Antenatal Booking Appointment Research Articles

Preconception health among migrant women in England: A cross-sectional analysis of maternity services data 2018–2019

BackgroundPerinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women. MethodsThis national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (n = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and 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; and/or experiencing domestic abuse. FindingsWe identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (n = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06–2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity. InterpretationInequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes. FundingMedical Research Council.

Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys

BackgroundThe perinatal period is a vulnerable time, with one in five women experiencing mental health problems. Antenatal and postnatal appointments are key contact points for identifying women in need of support. Since 2014, the UK National Institute for Health and Care Excellence (NICE) has recommended that all women be asked about their mental health at their antenatal booking appointment and early in the postnatal period. The aim of this study was to assess the proportions of women who reported being asked about their mental health during the perinatal period across consecutive national maternity surveys (NMS) in England and to evaluate sociodemographic disparities in who was asked.MethodsSecondary analysis was performed on cross-sectional data from the NMS in 2014–2020. In each survey, women reported whether they had been asked about their mental health antenatally (during their booking appointment) and postnatally (up to six months after giving birth). The proportions of women in each survey who reported being asked about their mental health were calculated and compared according to key sociodemographic characteristics and across survey years. Logistic regression was conducted to identify disparities in who was asked.ResultsThe proportion of women who reported being asked about their mental health antenatally increased from 80.3% (95%CI:79.0–81.5) in 2014 to 83.4% (95%CI:82.1–84.7) in 2020, yet the proportion of women who reported being asked postnatally fell from 88.2% (95%CI:87.1–89.3) in 2014 to 73.7% (95%CI:72.2–75.2) in 2020. Ethnic minority women (aOR range:0.20 ~ 0.67) were less likely to report being asked about their mental health antenatally and postnatally across all surveys compared to White women. Women living in less socioeconomically advantaged areas (aOR range:0.65 ~ 0.75) and women living without or separately from a partner (aOR range:0.61 ~ 0.73) were also less likely to report being asked about their mental health, although there was less consistency in these disparities across the antenatal and postnatal periods and across surveys.ConclusionsDespite NICE recommendations, many women are still not asked about their mental health during the perinatal period, particularly after giving birth. Women from ethnic minority backgrounds are less likely to be asked and these disparities have persisted over time.

Development and testing of a reduced carbohydrate intervention for the management of obesity and reduction of gestational diabetes (RECORD): protocol for a feasibility randomised controlled trial

IntroductionPrevious trials of dietary interventions to prevent gestational diabetes mellitus (GDM) have yielded only limited success. Low-carbohydrate diets have shown promise for the treatment of type 2 diabetes, but there...

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Pregnant women's awareness, knowledge, and attitudes about perinatal depression

BackgroundPerinatal depression (PD) is linked with a multitude of poor outcomes and far-reaching complications that extend within the whole family unit. A growing body of evidence suggests that measuring PD literacy levels, attitudes and awareness is important as these may influence a perinatal woman's ability to seek support. AimTo explore pregnant women's awareness, knowledge, and attitudes about PD and identify any personal characteristics which influence attitudes and beliefs about PD. MethodA mixed-method, cross-sectional survey design was adopted. The established Perinatal Depression Monitor Questionnaire was adapted for use amongst the local population. Pregnant women attending their antenatal booking appointment at Mater Dei Hospital, Malta, were recruited between April and July 2019. Descriptive data was generated, and a multivariate linear regression model was used to evaluate the relative influence of the sociodemographic variables on attitudes and beliefs towards PD. ResultsOut of 487 distributed questionnaires, 404 questionnaires were returned. While awareness of PD appeared to be high, there was limited understanding of the term PD. The sample was generally knowledgeable on the core signs and symptoms of PD. First help-seeking intentions generally revolved around family and friends. Attitudes towards PD and relevant screening measures were generally positive. Education, parity, gestational age, and marital status were identified as the main predictors of attitudes towards PD. ConclusionThis study exposed some shortcomings that ought to be addressed with appropriate education measures. The study findings are also valuable to policymakers in evaluating the introduction of PD screening services.

Maternal help seeking about early warning signs and symptoms of pre-eclampsia: A qualitative study of experiences of women and their families

BackgroundPre-eclampsia is a disorder of pregnancy, where delay in diagnosis and management of warning signs and symptoms can lead to serious morbidity and mortality for women and their infants. AimThe aim of this study was to understand factors that influenced women's help seeking in response to the onset of early warning signs and symptoms of pre-eclampsia as well as partners or family members’ ability to raise their health concerns with healthcare professionals during the progression of the disorder. Design and MethodsA qualitative narrative research design was used. In depth interviews were used to explore the experiences of 23 women who experienced pre-eclampsia and their families in an urban setting in the UK. Purposive heterogeneity sampling was used to select participants. ResultsThemes associated with help-seeking amongst women included: 1) Risk assessment, 2) Self-monitoring, 3) Organisational constraints.Women categorised as at low risk of hypertensive disorders at their antenatal booking appointment reported a lack of information on pre-eclampsia which affected their ability to seek help as they were unaware of signs and symptoms of the onset of the condition. In contrast women categorised as high risk at this initial appointment considered they were offered too much information about onset of pre-eclampsia, although this facilitated help seeking as they were much more able to recognise signs and symptoms of onset and knew who to contact.Of note is that some women did not experience ‘classic’ signs and symptoms of pre-eclampsia or were unable to distinguish these from normal signs and symptoms of pregnancy.Some women used self-monitoring, mainly self-initiated and self-taught, of their own blood pressure in order to a) negotiate access to treatment and b) to self-discharge from hospital postnatally. ConclusionWomen and their families need individualised information on signs and symptoms of pre-eclampsia to facilitate timely and appropriate help seeking.Women often used self-monitoring of their blood-pressure to negotiate for help.

Opening the door: midwives\u2019 perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study

BackgroundOne in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation.MethodsA two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings.ResultsMidwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37).ConclusionThe study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.

Predicting the risk of childhood overweight and obesity at 4\u20135\u2009years using population-level pregnancy and early-life healthcare data

BackgroundNearly a third of children in the UK are overweight, with the prevalence in the most deprived areas more than twice that in the least deprived. The aim was to develop a risk identification model for childhood overweight/obesity applied during pregnancy and early life using routinely collected population-level healthcare data.MethodsA population-based anonymised linked cohort of maternal antenatal records (January 2003 to September 2013) and birth/early-life data for their children with linked body mass index (BMI) measurements at 4–5 years (n = 29,060 children) in Hampshire, UK was used. Childhood age- and sex-adjusted BMI at 4–5 years, measured between September 2007 and November 2018, using a clinical cut-off of ≥ 91st centile for overweight/obesity. Logistic regression models together with multivariable fractional polynomials were used to select model predictors and to identify transformations of continuous predictors that best predict the outcome.ResultsFifteen percent of children had a BMI ≥ 91st centile. Models were developed in stages, incorporating data collected at first antenatal booking appointment, later pregnancy/birth, and early-life predictors (1 and 2 years). The area under the curve (AUC) was lowest (0.64) for the model only incorporating maternal predictors from early pregnancy and highest for the model incorporating all factors up to weight at 2 years for predicting outcome at 4–5 years (0.83). The models were well calibrated. The prediction models identify 21% (at booking) to 24% (at ~ 2 years) of children as being at high risk of overweight or obese by the age of 4–5 years (as defined by a ≥ 20% risk score). Early pregnancy predictors included maternal BMI, smoking status, maternal age, and ethnicity. Early-life predictors included birthweight, baby’s sex, and weight at 1 or 2 years of age.ConclusionsAlthough predictive ability was lower for the early pregnancy models, maternal predictors remained consistent across the models; thus, high-risk groups could be identified at an early stage with more precise estimation as the child grows. A tool based on these models can be used to quantify clustering of risk for childhood obesity as early as the first trimester of pregnancy, and can strengthen the long-term preventive element of antenatal and early years care.

Reducing risks for pregnant women with epilepsy: A qualitative study exploring experiences of using a toolkit at the antenatal booking appointment

PurposeEpilepsy is a high risk neurological disease associated with an increased risk of indirect maternal mortality due to sudden unexpected death in epilepsy. No evidence exists on the antenatal booking risk management process in women with epilepsy. This study therefore aimed to explore the experiences of midwives' in using a maternity epilepsy toolkit designed by the author to assist with this process. Midwives were chosen as the sample as they are predominantly the first health professional to learn of the diagnosis at the antenatal booking appointment. ObjectivesThe objective of this study was to explore the experiences of midwives in using a maternity epilepsy toolkit at the booking appointment. DesignThis is a qualitative study using the principles of hermeneutic phenomenology. SettingThe study setting is in One National Health Service (NHS) Trust in the South of England. ParticipantsThe participants of the study were n = 4 community midwives who used the maternity epilepsy toolkit at the booking appointment. MethodIn-depth semistructured one-to-one interviews were used. MeasurementsAn interview schedule using main questions, probes, and reinforcers was implemented. Audio-recorded interviews were transcribed verbatim. Transcripts were checked against audio recordings for accuracy. AnalysisInductive approach organized by phenomenological framework to identify recurrent codes, patterns, and themes were used for analysis. FindingsThe following three themes clearly emerged: ‘foundations of epilepsy knowledge’, ‘using the toolkit in midwifery practice’, and ‘the toolkits influence on learning’. ConclusionParticipants described lack of epilepsy knowledge and experience prior to using the ‘toolkit’ and how being prepared optimized its use. They articulated how it enabled them to collate the epilepsy and treatment history, share risk management strategies, and expedite referrals appropriately. They discussed how it increased confidence, reduced fear, and inspired motivation toward learning. The results of this study will provide a foundation for future research exploring the impact that the ‘toolkit’ has on multidisciplinary care provision. Implications for practiceThis small study demonstrated the ‘toolkits’ potential as a method of increasing knowledge about epilepsy and risk management. Initiation of its use in early pregnancy is intended to promote effective history taking, facilitate the identification of women at increased risk of morbidity and mortality, and encourage joint working through early multidisciplinary team referral and involvement.This paper is for the Special Issue :Prevent 21: SUDEP Summit - Time to Listen

Assessing the prevalence of alcohol consumption in early pregnancy using blood biomarker analysis: a consistent pattern across north-east England?

We previously investigated the prevalence of alcohol consumption in early pregnancy in Northumbria Healthcare NHS Foundation Trust, a locality of north-east England. The prevalence was 1.4% based on blood sample biomarker analysis using carbohydrate deficient transferrin (CDT) and 3.5% for gamma-glutamyltransferase (GGT). To supplement this research by investigating the prevalence of alcohol use using identical methods in a different locality of the same region. Six-hundred random blood samples taken at the antenatal booking appointment were anonymously analysed for the presence of CDT, a validated marker of chronic alcohol exposure (normalizing 2-3 weeks from abstinence) and GGT, a liver enzyme elevated for up to 8 weeks after alcohol exposure. The North Tees and Hartlepool NHS Foundation Trust data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7-2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6-5.9). However, these measures are not sensitive to low levels of alcohol; and no overlapping cases were identified or a significant correlation demonstrated between CDT or GGT. These data support our earlier work. Prevalence rates according to CDT and GGT analysis were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.

Adherence to the Healthy Eating Index-2015 across generations and associations with birth outcomes and weight status at age 5 years: results from the Lifeways Cross Generation Cohort Study in Ireland

BackgroundMaternal dietary quality during pregnancy is associated with birth outcomes. Limited data about similar paternal influences on offspring outcomes exist and these associations have not been examined in three-generation families. We investigated the intra-uterine hypothesis by comparing maternal, paternal, and grandparental lineage influences of dietary quality on offspring birth outcomes and weight status at age 5 years in a three-generation familial cohort in Ireland, the Lifeways Cross Generation Cohort Study. MethodsThe cohort comprised 1094 live infants born to 1082 mothers recruited at first antenatal booking appointment; 333 fathers and 707 grandparents also completed the baseline questionnaire. Dietary scores, determined with the Healthy Eating Index (HEI)-2015, were generated for expectant mothers, fathers, and up to four grandparents from prenatal dietary information collected using a validated food frequency questionnaire. Birth outcomes were abstracted from hospital records, and body-mass index was determined when the child was 5 years old. Associations were assessed by logistic regression. FindingsMean maternal and paternal HEI scores were 52·0 (SD 8·6) and 47·7 (9·4), respectively. After adjustment for confounders, greater adherence to maternal HEI was associated with lower risk of low birthweight (odds ratio 0·72, 95% CI 0·50–0·99; p=0·040). Similarly, maternal grandmothers with higher HEI scores were less likely to have grandchildren with low birthweight (0·87, 0·61–0·96; p=0·042) and more likely to have macrosomia (1·10, 1·01–1·22; p=0·033). Higher HEI scores of paternal and paternal grandmothers were associated with lower risk of childhood obesity (0·89, 0·30–0·94; p=0·034) and overweight grandchildren at 5 years (0·83, 0·22–0·99; p=0·043). Mediation analysis showed significant direct effects of HEI scores of both maternal and paternal grandmothers on grandchildren's birthweight (β=0·0006, p=0·035) and obesity (−0·0459, p=0·034). InterpretationHigher HEI-2015 scores were associated with lower risk of low birthweight in the maternal and maternal grandmother lines, whereas higher paternal and paternal grandmother dietary quality predicted lower risk of childhood overweight and obesity. These data suggest that differential intergenerational transmission of risk exists between maternal and paternal lines, whereby maternal line dietary quality appears to influence fetal growth and paternal line dietary quality appears to influence postnatal growth. FundingIrish Health Research Board (reference HRC/2007/13).

Assessing prevalence of alcohol consumption in early pregnancy: Self-report compared to blood biomarker analysis

Providing appropriate antenatal and postnatal care for women who drink alcohol in pregnancy is only possible if those at risk can be identified. We aimed to compare the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. Six-hundred routine blood samples from 2014, taken at the antenatal booking appointment, in the first trimester of pregnancy, were anonymously analysed for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. In a separate sample of women, from 2015, data taken during the antenatal visit, documenting women's self-reported alcohol consumption, were collected. The percentage of women who reported alcohol intake in the first trimester was 0.8%. This compared to 74.1% of women who reported consuming alcohol before pregnancy. CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. Results from CDT analysis and self-report may underestimate prevalence for different reasons. GGT appeared to lack specificity, but it may have value in supporting findings from CDT analysis. Further studies using additional blood biomarkers, or a combination of blood biomarkers and self-report, may be beneficial in accurately detecting alcohol drinking history in pregnancy.

Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations

BackgroundThe provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue.Methods/designThe study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2–7 and 8–13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority.DiscussionCommunity REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and delivered by local communities. This pragmatic cluster randomised controlled trial, with integrated process and economic evaluation, aims to rigorously assess the effectiveness of this public health intervention, which is particularly complex due to the required combination of standardisation with local flexibility. It will also answer questions about scalability and generalisability.Trial registrationISRCTN registry: registration number 63066975. Registered on 18 August 2015.

Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK

BackgroundIn the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy. The aim of this study was to identify predictors for late initiation of antenatal care within an ethnically diverse cohort in East London.MethodsCross-sectional analysis of routinely collected electronic patient record data from Newham University Hospital NHS Trust (NUHT). All women who attended their antenatal booking appointment within NUHT between 1st January 2008 and 24th January 2011 were included in this study. The main outcome measure was late antenatal booking, defined as attendance at the antenatal booking appointment after 12 weeks (+6 days) gestation. Data were analysed using multivariable logistic regression with robust standard errors.ResultsLate initiation of antenatal care was independently associated with non-British (White) ethnicity, inability to speak English, and non-UK maternal birthplace in the multivariable model. However, among those women who both spoke English and were born in the UK, the only ethnic group at increased risk of late booking were women who identified as African/Caribbean (aOR: 1.40: 95% CI: 1.11, 1.76) relative to British (White). Other predictors identified include maternal age younger than 20 years (aOR: 1.32; 95% CI: 1.13-1.54), high parity (aOR: 2.09; 95% CI: 1.77-2.46) and living in temporary accommodation (aOR: 1.71; 95% CI: 1.35-2.16).ConclusionsSocio-cultural factors in addition to poor English ability or assimilation may play an important role in determining early initiation of antenatal care. Future research should focus on effective interventions to encourage and enable these minority groups to engage with the maternity services.

M536 AN AUDIT ON RISK ASSESSMENT OF WOMEN AT ANTENATAL BOOKING APPOINTMENT

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S703-S704 Poster presentations M536 AN AUDIT ON RISK ASSESSMENT OF WOMEN AT ANTENATAL BOOKING APPOINTMENT K.V. Sellappan, K.V. SellappanSearch for more papers by this authorR. Farr, R. FarrSearch for more papers by this authorP. Hill, P. HillSearch for more papers by this author K.V. Sellappan, K.V. SellappanSearch for more papers by this authorR. Farr, R. FarrSearch for more papers by this authorP. Hill, P. HillSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61724-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S703-S704 RelatedInformation

Choice and birth method: mixed‐method study of caesarean delivery for maternal request

To explore whether women view decision-making surrounding vaginal or caesarean birth as their choice. Longitudinal cohort study utilising quantitative (questionnaire, routinely collected data) and qualitative (in-depth interviews) methods simultaneously. A large hospital providing National Health Service maternity care in the UK. Four-hundred and fifty-four primigravid women. Women completed up to three questionnaires between their antenatal booking appointment and delivery. Amongst these women, 153 were interviewed at least once during pregnancy (between 24 and 36 weeks) and/or after 12 moths after birth. Data were also obtained from women's hospital delivery records. Descriptive statistical analysis was performed (survey and delivery data). Interview data were analysed using a seven-stage sequential form of qualitative analysis. Whilst many women supported the principle of choice, they identified how, in practice their autonomy was limited by individual circumstance and available care provision. All women felt that concerns about their baby's or their own health should take precedence over personal preference. Moreover, expressing a preference for either vaginal or caesarean birth was inherently problematic as choice until the time of delivery was neither static nor final. Women did not have autonomous choice over their actual birth method, but neither did they necessarily want it. The results of this large exploratory study suggest that choice may not be the best concept through which to approach the current arrangements for birth in the UK. Moreover, they challenge the notion of choice that currently prevails in international debates about caesarean delivery for maternal request.

FACTORS THAT CONTRIBUTE TO WOMEN DECLINING ANTENATAL HIV TESTING

In this study we aimed to identify factors that contribute to women’s decisions to decline an HIV test during their pregnancy in an antenatal clinic setting in Metropolitan London. Voluntary HIV testing (“opt-in”) is recommended by the British Department of Health in areas of higher HIV prevalence.We developed a questionnaire that focused on attitudes toward testing, knowledge of transmission routes, a self-assessment of HIV risk, and reasons for declining the HIV test.All women attending the 16-week antenatal booking appointment were offered an HIV test. Of these 560 women, 124 (23%) had an HIV test and the 436 (77%) who declined the test were asked to complete a questionnaire that explored their reasons for declining. We based our findings on the 393 completed returned questionnaires.The major finding was that women declined testing because they did not think they had been at risk for HIV. However, they based this belief on patchy HIV knowledge. The women were making an important decision during their pregnancy on the basis of poor information. The antenatal setting may not be the most appropriate environment in which to give HIV information, however, this task must be performed also in other health environments.

Domestic violence in late pregnancy and splenic injury: delayed presentation

Domestic violence in late pregnancy and splenic injury: delayed presentation

Pregnancy‐associated weight gain – does it contribute to the rising rate of obesity in women in the UK?

In 1980, 8 per cent of women in the UK were classified as obese (body mass index over 30). By 1998, the prevalence of obesity had increased to 21 per cent and there is no sign that this upward trend is moderating. Many women retrospectively attribute the onset of their obesity to pregnancy, yet research in this area has yielded conflicting evidence. Unlike the USA, the UK does not have clinical guidelines for gestational weight gain. Health professionals such as GPs, midwives and obstetricians have a responsibility to monitor normal pregnancy, yet typically in the UK, women are weighed only once i.e. at the antenatal booking appointment, which is primarily undertaken for the interpretation of screening tests. This paper will review recent evidence relating gestational weight gain and maternal outcomes such as the burden of postpartum obesity and the risk of caesarean section. In addition, some practical advice is given for heath professionals to use when monitoring the weight gain of pregnant women in their care.

The uptake and acceptability to patients of cystic fibrosis carrier testing offered in pregnancy by the GP.

OBJECTIVE: To determine the uptake and acceptability of cystic fibrosis (CF) carrier testing when offered to women at the first antenatal booking appointment by their general practitioner. SETTING: Eight-general practices...