Systematic review of the measurement properties of indices of prenatal care utilization.

BACKGROUND: An accurate assessment of the adequacy of prenatal care utilization is critical to inform the relationship between prenatal care and pregnancy outcomes. This systematic review critically appraises the evidence on measurement properties of prenatal care utilization indices and provides recommendations about which index is the most useful for this purpose. METHODS: MEDLINE, EMBASE, CINAHL, and Web of Science were systematically searched from database inception to October 2018 using keywords related to indices of prenatal care utilization. No language restrictions were imposed. Studies were included if they evaluated the reliability, validity, or responsiveness of at least one index of adequacy of prenatal care utilization. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. We conducted an evidence synthesis using predefined criteria to appraise the measurement properties of the indices. RESULTS: From 2664 studies initially screened, 13 unique studies evaluated the measurement properties of at least one index of prenatal care utilization. Most of the indices of adequacy of prenatal care currently used in research and clinical practice have been evaluated for at least some form of reliability and/or validity. Evidence about the responsiveness to change of these indices is absent from these evaluations. The Adequacy Perinatal Care Utilization Index (APNCUI) and the Kessner Index are supported by moderate evidence regarding their reliability, predictive and concurrent validity. CONCLUSION: The scientific literature has not comprehensively reported the measurement properties of commonly used indices of prenatal care utilization, and there is insufficient research to inform the choice of the best index. Lack of strong evidence about which index is the best to measure prenatal care utilization has important implications for tracking health care utilization and for formulating prenatal care recommendations.

Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: A systematic review and meta-analysis.

BACKGROUND: Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers. METHODS: Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes. Study selection, risk of bias appraisal, and data extraction of study characteristics were independently performed by two reviewers. Pooled odds ratios (pOR) with 95% confidence intervals (95% CI) were calculated to assess the association between SDOH and adverse birth outcomes. RESULTS: Thirty-one studies met the inclusion criteria. The most frequently evaluated SDOH was race while the most commonly reported maternal and birth outcomes were caesarean section and preterm birth (PTB), respectively. The risk of bias of included studies was fair on the Newcastle-Ottawa Scale. Meta-analyses of retrospective cohort studies showed that, compared to White adolescent mothers, African American teens had increased odds of PTB (pOR 1.67; 95% CI 1.59, 1.75) and low birthweight (pOR 1.53; 95% CI 1.45, 1.62). Rural residence was consistently linked with PTB while low maternal socio-economic (SES) and illiteracy were found to increase the risk of adolescent maternal mortality and LBW infants. CONCLUSION: Social determinants of health contribute to the risk of adverse pregnancy outcomes in adolescent mothers. African American race, rural residence, inadequate education, and low SES are markers for poor pregnancy outcomes in adolescent mothers. Further research needs to be done to understand the underlying causal pathways to inequalities in adolescent pregnancy outcomes.

Postpartum Mental Health Disorders in Indigenous Women: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review synthesized and evaluated the evidence on the prevalence of postpartum mental health disorders in Indigenous women. METHODS: Comprehensive searches of biomedical electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and Web of Science were performed for peer-reviewed literature published from 1990 to September 2018. The search strategy included terms related to the postpartum period, mental health disorders, and Indigenous ancestry. Epidemiological observational studies that evaluated the prevalence of mental health disorders in the postpartum and included Indigenous women from Australia, Canada, New Zealand, and the United States were included. Two independent reviewers screened and evaluated the risk of bias of included studies. A narrative synthesis of study results was conducted. Prevalence estimates from homogeneous studies were pooled in a random-effects meta-analysis (Canadian Task Force Classification II-2). RESULTS: A total of 2297 references were initially identified, of which six studies were included in the review. All included studies evaluated the prevalence of postpartum depression (PPD) and were of moderate or low risk of bias. Other postpartum mental health disorders were not evaluated. Overall, Indigenous women had 87% increased odds of PPD compared with Caucasian groups of women (odds ratio 1.87; 95% confidence interval 1.14-3.09). Substantial heterogeneity across prevalence estimates was observed. CONCLUSION: Limited evidence suggests a greater burden of PPD affecting Indigenous women. There is insufficient evidence informing the prevalence of other postpartum mental health disorders in Indigenous women. More epidemiological research in this area is essential to provide accurate and reliable prevalence estimates of postpartum mental health disorders among Indigenous women.

Triple-Negative Breast Cancer: A Review of Current Curative Intent Therapies.

Breast cancer is the most commonly diagnosed malignancy in women, with triple-negative breast cancer (TNBC) accounting for 10-20% of cases. Historically, fewer treatment options have existed for this subtype of breast cancer, with cytotoxic chemotherapy playing a predominant role. This article aims to review the current treatment paradigm for curative-intent TNBC, while also reviewing potential future developments in this landscape. In addition to chemotherapy, recent advances in the understanding of the molecular biology of TNBC have led to promising new studies of targeted and immune checkpoint inhibitor therapies in the curative-intent setting. The appropriate selection of TNBC patient subgroups with a higher likelihood of benefit from treatment is critical to identify the best treatment approach.