Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: a cross-sectional study.

INTRODUCTION: This study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care. METHODS: A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression. RESULTS: The burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies. CONCLUSION: This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy.

The lived experience of receiving and providing antenatal care during the Covid-19 crisis in Southern Europe: An exploratory qualitative study.

OBJECTIVE: The Covid-19 pandemic led to a reorganization of antenatal care including the cancellation or shift into telemedicine of consultations and restrictions to the presence of an accompanying person. The aim was to explore healthcare professionals' and women's lived experience of such reorganisation consequences on the quality of care and specific challenges they faced, with a particular emphasis on telemedicine and equity. METHODS: Exploratory qualitative study using semi-structured interviews and focus group discussions of women and healthcare providers in New Aquitaine (France) and in the Basque Country (Spain). We collected data from a purposive sampling of women (n = 33) and professionals (n = 19) who had received or provided antenatal care in hospitals and ambulatory facilities between March 2020 and December 2021. Participants' narratives were thematically analysed to identify themes that were subsequently contextualised to the two territories. RESULTS: Antenatal care professionals and pregnant women experienced strong emotions and suffered from organizational changes that compromised the quality and equity of care. The pandemic and associated restrictions were sources of emotional distress, fear and loneliness, especially among more disadvantaged and isolated women. Among professionals, the lack of adequate means of protection and the multiple changes in caring protocols generated burnout, feeling of abandonment and emotional distress. CONCLUSIONS: The Covid-19 experience should serve to critically consider the unexpected consequences of reorganising healthcare services and the need to meet patients' needs, with a particular consideration for disadvantaged groups. Future scenarios of telemedicine generalisation should consider a combination of in presence and remote consultations ensuring antenatal care quality and equity.

Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study.

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.

"I just want the best for him." Pregnancy in the context of substance use disorders: Perspectives of postpartum women.

BACKGROUND: In the United States, the incidence of substance misuse among pregnant women has been steadily increasing. While pregnant women with substance use disorder (SUD) are in critical need of support during the prenatal period, they enter prenatal care stigmatized and facing the possibility of punitive responses. Little research has been done about how women with SUDs themselves experience pregnancy and the transition to motherhood. The aim of this study was to examine women's internal experiences of pregnancy in the context of SUD. METHODS: Semi-structured interviews were conducted with n = 19 postpartum women with SUD. Data were analyzed using a semantic, thematic approach. RESULTS: Participants expressed their thoughts and experiences about their pregnancies in four main themes: (1) fear of harming the baby; (2) fear about child welfare involvement; (3) guilt informed by recovery stage; and (4) mixed feelings about pregnancy amidst complicated circumstances. The women expressed fear about their children's well-being, coupled with motivation to protect their child and the need for clear medical information. Their expressions of guilt depended on the severity of their SUD and their stage in recovery during their pregnancy. Women entered prenatal care with mixed emotions about their pregnancy, such as guilt and excitement, in the midst of complicated life circumstances. CONCLUSIONS: These findings suggest a complexity of internal experiences for pregnant women with SUDs. Participants' feelings and experiences during pregnancy can inform practitioners' approaches to prenatal care in the context of SUDs.

Effect of antenatal depression on ANC service utilization in northwest Ethiopia.

Maternal morbidity and mortality remain high among women who did not attend antenatal care (ANC). Antenatal care is one of the interventions given to pregnant women to detect existed problems or problems that can develop during pregnancy, which harm the health of pregnant women and fetuses. In Ethiopia, however, there is limited evidence that revealed the effect of antenatal depression on ANC service utilization. Hence, this study aimed to see the effect of antenatal depression on ANC visits among women in urban northwest Ethiopia. A population-based, prospective cohort study was done from June 2019 to March 2020. The Edinburgh postnatal depression scale was administered to 970 women in the second and third trimesters of pregnancy to screen for antenatal depression. Additional data were collected on ANC visits, the mother's socio-demographic, obstetric, clinical, psychosocial, and behavioral factors. A logistic regression model was used to adjust confounders and determine associations between antenatal depression and inadequate ANC visits. The cumulative incidence of inadequate ANC visits was 62.58% (95% CI: 59.43, 65.63). The cumulative incidence of inadequate ANC visits among depressed pregnant women was 75% as compared to 56% in non-depressed. The incidence of inadequate ANC visits in the exposed group due to antenatal depression was 25.33%. After multivariable analysis, antenatal depression at the second and third trimesters of pregnancy remained a potential predictor of inadequate ANC visits (AOR = 1.96: (95% CI 1.22, 3.16)). In addition, antenatal depression, long travel time for ANC visits (AOR = 1.83 (95% CI 1.166, 2.870)), and late initiation of ANC visits (AOR = 2.20 (95% CI 1.393, 3.471)) were the predictors of inadequate ANC visits as compared to their counterpart. This study suggested that antenatal depression affects ANC visits in Ethiopian urban settings. Therefore, early detecting and treating depression symptoms during the antenatal period reduced significantly the impacts of depression on the health of the mother and fetus.

The effect of psychosocial stress on prenatal care among Hispanic immigrant women.

ABSTRACT: This article explores the effect of psychosocial stress on Hispanic immigrant women, including access to and use of prenatal care and birth outcomes. In addition to highlighting the health effects for this growing population, the article outlines strategies for clinicians to improve access to adequate prenatal care and to cultivate a supportive environment to promote use of prenatal services.

Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride'.

The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future.

Association between the continuum of care and postpartum depression among Angolan mothers.

BACKGROUND: This study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). METHODS: This study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. RESULTS: The data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00-2.10; AOR = 1.57, 95 % CI = 1.24-1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12-2.28) had significantly higher odds of PPD. LIMITATIONS: The onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. CONCLUSION: PPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.

Barriers to accessing and receiving antenatal care: Findings from interviews with Australian women experiencing disadvantage.

AIM: To identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group. DESIGN: A qualitative descriptive study utilizing semi-structured interviews and thematic analysis. METHODS: Interviews were conducted with 11 pregnant women who self-identified as experiencing disadvantage, purposively sampled from a local government area of Victoria, Australia, characterized by socio-economic disadvantage. Data were collected from February to July 2019. RESULTS: Study participants reported a range of barriers to receiving timely and adequate antenatal care (ANC). For several women, a combination of personal (e.g., emotions, knowledge), health service provision (e.g., limited access to continuity of care provider and continuity of information, inflexible scheduling, difficulty travelling, staff attitudes), and broader social-contextual factors (e.g., financial situation, language, cultural norms) were ultimately insurmountable. Whereas some barriers were experienced as hassles or annoyances, others were unacceptable, overwhelming, or humiliating. CONCLUSION: Women experiencing disadvantage in Australia value ANC but face multiple and complex barriers that undermine timely and regular access. IMPLICATIONS FOR THE PROFESSION AND/PATIENT CARE: A wide range of strategies targeting barriers across multiple levels of the social-ecological environment are required if ANC attendance rates are to improve and ultimately redress existing health disparities. Various continuity of care models are well-placed to address many of the identified barriers and should be made more accessible to women, and particularly those women experiencing disadvantage. IMPACT: Antenatal care appointments promote the health of women and their babies during pregnancy, but for many women, particularly those experiencing disadvantage, access is delayed or inadequate. ANC providers play a critical role in facilitating timely and adequate care. Health service practitioners and management, and health services policymakers need to understand the complexity of the barriers women encounter. These stakeholders can utilize the findings reported herein to develop more effective strategies for overcoming multiple and multi-level barriers. REPORTING METHOD: The study is reported in accordance with the relevant EQUATOR guidelines: the standards for reporting qualitative research (SRQR) and consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Women want male partner engagement in antenatal care services: A qualitative study of pregnant women from rural South Africa.

INTRODUCTION: Evidence strongly shows that a supportive, involved male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral (ART) adherence and increases HIV-free infant survival. Partner engagement in antenatal care (ANC) is influential; however, the most effective strategy to engage male partners is currently unknown. Engaging pregnant women to understand whether male partner involvement is welcome in ANC, what this involvement entails and how best to invite their partner is an important first step in determining how best to engage male partners. METHODS: We interviewed 36 pregnant women receiving ANC services at a district hospital in rural Mpumalanga, South Africa to assess the strengths and weaknesses of their current relationship, the type of partner support they receive, whether they would like their male partner to be involved in their ANC, and how best to invite their male partner to their appointments. We conducted a thematic analysis of the qualitative interviews using MAXQDA software. RESULTS: Financial, emotional, and physical support were noted as important aspects of support currently provided by male partners, with most pregnant women wanting their partners to engage in ANC services during pregnancy. Preferred engagement strategies included participation in couple-based HIV testing and counseling, regular ANC appointment attendance, and delivery room presence. Women who reported a positive relationship with her partner were more likely to prefer inviting their partner without health facility assistance, while those who reported challenges in their relationship preferred assistance through a letter or community health worker. Pregnant women perceived regular business hours (due to their partner being employed and unable to take off work) and having a partner involved in multiple relationships as barriers in getting their partner to attend ANC services. DISCUSSION: Rural South African women, even those in unsatisfactory relationships want their male partners to attend their ANC visits and birth. To make this possible, health facilities will have to tailor male partner engagement outreach strategies to the preferences and needs of the pregnant woman.

Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder.

OBJECTIVE: Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU). METHODS: Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression. RESULTS: Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07-5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01-3.41), having stable housing (aOR 2.49, 95% CI 1.41-4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54-10.7) or community supervision (aOR 2.05, 95% CI 1.16-3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27-3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45-7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07-1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22-3.76), having stable housing (aOR 1.94, 95% CI 1.06-3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19-8.15). CONCLUSION: While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).

Deep health: A qualitative, woman-centered perspective of health during pregnancy.

OBJECTIVE: To explore and define a woman-centered perspective on health during pregnancy. DESIGN: Qualitative study using abductive thematic analysis of semi-structured interview data. SETTING & PARTICIPANTS: Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy. FINDINGS: Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.

Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis.

OBJECTIVE: Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. DESIGN: Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. SETTING: An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. POPULATION: Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257). METHODS: Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. MAIN OUTCOME MEASURES: Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. RESULTS: After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). CONCLUSIONS: Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.

Maternity in prison: influence on physical and emotional health / Maternidade no cárcere: influência na saúde física e emocional

Abstract Objectives: to evaluate the repercussions of motherhood on patients deprived of their liberty. Methods: integrative review based on research in electronic databases: Medline (PubMed), LILACS, SciELO and Nursing Database (BDENF), using the following search strategy: ("Prisons" [Majr] AND "Pregnancy" [ Mesh]), as of 2016. Results: the research ended with 33 bibliographic references, being the highest level of evidence from cohort studies, which demonstrate the precariousness of health care offered to these pregnant women. Three main groups of results were identified: low quality prenatal care, negative maternal and neonatal health indicators in relation to the general population and the emotional issues involved in prison reality during the period of pregnancy and puerperium. Conclusions: prenatal care has flaws that influence, in some way, the maternal and neonatal health indicators. In addition, the precarious structure of prison system directly interferes with the emotional health of these women.

Resumo Objetivos: avaliar as repercussões da maternidade em pacientes privadas da liberdade. Métodos: revisão integrativa a partir de pesquisa nas bases de dados eletrônicas: Medline (PubMed), LILACS, SciELO e Base de Dados de Enfermagem (BDENF), sendo usada como estratégia de busca: ("Prisons"[Majr] AND "Pregnancy"[Mesh]), a partir de 2016. Resultados: a pesquisa finalizou com 33 referências bibliográficas, sendo o maior nível de evidência de estudos de coorte, que demonstram a precarização na assistência de saúde ofertada a essas gestantes. Foram identificados três grupos principais de resultados: pré-natal de baixa qualidade, indicadores de saúde maternos e neonatais negativos e as questões emocionais envolvidas na realidade carcerária durante o período de gestação e puerpério. Conclusões: a assistência pré-natal apresenta falhas que influenciam nos indicadores de saúde maternos e neonatais. Além disso, a estrutura precária do sistema prisional interfere diretamente na saúde emocional dessas mulheres

Construção mulher-mãe: dispositivos que envolvem maternidade, mídia e seus movimentos atuais / Construcción de la madre-mujer: dispositivos que involucran la maternidad, medios de comunicación y sus movimientos actuales / Mother-woman construction: devices which involve maternity, media and their current movements

RESUMO. O pré-natal tornou-se um modo de investir na gestação, porém, a forma como cada mulher vai exercer o cuidado envolve um conjunto heterogêneo de práticas. O objetivo deste artigo é problematizar como os discursos se articulam nas redes sociais e direcionam a mulher a um modelo específico de maternidade. O percurso metodológico dá-se pela cartografia, com apoio de ferramentas foucaultianas: verdade, poder e subjetividade. Nas discussões e resultados, percebemos que o discurso de medicalização do corpo se desdobra em um investimento na família moderna, que seria um agente privilegiado de medicalização, e que as mulheres são interpeladas diretamente por este processo. Concluiu-se que o processo de medicalização atua, no corpo, por meio de uma série de saberes e discursos e compõe uma política normativa de um modelo de maternidade a partir de diferentes enunciações.

RESUMEN. El prenatal se hizo una manera de invertir en la concepción, sin embargo, la forma en que cada mujer ejercita el cuidado involucra un grupo heterogéneo de las prácticas. El objetivo de este artículo es problematizar como todos los discursos que se articulan en las redes sociales y van dirigiendo a la mujer hacia un modelo específico de maternidad. El itinerario metodológico se da por la cartografía, con el soporte de herramientas foucaultianas: la verdad, el poder y la subjectividad. En las discusiones y los resultados, nos dimos cuenta de que el discurso de medicalización del cuerpo se desdobla en una inversión en la familia moderna, que sería un agente privilegiado de medicalización, y que las mujeres son interpeladas directamente por este proceso. Se concluyó que el proceso de medicalización actúa en el cuerpo a través de una serie de saberes y discursos y compone una política normativa de un modelo de maternidad basado en diferentes enunciados.

ABSTRACT. Prenatal care has become a way to invest in gestation, but the way each woman will carry it out involves a heterogeneous set of practices. This article is aimed to problematize how the discourses are articulated in the social networks and may direct the woman to a specific model of maternity. The methodological course is given by cartography, having as a basis the Foucauldian tools: truth, power and subjectivity. In the discussions and the results, it is possible to realize that the medicalization discourse of the body unfolds in an investment for the modern family, which would be a privileged agent of medicalization, and that women are directly interpellated by this process. It was concluded that the medicalization process acts in the body through a series of knowledge and discourses and composes a normative policy of a maternity model based on different enunciations.

Assessment of knowledge, attitude and practice towards ante natal exercise among pregnant women attending antenatal care at Health centers of Mekelle, Tigray Region, Ethiopia, 2020.

BACKGROUND: If pregnant mothers have no medical or obstetrical complications, they are encouraged to maintain active lifestyles during their pregnancies. Benefits of exercise during pregnancy include; prevention of gestational diabetes, pre-eclampsia and reduced low back pain. Therefore this study is done to assess knowledge, attitude and practice towards antenatal exercise among pregnant women who are attending antenatal care at health centers of Mekelle, Tigray Region, Ethiopia. METHOD: For this study cross-sectional study design was used. It was conducted from October 2019 up to January 2020 among 255 pregnant women who are attending antenatal care at selected health centers of Mekelle city. After the data were collected it was entered into epi-data 4.2.0 and was analyzed by using SPSS version 23. RESULT: Among the study participants of pregnant women 51%, 56% and 16.6% had good knowledge, positive attitude and practice towards antenatal exercise respectively. Among those 38.8%, 45.9% and 49.8% were expressed as antenatal exercise can decrease back pain, prevents excessive weight gain and increase energy and stamina during pregnancy respectively. Among those who practiced antenatal exercise, 95% and 83.4% was practicing with frequency ≥ three times per week and ≥20 minutes of the duration of exercise per session respectively. DISCUSSION: Generally, this study showed that the level of knowledge, attitude and practice of pregnant mothers regarding antenatal exercise is poor. Therefore, health care providers who work on maternal health (Gynecologists, Midwives, Nurses, Health extension workers and other community workers) should provide counseling and health education on antenatal exercise.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

OBJECTIVE: to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. METHOD: this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. RESULTS: 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. CONCLUSION: the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

'I fear my partner will abandon me': the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda.

BACKGROUND: Many women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out. METHODS: This study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12. RESULTS: Women described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women's ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women's mental health and treatment knowledge and self-efficacy. CONCLUSIONS: We found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women's mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required.

COVID-19 and Decision-Making for Pregnant Women: Taking or Relinquishing Control in Response to a Pandemic.

COVID-19 has uniquely impacted pregnant women. From the initial unknowns about its virulence during pregnancy, to frequent and rapidly changing hospital guidelines for prenatal care and delivery, pregnant women have felt intense uncertainty and, based on recent research, increased anxiety. This study sought to determine the impact COVID-19 had on women's birth plans. Open-ended qualitative responses from an anonymous, online survey of pregnant women in the United States, conducted on April 3-24, 2020, were analyzed using the Attride-Stirling qualitative framework. A conceptual framework for understanding the impact of COVID-19 on women's birth plans was generated. 2,320 pregnant women (mean age 32.7 years, mean weeks pregnant 24.6 weeks) responded to the open-ended prompts, reflecting the following themes: the impact(s) of COVID-19 on pregnant women (including unanticipated changes and uncertainty), the effect of COVID-19 on decision-making (including emotional reactions and subsequent questioning of the healthcare system), and how both of those things led women to either exercise or relinquish their agency related to their birth plan. These findings indicate that the changes and uncertainty surrounding COVID-19 are causing significant challenges for pregnant women, and absent more clarity and more provider-driven support, women seeking to cope are considering changes to their birth plans. Health systems and providers should heed this warning and work to provide pregnant women and their families with more information, support, and collaborative planning to ensure a positive, healthy birth experience, even during a pandemic.