Prenatal Appointments Research Articles

Resident Versus Attending Prenatal Care Models: an Analysis of the Effects of Race and Insurance on Appointment Attendance

ObjectiveTo describe patient differences by prenatal care (PNC) model and identify factors that interact with race to predict more attended prenatal appointments, a key component of PNC adherence.MethodsThis retrospective cohort study used administrative data targeting prenatal patient utilization from two OB clinics with different care models (resident vs. attending OB) from within one large midwestern healthcare system. All appointment data among patients receiving prenatal care at either clinic between September 2, 2020, and December 31, 2021, were extracted. Multivariable linear regression was performed to identify predictors of attended appointments within the resident clinic, as moderated by race (Black vs. White).ResultsA total of 1034 prenatal patients were included: 653 (63%) served by the resident clinic (appointments = 7822) and 381 (38%) by the attending clinic (appointments = 4627). Patients were significantly different across insurance, race/ethnicity, partner status, and age between clinics (p < 0.0001). Despite prenatal patients at both clinics being scheduled for approximately the same number of appointments, resident clinic patients attended 1.13 (0.51, 1.74) fewer appointments (p = 0.0004). The number of attended appointments was predicted by insurance in crude analysis (β = 2.14, p < 0.0001), with effect modification by race (Black vs. White) in final fitted analysis. Black patients with public insurance attended 2.04 fewer appointments than White patients with public insurance (7.60 vs. 9.64) and Black non-Hispanic patients with private insurance attended 1.65 more appointments than White non-Hispanic or Latino patients with private insurance (7.21 vs. 5.56).ConclusionOur study highlights the potential reality that the resident care model, with more care delivery challenges, may be underserving patients who are inherently more vulnerable to PNC non-adherence at care onset. Our findings show that patients attend more appointments at the resident clinic if publicly insured, but less so if they are Black than White.

Impact of telehealth implementation on diagnosis of hypertensive disorders of pregnancy

COVID-19 caused a rapid integration of telehealth into prenatal care. This raises questions about the ability to screen for hypertensive disorders of pregnancy when caring for patients remotely. This study aimed to assess the effect of telehealth adaptation on the timing and severity of diagnosis of hypertensive disorders of pregnancy. This was a retrospective study of patients with hypertensive disorders of pregnancy who delivered from April 2019 to October 2019 (before the pandemic) and April 2020 to October 2020 (during the pandemic) at 1 urban tertiary care center. The primary outcome was mean gestational age at diagnosis of a hypertensive disorder of pregnancy. The secondary outcomes included severity of diagnosis, both initially and at the time of delivery. The results were adjusted for baseline characteristic difference at P<.10, using multivariable logistic regression and analysis of covariance, as appropriate. The sample size was calculated based on a previous cohort study of patients who developed preeclampsia, with a mean gestational age at delivery of 36.3 weeks and a standard deviation of 2.8 weeks. A sample size of 124 patients would be needed per group to detect a gestational age difference of 1 week with 80% power and a 95% confidence interval. Overall, 498 patients were included, with 231 from 2019 and 267 from 2020. Of note, 17.1% of patients had preeclampsia with severe features initially, and 29.3% of patients met the criteria at delivery. In 2020, 80.5% of patients used telehealth (vs 0.9% of patients in 2019), doing so for a mean of 29.0% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, cohort year was not significantly associated with severity of initial diagnosis (adjusted odds ratio, 0.86; 95% confidence interval, 0.53-1.39; P=.53) or severity of diagnosis at delivery (adjusted odds ratio, 0.97; 95% confidence interval, 0.64-1.46; P=.87). However, Black race was significantly associated with increased risk of having severe preeclampsia at initial diagnosis (adjusted odds ratio, 1.70; 95% confidence interval, 1.01-2.85; P=.046). In addition, Black race (adjusted odds ratio, 2.62; 95% confidence interval, 1.60-4.28; P<.001), Hispanic ethnicity (adjusted odds ratio for non-Hispanic, 0.40; 95% confidence interval, 0.19-0.82; P=.01), and initial body mass index (adjusted odds ratio, 1.04; 95% confidence interval, 1.01-1.06; P=.005) were significantly associated with a diagnosis of severe preeclampsia at delivery. The adaptation of telehealth was not associated with delays in the diagnosis of hypertensive disorders of pregnancy or with increased severity of diagnoses.

The Feasibility and Impact of a Computer-Aided Genetics Education Module in an Obstetrics Clinic: A Randomized Controlled Trial

ABSTRACT Background Rapid advances in prenatal genetic testing highlight the need for technology-based tools to assist in informed decision-making. Purpose This study evaluates the feasibility, acceptability, and efficacy of a Computer-Aided Genetics Education Module (CAGEM) as an e-counseling tool and decision aid in a busy obstetric clinic among a socially disadvantaged patient population. Methods A randomized controlled trial with patients randomized (1:1) to receive the intervention in addition to standard of care or standard of care only. Participants responded to pre- and posttest questionnaires. Results Although limited in recruitment by the COVID-19 pandemic, this tool scored 81.0% acceptability and 91.0% feasibility among 88 participants. No statistically significant difference was detected between the overall improvement in knowledge scores and the total posttest knowledge scores among the intervention and control groups. However, the intervention group scored significantly higher on the posttest questions regarding NIPT interpretation (61.7 ± 49.1 vs 80.9 ± 39.8, p = .049), Down syndrome (78.7 ± 41.4 vs 93.6 ± 24.7, p = .016), and inheritance of recessive conditions (59.6 ± 49.6 vs 91.4 ± 28.2, p < .001). The intervention group also showed a greater improvement in knowledge scores for inheritance of recessive conditions (31.9 ± 8.1 vs 0 ± 7.8, p = .006) and a protective effect in knowledge scores for Down syndrome (0 ± 6.1 vs −17.1 ± 6.0, p =.049). Discussion CAGEM may be a feasible and acceptable e-counseling tool and decision aid, especially when compared to standard of care prenatal counseling. Although overall knowledge did not show significant improvement, CAGEM showed promise in enhancing knowledge acquisition for certain genetic education topics, showing that technology-based tools may be beneficial in informed consent. Future iterations may be revised to improve clarity, especially around invasive testing methods, race congruency, and insurance coverage. Translation to Health Education Practice: This study’s method creates a model for Health Educators to design and evaluate technology-based tools for improving informed decision-making around prenatal genetic testing. Tools like CAGEM may be utilized to improve patient education prior to prenatal appointments and thus serve as an adjunct to provider counseling. Specifically, CAGEM addresses multiple NCHEC Responsibilities and Competencies including #1.1.2, 1.3.2, 1.3.4, 4.2.9, and 6.4.3.

Effect of Telehealth Adaptation on the Diagnosis of Hypertensive Disorders of Pregnancy [ID: 1358276

INTRODUCTION: COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP). METHODS: This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P&lt;.10, using multivariable logistic regression and ANCOVA as appropriate. RESULTS: Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P&lt;.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87). CONCLUSION: The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.

Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: An ecological study.

The study aimed to analyze the temporal trend of congenital syphilis in Brazil in the period from 2008 to 2018 and its spatial distribution in the Immediate Regions of Urban Articulation, and to identify spatial correlations with socioeconomic factors and prenatal care. Spatial correlations between the incidence of congenital syphilis and socioeconomic conditions and access to prenatal care were assessed. This ecological study conducted a time series analysis in Brazil and spatial analysis in 482 Immediate Regions of Urban Articulation. Cases of congenital syphilis reported in the Notifiable Diseases Information System and the Live Birth Information System from January 1, 2008, to December 31, 2018 were included. Socioeconomic conditions (percentage of individuals with inadequate water supply and sanitation) were extracted from the 2010 census, whereas the Live Birth Information System provided data on access to prenatal care (percentage of live births with 1-3 prenatal care appointments). The Joinpoint Regression software performed the temporal trend analysis, while the GeoDa software assessed territorial clusters using the Moran's I and Local Spatial Association Indicator. The incidence of congenital syphilis showed an upward trend (annual percent change 1 = 26.96; 95% CI: 18.2-36.3; annual percent change 2 = 10.25; 95% CI: 2.7-28.4) and was unevenly distributed across Immediate Regions of Urban Articulation in Brazil (Moran's I = 0.264, p ≤ 0.05). It also presented a direct spatial correlation with the percentage of individuals with inadequate water supply and sanitation (Moran's I = 0.02, p ≤ 0.05) and the percentage of live births with 1-3 prenatal care appointments (Moran's I = 0.03, p ≤ 0.05). Agrowth trend of congenital syphilis in Brazil was observed between 2008 and 2018. Moreover, inequalities in socioeconomic conditions and access to prenatal care influenced the spatial distribution of this disease.

Factors that Determine the Self-Efficacy of The Maternal Care in Postpartum Women: Data for Future Memory

The birth of a child demands the provision of care. Mothers have different levels of safety or confidence when it comes to caring, which reveals the perception of self-efficacy. Our aim is to register, for future memory, the factors associated with self-efficacy in maternal care. Quantitative and cross-sectional study. It explores sociodemographic factors, factors related to the pregnancy and labor history, the newborn's characteristics, and related care environment with self-efficacy in maternal care. The study population included postpartum women from two Turkish maternity hospitals, in convenient sampling, with a response rate of 93,4%. Prudent ethical principles. The criterion variable was observed through the Perceived Maternal Parenting Self-Efficacy (PMP S-E). The statistical analysis was carried out on the SPSS software. The participants had an average age of 27.81(DP=5.13), the majority were married (95.9%) and for 40.1% this was their first child. The majority of labors were vaginal (52.4%). When it comes to the criterion variable, about 70% had a high perception regarding self-efficacy in maternal care. The univariate analysis revealed eight variables, included in the logistic regression: maternal age (p=.050), number of children (p&lt;.001), number of prenatal appointments (p=.006), time that elapsed between the birth and the first episode of breastfeeding (p=.047), maternal safety while breastfeeding (p&lt;.001), type of food given to the newborn p=.011), midwife support for exclusive maternal breastfeeding (p&lt;.001) and maternal breastfeeding self-efficacy (p&lt;.001). In the binary logistic regression, the best predictors of self-efficacy in maternal care were: midwife support for exclusive maternal breastfeeding (OR=1.092; B=0,088) and the self-efficacy in the maternal breastfeeding (OR=13.187; B=2.579). When it comes to maternal breastfeeding, both from the perspective of self-efficacy and the support offered by professionals, are the most relevant factors in the perception of maternal skills recognized by mothers. This study fills an information gap about the phenomenon, looking at it in retrospect.

LEVEL OF STRESS AMONG ANTENATAL MOTHERS DURING COVID -19 IN SELECTED HOSPITAL OF KAMRUP(M) ASSAM: A DESCRIPTIVE STUDY

The COVID-19 pandemic was having a tremendous impact on pregnant women. Since the World Health Organization declared that COVID-19 was a worldwide pandemic (WHO, 2020), restrictions related to maternal care emerged. In many countries, including Spain, prenatal and postnatal appointments were canceled or delivered by video-conference or telephone, accompaniment during delivery was restricted, wearing a mask was compulsory, and breastfeeding was in some places discouraged. Aim Aim :- of the study was to assess the level of stress during COVID-19 pandemic among antenatal mothers in selected hospitals of Kamrup (M), Assam. Methods and materials: A descriptive research design was used to accomplish the objectives. Study was undertaken on 150 antenatal mothers of selected hospitals of Kamrup (M), Assam by using purposive sampling technique. 5 point Likert scale was used to assess level of stress. The reliability of the tool was done by using Test retest Method, where r=0.95. So it was found to be reliable. Modied Lazaus and Flokman's stress and coping model 1966, was used as conceptual framework. Out 150 antenatal mothers 47(31.3%) Results : were aged between 18 – 20 years, 91(60.7%) were Hindus, 71(47.3%) had secondary education, 75(50%) were unemployed, 104(69.4%) had an income of ≤Rs.15000 per month, 89(59.3%) belonged to nuclear family, 102(68%) were primi mothers and 45(30%) received information related to COVID-19 and pregnancy through social media. In level of stress regarding physiological aspects, majority i.e. 136(90.67%) had moderate and 14(9.33%) had severe problems. With respect to the domain psychological problems 134(89.33%) had moderate and 15(10.67%) had severe problems. Regarding the domain behavioral problems, 140(93.33%) had moderate and 1(0.67%) had severe problems. Considering the cognitive symptoms, 143(95.33%) had moderate and 7(4.67%) had severe symptoms. The overall level of stress revealed that, 143(95.33%) had moderate stress and 7(4.67%) had severe stress and mean score was 88.35±11.82 with minimum score was 61.0 and the maximum score was 128.0. There was signicant association between the level of stress with selected demographic variables such as education, occupation, Source of information related to COVID-19 and pregnancy. From this study it was concluded that majority Conclusion: of antenatal mothers had moderate stress with regards to physiological, psychological, behavioral and cognitive aspects

Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. Maternal death. A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.

Multiple Factors as Mediators of the Reduced Incidence of Low Birth Weight in an Urban Clinic Population

A five year prospective observational study was initiated in 1985 at Howard University to describe the nutritional, clinical, dietary, lifestyle, environmental, and socioeconomic characteristics of women who enrolled in the hospital prenatal clinic. The participants were nulliparous, between the ages of 18 and 35 years, free of diabetes and abnormal hemoglobins (sickle cell disease, thalassemia, and hemoglobin C), and had been admitted prior to the 29th week of gestation. During the three year period from 1985-1988, the incidence of low birth weight (LBW) in 239 deliveries to project participants was 8.3%, whereas that of women simultaneously enrolled in the prenatal clinic with the same eligibility requirements, but not recruited for the research project, was 21.9% (P = 0.001). The incidence of LBW in infants of African American women with these eligibility requirements who were delivered by private physicians but were not enrolled in the project, was 6.3%. The reduction in LBW of infants delivered to participants in this study is attributed to the enhanced social and psychological support by project staff during their pregnancies. The caring, sensitive demeanor of the research project staff may have empowered the participants to (a) give greater compliance (91 vs. 70%) in the ingestion of the routine physician-prescribed vitamin/mineral supplement, which provided nutrients low (less than 70% of the 1989 RDAs) in their customary diets, such as folate, pyridoxine, iron, zinc, and magnesium and (b) show greater accountability in keeping prenatal clinic appointments.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital syphilis: associated factors in a follow-up outpatient clinic.

This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. Themothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Awareness and preventive practices of obesity among young women in Calabar South Local Government Area of Cross River State

Abstract Study aim: The purpose of this study was to ascertain how young women in Calabar South, Cross River State, were aware of the reasons and preventative measures for obesity. Material and methods: The study adopted the descriptive survey design using simple random sampling technique to select 400 participants (14–26years of age). Self-made and approved questionnaire was employed as a tool for data collection. With the use of descriptive statistics, the data was analyzed using frequency and percentages while chi square analysis was used to test hypothesis. Results: According to the results, a majority of respondents 65.9% had high understanding of the factors that contribute to obesity, compared to just 34.1% who had poor awareness. It was also revealed that short sleep duration, excessive use of technology, parenting and social hindered the preventive practice of obesity. Chi-square analysis showed that the calculated value 28.005a was greater than the critical value 7.81 (p-value = 0.000), thus the null hypothesis was rejected. This shows that there is a significant correlation between level of awareness of the causes of obesity and the educational level of young women. Conclusion: Nurses and midwives should educate young women about obesity during health consultations and prenatal clinic appointments in other to elevate their awareness to enhance their preventive practices

Association of prenatal stress with distance to delivery for pregnant women in Western North Carolina

PurposeRural areas throughout the US continue to see closures of maternity wards and decreasing access to prenatal and intrapartum care. Studies examining closure's impacts have demonstrated both positive and negative effects on maternal and neonatal outcomes of mortality and morbidity. Our study aims to build on growing evidence from Canada and Scandinavia that suggests increased travel time to give birth is associated with increased emotional and financial stress for rural pregnant women. MethodsPregnant patients at 7 clinic sites in western North Carolina were invited to complete the Rural Pregnancy Experience Scale (RPES) while waiting for their prenatal appointments. Results were analyzed using adjusted linear regressions to examine the correlation between RPES scores and self-reported distance to anticipated birth location as well as RPES scores with recent local labor and delivery closure. FindingsA total of 174 participants completed the survey and met inclusion criteria. For every 10 min increase in travel distance to the patient's anticipated place of delivery, RPES scores increased by an average of 0.72 points. Participants who reported a recent labor and delivery unit closure near them saw average increases of 2.52 on the RPES. ConclusionsOur findings are consistent with the growing body of literature internationally that demonstrates the distance required to travel to delivery location is associated with increased stress among rural pregnant women.

Self-management support by health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and prenatal individual appointments

ObjectiveThis cross-sectional questionnaire study investigates if there a difference in the extent to which health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and in prenatal individual appointments support self-management in patient education. It also investigates if there is a difference in the extent to which health care providers in CenteringPregnancy@ and in individual appointments pay attention to the factors of the Integrated Model for Behavioral Change (I-Change) in supporting self-management. MethodsDutch health care providers in prenatal care were invited to fill out a questionnaire. Respondents who provided care in CenteringPregnancy© formed the CenteringPregnancy© group, the others were categorized in the individual appointments’ group. After a definition of self-management and an introduction of the I-Change model, respondents were asked if they supported self-management and if they paid attention to the I-Change model for each of 17 themes of prenatal patient education. Pearson’s chi-squared tests and Fisher’s Exact tests were performed to compare both groups. ResultsWe included 133 respondents. Health care providers in the CenteringPregnancy@ group supported self-management to a higher extent compared to the individual appointments group. This difference was statistically significant for eight themes (body position and exercises, oral health, domestic violence, birth mechanism and premature birth, postnatal period, transition from pregnancy to parenthood, taking care of the baby and newborn’s safety). In both groups, health care providers paid most attention to information or to awareness factors instead of motivation factors. ConclusionWe found a first prove that health care providers in CenteringPregnancy@ support self-management to a higher extent than health care providers in individual appointments. This could be explained by factors as time, feelings of safety and bonding, continuity of care and emphasis on future health behaviour changes. For effective self-management support, attention to motivation factors is important. However, we found that health care providers in both groups paid more attention to information or to awareness factors than to motivation. Practice implicationsHealth care providers in prenatal individual appointments should be aware of the fact that they possibly support self-management less than health care providers in CenteringPregnancy@ . Health care providers in both types of prenatal care should be aware of the fact that they pay little attention to motivation factors. They might need some skills to change their role from teaching professional to supportive leader.

Prevalence of Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhoeae infections in a screening program for under‐30‐year‐old pregnant women with a high participation rate in northern Spain (2016–2020)

AbstractObjectiveTo assess a screening program for sexually transmitted infections (STIs) in under‐30‐year‐old pregnant women, focusing on Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections, which though often asymptomatic, may significantly affect women's health and can be vertically transmitted.DesignProspective, descriptive, observational study.SettingGipuzkoa (Basque Country, Spain).PopulationUnder‐30‐year‐old pregnant women.MethodsBetween 2016 and 2020, cervical samples were taken at first prenatal appointments from 3051 women. STIs were detected by multiplex nucleic acid amplification.Main Outcome MeasuresPrevalence of infections by age and geographical origin groups, and screening coverage.ResultsThe coverage rate was 86% between 2017 and 2020. At least one STI was detected in 5.2% of the under‐30‐year‐olds screened (95% confidence interval [CI]: 4.5%, 6.1%): C. trachomatis in 4%, M. genitalium in 1.3% and N. gonorrhoeae in 0.1%. C. trachomatis and M. genitalium prevalence rates were higher among younger women (7.2% and 2.8%, respectively in under‐25‐year‐olds), while C. trachomatis prevalence in 25‐ to 30‐year‐olds was 2.5%. C. trachomatis was more common among Latin American women (9.7% [95% CI: 7.4%, 12.3%] vs. 2.5% [95% CI: 2.0%, 3.2%] in other women). Additionally, analysing samples from 708 pregnant over‐30‐year‐old women with STI risk factors, 1.6% had at least one of the STIs studied. Notably, 20% of all cases had STI‐related symptoms or complications during pregnancy.ConclusionsThe high coverage achieved, and prevalence, clinical and epidemiological results support the view that the implementation of a screening program across Spain for C. trachomatis in under‐30‐year‐old pregnant women would be both feasible and appropriate.Tweetable abstractHigh Chlamydia trachomatis infection prevalence (4%) and coverage (&gt;80%) in local program support pregnancy screening across Spain.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study

BackgroundInfluenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica. MethodsWe conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information—separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP. ResultsWe surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89–6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06–5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08–4.68); and secondary/university education (aOR: 0.15–0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms. ConclusionVaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

Association between social support and pregnancy stress: a cross-sectional study of neighbors’ interactions

BackgroundPregnancy is associated with substantial stressful experiences. There are controversies concerning the positive and negative roles of social support during pregnancy. This research aimed to study the association of social support with the pregnancy-related stress.MethodsIn the current cross-sectional research, 200 pregnant women were recruited through convenience sampling from two teaching hospitals affiliated with Babol University of Medical Sciences and a private obstetric clinic. The women completed two self-reported questionnaires during prenatal care appointments. The questionnaires included the Revised Prenatal Distress Questionnaire (NuPDQ) and Social Support Questionnaire (SSQ).ResultsA significantly positive association was observed between the social support of neighbors and the total score of pregnancy stress (P<0.001), as well as the scores of its four subscales, namely medical problems (P<0.001), parenting (P=0.25), infant health stress (P=0.006), and pregnancy symptoms (P=0.001). Based on the linear regression models, the social support of neighbors was significantly related to the medical problem-associated stress in pregnant women (β = 0.147, 95% CI: 0.14 to 0.62, p = 0.047), pregnancy symptom (β = 0.203, 95% CI: −0.01 to 0.327, p = 0.017), and fear of childbirth (β = 0.164, 95% CI: 0.05 to 0.38, p = 0.046). Furthermore, the neighbors’ social support (β = 0.172, 95% CI: 0.02 to 0.32, p = 0.04) and the total score of social support (β = 0.155, 95% CI: 0.01 to 0.304, p = 0.046) were significantly associated with the total score of pregnancy stress.ConclusionsNeighbors’ support, as a component of social support, was found to be significantly related to pregnancy stress. This study recommends that healthcare providers consider the positive and negative impacts of social support during the pregnancy period.

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains...

Calcium serum concentration among pregnant women in a tertiary hospital and its satellite hospital in Medan, Indonesia

HIGHLIGHTS 1. Serum calcium concentration in pregnant women who took prenatal appointments in the general hospital and its satellite hospitals were evaluated.2. It was found that serum calcium concentration in those pregnant women who made the prenatal appointments were normal. ABSTRACT Objectives: This study aimed to evaluate serum calcium concentration in pregnant women who made prenatal appointments to Obstetric and Gynecologic Outpatient Clinics at Adam Malik General Hospital, Medan, Indonesia, and its satellite hospitals. Materials and Methods: This study was a descriptive study with a case series approach. The case series of the study included 35 pregnant women in their second or third trimester chosen by consecutive sampling method. Results: The mean calcium serum level of pregnant women in the second and third trimester was 9.12±0.49 mg/dl and 8.97±0.26 mg/dl, respectively. The mean calcium level of pregnant women aged &lt;20, 20-35, and &gt;35 years old were 9.0±0.28 mg/dl, 9.07±0.44 mg/dl, and 8.96±0.06 mg/dl, respectively. Conclusion: This study found that the mean calcium serum level of pregnant women who took prenatal appointments in Haji Adam Malik General Hospital, Medan, Indonesia, was normal.

Pregnant women: psychology, cognitive and behavioral responses, and solutions towards COVID-19

ABSTRACT COVID-19 (Corona Virus Disease 2019) has spread globally and is highly infectious, causing psychological disturbances such as anxiety, depression, or both. Pregnant women, as a vulnerable population, need further attention. This study aims to evaluate the psychological impact of pregnant women during COVID-19 to constitute base data for solution guidance. Using a self-designed questionnaire, self-rated anxiety scale (SAS), and self-rated depression scale (SDS), we conducted a web-based survey on 1160 pregnant women from February 20 to April 30, 2020. The prevalence of anxiety and depression during pregnancy was shown to be 12.93% and 31.21%, respectively. Besides, younger age, housewives, lower education level, and early pregnancy all contributed to psychological disturbance during the COVID-19 pandemic. The results revealed significant variations in cognitive and behavioral responses based on the levels of the COVID-19 pandemic concerns, perceptions of life impacts and family concerns, preparation of personal protection equipment and motherhood, and the need for psychological counseling (P < 0.05). Regarding their primary concerns, 73.2% of the participants worried about the health and safety of childbirth. And 90.6% of respondents anticipated scheduling prenatal appointments to avoid crowds. Pregnant women are susceptible to anxiety/depression during the COVID-19 outbreak, necessitating immediate psychological care and intervention.

Giving Birth in the Early Phases of the COVID-19 Pandemic: The Patient Experience.

ObjectiveObstetrical patients are at risk of complications from COVID-19 and face increased stress due to the pandemic and changes in hospital birth setting. The objective was to describe the perinatal care experiences of obstetrical patients who gave birth during the early phases of the COVID-19 pandemic.MethodsA descriptive epidemiological survey was administered to consenting patients who gave birth at The Ottawa Hospital (TOH) between March 16th and June 16th, 2020. The participants reported on prenatal, in-hospital, and postpartum care experiences. COVID-19 pandemic related household stress factors were investigated. Frequencies and percentages are presented for categorical variables and median and interquartile range (IQR) for continuous variables.ResultsA total of 216 participants were included in the analyses. Median participants age was 33 years (IQR: 30–36). Collectively, 94 (43.5%) participants felt elevated stress for prenatal appointments and 105 (48.6%) for postpartum appointments because of COVID-19. There were 108 (50.0%) were scared to go to the hospital for delivery, 97 (44.9%) wore a mask during labour and 54 (25.0%) gave birth without a support person. During postpartum care, 125 (57.9%) had phone appointments (not offered prior to COVID-19), and 18 (8.3%) received no postpartum care at all.ConclusionCOVID-19 pandemic and public health protocols created a stressful healthcare environment for the obstetrical population where many were fearful of accessing services, experienced changes to standard care, or no care at all. As the pandemic continues, careful attention should be given to the perinatal population to reduce stress and improve continuity of care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10995-022-03495-2.