High Proportion Of Pregnant Women Research Articles

Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon.

To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48euros per woman. A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.

Assessment of Implementation of Malaria Control Strategies among Pregnant Mothers Attending Antenatal Care at Bumanya Health Centre IV in Kaliro District

Although a high proportion of pregnant women had an antenatal care (ANC) visit at least once during pregnancy, the coverage level of intermittent preventive treatment of malaria in pregnancy (IPTp-SP) and insecticide-treated bednets (ITNs) remains low in Sub-Saharan Africa. A hospital-based descriptive cross-sectional study was carried out. The outcome of the survey revealed that the majority of participants, 79%, were above 20 years old, with a mean (+/-SD) age of 25.6 (+/-SD) years. The survey also revealed that 62.67% of the participants knew about IPTp; the biggest number of participants (86.67%) reported utilizing IPTp during their current pregnancy, while 13.33% did not take IPTp. Occupation, gestational age, several ANC visits, and information about IPTp were significantly associated with IPTp uptake. The current study explored malaria IPTp uptake among pregnant women attending ANC at Bumanya HCIV. It established that an increased number of ANC visits, providing IPTp information to pregnant women, and the gestational age of pregnancy resulted in increased uptake of IPTp and thus reduced incidences of malaria cases. Keywords: Pregnancy, Women, ANC, IPTp, Malaria, Gestational age.

Factors associated with HIV testing among pregnant women in Rwanda: A nationwide cross-sectional survey.

Human immunodeficiency virus (HIV) testing during pregnancy is crucial for the prevention of mother-to-child transmission of HIV, through aiding prompt treatment, care, and support. However, few studies have explored HIV testing among pregnant women in Rwanda. This study, therefore, aimed to determine the prevalence and associated factors of HIV testing among pregnant women in Rwanda. We used secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS), comprising 870 pregnant women. Multistage stratified sampling was used by the RDHS team to select participants. We conducted bivariable and multivariable logistic regression to explore factors associated with HIV testing using SPSS (version 25). Of the 870 pregnant women, 94.0% had tested for HIV during their current pregnancy. Younger age (24-34 years), not working, large household size, multiple sex partners, as well as secondary, primary, and no education were associated with higher odds of HIV testing compared to their respective counterparts. However, being unmarried, belonging to the western region, having not visited a health facility, and not having comprehensive HIV knowledge were associated with lower odds of HIV testing. A high proportion of pregnant women had tested for HIV. The study revealed that individual-level factors had the greatest influence on HIV testing in pregnancy, with a few household-level factors showing significance. There is a need for maternal health stakeholders to design and develop HIV testing programs that are region-sensitive. These programs should target older, more educated, working, and unmarried women with limited HIV knowledge.

Determinants of late initiation for Antenatal Care follow-up among pregnant mothers attending public health centers at Jimma Town, South West Ethiopia, 2021: unmatched case-control study

Background: The World Health Organization recommends that a woman without complications should have at least four antenatal care visits, the first of which should take place during the first trimester (not > 16 weeks). But a high proportion of pregnant women in most developing countries attended the first antenatal care at a late time. In Ethiopia, the magnitude of late antenatal care follow-up initiation is 64%, and in the study area, it is 68.7%. However, the determinants of the problem were not identified, particularly in the study area. Objective: To identify determinants of late antenatal care initiation among pregnant women attending antenatal care in public health centers in Jimma Town, South West Ethiopia, 2021. Methods: A facility-based unmatched case control study was conducted from May 1–30. The cases (n = 177) were mothers who attended their first antenatal care visit at >= 16 weeks of gestational age, and the controls (n = 177) were mothers who attended their first antenatal care visit at <16 weeks of gestational age during the data collection period. Data was collected through face-to-face interviews using a pre-tested, structured questionnaire. Descriptive and summary statistics were done. Bivariate and multivariable logistic regression analysis was done using SPSS version 21.0 to identify candidate variables at P-value <0.25 and determinants of late antenatal care initiation at P-value <0.05, respectively. Results: The current study identified that age > 25 years (AOR = 2.623, 95% CI 1.059– 6.496), poor knowledge about antenatal care (AOR = 3.856, 95% CI 1.266–11.750), lack of history of abortion (AOR = 3.326, 95% CI 1.082–10.224), place of previous delivery (AOR = 3.926, 95% CI 1.023–15.063), recognizing pregnancy through missed periods (AOR = 3.631, 95% CI 1.520–8.674), pregnancy-related pain (AOR = 3.499, 95% CI 1.423–8.603), and lack of family support (AOR = 2.647, 95% CI 1.092–6.415) were determinants of late antenatal care initiation. Conclusion: Age > 25 years, poor knowledge about antenatal care, lack of history of abortion, place of previous delivery, recognizing pregnancy through missed period, pregnancy related pain, and lack of family support during antenatal care booking were determinants of late antenatal care initiation. Health facilities and respective health care providers should provide health education at the facility level regularly, with due attention to late antenatal care initiation

Antenatal care coverage in a low-resource setting: Estimations from the Birhan Cohort.

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. The study population were women enrolled and followed during pregnancy between December 2018 and April 2020. ANC visits were measured by prospective facility chart abstraction and self-report at enrollment. The primary study outcomes were the total number of ANC visits attended during pregnancy and the coverage of at least one, four, or eight ANC visits. Additionally, we estimated ANC retention patterns. We included 2069 women, of which 150 (7.2%) women enrolled <13 weeks of gestation with complete prospective facility reporting. Among these 150 women, ANC coverage of at least one visit was 97.3%, whereas coverage of four visits or more was 34.0%. Among all women, coverage of one ANC visit was 92.3%, while coverage of four or more visits was 28.8%. No women were found to have attended eight or more ANC visits. On retention in care, 70.3% of participants who had an ANC visit between weeks 28 and <36 of gestation did not return for a subsequent visit. Despite the high proportion of pregnant women who accessed ANC at least once in our study area, the coverage of four visits remains low. Further efforts are needed to enhance access to more ANC visits, retain women in care, and adhere to the most recent Ethiopian National ANC guideline of at least eight ANC visits. It is essential to identify the factors that lead a large proportion of women to discontinue ANC follow-up.

Irrational nutrition as a risk factor during pregnancy and childbirth

Abstract Introduction Nutrition is a factor influencing pregnancy, birth and late fetal development. In Bulgaria, there is a tendency to increase both malnutrition and obesity. This leads to an increase in pregnancy complications. Questions related to nutrition during pregnancy are part of the National Program for Antenatal Care in Bulgaria. The aim is to study the factors associated with eating disorders in pregnant women. Material and methods A documentary study and a direct individual survey were conducted among hospitalized pregnant women at Pleven University Hospital. The questions touch on socio-economic, health and educational aspects. Results Only half (48%) are at an optimal weight. The percentage of pregnant women with malnutrition is high (24%). The highest proportion of malnourished pregnant women are teenagers (35%), and those over 30 are overweight (27%). The study proved the link of malnutrition with low social and economic status, low/no education. Obesity prevails in the group of unskilled workers (45%). Malnutrition is characteristic of teenage pregnancy (35%), living alone (80%), for ethnically isolated groups (Roma 71%) or living in small settlements (52%). The scope of antenatal care among the respondents is only 28%. Deviations in nutrition led to frequent hospitalizations (52%), anemia (39%), spontaneous abortions (59%). Women with eating disorders more often suffer from infections during pregnancy (46%) and complications in the puerperium (52%). No association was found with preterm birth, premature rupture of the amniotic sac, and low birth weight. Conclusions There is a significant share of pregnant women with eating disorders in Bulgaria. The proportion of malnourished pregnant women increases, increasing the risk of complications. Proper nutrition of pregnant women depends on socio-economic factors, education, employment. Key messages • In Bulgaria, a National program for antenatal care, including problems with the diet of pregnant women, has been introduced. • The high proportion of pregnant women with improper nutrition increases the risks for pregnant women and newborns.

Level and factors associated with compliance to iron-folic acid supplementation among pregnant women in rural Soro district, Hadiya Zone, Ethiopia: cross-sectional study

BackgroundDespite the advantages of iron and folic acid supplementation, the compliance status among pregnant women for the supplements is very low in Ethiopia. However, the factors found to be associated with the compliance of iron and folic acid supplementation varies depending on geographical locations and socio-cultural characteristics within the country. Therefore, this study assessed the compliance to iron and folic acid supplements and its associated factors among pregnant women in the rural Soro district, Hadiya Zone, Southern Ethiopia.MethodsCross-sectional study design was applied to conduct the study. The total sample size was 274. This study was conducted from June 10 up to 20, 2018. Women who live in rural Soro district at least for 6months and gave live birth 12 months prior to the survey were included in the study. The study subjects were selected by applying the simple random sampling method. Independent variables with p-value less than or equal to 0.25 during bivariate analysis were candidate for multivariable analysis. Finally, during multivariable analysis the independent variables with P-value less than 0.05 were declared as factors significantly associated with compliance to iron-folic acid supplementation during pregnancy.ResultsOf the whole study participants only 51(18.8%) women had taken iron folic acid supplements for at least 90 days during their last pregnancy. Women who had frequent visits to health facilities for ante natal care were more likely to be compliant with iron-folic acid supplements than their counterparts [AOR(95%CI) = 4.50(1.18, 17.14)].ConclusionIn this study, the higher proportion of pregnant women did not take adequate dose of iron and folic acid tablets during their last pregnancy. Women who had a frequent visit to health facilities for antenatal care were more likely to be compliant for iron folic acid supplements than their counterparts. Every effort should be made in the community and health facilities by concerned bodies working in the maternal health area to mobilize pregnant women to take the antenatal care for at least four times to achieve the minimum dose of iron and folic acid supplements.

Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria

A comparative cross-sectional study was conducted among 991 pregnant and 674 non-pregnant women of reproductive age attending healthcare facilities in Ibadan, Nigeria using the General Health Questionnaire-12 (GHQ), and WHO self-reporting questionnaire (SRQ). Logistic regression analysis was conducted to identify predictors of psychiatric morbidity at p < 0.05. A significantly higher proportion of pregnant women experienced psychological distress on the GHQ (51.8%) and psychiatric morbidity on SRQ (33.3%) compared with 28.6% and 18.2% of non-pregnant women, respectively. Predictors of psychiatric morbidity among pregnant women were the type of facility, poor satisfaction and communication with partners, the experience of violence in the home, previous abortions, and previous history of depression. Psychiatric morbidity among non-pregnant women was predicted by younger age, previous history of depression, poor satisfaction and communication with partners. There is a need for early identification of psychiatric morbidity among women of reproductive age, to ensure early interventions and prevent long-term disability. Impact statement What is already known on this subject? Psychiatric morbidity has immense effects on a woman’s quality of life, social functioning, obstetric outcome, and economic productivity. What do the results of this study add? Psychiatric morbidity among women of reproductive age is high. Pregnant women when compared to non-pregnant women had significantly higher rates of psychiatric morbidity. This high prevalence of psychiatric morbidity in both groups was predicted by poor satisfaction and communication with partners, and a previous history of depression. What are the implications of these findings for clinical practice and/or further research? Simple screening for women of reproductive age attending healthcare facilities may help with the early identification of psychiatric morbidity leading to prompt interventions, and preventing long-term disability.

A Prospective Analysis of Vitamin D Levels in Pregnant Women Diagnosed with Gestational Hypertension after SARS-CoV-2 Infection.

The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9-39.7) ng/mL compared to 27.9 (16.2-32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4-33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = -0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension.

Prevalence of Malaria Parasitemia and Perceptions of the Use of Long-Lasting Insecticide Nets in a Sample of Pregnant Women in a Malaria-Endemic Nigerian Community

Objectives: The objectives of the study were to evaluate the prevalence of malaria and the perception on the use of long-lasting insecticide-treated nets (LLINs) among pregnant women attending antenatal care at Neni Community Health Center, Anaocha Local Government Area, Anambra State, Nigeria. Methods: A sample of 364 pregnant women were randomly selected for the study. Malaria parasitemia and the use of LLINs were critically evaluated among pregnant women in the study area. Two milliliters of venous blood samples was collected by a medical laboratory scientist from each pregnant woman; it was stored in an ethylenediaminetetraacetic acid container. This was done under sterile conditions and examined for malaria parasites using Giemsa-stained thin and thick blood films under a microscope. Interviews and observations were used to collect information from pregnant women regarding their sociodemographic characteristics and use of LLINs. The level of statistical significance was set at Ρ ≤0.05. Results: The prevalence of malaria in relation to parity indicated that primigravidae had the highest proportion (46.2%). In terms of gestational stage, malaria infection was highest among women in their first trimester (37.2%). Based on occupational status, farmers recorded the highest prevalence of 40.7%. There was a significantly higher proportion of pregnant women who were aware of LLINs (χ2 = 25.36, P &lt; 0.05), chose antenatal classes as a source of information on awareness of LLINs (χ2 = 27.33, P &lt; 0.05), and had reasons for noncompliance with LLINs (χ2 = 25.71, P &lt; 0.05). Conclusions: This study reveals a relatively high prevalence of malaria parasitemia and low compliance with the use of long-lasting insecticide nets among pregnant women attending antenatal care at Neni Community Health Center in Anambra State, Nigeria.

Management and Implications of Severe COVID-19 in Pregnancy in the United Kingdom: Data From the UK OBSTETRIC Surveillance System National Cohort

(Acta Obstet Gynecol Scand. 2022;101:461–470. doi: 10.1111/aogs.14329) With the inauspicious rise to dominance of the Sars-CoV-2 Delta variant (B.1.617.2) in the United Kingdom in May 2021, the proportion of pregnant women experiencing severe disease proliferated significantly [35.8% during the Alpha variant duration vs. 45% in the Delta-dominant duration, adjusted odds ratio (aOR): 1.53]. A high proportion of pregnant women with COVID-19 deliver prematurely, are admitted to intensive care, and have neonates that also require intensive care. Most data thus far have come from single-center cohorts with small sample sizes, and present conflicting conclusions. There is an urgent need to investigate the risks and outcomes of severe COVID-19 illness in pregnant women to update guidelines for clinical management and prevention practices.

Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon.

There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon. An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20® and BioEstat 5.3® software. The odds ratio was calculated by multiple logistic regression. One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01). The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.

Identification and mitigation of high-risk pregnancy with the Community Maternal Danger Score Mobile Application in Gboko, Nigeria.

IntroductionRisk analyses within rural regions of Nigeria are not routinely conducted, yet could help inform access to skilled birth care. The objective of this study was to assess and compare the proportion of pregnant women at risk for maternal mortality or morbidity in Benue State, Nigeria by analysing data collected during routine antenatal visits and through the Community Maternal Danger Score (CMDS), a validated risk-analysis tool.MethodsTwo cohorts, comprised of pregnant women presenting to primary healthcare centres within Gboko, Benue State between 2015–2017 and 2020–2021, were included in this study. The 2015–2017 cohort had their risk assessed retrospectively through analysis of routinely collected data. Identification of risk was based on their age, parity, and disease status (HIV and diabetes). The 2020–2021 cohort had their risk assessed prospectively using the CMDS.ResultsRoutinely collected data from 2015–2017 demonstrated that up to 14.9% of women in Gboko were at risk for mortality or morbidity. The CMDS reported that up to 21.5% of women were at a similar level of risk; a significant difference of 6.6% (p = 0.006). The CMDS was more efficient in obtaining and assessing this data, and the identification of risk occurred in real-time.ConclusionRoutine data collected in Gboko identifies a high proportion of pregnant women at risk for mortality or morbidity. The CMDS is an evidence-based risk analysis tool that expands on this assessment by also estimating individual and community-level risk, which allows for more efficient mitigation and prevention strategies of maternal mortality.

Susceptibility to endemic Aedes‐borne viruses among pregnant women in Risaralda, Colombia

ObjectivesAedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses (ZIKV) highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. MethodsA cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood samples were obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. ResultsMost women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016. However, only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. ConclusionHence, a high proportion of pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating a risk for future epidemics in this region.

Niveles de inseguridad alimentaria y características asociadas en mujeres gestantes de Colombia en el 2015

IntroductionFood insecurity is the inability of households to acquire safe, nutritionally adequate food that meets physiological needs for leading a healthy and active life. ObjectiveTo describe the levels of food insecurity and associated factors in pregnant women in Colombia. MethodologyCross-sectional-analytical study; is a secondary analysis of the 2015 Nutritional Situation Survey of Colombia. 1393 pregnant women between 12 and 48 years old were examined. Food insecurity was assessed using the Latin American and Caribbean Food Security Scale. Sociodemographic, anthropometric and micronutrient characteristics were evaluated. The description of food insecurity distribution was made for each of the selected variables, through absolute and percentage frequencies. To estimate the association between the different variables and food insecurity, we used multivariate Poisson regression models. Results60.4% (CI95% 55.6%–64,7%) of pregnant women resided in homes with some degree of food insecurity; severe: 9.4% (CI95% 7.4%–11.9%), moderate: 17.6% (CI95% 13.5%–22.8%) and light: 33.2% (CI95% 28.9%–37.8%); we found that Black/Mulatto/Afro-descendant pregnant women (PR 1.22 CI95% 1.01–1.47), belong to quartile 1 of wealth (PR 2.23 CI95% 1.41–3.68), and residing in the región Atlántica (PR 1.34 CI95% 1.08–1.67), was associated with some food insecurity level. ConclusionA high proportion of pregnant women living in households with some food insecurity level. The pregnant women of low socioeconomic levels and those belonging to the black/mulatto/Afro-descendant ethnic group showed to be the main characteristics associated with residing in households with some degree of food insecurity.

Adequacy of prenatal dental care: social and geographical inequalities in a metropolitan region of Brazil

This study set out to analyze social and geographical inequalities in the adequacy of prenatal dental care in the Unified Health System (SUS) of the Greater Vitória Metropolitan Region, Espírito Santo, Brazil. A cross-sectional study was carried out with 1209 postpartum women living in the region admitted to hospital at SUS facilities for childbirth between 2010 and 2011. Data were collected on prenatal medical-dental care, the impact of oral health on the quality of life of pregnant women (Oral Health Impact Profile-14), and predisposing characteristics. Prenatal care was adequate when care corresponded to the recommended treatment. The adequacy of dental care during prenatal care was analyzed using a multivariate logistic model. Oral health was found to have an impact on the quality of life of 102 (8.4%) pregnant women and the adequacy of dental care during prenatal care was only 15.4% (n=156). There was a greater chance of adequacy of prenatal dental care in Vitória (OR=2.44; IC=1.63-3.66), in regions covered by the family health strategy (OR=1.88; IC=1.22-2.89), and in areas with a higher proportion of pregnant women with access to quality prenatal care (OR=3.59; IC=1.64-7.84). Contextual inequalities were decisive for the inadequacy of dental care in prenatal care.

High prevalence of vitamin D deficiency among normotensive and hypertensive pregnant women in Ghana

BackgroundHypovitaminosis D in pregnancy is associated with adverse health outcomes in mothers, newborns and infants. This study assessed the levels of 25-hydroxyvitamin D [25(OH)D] in normotensive pregnancies and in preeclampsia, evaluated the association between vitamin D deficiency and preeclampsia risk; and determined the foeto-maternal outcome in preeclamptic women with vitamin D deficiency.MethodsThis case-control study was conducted among pregnant women who visited the Comboni Hospital, in Ghana from January 2017 to May 2018 for antenatal care. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Socio-demographic, clinical and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of 25- hydroxyvitamin D [25(OH)D] using enzyme-linked immunosorbent assay technique. Lipids (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) were also estimated.ResultsA total of 81.7% of the study participants had vitamin D deficiency. Of these, 88.6% of the women with PE had vitamin D deficiency compared to 75.0% in the NP. Vitamin D levels were significantly reduced in the PE women compared to the normotensive pregnant women (p = 0.001). A higher proportion of the preeclamptic women who were vitamin D deficient had preterm delivery (p < 0:0001) and delivered low birth weight infants (p < 0:0001), and infants with IUGR (p < 0:0001) compared to the control group (p < 0:0001). Pregnant women with PE presented with significant dyslipidemia, evidenced by significantly elevated TC (p = 0.008), LDL (p < 0.0001), triglycerides (p = 0.017) and a significantly reduced HDL (p = 0.001) as compared to NP. In the preeclamptic women, serum 25(OH) D showed an inverse, but not significant association with TC (β = − 0.043, p = 0.722, TG (β = − 0.144, p = 0.210) and LDL (β = − 0.076, p = 0.524) and a positive, but not significant association with HDL (β = 0.171, p = 0.156).ConclusionThe prevalence of vitamin D deficiency is high in both normotensive pregnancies and pregnancies complicated by preeclampsia but amplified in preeclampsia. Higher proportion of pregnant women with hypovitaminosis D had preterm babies and delivered low birth weight neonates. Additional studies are needed to explore the potential benefits and optimal dosing of vitamin D use in pregnancy, especially in sub-Saharan Africa.

Psychological state during pregnancy is associated with sleep quality: preliminary findings from MY-CARE cohort study

ABSTRACT Psychological distress during pregnancy may increase the risk of adverse maternal and infant outcomes. Past studies have demonstrated the association between circadian disturbances with psychological health. However, the roles of chronotype and social jetlag on psychological state during pregnancy are yet to be identified. We aimed to examine the psychological state in pregnant women and its relations to chronotype, social jetlag (SJL), sleep quality and cortisol rhythm. The current study included a subsample of participants from an ongoing cohort study. A total of 179 primigravidas (mean age 28.4 ± 4.0 years) were recruited. Chronotype and sleep quality during the second trimester were assessed using the Morning-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI), respectively. SJL was calculated based on the difference between mid-sleep on workdays and free days. Psychological state of participants was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Subsamples (n = 70) provided salivary samples at 5 time points over a 24 h period during the second trimester for cortisol assay. A higher proportion of pregnant women experienced moderate to severe anxiety symptoms (n = 77, 43.0%), followed by depressive (n = 17, 9.5%) and stress (n = 14, 7.8%) symptoms. No association was observed between chronotype and psychological distress during pregnancy. There was no significant difference in cortisol rhythms in relation to psychological distress. SJL and sleep quality were significantly associated with stress symptoms among pregnant women in the second trimester. Poor sleep quality, particularly daytime dysfunction (β = 0.37, p = .006) and sleep disturbances (β = 0.23, p = .047), were significantly associated with psychological distress (depressive, anxiety and stress symptoms) during the second trimester. The findings suggest that sleep is a potential modifiable lifestyle factor that can be targeted to improve psychological health among pregnant women.

Intimate Partner Violence Before Pregnancy, During Pregnancy, and After Childbirth: A New Conceptualization Highlighting Individual Changes in Violence Against Pregnant Women Over Time.

Intimate partner violence (IPV) against pregnant women is a global public health problem. Yet, the trajectory of IPV during pregnancy and its association with health are unclear. This study set out to investigate the trajectory of IPV by categorizing pregnant women according to changes of IPV exposure before, during, and after pregnancy and to examine the predictive factors of these IPV-related categories. During 2016 and 2017, we conducted a longitudinal study with a sample of 1,083 pregnant women in Hong Kong. Pregnant women reported their IPV experiences, depression, and demographics in the baseline survey (at about 24-week gestation), and their IPV experiences, mental health outcomes, social support, and perceived father's involvement in the follow-up survey (around 4 weeks postpartum). We categorized pregnant women into four groups, including women with (a) sustaining abusive relationship (AR); (b) relationship with decreased violence over pregnancy (DVR); (c) relationship with stress-related violence (SVR); and (d) nonviolent relationship (NVR). Although we found an overall decline of IPV during pregnancy from 24.6% to 14.3%, there were still a considerable proportion of women reporting as a victim of IPV. We observed that a higher proportion of pregnant women were actually suffering from IPV during pregnancy and after childbirth continuously (22.3% of AR and SVR) than experiencing a termination of IPV due to pregnancy (11.4% of DVR). We also observed that more severe maternal depression, lower levels of father's involvement, and poorer social support were significantly associated with the categories that reflected greater severity of IPV over the course of pregnancy. Our findings reflected that the complexity of IPV related to pregnancy should never be overlooked. Mere reporting of prevalence in an aggregate might not sufficiently explain the problem. Father's involvement and social support are two important factors that might help reduce IPV related to pregnancy and childbirth.

COMPARATIVE ASPECTS OF PLACENTAL DYSFUNCTION IN WOMEN USING DIFFERENT METHODS OF CONTRACEPTION IN ANAMNESIS

The aim. To reduce the incidence of perinatal pathology in women who have used various methods of contraception, based on the study of the functional state of the fetoplacental complex (FPS), as well as improving diagnostic measures and tactics of pregnancy. Materials and methods. 140 pregnant women were studied with their division into control and 3 test groups depending on the method of contraception in the anamnesis, using clinical, laboratory and instrumental research methods during pregnancy and childbirth. Results. The study found that women with a history of intrauterine contraception (IUC), in contrast to combined oral contraception (COC) and combined oral contraception containing folate (COC+F), had a higher incidence of complications during pregnancy and childbirth, as well as fewer newborns with a satisfactory condition at birth. Assessment of folic acid levels at 6-8 weeks of gestation showed significantly better results among women with a history of COC+F, compared with IUC and COC. In the group of women with IUC in the anamnesis, significantly worse mean endocrinological values prevailed, and there was also a greater number of pregnant women with disorders of fetal-placental blood flow. More pronounced dystrophic changes in the placentas of women in this group were pathomorphologically confirmed. Conclusions. The presence in the anamnesis of IUC is accompanied by a high proportion of pregnant women with various pathological conditions and is a risk factor for FPS dysfunction. The use of COC+F in the anamnesis is the best option for women of different risk groups.