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1.
Natl Vital Stat Rep ; 70(2): 1-51, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814033

RESUMEN

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.


Asunto(s)
Tasa de Natalidad/tendencias , Adolescente , Adulto , Certificado de Nacimiento , Orden de Nacimiento , Tasa de Natalidad/etnología , Peso al Nacer , Grupos de Población Continentales/estadística & datos numéricos , Parto Obstétrico/economía , Parto Obstétrico/métodos , Femenino , Edad Gestacional , Hispanoamericanos/estadística & datos numéricos , Humanos , Recién Nacido , Masculino , Estado Civil/etnología , Estado Civil/estadística & datos numéricos , Edad Materna , Persona de Mediana Edad , Madres/estadística & datos numéricos , Progenie de Nacimiento Múltiple/estadística & datos numéricos , Embarazo , Atención Prenatal/estadística & datos numéricos , Uso de Tabaco/epidemiología , Uso de Tabaco/etnología , Estados Unidos/epidemiología , Adulto Joven
2.
JAMA Netw Open ; 4(4): e215854, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33852002

RESUMEN

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, and Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures: Prenatal care incorporating audio-only prenatal care visits. Main Outcomes and Measures: The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. Results: The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance: Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Atención Prenatal/métodos , Texas/epidemiología
3.
Int J Equity Health ; 20(1): 91, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33823852

RESUMEN

BACKGROUND: COVID-19 has an inevitable burden on public health, potentially widening the gender gap in healthcare and the economy. We aimed to assess gender-based desparities during COVID-19 in Jordan in terms of health indices, mental well-being and economic burden. METHODS: A nationally representative sample of 1300 participants ≥18 years living in Jordan were selected using stratified random sampling. Data were collected via telephone interviews in this cross-sectional study. Chi-square was used to test age and gender differences according to demographics, economic burden, and health indices (access to healthcare, health insurance, antenatal and reproductive services). A multivariable logistic regression analysis was used to estimate the beta-coefficient (ß) and 95% confidence interval (CI) of factors correlated with mental well-being, assessed by patients' health questionnaire 4 (PHQ-4). RESULTS: 656 (50.5%) men and 644 (49.5%) women completed the interview. Three-fourths of the participants had health insurance during the COVID-19 crisis. There was no significant difference in healthcare coverage or access between women and men (p > 0.05). Half of pregnant women were unable to access antenatal care. Gender was a significant predictor of higher PHQ-4 scores (women vs. men: ß: 0.88, 95% CI: 0.54-1.22). Among women, age ≥ 60 years and being married were associated with significantly lower PHQ-4 scores. Only 0.38% of the overall participants lost their jobs; however, 8.3% reported a reduced payment. More women (13.89%) were not paid during the crisis as compared with men (6.92%) (P = 0.01). CONCLUSIONS: Our results showed no gender differences in healthcare coverage or access during the COVID-19 crisis generally. Women in Jordan are experiencing worse outcomes in terms of mental well-being and economic burden. Policymakers should give priority to women's mental health and antenatal and reproductive services. Financial security should be addressed in all Jordanian COVID-19 national plans because the crisis appears widening the gender gap in the economy.


Asunto(s)
/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Salud Mental/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Jordania , Masculino , Persona de Mediana Edad , Embarazo , Factores Sexuales
4.
Artículo en Inglés | MEDLINE | ID: mdl-33753426

RESUMEN

BACKGROUND: The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. METHODS: Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. RESULTS: We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded. CONCLUSION: IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.


Asunto(s)
/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/epidemiología , Atención Prenatal/estadística & datos numéricos , Corticoesteroides/uso terapéutico , Adulto , Alopurinol/análogos & derivados , Alopurinol/uso terapéutico , Productos Biológicos/uso terapéutico , Lactancia Materna/estadística & datos numéricos , /epidemiología , Cesárea/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Enfermedades Inflamatorias del Intestino/virología , Embarazo , Resultado del Embarazo/epidemiología , Estudios Retrospectivos , Reino Unido/epidemiología , Privación de Tratamiento
5.
J Prev Med Public Health ; 54(1): 81-84, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33618503

RESUMEN

The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.


Asunto(s)
Práctica de Grupo/normas , Pobreza/clasificación , Atención Prenatal/normas , Adulto , Femenino , Práctica de Grupo/estadística & datos numéricos , Humanos , Servicios de Salud Materna/normas , Servicios de Salud Materna/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Embarazo , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos
6.
Nutrients ; 13(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33567634

RESUMEN

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0-5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Madres/estadística & datos numéricos , Embarazo en Adolescencia/estadística & datos numéricos , Adolescente , Conducta del Adolescente/psicología , Bangladesh , Alimentación Artificial/estadística & datos numéricos , Niño , Parto Obstétrico/estadística & datos numéricos , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Análisis Multivariante , Oportunidad Relativa , Paridad , Atención Posnatal/estadística & datos numéricos , Embarazo , Atención Prenatal/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven
7.
Nutrients ; 13(2)2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33572843

RESUMEN

BACKGROUND: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts. METHODS: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) (n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) (n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries. RESULTS: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (>100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (>100 g/day) compared to moderate protein intake (80-90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to <37) and greater risk was not observed at more extreme intakes. Very low (<60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)]. CONCLUSIONS: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.


Asunto(s)
Dieta Rica en Proteínas/efectos adversos , Proteínas en la Dieta/efectos adversos , Fenómenos Fisiologicos Nutricionales Maternos , Nacimiento Prematuro/epidemiología , Atención Prenatal/estadística & datos numéricos , Adulto , Dinamarca/epidemiología , Encuestas sobre Dietas , Suplementos Dietéticos , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Noruega/epidemiología , Oportunidad Relativa , Mortalidad Perinatal , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/etiología , Atención Prenatal/métodos , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
8.
Nutrients ; 13(2)2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33572898

RESUMEN

Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30-<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75-4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39-5.19), anaemic women (OR: 1.53; 95% CI: 0.99-2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22-3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06-4.21), nulliparous women (OR: 2.65; 95% CI: 1.34-5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12-5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28-4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband's occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.


Asunto(s)
Complicaciones del Embarazo/epidemiología , Atención Prenatal/estadística & datos numéricos , Deficiencia de Vitamina D/epidemiología , Adulto , Bangladesh/epidemiología , Estudios Transversales , Dieta/efectos adversos , Dieta/estadística & datos numéricos , Empleo/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Modelos Logísticos , Estado Nutricional , Paridad , Embarazo , Complicaciones del Embarazo/etiología , Primer Trimestre del Embarazo/sangre , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Esposos/estadística & datos numéricos , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/etiología , Adulto Joven
10.
Minerva Obstet Gynecol ; 73(2): 261-267, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33435661

RESUMEN

BACKGROUND: Since COVID-19 was declared a pandemic, governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study was to understand the impact of the changes imposed by COVID-19 emergency on the well-being of pregnant women and how the transformation of Schiavonia Hospital into a dedicated COVID hospital affected their pregnancy experience. METHODS: A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received, and attitudes regards giving birth in a COVID hospital. RESULTS: One hundred four women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia Hospital as COVID hospital did not modify the trust in the facility and in the obstetrics ward for the 90% of women, in fact for the 85.6% it was the planned Birth Center since the beginning of pregnancy. The communication was complete and exhaustive for 82.7% of the respondents. CONCLUSIONS: Despite the COVID hospital transformation, the women who came to give birth at Schiavonia Birth Center rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.


Asunto(s)
Actitud Frente a la Salud , Salas de Parto/organización & administración , Parto Obstétrico , Mujeres Embarazadas/psicología , Adulto , Estudios Transversales , Femenino , Clausura de las Instituciones de Salud , Hospitales de Aislamiento/organización & administración , Humanos , Italia/epidemiología , Estilo de Vida , Pandemias , Paridad , Embarazo , Atención Prenatal/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Mujeres Trabajadoras/estadística & datos numéricos , Adulto Joven
11.
Int J Gynaecol Obstet ; 153(1): 45-50, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33368273

RESUMEN

OBJECTIVE: To assess the incidence and predictors of intimate partner violence (IPV) during pregnancy amidst the coronavirus disease 2019 pandemic. METHODS: This cross-sectional study was conducted at the prenatal care clinic of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, among pregnant women from 31 August to 2 November 2020. Participants were interviewed using Open Data Kit. Logistic regression was used to assess predictors. RESULTS: Among the 464 pregnant women, 33 (7.1%) reported IPV during pregnancy, and among these 24 (72.7%) reported emotional violence, 16 (48.5%) reported sexual violence, and 10 (30.3%) reported physical violence. Among the study participants, only 8 (1.7%) were screened for IPV. IPV was reported 3.27 times more often by women who reported that their partner chewed Khat compared with those women whose partner did not (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.45-7.38), and 1.52 times more often women who reported that their partner drank alcohol compared with those women whose partner did not (aOR 1.52; 95% CI 1.01-2.28). CONCLUSION: Very few women were screened for IPV. Partners drinking alcohol and chewing Khat are significantly positively associated with IPV during pregnancy. IPV screening should be included in the national management protocol of obstetric cases of Ethiopia.


Asunto(s)
Violencia de Pareja , Atención Prenatal , Esposos , Trastornos Relacionados con Sustancias , Adulto , /prevención & control , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Incidencia , Violencia de Pareja/prevención & control , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Masculino , Evaluación de Necesidades , Embarazo , Mujeres Embarazadas , Atención Prenatal/métodos , Atención Prenatal/normas , Atención Prenatal/estadística & datos numéricos , Esposos/psicología , Esposos/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología
12.
MCN Am J Matern Child Nurs ; 46(1): 21-29, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33009009

RESUMEN

PURPOSE: The aim of this study is to describe how the COVID-19 (coronavirus) pandemic has affected pregnancy, prenatal maternity care practices, and infant feeding plans among pregnant persons in the United States. STUDY DESIGN: Cross-sectional descriptive study using an app-based survey. METHODS: A link to the survey was sent via email to users of the Ovia Pregnancy app on May 20, 2020 and was open for 1 week. Participants were asked to complete the survey as it applied to their pregnancy, breastfeeding, and maternity care received during the COVID-19 pandemic, beginning approximately February 2020 through the time of the survey. There were 258 respondents who completed the survey. RESULTS: The majority (96.4%; n = 251) of pregnant women felt they received safe prenatal care during this time period. Slightly less 86.3% (n = 215) felt they received adequate prenatal care during this time period. 14.2% (n = 33) reported changing or considering changing the location where they planned to give birth due to COVID-19. Of those who reported they had begun purchasing items for their baby, 52.7% reported that the COVID-19 pandemic has affected their ability to get items they need for their baby. CLINICAL IMPLICATIONS: Although it is imperative to implement policies that reduce risk of transmission of COVID-19 to pregnant women and health care providers, it is necessary for health care providers and policy makers to listen to the collective voices of women during pregnancy about how COVID-19 has affected their birth and infant feeding plans and their perception of changes in prenatal care.


Asunto(s)
Lactancia Materna/psicología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/psicología , Atención Prenatal/psicología , Adulto , Lactancia Materna/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Lactante , Servicios de Salud Materna/estadística & datos numéricos , Educación del Paciente como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/estadística & datos numéricos
13.
PLoS One ; 15(12): e0244640, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33373416

RESUMEN

BACKGROUND: Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. METHODS: Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). RESULTS: Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16-29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48-0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1-4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4-8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6-8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1-8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1-11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6-16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7-25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1-7.4). CONCLUSION: Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Bangladesh/etnología , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud del Indígena , Humanos , Edad Materna , Servicios de Salud Materna , Persona de Mediana Edad , Embarazo , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
14.
Cochrane Database Syst Rev ; 12: CD009599, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33336827

RESUMEN

BACKGROUND: Stillbirth is generally defined as a death prior to birth at or after 22 weeks' gestation. It remains a major public health concern globally. Antenatal interventions may reduce stillbirths and improve maternal and neonatal outcomes in settings with high rates of stillbirth. There are several key antenatal strategies that aim to prevent stillbirth including nutrition, and prevention and management of infections. OBJECTIVES: To summarise the evidence from Cochrane systematic reviews on the effects of antenatal interventions for preventing stillbirth for low risk or unselected populations of women. METHODS: We collaborated with Cochrane Pregnancy and Childbirth's Information Specialist to identify all their published reviews that specified or reported stillbirth; and we searched the Cochrane Database of Systematic Reviews (search date: 29 Feburary 2020) to identify reviews published within other Cochrane groups. The primary outcome measure was stillbirth but in the absence of stillbirth data, we used perinatal mortality (both stillbirth and death in the first week of life), fetal loss or fetal death as outcomes. Two review authors independently evaluated reviews for inclusion, extracted data and assessed quality of evidence using AMSTAR (A Measurement Tool to Assess Reviews) and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm; clear evidence of no effect or equivalence; possible benefit or harm; or unknown benefit or harm or no effect or equivalence. MAIN RESULTS: We identified 43 Cochrane Reviews that included interventions in pregnant women with the potential for preventing stillbirth; all of the included reviews reported our primary outcome 'stillbirth' or in the absence of stillbirth, 'perinatal death' or 'fetal loss/fetal death'. AMSTAR quality was high in 40 reviews with scores ranging from 8 to 11 and moderate in three reviews with a score of 7. Nutrition interventions Clear evidence of benefit: balanced energy/protein supplementation versus no supplementation suggests a probable reduction in stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94, 5 randomised controlled trials (RCTs), 3408 women; moderate-certainty evidence). Clear evidence of no effect or equivalence for stillbirth or perinatal death: vitamin A alone versus placebo or no treatment; and multiple micronutrients with iron and folic acid versus iron with or without folic acid. Unknown benefit or harm or no effect or equivalence: for all other nutrition interventions examined the effects were uncertain. Prevention and management of infections Possible benefit for fetal loss or death: insecticide-treated anti-malarial nets versus no nets (RR 0.67, 95% CI 0.47 to 0.97, 4 RCTs; low-certainty). Unknown evidence of no effect or equivalence: drugs for preventing malaria (stillbirth RR 1.02, 95% CI 0.76 to 1.36, 5 RCTs, 7130 women, moderate certainty in women of all parity; perinatal death RR 1.24, 95% CI 0.94 to 1.63, 4 RCTs, 5216 women, moderate-certainty in women of all parity). Prevention, detection and management of other morbidities Clear evidence of benefit: the following interventions suggest a reduction: midwife-led models of care in settings where the midwife is the primary healthcare provider particularly for low-risk pregnant women (overall fetal loss/neonatal death reduction RR 0.84, 95% CI 0.71 to 0.99, 13 RCTs, 17,561 women; high-certainty), training versus not training traditional birth attendants in rural populations of low- and middle-income countries (stillbirth reduction odds ratio (OR) 0.69, 95% CI 0.57 to 0.83, 1 RCT, 18,699 women, moderate-certainty; perinatal death reduction OR 0.70, 95% CI 0.59 to 0.83, 1 RCT, 18,699 women, moderate-certainty). Clear evidence of harm: a reduced number of antenatal care visits probably results in an increase in perinatal death (RR 1.14 95% CI 1.00 to 1.31, 5 RCTs, 56,431 women; moderate-certainty evidence). Clear evidence of no effect or equivalence: there was evidence of no effect in the risk of stillbirth/fetal loss or perinatal death for the following interventions and comparisons: psychosocial interventions; and providing case notes to women. Possible benefit: community-based intervention packages (including community support groups/women's groups, community mobilisation and home visitation, or training traditional birth attendants who made home visits) may result in a reduction of stillbirth (RR 0.81, 95% CI 0.73 to 0.91, 15 RCTs, 201,181 women; low-certainty) and perinatal death (RR 0.78, 95% CI 0.70 to 0.86, 17 RCTs, 282,327 women; low-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. Screening and management of fetal growth and well-being Clear evidence of benefit: computerised antenatal cardiotocography for assessing infant's well-being in utero compared with traditional antenatal cardiotocography (perinatal mortality reduction RR 0.20, 95% CI 0.04 to 0.88, 2 RCTs, 469 women; moderate-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. AUTHORS' CONCLUSIONS: While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife-led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide-treated anti-malarial nets and community-based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, indicating the need to carefully understand the context in which these interventions were tested. Further high-quality RCTs are needed to evaluate the effects of antenatal preventive interventions and which approaches are most effective to reduce the risk of stillbirth. Stillbirth (or fetal death), perinatal and neonatal death need to be reported separately in future RCTs of antenatal interventions to allow assessment of different interventions on these rare but important outcomes and they need to clearly define the target populations of women where the intervention is most likely to be of benefit. As the high burden of stillbirths occurs in low- and middle-income countries, further high-quality trials need to be conducted in these settings as a priority.


Asunto(s)
Muerte Fetal/prevención & control , Muerte Perinatal/prevención & control , Atención Prenatal/métodos , Mortinato , Cardiotocografía , Femenino , Desarrollo Fetal , Humanos , Recién Nacido , Mosquiteros Tratados con Insecticida , Partería , Evaluación Nutricional , Embarazo , Atención Prenatal/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto
15.
PLoS One ; 15(12): e0243455, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33382728

RESUMEN

OBJECTIVE: To determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania. METHODS: A 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth. RESULTS: A total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01-13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20-8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71-16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03-8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04-5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis. CONCLUSIONS: Educating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths.


Asunto(s)
Placenta/patología , Mortinato , Adolescente , Adulto , Estudios de Casos y Controles , Corioamnionitis/diagnóstico , Corioamnionitis/patología , Escolaridad , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Preeclampsia/patología , Embarazo , Complicaciones del Embarazo , Atención Prenatal/estadística & datos numéricos , Factores de Riesgo , Tanzanía , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-33327578

RESUMEN

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives' narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.


Asunto(s)
Partería , Pobreza , Atención Prenatal , Femenino , Política de Salud , Humanos , Nueva Zelanda , Pobreza/psicología , Pobreza/estadística & datos numéricos , Embarazo , Atención Prenatal/economía , Atención Prenatal/estadística & datos numéricos , Investigación Cualitativa , Vergüenza , Violencia
17.
J Pregnancy ; 2020: 6153146, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33062334

RESUMEN

Introduction: Obstetric danger signs are those signs that a pregnant woman will see or those symptoms that she will feel which indicate that something is going wrong with her or with the pregnancy. Evidence on the prevalence of obstetric danger signs and contributing factors were crucial in designing programs in the global target of reducing maternal morbidity and mortality. Objective: To assess the prevalence of obstetric danger signs during pregnancy and associated factors among mothers in a Shashemene rural district, South Ethiopia. Methods: A community-based cross-sectional study design was conducted among 395 randomly selected women who gave birth in the last six months. A pretested interviewer-administered questionnaire was utilized. Data were cleaned, coded, and entered into Epi data manager version 4.1 and then exported to SPSS version 20. Bivariable and multivariable logistic regression analyses were employed to assess the association between independent variables with the outcome variable. Statistical significance was declared at p < 0.05. Result: One hundred sixty-three (41.3%) of women had a history of obstetric danger signs during pregnancy. The most prevalent obstetric danger signs were vaginal bleeding (15.4%) followed by swelling of the body 12.7% and severe vomiting 5.3%. Women who have less than four times antenatal care visits were 6.7 times more likely to experience obstetric danger signs (AOR 6.7 (95% CI 3.05, 14.85)) compared to those who had antenatal care visit four times and above. Women who have inadequate knowledge of obstetric danger signs were 2.5 times more likely to experience obstetric danger signs during pregnancy (AOR 2.5 (95% CI 1.34, 4.71)), and primigravida women were 6.3 times more likely to have obstetric danger signs during pregnancy (AOR 6.3 (95% CI 2.61, 15.09)) compared to multiparous women. Conclusion: About half of the pregnant mothers have experienced at least one obstetric danger signs. Public health interventions on maternal health should give priority to the prevalent causes of obstetric danger signs, strengthening completion of four antenatal care visits and health education on obstetric danger signs for pregnant mothers at community level especially for primgravid women.


Asunto(s)
Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Estudios Transversales , Edema/epidemiología , Edema/etiología , Edema/prevención & control , Etiopía/epidemiología , Femenino , Número de Embarazos , Educación en Salud , Humanos , Conocimiento , Mortalidad Materna , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/prevención & control , Atención Prenatal/estadística & datos numéricos , Prevalencia , Encuestas y Cuestionarios , Hemorragia Uterina/epidemiología , Hemorragia Uterina/etiología , Hemorragia Uterina/prevención & control , Vómitos/epidemiología , Vómitos/etiología , Vómitos/prevención & control , Adulto Joven
18.
J Pregnancy ; 2020: 7363242, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029402

RESUMEN

Introduction: Reduction of maternal and neonatal morbidity and mortality has continued to be a challenge in developing countries. The majority of maternal and neonatal mortality occurred during the early postpartum period. This is mostly due to low postnatal care service utilization. There is a discrepancy of evidence on the effect status of antenatal care on the improvement of postnatal care service utilization. Therefore, this review study is aimed at estimating the pooled effect of antenatal care on postnatal care service utilization. Methods: We searched from PubMed and Cochrane library database, Google Scholar, and Google. Initially, we found 265 articles; after duplication was removed and screened by the relevance of the titles and abstracts, 36 studies were considered for assessment of eligibility. Finally, 14 articles passed the inclusion and exclusion criteria and are included in the meta-analysis. Study quality assessment was done using Janna Briggs Institute (JBI) critical appraisal tools. The main information was extracted from each study. Heterogeneity of studies was assessed using I 2 = 70% and more considered having high heterogeneity. The publication bias was checked using funnel plot and big test. Meta-analysis using a random effect model was conducted. A forest plot was used to show the estimated size effect of odds ratio with a 95% confidence interval. Results: A total of 14 articles were included with 15,765 participants for synthesis and meta-analysis. We found that a pooled estimate of women who had antenatal care was 1.53 times more likely to have postnatal care compared with those who had no antenatal care (AOR = 1.53, 95% CI 1.38-1.70, I 2 = 0%). Conclusions: This review results revealed a low utilization of postnatal care service. Antenatal care service utilization has a positive effect on postnatal care service utilization. Policymakers and programmers better considered more antenatal care service use as one strategy of enhancing the utilization of postnatal care service.


Asunto(s)
Muerte Materna/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Muerte Perinatal/prevención & control , Atención Posnatal/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Países en Desarrollo , Femenino , Humanos , Lactante , Mortalidad Infantil , Mortalidad Materna , Embarazo
19.
Obstet Gynecol ; 136(5): 995-1000, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030870

RESUMEN

OBJECTIVE: To assess total time for evaluation of women with first-trimester pregnancy concerns in an early pregnancy unit compared with an emergency department (ED) within a single safety net hospital system. METHODS: We performed a retrospective cohort study at Denver Health Medical Center from May 1, 2017, to April 30, 2018. All patients who presented to the early pregnancy unit and a random sample of patients who presented to the ED were identified, stratified by month. Patients were eligible if they were aged 12-55 years, hemodynamically stable, in the first trimester with a positive pregnancy test, and without a prior ultrasonogram. Evaluation time was calculated as difference between registration or check-in and the discharge time. We extracted patient demographics, reproductive histories, presenting symptoms, diagnosis, and management plans at time of discharge from the electronic medical record. Descriptive statistics and multivariate analyses were performed. Lastly, a preliminary analysis of total charges was conducted. RESULTS: Of 250 patients originally identified, 165 met inclusion criteria (79 from the early pregnancy unit and 86 from the ED). There was no statistical difference in race, ethnicity, or insurance type between groups. Median evaluation time was significantly reduced in the early pregnancy unit compared with the ED (45 minutes [interquartile range 31-61] vs 236 minutes [interquartile range 173-307], respectively, P<.001). After adjusting for patient characteristics and clinical presentation, the average total evaluation time among patients in the early pregnancy unit (36 minutes) was 80% lower compared with patients in the ED (180 minutes). Median evaluation charges were significantly less for patients in the early pregnancy unit compared with those in the ED ($586.22 [interquartile range 384.83-757.34] vs $1,350.97 [interquartile range 975.77-3,553.62], respectively, P<.001). CONCLUSION: Time and charges for evaluation of women with first-trimester pregnancy concerns were significantly lower in an early pregnancy unit compared with an ED. Early pregnancy units should be considered as an alternative care model for patients in the first trimester of pregnancy in the United States.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Complicaciones del Embarazo/diagnóstico , Atención Prenatal/estadística & datos numéricos , Proveedores de Redes de Seguridad/estadística & datos numéricos , Adulto , Servicio de Urgencia en Hospital/economía , Femenino , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/economía , Alta del Paciente/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/economía , Primer Trimestre del Embarazo , Atención Prenatal/economía , Atención Prenatal/métodos , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos , Adulto Joven
20.
PLoS One ; 15(10): e0239578, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031456

RESUMEN

BACKGROUND: Prevalence of Prevalence of malaria in pregnancy (MiP) in Kenya ranges from 9% to 18%. We estimated the prevalence and factors associated with MiP and anemia in pregnancy (AiP) among asymptomatic women attending antenatal care (ANC) visits. METHODS: We performed a cross-sectional study among pregnant women attending ANC at Msambweni Hospital, between September 2018 and February 2019. Data was collected and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared MiP and AiP in asymptomatic cases to those without either condition. Adjusted prevalence Odds odds ratios (aPOR) and 95% confidence intervals (CI) were calculated to identify factors associated with asymptomatic MiP and AiP. RESULTS: We interviewed 308 study participants; their mean age was 26.6 years (± 5.8 years), mean gestational age was 21.8 weeks (± 6.0 weeks), 173 (56.2%) were in the second trimester of pregnancy, 12.9% (40/308) had MiP and 62.7% had AiP. Women who were aged ≤ 20 years had three times likelihood of developing MiP (aPOR = 3.1 Cl: 1.3-7.35) compared to those aged >20 years old. The likelihood of AiP was higher among women with gestational age ≥ 16 weeks (aPOR = 3.9, CI: 1.96-7.75), those with parasitemia (aPOR = 3.3, 95% CI: 1.31-8.18), those in third trimester of pregnancy (aPOR = 2.6, 95% CI:1.40-4.96) and those who reported eating soil as a craving during pregnancy (aPOR = 1.9, 95%CI:1.15-3.29). CONCLUSIONS: Majority of the women had asymptomatic MiP and AiP. MiP was observed in one tenth of all study participants. Asymptomatic MiP was associated with younger age while AiP was associated with gestational age parasitemia, and soil consumption as a craving during pregnancy.


Asunto(s)
Anemia/epidemiología , Enfermedades Asintomáticas/epidemiología , Hospitales/estadística & datos numéricos , Malaria Falciparum/epidemiología , Plasmodium falciparum/fisiología , Complicaciones Parasitarias del Embarazo/epidemiología , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Kenia , Embarazo , Prevalencia , Factores de Riesgo , Adulto Joven
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