Perinatal Surveillance System Research Articles

"It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries.

Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice'). The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.

An evaluation of the perinatal mortality surveillance system in Gwanda District, Matabeleland South Province, Zimbabwe

Background. A preliminary review of perinatal mortality surveillance data (January - August 2017) suggested an under-reporting of perinatal deaths in Gwanda District, Matabeleland South. Objective. To evaluate the effectiveness of the perinatal mortality surveillance system in Gwanda District, Matabeleland South, Zimbabwe. Methods. This descriptive cross-sectional study interviewed 50 healthcare workers employed in the district using pretested intervieweradministered questionnaires. The sample was drawn from 16 randomly selected healthcare facilities. Records for perinatal mortality cases were reviewed and data were analysed. Results. Only 32% of healthcare workers knew the case definition of perinatal death. Approximately two-thirds of participants (68%) knew who should complete notification forms and ~half (52%) of the respondents cited fear of blame as the reason for a low perinatal death report rate in the district. Although 50% of participants reporting having participated in perinatal death reviews and 78% reporting using the data for planning community health programmes, there was no recorded evidence in support. Perinatal mortality case notification forms were not in stock at 13 of the 16 sampled healthcare facilities. Conclusion. Poor knowledge of the perinatal mortality surveillance system was found among participants. The low reporting rate suggests that the system does not function effectively in the district. Healthcare workers feared blame, which suggests management intervention is required to create a trusted reporting environment.

Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system.

Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.

Monitoring maternal near miss/severe maternal morbidity: A systematic review of global practices

There is international interest in monitoring severe events in the obstetrical population, commonly referred to as maternal near miss or severe maternal morbidity. These events can have significant consequences for individuals in this population and further study can inform practices to reduce both maternal morbidity and mortality. Numerous surveillance systems exist but we lack a standardized approach. Given the current inconsistencies and the importance in monitoring these events, this study aimed to identify and compare commonly used surveillance methods. In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and maternal near miss/severe maternal morbidity. We included papers that used at least three indicators to monitor for these events and collected data on specific surveillance methods. We calculated the rate of maternal near miss/severe maternal morbidity in hospitalization data obtained from the 2016 US National Inpatient Sample using five common surveillance methods. Of 18,832 abstracts, 178 papers were included in our review. 198 indicators were used in studies included in our review; 71.2% (n = 141) of these were used in <10% of included studies and only 6.1% (n = 12) were used in >50% of studies included in our review. Eclampsia was the only indicator that was assessed in >80% of included studies. The rate of these events in American hospitalization data varied depending on the criteria used, ranging from 5.07% (95% CI = 5.02, 5.11) with the Centers for Disease Control criteria and 7.85% (95% CI = 7.79, 7.91) using the Canadian Perinatal Surveillance System. Our review highlights inconsistencies in monitoring practices within and between developed and developing countries. Given the wide variation in monitoring approaches observed and the likely contributing factors for these differences, it may be more feasible for clinical and academic efforts to focus on standardizing approaches in developed and developing countries independently at this time.PROSPERO Registration: CRD42018096858.

Monitoring Maternal Near Miss/Severe Maternal Morbidity: A Systematic Review

Background: There is international interest in monitoring maternal near miss (MNM)/severe maternal morbidity (SMM). However, there is widespread variability in indicators used to monitor MNM/SMM. Methods: In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and MNM/SMM. We included papers that used at least three indicators to evaluate MNM/SMM. Using five common indicator sets, we calculated the MNM/SMM rate using hospitalization data obtained from the 2016 US National Inpatient Sample. Findings: Of 18,832 abstracts, 178 papers were included in our review. Overall, 43.3% used the term SMM, 39.9% used MNM, and the remaining 16.9% used a different term. In total, 198 unique indicators were used in studies included in our review; 71.2% (n=141) of indicators were used in 50% of studies included in our review. A single indicator, eclampsia, was assessed in >80% of included studies. The rate of MNM/SMM in American hospitalization data varied depending on the criteria used, with rates ranging from 5.07% (95% CI=5.02, 5.11) with the CDC indicators and 7.85% (95% CI=7.79, 7.91) using the Canadian Perinatal Surveillance system indicators. Interpretation: Our review highlights current inconsistencies in how MNM/SMM is defined and shows there is an urgent need for standardization to promote a concerted global effort in addressing MNM/SMM. Funding: funding was received for this study. Funding Statement: The authors stated: No funding was received for this study. Declaration of Interests: None of the authors had any conflicts of interest to declare. Ethics Approval Statement: As all data used for this study was publicly available, this study was deemed exempt from review by the Conjoint Health Research Ethics Board at the University of Calgary.

Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study.

Cardiac arrest in pregnancy is a rare and devastating condition with high mortality and morbidity. The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, potential etiologies, and survival rates. This retrospective population-based study used hospitalization data from the discharge abstract database of the Canadian Institute for Health Information relating to obstetric deliveries in Canada from April 1, 2002, to March 31, 2015. The data were accessed through the Public Health Agency of Canada's (PHAC) Canadian Perinatal Surveillance System. Cases of cardiac arrest were identified using the diagnostic and intervention codes from the International Statistical Classification of Diseases and the Canadian Classification of Health Interventions, respectively. Data on patient demographics, medical and obstetrical conditions, and potential etiologies of cardiac arrest were collected. Multivariable logistic regression analysis was used to identify conditions associated with cardiac arrest. There were 286 cases of maternal cardiac arrest among 3,568,597 hospitalizations for delivery during the 13-year period. A total of 204 (71.3%) women survived to hospital discharge (95% confidence interval, 65.7%-76.5%). There was no significant variation in the incidence of cardiac arrest or survival from arrest over time or across provinces. Among the pre-existing conditions, hypertensive disorders of pregnancy, gestational diabetes, malignancy, and diseases of the respiratory and nervous system were found to be significantly associated with cardiac arrest. Among the obstetrical conditions, placental abnormalities and polyhydramnios were associated with cardiac arrest. The common potential etiologies included postpartum hemorrhage, heart failure, amniotic fluid embolism, and complications of anesthesia. In this first Canadian study, the incidence of cardiac arrest during pregnancy was found to be 1:12,500 deliveries. The survival rate reported in our study is higher than reported previously in other countries. Our study findings contribute to better inform the development and implementation of policies and programs in an effort to prevent and manage this condition.

Non-elective C-sections in public hospitals: capacity constraints and doctor incentives

ABSTRACTUsing administrative records of births from the Perinatal Surveillance System of the Peruvian Social Security System (ESSALUD), we test whether high admissions of pregnant women affected non-elective caesarean section (C-section) rates in the ESSALUD public hospitals during 2005–2006. We present a basic theoretical model that considers physician preferences for leisure and hospital capacity constraints, and test the model predictions. We find that physician demand for leisure increases the probability of C-sections in small and medium-size hospitals, while hospital capacity constraints set a limit on them. We discuss the policy implications as well as the policies implemented to avoid unnecessary C-sections.

Perinatal health indicators 2013: a surveillance report by the Public Health Agency of Canada's Perinatal Surveillance System.

The Canadian Perinatal Surveillance System (CPSS) is a national health surveillance program of the Public Health Agency of Canada. The CPSS mandate is to monitor and report on key indicators of maternal, fetal and infant health. These indicators include both determinants and outcomes of perinatal health. Perinatal Health Indicators 2013 reports on 13 priority indicators using the most recent data from vital statistics, hospitalizations, the Canadian Community Health Survey and the National Longitudinal Survey of Children and Youth.

Analysis of the incidence and perinatal outcomes of multiple births in Zhejiang Province from 2008 to 2013

To analyze the trends of multiple births rates and their perinatal outcomes in Zhejiang province from 2008 to 2013. Data were obtained from hospital-based perinatal mortality surveillance system in Zhejiang, including all the hospitals in 30 monitoring counties (districts). All births (28 or more weeks of gestation) born in the monitoring hospitals were included in our study within 7 days after delivery from 2008 to 2013. Chi-square test was performed for statistical analyses for comparisons between regions. Trends in the incidence of multiple births and causes of perinatal death were analyzed using chi-square test for trend. From 2008 to 2013, the multiple births rate in Zhejiang province was increased and the rates were 2.32% (5 551/239 636), 2.49% (6 053/243 452), 2.61% (6 549/250 594), 2.82% (7 758/275 105), 2.91% (8 803/302 447) and 3.06% (9 051/295 709), respectively. And the perinatal mortality rates for multiple births were 4.32% (240/5 551), 3.45% (209/6 053), 3.76% (246/6 549), 2.86% (222/7 758), 2.77% (244/8 803) and 2.11% (191/9 051), respectively. A significant drop in the perinatal mortality rates for multiple births was observed between 2008 and 2013 (χ(2) trend = 66.52, P < 0.001). There was a significantly greater risk for perinatal death to multiple births when compared with single birth (OR = 3.62, 95% CI: 3.42-3.83). The three leading causes of perinatal death for multiple births were birth defect, premature and/or low birth weight, and twin-twin transfusion syndrome. The multiple births rates in Zhejiang province showed an increasing trend. The perinatal mortality rates for multiple births were decreased annually, however, it was still higher than those in developed countries.

Congenital anomalies in Canada 2013: a perinatal health surveillance report by the Public Health Agency of Canada's Canadian Perinatal Surveillance System.

Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report is the second national surveillance report from the Public Health Agency of Canada dedicated to congenital anomalies. It provides comprehensive data on congenital anomalies in Canada, focussing on 6 categories of congenital anomalies: Down syndrome, neural tube defects, congenital heart defects, orofacial clefts, limb deficiency defects and gastroschisis. The report presents national-level birth prevalence data and temporal trends, provincial and territorial estimates, and international comparisons. Known risk factors, prevalence-related impacts of prenatal diagnosis and preventative measures are also discussed.

Secular trends of operative vaginal delivery in southern and northern China during 1993-2010

To explore the secular trends of operative vaginal delivery (OVD) among nulliparous and multiparous women in southern and northern China. A population-based perinatal healthcare surveillance system has been established in 26 counties/cities in Zhejiang,Jiangsu and Hebei provinces since 1993. A total of 1 569 381 singleton pregnant women were registered during 1993-2010.Information concerning demographic characteristics and delivery mode was from surveillance records. OVD includes vacuum, forceps, assisted breech and breech extraction. Trend Chi-square test was performed to test the trends in OVD prevalence rate with the calendar years. 78 327 OVDs were identified among 1 317 771 nulliparous women and 8 702 among 251 610 multiparous women respectively. The OVD prevalence rate was 5.9% in nulliparous women and 3.5% in multiparous women. The OVD prevalence rate decreased remarkably by 92.5% from 10.6% (38 536/364 503) during 1993-1995 to 0.8% (691/84 714) during 2006-2010 in nulliparous women and by 90.0% from 5.9% (4 085/69 099) to 0.6% (116/20 280) in multiparous women. Moreover, stratified analyses consistently showed a decreasing trend in the OVD prevalence rate during the 18-year period regardless of living locations, delivery hospitals or demographic characteristics.In nulliparous women, the OVD prevalence rate decreased from 9.4% (5 271/56 163) during 1993-1995 to 1.4% (157/11 030) during 2006-2010 in southern urban area, from 11.8% (32 361/273 274) to 1.4% (402/29 069) in southern rural area and from 2.6% (904/35 066) to 0.3% (132/44 615) in northern rural area, and decreased from 8.6% (5 506/63 796) to 1.3% (208/16 408) at provincial hospitals, from 10.8% (13 659/126 529) to 0.7% (381/55 100) at county hospitals and from 12.1% (19 054/157 439) to 0.8% (100/12 959) at township hospitals. And similar results were further observed in different subgroups stratified by demographic characteristics.In multiparous women, a decreasing trend in OVD prevalence rate during the 18-year period was re-identified in various subgroups. The OVD prevalence rate in both nulliparous and multiparous women dramatically decreased in China during 1993-2010 and ranked the lowest in the world by 2010. Thus the relevant government departments should be prepared for the expected rebound in the occurrence of OVD given the national health policies of promoting vaginal deliveries.

Influence of health information levels on postpartum depression

While extensive research has been conducted on postpartum depression (PPD), the majority has been focused on psychological risk factors and treatments. There is limited research on the explicit relationship between the degree to which individuals are informed about relevant prenatal and postnatal health topics and whether this level of knowledge influences psychological outcome. This study assesses health information levels of new mothers and their influence on PPD as measured by Edinburgh Postnatal Depression Scale (EPDS) scores. Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N = 6,421) were used. The study population included mothers ≥15years of age at the time of the birth, who had a singleton live birth in Canada during a 3-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Pre- and postnatal health information components were measured using latent variables constructed by structural equation modeling. EPDS score was added to the model, adjusting for known covariates to assess the effects of information levels on EPDS score. Pre- and postnatal health information levels are associated with decreased EPDS scores. More specifically, information on topics such as postnatal concerns and negative feelings was associated with the largest decrease in score for primiparous and multiparous women, respectively (p < 0.0001 for both). The pre-established predictors of PPD were confirmed for both samples, with life stress associated with the largest change in EPDS score for both samples (p < 0.0001 for both). This study demonstrates a distinct role for pre- and postnatal health information in influencing EPDS scores, supplementing previous literature. Primiparous and multiparous women benefited from different information content, with information on postnatal concerns had the largest effect on the primiparous group while information on negative feelings had the largest effect on the multiparous group. Therefore, information provision should be tailored to these two groups.

G172 Neonatal Seizures: The Utility of Magnetic Resonance Imaging in Diagnosis and Prediction of Neurodisability

AimTo determine the etiological association, neurodevelopmental sequelae and role of Magnetic Resonance Imaging (MRI) in term newborn infants with seizures.MethodsCohort study of infants >37 weeks gestation delivered in a single...

Caesarean delivery, caesarean delivery on maternal request and childhood overweight: a Chinese birth cohort study of 181 380 children

What is already known about this subject Both rates of caesarean section and childhood overweight have been steadily increasing over the past decade in many parts of the world. Caesarean delivery on maternal request contributes remarkably to the rising trend of caesarean births. A few small-scale studies suggest that caesarean section may be associated with later overweight and obesity, whereas little is known about the impact of caesarean delivery on maternal request. What this study adds Caesarean section is associated with an increased risk of childhood overweight. Children born by caesarean delivery on maternal request are also more likely to be overweight. The strength of the caesarean-overweight association is modest. To assess the impact of caesarean delivery including non-medically indicated maternal request caesarean delivery on childhood overweight. We conducted a prospective investigation of a Chinese birth cohort involving 181 380 children, who were born during 1993-1996 to mothers registered in a perinatal care surveillance system and whose weight and height were measured in 2000. Information on delivery mode and covariates was obtained from the surveillance system. Overweight was defined according to the International Obesity Task Force body mass index (BMI) cutoffs. Multivariable logistic regression was used to estimate adjusted odds ratios. Stratified analyses were done to test whether the association between caesarean section and overweight persisted across subgroups. The adjusted odds ratio of overweight for children born by caesarean compared with vaginal delivery was 1.13 [95% confidence interval {CI}: 1.08, 1.18]. The association persisted in subgroups stratified by gender, maternal education, maternal BMI, weight gain during pregnancy and child birthweight (all P values for interaction test ≥0.30). The adjusted odds ratio of overweight for children born by non-medically indicated caesarean delivery compared with vaginal delivery was 1.18 (95% CI: 1.00, 1.41). Caesarean delivery including non-medically indicated maternal request caesarean delivery compared with vaginal delivery modestly increases childhood overweight risk.

Corrigendum

Paediatric and Perinatal EpidemiologyVolume 26, Issue 6 p. 600-600 Free Access Corrigendum This article corrects the following: Temporal trends in sudden infant death syndrome in Canada from 1991 to 2005: contribution of changes in cause of death assignment practices and in maternal and infant characteristics Nicolas L. Gilbert, Deshayne B. Fell, K. S. Joseph, Shiliang Liu, Juan Andrés León, Reg Sauve, , Volume 26Issue 2Paediatric and Perinatal Epidemiology pages: 124-130 First Published online: January 9, 2012 First published: 15 October 2012 https://doi.org/10.1111/ppe.12009AboutSectionsPDF 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 onFacebookTwitterLinked InRedditWechat In [1], the following error was published on page 128. The number of SIDS deaths in 1996–2000 is 469 and not 569 as reported in Table 3. The odds ratios are correct, however. The authors regret the error. Reference 1 Gilbert NL, Fell DB, Joseph KS, Liu S, León JA, Sauve R. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Temporal trends in sudden infant death syndrome in Canada from 1991 to 2005: contribution of changes in cause of death assignment practices and in maternal and infant characteristics. Paediatric & Perinatal Epidemiology 2012; 26: 124– 130. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume26, Issue6November 2012Pages 600-600 ReferencesRelatedInformation

Epidemiology of Postpartum Depressive Symptoms among Canadian Women: Regional and National Results from a Cross-Sectional Survey

To describe national and regional prevalence rates for significant depressive symptoms in women after 12 weeks during the postpartum period, and to identify predictors of postpartum depressive symptoms during this later time period. Data from the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were analyzed. Participants completed a computer-assisted telephone interview between 5 and 14 months during the postpartum period (n = 6421). Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Proportions and odds ratios with 95% confidence intervals were calculated using bootstrap methods to account for sample design and weighting adjustments. About 8% of Canadian women exhibited depressive symptoms past 12 weeks during the postpartum period. Prevalence rates varied between regions. In multivariable analysis, previous history of depression (OR 1.87; 95% CI 1.43 to 2.45, P < 0.001), low household income (OR 1.64; 95% CI 1.27 to 2.11, P < 0.001), low postpartum social support (OR 3.95; 95% CI 2.77 to 5.62, P < 0.001), stressful life events (OR 2.43; 95% CI 1.88 to 3.15, P < 0.001), interpersonal violence (OR 1.40; 95% CI 1.04 to 1.87, P = 0.02), and poor self-perceived maternal health (OR 4.48; 95% CI 3.15 to 6.38, P < 0.001) were independently associated with postpartum depressive symptoms. Regional differences in correlates of postpartum depressive symptoms were found. The finding that depression rates are elevated throughout the first postpartum year is important because of the known negative impact of postpartum depression (PPD). Targeted public health interventions may be needed to reduce the prevalence of PPD and its associated impact.

Maternal characteristics and satisfaction associated with intrapartum epidural analgesia use in Canadian women

BackgroundThe use of epidural analgesia for intrapartum pain relief has increased over recent decades, with rates varying among developed countries. The objective of this study was to determine the socio-demographic and obstetric characteristics and satisfaction associated with epidural analgesia use for intrapartum analgesia in Canadian women. MethodsUsing the Maternity Experiences Survey of the Canadian Perinatal Surveillance System, a randomly-selected sample of 5350 women who had attempted a vaginal birth was examined, representing 63900 Canadian women. Univariate and multivariate logistic regression models were used to determine the association between socio-demographic and obstetric characteristics and use of epidural analgesia. ResultsThe rate of epidural analgesia use was 57.3% among women with a trial of vaginal birth. Women with higher education levels (OR 1.12, 95%CI 1.07–1.18) and higher income (OR 1.10, 95%CI 1.05–1.14) were more likely to use epidural analgesia. Women were less likely to use epidural analgesia if they were First Nations (OR 0.77, 95%CI 0.69–0.84), unemployed (OR 0.89, 95%CI 0.81–0.97) or a homemaker (OR 0.86, 95%CI 0.82–0.9), living in a rural area (OR 0.60, 95%CI 0.57–0.63), multiparous (OR 0.32, 95%CI 0.31–0.33) and seeing a midwife, family physician or nurse for prenatal (OR 0.6, 95%CI 0.53–0.67, OR 0.71, 95%CI 0.67–0.74, OR 0.75, 95%CI 0.56–0.99, respectively) and intrapartum care (OR 0.12, 95%CI 0.10–0.14, OR 0.58, 95%CI 0.55–0.61, OR 0.58, 95%CI 0.54–0.63, respectively). Maternal prenatal stressors were associated with epidural analgesia use in a non-linear fashion: compared with women with zero stressful events, women with one stressful event were more likely to use epidural analgesia (OR 1.07, 95%CI 1.02–1.12), but women with two or more events were less likely to use epidural analgesia (OR 0.88, 95%CI 0.84–0.92). Satisfaction with labor was high, regardless of type of analgesia used. ConclusionsSocio-demographic and obstetric characteristics, combined with a high satisfaction with labor regardless of the method of pain relief, support the existence of smaller rural obstetric centers unable to provide availability of continuous epidural labor analgesia.

Examining the pathways of pre- and postnatal health information.

The objectives of our study were to 1) assess Canadian women's health information levels regarding pre- and postnatal topics in both primiparous and multiparous samples, and 2) identify factors associated with levels of health information in both groups and the pathways of such associations. Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N=6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a three-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Structural equation modeling was used to identify and examine pre- and postnatal acquired health information components in both samples and to assess factors that may influence this level of information. Primiparous and multiparous women perceived insufficient levels of information on similar topics: pain medication/anesthesia, warning signs/complications, formula feeding and changes in sexual responses. This common finding underscored that these informational needs had a large impact on the entire population of pregnant women, rather than being parity-specific. Level of perceived social support was positively associated with information acquisition on all health topics studied in both samples (p&lt;0.0001 for both). Income was also positively associated with information levels to a similar extent on a range of topics in both samples (p&lt;0.0001 - p&lt;0.05). Canadian primiparous and multiparous women perceived an inadequate level of information on the same topics, identifying knowledge gaps that should be addressed. Perceived level of social support and income significantly influenced information levels on pre- and postnatal health topics. Therefore women with low income and those with perceived lack of social support may be identified by health care providers as requiring additional health information.

Examining the Pathways of Pre- and Postnatal Health Information

The objectives of our study were to 1) assess Canadian women's health information levels regarding pre- and postnatal topics in both primiparous and multiparous samples, and 2) identify factors associated with levels of health information in both groups and the pathways of such associations.Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N=6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a three-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Structural equation modeling was used to identify and examine pre- and postnatal acquired health information components in both samples and to assess factors that may influence this level of information.Primiparous and multiparous women perceived insufficient levels of information on similar topics: pain medication/anesthesia, warning signs/complications, formula feeding and changes in sexual responses. This common finding underscored that these informational needs had a large impact on the entire population of pregnant women, rather than being parity-specific. Level of perceived social support was positively associated with information acquisition on all health topics studied in both samples (p&lt;0.0001 for both). Income was also positively associated with information levels to a similar extent on a range of topics in both samples (p&lt;0.0001 - p&lt;0.05).Canadian primiparous and multiparous women perceived an inadequate level of information on the same topics, identifying knowledge gaps that should be addressed. Perceived level of social support and income significantly influenced information levels on pre- and postnatal health topics. Therefore women with low income and those with perceived lack of social support may be identified by health care providers as requiring additional health information.

Correlates of Mother-to-Child Transmission of Human Immunodeficiency Virus in the United States and Puerto Rico

The most common mode of human immunodeficiency virus (HIV) infection in children is mother-to-child transmission during pregnancy, labor, and delivery. The use of current guidelines can prevent a significant proportion of perinatally acquired HIV infections. Current recommendations for prevention include HIV testing early in pregnancy; combination antiretroviral prophylaxis during pregnancy; administration of zidovudine during labor and to the neonate, planned cesarean delivery before labor when indicated, and avoidance of breast-feeding. Implementation of these recommendations has resulted in a marked decline in the number of perinatally infected infants during the past decade. Failure to use any of these interventions is a missed opportunity for prevention of perinatal HIV transmission. This study explored the association between missed prevention opportunities and mother-to-child transmission in 15 US jurisdictions for birth years 2005 through 2008, while controlling for variables associated with transmission. Data regarding HIV-infected women who gave birth to live infants were obtained from the Enhanced Perinatal Surveillance system. Multivariable logistic regression analysis was used to control for demographic, behavioral, clinical, and missed opportunity variables associated with mother-to-child transmission. HIV infection was diagnosed in 179 infants (2.2%) among the 8054 births to HIV-infected women during the 4-year study period. There was at least one missed opportunity for prevention of mother-to-child transmission in 74.3% of infected infants and 52.1% of uninfected infants. A total of 7757 mother–infant pairs had sufficient data for analysis. The adjusted data showed that the odds of having an HIV-infected infant were higher for women who received late testing (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.5–4.0) or no prenatal antiretroviral medications (aOR, 3.5; 95% CI, 2.0–6.4). The odds of having a HIV-infected infant for women who breastfed were >4-fold higher than for those that did not (aOR, 4.6; 95% CI, 2.2–9.8). The odds were >2-fold higher among women with CD4 counts <200 cells per microliter compared with those with CD4 counts ≥500 cells per microliter (aOR, 2.4; 95% CI, 1.4–4.2). Similarly, the odds for women with substance abuse were twice those for women without this risk factor (aOR, 2.0; 95% CI, 1.4–2.9). These findings indicate that further decreasing, or ultimately eliminating, perinatal HIV infections in the United States will require increased attention to the following interventions: an increase in earlier HIV diagnosis, lowering CD4 counts through the use of prenatal antiretroviral medications, substance abuse treatment, and avoidance of breast-feeding. Failure to use any of these interventions represents a missed opportunity for prevention.