of Function, The Affiliated Wuxi Maternal and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002 Jiangsu, China
| | - Xi Liang
- Department of Function, The Affiliated Wuxi Maternal and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002 Jiangsu, China
| | - Wen Cao
- Department of Function, The Affiliated Wuxi Maternal and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002 Jiangsu, China
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Robledo-Gil T, Kemet S, Pensak M, Cutler A, McNamara B, Kennedy HP, Lundsberg L, Gariepy A. " Un abrazo a la distancia": An Exploration of Spanish-Speaking Women's Experiences with Pregnancy and Social Isolation in an Urban U.S. Setting. Hisp Health Care Int 2021; 20:107-114. [PMID: 34520260 DOI: 10.1177/15404153211041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Research on Spanish-speaking Latina/Hispanic women's experiences during pregnancy is limited. Methods: We recruited women from urban, walk-in pregnancy testing clinics from June 2014 to June 2015. Women aged 16-44 years, at less than 24 weeks gestational age, who spoke either English or Spanish were eligible and completed an enrollment questionnaire and individual interview according to language preference. During qualitative interviews, we explored pregnancy intentions, initial reactions to a new pregnancy, and feelings about the impact of this pregnancy on relationships and daily life. Qualitative narrative content analysis was conducted using Atlas.ti software. Results: Among interviews with 31 Spanish-speaking Latina/Hispanic pregnant women, participants' average age was 28 years old with a mean gestational age of 7 weeks. We identified social isolation as the most common theme, characterized by four interwoven and overlapping subthemes: (1) sola-the experience of feeling alone; (2) familismo cercano-the importance of close relationships; (3) familismo lejano-overcoming long distance relationships; and (4) mi patria-preserving homeland cultural connectedness. Conclusions: Spanish-speaking Latina/Hispanic pregnant women described experiencing multiple aspects of social isolation. Language preference may suggest risk of social isolation, necessitating provider awareness and support initiatives to improve social support and lessen social isolation among newly pregnant, Spanish-speaking Latina women.
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Affiliation(s)
| | | | | | - Abigail Cutler
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
| | | | | | - Lisbet Lundsberg
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
| | - Aileen Gariepy
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
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Chmaj-Wierzchowska K, Rzymski P, Wojciechowska M, Parda I, Wilczak M. Health-related quality of life (Nottingham Health Profile) of women with normal and pathological pregnancy and during delivery: correlation with clinical variables and self-reported limitations. J Matern Fetal Neonatal Med 2021; 35:1825-1833. [PMID: 34074212 DOI: 10.1080/14767058.2021.1910665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pregnancy is often associated with changes in the psychological functioning of women. The present study aimed to analyze the incidence of health problems in pregnant mothers and the influence of these problems on their daily functioning using a survey. MATERIAL AND METHODS The study included a total of 232 women aged 19-42 years. The tools used in the study were a self-developed questionnaire and the NHP questionnaire. The study was performed among women with pathological pregnancies and healthy pregnancies who delivered. Women with pathological pregnancies had pregnancy-induced hypertension, fetal hypotrophy, cholestasis, or gestational diabetes mellitus. Women with healthy pregnancies were recruited from the hospital ambulatory and cooperating private practices or during admission for delivery. RESULTS Group K had significantly lowest "TOTAL" intensity in relation to the other groups. For variable "PROBLEMS," a statistically significant difference was found between group K and group P (p=.001) and between group D and group P. CONCLUSIONS Every woman may experience a different level of satisfaction with life during pregnancy. This is typically determined by the personality of the given individual, as well as by pregnancy-associated emotions. It is important that health care personnel should provide psychological support and follow individual approach for each pregnant woman.
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Affiliation(s)
| | - Paweł Rzymski
- Department of Maternal and Child Health, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Ilona Parda
- Department of Maternal and Child Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Wilczak
- Department of Maternal and Child Health, Poznan University of Medical Sciences, Poznan, Poland
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14
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Rastad Z, Golmohammadian M, Jalali A, Kaboudi B, Kaboudi M. The effect of positive psychology intervention on quality of life among women with unintended pregnancy. J Educ Health Promot 2021; 10:165. [PMID: 34250099 PMCID: PMC8249986 DOI: 10.4103/jehp.jehp_784_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/11/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies have shown that quality of life in women with unintended pregnancy is significantly less than the ones with wanted gestation. Therefore, this study was aimed to determine the effect of intervention based on the positive psychology interventions on women's QoL with unintended pregnancies in Kermanshah, Iran. MATERIALS AND METHODS In this randomized clinical trial, 40 women with unintended pregnancy met the eligibility criteria and were randomized into experimental (n = 20) or control (n = 20) groups. The Short-form 36-item Questionnaire (SF-36) was administered at pretest, post-test, and six weeks after the intervention. Positive psychology interventions were performed in each session once a week for 10 weeks, with a duration of 90 minutes. The Friedman test and Mann-Whitney U-test were used to analyze QoL and all eight domains for within-group and between-group comparisons, respectively. The level of confidence was set at 0.05 significant. RESULTS Distribution of matched variables was not significantly different between the two trial groups. Over the intervention period, the mean of total scores of QoL and seven dimensions showed significant improvement among the experimental group, whereas in the control group, it decreased significantly (P < 0.05). In addition, in the posttest and follow-up stages, the mean score of six dimensions of QoL was higher than the control group (P < 0.05). CONCLUSION According to the results of the present study, unintended pregnancy has side effects on QoL in women. Positive counseling interventions can improve the quality of life in women with unintended pregnancy.
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Affiliation(s)
- Zahra Rastad
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Golmohammadian
- Department of Counseling, School of Social Sciences, Razi University, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, Substance Abuse Prevention Research Center, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bijan Kaboudi
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Marzieh Kaboudi
- Department of Reproductive Health, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Hoff E, Adams ZM, Grimshaw A, Goddard-Eckrich DA, Dasgupta A, Sheth SS, Meyer JP. Reproductive Life Goals: A Systematic Review of Pregnancy Planning Intentions, Needs, and Interventions Among Women Involved in U.S. Criminal Justice Systems. J Womens Health (Larchmt) 2021; 30:412-428. [PMID: 32589492 PMCID: PMC7957381 DOI: 10.1089/jwh.2019.7951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Women involved in criminal justice systems (WICJ) are affected by multilevel biological and sociocultural factors that result in adverse health outcomes and health disparities. Criminal justice systems (CJS) must be appropriately resourced to address these issues. Materials and Methods: We developed a systematic review to understand the intentions and needs for pregnancy prevention and planning among WICJ to inform future reproductive health services. We conducted a systematic literature review of epidemiologic and interventional studies that addressed the pregnancy prevention and planning needs of U.S. WICJ (2000-2019). An initial screen identified 7061 articles and 3 independent reviewers determined that 28 articles (16 descriptive studies in adults, 7 descriptive studies in adolescents, and 5 interventional studies) met inclusion criteria. Results: The literature review identified high rates of contraception underutilization and negative attitudes toward pregnancy among WICJ in a wide variety of settings. WICJ described minimal access to reproductive health services, including evidence-based contraception, and experienced high rates of unplanned and undesired pregnancies. Results were interpreted in the context of the reproductive justice (RJ) framework. Conclusions: The CJS, although not designed to provide health care, should dedicate resources to address the multilevel barriers to care experienced by women. WICJ require targeted, gender-responsive, trauma-informed pregnancy prevention and planning interventions that acknowledge the history of reproductive coercion in this population and address key aspects of RJ, including the right to and to not have a child.
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Affiliation(s)
- Emily Hoff
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Zoe M. Adams
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Alyssa Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Dawn A. Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Anindita Dasgupta
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Sangini S. Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaimie P. Meyer
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
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Vignato J, Perkhounkova Y, Saeidzadeh S, Patsais M, Inman M, Marie McCarthy A, Segre LS. Pathways from pain to physical and mental health-related quality of life during the third trimester of pregnancy: an exploratory mediation analysis. J Clin Nurs 2021; 30:1372-1382. [PMID: 33529358 DOI: 10.1111/jocn.15686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To understand how pain affects physical and mental health-related quality of life during the third trimester of pregnancy. BACKGROUND Poor health-related quality of life during pregnancy is associated with adverse maternal foetal health outcomes such as increased risk of low-birth-weight neonates. Poor health-related quality of life is linked to pain, pain interference and anxiety in the general adult population. However, we do not know how pain, pain interference (i.e., interference of pain with patient function), and anxiety are interrelated during the third trimester of pregnancy. METHODS This exploratory cross-sectional study followed STROBE guidelines. A mobile educational and tracking pregnancy application was used to obtain a racially/ethnically diverse convenience sample of 141 third trimester pregnant women from the U. S. In this sample, 58.2% of women had commercial health insurance, 68.8% were Caucasian, 86.5% were younger than 35 years, and 85.1% had a partner. Women completed demographics, Edinburgh Postnatal Depression Scale and the Brief Pain Inventory on REDCap. Path analysis was used to investigate a model for the relationships among pain intensity, pain interference, anxiety and physical and mental health-related quality of life. RESULTS Pain intensity affected health-related quality of life indirectly by increasing pain interference, which in turn, decreased both physical and mental health-related quality of life. In addition, pain interference also increased anxiety, which in turn worsened mental health-related quality of life, but not physical health-related quality of life. CONCLUSIONS Treating perinatal pain may improve health-related quality of life by decreasing pain interference and anxiety. RELEVANCE TO CLINICAL PRACTICE Nurses should assess for pain interference and anxiety in women experiencing moderate to severe pain during the third trimester of pregnancy. With this knowledge, nurses may advocate for women in receiving effective treatment for their conditions and improvements in their physical and mental health-related quality of life.
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Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Micayla Patsais
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Michaela Inman
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | - Lisa S Segre
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Aduloju OP, Akintayo AA, Adefisan AS, Aduloju T. Utilization of Long-Acting Reversible Contraceptive (LARC) Methods in a tertiary hospital in southwestern Nigeria: A Mixed Methods Study. J Obstet Gynaecol India 2021; 71:173-80. [PMID: 34149220 DOI: 10.1007/s13224-020-01386-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022] Open
Abstract
Background/Purpose There is an increasing trend in the utilization of long-acting reversible contraceptive (LARC) methods globally. The study assessed the utilization of LARC methods and its determinants in a tertiary hospital, southwestern Nigeria using a mixed method study. Methods A cross-sectional study of women attending the Family Planning Clinic of the tertiary hospital was conducted between November 1, 2018 and October 31, 2019 using both quantitative and qualitative methods. Quantitative data was collected using structured questionnaire while in-depth interviewer topic guide was used to obtain qualitative data from the respondents. The quantitative and qualitative data obtained from the respondents were analyzed using SPSS version 22 and open code version 3.6.2, respectively, and the determinants of utilization of LARC methods were identified using multivariate regression model. Results The current utilization rate of LARC methods was 65.6% and implants accounted for 75% of LARC used. Higher education (p = 0.035), more than 3 living children (p = 0.030), previous use of LARC (p = 0.028), good knowledge (p = 0.025) and positive attitude of the women about LARC (p = 0.026) were significant determinants of utilization among the women. Limiting size of family was the commonest reason among LARC users, while partner disapproval, fear of procedure and side effects were reasons given by non-users. Conclusions The utilization rate of LARC methods are high, and this should be sustained through improved information dissemination, education of women and involvement of male partners in reproductive health matters including family planning.
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Moghaddamhosseini V, Gyuró M, Makai A, Varga K, Hashemian M, Várnagy Á. Prenatal health-related quality of life assessment among Hungarian pregnant women using PROMIS-43. Clinical Epidemiology and Global Health 2021; 9:237-44. [DOI: 10.1016/j.cegh.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Voltas N, Arija V, Hernández-Martínez C, Nappi L, Cibelli G, Basora J, Canals J. Perinatal emotional states: a comparative study between two cohorts recruited in a Mediterranean environment. Women Health 2020; 61:221-234. [PMID: 33213300 DOI: 10.1080/03630242.2020.1847749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1st phase (3rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term.
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Affiliation(s)
- Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain.,Nutrition and Public Health Unit, Universitat Rovira I Virgili, Reus, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Josep Basora
- Institut d'Investigació en Atenció Primària Jordi Gol, Tarragona, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira I Virgili, Tarragona, Spain.,Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira I Virgili, Spain
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Lundsberg LS, Cutler AS, Stanwood NL, Yonkers KA, Gariepy AM. Association of Pregnancy Contexts with Depression and Low Social Support in Early Pregnancy. Perspect Sex Reprod Health 2020; 52:161-170. [PMID: 33047499 DOI: 10.1363/psrh.12155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/29/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Research into the relationship between pregnancy intention and perinatal depression or low social support is limited. Women's perspectives on pregnancy and their associations with perinatal depression could help in developing targeted efforts for screening and intervention. METHODS In 2014-2015, 161 women seeking pregnancy testing or abortion care at clinics in New Haven, Connecticut, were surveyed. They were asked about pregnancy context (intentions, planning, wantedness, desirability, timing and happiness), and the Edinburgh Depression Screen (EDS) and the Modified Kendler Social Support Index (MKSSI) were used to identify possible antenatal depression and low social support, respectively. Multivariable logistic regression analysis was employed to examine associations between pregnancy context and these outcomes. RESULTS On average, participants were 27 years old and at nine weeks' gestation. One-fifth reported a previous diagnosis of depression or anxiety, and 22% and 33% screened positive for depression (EDS scores of 13 or higher and 10 or higher, respectively); 52% received low social support (MKSSI score of 3.2 or less). Regression analysis found that pregnancies described as unintended, poorly timed or undesired were associated with depression at the higher cutoff (odds ratios, 3.2-4.5); all unfavorable pregnancy measures were associated with depression at the lower cutoff. Ambivalence regarding pregnancy timing, intention, wantedness and desirability was associated with increased odds of depression by either EDS score. Unplanned pregnancies and those about which the woman was ambivalent were associated with low social support. CONCLUSIONS Findings support the need to screen women for depression early in pregnancy and to integrate assessments of pregnancy context into the evaluation of potential risk factors.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Abigail S Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Kimberly A Yonkers
- Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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Abstract
Background: To evaluate the relationship between periconceptional (period before and/or after conception) substance use and unfavorable pregnancy contexts, including unintended pregnancy. Materials and Methods: This is a cross-sectional analysis of English- or Spanish-speaking women aged 16–44 years with pregnancies <24 weeks' gestation presenting to pregnancy testing clinics and enrolled between June 2014 and June 2015. Participants self-reported periconceptional substance use (tobacco, alcohol, marijuana, and other illicit substances during the 3 months before enrollment), and pregnancy “contexts,” including pregnancy intention, wantedness, planning, timing, desirability, and happiness. Multivariable logistic regression was performed adjusting for potential confounding variables. Results: We enrolled 123 women, averaging 27 ± 6 years, and mean gestational age 7.5 ± 3.0 weeks. Most participants were black, non-Hispanic (37%), or Hispanic (46%), and chose to complete the study in English (69%). Sixty-five percent participants reported use of one or more substances during prior 3 months: alcohol (54%), tobacco (31%), and marijuana (21%). In multivariate analysis, periconceptional alcohol use was associated with increased odds of unintended or ambivalent pregnancy and unwanted or mixed feelings regarding pregnancy (odds ratios [OR] = 3.29, 95% confidence interval [CI] 1.08–10.08 and OR = 2.81, 95% CI 1.07–7.36, respectively). Weekly or daily tobacco use was associated with unhappiness about pregnancy (OR = 7.56, 95% CI 1.65–34.51) and undesired or unsure pregnancy (OR = 4.00, 95% CI 1.14–14.06). Conclusions: Periconceptional alcohol or tobacco use demonstrates increased odds of specific unfavorable pregnancy contexts, including pregnancy described as undesired, unintended, unwanted, and unhappiness with pregnancy. Primary prevention of periconceptional substance use and the negative effects of alcohol and tobacco may be improved by increasing contraception access for women at risk for unfavorable pregnancy contexts.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Meredith J Pensak
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Abstract
OBJECTIVE Unplanned and poorly timed pregnancies are associated with adverse maternal and neonatal outcomes. Further understanding of preconception substance use with unplanned and poorly timed pregnancy is warranted. METHODS Data were analyzed from a prospective study enrolling women early in pregnancy. Preconception tobacco, alcohol, marijuana, opioid, and cocaine use was ascertained. Participants reported whether their current pregnancy was planned and whether it was a good time to be pregnant. Multivariable logistic regression modeling generated risk estimates for preconception substance use, and pregnancy planning and timing, adjusting for confounders. RESULTS Overall, 37.2% reported unplanned pregnancy, 13.0% poorly timed pregnancy, and 39.0% reported either unplanned and/or poorly timed pregnancy. Within 6 months preconception, one-fifth (20.2%) reported nicotine cigarette use. In the month before conception, 71.8% reported alcohol use, 6.5% marijuana, and approximately 1% opioid or cocaine use. Multivariable analysis demonstrated preconception opioid use was associated with increased odds of poorly timed pregnancy (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.03-7.99). Binge drinking the month before conception was associated with increased odds of poorly timed pregnancy and unplanned pregnancy (OR 1.75, 95% CI 1.01-3.05; and OR 1.68, 95% CI 1.01-2.79, respectively). Marijuana use 2 to 3 times in the month preconception was associated with increased risk of unplanned pregnancy, and unplanned and/or poorly timed pregnancy compared with nonuse (OR 1.78, 95% CI 1.03-3.08; and OR 1.79, 95% CI 1.01-3.17, respectively). Preconception tobacco or cocaine use was not associated with unplanned or poorly timed pregnancy following adjustment. CONCLUSIONS We demonstrate increased odds of unplanned or poorly timed pregnancy among women with preconception binge drinking, marijuana use, and opioid use; however, no association is observed with other substances after multivariable adjustment, including tobacco. Further research to evaluate high-level preconception substance use and substance disorders with pregnancy planning and timing is warranted. Focused efforts optimizing preconception health behaviors and reducing risk of unplanned or poorly timed pregnancy are needed.
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Affiliation(s)
- Lisbet S. Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
| | - Stephanie Peglow
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA 23507
| | - Neena Qasba
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
| | - Kimberly A. Yonkers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520
| | - Aileen M. Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
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Alzboon G, Vural G. Factors Influencing the Quality of Life of Healthy Pregnant Women in North Jordan. Medicina (Kaunas) 2019; 55:E278. [PMID: 31208100 PMCID: PMC6631935 DOI: 10.3390/medicina55060278] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Quality of life (QOL) assessment during pregnancy contributes to determining women's unmet needs and preventing negative health outcomes. In this study, we aimed to identify the effects of participants' characteristics, perceived stress, and perceived social support on their QOL. We also aimed to determine the differences in QOL according to these factors. Materials and Methods: A cross-sectional study was carried out in a city in Jordan. Purposive sampling was used to select 218 participants. Data was collected by the quality of life Short Form- 36(SF-36) survey, perceived stress scale (PSS), and The Multidimensional perceived Social Support Scale (MSPSS). Results: We found that only parity had a significant effect on the QOL. High-parity women had lower QOL scores than low-parity women. The participants reported high social support, specifically from their families and significant others. The 36-Item Short-Form Health Survey was a reliable tool for measuring the QOL in pregnancy. Conclusions: Parity factor and social support should be recognized in any health promotion intervention and during providing antenatal care. Further research is needed toassess the QOL during pregnancy.
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Affiliation(s)
- Ghadeer Alzboon
- Department of Birth and Women's Health Nursing, Near East University, 99138 Nicosia, Cyprus, via Mersin 10, Turkey.
| | - Gülşen Vural
- Department of Birth and Women's Health Nursing, Near East University, 99138 Nicosia, Cyprus, via Mersin 10, Turkey.
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24
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Hill B, Kothe EJ, Currie S, Danby M, Lang AY, Bailey C, Moran LJ, Teede H, North M, Bruce LJ, Skouteris H. A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing. Prev Med Rep 2019; 14:100869. [PMID: 31011520 PMCID: PMC6465583 DOI: 10.1016/j.pmedr.2019.100869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to conduct a systematic mapping review of the literature that explored associations of pregnancy intentions with health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Six databases were searched (May 2017) for papers relating to pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing. The literature was mapped according to the preconception or pregnancy period; prospective or retrospective variable assessment; and reported lifestyle behaviours and psychological wellbeing outcomes. Of 19,430 retrieved records, 303 studies were eligible. Pregnancy intentions were considered during the preconception period in 103 studies (only 23 assessed prospectively), and during the pregnancy period in 208 studies (141 prospectively). Associations between pregnancy intention and preconception behaviours/psychological wellbeing were primarily reported for supplement use (n = 58) and were lacking for diet/exercise, and psychological factors. For behaviours/psychological wellbeing during pregnancy, associations with pregnancy intention were focused on prenatal care (n = 79), depression (n = 61), and smoking (n = 56) and were lacking for diet/exercise. Only 7 studies assessed pregnancy intentions with a validated tool. Despite a large body of literature, there were several methodological limitations identified, namely assessment of pregnancy intentions with non-validated measures and the reliance on retrospective assessment. Future primary studies are needed to fill gaps in our understanding regarding energy-balance-related behaviours. Future studies (including reviews/meta-analyses) should take care to address the noted limitations to provide a comprehensive and accurate understanding of the relationships between pregnancy intentions and health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Reliance on the assessment of pregnancy intentions with non-validated measures Reliance on retrospective assessment Studies on preconception pregnancy intentions and diet/exercise lacking
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Affiliation(s)
- Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia.,School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Emily J Kothe
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Sinéad Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, FK9 4LA, United Kingdom
| | - Meaghan Danby
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Madelon North
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Lauren J Bruce
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
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25
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Olakunde BO, Sam-Agudu NA, Patel TY, Hunt AT, Buffington AM, Phebus TD, Onwasigwe E, Ezeanolue EE. Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators. Contraception 2019; 99:205-211. [PMID: 30685286 DOI: 10.1016/j.contraception.2018.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa. STUDY DESIGN We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model. RESULTS We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level). CONCLUSIONS Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.
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Affiliation(s)
- Babayemi O Olakunde
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tanviben Y Patel
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T Hunt
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aurora M Buffington
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA; University of Nevada Cooperative Extension, Las Vegas, NV, USA
| | - Tara D Phebus
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | | | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria; HealthySunrise Foundation, Las Vegas, NV, USA
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26
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McNamara BC, Cutler A, Lundsberg L, Kennedy HP, Gariepy A. "I'm used to doing it by myself": exploring self-reliance in pregnancy. BMC Pregnancy Childbirth 2018; 18:393. [PMID: 30290785 PMCID: PMC6173858 DOI: 10.1186/s12884-018-2022-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-reliance (the need to rely on one's own efforts and abilities) is cited as a potential coping strategy for decreased or absent social support during pregnancy. Little data exists on how women view self-reliance in pregnancy. METHODS We recruited women from urban, walk-in pregnancy testing clinics from June 2014-June 2015. Women aged 16 to 44 and at less than 24 weeks gestational age were eligible. Participants completed an enrollment survey and in-person, semi-structured interviews. We used framework analysis to identify key concepts and assess thematic relationships. RESULTS Eighty-four English-speaking women completed qualitative interviews. Participants averaged 26 years of age and 7 weeks estimated gestational age. Most identified as Black (54%) or Hispanic (20%), were unemployed or homemakers (52%), unmarried (92%), and had at least one child (67%). Most did not intend to get pregnant (61%) and planned to continue their pregnancy and parent (65%). We identified self-reliance as a prevalent concept that almost half (48%) of participants discussed in relationship to their pregnancy. Self-reliance in pregnancy consisted of several subthemes: 1) past experiences, 2) expectations of motherhood, 3) financial independence, 4) decision making, and 5) parenting. CONCLUSIONS Self-reliance is an important aspect of women's reproductive lives and is threaded through women's past and current thoughts, feelings, experiences and decisions about pregnancy. Women's belief in their own self-reliance as well as a recognition of the limits of self-reliance merits further research, especially as a potential strategy to cope with decreased or absent social support during pregnancy.
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Affiliation(s)
- Blair C McNamara
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
| | - Abigail Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | | | - Aileen Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Dehlendorf C, Reed R, Fox E, Seidman D, Hall C, Steinauer J. Ensuring our research reflects our values: The role of family planning research in advancing reproductive autonomy. Contraception 2018; 98:4-7. [PMID: 29545022 PMCID: PMC6033836 DOI: 10.1016/j.contraception.2018.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/23/2018] [Accepted: 03/07/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Christine Dehlendorf
- Department of Family & Community Medicine, UCSF, San Francisco, CA; Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA; UCSF Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA.
| | - Reiley Reed
- Department of Family & Community Medicine, UCSF, San Francisco, CA.
| | - Edith Fox
- Department of Family & Community Medicine, UCSF, San Francisco, CA.
| | - Dominika Seidman
- UCSF Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA.
| | - Cara Hall
- Duke University Department of Family & Community Medicine, Durham, NC.
| | - Jody Steinauer
- UCSF Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA.
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28
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Kemet S, Lundsberg LS, Gariepy AM. Race and ethnicity may not be associated with risk of unintended pregnancy. Contraception 2018; 97:313-8. [PMID: 29288654 DOI: 10.1016/j.contraception.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to use improved measures and methodology to investigate whether race and ethnicity are associated with unintended pregnancy. STUDY DESIGN Cross-sectional study of English- or Spanish-speaking women, aged 16-44, with pregnancies <24weeks' gestation recruited from pregnancy testing and abortion care sites in New Haven, CT, between June 2014 and June 2015. Participants completed self-assessments of race, ethnicity and multidimensional measures of pregnancy "context," including timing, intention, wantedness, desirability, happiness and planning (measured with the London Measure of Unplanned Pregnancy). Multivariable analysis was performed, adjusting for maternal demographics, language, recruitment site, substance use and medical conditions including history of depression. RESULTS Among 161 participants (mean age=27.2±6.6years), mean gestational age was 9±4.6weeks. Overall, 14% self-identified as White non-Hispanic, 37% Black non-Hispanic, 42% Hispanic and 7% multiracial. Most (85%) were unmarried, and 75% had at least one child. After adjustment, happiness about new pregnancies was more likely among Black non-Hispanic than White non-Hispanic women OR=5.66 (95%CI: 1.51-21.20). Neither race nor ethnicity was significantly associated with pregnancy intention, wantedness, planning, timing or desirability. CONCLUSION In a diverse cohort with multiple, antenatal measures of pregnancy context, neither race nor ethnicity is significantly associated with unintended pregnancy, as previous studies reported. Black non-Hispanic women were more likely to report happiness about new pregnancies than White non-Hispanic women. This study improves upon previous analyses that used retrospective and limited assessments of pregnancy intention, excluded women with miscarriages or abortions, and lacked adjustment for confounding. IMPLICATIONS Evaluation of multidimensional pregnancy contexts assessed antenatally is important and may capture the experiences of women more accurately, especially Black and Hispanic women.
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29
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Lundsberg LS, Xu X, Schwarz EB, Gariepy AM. Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women. Contraception 2017; 96:411-419. [PMID: 28823842 PMCID: PMC6267929 DOI: 10.1016/j.contraception.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts. STUDY DESIGN Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014-June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics. RESULTS Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28-0.91), PROMIS GSF-derived utility (0.66-0.75), SG (0.985-1.00) or TTO (0.9990-0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. CONCLUSIONS Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. IMPLICATIONS Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Eleanor B Schwarz
- Department of Internal Medicine, University of California Davis, Davis, CA
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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30
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Cutler A, McNamara B, Qasba N, Kennedy HP, Lundsberg L, Gariepy A. "I Just Don't Know": An Exploration of Women's Ambivalence about a New Pregnancy. Womens Health Issues 2017; 28:75-81. [PMID: 29108986 DOI: 10.1016/j.whi.2017.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to examine how ambivalence manifests in women's lives after confirmation of a new pregnancy by exploring women's feelings, attitudes, and experiences regarding pregnancy intentions, the news itself, and related pregnancy decision making. STUDY DESIGN We recruited women aged 15 to 44 and at less than 24 completed weeks of gestational age from urban, walk-in pregnancy testing clinics in New Haven, Connecticut, from June 2014 to June 2015. We obtained quantitative and qualitative data via an enrollment survey and face-to-face, semistructured interviews, respectively. Transcripts were analyzed using framework analysis. RESULTS The sample included 84 women. Participants had a mean age of 26 years and were on average 7 weeks estimated gestational age at enrollment. Most identified as Black (54%) or Hispanic (20%), were unmarried (92%), and had at least one other child (67%). More than one-half (55%) described feelings of ambivalence regarding their current pregnancy. We identified ambivalence as a frequent and complex thread that represented distinct but overlapping perspectives about pregnancy: ambivalent pregnancy intentions, ambivalent response to new diagnosis of pregnancy, and ambivalence as uncertainty or conflict over pregnancy decision-making. Sources of ambivalence included relationship status, pregnancy timing, and maternal or fetal health problems. CONCLUSIONS This study improves on previous findings that focus only on ambivalence related to pregnancy intention or to decision making, and explores women's mixed, fluctuating, or unresolved feelings and attitudes about pregnancy before many participants had completed pregnancy decision making. Acknowledging and exploring sources of ambivalence regarding pregnancy may help health providers and policymakers to comprehensively support women with respect to both their experiences and reproductive goals.
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Affiliation(s)
- Abigail Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
| | | | - Neena Qasba
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | | | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Aileen Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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