RESUMEN
Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined. Objective: To determine the association of eviction actions during pregnancy with birth outcomes. Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020. Exposures: Eviction actions occurring during gestation. Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death. Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10â¯135 births to women who had an eviction action during pregnancy and 78â¯727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively. Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.
Asunto(s)
Bienestar del Lactante/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Vivienda Popular/estadística & datos numéricos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Estudios de Casos y Controles , Composición Familiar , Femenino , Georgia , Vivienda/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Embarazo , Salud PúblicaAsunto(s)
COVID-19/terapia , Protección a la Infancia/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Centros de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/organización & administración , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Femenino , Humanos , India , Lactante , Recién Nacido , Programas Nacionales de Salud/organización & administración , EmbarazoAsunto(s)
COVID-19/epidemiología , Bienestar del Lactante/estadística & datos numéricos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Bienestar Materno/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/prevención & control , Adulto , COVID-19/fisiopatología , Niño , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiologíaRESUMEN
BACKGROUND: The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection. METHODS: In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020). RESULTS: A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18-34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36-39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing. CONCLUSIONS: In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.
Asunto(s)
COVID-19/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Diagnóstico Prenatal/estadística & datos numéricos , Adulto , COVID-19/diagnóstico , Femenino , Humanos , Recién Nacido , Kuwait , Bienestar Materno/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
Around the end of December 2019, a new beta-coronavirus from Wuhan City, Hubei Province, China began to spread rapidly. The new virus, called SARS-CoV-2, which could be transmitted through respiratory droplets, had a range of mild to severe symptoms, from simple cold in some cases to death in others. The disease caused by SARS-CoV-2 was named COVID-19 by WHO and has so far killed more people than SARS and MERS. Following the widespread global outbreak of COVID-19, with more than 132758 confirmed cases and 4955 deaths worldwide, the World Health Organization declared COVID-19 a pandemic disease in January 2020. Earlier studies on viral pneumonia epidemics has shown that pregnant women are at greater risk than others. During pregnancy, the pregnant woman is more prone to infectious diseases. Research on both SARS-CoV and MERS-CoV, which are pathologically similar to SARS-CoV-2, has shown that being infected with these viruses during pregnancy increases the risk of maternal death, stillbirth, intrauterine growth retardation and, preterm delivery. With the exponential increase in cases of COVID-19 throughout the world, there is a need to understand the effects of SARS-CoV-2 on the health of pregnant women, through extrapolation of earlier studies that have been conducted on pregnant women infected with SARS-CoV, and MERS-CoV. There is an urgent need to understand the chance of vertical transmission of SARS-CoV-2 from mother to fetus and the possibility of the virus crossing the placental barrier. Additionally, since some viral diseases and antiviral drugs may have a negative impact on the mother and fetus, in which case, pregnant women need special attention for the prevention, diagnosis, and treatment of COVID-19.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Coronavirus del Síndrome Respiratorio de Oriente Medio , Neumonía Viral/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , COVID-19 , Femenino , Humanos , Bienestar Materno/estadística & datos numéricos , Pandemias , Embarazo , SARS-CoV-2Asunto(s)
Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Salud Materna/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , COVID-19 , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Kenia , Pandemias , SARS-CoV-2 , Factores SocioeconómicosRESUMEN
OBJECTIVE: To review what is known about COVID-19 and highlight gaps in the context of Nigerian obstetric practice. Research data on COVID-19 are understandably sparse in Africa. Nigeria, like most African countries, is battling a disease she is poorly equipped to fight. METHODS: The current available literature on COVID-19 was reviewed in relation to obstetric practice in the Nigerian context, gaps were identified, and recommendations were made to improve the handling of the COVID-19 pandemic in Nigerian obstetric practice. RESULTS: In and out of hospital, both the obstetrician and the obstetric patient are constantly being put at risk of exposure to the coronavirus because testing and preventive measures are either ineffective or non-existent. CONCLUSION: The pandemic has exposed the gross inadequacies in Nigeria's healthcare system and is therefore a wake-up call to the need for a complete overhaul of infrastructure and services. The government will do well to increase the budget allocation for health from the current paltry 4.14% to the recommended 15% of the total budget. The Nigerian obstetrician stands a high risk of exposure due to inadequate preventive measures, and testing and diagnostic challenges.
Asunto(s)
COVID-19/prevención & control , COVID-19/terapia , Control de Infecciones/organización & administración , Servicios de Salud Materna/organización & administración , Complicaciones Infecciosas del Embarazo/prevención & control , Prevención Primaria/organización & administración , COVID-19/epidemiología , Atención a la Salud , Femenino , Humanos , Bienestar Materno/estadística & datos numéricos , Nigeria , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , SARS-CoV-2RESUMEN
BACKGROUND: This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. METHODS: Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. RESULTS: Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. CONCLUSIONS: Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.
Asunto(s)
Bienestar Materno/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Complicaciones del Embarazo/prevención & control , Adulto , Estudios Transversales , Violencia Doméstica/prevención & control , Desarrollo Económico , Femenino , Humanos , Bienestar Materno/psicología , Pobreza/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/psicología , Escalas de Valoración Psiquiátrica , Población Rural/estadística & datos numéricos , Vietnam/epidemiologíaAsunto(s)
Servicios de Salud Materna/organización & administración , Resultado del Embarazo/epidemiología , Embarazo de Alto Riesgo , Nacimiento Prematuro/prevención & control , Femenino , Humanos , Bienestar del Lactante/estadística & datos numéricos , Recién Nacido , Bienestar Materno/estadística & datos numéricos , Trabajo de Parto Prematuro/prevención & control , Embarazo , Servicios Preventivos de Salud/organización & administraciónAsunto(s)
Servicios de Salud Materna/organización & administración , Resultado del Embarazo/epidemiología , Embarazo de Alto Riesgo , Nacimiento Prematuro/prevención & control , Femenino , Humanos , Bienestar del Lactante/estadística & datos numéricos , Recién Nacido , Bienestar Materno/estadística & datos numéricos , Trabajo de Parto Prematuro/prevención & control , Embarazo , Servicios Preventivos de Salud/organización & administración , Salud de la MujerRESUMEN
This quasi-experimental pilot study describes preliminary impacts of the "Home Visitation Enhancing Linkages Project (HELP)," a pragmatic screen-and-refer approach for promoting identification of and linkage to treatment for maternal depression (MD), substance use (SU), and intimate partner violence (IPV) within early childhood home visiting. HELP includes screening for MD, SU, and IPV followed by a menu of motivational interviewing and case management interventions aimed at linking clients to treatment, designed for delivery within routine home visiting. HELP was piloted within four counties of a statewide home visiting system that were implementing Healthy Families America. HELP clients (N = 394) were compared to clients in five demographically matched counties that received usual Healthy Families services (N = 771) on whether their home visitors (1) identified MD, SU, and IPV risk; (2) discussed MD, SU, and IPV during home visits; and (3) made referrals for MD, SU, and IPV. All data were extracted from the program's management information system. A significant impact of HELP was found on discussion of risk in home visits for all three risk domains with large effect sizes (MD OR = 4.08; SU OR = 15.94; IPV OR = 9.35). HELP had no impact on risk identification and minimal impact on referral. Findings provide preliminary support for HELP as a way of improving discussion of client behavioral health risks during home visits, an important first step toward better meeting these needs within home visiting. However, more intensive intervention is likely needed to impact risk identification and referral outcomes.
Asunto(s)
Enfermería en Salud Comunitaria/organización & administración , Depresión Posparto/prevención & control , Visita Domiciliaria/estadística & datos numéricos , Violencia de Pareja/prevención & control , Bienestar Materno/estadística & datos numéricos , Adulto , Femenino , Humanos , Proyectos Piloto , Atención Posnatal/organización & administración , Embarazo , Relaciones Profesional-Familia , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: The increased potential for negative pregnancy outcomes in both extremes of reproductive age is a well-debated argument. The aim of this study was to analyze the prevalence and the outcome of pregnancies conceived at extreme maternal ages. METHODS: This retrospective study considered all single consecutive pregnancies delivered in a tertiary referral center between 2001 and 2014. Patients were categorized into 4 groups according to maternal age at delivery (< 17 years; 18-28 years; 29-39 years; > 40 years). The following outcomes were considered (amongst others): pregnancy-related hypertensive disorders (PRHDs), neonatal resuscitation (NR), neonatal intensive care unit (NICU) admission, periventricular leucomalacia (PVL), and grade 3 and 4 intraventicular hemorrhage (IVH). RESULTS: During the considered period 22,933 single pregnancies gave birth in our unit. We observed 71 women aged < 17 years, and 1552 aged > 40 years. In each year throughout the study period, there was a significant increment in maternal age of 0.041 years (95% CI 0.024-0.058) every new year. Multivariate analysis concluded out that maternal age over 40 years was an independent risk factor for preterm delivery (OR 1.36 95% CI 1.16-1.61, p < 0.05, PRHDs (OR 2.36 95% CI 1.86-3.00, p < 0.05), GDM (OR 1.71 95% CI 1.37-2.12, p < 0.05) cesarean section (OR 1.99 95% CI 1.78-2.23, p < 0.05), abnormal fetal presentation (OR 1.29 95% CI 1.03-1.61, p < 0.05), and fetal PVL (OR 3.32 95% CI 1.17-9.44, p < 0.05). We also observed that maternal age under 17 years or over 40 years was an independent risk factor for grade 3 or 4 neonatal IVH (OR 2.97 95% CI 1.24-7.14, p < 0.05). CONCLUSIONS: These findings confirm a negative impact of extreme maternal ages on pregnancy. These results should be carefully taken into account by maternal care providers in order to inform women adequately, supporting them in understanding potential risks associated with their procreation choices, and to improve clinical surveillance.
Asunto(s)
Edad Materna , Bienestar Materno/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Adolescente , Adulto , Cesárea/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Preeclampsia/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Mortinato/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The investigation of the potential impact of unintended pregnancy on maternal and child health is important to design effective interventions. This study explored the associations between unintended pregnancy and low birthweight (LBW) and pregnancy complications. METHODS: A cross-sectional survey was conducted among 400 randomly selected women in the postnatal wards of Rajshahi Medical College Hospital, Bangladesh. Multivariate logistic regression analyses were used to identify associations. RESULTS: Results of this study indicate that 30.5% of all pregnancies were unintended and 29.3% of babies were born with LBW. Additionally, 79.3% of women experienced any pregnancy complication (AC), 69.5% experienced medical complications and 44.3% experienced obstetric complications (OCs) during their last pregnancy. Unintended pregnancy was significantly associated with LBW (adjusted odds ratio [AOR]: 3.18, 95% CI: 1.79 to 5.54), maternal experience of OCs (AOR: 1.83, 95% CI: 1.03 to 3.28) and AC (AOR: 2.93, 95%: 1.14 to 7.58). Women with unintended pregnancies were at higher risk of developing high blood pressure and anemia during pregnancy. CONCLUSIONS: Women with unintended pregnancies are at increased risk of producing LBW babies and experiencing complications during pregnancy. Therefore, maternal pregnancy intention should be addressed in interventions aimed to reduce maternal and child morbidity and mortality.
Asunto(s)
Actitud Frente a la Salud , Recién Nacido de Bajo Peso , Bienestar Materno/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Embarazo no Planeado/psicología , Adolescente , Adulto , Bangladesh , Estudios Transversales , Femenino , Humanos , Recién Nacido , Intención , Oportunidad Relativa , Embarazo , Adulto JovenRESUMEN
INTRODUCTION: Women, during the antenatal and post-partum period, report pelvic, low back pain, stress and urge urinary incontinence, colorectal dysfunction, and other co-morbidities that negatively affect health-related quality of life. Exercise and nutrition are important considerations for improving maternal health in this period. PURPOSE: The purpose of this study was to examine the effects of a community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling over an 8-week period on pelvic floor and urinary distress (UDI), prolapse and colorectal distress for antenatal and post-partum women with limited access to health care, and low socio-economic resources from a Midwestern Region of the United States. MATERIALS AND METHODS: Purposive sample of 35 females, ages 18-44, were recruited for this prospective, preintervention to postintervention study, following ethical approval from Institutional Review Board and voluntary written consent from participants. The Health History Questionnaire, SF-36, Food Frequency Questionnaire, report of pelvic organ prolapse dysfunction (POPDI), colorectal-anal dysfunction (CRADI), and UDI as measured by the Pelvic Floor Distress Inventory (PFDI) were completed before and after intervention. RESULTS: Thirty-five women (n = 35) 18 to 44 years old (mean age of 22.72 ± 3.45 years) completed the study. A significant difference was found from preintervention to postintervention scores means for PFDI total scores, CRADI individual scores, and UDI individual scores (p < .05). POPDI scores decreased preintervention to postintervention but were not significant. A significant improvement in healthy nutrition and breastfeeding postintervention was also found (z = 3.21, p = .001). Further analysis showed significant, but weak, correlation between parity and POPDI (r = .366, p = .033); between parity and UDI (r = .384, p = .03); and between parity and PFDI (r = .419, p = .014). DISCUSSION: Our study found a significant reduction in pelvic floor dysfunction, urinary, and colorectal-anal distress symptoms and improvement in breastfeeding and healthy nutrition following an 8-week community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling.
Asunto(s)
Educación en Salud/métodos , Salud Materna , Madres/educación , Calidad de Vida , Adolescente , Adulto , Femenino , Humanos , Bienestar Materno/estadística & datos numéricos , Prolapso de Órgano Pélvico/prevención & control , Embarazo , Complicaciones del Embarazo/prevención & control , Estudios Prospectivos , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Muerte Materna/estadística & datos numéricos , Mortalidad Materna/tendencias , Complicaciones del Trabajo de Parto/mortalidad , Grupo de Atención al Paciente/organización & administración , Adulto , Causas de Muerte , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Bienestar Materno/estadística & datos numéricos , Hemorragia Posparto/mortalidad , Embarazo , Complicaciones del Embarazo/mortalidad , Calidad de la Atención de Salud/organización & administraciónRESUMEN
OBJECTIVE: To analyze quality improvement opportunities (QIOs) identified through review of cases of maternal death from cardiovascular disease (CVD) by the California Pregnancy-Associated Mortality Review committee. DESIGN: Qualitative descriptive design using thematic analysis. SAMPLE: A total of 269 QIOs identified from 87 pregnancy-related deaths from CVD in California from 2002 to 2007. METHODS: We coded and thematically organized the 269 QIOs using three of the four domains commonly applied in quality improvement initiatives for maternal health care: Readiness, Recognition, and Response. Data did not include reporting issues, so the Reporting domain was excluded from the analysis. RESULTS: The most prevalent theme within the Readiness domain was the care of women in a facility or a department within a facility that was not equipped to handle the severity of their CVD conditions. For Recognition, a common theme was an underappreciation of the severity of illness, including high-risk factors and clinical warning signs, which led to inaccurate diagnoses, such as anxiety or asthma, and missed diagnoses of CVD. The lack of recognition of CVD led to delays in treatment or inaccurate treatment, the leading themes in the Response domain. CONCLUSION: Identification of CVD or its risk factors during pregnancy can lead to timely, multidisciplinary approaches to management and birth in facilities that offer appropriately trained health care professionals and appropriate equipment. Maternal mortality can be reduced if signs and symptoms of CVD in women are recognized early and treatment modalities are implemented quickly during pregnancy, childbirth, and the postpartum period.
Asunto(s)
Muerte Materna/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Complicaciones Cardiovasculares del Embarazo/mortalidad , Mejoramiento de la Calidad/organización & administración , Adulto , California , Cardiomiopatías/mortalidad , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Femenino , Humanos , Embarazo , Factores de RiesgoRESUMEN
INTRODUCTION: Women in regions with high HIV prevalence are at high risk of HIV acquisition during pregnancy and postpartum, and acute maternal HIV contributes a substantial proportion of infant HIV infections. Pre-exposure prophylaxis (PrEP) could prevent HIV during pregnancy/postpartum; however, identifying women who would most benefit from PrEP in this period is challenging. Women may not perceive risk, may not know partner HIV status and partners may have external partners during this period. PrEP offer in pregnancy could be universal or risk guided. METHODS AND ANALYSIS: The PrEP Implementation for Mothers in Antenatal Care (PrIMA) study is a cluster randomised trial that aims to determine the best model for PrEP implementation in pregnancy, among women attending public sector maternal child health clinics in Western Kenya (HIV prevalence >25%). Twenty clinics are randomised to either universal PrEP offer following standardised counselling ('Universal arm' 10 clinics) or risk screening with partner self-test option ('Targeted arm' 10 clinics). Four thousand women will be enrolled and followed through 9-month postpartum. The primary analysis will be intention to treat. Outcomes reflect the balance between HIV preventive effectiveness and avoiding unnecessary PrEP exposure to women at low risk and include: maternal HIV incidence, PrEP uptake, PrEP adherence, PrEP duration, 'appropriate' PrEP use (among women with objective evidence of potential risk), infant birth outcomes, infant growth and partner self-testing uptake. To better understand the feasibility and acceptability of the provision of PrEP in these settings, qualitative interviews and cost-effectiveness analyses will be conducted. ETHICS AND DISSEMINATION: The protocol was approved by the institutional review boards at Kenyatta National Hospital and the University of Washington. An external advisory panel monitors adverse and social harm events. Results will be disseminated through peer-reviewed journals, presentations at local and international conferences to national and global policy makers, community and participants. TRIAL REGISTRATION NUMBER: NCT03070600.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Salud Materna/estadística & datos numéricos , Bienestar Materno/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Atención Prenatal/organización & administración , Adulto , Femenino , Humanos , Kenia , Embarazo , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
INTRODUCTION: Group prenatal care models have been in use in the USA for over 20 years and have shown benefits in reducing rates of preterm birth and low birth weight infants in high-risk civilian populations. Group prenatal care has been widely implemented at military treatment facilities, despite a lack of high-quality evidence for improved perinatal outcomes in this population. MATERIALS AND METHODS: In this randomized, controlled trial, 129 patients at a military treatment facility received either traditional one-on-one prenatal care or group prenatal care using the CenteringPregnancy model. CenteringPregnancy care was administered by certified nurse midwives and family medicine residents and faculty. The primary outcomes were infant birthweight appropriateness for gestational age, maternal anxiety (as measured by the State-Trait Anxiety Inventory) and depression (as measured by the Center for Epidemiologic Studies-Depression scale), and patient satisfaction (as measured by the Short-Form Patient Satisfaction Questionnaire). Infant birthweights were compared using Chi-square tests for the categorical variables of small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age. Maternal mood and satisfaction scores were evaluated before, during, and after the intervention and analyzed using rank sum tests. Additional demographic and outcome data were collected directly from participants and extracted from patient records. RESULTS: Patients receiving group care were more likely to deliver an infant that was appropriate for gestational age, with an incidence ratio of 1.12 [CI = 1.01-1.25, p = 0.04]. Depression and anxiety levels remained similar between groups throughout the study. Satisfaction was similar between groups, though patients receiving group care reported higher satisfaction with the accessibility and convenience of their care at the study's end [p = 0.048]. There were no differences between groups in preterm births, maternal or neonatal morbidity, mode of delivery, maternal weight gain, or breastfeeding rates. CONCLUSIONS: Military parturients receiving group prenatal care in the CenteringPregnancy model were less likely to deliver an small for gestational age or large for gestational age newborn and were more likely to be satisfied with their access to care. Group prenatal care is well received by patients and may positively influence neonatal metabolic status.
Asunto(s)
Peso al Nacer , Procesos de Grupo , Bienestar Materno/psicología , Atención Prenatal/métodos , Atención Prenatal/normas , Adulto , Distribución de Chi-Cuadrado , Femenino , Humanos , Recién Nacido , Bienestar Materno/estadística & datos numéricos , Embarazo , Resultado del Embarazo , Atención Prenatal/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Epidemiological studies report conflicting findings regarding association between maternal immigration status and pregnancy outcomes. In this study we compared risk factors and prevalence of adverse pregnancy outcomes in native Portuguese and migrants. Cross-sectional analysis was conducted using information collected at delivery from the participants of Generation XXI birth cohort. Logistic regression models were fitted to assess the association between migrant status and adverse pregnancy outcomes. Prevalence of risk factors for adverse pregnancy outcomes varied between native Portuguese and migrants: teenage mothers (5.6 and 2.0%), primiparae (57.1 and 63.9%), smoking during pregnancy (23.0 and 19.1%), twins (3.2 and 8.0%), and caesarean section (35.2 and 45.7%). Among singleton births, prevalence of low birthweight, preterm birth and small for gestational age were 7.3 and 3.9%, 7.5 and 6.2%, and 15.1 and 7.6%, respectively for native Portuguese and migrants. The native Portuguese had an adjusted significantly higher risk of low birthweight (OR 2.67, 95% CI 1.30, 5.48) and small for gestational age (OR 2.01, 95% CI 1.26, 3.21), but a similar risk for preterm birth (OR 1.38, 95% CI 0.81, 2, 34). Migrant mothers presented a lower risk of low birthweight and small for gestation and data suggest a healthy immigrant effect.