Non-pregnant Peers Research Articles

Prevalence of malaria infection in pregnant women compared with children for tracking malaria transmission in sub-Saharan Africa: a systematic review and meta-analysis.

SummaryBackgroundIn malarious areas, pregnant women are more likely to have detectable malaria than are their non-pregnant peers, and the excess risk of infection varies with gravidity. Pregnant women attending antenatal clinic for their first visit are a potential pragmatic sentinel group to track the intensity of malaria transmission; however, the relation between malaria prevalence in children, a standard measure to estimate malaria endemicity, and pregnant women has never been compared.MethodsWe obtained data on malaria prevalence in pregnancy from the Malaria in Pregnancy Library (January, 2015) and data for children (0–59 months) were obtained from recently published work on parasite prevalence in Africa and the Malaria in Pregnancy Library. We used random effects meta-analysis to obtain a pooled prevalence ratio (PPR) of malaria in children versus pregnant women (during pregnancy, not at delivery) and by gravidity, and we used meta-regression to assess factors affecting the prevalence ratio.FindingsWe used data from 18 sources that included 57 data points. There was a strong linear relation between the prevalence of malaria infection in pregnant women and children (r=0·87, p<0·0001). Prevalence was higher in children when compared with all gravidae (PPR=1·44, 95% CI 1·29–1·62; I2=80%, 57 studies), and against multigravidae (1·94, 1·68–2·24; I2=80%, 7 studies), and marginally higher against primigravidae (1·16, 1·05–1·29; I2=48%, 8 studies). PPR was higher in areas of higher transmission.InterpretationMalaria prevalence in pregnant women is strongly correlated with prevalence data in children obtained from household surveys, and could provide a pragmatic adjunct to survey strategies to track trends in malaria transmission in Africa.FundingThe Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine, UK; US Centers for Disease Control and Prevention; and Wellcome Trust, UK.

Vitamin D supplementation in pregnancy.

Vitamin D supplementation in pregnancy.

Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong

BackgroundPregnant women infected with influenza virus are more likely to experience severe complications when compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence of seasonal influenza vaccine uptake among pregnant women in Hong Kong and to identify predictors of vaccine uptake. MethodsUsing a multi-center cross-sectional design, we recruited 2822 new mothers during their immediate postpartum stay from all eight public obstetric hospitals in Hong Kong. We assessed antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake. ResultsOnly 49 (1.7%; 95% CI 1.3–2.3%) participants were vaccinated during their pregnancy. Fear that the vaccine would cause harm to the fetus or themselves were the most common reasons for not being vaccinated. Being aware of the vaccination recommendations (OR=2.69; 95% CI 1.06–6.82), being advised by a health-care provider (OR=6.30; 95% CI 3.19–12.46), history of vaccination (OR=2.47; 95% CI 1.25–4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64–8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79–26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07–0.40) were strongly associated with failure to vaccinate. ConclusionsLow seasonal influenza vaccination uptake among Hong Kong pregnant women was related to a number of factors, all of which are amenable to interventions. Vaccination promotion strategies need to focus on encouraging health-care providers to discuss vaccination with their pregnant clients and in providing pregnant women with accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.

Individualized Oral Health Education Improves Oral Hygiene Compliance and Clinical Outcomes in Pregnant Women with Gingivitis

Background: Pregnant women have been shown to demonstrate an increase in clinical signs and symptoms of gingivitis despite similar plaque levels to non-pregnant peers. Objective: The goal of this investigation was to utilize a comprehensive regimen of oral hygiene techniques and practices and to evaluate the methodology to teach that regimen by assessing periodontal health outcomes and health behaviors and knowledge in pregnant women. Methods: 120 pregnant participants with Gingival Index (GI) scores ≥ 2 at ≥ 50 % of tooth sites were recruited. At baseline, patients were examined and Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded. Patients’ self-reported oral hygiene compliance and oral hygiene knowledge was examined using a pre- and post-test examination at baseline and after the study period. Intensive oral hygiene counseling was provided at baseline, 4 and 8 week visits. Clinical measures and tests of oral hygiene compliance and knowledge were repeated at follow up. Results: A statistically significant reduction in all clinical parameters was shown over the study period. On average whole mouth PI and GI scores were reduced by 54.7% and 48.4%, respectively, and the percentage of sites with PI and GI ≥ 2 decreased from 40% to 17% and 53% to 21.8%, respectively. Whole mouth PD also decreased an average of 0.45 mm and whole mouth CAL decreased an average of 0.24 mm. A statistically significant proportion of patients self-reported an increase in frequency of oral hygiene procedures and an increase in the use of all materials provided in the study oral care regimen. A greater proportion of patients also demonstrated increased knowledge regarding dental and maternal/fetal health after the intervention. Conclusion: Pregnancy may represent a unique opportunity for oral hygiene intervention.

Life History of Female Preferences for Male Faces

Although scientific interest in facial attractiveness has developed substantially in recent years, few studies have contributed to our understanding of the ontogeny of facial preferences. In this study, attractiveness of 30 male faces was evaluated by four female groups: girls at puberty, nonpregnant and pregnant young women, and middle-aged women. The main findings are as follows: (1) Preference for sexy-looking faces was strongest in young, nonpregnant women. (2) Biologically more mature girls displayed more adultlike preferences. (3) The intragroup consistency for postmenopausal women was relatively low. (4) In terms of the preference pattern, pregnant women were more similar to perimenopausal women than they were to their nonpregnant peers. (5) Preference for youthful appearance decreased with the age of the women. I argue that the life history of female preferences for male faces is, to a large extent, hormone-driven and underpinned by a set of evolutionary adaptations.

Influenza-Attributed Hospitalization Rates Among Pregnant Women in Canada 1994–2000

BackgroundAlthough it is recommended that pregnant women at risk for influenza complications receive influenza vaccine, it is not clear if healthy pregnant women are at increased risk for adverse outcomes. We aimed to estimate the rate of hospitalization attributable to influenza for healthy pregnant women and for those with known co-morbidities. MethodsHospital admission records of women admitted from 1994 to 2000 with a respiratory condition during pregnancy were extracted from the hospitalization database (Canadian Institute of Health Information). Admissions for childbirth were excluded. Weekly admissions, stratified by the presence of co-morbid conditions, were modelled as a function of viral activity, seasonality, trend, and holiday effects using Poisson regression with proxies for influenza and other viral activity developed previously for similar age-specific models of influenza-attributed hospital admissions. ResultsApproximately 300 hospitalizations of pregnant women per year were attributed to influenza, of which 140 were in women with co-morbidities. This hospitalization rate corresponds to 150 (95% CI 140–170) hospitalizations per 100 000 pregnant women per year. An estimated 1 in 1000 healthy pregnant women were hospitalized due to influenza per year. Asthma was the most important risk factor, accounting for an estimated 450 (95% CI 300–600) admissions per 100 000 pregnant women. Admission rates in pregnant women were relatively constant across multiple influenza seasons of varying severity among older adults. During the four weeks of peak influenza activity, 60% of respiratory-related admissions of otherwise healthy pregnant women could be attributed to influenza. ConclusionHealthy pregnant Canadian women have consistently higher rates of hospital admission attributable to influenza infection than their non-pregnant peers. The admission rate for healthy pregnant women corresponds to the rate for men and women aged 65 to 69 years, which suggests that this population may benefit from annual influenza immunization.

Teenagers who plan parenthood

It is clear that a variable number of teenage mothers have, to some extent, planned parenthood. From an evolutionary perspective, it could be argued that teenage childbearing may in fact be a positive adaptive mechanism for humans raised in a hostile environment. Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximise the probability of leaving any descendents at all. If some teenagers are planning or hoping for pregnancy, it is possible that some positive behavioural changes may be observed. This has proven to be the case with many teenagers altering their risk taking behaviours in the anticipation and expectation of pregnancy. There is now substantial evidence that teenagers who become pregnant were at higher risk than the general population for using cigarettes, alcohol, and marijuana. However, once pregnant, rates of consumption are usually lower compared with their non-pregnant peers or even their own personal pre-pregnancy rates of consumption. Therefore, for some teenagers, the conscious or unconscious prospect of pregnancy represents a potential space in which to rethink behaviours that may be harmful to themselves as a future mother, and also to their child. Given that teenage motherhood is not going to simply vanish, it is important to remember to focus research and services on validated interventions that may assist teenage mothers fulfill their ambitions of parenthood and simultaneously provide the best outcomes for their offspring. Evidence-based interventions focus on sustained home visitation by nurses, with limited evidence supporting the use of volunteers. In contrast, evidence suggests that home visitation by paraprofessionals may not be effective. Other strategies that may be helpful include the use of multidisciplinary teenage pregnancy clinics that have been noted to be associated with improved pregnancy outcomes. The role of new mothers' groups, other community based group activities, peer support workers and intensive educational interventions to encourage return to schooling may be useful but have not been subjected to randomised evaluation. Such evaluation needs to occur.

Venous thromboembolism in pregnancy and the puerperium in Sudanese women

Multiple changes in the coagulation system which occur during pregnancy account for its hypercoaguable state. Consequently pregnant women are more likely to experience venous thromboembolism (VTE) than their non-pregnant peers. Numerous risk factors have been shown to predispose the pregnant women to venous thrombosis. We performed a retrospective case–control study at Wad Medani Hospital between January 1999 and December 2000 to examine the incidence timing and the risk factors for VTE in pregnancy and puerperium in a population of women in the central Sudan. (excerpt)

Pregnant African-American Teens Are Less Likely Than Their Nonpregnant Peers to Use Condoms

Objective. The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition.Methods. Sexually active African-American females (N = 522), ages 14–18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded.Results. Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%).Conclusions. Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.

A Comparison of the Risk Characteristics of Ever-Pregnant and Never-Pregnant SexuallyActive Adolescents

Abstract This article describes the risk behaviors of a sample of sexually active, urban African American adolescent females, and examines the differences between adolescents who havebeen pregnant (ever-pregnant) and adolescents who have not been pregnant (never-pregnant). Of the 279 young women interviewed, 48% had a history of pregnancy. Logistic regression indicated that adolescents who had a history of pregnancy engaged in higher-risk behaviors than their non-pregnant peers. Adolescents who had been pregnant were more likely to have multiple sexual partners, more likely to have had sex under the influence of drugs, and more likely to have had an STD. These adolescents also were less likely to have used a condom during their last episode of sexual intercourse and less likely to use condoms every time they have sex. Our results suggest that a history of pregnancy is associated with higher-risk sexual behaviors. Moreover, for many young women, the experience of getting pregnant does not appear to decreas...

A village would be nice but …: It takes a long-acting contraceptive to prevent repeat adolescent pregnancies

Objective: To determine which components of a comprehensive, multidisciplinary, adolescent-oriented maternity program help teenage mothers delay subsequent pregnancies. Design/ Setting/ Patients: A cohort of 373 participants in a comprehensive, multidisciplinary, adolescent-oriented maternity program was studied. Intervention: The program was designed to prevent rapid subsequent pregnancies directly by simplifying access to contraceptives and indirectly by discouraging school drop-out and encouraging the pursuit of careers incompatible with closely spaced childbearing. Parents and children were seen together; nine visits were scheduled during the first postpartum year and four visits during the second year. Main Outcome Measure: Repeat adolescent pregnancy. Results: The repeat pregnancy rate was 14% at 1 year and 35% at 2 years. Teenage mothers who became pregnant exhibited significantly more repeat pregnancy risk factors but were as compliant with clinic visits as their nonpregnant peers. The contraceptive choices the teenagers made during the puerperium had the most profound effect on their subsequent fertility. A logistic regression analysis identified failure to use Norplant during the puerperium as the strongest predictor of repeat pregnancy during the first 2 postpartum years (relative risk [RR]=8.89; 95% confidence interval [CI]=2.80–28.50). Exhibiting nine or more repeat pregnancy risk factors (RR=2.37; 95% CI=1.38–4.06) and not using Depo-Provera during the puerperium (RR=2.30; 95% CI=1.60–3.29) also predicted repeat conception, but clinic visits and return to school postpartum did not. Conclusions: Using a long-acting hormonal contraceptive during the puerperium was associated with pregnancy prevention during the first 2 postpartum years, but frequent clinic visits, contact with supportive healthcare and social service providers, and return to school were not.

Teen Pregnancy and Substance Use

Pregnant adolescents use cigarettes and alcohol, and possibly illicit drugs, at rates similar to those of their non-pregnant peers. Most discontinue use during the first trimester of pregnancy, but use tends to increase after delivery. Substance use is best detected by direct questioning; urine screening is not universally effective. Several therapeutic interventions can be used in helping pregnant adolescents discontinue substance use and establish a drug-free environment.

Relationship between scholastic and health behaviors and reading level in adolescent females.

This was a study of 102 adolescent females, 12-20 years of age, presenting to a central city clinic for medical care. Participants completed an oral questionnaire that included demographics, and questions regarding scholastic history, sexual behavior, and substance use. Each subject completed the Accuracy Level Test (ALT), a reading test. The subject's reading test grade level was subtracted from her appropriate grade in school to give a reading delay level (RDL). The mean reading grade level for all subjects was 6.7 +/- 2.6 and the average reading delay was 4.5 +/- 2.5 grades. Poor school attenders had greater reading delays (5.8 +/- 3.4 grades behind vs. 4.3 +/- 2.2 for good attenders p < 0.04), and those who repeated grades were also significantly delayed (5.5 +/- 2.4 grades behind vs. 3.7 +/- 2.3, p < 0.0007). Previously pregnant students had a greater delay in reading level than their nonpregnant peers (5.2 +/- 2.3 vs. 3.9 +/- 2.5 respectively p < 0.01). Delayed reading levels appear to correlate with some risk behaviors. The ALT may serve as a tool to identify high-risk patients who need more intensive clinical intervention.

The transtheoretical model of smoking: Comparison of pregnant and nonpregnant smokers

Pregnant smokers represent a special population of women smokers. Since smoking affects both the mother and the unborn child, it might be hypothesized that pregnant women should be highly motivated to quit smoking during pregnancy. Results from both naturalistic studies and intervention studies have generally shown only modest changes in smoking during pregnancy. To help design more effective interventions tailored for this special population of smokers, more information is needed on how they differ from other smokers. The current study was designed to examine patterns and differences on constructs of the Transtheoretical Model between low-income culturally diverse pregnant and nonpregnant female smokers. Groups were compared on the distribution of the stages of change. In addition, stage and group comparisons were conducted for the pros and cons of smoking, situational temptations to smoke, and the processes of change. The sample included 103 economically disadvantaged, culturally diverse pregnant women and a matched group of 103 nonpregnant women smokers. Pregnant smokers as a group were similar to their nonpregnant peers on their readiness for quitting. In general, the patterns observed across the stages of change were consistent with those seen in other populations of smokers. The primary difference found between the groups were on the cons of smoking, habit-related temptations to smoke, and experiential processes of change. Specifically, pregnant women perceived a less negative attitude toward their smoking, were more tempted in habit-related situations, and made less use of important experiential processes of change. The implications of these findings for designing interventions tailored for this special group of smokers are discussed.

Teenage Pregnancy and Female Educational Underachievement: A Prospective Study of a New Zealand Birth Cohort

This paper examines the relationship between teenage pregnancy and educational underachievement in a cohort of 520 young women studied from birth to 21 years. Results showed that young women who became pregnant by the age of 18 years were at increased risk of poor achievement in the national School Certificate examinations, of leaving school without qualifications, and of failing to complete their sixth‐form year at high school. In addition, pregnant teenagers had lower rates of participation in tertiary education and training than their nonpregnant peers. Subsequent analyses showed that the links between teenage pregnancy and tertiary educational participation were largely noncausal and reflected the earlier academic ability, behavior, and family circumstances of young women who became pregnant. In contrast, antecedent child and family factors only partially explained associations between teenage pregnancy and high school participation and achievement. After adjustment for these factors, significant associations remained between teenage pregnancy and educational achievement at high school. An examination of the diverse life histories of young women who became pregnant revealed that for the majority of young women, pregnancy occurred after they had left school before finishing. These findings suggest that rates of teenage pregnancy might be elevated among young women who leave school early, rather than rates of early school leaving being elevated among young women who become pregnant during their teenage years.

Family risk factors associated with adolescent pregnancy: study of a group of adolescent girls and their families in Ecuador

Purpose: To identify characteristics within the family that were associated with adolescent pregnancy in a group of adolescent girls in Quito, Ecuador. Methods: Of 135 female adolescents (12–19 years of age), 47 were pregnant and seen at the adolescent prenatal care clinic at an inner city hospital in Quito, and 88 were students from schools located within the same geographic area. Family variables were compared for pregnant and nonpregnant adolescents using chi-square, Student’s t-test, and analysis of variance. Results: More nonpregnant adolescents lived with their biological parents when compared with their pregnant peers ( p < .002). Pregnant adolescents reported lower mother–daughter and father–daughter communication ( p < .02), lesser life satisfaction and happiness in general, and more school and economic difficulties ( p < .001). They were less likely to find support for their problems in or outside the family ( p < .0001) and showed higher levels of depression and sexual abuse than their nonpregnant peers (68.8% vs. 34.5%, and 14.9% vs. 4.5%, respectively). Nonpregnant adolescents showed higher school performance and expectations regarding school achievement and future perspectives ( p < .001). Values such as respect for others and religiosity were higher among nonpregnant adolescents ( p < .0001). Parental education was lower in the families of pregnant adolescents ( p < .05). Among nonpregnant adolescents, both parents worked outside the home ( p < .006), whereas mothers of pregnant adolescents usually stayed at home. Conclusion: The current study showed that parental separation or divorce, and poor parent–daughter communication were associated with adolescent pregnancy. Families of nonpregnant adolescents had a higher educational level, and both parents worked to provide financial support to the family in an environment where family authority is shared by both parents. There were also better problem-solving strategies and parent–daughter communication, higher levels of cohesion, connectedness, and life satisfaction in general, and higher future expectations.

Trends in Teenage Smoking During Pregnancy

Smoking rates in the United States have decreased since 1963, but this trend is less apparent in adolescents, especially girls. Using data on birth certificates from 1984 through 1988, we analyzed smoking trends during pregnancy in teenagers in Washington State. There was a small but significant increase in the overall smoking prevalence during pregnancy between 1984 (32%) and 1988 (37%). Smoking rates varied by mother's age, race and ethnicity, marital status, and prenatal care. Whites had the highest smoking prevalence, and native Americans showed the largest increase in smoking prevalence over time. In the 5 years studied, unmarried pregnant teenagers had a smoking prevalence of 42.8%, compared with a rate of 31.7% in married teenagers. Compared with other studies of smoking rates in nonpregnant teenagers, pregnant teenagers in Washington State had a much higher smoking prevalence than their nonpregnant peers, and the differences between these two groups did not appear to diminish over time. This study suggests that there is little movement toward meeting the 1990 Health Objectives for the Nation regarding smoking in Washington State teenagers who become pregnant.

Intervention Challenges with Adolescent Mothers and Their Infants

Adolescent pregnancy is a major social issue resulting in significant risk for both the infants and young mothers. In this paper, we will describe the effects of an intervention program for adolescent mothers and their infants, including the complexities of evaluating the effects of intervention for risk groups. More than half of the teenagers in the United States are sexually active, and more than 1.1 million become pregnant each year. It has been estimated that in 1981 approximately 22% of sexually active teens 15-19 experienced a pregnancy (Hofferth 1984). Among teen pregnancies, 70-80% are unintended and unwanted (PPFA 1984). Adolescent mothers and their infants appear to be at higher risk than older mothers for a variety of medical complications that may affect subsequent infant health and may impact on infant development and parent-infant interaction. While a number of studies have indicated that the biomedical risk for teenage mothers, especially those ages 15 and older, can be decreased considerably with adequate nutrition and proper prenatal care (Carey et al. 1983; Osofsky 1968; Osofsky and Osofsky 1970), for a variety of reasons, most teens do not receive the type of prenatal care that would most likely minimize risk and optimize outcome. Adolescent mothers are more likely than their nonpregnant peers to have lower education attainment, lesser job and economic success, and less frequent marital stability (Furstenberg 1976; Simkins 1984).

Television and Movie Behaviors of Pregnant and Non-Pregnant Adolescents

Television and film viewing by many adolescents constitutes a substantial part of their leisure time. While no single factor can account wholly for the development of sexually-oriented attitudes, values, and behaviors, it is believed that media play at least a subtle role. The purpose of this study was to determine whether media viewing habits of pregnant and non-pregnant, Black and White adolescent girls differ and how they differ. Data were collected by questionnaires given to 649 9th and 10th grade girls in three large high schools and 146 pregnant adolescents in alternative education programs in the same Midwestern state. Systematic analysis of sexual content in the soaps, primetime TV, and R-rated films most viewed by these adolescents revealed that Blacks and the pregnant adolescents had significantly greater exposure to the media. Pregnant respondents watched television programming more often in the company of their steady boyfriends than did their non-pregnant peers. Black adolescents reported a greater effort by their parents to control viewing behaviors.