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1.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-31533243

RESUMO

Delaying motherhood is becoming increasingly common, raising questions of the possible influence that maternal age may have on newborn health. Therefore, the objective of this study was to determine the association between maternal age and different newborn health parameters. An observational study was conducted in Spain on primiparous women and their infants. Data were collected on newborn health variables, breastfeeding, and different clinical practices that are beneficial for child health and development. Crude and adjusted mean differences were calculated along with the standard error of the mean. A total of 373 women and their children participated. In terms of early commencement skin-to-skin contact, the mean age of women that did skin-to-skin contact was 29.95 ± 0.31 years compared to 31.49 ± 0.66 years in those that did not (p = 0.042). In terms of other newborn parameters, such as preterm birth, health problems or complications, or the need for hospital admission, these were more frequent in the oldest group of mothers, but the differences found were not significant (p > 0.05). Hence, indicators of newborn morbidity were not found to be significantly associated with maternal age; however, beneficial practices such as early commencement skin-to-skin contact were found to be significantly associated with maternal age.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Idade Materna , Mães/estatística & dados numéricos , Adulto , Fatores Etários , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Avaliação Nutricional , Estado Nutricional , Gravidez , Espanha , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-31487782

RESUMO

Having good health-related quality of life (HRQoL) is essential, particularly for women after childbirth. However, little is known about its determinants. We aimed to identify the determinants of HRQoL after childbirth in a large community sample in the Netherlands. We have included 4312 women in the present study. HRQOL was assessed by a 12-Item Short Form Survey (SF-12) at around two months after childbirth; Physical and Mental Component Summary scores were calculated. Information on 27 potential determinants of HRQoL was collected through questionnaires and medical records. Multivariate linear regression models were applied to assess significant determinants of physical and mental HRQoL. Our study showed that older maternal age, shorter time since childbirth, elective/emergency cesarean delivery, loss of energy, maternal psychopathology, and the hospital admission of the infant were significantly associated with worse physical HRQoL (p < 0.05); older maternal age, non-western background, low household income, loss of energy, and maternal psychopathology were significantly associated with worse mental HRQoL (p < 0.05). We identified multiple determinants of suboptimal physical and mental HRQoL after childbirth. In particular, maternal psychopathology after childbirth was profoundly associated with mental HRQoL. These women may need support. We therefore call for awareness among health care professionals.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Países Baixos , Parto
4.
BMC Res Notes ; 12(1): 427, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315651

RESUMO

OBJECTIVE: The aim of this study was to assess the immediate newborn care of knowledge, practice and associated factors among healthcare providers in Northwestern Zonal health facilities Tigray, Ethiopia, 2018. RESULTS: Among the total healthcare providers, who participated in this study, 64.8% had good knowledge and 59.8% of the respondents had a good level of essential newborn care practice. Unavailability of adequate materials (like guidelines, drug, etc.) and training status were significant variables with knowledge and practice of newborn care.


Assuntos
Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Adulto , Estudos Transversais , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Etiópia , Feminino , Humanos , Saúde do Lactente/normas , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Infant Ment Health J ; 40(4): 523-540, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31095763

RESUMO

This article describes an infant-toddler court team in Michigan, the community-based participatory research approach to the implementation evaluation, and the resulting changes in parenting. Like other court teams, Michigan's Baby Court is led by a science-informed jurist, and all service providers are knowledgeable about the developmental needs of young children and engage in collaborative communication throughout the case. Relationship-based treatment in the form of infant mental health home-visiting was provided to families. Sixteen parents participated in pre- and posttest evaluation visits to assess changes in parents' reflective functioning and interactions with their child. Findings suggest improvements in parents' responsiveness, positive affect, and reflective functioning, with moderate effects. Higher risk parents demonstrated significant changes in reflective functioning, as compared to those at lower risk. These findings add to and support the limited literature on the effectiveness of infant-toddler court teams, which include relationship-based and trauma-informed services.


Assuntos
Bem-Estar da Criança/psicologia , Visita Domiciliar/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Transtornos Mentais/prevenção & controle , Relações Pais-Filho , Poder Familiar/psicologia , Adolescente , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/psicologia , Michigan , Pais/psicologia , Adulto Jovem
7.
Int J Equity Health ; 18(1): 55, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971254

RESUMO

BACKGROUND: A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi. METHODS: We conducted 42 focus group discussions (FGDs) with women who had attended groups and women who had not attended, in poor and better-off communities. We also interviewed six better-off women and nine poor women who had delivered babies during the trials and had demonstrated recommended behaviours. We conducted 12 key informant interviews and five FGDs with women's group facilitators and fieldworkers. RESULTS: Women's groups addressed a knowledge deficit in poor and better-off women. Women were engaged through visual learning and participatory tools, and learned from the facilitator and each other. Facilitators enabled inclusion of all socioeconomic strata, ensuring that strategies were low-cost and that discussions and advice were relevant. Groups provided a social support network that addressed some financial barriers to care and gave women the confidence to promote behaviour change. Information was disseminated through home visits and other strategies. The social process of learning and action, which led to increased knowledge, confidence to act, and acceptability of recommended practices, was key to ensuring behaviour change across social strata. These equitable effects were enabled by the accessibility, relevance, and engaging format of the intervention. CONCLUSIONS: Participatory learning and action led to increased knowledge, confidence to act, and acceptability of recommended practices. The equitable behavioural effects were facilitated by the accessibility, relevance, and engaging format of the intervention across socioeconomic groups, and by reaching-out to parts of the population usually not accessed. A PLA approach improved health behaviours across socioeconomic strata in rural communities, around issues for which there was a knowledge deficit and where simple changes could be made at home.


Assuntos
Equidade em Saúde , Promoção da Saúde , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , População Rural/estatística & dados numéricos , África , Ásia , Feminino , Grupos Focais , Avaliação do Impacto na Saúde , Humanos , Recém-Nascido , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos
8.
Biomed Res Int ; 2019: 7596165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30895195

RESUMO

Aim: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.


Assuntos
Analgesia/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Internacionalidade , Trabalho de Parto/fisiologia , Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto , Feminino , Humanos , Análise Multivariada , Gravidez , Resultado da Gravidez , Prevalência , Adulto Jovem
9.
PLoS One ; 14(3): e0213006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901325

RESUMO

BACKGROUND: Trials have examined on the benefits of vitamin D supplementation in pregnant women. OBJECTIVE: This review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo. METHOD: We performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality. CONCLUSION: We did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.


Assuntos
Diabetes Gestacional/dietoterapia , Suplementos Nutricionais , Vitamina D/administração & dosagem , Cesárea/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Saúde Materna/estatística & dados numéricos , Placebos/administração & dosagem , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
J Glob Health ; 9(1): 010413, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30643636

RESUMO

Background: Despite improvement in recent decades, maternal and newborn mortality in Bangladesh remain high. A community-based intervention package was initiated in 2009 in Netrokona, a rural district in Bangladesh, to engage individuals, families and communities to improve maternal and newborn health. In this article, we present the effect of the intervention package on improvement of women's capacities with regard to maternal and newborn health, their husbands' capacities to effectively support them and use of skilled services during pregnancy, childbirth and after childbirth. Methods: We adopted a quasi-experimental design to evaluate the effect of the intervention package. A cross-sectional household survey was conducted in the intervention and comparison sites at baseline in 2014 and at endline in 2016. A total of 725 women were interviewed at baseline (intervention n = 444; comparison n = 281) and 737 at end-line (intervention n = 442; comparison n = 295). A total of 317 of their husbands were interviewed at baseline (intervention n = 178; comparison n = 139) and 731 at endline (intervention n = 440; comparison n = 291). Propensity score matching (1:1) was performed and the subsequent analysis was restricted among 235 matched women at baseline and 217 matched women at endline. Descriptive analyses were performed for the covariates for matching. Bivariate analyses between baseline and endline were done for reporting women and their husbands' knowledge regarding pregnancy and childbirth, birth preparedness and complication readiness practices and utilization of health services. Results: There was significant increase in awareness of danger signs during pregnancy, childbirth and following childbirth among women and their husbands, as well as increase in awareness of rights related to maternal and newborn health. There was also significant increase in birth preparedness and complication readiness practice among pregnant women and their husbands in the intervention site. Regarding use of skilled health services, there was significant increase in early initiation of antenatal care, attending at least one antenatal care contact and attending at least four antenatal care contacts. No notable improvement was observed in giving birth in the presence of skilled attendant or use of postnatal care. Conclusions: We conclude that the intervention package was effective in building the capacities of women and in engaging their husbands positively in maternal and newborn health. This may have translated into increased use of skilled care during pregnancy.


Assuntos
Serviços de Saúde Comunitária , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , População Rural , Adolescente , Adulto , Bangladesh , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Masculino , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , População Rural/estatística & dados numéricos , Adulto Jovem
11.
Paediatr Perinat Epidemiol ; 33(1): O60-O72, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30320453

RESUMO

BACKGROUND: Numerous studies use birth certificate data to examine the association between interpregnancy interval (IPI) and maternal and perinatal health outcomes. Substantive changes from the latest birth certificate revision have implications for examining this relationship. METHODS: We provide an overview of the National Vital Statistics System and recent changes to the national birth certificate data file, which have implications for assessing IPI and perinatal health outcomes. We describe the calculation of IPI using birth certificate information and related measurement issues. Missing IPI values by maternal age, race and education using 2016 birth certificate data were also compared. Finally, we review and summarise data quality studies of select covariate and outcome variables (sociodemographic, maternal health and health behaviours, and infant health) conducted after the most recent 2003 birth certificate revision. RESULTS: Substantive changes to data collection, dissemination and quality have occurred since the 2003 revision. These changes impact IPI measurement, trends and associations with perinatal health outcomes. Missing values of IPI were highest for older ages, lower education and non-Hispanic black women. Minimal differences were found when comparing IPI using different gestational age measures. Recent data quality studies pointed to substantial variation in data quality by item and across states. CONCLUSION: Future studies examining the association of IPI with maternal and perinatal data using vital records should consider these aspects of the data in their research plan, sensitivity analyses and interpretation of findings.


Assuntos
Declaração de Nascimento , Intervalo entre Nascimentos/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Confiabilidade dos Dados , Escolaridade , Feminino , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Idade Materna , Gravidez , Estados Unidos/epidemiologia
12.
Am J Clin Dermatol ; 20(3): 367-377, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30465329

RESUMO

BACKGROUND: Probiotic supplementation in early life may be effective in preventing atopic dermatitis (AD); however, results regarding efficacy have been controversial. OBJECTIVE: The aim of our study was to investigate the effect of probiotic supplementation on the risk of AD. METHODS: We systematically searched PubMed, EBSCO, Embase and Web of Science databases up to 8 March 2018 for potentially relevant studies regarding probiotic supplementation and AD. Included infants and children were those with probiotic exposure in utero and/or after birth who were not previously diagnosed with AD. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) and used the Jadad and Newcastle-Ottawa scales to assess methodologic quality. RESULTS: A total of 28 studies met the inclusion criteria. Compared with controls, probiotic treatment was associated with a reduced risk of AD (OR 0.69; 95% CI 0.58-0.82, P < 0.0001). The use of probiotics during both the prenatal and the postnatal period significantly reduced the incidence of AD (OR 0.67; 95% CI 0.54-0.82); however, analysis of studies of probiotics given prenatally only or postnatally only did not reach statistical significance. CONCLUSIONS: Our meta-analysis showed that probiotic supplementation during both the prenatal and the postnatal period reduced the incidence of AD in infants and children. Our findings suggest that starting probiotic treatment during gestation and continuing through the first 6 months of the infant's life may be of benefit in the prevention of AD.


Assuntos
Dermatite Atópica/prevenção & controle , Suplementos Nutricionais , Exposição Materna , Probióticos/administração & dosagem , Ensaios Clínicos como Assunto , Dermatite Atópica/epidemiologia , Feminino , Humanos , Incidência , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Cuidado Pós-Natal/métodos , Gravidez , Cuidado Pré-Natal/métodos , Resultado do Tratamento
13.
Int J Qual Health Care ; 31(3): 183-190, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-29917087

RESUMO

OBJECTIVE: Present methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries. DESIGN: We constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software. SETTING: We present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January-October 2014). RESULTS: We collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5-72.9] in Costa Rica to 5.7% [CI:4.0-8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries. CONCLUSIONS: Our study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries.


Assuntos
Países em Desenvolvimento , Garantia da Qualidade dos Cuidados de Saúde/métodos , Criança , Anticoncepção/estatística & dados numéricos , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Serviços de Saúde Materna/normas , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
14.
J Policy Anal Manage ; 38(1): 155-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30572413

RESUMO

The effects of paid parental leave policies on infant health have yet to be established. In this paper we investigate these effects by exploiting the introduction of California Paid Family Leave (PFL), the first program in the U.S. that specifically provides working parents with paid time off for bonding with a newborn. We measure health using the full census of infant hospitalizations in California and a set of control states, and implement a differences-in-differences approach. Our results suggest a decline in infant admissions, which is concentrated among those causes that are potentially affected by closer childcare (and to a lesser extent breastfeeding). Other admissions that are unlikely to be affected by parental leave do not exhibit the same pattern.


Assuntos
Licença para Cuidar de Pessoa da Família/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Licença Parental/estatística & dados numéricos , California , Nível de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Mães
15.
PLoS One ; 13(12): e0208299, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30521575

RESUMO

Pakistani women suffer the highest rate of maternal mortality in South Asia. A lack of comprehensive knowledge about maternal and newborn health (MNH) services costs impedes policy decisions to maximize the benefit from existing, as well as emerging, MNH interventions in Pakistan. We compared MNH service costs at different levels of care. A cross-sectional survey was conducted during January to March 2016 as part of a large economic evaluation in Sindh, Pakistan. Health providers and facilities were selected from a sampling frame, inclusive of public and private sectors. This study utilized a broad perspective (i.e. costs to the health system and patients/families). The unit costs of MNH services were determined through a simultaneous allocation method in the public facilities; and patient billing department in the private facilities. Descriptive analysis was performed, and an analysis of variance (ANOVA) test was applied to compare overall mean costs both within and between health facilities. A total of 31 eligible health providers and facilities (n = 25 in private; n = 7 in public) were included in the final analysis. An ambulatory visit (AV) for routine antenatal care (ANC) costs $3.6 and $0.9 at secondary- and tertiary-level public facilities, respectively. In the private sector, the costs of an AV for ANC were slightly less ($2.8) at secondary-level and much higher ($6) at tertiary-level facilities compared to the public sector. Diagnostic test costs were much higher in private facilities. The average costs of inpatient admissions were $30.5 at general ward (GW), and $151 at the intensive care unit (ICU) in public facilities. In-patient admissions costs were lower such as $9.3 at GW and $36.5 at ICU in private facilities. Understanding cost is critical to guide decisions of resource allocation within the public sector; and risk mitigation for excessive OOP costs through third party payer for services in the private sector.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Paquistão , Gravidez , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
16.
Sci Rep ; 8(1): 18072, 2018 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-30584240

RESUMO

This was a nine-year retrospective cohort study to investigate obstetric and perinatal outcomes in a cohort of adolescent girls with twin pregnancies from a major Australian tertiary centre in Brisbane, Australia. The adolescent cohort was aged <19 years and the control group was aged 20-24 years. The total study cohort comprised of 183 women. Of these, the adolescent cohort contained 29 girls (15.8%) and the control group comprised of 154 women (84.2%). Adolescent girls were less likely to delivery via an elective caesarean section compared to women in the control group (10.3% vs. 25.7%, p < 0.001). There were no differences in duration of labour, post-partum haemorrhage or perineal trauma rates. After controlling for the confounding effects of parity, chronicity and birth weight, birth <28 weeks remained significant (aOR 11.20, 95% CI 2.97-42.18, p < 0.001) for the adolescent cohort. There was a higher proportion of adolescents whose babies had an adverse composite perinatal outcome (87.9% vs. 69.5%, OR 3.20 95% CI: 1.40-7.31, p = 0.01) however significance was lost after adjusting for parity, chorionicity, birthweight and gestation at birth (aOR 3.27 95% CI: 0.95-11.31, p = 0.06). Our results show that obstetric and perinatal outcomes for twin pregnancies in teenagers were broadly similar compared to controls although the risk of extreme preterm birth was increased after controlling for confounders.


Assuntos
Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Gravidez de Gêmeos/estatística & dados numéricos , Adolescente , Cesárea/estatística & dados numéricos , Feminino , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Masculino , Gravidez , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 18(1): 449, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30453908

RESUMO

BACKGROUND: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. RESULTS: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy. CONCLUSION: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos , Adulto , Índice de Apgar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Mortalidade Materna , Distribuição de Poisson , Gravidez , Complicações na Gravidez/etiologia , Nascimento Prematuro/epidemiologia , Prevalência , Análise de Regressão , Natimorto/epidemiologia , Gêmeos/estatística & dados numéricos , Adulto Jovem
18.
Public Health ; 165: 82-87, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30384032

RESUMO

OBJECTIVES: Parental incarceration (PI) is a prevalent adverse childhood experience (ACE) that has been linked to numerous social, emotional, and health problems in childhood and adulthood. A growing body of research has emphasized the importance of the timing of parent's incarceration on developmental outcomes. STUDY DESIGN: The present study uses case-control matching to examine the impact of recent PI on newborn health and home safety outcomes. METHODS: Neonatal health and newborn sleep and home safety data, including rates of premature birth, low birth weight (LBW), neonatal intensive care unit admittance, breastfeeding initiation, safe sleep, and home environment (e.g. working smoke alarm, proper firearm storage), were collected from 108 women who completed the Virginia Pregnancy Risk Assessment Monitoring survey. Half of these women (n = 54) had experienced the incarceration of themselves or their partner during the previous 12 months. Participants were matched by age, race, income, and the education level with those of 54 women who completed the survey and who had not experienced incarceration in the previous year. RESULTS: Controlling for nicotine and alcohol consumption during pregnancy and other stressors, path analyses show that the women who experienced incarceration of themselves or their husband/partner were significantly less likely to deliver an LBW infant and more likely to live in a home with a loaded firearm in the home. No other significant differences emerged between the two matched groups among neonatal health or newborn sleep and home safety outcomes. CONCLUSIONS: This result is considered from a public health perspective, as PI is an ACE which can be impacted by policy, particularly policies that promote practices that healthcare workers can use in correctional and other environments to encourage healthy pregnancies and home environments for newborns.


Assuntos
Habitação/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Pais , Prisioneiros/estatística & dados numéricos , Segurança , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Mães/estatística & dados numéricos , Gravidez , Nascimento Prematuro/epidemiologia , Medição de Risco , Inquéritos e Questionários , Adulto Jovem
19.
PLoS One ; 13(10): e0204763, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30300361

RESUMO

BACKGROUND: A variety of global-level monitoring initiatives have recommended indicators for tracking progress in maternal and newborn health. As a first step supporting the work of WHO's Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR) Technical Advisory Group, we aimed to compile and synthesize recommended indicators in order to document the landscape of maternal and newborn measurement and monitoring. METHODS: We conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring. Indicators pertaining to pregnancy, childbirth, and postpartum/postnatal and newborn care were extracted and included in the indicator compilation, together with key indicator metadata. We examined patterns and relationships across the compiled indicators. RESULTS: We identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered "aspirational", highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation. CONCLUSION: Rapid, wide-ranging work by a number of multi-stakeholder groups has resulted in a substantial number of indicators, many of which partially overlap and many are not supported with adequate documentation or guidance. The volume of indicators, coupled with the number of initiatives promoting different indicator lists, highlight the need for strengthened coordination and technical leadership to harmonize recommendations for improved measurement and monitoring of data related to maternal and newborn heath.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Recém-Nascido , Mães , Parto/fisiologia , Gravidez
20.
JBI Database System Rev Implement Rep ; 16(10): 1929-1938, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30335039

RESUMO

REVIEW QUESTION/OBJECTIVE: The objective of this umbrella review is to determine the characteristics of dietary interventions delivered any time before, during or after pregnancy for women living in developed countries, identified in quantitative systematic reviews as effective for improving mother and infant health outcomes and feasible for translation into practice.Specifically, the review will address the following questions:For the purpose of this overview, dietary interventions encompass the broad scope of dietary manipulations, including the direct provision of food and/or nutrients to participants, nutrition education, nutrition counseling, nutrition care teams, or any combination of these four intervention types.Both a narrative and quantitative summary on the effect of maternal dietary interventions on maternal and infant health outcomes as compared with usual care will be provided. The quantitative summary of the maternal and infant outcomes will be supported by an appraisal of the certainty of evidence of the effects and the strength of the recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.


Assuntos
Dieta/métodos , Saúde do Lactente/normas , Mães/educação , Aconselhamento/métodos , Feminino , Educação em Saúde/métodos , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Gravidez
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