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2.
MMWR Morb Mortal Wkly Rep ; 69(32): 1058-1063, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32790656

RESUMO

Marijuana is the most commonly used illicit substance under federal law in the United States (1); however, many states have legalized medical and adult nonmedical use. Evidence regarding the safety and health effects of cannabis use during pregnancy is largely inconclusive (2). Potential adverse health effects to exposed infants (e.g., lower birthweight) have been documented (2). To provide population-based estimates of use surrounding pregnancy, identify reasons for and mode of use, and understand characteristics of women who continue versus cease marijuana use during pregnancy, CDC analyzed data from eight states participating in the 2017 Pregnancy Risk Assessment Monitoring System (PRAMS) marijuana supplement. Overall, 9.8% of women self-reported marijuana use before pregnancy, 4.2% during pregnancy, and 5.5% after pregnancy. The most common reasons for use during pregnancy were to relieve stress or anxiety, nausea or vomiting, and pain. Smoking was the most common mode of use. In multivariable models that included age, race/ethnicity, marital status, education, insurance status, parity, trimester of entry into prenatal care, and cigarette and e-cigarette use during pregnancy, women who continued versus ceased marijuana use during pregnancy were more likely to be non-Hispanic white or other race/ethnicity than non-Hispanic black, be unmarried, have ≤12 years of education, and use cigarettes during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend refraining from marijuana use during pregnancy and lactation (3,4). Given the increasing number of states legalizing medical and adult nonmedical marijuana use, surveillance of perinatal marijuana use can inform clinical guidance, provider and patient education, and public health programs to support evidence-based approaches to addressing substance use.


Assuntos
Uso da Maconha/epidemiologia , Gestantes/psicologia , Adulto , Monitoramento Epidemiológico , Feminino , Humanos , Gravidez , Medição de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
3.
Womens Health (Lond) ; 16: 1745506520952045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821024

RESUMO

BACKGROUND: Despite many benefits of physical exercise to women during pregnancy, the majority of Saudi women do not engage in an adequate amount of activity because of common barriers such as fatigue, lack of motivation, and childcare. The purpose of this study was to estimate the proportion of Saudi women who get adequate exercise during pregnancy as well as to evaluate their knowledge of, attitude toward, and barriers to physical exercise during pregnancy. METHODS: This study had a cross-sectional design. Data were collected retrospectively (average time: 1 year after the birth), using translated questionnaires (English to Arabic), from primary health care centers and from the Maternity and Children Hospital in Qassim, Saudi Arabia. Logistic regression was employed to assess the a priori correlates of adequate exercise during pregnancy (primary outcome). RESULTS: The sample included 274 women, who had a mean age of 31.9 years. A majority of the women thought that physical exercise during pregnancy was necessary and had high knowledge levels (mean = 77; median = 75) about types and amount of physical activity. Less than half of the women were either walking (26%) or exercising (42%) adequately (i.e. ⩾150 min/week). Age (odds ratio: 1.79), number of pregnancies (odds ratio: 2.41), attitude toward exercise (odds ratio: 2.71), and self-rated health (odds ratio: 2.50) were significant correlates of adequate exercise during pregnancy. Among those who reported no physical exercise during pregnancy (n = 68), the following barriers were most common: tiredness (25.0%), fear (18.1%), dislike of exercise (16.7%), and lack of information (16.7%). CONCLUSION: For Saudi women, interventions are needed during pre-natal checkups to promote and maintain adequate physical activity levels during pregnancy.


Assuntos
Exercício Físico , Hábitos , Conhecimentos, Atitudes e Prática em Saúde , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Arábia Saudita , Inquéritos e Questionários , Adulto Jovem
4.
Public Health Rep ; 135(1_suppl): 189S-196S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735201

RESUMO

In 2006, the Centers for Disease Control and Prevention updated its recommendations for HIV testing of 4 population groups in health care settings: adults, adolescents, pregnant women, and newborns. Important components of the revised recommendations included opt-out routine HIV screening; eliminating prevention counseling for opt-out routine HIV screening; repeat HIV testing in the third trimester for all women at high risk for acquiring HIV and for women receiving health care in facilities and/or jurisdictions with high HIV burden; testing during labor and delivery for women with undocumented HIV status; and testing the newborn when the mother's HIV status is unknown. To assess the integration of these testing recommendations into state laws and to inform future recommendations, we researched and assessed statutes and regulations that addressed HIV testing in the 4 population groups in all 50 states and the District of Columbia in 2018. We then classified the laws, based on their consistency with the recommendations for each of the 4 population groups. Of 31 states and the District of Columbia that had relevant laws, all addressed at least 1 component of the recommendations. Although no state had laws that incorporated all the recommendations for all the population groups, 5 states (Delaware, Illinois, Louisiana, Maryland, and New Hampshire) had incorporated all the recommendations for adults and adolescents, and 4 states (Connecticut, Nevada, North Carolina, and West Virginia) had incorporated all the recommendations for pregnant women and newborns.


Assuntos
Centers for Disease Control and Prevention, U.S./normas , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/normas , Gestantes , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
5.
Niger J Clin Pract ; 23(8): 1087-1094, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788486

RESUMO

Background: Maternal hyperglycemia first diagnosed in pregnancy, previously referred to as gestational diabetes mellitus is associated with health consequences for both the mother and her fetus/baby, not only in the short term but also in the long term. Early screening helps to identify women with overt diabetes or those with early onset GDM. Aims: The aim of this study was to determine the diagnostic performance of two screening tests (Random plasma glucose, Random capillary glucose) in relation to 75g Oral glucose tolerance test (OGTT) done before 24 weeks gestation. Methods: This prospective longitudinal cohort study was carried out between 1st February, 2017 and 31st July, 2017, at two teaching hospitals in Nigeria. Two hundred and eighty one (281) pregnant women who met the inclusion criteria were selected and screened with both random plasma glucose (RPG) and random capillary glucose (RCG) before 24 weeks of pregnancy. They were then made to undergo 75g OGTT a week later. The diagnostic performance of the screening tests were determined. Results: A total of 270 women had 75g OG. Conclusion: Random plasma glucose and Random capillary glucose performed poorly compared to 75g-OGTT in detecting hyperglycemia in early pregnancy.


Assuntos
Glicemia/análise , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Hiperglicemia/diagnóstico , Programas de Rastreamento/métodos , Adulto , Feminino , Humanos , Hiperglicemia/sangue , Estudos Longitudinais , Nigéria/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Gestantes , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes
6.
Matern Child Health J ; 24(9): 1170-1178, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32754861

RESUMO

INTRODUCTION: Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. METHODS: In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. RESULTS: Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. CONCLUSION: Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.


Assuntos
Gestantes/psicologia , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Feminino , Grupos Focais , Redução do Dano , Humanos , Relações Interpessoais , Entrevistas como Assunto , Quênia , Pessoa de Meia-Idade , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
8.
Pediatrics ; 146(Suppl 1): S93-S98, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737240

RESUMO

A central tension in pediatric research ethics arises from our desire to protect children from harm while also allowing progress toward discoveries that could improve child health. A prime example of this tension is research on a controversial yet increasingly common practice: the use of cannabis by women to treat nausea and vomiting of pregnancy. Studies of cannabis use in pregnancy face a combination of ethical hurdles because of the inclusion of pregnant women and involvement of a schedule I controlled substance. Given the growing need for research on the safety and efficacy of cannabis for nausea and vomiting of pregnancy, we reflect on the multiple historical contexts that have contributed to the challenge of studying cannabis use during pregnancy and make a case for the ethical rationale for such research.


Assuntos
Ética em Pesquisa , Maconha Medicinal/uso terapêutico , Êmese Gravídica/terapia , Pediatria/ética , Gestantes , Sujeitos da Pesquisa , Antieméticos/efeitos adversos , Diciclomina/uso terapêutico , Doxilamina/uso terapêutico , Aprovação de Drogas , Combinação de Medicamentos , Feminino , Humanos , Maconha Medicinal/efeitos adversos , Ondansetron/uso terapêutico , Gravidez , Piridoxina/uso terapêutico , Teratogênios , Talidomida/efeitos adversos
9.
J Psychosom Obstet Gynaecol ; 41(3): 191-197, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32838629

RESUMO

PURPOSE: Pregnant women are facing numerous COVID-19 related burdens including social isolation, financial insecurity, uncertainty about the impact of the virus on fetal development, and prenatal care restrictions. We tested the psychometric properties of a new instrument designed to assess the extent and types of pandemic-related stress experienced by pregnant women. MATERIALS AND METHODS: 4,451 pregnant women from across the U.S. were recruited via social media and completed an online questionnaire in April-May 2020. The questionnaire included measures of psychological, sociodemographic, and obstetric factors and the new Pandemic-Related Pregnancy Stress Scale (PREPS). RESULTS: Confirmatory factor analyses of the PREPS showed excellent model fit. Three factors - Perinatal Infection Stress (5 items), Preparedness Stress (7 items), and Positive Appraisal (3 items) - converged and diverged with expected psychological factors, and scales created from these factors demonstrated acceptable to good reliability (α's 0.68-0.86). In addition, mean PREPS scores were associated with perceived risk of infection, and with financial and vocational COVID-19 related burdens. CONCLUSION: The PREPS is a robust instrument to assess multidimensional COVID-19 pandemic prenatal stress. It is a valuable tool for future research to examine vulnerability to pandemic stress and how this stress may affect women and their offspring.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Estresse Psicológico/diagnóstico , Inquéritos e Questionários , Adulto , Análise Fatorial , Feminino , Humanos , Pandemias , Gravidez , Gestantes/psicologia , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/psicologia
11.
MMWR Morb Mortal Wkly Rep ; 69(31): 1009-1014, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32759915

RESUMO

Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders, including birth defects, behavioral disorders, and impaired cognitive development (1). Little is known about the co-use of other substances by females who drink during pregnancy. CDC used 2015-2018 data from the National Survey on Drug Use and Health (NSDUH) to estimate the overall and trimester-specific prevalence of self-reported drinking in the past 12 months, current drinking, and binge drinking, overall and by trimester, and the co-use of other substances among pregnant females aged 12-44 years. Past drinking (12 months) was reported by 64.7% of pregnant respondents. Current drinking (at least one drink in the past 30 days) was reported by 19.6% of respondents who were in their first trimester of pregnancy and 4.7% of respondents who were in their second or third trimester. Binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) was reported by 10.5% of first trimester respondents and 1.4% of second or third trimester respondents. Overall, 38.2% of pregnant respondents who reported current drinking also reported current use of one or more other substances. The substances used most with alcohol were tobacco and marijuana. Self-reported drinking prevalence was substantially lower among second or third trimester respondents than among first trimester respondents. The American College of Obstetricians and Gynecologists (ACOG) recommends alcohol use and substance use disorders screening for all females seeking obstetric-gynecologic care and counseling patients that there is no known safe level of alcohol use during pregnancy (2).


Assuntos
Alcoolismo/epidemiologia , Gestantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Gravidez , Estados Unidos/epidemiologia , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-32824191

RESUMO

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18-31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/psicologia , Internet , Estilo de Vida , Pneumonia Viral/psicologia , Qualidade de Vida , Quarentena/psicologia , Adulto , Infecções por Coronavirus/virologia , Estudos Transversais , Dieta/psicologia , Exercício Físico , Feminino , Humanos , Pandemias , Pneumonia Viral/virologia , Gravidez , Gestantes , Espanha , Inquéritos e Questionários
13.
Pediatrics ; 146(Suppl 1): S86-S92, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737239

RESUMO

Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.


Assuntos
Bem-Estar da Criança , Coerção , Saúde da Família , Tratamento Involuntário/legislação & jurisprudência , Complicações na Gravidez/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Grupo com Ancestrais do Continente Africano , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/etnologia , Gestantes/etnologia , Cuidado Pré-Natal , Classe Social , Sociedades Médicas , South Carolina , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1072-1075, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741173

RESUMO

Objective: To investigate the impacts of antenatal anxiety on preterm birth and low birth weight. Methods: Women in early pregnancy were recruited for follow-up, antenatal anxiety in three trimesters was screened using Self-Rating Anxiety Scale and the score ≥50 was regarded as anxiety. Logistic regression analysis was conducted to evaluate the associations of the anxiety in three trimesters, new onset anxiety in the second and third trimesters with infant birth outcomes, such as preterm birth and low birth weight. Results: The rates of anxiety in the first, second and third trimesters of pregnancy were 12.5%, 3.7%, and 7.4% respectively. We found that there was no statistical association between anxiety in the first and second trimester and preterm birth. The anxiety in the third trimester was associated with increased odds for preterm birth (OR=3.55, 95%CI: 1.62-7.82). Associations between anxiety in all three trimesters and low birth weight were not significant. New onset anxiety in the third trimester was associated with significant increased risk of premature delivery (OR=5.20, 95%CI: 1.84-14.70) and low birth weight (OR=6.93, 95%CI: 2.42-19.88). Conclusions: Our study showed that anxiety in the third trimester is an important risk factor for premature delivery, new onset anxiety symptoms in the third trimester can significantly increase the incidence of premature birth and low birth weight of infant.


Assuntos
Ansiedade/epidemiologia , Recém-Nascido de Baixo Peso , Gestantes/psicologia , Nascimento Prematuro/epidemiologia , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de Risco
15.
Medicine (Baltimore) ; 99(30): e21279, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791708

RESUMO

INTRODUCTION: The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants. METHODS AND ANALYSIS: It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.


Assuntos
Ansiedade/psicologia , Infecções por Coronavirus/psicologia , Depressão/psicologia , Pneumonia Viral/psicologia , Complicações Infecciosas na Gravidez/psicologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Adulto , Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
17.
Wei Sheng Yan Jiu ; 49(3): 386-396, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32693904

RESUMO

OBJECTIVE: To study the effect of pregnant serum folate concentrations on the birth weight. METHODS: This study was a prospective cohort study. Pregnant women aged 18-45 who were examined and delivered in a county in Hebei Province from June 2016 to August 2018 and their newborns were included in the study. A total of 490 women were recruited and collected venous blood before the 20 th week of pregnancy. Basic information of women as well as their use of folic acid supplements was collected at the same time. Newborns' basic information, such as sex and birth weight, had been collected after delivery. The chemiluminescence method was used to determine the serum folate concentrations. Folate concentrations quartile were used as the cut-off point to divide subjects into four groups. The general linear model and multivariate unconditional Logistic regression analysis were used to study the effect of different serum folate concentrations on the infant birthweight. RESULTS: The age of 490 pregnant women was(27. 9±4. 1) years. The serum folate value P50(P25, P75) was 12. 3(9. 0, 14. 5) ng/mL and its' detection time was(13. 7±2. 6) weeks. 49. 3%(242/490) newborns were male. The average gestational age of the newborns was(39. 1±1. 0) weeks and the average birth weight was(3403±425) g. The birth weight of four groups' newborns were(3408±456) g, (3405±450) g, (3427±418) g and(3374±378) g, respectively. General linear model analysis showed that there was no significant difference in the effect of serum folate levels before the 20 th week of gestation on the birth weight(serum folate concentration<9. 0 ng/mL(ß=32. 24, P=0. 55), serum folate concentration 9. 0-12. 2(ß=18. 01, P=0. 74), serum folate concentration 12. 3-14. 4(ß=42. 27, P=0. 43)]. Multivariate unconditional Logistic regression analysis showed that the group with folate concentration above 14. 5 ng/mL can reduce the risk of small for gestational age(SGA) [(P=0. 02, OR=0. 08(95% CI 0. 01-0. 61)]. Comparing with ghe pregnant women whose serum folate concentration was in 9. 0-12. 4 ng/mL. Hovever, there was no significant difference between the pregnant serum folate levels and large for gestational age(LGA). CONCLUSION: There was no significant correlation between serum folate concentrations and the birth weight. But higher folate level may reduce the risk of SGA.


Assuntos
Ácido Fólico , Gestantes , Adolescente , Adulto , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
18.
PLoS One ; 15(7): e0235675, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645075

RESUMO

BACKGROUND: Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands' education status and their wives unintended pregnancy in southern Ethiopia. METHODS: The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands' education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy. RESULTS: The proportion of unintended pregnancy in this sample was 20.6%. Husbands' education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]). CONCLUSION: Unintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Gravidez não Planejada , Cônjuges/educação , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Gestantes/educação , População Rural , Adulto Jovem
19.
PLoS One ; 15(7): e0234575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645002

RESUMO

INTRODUCTION: Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. METHODS: A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. RESULTS: Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. CONCLUSION: Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/tendências , Adulto , Estudos Transversais , Parto Obstétrico , Feminino , Gana/epidemiologia , Humanos , Serviços de Saúde Materna , Pessoa de Meia-Idade , Parto , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Fatores Socioeconômicos
20.
PLoS One ; 15(7): e0234827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645112

RESUMO

BACKGROUND: The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake. METHODS: We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type. FINDINGS: We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited. CONCLUSIONS: The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Vacinação/psicologia , Adulto , Tomada de Decisões , Feminino , Pessoal de Saúde/psicologia , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Razão de Chances , Gravidez , Inquéritos e Questionários
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