Pregnant Women In Urban Areas Research Articles

Anaemia and its Determinants Among Pregnant Women: A Study in Urban Slums of Kolkata Metro City

Anemia among pregnant women remains a significant public health concern, particularly in urban slum areas where access to healthcare and proper nutrition is often limited. Iron deficiency anemia is a pervasive issue, particularly impacting pregnant women and adolescent girls, considered by the World Health Organization with hemoglobin levels below 11 g/dl. On a global scale, as of 2019, 37% of pregnant women and 30% of women aged 15 to 49 experience anemia. NFHS-5 data reveals that the prevalence of anemia among pregnant women in urban areas of India stands at 45.7%. This study explores the multifaceted factors influencing the prevalence of anemia among pregnant women residing in the urban slums of Kolkata, India. The study adopted a mixed-methods approach, combining quantitative surveys and qualitative interviews to comprehensively assess the determinants of anemia among pregnant women in the Urban slums of Kolkata. Quantitative data collection involves structured surveys administered to pregnant women, focusing on socio-demographic characteristics, dietary habits, access to healthcare services, and knowledge of anemia prevention and management. Qualitative interviews delve deeper into the experiences and perceptions of pregnant women regarding anemia, exploring cultural beliefs, social norms, and barriers to accessing healthcare services. Additionally, healthcare providers and community health workers contribute insights into the challenges faced in addressing anemia in urban slum settings. Preliminary findings suggest that several interconnected factors contribute to the high prevalence of anemia among pregnant women in urban slum areas of Kolkata. These include inadequate antenatal care, limited availability of iron-rich foods, poor sanitation and hygiene practices, cultural beliefs surrounding pregnancy and nutrition, and socio-economic constraints. The study underscores the importance of multi-sectoral interventions aimed at addressing the complex determinants of anemia among pregnant women in urban slums. Effective strategies may involve improving access to antenatal care services, promoting nutrition education and supplementation, enhancing sanitation infrastructure, and fostering community engagement to challenge harmful cultural norms. By elucidating the nuanced factors influencing anemia in this vulnerable population, this research seeks to inform targeted interventions and policies aimed at improving maternal and child health outcomes in urban slum areas of Kolkata and similar settings worldwide.

Prevalence and associated factors of intimate partner violence against pregnant women in urban areas of Japan: a cross-sectional study

BackgroundIntimate partner violence (IPV) against pregnant women is associated with many negative maternal and fetal outcomes and is a common public health problem all over the world. However, the issue has not been fully explored in Japan. This study aimed to explore the prevalence and risk factors of IPV against pregnant women in urban areas of Japan.MethodsThis study was a secondary data analysis of a cross-sectional survey that was conducted on women beyond 34 weeks’ gestation in five perinatal facilities in urban areas of Japan, from July to October 2015. The sample size was calculated to be 1230. The Violence Against Women Screen was used for IPV screening. Multiple logistic regression analysis was used to calculate the adjusted odds ratio (AOR) with 95% confidence interval (CI) for risks of IPV while adjusting for confounding factors.ResultsOf the 1346 women who participated in this study, 180 (13.4%) were identified as experiencing IPV. Compared to those who did not experience IPV (n = 1166 (86.6%)), women experiencing IPV had higher odds of being single mothers (AOR = 4.8; 95%CI: 2.0, 11.2), having lower household income (< 3 million yen, AOR = 2.6; 95%CI: 1.4, 4.6; ≥ 3 million yen and < 6 million yen, AOR = 1.9; 95%CI: 1.2, 2.9), having junior high school education background (AOR = 2.3; 95%CI: 1.0, 5.3) and being multipara (AOR = 1.6; 95%CI: 1.1, 2.4).Conclusions13.4%, or about one in seven women, experienced IPV while pregnant. This high proportion indicates the need for policy to address the issue of violence against pregnant women. There is an urgent need to build a system for the early detection of victims that offers appropriate support to prevent the recurrence of violence while encouraging victim recovery.

Association of marital relationships with obstetrical history and physical and psychosocial factors of pregnant women in urban areas: A cross-sectional analysis from the perspective of adaptation to pregnancy

Objectives This study aimed to determine the association of marital relationships with pregnant women's obstetrical history, physical and psychosocial factors, and characteristics of women and husbands from the perspective of adaptation to pregnancy. Moreover, it sought to offer suggestions regarding support for couples during pregnancy in urban areas.Methods We distributed self-reported questionnaires to pregnant women who participated in antenatal classes, organized by Public Interest Incorporated Foundation A, in four designated cities in the Kansai region of Japan. We investigated women's obstetrical history, physical and psychosocial factors, and characteristics of women and husbands using the Japanese Prenatal Self-Evaluation Questionnaire (Relationship with Husband) (J-PSEQ). Of the 778 women, 413 (53.1%) responded. After applying the exclusion criteria, 388 participants were eligible for analysis (valid response rate: 93.9%). Based on their J-PSEQ scores, participants were divided into two groups: poor marital relationship and normal or good marital relationship. Logistic regression analysis was performed to examine the factors related to the quality of marital relationships from the perspective of adaptation to pregnancy.Results Based on the J-PSEQ scores, 93 (24.0%) participants were categorized into the poor marital relationship group, and 295 (76.0%) were categorized into the normal or good marital relationship group. For the poor marital relationship group, the logistic regression analysis showed that the odds ratios (confidence intervals) for "pregnancy after infertility treatment," "easily angered and irritated," and "husband's health: somewhat poor" were 2.54 (1.38-4.66), 3.55 (1.86-6.78), and 3.54 (1.06-11.87), respectively. Women who described household finances, husbands' working conditions, and lack of support to be the most stressful factors were more likely to have poor marital relationships. The factors associated with normal or good marital relationships included women experiencing physical discomfort, women not engaging in Satogaeri Shussan (staying at women's parents' homes before and after birth), husbands taking paternity leave after childbirth, and husbands having good health.Conclusions This study revealed that the factors associated with poor marital relationships in terms of adaptation to pregnancy were pregnancy after infertility treatment, anger and irritation in women, and poor health of husbands. Healthcare professionals may need to focus more closely on supporting such couples in urban areas during pregnancy.

Psychological Stress Perceived by Pregnant Women in the Last Trimester of Pregnancy.

Pregnancy is characterized by changes in neuroendocrine, cardiovascular, and immune function. For this reason, pregnancy itself is perceived as a psychological “stress test”. Research to date has focused on stress exposure. The aim of the study was to evaluate the influence of associated factors on the level of stress experienced by pregnant patients. We conducted a prospective study that included 215 pregnant women in the third trimester of pregnancy, hospitalized in the Obstetrics and Gynecology Clinic II in Târgu-Mureș, between December 2019 and December 2021, who were evaluated by the ABS II scale. All patients included in the study filled in a questionnaire that included 76 questions/items, in which all the data necessary for the study were recorded. The results obtained from the study showed that pregnant women in urban areas (53.49%) are more vulnerable than those in rural areas (46.51%), being influenced by social and professional stressors, social determinants playing a critical role in pregnancy and in the newborn. Patients who have had an imminent abortion in their current pregnancy have a significantly higher score of irrationality than those with normal pregnancy, which shows that their emotional state can negatively influence the phenomenon of irrationality. There is a statistically significant association between pregnancy type I (normal pregnancy or imminent pregnancy) and irrationality class (p = 0.0001; RR: 2.150, CI (95%): 1.154–4.007). In the case of women with desired pregnancies, the risk of developing irrationality class IV–V is 4.739 times higher, with the association being statistically significant (p < 0.0001; RR 4.739; CI (95%): 2.144–10.476). The analysis of the obtained results demonstrates the importance of contributing factors and identifies the possibility of stress disorders, occurring in the last trimester of pregnancy, disorders that can have direct effects on maternal and fetal health. We consider it extremely important to carry out evaluations throughout the pregnancy. At the same time, it is necessary to introduce a screening program to provide psychological counseling in the prenatal care of expectant mothers.

Prevalence of depressive symptoms and correlated factors among pregnant women during their second and third trimesters in northwest rural China: a cross-sectional study

BackgroundThe depression mood during their second and third trimesters has a negative impact on both the mother and her child. Compared with pregnant women in urban areas, rural pregnant women who are in more disadvantaged situation may have more serious psychological problems. Particular, many rural pregnant women had internal migrant work experience during pregnancy in rural China. It is thus necessary to study the prevalence of depressive symptoms and correlated factors among Chinese northwest rural pregnant women.MethodsThis study was conducted from October 2017 to April 2018 and surveyed 1053 pregnant women in the middle and late stages of pregnancy who were registered in rural areas, gave informed consent and did not suffer from cognitive impairment or severe mental illness. Depressive symptoms were evaluated by the Chinese Version of the Short Depression Anxiety and Stress Scale (DASS-C21). Demographic characteristics, pregnancy characteristics and family factors were obtained through structured questionnaires. This study employed multiple factor logistic regression to analyze the relationship between depressive symptoms and their correlates.ResultsThe prevalence of depressive symptoms among pregnant women during their second and third trimesters was 16.14% (95%CI 13.92%-18.36%). Higher education levels (OR = 0.50; 95%CI 0.29–0.85) and taking folic acid (OR = 0.59; 95%CI 0.39–0.89) reduced the risk of depression symptoms. The family receiving rural welfare (OR = 1.69; 95%CI 1.04–2.75), migration for work (OR = 1.95; 95%CI 1.03–3.71) and living with both parents and parents-in-law (OR = 2.55; 95%CI 1.09–5.96) increased the risk of depressive symptoms.ConclusionsThe prevalence of depressive symptoms among pregnant women during their second and third trimesters in Northwest rural China was 16.14% that was nearly 4 percentage points higher than the average survey result of the pregnant women in developed countries and was higher than the findings in Chinese urban areas. To prevent depression symptoms, it’s essential to early screen and provide folic acid for free when antenatal examination. Moreover, maternal examination files should be established so that wo pay attention to the psychological status of pregnant women who were with low education levels, poor family economic situations, excessive parental burden and who had been migrant workers.

Women Autonomy on Prenatal Care among Bangladeshi Pregnant Women: a Qualitative Study

Background: Women from South Asian countries have challenges related to different cultural issues. In South Asia, women have a considerably lower social status and autonomy than men which is associated with lower access of pregnancy care. It is crucial for decision-making to deciding treatment options. The literature review revealed that there is very limited study related to women autonomy on prenatal care in Bangladesh. Objective: The objective of this study was to explore the sociocultural influences underlying women’s autonomy among pregnant women in urban areas of Bangladesh. Methods: A descriptive qualitative research was conducted with 20 pregnant women in three purposively sampled hospitals in Bangladesh using individual in-depth interviews with semi-structured interview questions during the period between August 2016 and April 2017. The content analysis framework was used for analysis and to present qualitative data. Findings: The major categories emerged from data analysis were: cultural restriction on women’s decision making, unfavorable attitude toward prenatal care of the authorized persons in family, cultural restriction on women’s travelling. Conclusion and policy implications: Based on the findings, it is recommended that promoting prenatal care adequacy among pregnant women in Bangladesh, policymakers should collaborate with husband/partners to improve the decision-making of women and empower them to seek prenatal care services when desired

Insulin Resistance Among Pregnant Women in Urban Areas of Arusha Region, Tanzania.

Aim: To establish the prevalence of insulin resistance (IR) and its determinants among selected pregnant women in urban Arusha for taking preventive measures. Methods: A cross-sectional study was conducted between March and December 2018 at Ngarenaro and Kaloleni health facilities in Arusha District involving 230 randomly selected pregnant women who were not known to have diabetes before pregnancy. Blood glucose at fasting and 2 hr after consuming 75 grams of glucose dissolved in 300 mL of water was measured using Gluco-Plus™, serum insulin concentrations using ELISA machine (Synergy/HTX™; BioTek), and IR was calculated using the Homeostasis Model of Assessment formula. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regular tape, weight using SECA™, blood pressure using GT-868UF Geratherm™ machine, and height by stadiometer. Maternal characteristics were collected through face to face interviews using a structured questionnaire. Data were analyzed using the Statistical Package for Social Science™ Version 20. Results: The prevalence of IR was 21% (n = 49) and significantly associated with increased body fat percentage (adjusted odds ratio [AOR]: 1.68, 95% confidence interval [CI]: 1.01-2.5), family history of Type 2 diabetes mellitus (T2DM; AOR: 2.77, 95% CI: 1.21-6.33), hypertension (AOR: 2.5, 95% CI: 1.12-5.6), edema (AOR: 3.01, 95% CI: 1.31-6.96), and proteinuria (AOR: 3.44, 95% CI: 1.11-10.69). Conclusions: IR was higher among pregnant women with increased body fat percentage, family history of T2DM, hypertension, edema, and proteinuria. These findings call for large-scale screening to further explore risk factors to prevent gestational diabetes mellitus.

Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania

BackgroundHyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania.MethodsA cross–sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire.ResultsThe participants’ mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22–1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11–15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00–5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09–1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53–6.92).ConclusionThe prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.

Intentions and influencing factors regarding natural childbirth among urban pregnant women in China, based on the theory of reasoned action and structural equation modeling.

ObjectivesIn the present study, we aimed to analyze the status of natural childbirth and factors influencing delivery behaviors among pregnant women in urban areas based on the theory of reasoned action, to provide a basis for health education on natural childbirth.MethodsWe recruited 658 pregnant women at West China Second University Hospital, Sichuan University. Using a literature review, expert consultation, and self-report questionnaires based on the theory of reasoned action, we investigated delivery behaviors and influencing factors among the included pregnant women. The questionnaires primarily comprised general situations and behavioral intentions regarding natural childbirth among pregnant women. The data were analyzed using IBM SPSS 21.0 software.ResultsAccording to structural equation modeling, participants’ behavioral intentions regarding natural childbirth were influenced by normative beliefs (standardized regression coefficient 0.402), outcome evaluation (standardized regression coefficient 0.123), and behavioral beliefs (standardized regression coefficient 0.316). Conformity motivation and knowledge about childbirth affected the choice of natural childbirth via normative beliefs (standardized regression coefficients 0.431 and 0.338, respectively).ConclusionsWe found that the behavioral intentions of urban pregnant women with respect to natural childbirth were affected by normative beliefs, outcome evaluations, behavioral beliefs, conformity motivation, and knowledge about childbirth.

Knowledge and awareness of breastfeeding, weaning practices and newborn care in pregnant women in urban areas

Background: Breastfeeding, proper weaning practices, and newborn care play a crucial role in the health of a child. The objective of the study is to determine the availability of information regarding breastfeeding, newborn care and immunization and to find out about the attitude of women towards newborn care practices.Methods: A cross-sectional observational study was conducted in a tertiary health care centre in an urban area in Navi Mumbai, on primigravidae in their third trimester of pregnancy. The data was collected by a questionnaire, results were analysed by EpiInfo7.Results: 93% women knew the benefits of breastfeeding, 92% knew of exclusive breastfeeding. 90% would initiate breastfeeding immediately after delivery, 83% would not give prelacteal feeds. 75% would practise skin-to-skin contact and 95% would practise rooming-in technique. 44% would delay bathing the newborn. 95% women received TT immunisation. All agreed to vaccinate their child. 19% believed traditional practices like applying kajal to eyes, prelacteal feeds etc. to be hazardous.Conclusions: The knowledge pregnant women have about breastfeeding and newborn care is inadequate. There is a need for intervention measures such as behavior-change-communication and better health services, to equip mothers so they may provide optimal care to their babies.

Epidemiological analysis of maternal deaths in Hunan province in China between 2009 and 2014.

BackgroundThe control of maternal deaths continues to be a significant public health issue and commands an enormous amount of attention, especially under the future family planning policy. Here, we describe the epidemiology and trends of maternal deaths in Hunan province, and give several policy implications.MethodsMaternal deaths in Hunan province between 2009 and 2014 were retrospectively reviewed and analyzed. Cochran-Armitage trend test was used to assess the time trends of maternal mortality rates. Binary logistic regression analyses were undertaken to identify the factors that were associated with unavoidable maternal deaths.ResultsIn total, there were 987 maternal deaths, with the overall MMR declining by 45.24%. The most common causes of maternal death during this period were pregnancy complications (28.37%), obstetric hemorrhage (25.33%), and amniotic fluid embolism (15.70%). Obstetric hemorrhage (28.14%) was higher in rural areas, while pregnancy complications were higher (29.27%) in urban areas. In all, 627 (63.5%) deaths were avoidable. The risk factors associated with unavoidable maternal deaths was above 35 years (aOR = 1.80 95%CI: 1.27–2.55), without prenatal examination (aOR = 8.97 95%CI: 1.11–7.78), low household incomes (aOR = 1.15 95%CI: 1.02–1.29), without adopting the new way to deliver (aOR = 5.15 95%CI: 3.20–8.31), and death location (aOR = 1.09 95%CI: 1.02–1.18). The most frequent and important factors associated with avoidable deaths was improper knowledge and skills of the county medical institutions.ConclusionsModerate progress was made in reducing the MMR in Hunan province. The government should aim to improve the basic midwifery skills in rural areas and the obstetric emergency rescue service for critically ill pregnant women in urban areas, and strengthen training to improve knowledge and skills in medical institutions in counties.

Survey of prevalence of iron deficiency and iron deficiency anemia in pregnant women in urban areas of China

Objective: To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods: The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country.Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results: The median serum ferritin level during pregnancy was 20.60 μg/L (11.78-36.98 μg/L) , the hemoglobin level was (118±12) g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L (34.48-94.01 μg/L) , 28.60 μg/L (16.40-50.52 μg/L) , and 16.70 μg/L (10.20-27.00 μg/L) respectively (P<0.01) . The mean hemoglobin levels were (127±10) g/L, (119±11) g/L and (117±11) g/L respectively (P<0.01) . The prevalence of ID in urban pregnant women was 48.16% (5 973/12 403) , and IDA prevalence was 13.87% (1 720/12 403) . The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019) , 8.40% (293/3 487) and 17.82% (1 407/7 897) ,respectively (P<0.01) . The prevalence of standardized ID and IDA were significantly different in various regions of China (P<0.01) . The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%, the differents in various regions were significant (all P<0.01) . Conclusion: The current phenomenon of ID and IDA in pregnant women is still very common, and nutrition and health care during pregnancy should be strengthened.

The prevalence of anemia in pregnant women and its associated risk factors in North Sumatera, Indonesia

The gestation period is the period that determines the quality of human resources in the future because the development of the child is determined from the time of the fetus in utero. The most common nutrition problems suffered by pregnant women in Indonesia is Chronic Energy Deficiency (CED) and anemia. The aim of this research to determine the prevalence of anemia in pregnant women and the risk factors associated with anemia in urban and rural areas of North Sumatera Province. This research is as descriptive analyticwith cross-sectional approach. Total sample 140 pregnant women from the Medan City, Langkat District and South Labuhan Batu District, and was from June to October 2016. Data collected by using interviews, hemoglobinometer tool and analyzed with Chi-square test. Anemia was in 40.7% of pregnant women, and the incidence of anemia is more common in pregnant women in urban areas than in rural areas. The factors associated with anemia in pregnant women is parity, knowledge of nutrition, diet and the risk of chronic energy deficiency (p <0.05). This study concludes that the prevalence of anemia in pregnant women in North Sumatra was higher than the national prevalence.

1 year weight losses in the Tianjin Gestational Diabetes Mellitus Prevention Program: a randomised trial

BackgroundGestational diabetes affects about 8% of pregnant women in urban areas of China, and is an important indicator of risks of type 2 diabetes and impaired glucose tolerance later in life. The Tianjin Gestational Diabetes Mellitus Prevention Program aims to investigate the extent to which a postpartum lifestyle intervention given soon after delivery can reduce risk or delay onset of type 2 diabetes in women with gestational diabetes. Here, we report weight loss after the first year of the trial. MethodsThe Tianjin Gestational Diabetes Mellitus Prevention Program is a randomised trial done at Tianjin Women's and Children's Health Center, Tianjin, China. We recruited women (aged >24 years) with gestational diabetes diagnosed on the basis of WHO criteria from six urban districts in Tianjin between July 1, 2005, and June 30, 2009. After participants completed the baseline survey administered by health workers from the study centre, eligible participants were randomly assigned (1:1) to receive a 4 year lifestyle intervention (intervention group) or standard care (control group). Statistical Package for the Social Science (SPSS) was used to generate a list of 1200 random allocation statuses, and the list of random assignments was kept centrally by an independent person. Major elements of the intervention included six face-to-face sessions with study dietitians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Weight loss after the first year of the trial was analysed in patients with complete data. Ethics approval was granted by the human subjects committee of Tianjin Women's and Children's Health Center, and all participants provided written informed consent. This trial is registered with ClinicalTrials.gov, number NCT01554358, and is ongoing. FindingsBetween Aug 1, 2009, and July 31, 2011, we recruited and randomly assigned 1180 women into the intervention group (n=586) or the control group (n=594). At the end of year 1, mean weight loss was 0·8 kg (SD 3·5; 1·1% [SD 5·4] of initial weight) in the intervention group and 0·1 kg (3·3; 0·03% [5·0%] of initial weight) in the control group (p<0·001). In prespecified subgroup analysis, weight loss was more pronounced in women who were overweight (BMI ≥24 kg/m2) at baseline: mean weight loss was 2·0 kg (4·3; 2·9% [6·1%] of initial weight) in the intervention group and 0·44 kg (4·0; 0·5% [5·5%] of initial weight) in the control group (p<0·001). Compared with those in the control group, women in the intervention group had a greater decrease in body fat (0·50% vs 0·05% increase; p=0·001) and waist circumference (1·76 cm vs 0·73 cm; p=0·003). InterpretationThe 1 year lifestyle intervention led to significant weight loss after delivery in women who had gestational diabetes, and such an effect was more pronounced in those who were overweight. Our findings indicate that lifestyle intervention is feasible and effective in women with gestational diabetes. FundingEuropean Foundation for the Study of Diabetes–Chinese Diabetes Society–Lilly programme for Collaborative Research between China and Europe, Tianjin Women's and Children's Health Center, Tianjin Public Health Bureau, and the National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health (R01DK100790).

Physical violence against pregnant women by an intimate partner, and adverse pregnancy outcomes in Mazandaran Province, Iran.

Background and Aim:Violence against women during pregnancy is linked to poor outcome of pregnancy, which is reported to have widespread in Iran. The aim of this study was to determine the prevalence of physical violence against women by an intimate partner during pregnancy, and to assess the impact of this physical violence on pregnancy outcomes.Materials and Methods:A prospective cohort study was conducted on the characteristics of pregnant women in urban areas and related violence. The modified standard World Health Organization Domestic Violence Questionnaire was used to classify pregnant women and domestic violence. A total of 1461 pregnant women were selected using cluster sampling. The association between sociodemographic with intimate partner violence (IPV) and IPV with pregnancy outcomes was determined using logistic regression.Results:Of these, 206 (14.1%) (confidence interval = 12.3-15.9) reported physical IPV during pregnancy. The adjusted odds ratio for IPV in illiterate women or those with primary level of education (0.001), secondary level education (0.003), and in low income households (0.0001) were significantly higher than in those women with university level education and in higher income households. After adjusting for suspected confounding factors, the women with a history of violence by partners had 1.9 fold risk of premature rupture of membranes, and a 2.9 fold risk of low birth weight compared to women who did not experience any violence from their partners.Conclusion:The results of this research indicated that the prevalence of IPV was high among pregnant women. Therefore, it is necessary to emphasize the screening of pregnant women at Primary Health Centers to prevent physical abuse.

Social environment and depression among pregnant women in urban areas of Pakistan: Importance of social relations

Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts’ opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants of depression were grouped into themes of social conditions and social relations and pregnancy-related concerns. In the study's quantitative phase, the relative power of the identified themes and categories, based on their scores for predicting depression (determined by the Center for Epidemiological Studies—Depression Scale (CES-D scale)), was determined through multivariate linear regression. Social environmental determinants of pregnant women were described under the themes and categories of (1) social relations: involving husband, in-laws and children; (2) social conditions: involving the economy, illness, life events, household work, environmental circumstances and social problems; and (3) pregnancy-related concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency and concern for unborn baby. Multivariate analysis found that among these themes, social relations and pregnancy-related concerns were significantly associated with total CES-D scores. Among the categories besides increasing age and less education, husband, in-laws, household work and pregnancy symptoms were significantly associated with total CES-D scores. The study highlights the importance of social relations compared to social conditions for determining depression in pregnant women.

Hepatitis B Surface Antigen Prevalence Among Pregnant Women in Urban Areas: Implications for Testing, Reporting, and Preventing Perinatal Transmission

To estimate race/ethnicity-specific prevalence of hepatitis B surface antigen (HBsAg) in pregnant urban women and to evaluate factors associated with maternal HBsAg testing. A multicenter, retrospective chart review was conducted of a racially/ethnically stratified random sample of maternal/infant charts of 10 523 women who gave birth to live infants during 1990-1993 in 4 urban areas in the United States. Data were collected on multiple variables, including demographic variables, HBsAg test dates and results, prenatal care type, and amount and source of payment. HBsAg prevalence among white non-Hispanics was 0.60% (95% confidence interval [CI]: 0.22-0.98), black non-Hispanics 0.97% (95% CI: 0.48-1.47), Hispanics 0.14% (95% CI: 0.01-0.26), and Asians 5.79% (95% CI: 4.42-7.16). HBsAg testing rates increased from 56.6% in 1990 to 78.2% in 1993. Factors associated with not being tested varied by urban area, but in the combined area model, they were having no or private prenatal care (odds ratios: 18.75 and 5.07, respectively) and being black (odds ratios: 2.08). Only 20.9% (95% CI: 19.1%-22.8%) of those not tested prenatally were tested at delivery. The expected number of infants born to HBsAg-positive study-area women was 3327 using study prevalence rates, compared with 1761 using national rates. To help ensure that all urban infants who are born to HBsAg-positive women receive appropriate prophylaxis, health officials in urban areas should use urban-area prevalence rates to ascertain completeness of reporting maternal HBsAg positivity. Needed steps to increase maternal HBsAg testing rates include ensuring that more pregnant women receive prenatal care, promoting testing by private providers, educating providers about testing in all racial and ethnic groups, and reminding providers to test at delivery those women not tested prenatally.

No increase in renal iodine excretion during pregnancy: a telling comparison between pregnant women and their spouses

Adequate dietary iodine intake is necessary for normal thyroid gland function at all times, and most particularly during pregnancy. Increased iodine loss is cited, among other factors, as responsible for the increased iodine demand in this period. Our aim was to compare renal iodine excretion between women during all three pregnancy trimesters with that of their spouses and thereby to estimate the iodine intake in an a large sample of pregnant women in urban areas in Greece. Four hundred twenty-four healthy pregnant women were included prospectively (residents of Athens n=218, residents of Patras n=206). The spouses of 177 of these women following the same diet were also studied. Determinations included serum FT4, TSH and aTPO and urinary iodine excretion (UIE). No difference was found either in median UIE throughout pregnancy or between the UIE of the pregnant women and their spouses during the trimesters. Throughout pregnancy, mild iodine deficiency was noted and was classified as mild in 60%, moderate in 30% and severe in 10% of the women studied. Users of iodized salt had significantly higher median UIE compared with non-users. Serum FT4 levels decreased and TSH increased as pregnancy progressed. Our study indicates that renal iodine excretion is not increased during pregnancy. This finding needs to be confirmed by further investigation in other populations with different iodine intakes. Thus, increased iodine requirements in pregnancy are possibly due to extra-renal causes. The population of pregnant women in Greek urban areas is mildly-and often moderately and severely-iodopenic and needs to be treated accordingly.

Rational, bureaucratic, collegial, and political views of the principal's role

Thomas Sergiovanni Faculty of Educational Administration and Supervision University of Illinois Urbana, Illinois In the more established professions, and to a lesser extent in educational administration, frames of reference, models or paradigms govern professional practice. The terms frames of reference, models and paradigms are used by theorists to refer to systematic ways of thinking, conceptual frameworks, patterns, examples, miniature representations and other approximations of reality which help to more fully understand this reality. For purposes of their discussion the term will generally be used to encompass the three. Models are systematic approximations of reality. They come complete with a convincing internal logic, a set of assumptions, postulates, data, and inferences about some phenomenon. Sometimes models are formal and explicit but often models are implicit and indeed articulated unknowingly by administrators. Models determine what problems are critical for a particular profession and provide the practitioner with a theoretical framework for understanding and dealing with problems. Models underlying the administration of special education, for example, emphasize remediation of difficulties rather than prevention. Thus special education administrators are more likely to be concerned with the critical problem of learning disabilities in urban youth than poor nutrition of pregnant women in urban areas though the first seems causally related to the second. Models undergirding the various professions also suggest to the practitioner certain actions or routines as being more valid than others and certain standards of proof for determining effectiveness of these methods. A principal who operates from a human relation model, for example, might consider interpersonal relationships as the critical administrative priority in a school. This principal would employ specific techniques such as participating in decision-making to improve these relationships and would judge his effectiveness by positive changes in morale of the staff. Another principal who operates from an accountability model might consider increased performance as the critical concern in this same school. This principal would employ specific techniques such as management by objectives (MBO) and teaching by objectives (TBO) to improve performance and would judge his effectiveness by the number of objectives achieved. The behavior and orientation of each principal is governed by the model from which he is working. This article examines the development of thought in administration seeking to identify the major models which undergird the profession and shifts in these models which help explain changes in professional practice. Examining the development of thought in