Desafios do processo gestacional de mulheres negras: uma revisão narrativa / Challenges in the gestational process of black women: a narrative review

Esta revisão narrativa procura discutir aspectos concernentes ao processo gestacional de mulheres negras, quais sejam: se existem diferenças de tratamento entre mulheres brancas e negras durante a gravidez e nos momentos do parto e pós-parto, como essas diferenças são influenciadas pelos aspectos fisiológicos de cada grupo étnico e como isso afeta as taxas de morbimortalidade. Para esta revisão, quatro bases de dados foram usadas (SciELO, LILACS, PubMed e MEDLINE) e 23 artigos foram lidos na íntegra, depois de selecionados por data de publicação, língua, país da pesquisa e análise dos títulos e resumos. Como principais resultados, os autores encontraram diferenças claras entre mulheres brancas e negras quanto ao acesso à saúde, sendo as negras mais propensas a usar os sistemas públicos e ter menos consultas pré-natal. Também foi observado que as mulheres negras reportaram maus-tratos mais vezes, tinham maiores chances de serem proibidas de ter um acompanhante durante o parto e recebiam menos anestesia para episiotomias. As características fisiológicas também foram apontadas várias vezes. Nesse sentido, altas taxas de anemia ferropriva e hipertensão durante a gravidez foram mais comuns entre as negras. Além disso, em se tratando de taxas de morbimortalidade, mulheres negras tinham uma chance consideravelmente maior de serem readmitidas pós-parto e maiores taxas de mortalidade, quando comparadas com mulheres brancas.(AU)

This review aims to discuss aspects related to the gestational process of black women, namely: if there is a difference in how black and white women are treated throughout pregnancy, partum and postpartum moments, how this difference is influenced by the physiological aspects of each ethnical group and how it affects their morbidity and mortality rates. For this review, four databases were used (SciELO, LILACS, PubMed and MEDLINE) and 23 articles were fully read, after being selected by publishing date, language, country of research, title and abstract analysis. The authors found as the main results clear differences between black women's and white women's access to health care, as black women are more likely to use public health care systems and have fewer prenatal appointments. It was also noticed that black women reported maltreatment more frequently, had a higher chance of being prohibited from keeping a companion during labor and suffering from less local anesthesia for episiotomy. The physiological characteristics were also pointed out several times, with high rates of iron deficiency anemia and hypertension during pregnancy being more common among black women. Moreover, when it comes to morbidity and mortality rates, black women had an extremely higher chance of being readmitted postpartum, and a higher mortality rate, when compared to white women.(AU)

DNA methylation loci in placenta associated with birthweight and expression of genes relevant for early development and adult diseases.

BACKGROUND: Birthweight marks an important milestone of health across the lifespan, including cardiometabolic disease risk in later life. The placenta, a transient organ at the maternal-fetal interface, regulates fetal growth. Identifying genetic loci where DNA methylation in placenta is associated with birthweight can unravel genomic pathways that are dysregulated in aberrant fetal growth and cardiometabolic diseases in later life. RESULTS: We performed placental epigenome-wide association study (EWAS) of birthweight in an ethnic diverse cohort of pregnant women (n = 301). Methylation at 15 cytosine-(phosphate)-guanine sites (CpGs) was associated with birthweight (false discovery rate (FDR) < 0.05). Methylation at four (26.7%) CpG sites was associated with placental transcript levels of 15 genes (FDR < 0.05), including genes known to be associated with adult lipid traits, inflammation and oxidative stress. Increased methylation at cg06155341 was associated with higher birthweight and lower FOSL1 expression, and lower FOSL1 expression was correlated with higher birthweight. Given the role of the FOSL1 transcription factor in regulating developmental processes at the maternal-fetal interface, epigenetic mechanisms at this locus may regulate fetal development. We demonstrated trans-tissue portability of methylation at four genes (MLLT1, PDE9A, ASAP2, and SLC20A2) implicated in birthweight by a previous study in cord blood. We also found that methylation changes known to be related to maternal underweight, preeclampsia and adult type 2 diabetes were associated with lower birthweight in placenta. CONCLUSION: We identified novel placental DNA methylation changes associated with birthweight. Placental epigenetic mechanisms may underlie dysregulated fetal development and early origins of adult cardiometabolic diseases. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00912132.

Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11-13 weeks' gestation.

OBJECTIVE: To examine the performance of the routine 11-13-week scan in detecting fetal non-chromosomal abnormalities. METHODS: This was a retrospective study of prospectively collected data from 100 997 singleton pregnancies attending for a routine ultrasound examination of fetal anatomy, performed according to a standardized protocol, at 11-13 weeks' gestation. All continuing pregnancies had an additional scan at 18-24 weeks and 71 754 had a scan at either 30-34 or 35-37 weeks. The final diagnosis of fetal abnormality was based on the results of postnatal examination in cases of live birth and on the findings of the last ultrasound examination in cases of pregnancy termination, miscarriage or stillbirth. The performance of the 11-13-week scan in the detection of fetal abnormalities was determined. RESULTS: The study population contained 1720 (1.7%) pregnancies with a fetal abnormality, including 474 (27.6%) detected on the first-trimester scan, 926 (53.8%) detected on the second-trimester scan and 320 (18.6%) detected in the third trimester or postnatally. At 11-13 weeks' gestation, we diagnosed all cases of acrania, alobar holoprosencephaly, encephalocele, tricuspid or pulmonary atresia, pentalogy of Cantrell, ectopia cordis, exomphalos, gastroschisis and body-stalk anomaly and > 50% of cases of open spina bifida, hypoplastic left heart syndrome, atrioventricular septal defect, complex heart defect, left atrial isomerism (interrupted inferior vena cava with normal intracardiac anatomy), lower urinary tract obstruction, absence of extremities, fetal akinesia deformation sequence and lethal skeletal dysplasia. Common abnormalities that were detected in < 10% of cases at 11-13 weeks included ventriculomegaly, agenesis of the corpus callosum, isolated cleft lip, congenital pulmonary airway malformation, ventricular septal defect, abdominal cysts, unilateral renal agenesis or multicystic kidney, hydronephrosis, duplex kidney, hypospadias and talipes. CONCLUSIONS: A routine 11-13-week scan, carried out according to a standardized protocol, can identify many severe non-chromosomal fetal abnormalities. A summary statistic of the performance of the first-trimester scan is futile because some abnormalities are always detectable, whereas others are either non-detectable or sometimes detectable. To maximize prenatal detection of abnormalities, additional scans in both the second and third trimesters are necessary. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Diagnóstico de anomalías fetales no cromosómicas en la ecografía de rutina a las 11-13 semanas de gestación OBJETIVO: Examinar el desempeño de la ecografía de rutina a las 11-13 semanas en la detección de anomalías fetales no cromosómicas. MÉTODOS: Esta investigación fue un estudio retrospectivo de datos recogidos prospectivamente de 100 997 embarazos con feto único que acudieron a un examen ecográfico de rutina de la anatomía fetal, realizado de acuerdo con un protocolo estandarizado, a las 11-13 semanas de gestación. Todos los embarazos que continuaron se sometieron a una exploración adicional a las 18-24 semanas y 71754 se sometieron a una exploración a las 30-34 o a las 35-37 semanas. El diagnóstico final de la anomalía fetal se basó en los resultados del examen postnatal en los casos de nacimientos vivos y en los hallazgos del último examen ecográfico en los casos de interrupción del embarazo, aborto o éxitus fetal. Se determinó el rendimiento de la exploración de las 11-13 semanas en la detección de anomalías fetales. RESULTADOS: La población del estudio contenía 1720 (1,7%) embarazos con una anormalidad fetal, entre ellos 474 (27,6%) detectados en la exploración del primer trimestre, 926 (53,8%) detectados en la del segundo trimestre y 320 (18,6%) detectados en el tercer trimestre o postnatalmente. A las 11-13 semanas de gestación, se diagnosticaron todos los casos de acrania, holoprosencefalia alobar, encefalocele, atresia tricúspide o pulmonar, pentalogía de Cantrell, ectopia cordis, onfalocele, gastrosquisis y anomalía del pedículo embrionario y >50% de los casos de espina bífida abierta, síndrome del hemicardio izquierdo hipoplásico, comunicación auriculoventricular, defecto cardíaco complejo, isomerismo de la aurícula izquierda (vena cava inferior interrumpida con anatomía intracardíaca normal), obstrucción del tracto urinario inferior, ausencia de extremidades, secuencia de deformación de la acinesia fetal y displasia esquelética letal. Las anomalías comunes que se detectaron en <10% de los casos a las 11-13 semanas incluyeron ventriculomegalia, agenesia del cuerpo calloso, labio leporino aislado, malformación congénita de las vías respiratorias pulmonares, comunicación interventricular, quistes abdominales, agenesia renal unilateral o riñón multiquístico, hidronefrosis, duplicidad renal, hipospadias y pie zambo. CONCLUSIÓN: Una exploración rutinaria a las 11-13 semanas, realizada de acuerdo con un protocolo estandarizado, puede identificar muchas anomalías fetales no cromosómicas graves. Un resumen estadístico del desempeño de la exploración del primer trimestre es inútil porque algunas anomalías son siempre detectables, mientras que otras no lo son o solo lo son a veces. Para maximizar la detección prenatal de anormalidades, se necesitan exploraciones adicionales tanto en el segundo como en el tercer trimestre.

Serum ferritin, soluble transferrin receptor, and total body iron for the detection of iron deficiency in early pregnancy: a multiethnic population-based study with low use of iron supplements.

BACKGROUND: Which blood-based indicator best reflects the iron status in pregnant women is unclear. Better assessments of iron status in today's multiethnic populations are needed to optimize treatment and clinical recommendations. OBJECTIVES: We aimed to determine the prevalence of anemia (hemoglobin <11.0 g/dL in first and <10.5 g/dL in second trimester) and iron deficiency (ID) by the iron indicators serum ferritin <15 µg/L, serum soluble transferrin receptor (sTfR) >4.4 mg/L, and calculated total body iron <0 mg/kg, and their associations with ethnicity. METHODS: This was a population-based cross-sectional study from primary antenatal care of 792 healthy women in early pregnancy in Oslo, Norway. We categorized the women into 6 ethnic groups: Western European, South Asian, Middle Eastern, Sub-Saharan African, East Asian, and Eastern European. RESULTS: Anemia was found in 5.9% of women (Western Europeans: 1.8%; non-Western: 0-14%, P < 0.05). ID from ferritin was found in 33% (Western Europeans: 15%; non-Western: 27-55%, P < 0.05). ID from sTfR was found in 6.5% (Western Europeans: 0.3%; non-Western: 0-20%, P < 0.01). Calculated total body iron indicated ID in 11% (Western Europeans: 0.6%, non-Western: 7.0-28%, P < 0.01). The prevalence of ID was significantly higher by all measures in South Asian, Sub-Saharan African, and Middle Eastern than in Western European women, and the ethnic differences persisted after adjusting for confounders. South Asians, Sub-Saharan Africans, and Middle Easterners had lower iron concentrations by all measures for all hemoglobin intervals. Anemia related to ID varied from 35% (sTfR) to 46% (total body iron) and 72% (ferritin) depending on the iron indicator used. CONCLUSIONS: Women at the highest risk of ID and anemia were of South Asian, Middle Eastern, and Sub-Saharan African origin. The prevalence of ID differed considerably depending on the iron indicator used.

Ethnic differences in the clustering and outcomes of health behaviours during pregnancy: results from the Born in Bradford cohort.

Background: Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes. Methods: We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation and exposure to second-hand smoke. Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birthweight. Results: For WB mothers, offspring of those in the 'Unhealthiest' group had lower mean birthweight than those in the 'Mostly healthy but inactive' class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birthweight differences, although the odds of preterm birth was higher in 'Inactive smokers' compared to the 'Mostly healthy but inactive' group. Conclusions: The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes.

Reproductive Health Knowledge among African American Women Enrolled in a Clinic-Based Randomized Controlled Trial to Reduce Psychosocial and Behavioral Risk: Project DC-HOPE.

BACKGROUND: Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care. METHODS: Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ(2) tests. Differences in postpartum mean total score by group were assessed via multiple linear regression. RESULTS: Women in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001). CONCLUSIONS: Although intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.

Da gravidez de "risco" às "maternidades de risco". Biopolítica e regulações sanitárias nas experiências de mulheres de camadas populares de Recife / From the "risk pregnancy" to the "risk maternity". Biopolitic and health regulation in working class women experience in Recife, Brazil

A categoria epidemiológica do risco organiza atualmente, no Brasil, a gestão das gravidezes com o objetivo de atingir metas de saúde, como a redução das mortalidades infantil e materna. Tal categoria vem enquadrada em toda uma transformação no sistema de saúde, de passagem para uma nova etapa biomédica baseada na avaliação e na vigilância de riscos. Poucos trabalhos na área das ciências sociais tomaram o risco como objeto de estudo empírico a partir de uma perspectiva de análise crítica das mudanças que ele introduziu nas práticas sociais. Baseado num trabalho de pesquisa mais amplo, com metodologia etnográfica, o artigo propõe-se a examinar esta categoria na gestão das gravidezes nos serviços públicos de saúde e em mulheres de camadas populares na cidade de Recife. O artigo analisará as modalidades de regulação, cada vez mais individualizantes e sanitarizadas, ligadas à utilização da noção de risco pelos profissionais da saúde e às representações sociais estigmatizantes para as mulheres de camadas populares. Finalmente, o artigo relativiza a força disciplinadora dessa categoria biomédica para mostrar como ela é subjetivada, pelas mulheres, em uma experiência relacional da gravidez.

The epidemiological risk category currently organizes, in Brazil, the management of pregnancies in order to achieve health goals, such as reducing infant and maternal mortality. This category is framed in an entire transformation in the health system, the transition to a new biomedical step based on the assessment and risk monitoring. Few studies in the social sciences took risk as empirical object of study from a perspective of critical analysis of the changes he introduced in social practices. Based on a broader research work with ethnographic methodology, the paper proposes to examine this category in the management of pregnancies in public health services and lower classes of women in the city of Recife, Brazil. The article will examine the modalities of regulation, increasingly individualized and sanitized, linked to the use of the notion of risk by health professionals and stigmatizing social representations for women of lower classes. Finally, the article relativizes the disciplining force of this biomedical category to show how it is subjectivized by women in a relational experience of pregnancy.

Pregnancy and birth in an indigenous Huichol community: from structural violence to structural policy responses.

Mexico's indigenous regions are characterised by socio-economic marginalisation and poor health outcomes and the Maternal Mortality Rate in indigenous communities continues to be around six times higher than the national rate. Using as a case study the Huichol community of North-Western Mexico we will discuss how institutional health and welfare programmes which aim to address accepted risk factors for maternal health are undermined by a series of structural barriers which put indigenous women especially in harm's way. Semi-structured interviews and observational data were gathered between 2009 and 2011 in highland communities and on coastal tobacco plantations to where a large number of this ethnic group migrate. Many Huichol women birth alone, and to facilitate this process they maintain a low nutritional intake to reduce their infant's growth and seek spiritual guidance during pregnancy from a shaman. These practices are reinforced by feelings of shame and humiliation encountered when using institutional health provision. These are some of the structural barriers to care that need to be addressed. Effective interventions could include addressing the training of health professionals, focusing on educational inequalities and the structural determinants of poverty whilst designing locally specific programmes that encourage acceptance of available health care.

Physical activity and dietary behaviors associated with weight gain and impaired glucose tolerance among pregnant Latinas.

Pregnancy has been proposed as a critical period for the development of subsequent maternal overweight and/or obesity. Excessive gestational weight gain is, in turn, associated with maternal complications such as cesarean delivery, hypertension, preeclampsia, impaired glucose tolerance, and gestational diabetes mellitus. Although there is substantial evidence that targeting at-risk groups for type 2 diabetes prevention is effective if lifestyle changes are made, relatively little attention has been paid to the prevention of excessive gestational weight gain and impaired glucose tolerance during pregnancy. Latinos are the largest minority group in the United States, with the highest birth and immigration rates of any minority group and are disproportionately affected by overweight and obesity. However, due to cultural factors, socioeconomic factors, and language barriers, Latinos have had limited access to public health interventions that promote healthy lifestyles. Therefore, the objective of this article is to review the scientific evidence regarding the association between physical activity, dietary behaviors, and gestational weight gain and impaired glucose tolerance among Latinas. A second objective is to discuss how lifestyle interventions including weight management through diet and exercise could be successful in reducing the risk of excessive gestational weight gain and gestational diabetes mellitus. Finally, recommendations are provided for future lifestyle intervention programs in this population with a focus on translation and dissemination of research findings.

Iron status, iron supplementation and anemia in pregnancy: ethnic differences.

OBJECTIVES: To investigate the anemia prevalence during pregnancy and the use of and response to iron supplementation in a multi-ethnic population as well as the possible association between anemia and birth outcomes (pregnancy duration, birth weight). METHODS: Cross-sectional study conducted in a university hospital (Brussels, Belgium) in 341 women. Hemoglobin, ferritin and iron prescription data were extracted from the patients' electronic dossiers; a questionnaire was used to assess iron intake during pregnancy. RESULTS: Anemia prevalence was higher during the 3rd trimester (24.3%) than in the 1st trimester (6.2%). Arab/Turkish women had a higher prevalence of anemia (9.1%) in the 1st trimester compared to Western women (2.4%; p = 0.044). The frequency of iron prescription was significantly higher among Arab/Turkish (43.7%) compared to Western women (27.9%; p = 0.006). A significantly lower mean birth weight was found among women presenting with anemia in the 1st trimester (3166 g) compared to non anemic women (3442 g; p = 0.036) but no significant difference was detected in mean pregnancy duration between both groups (p = 0.804). CONCLUSIONS: Anemia was more prevalent among Arab/Turkish women in spite of receiving more iron prescriptions than Western women. Efficient iron therapy and intensive follow-up are warranted to decrease the anemia prevalence during pregnancy, especially among non-Western women.

Sífilis em gestantes na faixa de fronteira do Mato Grosso do Sul, 2007 a 2010 / Syphilis in pregnant women in the border of Mato Grosso do Sul, from 2007 to 2010

Foi realizada análise sobre sífilis em gestantes no estado de Mato Grosso do Sul, no período de 2007 a 2010. Os 78 municípios do Estado fizeram parte da avaliação e foram divididos em dois grupos: um formado por 44 municípios situados na faixa de fronteira e outro formado pelos 34 municípios restantes. A população do estudo foi composta por todas as gestantes com sífilis notificadas no SINAN no período avaliado. Mostrou-se que a maior parte dos casos notificados era proveniente da região compreendida pela faixa fronteiriça correspondendo 58,9% do total de casos (n=2029). A taxa de prevalência para a sífilis em gestante apresentada na faixa de fronteira região nos anos de 2008, 2009 e 2010 foi de 2,0 por cento, 1,9 por cento e 1,6 por cento, respectivamente, sendo maior do que nos demais municípios no mesmo período e acima do esperado para a região Centro-Oeste. Com relação à cobertura de equipes de saúde da família, nos municípios do primeiro grupo os percentuais foram de 41,8 por cento no primeiro ano de estudo, e 48,8 por cento no último ano, enquanto que nos demais municípios os percentuais foram de 62,5 por cento e 68,8 por cento, respectivamente. A maior frequência de gestantes com sífilis está na faixa etária de 20 a 29 anos, mas na região da fronteira a faixa etária de 15 a 19 anos chama a atenção. Também se destaca nesse estudo a frequência de gestantes com sífilis pertencentes à raça indígena, que em 2007 foi a raça com maior frequência apresentando percentual de 36,4 por cento. Embora quase 95 por cento da população encontrem-se nesta região, representa apenas 6,5 por cento da população de mulheres nesta área. Observou-se também que a variável tratamento do parceiro apresenta registros significativos no ano de 2010, com percentual de tratamento de 30,7 por cento nos municípios da faixa de fronteira e 42,1 por cento nos municípios restantes. As variáveis foram avaliadas quanto à completude e as que mais se destacaram quanto à ocorrência de caselas vazias ou preenchidas como ignoradas foram escolaridade, ocupação, classificação clínica e tratamento do parceiro. Verificou-se também, através do Reclink, que o SINAN apresentou percentual de subnotificação de 12,7 por cento em relação às gestantes com sífilis existentes no banco de dados do IPED-APAE para o mesmo período. Conclui-se que a região de fronteira precisa ser vista de maneira diferenciada para que as estratégias que visam o controle da sífilis em gestante tenham resultados satisfatórios.

Maternal smoking and smoking in the household during pregnancy and postpartum: findings from an Indigenous cohort in the Northern Territory.

OBJECTIVE: To describe the trends in maternal smoking and smoking in the household for a cohort of Indigenous women followed from late pregnancy to 7 months postpartum. DESIGN AND SETTING: Prospective cohort study embedded within a randomised controlled trial (RCT) performed in the Northern Territory involving participants recruited between 30 June 2006 and 4 May 2010. PARTICIPANTS: 215 Indigenous women aged 17-39 years who had been recruited into the RCT, 162 of whom had completed their last study visit at 7 months postpartum by 1 June 2010. MAIN OUTCOME MEASURES: Smoking status of women, and smoking within their households, in their third trimester, and at 1 month, 2 months and 7 months postpartum. RESULTS: There were complete data on women's smoking status for 121 participants. Among these, the self-reported smoking rate was 45% (95% CI, 36%-55%) during pregnancy, increasing to 63% (95% CI, 54%-71%) at 7 months postpartum. Of the 66 women who were non-smokers at the antenatal visit, 23 (35%; 95% CI, 23%-47%) were smoking by the time their baby reached 7 months of age. Thirty-one per cent (95% CI, 23%-39%) of households included people who smoked inside during the antepartum period, whereas 16% (95% CI, 10%-23%) included people who smoked inside at 7 months postpartum. CONCLUSIONS: While an apparent reduction in indoor exposure to tobacco smoke during the postpartum period is encouraging, this is offset by an increase in the proportion of antenatal non-smokers who subsequently reported smoking after the birth of their child. More health care service delivery and research attention needs to be directed to smoking during pregnancy and to postpartum relapse in this population.

Human capital, resources, and healthy childbearing for Mexican women in a new destination immigrant community.

PURPOSE: To describe a healthy mother, a healthy pregnancy, a healthy baby, and the resources essential for achieving these goals from the perspective of Mexican women in a new destination immigrant community in the United States. BACKGROUND: Traditional care and health behaviors are often cited to explain the favorable birth outcomes of Mexican-born women in the United States. Little is known about the approaches Mexican women use to have healthy babies in new destination communities. SAMPLE: Eleven Mexican women of childbearing age in the early years of their settlement participated in semifocused ethnographic interviews. FINDINGS: Healthy mothers have good nutrition and abstain from substance use. Healthy pregnancies are worry-free and tranquil, and healthy behaviors are supported by networks of people with good morals who motivate women and provide sound advice. Information needs include vitamin supplementation before and after pregnancy and family planning. English skills and having the courage to go out and meet people are vital for healthy childbearing. CONCLUSIONS AND IMPLICATIONS: Informed prenatal care programs preserve diet and low substance use behaviors, reduce stress, and provide networking opportunities and information about family planning, prenatal care services, nutrition, and folic acid supplementation.

Reducing psychosocial and behavioral pregnancy risk factors: results of a randomized clinical trial among high-risk pregnant african american women.

OBJECTIVES: We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, secondhand smoke exposure, depression, and intimate partner violence). METHODS: Pregnant African American women (N = 1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the second follow-up. RESULTS: Number of risks did not differ between the intervention and usual care groups at baseline, the second trimester, or the third trimester. Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group (odds ratio = 1.61; 95% confidence interval = 1.08, 2.39; P = .021). CONCLUSIONS: In comparison with usual care, a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care.

Health behaviors, nutritional status, and anthropometric parameters of Roma and non-Roma mothers and their infants in the Czech Republic.

OBJECTIVE: To compare maternal health behaviors, maternal nutritional status, and infant size at birth of Romas and non-Romas in the Czech Republic. DESIGN: Maternal interviews and food frequency questionnaire, maternal blood samples, physical measurements of mothers and infants. SETTING: Hospital, maternal/child care center; 2-4 days postpartum. PARTICIPANTS: 76 Roma mothers and 151 mothers from the majority population. MAIN OUTCOME MEASURES: Infant length/weight; maternal height/weight; weight gain during pregnancy; duration of pregnancy; maternal smoking habits; dietary intake; use of food supplements during pregnancy; and maternal blood levels of folate, beta-carotene, retinol, and alpha-tocopherol. ANALYSIS: Comparison of ethnic groups by 2-sample Wilcoxon test, chi-square, Fischer's exact test, relative risk, and analysis of variance (ANOVA). RESULTS: Pregnancy duration was about 1 week shorter in Roma women (P < .001), and their infants had lower birth weight (P < .001) and shorter length (P < .001). Prevalence of smoking was significantly higher among Roma mothers (P < .001). Roma women used food supplements less frequently than non-Roma women (P < .001) and had significantly lower mean blood concentrations of folate (P < .001), beta-carotene (P < .001), retinol (P < .02), and alpha-tocopherol (P < .02). CONCLUSIONS AND IMPLICATIONS: The nutritional status of Roma mothers is worse than that of mothers from the majority Czech population. The dietary and smoking habits of pregnant Roma women should be of special concern to family doctors, obstetricians, nutrition educators, and social workers.

Álcool e suas conseqüencias: uma abordagem multiconceitual / Alcohol and its consequences: an approach multiconceitual

A publicação, que apresenta diversas informações e resultados das mais recentes pesquisas sobre o consumo de álcool ao redor do mundo, foi organizada em nove capítulos, abordando temas como: dados epidemiológicos mundiais sobre o consumo nocivo de álcool; as principais consequências em longo prazo relacionadas ao consumo moderado de álcool; dependência do álcool; consumo nocivo de álcool entre estudantes; padrões de consumo do álcool e problemas decorrentes do beber pesado episódico no Brasil; álcool e HIV/AIDS; álcool e violência; álcool e trânsito; e consumo nocivo de álcool durante a gravidez.

Estado bucodental en gestantes de la ciudad de Armenia, Colombia / Buco-dental health status on pregnant women in Armenia city, Colombia

Objetivo: La salud bucodental en las gestantes es hoy por hoy un tema de mucha relevancia social cultural y académica, por todos los procesos y cambios que intervienen y se manifiestan en este estado, igualmente la salud bucodental hace parte esencial del bienestar que se debe tener en la gestación para un desarrollo y resultado exitoso de este proceso, por eso el objetivo de este estudio fue determinar el estado bucodental de las gestantes de Armenia. Materiales y Métodos: Se realizo un estudio observacional descriptivo de corte transversal, en el municipio de Armenia (Quindío), se tomaron las gestantes que asisten al control prenatal en la Red de salud del municipio, se incluyeron en total 186 gestantes que cumplieron con los criterios de selección y desearon participar voluntariamente en la investigación. Resultados: El promedio de edad fue de 22 años, la mayoría (58.3%) con procedencia del Quindío, El 65.9% (122) habían visitado al odontologo durante la actual gestación, Al examen clínico se encontró en el 34.59% de las gestantes presentaban lesiones en tejidos blandos, el 94.05% caries y el 70.27% enfermedad periodontal. Conclusiones: El estado de salud bucodental en las gestantes es alterado con prevalencias altas de enfermedades como caries que se puede decir que es una enfermedad que existe antes de la gestación y adicionalmente la asistencia a consulta odontológica dentro de época de gestación no es en la proporción ideal a las necesidades evidenciadas.

Objective: The pregnant oral health is nowdays a very important issue of socialcultural and academic matter due to chances that can be seen. The oral health is essential for the well-being of pregnant woman. The objective was: To determinate the bucodental status of pregnantwomen in Armenia City.Methods: It was made a observational descriptive study, at the city of Armenia, Quindio. We take the pregnant who assisted to pre-birth control at the city’s services of health. We include 186 pregnants who could meet the selection characteristic and wish to be part of the research. Results: Age average was 22 years, mostly 58.3% From quindio. 65.9% have been at the dentist during the pregnancy. In the clinical examination we found that 34.5% of pregnants showed soft tissue injuries, 94.05% tooth decay and 70.2% periodontal disease. Conclusions: Oral health is pregnants is modificad with prevalences of disease such as tooth decay, the mother did not go for dental care during their pregnancy.

Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden.

BACKGROUND: The aim of this study was to investigate differences in use of antenatal care in a multi-ethnic population in Malmö, Sweden, over a 4-year period. Age, parity, cohabiting status, use of an interpreter, and tobacco-use were examined to assess the potential effects of confounding factors. METHODS: A 4-year (2000-2003) retrospective community-based register study was performed. Low-risk singleton pregnancies (n=5,373) registered for antenatal care at 5 municipal clinics and at the delivery ward at Malmö University Hospital were included, and divided into 6 subgroups by country of origin. The odds for utilisation of antenatal care were analysed by means of logistic regression. RESULTS: Significantly increased odds of lower utilisation of planned antenatal care were found among some groups of foreign-born women. Women born in Eastern and Southern Europe, Iraq and Lebanon, and Asia had fewer antenatal visits than recommended, and all foreign-born women (except for women born in Iraq and Lebanon, and South and Central America) had a late first visit compared to Swedish-born women. Foreign-born women had, in general, fewer unplanned visits to a physician at the delivery ward, but women originating from Asia, Iraq and Lebanon, and Africa had higher utilisation visits to midwives at the delivery ward compared to Swedish-born women. CONCLUSIONS: Foreign-born women had lower utilisation of planned antenatal care. Approximately 50% of women had higher utilisation of care, by making unplanned visits to the delivery ward. This puts strain on both economical as well as staff resources. The delivery clinic at the hospital level is not intended to handle routine visits, and, moreover, some of these women do not receive the full benefits of planned routine antenatal care.