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1.
BMJ ; 368: l7057, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996343

RESUMO

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN: National register based birth cohort study with a sibling comparison design. SETTING: Sweden. PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years. RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.


Assuntos
Fraturas Ósseas , Gestantes/psicologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar , Adulto , Fatores Etários , Criança , Correlação de Dados , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Humanos , Lactente , Masculino , Gravidez , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Suécia/epidemiologia
2.
Niger J Clin Pract ; 22(12): 1635-1643, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793468

RESUMO

Background: Prenatal distress and fear of childbirth negatively affect the health of the mother and the fetus. Sociodemographic and pregnancy related characteristics may influence prenatal distress and fear of childbirth. Aim: This study aimed to explore the relationship between fear of childbirth and prenatal distress levels with accompanying factors. Subjects and Methods: The study was designed as a cross-sectional survey study and conducted in the outpatient clinic of Obstetrics and Gynecology Department of Pamukkale University Hospital, Denizli, Turkey, between April 2017 and January 2018. Survey data were collected from 103 third-trimester pregnant women who had admitted to the hospital for routine prenatal examination. Sociodemographic Information Form, the Revised Prenatal Distress Questionnaire (NUPDQ), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) were used to collect data. Sociodemographics, obstetrics, and other variables were summarized by descriptive statistics. Mann-Whitney U-test, Chi-squared test, and Fisher's exact test were used for comparison of data between groups. Results: The mean score of NUPDQ was 7.58 (SD 4.09) in the nulliparous group and 8.17 (SD 5.16) in the multiparous group (P = 0.68). The mean W-DEQ score was 40.46 (SD 21.80) in nulliparous women and 45.55 (SD 26.72) in multiparous women (P = 0.38). The W-DEQ and NUPDQ scores were moderately correlated with a Spearman correlation co-efficient of 0.58 (P < 0.001). Conclusions: The results of this study revealed that fear of childbirth and prenatal distress were moderately and positively correlated. NUPDQ and W-DEQ can be used during pregnancy to understand if pregnant women have fear or distress. This could help to give a better support to pregnant women.


Assuntos
Ansiedade/psicologia , Parto Obstétrico/psicologia , Medo/psicologia , Parto/psicologia , Gestantes/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Paridade , Gravidez , Cuidado Pré-Natal , Estresse Psicológico , Inquéritos e Questionários , Turquia , Adulto Jovem
3.
ABCS health sci ; 44(3): 187-194, 20 dez 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047751

RESUMO

INTRODUÇÃO: O aparecimento de transtornos emocionais no início da gestação é frequente, entre eles estão os sintomas depressivos (SD), como sentimento de culpa, falta de apetite e de energia. OBJETIVO: Medir a prevalência de sintomas depressivos e fatores associados em gestantes atendidas na Atenção Básica. MÉTODOS: Estudo epidemiológico observacional transversal, constituído por gestantes, usuárias da Atenção Básica de Caxias do Sul/RS. Os SD foram avaliados por meio Patient Health Questionnaire (PHQ-9). Realizou-se a análise bruta, onde calculou-se as razões de prevalência (RP) e respectivos intervalos de confiança (IC 95%). A comparação de variáveis categóricas ocorreu por meio do teste de Qui-Quadrado. A análise ajustada foi realizada por regressão de Poisson, utilizou-se a técnica de backwards, onde o modelo final foi construído a partir das variáveis com p ≤0,20 na análise bruta. RESULTADOS: A amostra constituiu-se de 76 gestantes, destas 46,1% apresentaram SD. A média de idade foi de 26,6 anos (±5,95) e 72,4% estavam casadas ou em união estável. Houve associação significativa entre SD e estado civil (RP: 1,54; IC 95% 1,00-2,37; p=0,045) e a ocorrência de aborto em outras gestações (RP: 1,72; IC 95% 1,08-2,74; p=0,022). CONCLUSÃO: Observou-se uma elevada prevalência de SD, comparando a estudos regionais, nas gestantes investigadas. Identificou-se como fatores associados ao desfecho, o estado civil e histórico de aborto, podendo trazer problemas na gestação e no pós-parto. Assim, percebe-se a necessidade de instrumentos e estratégias para identificar a presença de SD na fase inicial da gestação, para que sejam diagnosticados e tratados.


INTRODUCTION: The onset of emotional disorders early in pregnancy is frequent, including depressive symptoms (DS) such as guilt, lack of appetite and energy. OBJECTIVE: To measure the prevalence of depressive symptoms and associated factors in pregnant women attending primary care. METHODS: Cross-sectional observational epidemiological study of pregnant women, who attend primary care in Caxias do Sul, Rio Grande do Sul, Brazil. Depressive symptoms were assessed using Patient Health Questionnaire (PHQ-9). Gross analysis was performed, in which prevalence ratios (PR) and respective confidence intervals (CI 95%) were calculated. The comparison of categorical variables occurred through the Chi-square test. The adjusted analysis was performed by Poisson regression, using the backwards technique, where the final model was constructed from the variables with p≤0.20 in the gross analysis. RESULTS: The sample consisted of 76 pregnant women, of these 46.1% had depressive symptoms. The average age was 26.6 years (±5.95) and 72.4% were married or in a stable union. There was a significant association between depressive symptoms and marital status (PR: 1.54; 95% CI 1.00-2.37; p=0.045) and the occurrence of abortion in other pregnancies (PR: 1.72; 95% CI 1, 08-2.74; p=0.022). CONCLUSION: There was a high prevalence of depressive symptoms compared to regional studies in the pregnant women investigated. Factors associated with the outcome were marital status and history of abortion, which may cause problems during pregnancy and postpartum. Thus, there is a need for tools and strategies to identify the presence of depressive symptoms in early pregnancy, so that they can be diagnosed and treated.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Atenção Primária à Saúde , Gravidez/psicologia , Epidemiologia , Fatores de Risco , Gestantes/psicologia , Depressão/psicologia , Depressão/epidemiologia
4.
Afr J Reprod Health ; 23(3): 49-56, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782631

RESUMO

Sexually Transmitted Infections (STIs) during pregnancy remain a public health concern especially in developing countries including The Gambia. This study assessed the knowledge of STIs and its associated factors amongst pregnant women attending antenatal clinics in West Coast region of The Gambia. A descriptive cross-sectional study design was used. Two hundred and eighty pregnant women attending antenatal care in Brikama District Hospital, Brikama, and Bandung Maternity and Child Health Hospital, Bandung, who gave their consent, participated in this study. The instrument for data collection was an interviewer administered questionnaire. Data was analyzed using IBM SPSS for Windows, version 21.0. Level of significance was set at p < 0.05. All the respondents were aware of HIV/AIDS and their main source of information was from health care providers. However, most of them 263 (93.9%) had poor knowledge of STIs. Level of education (p < 0.001) and employment status (p = 0.001) had significant association with level of knowledge of STIs. This study also identified low level of education [AOR: 0.04 (95% CI: 0.01 - 0.35)], and unemployment [AOR: 21.97 (95% CI: 1.57 - 306.65)] as statistically significant predictors of low level of knowledge of STIs amongst the respondents. There is need for mass media campaigns and other public health measures aimed at increasing knowledge of STIs as this will herald effective intervention strategies towards the prevention of STIs.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Gâmbia , Humanos , Gravidez , Gestantes/etnologia , Gestantes/psicologia , Doenças Sexualmente Transmissíveis/transmissão , Fatores Socioeconômicos , Adulto Jovem
5.
BMC Health Serv Res ; 19(1): 747, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651307

RESUMO

BACKGROUND: Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunization is a strategy to protect pregnant women and their newborns. This study aimed to find out how patient-provider relationships affect maternal vaccine uptake, particularly in the context of a lower middle- income country where limited research in this area exists. METHODS: We conducted semi-structured, in-depth narrative interviews of both providers and pregnant women from four sites in Kenya: Siaya, Nairobi, Mombasa, and Marsabit. Interviews were conducted in either English or one of the local regional languages. RESULTS: We found that patient trust in health care providers (HCPs) is integral to vaccine acceptance among pregnant women in Kenya. The HCP-patient relationship is a fiduciary one, whereby the patients' trusts is primarily rooted in the provider's social position as a person who is highly educated in matters of health. Furthermore, patient health education and provider attitudes are crucial for reinstating and fostering that trust, especially in cases where trust was impeded by rumors, community myths and misperceptions, and religious and cultural factors. CONCLUSION: Patient trust in providers is a strong facilitator contributing to vaccine acceptance among pregnant women in Kenya. To maintain and increase immunization trust, providers have a critical role in cultivating a positive environment that allows for favorable interactions and patient health education. This includes educating providers on maternal immunizations and enhancing knowledge of effective risk communication tactics in clinical encounters.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes/psicologia , Relações Profissional-Paciente , Confiança , Vacinas , Adolescente , Adulto , Atitude do Pessoal de Saúde , Família , Feminino , Pessoal de Saúde/psicologia , Humanos , Imunização , Quênia , Defesa do Paciente , Educação de Pacientes como Assunto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Vacinação , Adulto Jovem
6.
Health Care Women Int ; 40(12): 1302-1335, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31600118

RESUMO

First Nations women who live on rural and remote reserves in Canada leave their communities between 36 and 38 weeks gestational age to receive labor and birthing services in large urban centers. The process and administrative details of this process are undocumented despite decades of relocation as a routine component of maternity care. Using data from 32 semistructured interviews and information from peer-reviewed literature, grey literature, and public documents, I constructed a descriptive map and a visual representation of the policy. I present new and detailed information about Canada's health policy as well as recommendations to address the health care gaps identified.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Índios Norte-Americanos , Tocologia/métodos , Parto/etnologia , Gestantes/psicologia , Canadá , Feminino , Humanos , Entrevistas como Assunto , Manitoba , Serviços de Saúde Materna/organização & administração , Área Carente de Assistência Médica , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , População Rural
7.
Epidemiol Health ; 41: e2019036, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31606979

RESUMO

OBJECTIVES: The study was to conduct a comparative assessment of drinking behaviors and overall health among pregnant and breastfeeding women. METHODS: This study used data collected from the Korean Community Health Survey in 2015. Data obtained from 2,156 pregnant or breastfeeding women were analyzed using descriptive statistics, the t-test, the chi-square test, and the Pearson correlation coefficient. RESULTS: Current drinking and alcohol consumption were higher among pregnant women than among breastfeeding women. Depression was twice as common among breastfeeding women than among pregnant women, and stress was much higher among breastfeeding women as well. Breastfeeding women also had lower subjective dental health and more unmet medical needs than pregnant women. CONCLUSIONS: Although pregnant women were in better overall health than breastfeeding women, many of them were unable to stop drinking, which is a risky and adverse health behavior that negatively affects maternal and fetal health. In order to reduce drinking among pregnant and breastfeeding women, it is necessary to develop a tailored, standardized educational program and national guidelines.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Aleitamento Materno/estatística & dados numéricos , Nível de Saúde , Gestantes/psicologia , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , República da Coreia
8.
BMC Health Serv Res ; 19(1): 760, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655575

RESUMO

BACKGROUND: With most countries in sub-Saharan Africa (SSA) lagging behind schedule to implement a comprehensive viral hepatitis elimination strategy, several barriers to accurate information and hepatitis B virus (HBV) services still exist, that are unique to different regions. In an obstetric population of a high HBV burden SSA setting without antenatal HBV services, we systematically evaluated perceptions and prevention behavioral intentions in relation to HBV and liver cancer. METHODS: Eligible consenting pregnant women were recruited from public health care facilities in the central and northern regions of Uganda, between October 2016 and December 2017. Standardized procedures and instruments based on the health belief model and theory of planned behavior were used to collect data on socio-demographic characteristics, HBV perceptions and behavioral intentions. Descriptive analysis using Chi-square tests was done to obtain distribution of respondents by levels of perceived risk of HBV and liver cancer for themselves, their child under 5 years and their spouse. Modified Poisson regression analyses were used to evaluate relationships between perception variables and different behavioral outcomes (intention to screen, vaccinate and treat HBV). RESULTS: Perceived risk (PRR = 0.95(0.90-1.00), p = 0.055) was inversely associated with intention to screen for HBV. Conversely, perceived self-efficacy showed a consistent association with intention to screen for HBV (PRR = 1.18(1.10-1.23) p = 0.005), to vaccinate (PRR = 1.20(1.05-1.36) p = 0.006) and to seek treatment for HBV (PRR = 1.40(1.18-1.67) p < 0.001). Women from the north, compared to the central region (PRR = 1.76 (1.13-2.72) p = 0.012), and those who self-identified as Catholic (PRR = 1.85 (0.99-3.56) p = 0.056), and as Protestant, (PRR = 2.22 (1.22-4.04) p = 0.002), were more likely to have higher perceived self-efficacy, compared to Muslims. Age and education were not related to perceived self-efficacy. CONCLUSION: Women in both regions hold incorrect perceptions of HBV and liver cancer risk, with women from the central reporting higher perceived risk than those from the north. High perceived self-efficacy influenced intention to participate in HBV prevention. Programs and policies geared towards enhancing HBV prevention in this sub-population may consider socio-cultural factors observed to influence prevention behaviors. These findings may guide HBV interventions aimed at improving capacity to seek HBV prevention services, thereby promoting HBV micro-elimination in this sub-population.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Política de Saúde , Humanos , Gravidez , Medição de Risco , Uganda , Adulto Jovem
9.
Matern Child Health J ; 23(12): 1686-1698, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31529248

RESUMO

INTRODUCTION: The quality of the mother-child relationship in the first year of life has far reaching implications across the life course (Bornstein in Annu Rev Psychol 65:121-158, 2014). Yet little is known about predictors of maternal bonding and emotional availability in early infancy. In this study we examined the extent to which postnatal bonding, maternal mental health, and substance use at 8-weeks postpartum predicted mother-infant bonding (self-report) and mother emotional availability (observational) at 12-months of age. METHODS: Data were obtained from an Australian longitudinal cohort study of pregnancy (n = 308). Data were collected during pregnancy, at birth, and postnatally at 8-weeks and 12-months. RESULTS: The results show strong continuity between postnatal bonding at 8-weeks and 12-months. Early postpartum stress and depression were associated with bonding at 12-months; however, the effect did not persist after adjustment for bonding at 8-weeks. Tobacco use at 8-weeks, but no other indicators of mental health, predicted lower emotional availability scores at 12-months. DISCUSSION: Results suggest that the mother's felt bond to her child is stable across the first year of life and that early bonding is a more robust indicator of bonding at 12-months than a mother's mental health or substance use. These findings point to the importance of clinical and public health investments in establishing a strong bond between mother and child in the early postpartum period.


Assuntos
Saúde Mental , Relações Mãe-Filho/psicologia , Mães/psicologia , Apego ao Objeto , Gestantes/psicologia , Transtornos Relacionados ao Uso de Substâncias , Adulto , Austrália , Depressão Pós-Parto/psicologia , Emoções , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Período Pós-Parto/psicologia , Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
10.
Matern Child Health J ; 23(12): 1648-1657, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535257

RESUMO

OBJECTIVES: Intimate partner violence (IPV) around the time of pregnancy is a risk factor for adverse pregnancy and birth outcomes. The supplemental nutrition program for women, infants, and children (WIC), available to low income pregnant women, may provide an opportunity to identify victims of IPV and refer them to services. This cross-sectional study aims to determine whether WIC participants are more likely than non-WIC participants to have reported IPV before or during pregnancy in the United States. METHODS: The 2004-2011 National Pregnancy Risk Assessment Monitoring System (PRAMS) survey (n = 319,689) was analyzed in 2015. Self-reported WIC participation, pre-pregnancy IPV, and IPV during pregnancy were examined. The associations between IPV and WIC participation were analyzed using multiple logistic regression and adjusted odds ratios with corresponding 95% confidence intervals were calculated. Subpopulation analysis was conducted, stratified by race/ethnicity. RESULTS: Nearly half of the study sample received WIC (48.1%), approximately 4% of women reported physical abuse 12 months before their most recent pregnancy, and 3% reported abuse during pregnancy. After adjusting for confounders, women who reported IPV before and during pregnancy had significantly higher odds of WIC utilization compared to women who did not report IPV. However, when stratified by race, the association was only significant for non-Hispanic White women (pre-pregnancy AOR 1.47, 95% CI [1.17, 1.85]; during pregnancy AOR 1.47, 95% CI [1.14, 1.88]). CONCLUSIONS FOR PRACTICE: There is an association between IPV before and during pregnancy and utilization of WIC. Public health professionals and policy makers should be aware of this association and use this opportunity to screen and address the needs of WIC recipients.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Violência por Parceiro Íntimo/etnologia , Gravidez , Cuidado Pré-Natal , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
11.
Psychiatr Danub ; 31(Suppl 3): 615-618, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488801

RESUMO

The psychological and physiological interaction between anorexia and the pregnant state has a large intrapartum and postpartum impact on mother and baby. Current research has attempted to discern the short and long term effects of eating disorders (EDs) on pregnancy as well as mother and baby-related sequelae; however little is understood about which management strategies are likely to prove most successful in mitigating these risks. The incidence and effect of low pre-pregnancy body mass index (BMI) on obstetric outcomes, and possible health complications in the future child, has attracted widespread attention. Especially concerning is the fact that it has long been known that the incidence of EDs in women of childbearing age is not only the highest out of all age categories but also is on an increasing trajectory. This paper aims to highlight the recent evidence underpinning the management of pregnant women with EDs in the light of the discussed short and long term effects of the disorders on mother and baby. We shall focus on those women who have a previous diagnosis of an ED prior to being pregnant. Particular attention will be paid to those studies considering anorexia nervosa. We argue for the use of early intervention strategies for the management of pregnant women with eating disorders, and for the use of a multidisciplinary approach in the treatment of these patients with complex problems.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Mães/psicologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Índice de Massa Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Lactente , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez
12.
BMC Public Health ; 19(1): 1094, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409306

RESUMO

BACKGROUND: Attending antenatal care (ANC) early contribute to better birth outcomes. Studies have shown that many pregnant women in Sub-Saharan Africa do not initiate ANC early (i.e. in the first trimester). This study determined the gestational age of pregnancy at first ANC attendance. It also explored factors that influence initiation of ANC. METHODS: This cross-sectional study, conducted in Ghana, used mixed methods to collect data from women aged 15-45 years who delivered 6 months prior to the study. Crosstabs, chi-square test and logistic regression were used to analyse quantitative data. Also, 33 participants were engaged in focus group discussions (FGDs). Thematic content analysis was used to develop themes from the data. RESULTS: Of the 431 participants, 8.9, 8, 25.4, 45.3 and 10.7% started ANC in the first, second, third, fourth and fifth months of pregnancy respectively. Formal education, employment and number of living children were predictors of initiating ANC early; by 12 weeks of gestation. Women who attained primary, junior high, secondary education and above had 5.6, 57.5 and 163.2 higher odds respectively of initiating ANC in the first trimester compared to women with no education (p ≤ 0.05). Women with two, three and four to nine living children were 4.1, 3 and 3.5 times respectively more likely to access ANC early compared to primigravidae women. However, women with five or more children and primigravidae women are more likely to initiate ANC late; after 12 weeks gestation. The FGD data also show that most of the participants initiated ANC late. Two themes: visible signs of pregnancy and or sickness influence ANC attendance in the first trimester. The themes that explain late initiation of ANC are: healthy, do not value the benefits of early ANC attendance, desire to avoid embarrassment associated with the pregnancy, unplanned pregnancy, indirect cost of accessing ANC and traditional rites and practices. CONCLUSION: Contextual factors influence ANC initiation. Investment in female education, intensification of health promotion activities by health workers, non-governmental organisations, community and religious leaders to sensitise communities on the benefits of initiating ANC at the onset of pregnancy is needed to improve first trimester attendance.


Assuntos
Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Grupos Focais , Idade Gestacional , Gana , Humanos , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , População Rural/estatística & dados numéricos , Adulto Jovem
13.
AIDS Behav ; 23(11): 3140-3151, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410618

RESUMO

We developed and piloted a video-based intervention targeting HIV-positive pregnant women to optimize antiretroviral therapy (ART) retention and adherence by providing a VITAL Start (Video-intervention to Inspire Treatment Adherence for Life) before ART. VITAL Start (VS) was grounded in behavior-determinant models and developed through an iterative multi-stakeholder process. Of 306 pregnant women eligible for ART, 160 were randomized to standard of care (SOC), 146 to VS and followed for one-month. Of those assigned to VS, 100% completed video-viewing; 96.5% reported they would recommend VS. Of 11 health workers interviewed, 82% preferred VS over SOC; 91% found VS more time-efficient. Compared to SOC, VS group had greater change in HIV/ART knowledge (p < 0.01), trend towards being more likely to start ART (p = 0.07), and better self-reported adherence (p = 0.02). There were no significant group differences in 1-month retention and pharmacy pill count. VITAL Start was highly acceptable, feasible, with promising benefits to ART adherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Aconselhamento/métodos , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adesão à Medicação/psicologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Gestantes/psicologia , Adulto , Feminino , Infecções por HIV/psicologia , Pessoal de Saúde , Humanos , Malaui/epidemiologia , Gravidez , Autorrelato , Cooperação e Adesão ao Tratamento , Gravação em Vídeo
14.
Sex Reprod Healthc ; 21: 39-45, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395232

RESUMO

AIM: This study explores the association between infant temperament at six months postpartum and pre- and postpartum depressive and anxiety symptoms. The association between infant temperament and stressful life events is also evaluated. METHOD: A total of 210 Mexican women were assessed during pregnancy (gestational age 32.39 ±â€¯4.01) and at six months postpartum. The instruments used were: Patient Health Questionnaire (PHQ-9), the Anxiety Subscale of the Hopkins Symptoms Checklist (SCL-90R), a short form of Stressful Life Events and The Infant Characteristics Questionnaire, when infants were six months old. RESULTS: Although a mother's emotional state during pregnancy (depressive and anxiety symptoms and stressful life events) was not associated with difficult infant temperament, it was associated with depressive and anxious symptomatology during the postpartum period. Mothers with prenatal depressive symptoms who remained depressed and mothers who only had depression symptoms during the postpartum period reported having more difficult infants. Likewise, mothers with prenatal anxiety symptoms who maintained anxiety symptoms postpartum and mothers with anxiety symptoms during the postpartum period alone reported having more difficult infants. Comorbidity was found between depressive and anxious postnatal symptomatology in its association with difficult infant temperament. CONCLUSION: In this study, postpartum depressive and anxiety symptoms played an important role in shaping difficult infant temperament. Comorbidity between the two conditions warrants clinical attention and additional research, since it is related to maternal perception of difficult infant temperament. Psychological interventions are required, since these women may require assistance with emotional adaptation in the transition to motherhood.


Assuntos
Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Mães/psicologia , Gestantes/psicologia , Temperamento , Adulto , Ansiedade/epidemiologia , Comorbidade , Depressão Pós-Parto/epidemiologia , Emoções , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , México , Período Pós-Parto , Gravidez , Psicologia da Criança , Adulto Jovem
15.
Sex Reprod Healthc ; 21: 46-50, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395233

RESUMO

OBJECTIVES: This study aimed to assess the misconceptions and attitude regarding HIV transmission and prevention among antenatal mothers, with regards to mother-to-child-transmission (MTCT) in three tertiary care hospitals of Karachi. METHODS: A cross-sectional study comprising 350 pregnant females was conducted at three tertiary care hospitals in Karachi for 4 months, in 2018. A structured questionnaire covering knowledge about MTCT, prevention of mother-to-child-transmission (PMTCT) and attitudes about HIV transmission was used and all collected data entered and analyzed via SPSS (Statistical Package for the Social Sciences) software version 25, owned by the IBM Company. PRINCIPLE RESULTS: Of the 350 pregnant females participating, around 66.7% (N = 232) were urban residents, lying in their mid-twenties and over 86% (N = 303) were Muslims. Over 14.3% (N = 52) of the participants had full knowledge regarding MTCT of HIV, with only 6% of the respondents having full knowledge related to PMTCT of HIV. Significant associations were found between knowledge about MTCT and residence (p = 0.001), education level (p = 0.001) and expected response from the partner (p = 0.001). While only 17% (60 out of 350) women agreed to invite their partner for testing, 84% showed an interest in looking after an HIV infected family member and 49% believed that all pregnant females should be tested for HIV. CONCLUSIONS: This study shows that majority of the pregnant women in Karachi are unaware of MTCT and PMTCT and they are reluctant towards routine HIV testing. Thus, we see the need for collective and focused efforts for educational programs and further research.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Escolaridade , Feminino , Infecções por HIV/prevenção & controle , Humanos , Paquistão , População Rural , Inquéritos e Questionários , População Urbana , Adulto Jovem
16.
Sex Reprod Healthc ; 21: 87-94, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395239

RESUMO

BACKGROUND: Positive birth experiences lead to better postnatal functioning, and influence mode of delivery choice for subsequent pregnancies. Healthcare workers can influence the birth experience through relevant support and care. This study seeks to explore the experience of Sierra Leonean women in relation to ante-natal, intrapartum and post-partum care with special reference to their experience of caesarean section. METHODS: In November 2016, individual semi structured interviews were performed with sixteen women of varying age from different geographical areas, levels of schooling, and parity. The interviews were analysed by systematic text condensation. RESULTS: During interviews, participants mentioned a fear of dying or losing their baby. This fear was managed by praying and putting trust in a higher power. However, placing trust in healthcare workers was also described by some participants. Moreover, the present study demonstrates that women experienced a great deal of pain and discomfort after the caesarean section was performed, and that they found it difficult to return to expected activities. This was managed by a large amount of practical assistance from their social network. Healthcare workers were described as providing medicines, advice, and practical care. Negative experiences in which healthcare workers took money for medicines and refused to help women were also described. CONCLUSIONS: This study indicates that women locate resources to cope with pain and fear within themselves, while also utilising extended support from social networks and healthcare workers. This confirms that women from all backgrounds in Sierra Leone have access to resources for health and well-being.


Assuntos
Cesárea/psicologia , Cuidado Pós-Natal/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adaptação Psicológica , Adulto , Cesárea/efeitos adversos , Medo , Feminino , Humanos , Controle Interno-Externo , Entrevistas como Assunto , Relações Enfermeiro-Paciente , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/psicologia , Relações Médico-Paciente , Gravidez , Pesquisa Qualitativa , Serra Leoa , Apoio Social
17.
BMC Pregnancy Childbirth ; 19(1): 273, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370814

RESUMO

BACKGROUND: Mindfulness courses are being offered to numerous groups and while a large body of research has investigated links between dispositional mindfulness and mood, few studies have reported this relationship during pregnancy. The aim of this study was to investigate this relationship in pregnant women to offer insight into whether an intervention which may plausibly increase dispositional mindfulness would be beneficial for this population. METHODS: A cross-sectional analysis was conducted to explore potential relationships between measures of mindfulness and general and pregnancy-specific mood. A sample of pregnant women (n = 363) was recruited using online advertising and community-based recruitment and asked to complete a number of questionnaires online. RESULTS: Overall, higher levels of mindfulness were associated with improved levels of general and pregnancy-related mood in pregnant women. Controlling for general stress and anxiety, higher scores for mindfulness in (psychologically) healthy women were associated with lower levels of pregnancy-related depression, distress and labour worry but this relationship was not apparent in those with current mental health problems. In participants without children, higher mindfulness levels were related to lower levels of pregnancy-related distress. CONCLUSIONS: These results suggest a promising relationship between dispositional mindfulness and mood though it varies depending on background and current problems. More research is needed, but this paper represents a first step in examining the potential of mindfulness courses for pregnant women. Increasing mindfulness, and therefore completing mindfulness-based courses, is potentially beneficial for improvements in mood during pregnancy.


Assuntos
Afeto , Ansiedade/psicologia , Depressão/psicologia , Atenção Plena , Gestantes/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Trabalho de Parto/psicologia , Gravidez , Complicações na Gravidez/psicologia , Adulto Jovem
18.
Rev Esc Enferm USP ; 53: e03464, 2019 Aug 19.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31433011

RESUMO

OBJECTIVE: To explore the social construction of obstetric violence developed by Tenek and Nahuatl women in Mexico. METHOD: Qualitative, socio-critical study conducted through focal groups in which were deepened the childbirth experiences lived in the period 2015-2016. RESULTS: Participation of 57 women. Through discourse analysis, it was identified that participants do not have enough information about obstetric violence and/or sexual and reproductive rights. This makes the association of their negative experiences with the legal term "obstetric violence" impossible. Most of their speeches correspond to the legal denomination of "obstetric violence". Experiences like prolonged fasting or the use of technologies for invading their privacy were narrated like situations they perceive as violent, but have not been incorporated within the legal term. CONCLUSION: Multiple actions against women's human rights take place within delivery rooms. Most remain unidentified by users, since they have not socially constructed the image of obstetric violence. However, that fact does not make them less susceptible to feel attacked and denigrated during their childbirth experiences.


Assuntos
Parto Obstétrico/psicologia , Índios Norte-Americanos/psicologia , Gestantes/psicologia , Violência/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Direitos Humanos/psicologia , Humanos , México , Gravidez , Gestantes/etnologia , Direitos Sexuais e Reprodutivos/psicologia , Terminologia como Assunto , Violência/etnologia , Adulto Jovem
19.
J Natl Black Nurses Assoc ; 30(1): 7-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465679

RESUMO

Fetal alcohol spectrum disorders (FASD) affect all nations harshly, however, very little is known about the scope of FASD in Swaziland. Alcohol exposure in utero is one of the leading preventable causes of poor fetal birth outcomes. This study assessed the knowledge and practices of pregnant Swazi women, revealing that most participants had knowledge deficit on the effects of consuming alcohol on both the woman (63.3%, n = 19) and her fetus (83.3%, n = 25). The majority (83.0%, n = 25) of the participants reported that they did not drink alcohol, while 16.7% (n = 5) reported that they did consume alcohol. In health facilities, there is a need to intensify health education concerning the effects of alcohol consumption to both the fetus and the pregnant woman. A policy that enforces screening of pregnant women at risk for giving birth to infants with FASD is essential.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Gestantes/psicologia , Feminino , Transtornos do Espectro Alcoólico Fetal/etiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Humanos , Gravidez
20.
AIDS Behav ; 23(9): 2610-2617, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377894

RESUMO

Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Comportamentos Relacionados com a Saúde , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adesão à Medicação/psicologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Gestantes/psicologia , Adulto , Aconselhamento , Feminino , Infecções por HIV/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Estudos Longitudinais , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto/psicologia , Gravidez , Gestantes/etnologia , Tanzânia/epidemiologia , Adulto Jovem
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