Insufficient Prenatal Care Research Articles

Intrauterine fetal death during pregnancy: limitations of fetal surveillance.

Perinatal statistics in Germany have shown that fetal death during pregnancy remained unchanged during the past 12 years. The question arises whether the quality of prenatal care can be improved and contributing factors to ante partum mortality (APM) reduced. The perinatal data base from Hesse was evaluated for 1990-1995. It comprises 347,463 deliveries in a population based survey from the state of Hesse/Germany. Antepartum death occurred in 1,133 cases (0.33%). Pregnancy care was evaluated in a longitudinal investigation analysed from 1982 to 1995. Fetal surveillance showed during the past years a steady improvement demonstrated by the number antenatal visits of more than 10: it rose from 54 to 75%, by the CTG recordings ante partum: it increased from 55 to 90% and ultrasound examinations more than 5: it rose from 12 to 26%. Despite the increase of ante partum care fetal death during pregnancy remained constant since 1985 at 0.5 to 0.6%. Malformations contribute to APM in 8.3%. In 44.4% various risk factors could be identified, whereas in 47.4% no causes could be shown. Special risk factors are hydramnios, diabetes, placenta praevia, multiple pregnancy, IUGR and others. Fetal death occurs preferentially during the last weeks of pregnancy with a maximum at 40 weeks of gestation. Social burden and insufficient prenatal care are contributing factors to APM. APM can still be improved by using simple clinical estimates and by defined application of surveillance tools at present available.

Insufficient prenatal care in Finland and Baden-Wurttemberg. Characteristics of women and infant outcome

The amount of prenatal care and the relationship between insufficient prenatal care, mothers' characteristics and infant outcome were studied in Finland and in Baden-Wurttemberg, Germany. The main sources of data were the Finnish Medical Birth Register (N=193,659) and the Perinatal Survey of Baden-Wurttemberg (N=307,152) in 1991–1993. Insufficient prenatal care was defined as no visits, 1 or 2 visits or late attendance. Most of the women - also those in the risk groups for low use of care (foreigners, young mothers, grand multiparas, single mothers and women with a poor social status) - were using prenatal care extensively. The proportion of women having insufficient care was 3.4% in Finland and 8.1% in Baden-Wurttemberg, most of them being late attenders. Among women with insufficient care, 39% in Finland and 55% in Baden-Wurttemberg were from the risk groups identified. Foreign nationals contributed 10% of the women with insufficient care in Finland and 44% in Baden-Wurttemberg. The group of women with insufficient prenatal care was heterogeneous and it could not be defined by using traditional risk factors only. Infants of mothers with few prenatal visits had poorer outcomes, but the attributable proportion of insufficient prenatal care to infant outcome was small.

Nutrient Intake among Pregnant Women

Providing all the critical nutrients during pregnancy is essential for the mother's and baby's health. Nutrition plays an important role in the outcome of pregnancy. Low birthweight (LBW), which is a common cause of infant morbidity and mortality in the United States, may be reduced if all the essential nutrients are available in sufficient amounts in the diets of pregnant women. There are many maternal risk factors which contribute to LBW and many are preventable. In addition to poor nutrition, poor maternal health and substance abuse during pregnancy can contribute to delivering babies with lower than normal weight, less than 5 1/2 pounds or 2500 grams. The purpose of this study is therefore, to identify some of these risk factors such as poor nutrient intake of the mothers, inadequate weight gain, and insufficient prenatal care during pregnancy. Demographic and nutrient intake data were obtained from 215 pregnant women, average age of 24±5.5 years, enrolled in a hospital-based prenatal clinic. Thirty two percent (32%) of participants were smoking cigarettes, 17% were drinking alcohol, and 11% used drugs during pregnancy. Nutrient intake records were obtained from food frequency questionnaires and analyzed with the Nutrient Analysis System II (NAS II) computer program. While other nutrients seemed sufficient in the diets of these women, two very essential nutrients, iron and zinc, were below the Recommended Dietary Allowances (RDA) for pregnancy. Average iron and zinc dietary intake were low, 56.5%±22 of the RDA and 62% ± 36 respectively. Correlation between birth weight and calcium intake was r=0.34 and for other nutrients it was lower. Average weight gain for mothers was normal for gestational age and average birth weight was 3.26±0.78 kilograms. Other research studies report a positive correlation between iron and zinc intake and infant birth weight. Although our study did not show a strong relationship between these nutrients and birth weight, this study, however, supports previous findings that essential nutrients such as iron and zinc are often low in the diets of pregnant women.

Maternal health antecedents of infant and early childhood mortality and morbidity.

The article reviews the maternal demographic factors the availability and accessibility of health care services preconceptual care risk assessment breast feeding the training of traditional birth attendants (TBAs) adolescent health care and family planning (FP) as antecedents of infant and early childhood mortality and morbidity. The maternal demographic factors which affect infant outcome are the age of the mother the mothers age at marriage marital status education poverty and family size and use of FP. Many of the maternal demographic factors are closely associated with insufficient prenatal care. Prenatal care services need to be easily available and accessible to all and be culturally sensitive. Understanding of a womans nutritional needs and broader living conditions is also needed. Tetanus immunization is required. Low birth weight can be reduced with early and regular high quality prenatal care. Womens general health before pregnancy can be assured with good personal habits nutrition treatment for medical conditions and safe environmental conditions. Preconceptual care involves risk assessment health promotion immunization against tetanus and intervention and followup. Only low risk women should deliver at home. Criteria for high risk need to be identified and might include: cephalopelvic disproportion in short women hemorrhage in a high parity or a history of previous postpartum hemorrhage and previous history of complications in pregnancy labor and delivery. Breast feeding particularly through the hazardous period of infancy is recommended. Nutrition of lactating women is an important consideration TBAs should be trained in hand-washing and safe umbilical cord care as well as more comprehensive training in anemia screening recognition of twins and abnormal presentations by palpation application of prophylactic eye ointment and assessment of at-risk pregnancies. Women should be referred for prenatal care and FP services. Predisposing factors to infant mortality may be grand multiparity poor nutrition unwanted pregnancy and overwork. FP can help birth spacing of more than 2 years and provide protection for young and older women. Health education and family life education are also needed.

General theory of paradigms in health

In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.Costa Rica's health care experience is explained in terms of 3 sequential paradigms. The 1st malnutrition paradigm (1940-69) considers the causes of ill health as poverty, ignorance, exploitation, and food shortages. The problems are malnutrition, parasitosis, infectious diseases, high mortality, high rates of hospitalization, and requiring health and hospital based services. The strategies were to improve diet through food distribution, create nutrition departments within the Ministries of Health, increase the number of doctors and nurses, and politicize medicine. Socialism was the model and economic growth and industrialization were seen as prerequisites. Curative medicine was practiced. The attitude was hopelessness is being able to solve problems and acceptance of the status quo. The 2nd infectious disease paradigm (the 1970s) focused the causes as infectious diseases, intestinal parasitosis, unwanted pregnancy, low birth weight, artificial feeding, and limited health services supply, which were given priority. Primary health care for all and health sector reform were some of the strategies. Healthier families were thought to contribute more to economic and social development. Full health services were promoted and the politicization of medicine was reduced. The attitude changed to one of being able to solve one's own problems. The National Health System began to evolve based on a holistic approach where the environment and the life cycle were integrated. Implementation of the national framework was replicated at the regional and local levels; institutions and programs were integrated in a synchronic approach so that the effects of infection, malnutrition, and fertility on human growth and development were considered. Infant mortality dropped by 70%, and infectious diseases were eliminated or greatly reduced. The 3rd chronic disease paradigm (1980s) assumes the causes to be unwanted children, insufficient prenatal and maternity care, inadequate environmental conditions, inadequate life style, and social pathology. The approach is holistic. The philosophical base is the development of individual responsibility and efficient use of science and technology; health contributes to democracy and peace. Prevention, cure, and rehabilitation are equal. The application to other countries must consider that there are more technological options but fewer resources. Rigid and dogmatic plans will not work.

STUDY OF THE RELATIONSHIP BETWEEN PRENATAL CARE AND OUTCOME OF PREGNANCY

The relationship between prenatal care and perinatal mortality, and incidence of prematurity was studied in Omama town (pop., 18, 000) of Gunma prefecture.There was no conclusive evidence of a significant association between prenatal care and perinatal mortality. However, an incidence of prematurity, particularly of low birth weight group, wats more prevalent among the group of insufficient prenatal care, as judged from later onset of prenatal care and fewer visits during prenatal period. Furthermore, several socio-medical aspecs were analyzed and discussed. On the basis of these findings, special risk group of parents was suggested and the problem-centered approach of maternity care in the community was stressed.