1
|
Schmidt M, Schaefer-Graf UM. The German guideline "Obesity in pregnancy": comparison with the international approach. Arch Gynecol Obstet 2024; 309:1699-1705. [PMID: 38180566 DOI: 10.1007/s00404-023-07314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Obesity is an increasing problem, even in young women of reproductive age. Obesity has a negative impact on conception, the course of pregnancy, and neonatal outcomes. Caring for obese pregnant women has becoming an important aspect of standard prenatal care. The Guideline "Obesity and Pregnancy" of the German Society of Gynecology and Obstetrics aims to create evidence-based recommendations which can be used to improve the care of obese pregnant women. As obesity is a worldwide problem, many societies for obstetrics and gynecology have created national guidelines. METHODS We reviewed the following guidelines for obesity and pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2021, Royal College of Obstetrics and Gynecology (RCOG) 2018; AND Society of Obstetricians and Gynecologists of Canada (SOGC) 2019. These guidelines were compared to the German guideline. RESULTS There are some variations between the guidelines, though no major contradictions exist. Disparities were found regarding the recommendations for substitution of high folic acid and Vitamin D. Furthermore, the recommended time for screening for gestational diabetes and the methods to control fetal growth differ between the guidelines. Regarding place of birth, RCOG allows delivery in midwifery-led units in the absence of other high-risk circumstances, while others request facility of care by neonatologists and medical staff trained in care of obese women. Induction of labor at term due to increased risk of intrauterine demise is mostly limited to women with a body mass index of 40 kg/m2. Only one guideline considers induction of all obese women. For intrapartum management, the majority allows tolerating of longer labor times to delivery if fetal monitoring is sufficient and fetal stress is excluded. Special encouragement of breastfeeding and healthy lifestyle is commonly recommended; only in the Canadian guideline, postpartum depression evaluation is requested due to the overall high prevalence of depression and anxiety in obese women. CONCLUSION All guidelines consider pregnancies in obese women as high-risk pregnancies and emphasize the need for preconception counseling. There are special needs in pregnancy care and in the intrapartum and postpartum management to be observed.
Collapse
Affiliation(s)
- Markus Schmidt
- Department of Gynecology and Obstetrics, Sana Clinics Duisburg, Zu den Rehwiesen 3, 47055, Duisburg, Germany.
| | - U M Schaefer-Graf
- Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| |
Collapse
|
2
|
Brown HK, Mitra M. Perinatal health framework for people with intellectual disability. Disabil Health J 2024; 17:101576. [PMID: 38216418 DOI: 10.1016/j.dhjo.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
We propose a framework for guiding research on perinatal health in people with intellectual disability (ID). We developed this framework based on the perinatal health framework for people with physical disabilities, American Association on Intellectual and Developmental Disabilities conceptual framework of human functioning, disability reproductive justice framework, trauma-informed care, and socio-ecological model. The framework reflects health outcomes of birthing people with ID and their infants that result from interactions of factors across the life course at policy (health, social, and disability policies), community (attitudes, social and physical environment), institutional (health care delivery-related factors, access to information/resources), interpersonal (social determinants of health/histories of trauma, social support, interactions with service-providers), and individual levels (demographics, intellectual functioning, adaptive behavior, health conditions, genetic factors, psychosocial factors, health behaviors). This framework will facilitate research to identify factors leading to perinatal health disparities in people with ID and development and evaluation of resources to address them.
Collapse
Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| |
Collapse
|
3
|
Albert L, Romero A, Capel I, Cano A, Subías D, Casamitjana L, Mazarico I, Rigla M. Off-label use of an automated insulin delivery system in pregnant women with type 1 diabetes. Diabetes Res Clin Pract 2023; 202:110800. [PMID: 37364659 DOI: 10.1016/j.diabres.2023.110800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
Using commercially available automated insulin delivery (AID) systems for treating type 1 diabetes during pregnancy remains controversial. This retrospective study assessed six pregnant women with type 1 diabetes who underwent AID therapy. Our observations revealed that AID treatment, in most cases, did not achieve the desired glycemic targets for pregnancy.
Collapse
Affiliation(s)
- Lara Albert
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain.
| | - Ana Romero
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - Ismael Capel
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - Albert Cano
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - David Subías
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - Laia Casamitjana
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - Isabel Mazarico
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| | - Mercedes Rigla
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain
| |
Collapse
|
4
|
Du Y, McNestry C, Wei L, Antoniadi AM, McAuliffe FM, Mooney C. Machine learning-based clinical decision support systems for pregnancy care: A systematic review. Int J Med Inform 2023; 173:105040. [PMID: 36907027 DOI: 10.1016/j.ijmedinf.2023.105040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Clinical decision support systems (CDSSs) can provide various functions and advantages to healthcare delivery. Quality healthcare during pregnancy and childbirth is of vital importance, and machine learning-based CDSSs have shown positive impact on pregnancy care. OBJECTIVE This paper aims to investigate what has been done in CDSSs in the context of pregnancy care using machine learning, and what aspects require attention from future researchers. METHODS We conducted a systematic review of existing literature following a structured process of literature search, paper selection and filtering, and data extraction and synthesis. RESULTS 17 research papers were identified on the topic of CDSS development for different aspects of pregnancy care using various machine learning algorithms. We discovered an overall lack of explainability in the proposed models. We also observed a lack of experimentation, external validation and discussion around culture, ethnicity and race from the source data, with most studies using data from a single centre or country, and an overall lack of awareness of applicability and generalisability of the CDSSs regarding different populations. Finally, we found a gap between machine learning practices and CDSS implementation, and an overall lack of user testing. CONCLUSION Machine learning-based CDSSs are still under-explored in the context of pregnancy care. Despite the open problems that remain, the few studies that tested a CDSS for pregnancy care reported positive effects, reinforcing the potential of such systems to improve clinical practice. We encourage future researchers to take into consideration the aspects we identified in order for their work to translate into clinical use.
Collapse
Affiliation(s)
- Yuhan Du
- UCD School of Computer Science, University College Dublin, Dublin, Ireland
| | - Catherine McNestry
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Lan Wei
- UCD School of Computer Science, University College Dublin, Dublin, Ireland
| | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Catherine Mooney
- UCD School of Computer Science, University College Dublin, Dublin, Ireland.
| |
Collapse
|
5
|
Lundholm MD, Marquard J, Rao PP. Paraganglioma in pregnancy, a mimic of preeclampsia: a case report. J Med Case Rep 2023; 17:124. [PMID: 37024931 PMCID: PMC10080865 DOI: 10.1186/s13256-023-03871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. CASE PRESENTATION We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new onset hypertension associated with headaches, dry heaves, diaphoresis, and palpitations. She was initially diagnosed with preeclampsia and treated with labetalol and an urgent cesarean section, delivering a healthy baby girl. The diagnosis of preeclampsia came into question when, 6 weeks postpartum, she continued to have hypertension with atypical features. Testing revealed metastatic paraganglioma associated with a succinate dehydrogenase B gene mutation. The patient was then started on alpha-adrenergic blockade and has had close blood pressure monitoring while discussion of advances therapies is ongoing. CONCLUSION This case demonstrates how paraganglioma/pheochromocytoma can be misdiagnosed as preeclampsia due to the overlapping features of new-onset hypertension late in pregnancy accompanied by headache and proteinuria. It is impractical to routinely screen for paraganglioma/pheochromocytoma in all pregnant patients diagnosed with preeclampsia due to the rarity of these tumors and the harm from high false-positive rates. Therefore, it is incumbent on the provider to have a high degree of suspicion for paraganglioma/pheochromocytoma when clinical features are unusual for preeclampsia, such as intermittent palpitations, diaphoresis, orthostatic hypotension, or hyperglycemia. Early detection of paraganglioma/pheochromocytoma with interventions to mitigate the risk of hypertensive crisis greatly reduce maternal and fetal mortality. Fortunately, our patient delivered a healthy baby and did not have any additional pregnancy complications despite the delay in her diagnosis.
Collapse
Affiliation(s)
- Michelle D Lundholm
- Department of Endocrinology, Diabetes and Metabolism Cleveland Clinic, 9500 Euclid Avenue, F20, Cleveland, OH, 44195, USA.
| | - Jessica Marquard
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Pratibha Pr Rao
- Department of Endocrinology, Diabetes and Metabolism Cleveland Clinic, 9500 Euclid Avenue, F20, Cleveland, OH, 44195, USA
| |
Collapse
|
6
|
Azugbene EA. Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature. Matern Child Health J 2023:10.1007/s10995-023-03644-1. [PMID: 36988796 DOI: 10.1007/s10995-023-03644-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. METHODS Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. RESULTS The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. DISCUSSION Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.
Collapse
Affiliation(s)
- Ehiremen Adesua Azugbene
- Maternal and Child Health Translational Research Team (MCHTRT), College of Public Health Solutions, Arizona State University, Phoenix, AZ, United States.
| |
Collapse
|
7
|
Szmuilowicz ED, Levy CJ, Buschur EO, Polsky S. Expert Guidance on Off-Label Use of Hybrid Closed-Loop Therapy in Pregnancies Complicated by Diabetes. Diabetes Technol Ther 2023; 25:363-373. [PMID: 36724300 DOI: 10.1089/dia.2022.0540] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Indexed: 02/03/2023]
Abstract
Automated insulin delivery (AID) systems have established benefits in terms of glycemic control, health outcomes, and quality of life and are strongly recommended for people with type 1 diabetes outside of pregnancy. While evidence for use of investigational AID systems during pregnancy is promising, data and guidance are still needed regarding use of commercially available systems during pregnancy. Unfortunately, none of the hybrid closed-loop (HCL) systems that are currently available in the United States have glucose targets that are as aggressive as pregnancy glycemic targets, none have a pregnancy-specific algorithm, and none are approved for use during pregnancy. As such, any use of these systems during pregnancy is considered off-label in the United States and would be "assisted" by provider/user techniques. Despite these limitations, many women conceive while using clinically available HCL systems and may be hesitant to cease use during pregnancy. Achievement of strict pregnancy glycemic targets can be difficult, and it is conceivable that selective off-label use of clinically available HCL systems in some women could lead to improved glycemia. We herein offer expert guidance based on clinical experience and available case reports on how to identify appropriate candidates for HCL therapy in pregnancy, how to counsel pregnant women with diabetes on the potential risks and benefits of HCL therapy during pregnancy, and how to manage commercially available systems off-label throughout gestation in an assisted HCL approach.
Collapse
Affiliation(s)
- Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carol J Levy
- Divisions of Endocrinology and Obstetrics, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth O Buschur
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
8
|
Kozica-Olenski SL, Soldatos G, Marlow L, Cooray SD, Boyle JA. Exploring the acceptability and experience of receiving diabetes and pregnancy care via telehealth during the COVID-19 pandemic: a qualitative study. BMC Pregnancy Childbirth 2022; 22:932. [PMID: 36514010 PMCID: PMC9745277 DOI: 10.1186/s12884-022-05175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic. METHODS In-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied. RESULTS Eigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality. CONCLUSION In this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond.
Collapse
Affiliation(s)
- S. L. Kozica-Olenski
- grid.1002.30000 0004 1936 7857Monash Centre for Health Research and Implementation, Monash University, Melbourne, Locked Bag 29, Clayton, Victoria 3168 Australia
| | - G. Soldatos
- grid.1002.30000 0004 1936 7857Monash Centre for Health Research and Implementation, Monash University, Melbourne, Locked Bag 29, Clayton, Victoria 3168 Australia ,grid.419789.a0000 0000 9295 3933Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - L. Marlow
- grid.1002.30000 0004 1936 7857Monash Centre for Health Research and Implementation, Monash University, Melbourne, Locked Bag 29, Clayton, Victoria 3168 Australia
| | - S. D. Cooray
- grid.1002.30000 0004 1936 7857Monash Centre for Health Research and Implementation, Monash University, Melbourne, Locked Bag 29, Clayton, Victoria 3168 Australia ,grid.419789.a0000 0000 9295 3933Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - J. A. Boyle
- grid.419789.a0000 0000 9295 3933Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria Australia ,grid.1002.30000 0004 1936 7857Eastern Health Clinical School, Monash University, Box Hill, Melbourne, Australia
| |
Collapse
|
9
|
Buultjens M, Gill J, Fielding J, Lambert KA, Vondeling K, Mastwyk SE, Sloane S, Fedele W, Karimi L, Milgrom J, von Treuer K, Erbas B. Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health? Women Birth 2022; 36:305-313. [PMID: 36184532 PMCID: PMC9551992 DOI: 10.1016/j.wombi.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
Background The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing. Aim To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. Methods Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. Findings Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). Discussion The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. Conclusion This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.
Collapse
Affiliation(s)
- Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Jessica Gill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jennifer Fielding
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kirsty Vondeling
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sally E Mastwyk
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sarita Sloane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Wendy Fedele
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Applied Health, Psychology Department, RMIT University, Melbourne, Australia.
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | | | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
10
|
Zhang Y, Tayarani M, Wang S, Liu Y, Sharma M, Joly R, RoyChoudhury A, Hermann A, Gao OH, Pathak J. Identifying urban built environment factors in pregnancy care and maternal mental health outcomes. BMC Pregnancy Childbirth 2021; 21:599. [PMID: 34481472 PMCID: PMC8417675 DOI: 10.1186/s12884-021-04056-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Backgrounds Risk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting. Methods In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients’ residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study. Results We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality. Conclusions In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04056-1.
Collapse
Affiliation(s)
- Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA. .,Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Mohammad Tayarani
- School of Civil and Environmental Engineering, Cornell University, Ithaca, NY, USA
| | | | - Yifan Liu
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA
| | - Mohit Sharma
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Oliver H Gao
- School of Civil and Environmental Engineering, Cornell University, Ithaca, NY, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
11
|
Laksono AD, Wulandari RD, Matahari R. The determinant of health insurance ownership among pregnant women in Indonesia. BMC Public Health 2021; 21:1538. [PMID: 34380463 PMCID: PMC8359302 DOI: 10.1186/s12889-021-11577-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health insurance ownership is one indicator of the readiness of pregnant women for the delivery process. The study aimed to analyze the determinants of health insurance ownership among pregnant women in Indonesia. METHODS The study population was pregnant women in Indonesia. The study involved 2542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. In the final step, the study employed binary logistic regression to explain the relationship between health insurance ownership and predictor variables. RESULTS The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don't see the danger signs of pregnancy to have health insurance. CONCLUSIONS The study concluded that four variables, including education level, wealth status, parity, and knowledge of the danger signs of pregnancy, were significant determinants of health insurance ownership in Indonesia.
Collapse
Affiliation(s)
- Agung Dwi Laksono
- The Ministry of Health of the Republic of Indonesia, National Institute of Health Research and Development, Jakarta, Indonesia.
| | | | - Ratu Matahari
- Faculty of Public Health, Ahmad Dahlan University, Jogjakarta, Indonesia
| |
Collapse
|
12
|
Mahey R, Sharma A, Kumari A, Kachhawa G, Gupta M, Meena J, Bhatla N. The impact of a segregated team roster on obstetric and gynecology services in response to the COVID-19 pandemic in a tertiary care center in India. Int J Gynaecol Obstet 2020; 151:341-346. [PMID: 33011974 PMCID: PMC9087524 DOI: 10.1002/ijgo.13408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/23/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
Objective To determine the impact of roster reorganization on ensuring uninterrupted services while providing necessary relief to healthcare workers (HCW) in the obstetrics department of a tertiary care center amid the COVID‐19 outbreak. Methods The COVID‐19 rostering response began in April 2020 and evolved in two phases: (1) development of new areas for screening and managing suspected/positive cases of COVID‐19; and (2) team segregation according to area of work. The impact of these changes on HCWs and patients was assessed 3 months later. Results Developing separate areas helped to minimize the risk of exposure of patients and HCWs to those with COVID‐19. Residents and consultants worked intensively in clinical areas for 1 week followed by 1–2 weeks of non‐clinical or standby assignments, providing adequate opportunity for isolation. Frequent re‐evaluation of the roster was nevertheless required as the pandemic progressed. Segregating teams vertically significantly reduced the number of contacts identified on contact tracing and quarantine leaves, while maintaining patient satisfaction with no increase in adverse events. Residents found the roster to be “smart” and “pandemic‐appropriate.” Conclusion The “COVID emergency roster” helped ensure quality care with minimum risk of exposure and sufficient breaks for physical and psychological recovery of HCWs.
Collapse
Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| |
Collapse
|
13
|
Merlino L, Del Prete F, Titi L, Piccioni MG. Cerebral cavernous malformation: Management and outcome during pregnancy and puerperium. A systematic review of literature. J Gynecol Obstet Hum Reprod 2021; 50:101927. [PMID: 33035718 DOI: 10.1016/j.jogoh.2020.101927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral cavernomas malformations (CCMs) are vascular malformations that occur with an incidence of 0,4-0,8 % in general population. The most feared complication is cerebral hemorrhage. Currently there are no guidelines for pregnant women with CCMs. Some authors claimed that many physiological changes related to pregnancy could be linked to an high risk of rupture and bleeding of the cerebral cavernoma. However, more recent studies highlight that the presence of cerebral cavernomatosis is not a contraindication for pregnancy and that the risk of bleeding is similar in pregnant and in non-pregnant women. AIM OF THE STUDY The purpose of our work is to analyze, through the study of controversial findings in literature, all the information currently available trying to establish a common approach for management of women with cerebral cavernomatosis in pregnancy, during childbirth and in the puerperium. FINDINGS In accordance with existing literature, pregnancy does not appear to be a significant risk factor for the worsening of clinical manifestations associated with the presence of CCMs. Vaginal delivery is not contraindicated in patients with CCMs and there is no indication to perform cesarean section to reduce the incidence of hemorrhage. The only indication for neurosurgery of CCMs in pregnancy is the presence of rapidly progressive symptoms and should be postponed to the puerperium if arises after 30 weeks. The puerperium is a critical time for the woman with cavernomas for the possibility of bleeding and clinical observation must be continued. CONCLUSION The patients with a diagnosis of a CCMs can have a pregnancy without any particular risk to themselves and the fetus but should be addressed to highly specialized obstetrics center to assesses the initial individual risk related to their pathology and to follow the pregnancy.
Collapse
|
14
|
Dehingia N, Dixit A, Atmavilas Y, Chandurkar D, Singh K, Silverman J, Raj A. Unintended pregnancy and maternal health complications: cross-sectional analysis of data from rural Uttar Pradesh, India. BMC Pregnancy Childbirth 2020; 20:188. [PMID: 32228511 PMCID: PMC7106893 DOI: 10.1186/s12884-020-2848-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications. METHODS Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh (N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications. RESULTS Around one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57-2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01-2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47-3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage (p < 0.001). CONCLUSION Unintended pregnancy is associated with increased risk for maternal health complications, but provision of ANC clinical visits and CHW home visits in pregnancy may be able to reduce potential effects of unintended pregnancy on maternal health.
Collapse
Affiliation(s)
- Nabamallika Dehingia
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, USA
| | - Anvita Dixit
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, USA
| | - Yamini Atmavilas
- Bill and Melinda Gates Foundation, 5th Floor, Capital Court, Olof Palme Marg, Munirka, New Delhi, India
| | - Dharmendra Chandurkar
- Sambodhi Research and Communications Pvt. Ltd., C-126, Sector -2, Noida, Uttar Pradesh 201301 India
| | - Kultar Singh
- Sambodhi Research and Communications Pvt. Ltd., C-126, Sector -2, Noida, Uttar Pradesh 201301 India
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA USA
| |
Collapse
|
15
|
Żółkowska J, Hozyasz K, Ph D. Low increase in phenylalanine tolerance during pregnancies in PKU woman with high prepregnancy BMI and postconceptional initiation of diet: A case report. Int J Reprod Biomed 2019; 17:763-770. [PMID: 31807725 PMCID: PMC6844282 DOI: 10.18502/ijrm.v17i10.5302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/12/2018] [Revised: 04/27/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Women with untreated phenylketonuria (PKU) are at an increased risk to have offspring with multiple abnormalities due to teratogenic effects of hyperphenylalaninaemia. Treatment goals include blood phenylalanine concentrations between 120 and 360 µmol/L, however, there are limited pieces of evidence for the practical management of pregnant PKU patient and prediction of phenylalanine tolerance changes during a course of pregnancy. Case We report the case of a mother with classical PKU (p.R408W/p.R408W) and the course of her two pregnancies with low phenylalanine tolerance increase (347mg and 227mg) despite the rewarding collaboration with a nutritionist. Conclusion This case report does not confirm the observation that a very low phenylalanine tolerance increase in pregnancy of PKU patient is a marker of coexisting PKU-affection in fetus.
Collapse
Affiliation(s)
| | - Kamil Hozyasz
- Institute of Health Sciences, State School of Higher Education, Biała Podlaska, Poland
| | - Ph D
- PKU Polyclinic, Institute of Mother and Child, Warsaw, Poland.,Institute of Health Sciences, State School of Higher Education, Biała Podlaska, Poland
| |
Collapse
|
16
|
Ghi T, Dall'Asta A, Valensise H. Antenatal Care of Preeclampsia: From the Inverted Pyramid to the Arrow Model? Fetal Diagn Ther 2018; 44:81-84. [PMID: 30001543 DOI: 10.1159/000490047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
The recent demonstration of the effectiveness of low-dose aspirin administered from the first trimester in the prevention of preeclampsia will probably lead to establishing and radicating the "inverted pyramid" screening model for preeclampsia. Such a multiparametric approach for the screening of preeclampsia in the first trimester, albeit highly sensitive in identifying early-onset disease, is poor at screening the forms of preeclampsia occurring close to term. Late-onset preeclampsia is 3 to 6 times more common than early-onset preeclampsia and currently represents the major determinant of maternal morbidity related to hypertensive disorders of the pregnancy. On this ground, we discuss our idea to construct a second "screening checkpoint" in the third trimester with the aim of reassessing the risk of preeclampsia of those women who screened negative in the first trimester. If implemented, the sequential screening model we propose would convert the "inverted pyramid model" into an "arrow model" for the antenatal care of preeclampsia.
Collapse
Affiliation(s)
- Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Herbert Valensise
- Obstetrics and Gynaecology Unit, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
17
|
Rump A, Schöffski O. Pregnancy care in Germany, France and Japan: an international comparison of quality and efficiency using structural equation modelling and data envelopment analysis. Public Health 2018; 160:129-42. [PMID: 29803690 DOI: 10.1016/j.puhe.2018.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Healthcare systems in developed countries may differ in financing and organisation. Maternity services and delivery are particularly influenced by culture and habits. In this study, we compared the pregnancy care quality and efficiency of the German, French and Japanese healthcare systems. STUDY DESIGN Comparative healthcare data analysis. METHODS In an international comparison based mainly on Organisation for Economic Co-operation and Development (OECD) indicators, we analysed the health resources significantly affecting pregnancy care and quantified its quality using structural equation modelling. Pregnancy care efficiency was studied using data envelopment analysis. Pregnancy output was quantified overall or separately using indicators based on perinatal, neonatal or maternal mortality. RESULTS The density of obstetricians, midwives, paediatricians and the average annual doctor's consultations were positively and the caesarean delivery rate negatively associated with pregnancy outcome. In the international comparison at an aggregate level, Japan ranked first for pregnancy care quality, whereas Germany and France were positioned in the second part of the ranking. Similarly, at an aggregate level, the Japanese system showed pure technical efficiency, whereas Germany and France revealed mediocre efficiency results. Perinatal, neonatal and maternal care quality and efficiency taken separately were quite similar and mediocre in Germany and France. In Japan, there was a marked difference between a highly effective and efficient care of the unborn and newborn baby, and a rather mediocre quality and efficiency of maternal care. CONCLUSION Germany, France, and Japan have to struggle with quality and efficiency issues that are nevertheless different: in Germany and France, disappointing pregnancy care quality does not correspond to the high health care expenditures and lead to low technical efficiency. The Japanese system shows a high variability in outcomes and technical efficiency. Maternal care quality during delivery seems to be a particular issue that could possibly be addressed by legally implementing quality assurance systems with stricter rules for reimbursement in obstetrics.
Collapse
|
18
|
Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. Health Econ Rev 2018; 8:7. [PMID: 29525909 PMCID: PMC5845483 DOI: 10.1186/s13561-018-0190-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/02/2018] [Indexed: 05/23/2023]
Abstract
Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.
Collapse
Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
| |
Collapse
|
19
|
Simpson M, Schmied V, Dickson C, Dahlen HG. Postnatal post-traumatic stress: An integrative review. Women Birth 2018; 31:367-379. [PMID: 29337007 DOI: 10.1016/j.wombi.2017.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
PROBLEM Post-traumatic stress disorder and post-traumatic stress symptoms following birth occur amongst a small proportion of women but can lead to poor maternal mental health, impairment in mother-infant bonding and relationship stress. This integrative review aims to examine the associated risk factors and women's own experiences of postnatal post-traumatic stress in order to better understand this phenomenon. METHOD Fifty three articles were included and critically reviewed using the relevant Critical Appraisal Skills Program checklists or Strengthening the Reporting of Observational studies in Epidemiology assessment tool. FINDINGS Risk factors for postnatal post-traumatic stress symptoms and disorder include factors arising before pregnancy, during the antenatal period, in labour and birth and in the postnatal period. Potential protective factors against postnatal post-traumatic stress have been identified in a few studies. The development of postnatal post-traumatic stress can lead to negative outcomes for women, infants and families. DISCUSSION Risk factors for post-traumatic stress symptoms and disorder are potentially identifiable pre-pregnancy and during the antenatal, intrapartum and postnatal periods. Potential protective factors have been identified however they are presently under researched. Predictive models for postnatal post-traumatic stress disorder development have been proposed, however further investigation is required to test such models in a variety of settings. CONCLUSIONS Postnatal post-traumatic stress symptoms and disorder have been shown to negatively impact the lives of childbearing women. Further investigation into methods and models for identifying women at risk of developing postnatal post-traumatic stress following childbirth is required in order to improve outcomes for this population of women.
Collapse
Affiliation(s)
- Madeleine Simpson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Cathy Dickson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751 NSW, Australia; Ingham Institute, Liverpool, NSW, Australia.
| |
Collapse
|
20
|
Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study. BMC Pregnancy Childbirth 2018; 18:25. [PMID: 29325518 PMCID: PMC5765597 DOI: 10.1186/s12884-018-1657-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 01/27/2017] [Accepted: 01/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is an increasingly common condition of pregnancy. It is associated with adverse fetal, infant and maternal outcomes, as well as an increased risk of GDM in future pregnancies and type 2 diabetes for both mother and offspring. Previous studies have shown that GDM can result in an emotionally distressing pregnancy, but there is little research on the patient experience of GDM care, especially of a demographically diverse UK population. The aim of this research was to explore the experiences of GDM and GDM care for a group of women attending a large diabetes pregnancy unit in southeast London, UK, in order to improve care. Methods Framework analysis was used to support an integrated analysis of data from six focus groups with 35 women and semi-structured interviews with 15 women, held in 2015. Participants were purposively sampled and were representative of the population being studied in terms of ethnicity, age, deprivation score and body mass index (BMI). Results We identified seven themes: the disrupted pregnancy, projected anxiety, reproductive asceticism, women as baby machines, perceived stigma, lack of shared understanding and postpartum abandonment. These themes highlight the often distressing experience of GDM. While most women were grateful for the intensive support they received during pregnancy, the costs to their personal autonomy were high. Women described feeling valued solely as a means to produce a healthy infant, and felt chastised if they failed to adhere to the behaviours required to achieve this. This sometimes had an enduring impact to the potential detriment of women’s long-term psychological and physical health. Conclusions This study reveals the experiences of a demographically diverse group of patients with GDM, reflecting findings from previous studies globally and extending analysis to the context of improving care. Healthcare delivery may need to be reoriented to improve the pregnancy experience and help ensure women are engaged and attentive to their own health, particularly after birth, without compromising clinical pregnancy outcomes. Areas for consideration in GDM healthcare include: improved management of emotional responses to GDM; a more motivational approach; rethinking the medicalisation of care; and improved postpartum care. Electronic supplementary material The online version of this article (10.1186/s12884-018-1657-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Judith Parsons
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Katherine Sparrow
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Katharine Hunt
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - Helen Rogers
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - Angus Forbes
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| |
Collapse
|
21
|
Wright D, Pincombe J, McKellar L. Exploring routine hospital antenatal care consultations - An ethnographic study. Women Birth 2017; 31:e162-e169. [PMID: 28969996 DOI: 10.1016/j.wombi.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Listening to women as part of their antenatal care has been recognized as valuable in understanding the woman's needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman's issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman's voice and woman-centred care in the hospital setting. METHOD Contemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women. FINDINGS Thematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy. CONCLUSION Individual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women's participation.
Collapse
Affiliation(s)
- Diane Wright
- University of South Australia, School of Nursing and Midwifery, North Tce, Adelaide, SA 5000, Australia.
| | - Jan Pincombe
- University of South Australia, School of Nursing and Midwifery, North Tce, Adelaide, SA 5000, Australia
| | - Lois McKellar
- University of South Australia, School of Nursing and Midwifery, North Tce, Adelaide, SA 5000, Australia
| |
Collapse
|
22
|
Marhamati T, Torkzahrani S, Nasiri M, Lotfi R. The examination of quality of pregnancy care based on the World Health Organization's "Responsiveness" model of selected pregnant women in Tehran. Electron Physician 2017; 9:3720-3727. [PMID: 28465798 PMCID: PMC5410897 DOI: 10.19082/3720] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) Responsiveness model showing the ability of health systems in fulfilling people's expectations in connection with nonclinical aspects is an appropriate pattern to assess healthcare. The purpose of this study was to determine the status of pregnancy care provisions based on the responsiveness model. METHODS This was a cross-sectional study conducted by randomly sampling 130 women visiting selected hospitals in Tehran in 2015. A researcher-made questionnaire based on the responsiveness model of WHO was used to collect data. We determined the face validity and content validity of the questionnaire, and its reliability was confirmed by Cronbach's alpha coefficient (0.94) and test-retest analysis (0.96). The obtained data were analyzed by SPSS version 20 descriptive statistics, t-test, one-way ANOVA, Pearson product-moment correlation coefficient, and Spearman correlation. RESULTS Total responsiveness from the perspective of service recipients was 69.46±14.65 from 100. The obtained scores showed that, in the range of 0 to 100, 73.02 were about basic amenities (the most score), 72.93 about dignity, 70.91 about communication, 70.76 about confidentiality, 66.30 about provision social needs, 65.96 about choice of provider, 65.92 about autonomy, and 52.65 about prompt attention (the lowest score), which are representing the average level of service quality. There were significant relationships between participating in preparation class of labor and dignity (p<0.001), autonomy (p=0.01), provision social needs (p=0.01), and overall responsiveness (p=0.03). It was obtained that there is a significant linear relationship between scores given to hospitals and dimensions of responsiveness (p=0.05). Findings indicated a significant relationship between insurance type and dimensions of choice of provider (p=0.03) and communication (p=0.03). CONCLUSION The mean score of service quality in the present investigation illustrated that nonclinical dimensions have been disregarded and it has potential to be better. So some grand plans are needed.
Collapse
Affiliation(s)
- Tahereh Marhamati
- M.Sc. of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, International Branch, Tehran, Iran
| | - Shahnaz Torkzahrani
- M.Sc. of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Ph.D. in Biostatistics, Assistant Professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Lotfi
- Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
23
|
Abstract
Background Infant mortality rate in Nigeria is among the highest world-wide. Utilization of modern health care facilities during pregnancy and at delivery reduces infant mortality rate. We examined the relationship between Infant Mortality (IM) and Maternal Health Care Services Access Index (MHCI) in Nigeria. Methods This cross-sectional study utilized 2013 NDHS data and included women aged 15–49 years (n=12511). MHCI was obtained from information on antenatal visit, antenatal attendance, tetanus toxoid injection during pregnancy, place of delivery and birth attendance. Cox-proportional hazard and Brass models were used for the analysis (α=0.05). Results Mean MHCI was higher among women with lower prevalence of IM. About 5.1% and 3.4% of the women with none and complete MHCI had experienced infant deaths respectively. The hazard of experienced infant deaths was 1.497(1.068–2.098) and 1.466(1.170–1.836) significantly higher among women with no and low MHCI respectively than those with complete MHCI. This pattern was observed when other factors were used as control. The refined IM probability (range=0.0482–0.1102) and IM rates (range=50–119) increased with reduction in the level of MHCI. The IM rate reduces from 119 per 1,000 live births among women whose MHCI score was zero to 50 per 1,000 live births among those with complete MHCI score. Conclusion Infant death was least experienced among women who had complete MHCI. If women optimize utilization of health facility during pregnancy and delivery, infant deaths will reduce in Nigeria.
Collapse
Affiliation(s)
- Adebowale Sa
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Udjo E
- 2Bureau of Marketing Research, University of South Africa, South Africa
| |
Collapse
|
24
|
Molnár A, Surányi A, Nyári T, Németh G, Pál A. Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction. Int J Gynaecol Obstet 2015; 129:5-8. [PMID: 25747494 DOI: 10.1016/j.ijgo.2014.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/13/2014] [Revised: 10/21/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine placental vascularization using three-dimensional power Doppler (3DPD) ultrasonography in pregnancies complicated by intrauterine growth restriction (IUGR). METHODS The present prospective study was conducted at the University of Szeged (Szeged, Hungary) from February 2012 to March 2013. Women with a singleton pregnancy who attended the maternity outpatient ward in the second or third trimester were enrolled consecutively. Women were divided into two groups: those with a normal pregnancy and those with a pregnancy complicated by IUGR. Three 3DPD indices-vascularization index (VI), flow index (FI), and vascularization flow index (VFI)-were assessed. RESULTS A total of 223 women were enrolled: 171 were in the control group and 52 in the IUGR group. Median VI was 3.7% (interquartile range [IQR] 3.2%-4.2%) in the IUGR group and 10.1% (IQR 8.6%-10.9%) in the control group (P=0.001). Median FI was 40.0 (IQR 39.7-42.5) in the IUGR group and 45.1 (IQR 44.1-53.1) in the control group (P=0.012). Median VFI was 2.2 (IQR 2.1-2.4) in the IUGR group and 4.8 (IQR 4.4-5.3) in the control group (P<0.001). CONCLUSION Placental vascularization was reduced in pregnancies complicated by IUGR.
Collapse
Affiliation(s)
- András Molnár
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Gábor Németh
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Attila Pál
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| |
Collapse
|