Antenatal Appointment Research Articles

A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM

AimsTo investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.MethodsA prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).ResultsA total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070–1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188–0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364–10.996, P = 0.011).ConclusionsUnderstanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.

Exploring factors associated with first antenatal care booking among pregnant women in Northwestern Tanzania

Objectives: Pregnant women are advised to schedule their initial antenatal care (ANC) visit during the first trimester to detect and treat any medical issues as well as screen for risk factors that may affect the course and outcome of their pregnancy. Nonetheless, delayed first ANC presentation is typical, especially in Sub-Saharan Africa. This study sought to determine the timing of the first ANC booking and identify factors that influence the first ANC booking among pregnant women. Material and Methods: This was a cross-sectional study which was carried out from June–August 2023. Data were collected using a structured questionnaire. Data analysis was done using Epi Info 7.2 and STATA version 15.0 software. Independent factors for the first ANC booking were determined by multivariate logistic regression analysis using odds ratios, 95% confidence intervals, and a P-value cut-off of ≤0.05. Results: A total of 402 pregnant women were recruited for the study. The bulk of participants, 189 (47.0%), were between 25 and 34 years. More than half 279/402(69.4%) of the pregnant women booked their first ANC appointment beyond 12 weeks of gestation. The married pregnant women had almost four-fold booking ANC earlier compared to single women (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI] = 1.1–14.4, P = 0.036). Similarly, employed pregnant women were 2.8 times more likely to book their first ANC visits earlier as compared to self-employed women (AOR = 2.8, 95% CI = 1.3–5.8, P = 0.006). In addition, women receiving support from their family or partner were more likely to book their first ANC as recommended compared to those lacking such support (AOR = 0.5, 95% CI = 0.3–0.9, P = 0.022). Finally, those who planned pregnancy were 2 times more likely to book their first ANC visit within the recommended time, unlike those who did not (AOR = 2.3, 95% CI = 1.3–2.1, P = 0.03). Conclusion: Despite the known benefits of early antenatal appointments, many pregnant women delay their first visit, highlighting the need for targeted policies to address socioeconomic barriers and improve health-care access, thus encouraging timely ANC bookings and better maternal health outcomes.

Preconception health among migrant women in England: a cross-sectional analysis of maternity services data 2018–19

BackgroundDespite poor perinatal outcomes among migrants in vulnerable situations (eg, asylum seekers), little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrants. MethodsThis national cross-sectional study used NHS Maternity Services Dataset version 1.5, incorporating English NHS maternity services. Those with antenatal booking appointments between 1/4/2018-31/3/2019 were included (n=652 880). Odds ratios (OR), calculated using logistic regression, compared indicators of preconception health (selected via systematic review) among probable migrants in vulnerable situations (PMVS: first language other than English [FLOTE] with complex social factors [CSF]) to the reference category ‘probable non-migrants not in vulnerable situations’ (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20 years; and/or experiencing domestic abuse. University of Warwick ethics committee approved the study. FindingsPMVS represented 3·8% (n=25 070) of the study population, 10·2% (n=66 783) had FLOTE without CSF, 5·6% (n=36 433) spoke English as their first language with CSF, 46·5% (n=303 737) were in the reference category, and 33·8% (n=220 858) had missing migration data (included as ‘missing’ category). PMVS had higher odds of not taking folic acid preconception (OR 2·15, 95% CI 2·06–2·25), previous obstetric complications (OR 1·26, 95% CI 1·21–1·31), hepatitis B (OR 5·40, 95% CI 4·43–6·58), diabetes (OR 1·30, 95% CI 1·17–1·45) and underweight (OR 1·55, 95% CI 1·44–1·68), but lower odds of physical/mental health conditions (OR 0·54, 95% CI 0·52–0·56), smoking (OR 0·86, 95% CI 0·82–0·90) and overweight/obesity (OR 0·73, 95% CI 0·71–0·75). InterpretationInequalities occur across preconception indicators. Lower odds of preconception folic acid have also been identified in studies elsewhere and is a serious concern for migrant maternal health. Limitations include lack of granular data on migration category and missing data. Opportunities exist for more targeted preconception care. FundingMedical Research Council (Grant number MR/W01498X/1)

Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda: a qualitative study

IntroductionIn Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda.MethodsWe conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework.ResultsThe use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples’ counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) .ConclusionLow uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies.

8046 Milk Provision as a Potential Intervention to Improve Iodine Status in a Pregnant Cohort in Northern Ireland (NI), UK: A Randomised Controlled Trial

Abstract Disclosure: L.R. Kayes: None. K.R. Mullan: None. J.V. Woodside: None. Iodine deficiency is the leading cause of reversible mental retardation worldwide. During pregnancy there is ∼50% increase in iodine requirement for foetal neurodevelopment. The most recently studied cohorts of pregnant women across Ireland and UK consistently demonstrated mild iodine deficiency (target median urinary iodine concentration (mUIC) ≥150 µg/L). A recent study in NI has shown that women of child-bearing age provided with three litres of cow’s milk per week had improved iodine status. We wished to explore whether a similar milk intervention might improve iodine status during pregnancy. Pregnant women were recruited at their first antenatal appointment, and all were provided with the British Dietetic Association’s iodine food fact sheet. Participants were randomised to either milk intervention, (four litres/week milk delivered weekly free of charge), or no milk delivery (control group). Patients were stratified based on use of an iodine-containing multivitamin prior to randomisation. Urine was collected at recruitment, after 12-week intervention period, in the third trimester and 6-12 weeks postnatally along with an infant urine sample when possible. A total of 55 urine samples were collected from infants. A total of 118 women were recruited. Participants had a mean age of 32 years, (range 21 - 45) with a mean BMI of 27.5 kg/m2. Mean gestational age was 12 weeks (IQR 12-13 weeks). The mUIC in the whole group women was 53.2 µg/L in the first trimester. In the control group the mUIC at the first study visit (n=59) was 93.4 µg/L (22% achieving iodine sufficiency); at the second visit (n=38), the mUIC was 158.7 µg/L with 34% achieving sufficiency. In the milk group the mUIC at the first study visit (n=59) was 82.0 µg/L with 10% achieving sufficiency (no statistical significance between groups, p=0.08); at the second visit (n=43), mUIC was 154.7 µg/L with 37% achieving sufficiency (no statistical difference between groups p=0.78). The mean change in UIC between the first and second trimesters was 44.5 and 88.1 µg/L in the control and milk arms respectively (p=0.27). In this cohort, 71.4% of women reported taking an iodine-containing multivitamin in the first trimester of pregnancy with no difference between group randomised to milk intervention (p=0.95). In the infants, mUIC was 124.1 µg/L with no statistically difference in the proportion reaching iodine sufficiency according to maternal randomisation (p=0.64) or maternal use of an iodine-containing multivitamin (p=0.95). In this cohort, there was no significant improvement in mUIC in those receiving a milk intervention. Presentation: 6/1/2024

8046 Milk Provision as a Potential Intervention to Improve Iodine Status in a Pregnant Cohort in Northern Ireland (NI), UK: A Randomised Controlled Trial

Abstract Disclosure: L.R. Kayes: None. K.R. Mullan: None. J.V. Woodside: None. Iodine deficiency is the leading cause of reversible mental retardation worldwide. During pregnancy there is ∼50% increase in iodine requirement for foetal neurodevelopment. The most recently studied cohorts of pregnant women across Ireland and UK consistently demonstrated mild iodine deficiency (target median urinary iodine concentration (mUIC) ≥150 µg/L). A recent study in NI has shown that women of child-bearing age provided with three litres of cow’s milk per week had improved iodine status. We wished to explore whether a similar milk intervention might improve iodine status during pregnancy. Pregnant women were recruited at their first antenatal appointment, and all were provided with the British Dietetic Association’s iodine food fact sheet. Participants were randomised to either milk intervention, (four litres/week milk delivered weekly free of charge), or no milk delivery (control group). Patients were stratified based on use of an iodine-containing multivitamin prior to randomisation. Urine was collected at recruitment, after 12-week intervention period, in the third trimester and 6-12 weeks postnatally along with an infant urine sample when possible. A total of 55 urine samples were collected from infants. A total of 118 women were recruited. Participants had a mean age of 32 years, (range 21 - 45) with a mean BMI of 27.5 kg/m2. Mean gestational age was 12 weeks (IQR 12-13 weeks). The mUIC in the whole group women was 53.2 µg/L in the first trimester. In the control group the mUIC at the first study visit (n=59) was 93.4 µg/L (22% achieving iodine sufficiency); at the second visit (n=38), the mUIC was 158.7 µg/L with 34% achieving sufficiency. In the milk group the mUIC at the first study visit (n=59) was 82.0 µg/L with 10% achieving sufficiency (no statistical significance between groups, p=0.08); at the second visit (n=43), mUIC was 154.7 µg/L with 37% achieving sufficiency (no statistical difference between groups p=0.78). The mean change in UIC between the first and second trimesters was 44.5 and 88.1 µg/L in the control and milk arms respectively (p=0.27). In this cohort, 71.4% of women reported taking an iodine-containing multivitamin in the first trimester of pregnancy with no difference between group randomised to milk intervention (p=0.95). In the infants, mUIC was 124.1 µg/L with no statistically difference in the proportion reaching iodine sufficiency according to maternal randomisation (p=0.64) or maternal use of an iodine-containing multivitamin (p=0.95). In this cohort, there was no significant improvement in mUIC in those receiving a milk intervention. Presentation: 6/1/2024

Midwives’ perceptions and experiences of recommending and delivering vaccinations to pregnant women following the Covid-19 pandemic: a qualitative study

BackgroundPregnant women and their unborn babies are at an increased risk of hospitalisation, morbidity, and mortality from illness. However, uptake of influenza, pertussis and Covid-19 vaccinations offered during pregnancy is below the desired rate. This research aims to explore UK midwives’ experiences of approaching and discussing vaccinations with pregnant women, and their perceived role in pregnant women's vaccination decisions. MethodsMidwives in the West Midlands, UK were recruited via participating hospitals and midwife specific social media groups. Interviews were conducted remotely from April to July 2023 and analysed with a deductive codebook coding strategy using thematic analysis. FindingsSemi-structured interviews were conducted with 16 midwives identifying the following key themes: Recommendations to have vaccinations reported on the contents of recommendations and how they are communicated; Messages and guidance included the importance of up-to-date informational needs for midwives to administer vaccinations and the barriers caused by uncertainty and conflicting messages about the Covid-19 vaccine during pregnancy; Delivery of vaccinations included the convenience of offering vaccinations during standard antenatal appointments; and Midwives’ barriers explored the pandemic specific and other barriers midwives face in the administering of vaccinations. DiscussionThese findings contribute to the understanding of how midwives discuss the topic of vaccinations with pregnant women. This research highlights the importance for midwives to receive clear and consistent information. A strong emphasis on why vaccines are important when recommending to pregnant women in addition to standard information on the availability and timing may have a bearing in helping women to make informed decisions about accepting vaccinations.

What good emotional care for miscarriage looks like: A mixed-methods investigation in an Australian private hospital setting.

Miscarriage is a common medical occurrence which can be associated with significant psychological distress. Patients and partners are frequently disappointed by aspects of their care, especially with regard to emotional support. Although most published studies investigated the experiences of patients and partners in emergency departments (EDs) of public hospitals, miscarriage is also frequently diagnosed in non-emergency settings, such as during sonography or antenatal appointments, and approximately 25% of Australian women receive maternity care in private hospitals. Because the experience of miscarriage is known to be setting-dependent, it is important to understand how patients and partners experience care outside the ED. Here, we addressed this gap by investigating the experiences of patients and partners who attended a private maternity hospital for miscarriage using a mixed-methods approach. Eighteen patients and six partners who had recently experienced a miscarriage were recruited at a private maternity hospital to take part in both semi-structured interviews and online surveys. Overall, patients and partners were highly satisfied with the emotional care they received. Thematic analysis of semi-structured interviews allowed us to identify a total of ten themes that contributed to satisfaction with emotional care. We provide the first specific insights into the experiences of women and partners who received care for miscarriage in an Australian private hospital setting, and the first example of a healthcare setting that achieves high satisfaction with emotional care around miscarriage. The ten themes we identify provide a framework for improving satisfaction with care also in other settings.

Analysis of factors related to the incident of hypertension in pregnancy

Introduction: Pregnancy-related hypertension is defined as hypertension that develops during pregnancy, usually in the final month of the pregnancy or after 20 weeks of gestational age that was previously normal. Five to fifteen percent of pregnancy-related problems are caused by hypertension, which is also one of the leading causes of maternal death and morbidity. Objective: The purpose of this study is to determine how the risk of hypertension during pregnancy is related to maternal age, parity, pregnancy spacing, BMI, junk food consumption habits, and prenatal visits. Method: Case control research design was employed. Eighty control samples were acquired using a simple random technique, while forty samples from the case group were taken using the accidental technique. A questionnaire was used to collect data. The logistic regression test and the chi square test were used in the data analysis. This study was taken in Ardita's Clinic, Indonesia. This study's sample was taken using the total sampling technique involving 33 respondents. Result: The incidence of hypertension proved to be significantly correlated (p&lt;0.05) with maternal age, junk food consumption, and prenatal visits while parity, pregnancy interval, and BMI weren't associated with a significant correlation (p&gt;0.05). The most significant factor is the junk food consumption habit (OR=13.483). Conclusion: Women should plan their pregnancies at a peak age, avoid from junk food, and arrange many antenatal appointments in order to ensure a successful pregnancy.

Faktor-Faktor yang Berhubungan dengan Kunjungan Antenatal Care (K4) pada Ibu Hamil di Wilayah Kerja Puskesmas Tarus Kupang

The Maternal Mortality Rate (MMR) is an important measure of a country's health sector progress. Governments aim to lower MMR through initiatives like safe motherhood programs, which include antenatal care (ANC) services. ANC consists of regular pregnancy check-ups to prevent maternal fatalities, with six visits being the minimum recommended number. Although Tarus Community Health Center has reached the K4 service goal, it has not yet met the necessary standards.Based on the data from the Tarus Community Health Center PWS report over the past three years, the National Health Sector SPM target of 100% has not been met. The average K4 coverage was 73.10% in 2020, 70.48% in 2021, and 74.9% in 2022. The underutilization of ANC services by pregnant women at Tarus Health Center is the primary factor contributing to this low performance.This research aims to identify factors related to ANC visits in pregnant women at Tarus Community Health Center in Kupang Regency. The study utilized a quantitative descriptive research method with an analytical survey and cross-sectional approach, analyzing data from 43 individuals using the chi-square test. The findings suggest a correlation between maternal knowledge (p=0.030), parity (p=0.014), culture (p=0.000), and accessibility (p=0.014) with ANC visits. However, the study did not find a significant relationship between mother's attitude (p=0.551) and ANC visits in the research area.The community health center should improve maternal and child health education through electronic and print media. Regular visits and counseling for pregnant women can motivate them to attend antenatal care appointments.

Physical activity and circulating inflammatory markers and cytokines during pregnancy: A population-based cohort study.

Physical activity (PA) during pregnancy has numerous benefits, which may be mediated via effects on the immune system. However, supportive evidence is inconsistent and is mainly from studies in high-risk groups. We estimated the effect of PA during pregnancy on systemic inflammatory markers and cytokines in mothers recruited in the Barwon infant study. The Barwon infant study is a prebirth cohort of 1064 mothers recruited in the Barwon Region of Victoria, Australia. Participants reported their previous week's PA at their 28-week antenatal appointment using the International PA Questionnaire. Women were grouped into low, moderate, and high PA categories based on daily duration and weekly frequency of walking, moderate- or vigorous-intensity PA. Women reporting moderate levels of PA, consistent with current recommendations, served as the comparison group. Markers of systemic inflammation, high-sensitivity C-reactive protein (hsCRP), glycoprotein acetyls (GlycA), and 17 cytokines were measured at 28 weeks gestation and log transformed as appropriate. Regression analyses adjusted for maternal smoking, gestational diabetes mellitus, prepregnancy BMI, and household size were performed. Compared to women in the moderate group (n = 371, 42%), women reporting low PA (n = 436, 50%) had 10.1% higher hsCRP (95% CI (3.7% to 16.6%), p < 0.01) while women in high PA (n = 76, 9%) had a 14% higher hsCRP (95% CI (3.1% to 24.8%), p = 0.01). Women in the high PA category had higher interleukin (IL)-4 (q = 0.03) and IL-9 (q = 0.03) levels compared to those in moderate category. Each vigorous MET minute/week was associated with lower GlycA (β = -0.004, 95% CI (-0.044 to 0.035); p = 0.03). Low and high PA are each associated with higher hsCRP than moderate PA, suggesting that undertaking the recommended moderate PA during pregnancy decreases systemic inflammation. High PA affects T cell-associated cytokines during pregnancy. Evidence from our study suggests that PA can modulate the immune responses during pregnancy. Studies are now required to assess whether PA during pregnancy impacts maternal and infant clinical outcomes by modifying inflammatory responses.

Implementation of the London Measure of Unplanned Pregnancy in routine antenatal care: A mixed-methods evaluation in three London NHS Trusts.

Unplanned pregnancies are associated with increased risks. Despite this, they are currently not routinely detected during antenatal care. This study evaluates the implementation of the London Measure of Unplanned Pregnancy (LMUP) - a validated measure of pregnancy planning - into antenatal care at University College London Hospital, Homerton Hospital, and St Thomas' Hospital, England, 2019-2023. We conducted a mixed methods evaluation of the pilot. Uptake and acceptability were measured using anonymized data with non-completion of the LMUP as a proxy measure of acceptability overall. We conducted focus groups with midwives, and one-to-one interviews with women, to explore their thoughts of asking, or being asked the LMUP, which we analyzed with a Framework Analysis. Asking the LMUP at antenatal appointments is feasible and acceptable to women and midwives, and the LMUP performed as expected. Advantages of asking the LMUP, highlighted by participants, include providing additional support and personalizing care. Midwives' concerns about judgment were unsubstantiated; women with unplanned pregnancies valued such discussions. These findings support the implementation of the LMUP in routine antenatal care and show how it can provide valuable insights into the circumstances of women's pregnancies. This can be used to help midwives personalize care, and potentially reduce adverse outcomes and subsequent unplanned pregnancy. Integration of the LMUP into the Maternity Services Data Set will establish national data collection of a validated measure of unplanned pregnancy and enable analysis of the prevalence, factors, and implications of unplanned pregnancies across subpopulations and over time to inform implementation.

E-cigarette use in pregnancy in Australia: A cross-sectional survey of public antenatal clinic attendees.

E-cigarette use has rapidly increased amongst young people in Australia, however the prevalence of use amongst pregnant people is not known. The aim of this study was to examine the prevalence of e-cigarette use and dual use of e-cigarettes and tobacco cigarettes, characteristics associated with use and reasons for use amongst a sample of pregnant Australian people attending public antenatal clinics. A cross-sectional survey was conducted with 4024 pregnant people attending antenatal appointments, between July 2021 and December 2022, in one local health district in New South Wales, Australia. Main outcome measures were current use of e-cigarettes, dual use with tobacco cigarettes, participant characteristics associated with use and reasons for use. 1.24% of pregnant people used e-cigarettes, 34% of these were dual smokers. Being a current smoker (OR 39.49; 95% CI 9.99-156.21) or ex-smoker (OR 29.86; 95% CI 8.75-101.95) were associated with e-cigarette use. Quitting smoking was the most reported reason for use (52%). This study is the first to report on the prevalence of e-cigarette use amongst pregnant people in Australia. We found that a small proportion of pregnant people use e-cigarettes and that many are dual users or ex-smokers. E-cigarette use and rates of dual use in pregnancy in Australia appear lower than internationally, however they are similarly being used as a smoking-cessation aid by many. As regulatory environments relating to e-cigarette access change in Australia, large-scale studies are required to continue to monitor e-cigarette use and dual use in pregnancy.

The Effect of Prenatal Yoga on Changing Sleep Quality Among Third Trimester Primigravida in Posyandu Mawar 19 Batam City

During the third trimester of pregnancy, it is estimated that over 75% of women experience sleep difficulties. Preterm labour, low birth weight, blood pressure issues, decreased glucose tolerance, and depression during and after pregnancy are all direct outcomes that can be directly attributed to sleeping conditions that are of poor quality. This study examines the impact of practising prenatal yoga on the quality of sleep experienced by Primigravida women in the third trimester of pregnancy. Methods: This study includes a control group design and is a quasi-experimental study. This research was carried out in Posyandu Mawar 19 in Batam City. The samples for this study consisted of sixty pregnant women between the ages of 28 and 32 weeks along in their pregnancies. These women were split into two groups: thirty individuals were assigned to the intervention group, which received prenatal yoga four times every two weeks, and thirty individuals were assigned to the control group, which consisted of pregnant women who went to their regular antenatal check-up appointments as they normally would. The results of this study were analyzed using the purposive sampling technique. The data was analyzed using the Wilcoxon test (p &lt; 0.05). The statistical test findings indicate that the control group (p-value 0.001 &lt;0.05) and intervention (p-value 0.001 &lt;0.05) both exhibited a significant difference. The conclusion can be drawn from this is that there is a substantial change in sleep quality before and after the intervention. Prenatal yoga has the potential to enhance the quality of sleep experienced by Primigravida women who are in their third trimester of pregnancy.

Reducing waiting time among pregnant women attending antenatal care clinic at Alexandria University Hospital, Egypt: quality improvement project

ABSTRACT Introduction Antenatal Care (ANC) is crucial for preventing maternal morbidity and death. WHO guidelines published in 2016 recommended that women should attend eight ANC visits as a minimum throughout pregnancy. This research aims at boosting pregnant women satisfaction with the ANC in a public health care facility and thus their willingness to comply with treatment and care. Objectives of this study were to assess the current state of ANC visits system inside Alexandria Main University Hospital (AMUH) and to examine the outcome of appointment scheduling approach on waiting time and utilization of ANC. Methods A prospective survey with pre & post intervention (quasi-experimental study). The study took place between Jan 2023 and April 2023. All expectant mothers who showed up for their regularly scheduled antenatal appointment were advised and invited to take part in the study. The study enrolled pregnant females who were eligible and gave their verbal consent. Pregnant women seeking emergency medical attention and pregnant women who refused to participate in the study were among the exclusion criteria. A purposive sampling technique was used to enroll pregnant women. When they arrived at the clinic, pregnant women who were eligible for the study were recognized and given counseling regarding the study’s goals and the extent of their participation. Prior to enrollment in the study, oral informed permission was obtained from each participant. Results The findings of the study imply that patient experience is a crucial factor in and of itself, and that it may significantly influence utilization patterns. Discussion By practically applying QI tools a sound effective outcomes can be reached. However, patient engagement & effective communication with stakeholders are cornerstones for sustainability of any project and to ensure continuous commitment and leadership support.

Maternal positional therapy for fetal growth and customised birth weight centile benefit in a Bayesian reanalysis of a double-blind, sham-controlled, randomised clinical trial

ObjectivesTo update the Ghana PrenaBelt Trial’s (GPT) primary outcome data with the latest fetal growth standard and reanalyse it. To estimate the posterior probability, under various clinically relevant prior probabilities,...

Effect of implementation strategies on the routine provision of antenatal care addressing smoking in pregnancy: study protocol for a non-randomised stepped-wedge cluster controlled trial

IntroductionGlobally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety...

HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study.

Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame(Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

Homelessness in pregnancy

ObjectivesTo evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. MethodsA retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. ResultsWomen in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001).They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01–2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). ConclusionWomen in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study

BackgroundWomen referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AimsThis study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. MethodsA qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FindingsContinuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. ConclusionsContinuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.