Prenatal Care Characteristics Research Articles

COVID-19 Pandemic and Food Insecurity among Pregnant Women in an Important City of the Amazon Region: A Study of the Years 2021 and 2022.

Food insecurity (FI) experienced during pregnancy represents a relevant public health problem, as it negatively affects maternal and child health. To investigate the prevalence of FI among pregnant women during the COVID-19 pandemic and determine associated factors. A cross-sectional study was carried out in the period from 2021 to 2022, with a representative sample of 423 women resulting from a sample calculation based on the average (2912 births) that occurred in the years 2016 to 2020 in the only maternity hospital in the municipality. After analyzing the medical records, interviews were carried out with the postpartum women using a standardized questionnaire and the Brazilian Food Insecurity Scale. Poisson regression with robust variance was used to calculate prevalence ratios and 95% confidence intervals to measure associations. FI was observed in 57.0% of cases and was associated with age under 20 years (PR = 1.52; 95% CI 1.29; 1.79), receipt of government assistance (PR = 1.31; 95% CI 1.10; 1.55), loss of family employment (PR = 1.40; 95% CI 1.20; 1.64), greater number of residents (PR = 1.17; 95% CI 1.00; 1.37), and prenatal care in a public institution (PR = 1.53; 95% CI 1.04; 2.26). There was a high prevalence of FI cases, associated with socioeconomic, demographic, and prenatal care characteristics during the COVID-19 pandemic.

Differences between influenza and pertussis vaccination uptake in pregnancy: a multi-center survey study in Italy.

A suboptimal maternal vaccination coverage in 2017-18 has been reported in Italy. The study aims were to (i) assess changes in maternal influenza and tetanus, diphtheria and acellular pertussis vaccination coverage during 2018-19 influenza season compared to the previous season (ii) estimate influenza vaccine coverage among maternal care providers (MCPs) and (iii) explore the characteristics of vaccine delivery to pregnant women. We conducted a cross-sectional survey among pregnant women and MCPs about influenza and pertussis immunization during pregnancy. We also collected information regarding prenatal care characteristics and vaccine delivery among four centers in Italy. We recruited 483 pregnant women and 452 MCPs. The influenza and pertussis vaccine uptake among pregnant women for the season 2018-19 was 14.9% and 60.9%, respectively. MCPs' influenza vaccine uptake was 33.6%. Knowing that the flu vaccine was safe for mothers and their infants and being vaccinated in the previous influenza season were associated with higher vaccine uptake. Regarding pertussis, being a housewife was associated to lower vaccine uptake, while knowing the vaccine is effective and safe for mothers and newborns were associated with higher pertussis vaccine uptake. The single most important factor associated to higher coverage of both influenza and pertussis vaccines was receiving a health-care provider's vaccine advice. Most pregnant women (69.4%) stated that they preferred to be vaccinated in their same prenatal care setting. Receiving a health-care provider's vaccine advice and the availability of vaccines during prenatal care visits might improve vaccination coverage among pregnant women.

Hospitalizations due to Congenital Syphilis in Neonates: Associated Factors from the Prenatal Care Process

Objective: To identify the factors associated with hospitalizations due to congenital syphilis in neonates, based on the characteristics of prenatal care. Materials and method: A quantitative case-control study, conducted by applying a questionnaire to 65 puerperal women with their babies hospitalized from July to November 2017. The data were analyzed using logistic regression, according to the plan proposed in the hierarchical approach. Results: 20% of the hospitalizations were due to syphilis (cases) and 80% to other causes (control). The vulnerability risk (p = 0.036), previous history of sexually transmitted infection (p = 0,006), use of oral contraceptives (p = 0.011) and parity (p = 0.043) variables were statistically significant. The absence of the partner during the consultation (p = 0.028), failure to perform a rapid test for syphilis (p = 0.035) and educational activity for the partner (p = 0.033) were also associated with the occurrence of the outcome, in addition to the variables of the newborn: low birth weight (p = 0.025), not being on exclusive breastfeeding (p = 0.036) and not having had skin-to-skin contact (p = 0.043). Conclusions: Congenital syphilis has several risk factors for its occurrence. It was possible to observe that the assistance inequalities existing in care during the prenatal consultations directly reflect on the occurrence of this condition.

Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014.

Universal prenatal screening in the Canadian province of Alberta employs an 'opt-out' HIV screening strategy. We examined all women giving birth in the province and determined the frequency and characteristics of women having and not having HIV screening. All livebirths in Alberta from January 1, 2010 to December 31, 2014 were compiled from the Vital Statistics database and linked to HIV screening data to determine maternal demographic and prenatal care characteristics. Correlates associated with prenatal HIV screening, opting out of HIV screening, and not having any prenatal communicable disease screening were determined by multivariable statistics. Of the 256,280 live births, 94.2% had prenatal HIV screening, 1.9% declined prenatalHIV screening, and 3.9% had no record of any prenatal communicable disease testing. Compared with those who had HIV screening, those who opted out of prenatalHIV screening were more likely to be over 40years of age (adjusted odds ratio (AOR), 2.83 [2.12-3.78]) and less likely to be single (AOR, 0.67 [0.62-0.73]) and First Nations (AOR, 0.67 [0.56-0.82]). Those who received no prenatal communicable disease screening were less likely to be over 40years of age (AOR, 0.81 [0.69-0.95]) and more likely to be single (AOR, 1.27 [1.21-1.33]) and have received no prenatal care (AOR, 6.78 [6.40-7.19]). Both the HIV decliners and prenatal non-testers were more likely to have used a midwife (AOR, 4.52 [3.83-5.35] and AOR, 2.44 [2.03-2.92], respectively). Demographic and prenatal care characteristics differ by a pregnant woman's prenatal screening status. Policies to improve HIV screening coverage should take these variations into account.

Predictors of Women's Satisfaction with Prenatal Care in a Canadian Setting.

Prenatal care is a vital and important part of a healthy pregnancy, providing many maternal and health benefits. Despite Canada's publically funded health care system with universal access, inadequate rates of prenatal care continue to be observed. As a modifiable risk factor, the process variables that influence satisfaction with prenatal care in Canadian settings have received little attention. The objective of this study was to identify the predictors of satisfaction with prenatal care. A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, and with four dimensions of satisfaction. A convenience sample of 216 pregnant women was surveyed using self-administered questionnaires with women in their third trimester. Multiple linear regression analyses were used to identify predictors of satisfaction. The quality of prenatal care and provider interpersonal style together explained 80% of the variance in overall satisfaction. Patient-centered decision-making was a significant predictor of satisfaction with information, while having a midwife was a predictor of satisfaction with system characteristics. Expectations were not related to satisfaction. Improving quality of care, provider interpersonal style and patient-centered decision making, and improving the structural characteristics of prenatal care may be effective in improving women's satisfaction and utilization of prenatal care.

ASSISTÊNCIA PRÉ-NATAL NO ESTADO DE PERNAMBUCO: UM ESTUDO COMPARATIVO DE INQUÉRITOS

A assistência pré-natal se destaca como fator essencial na proteção e prevenção a eventos adversos sobre a saúde do binômio mãe e filho, possibilitando a identificação e o manuseio clínico de intervenções oportunas sobre potenciais fatores de risco para complicações à saúde. Objetiva-se descrever e comparar as principais características da assistência pré-natal nos anos de 1997 e 2006, no estado do Pernambuco. Realizou-se estudo de base populacional, observacional, de coorte transversal, utilizando dados secundários, extraídos de informações dos bancos de dados das segunda e terceira Pesquisas Estaduais de Saúde e Nutrição, realizadas nos anos de 1997 e 2006, respectivamente. Considerou- -se satisfatória, em 2006, a assistência pré-natal que atendeu três das recomendações mínimas preconizadas pelo Ministério da Saúde: início do pré-natal até a 16ª semana de gestação, seis ou mais consultas e orientações sobre razões e prática do aleitamento materno. Houve importante melhora na assistência pré-natal em 2006 (acréscimo de 17,1%) quando comparada a 1997. O pré-natal no ano de 2006 foi mais satisfatório para as mulheres com 20 a 35 anos (60,7%), brancas (60,0%), de maior escolaridade (71,8%), com renda superior ou igual a um salário-mínimo (75,8%), com dois a três filhos (63,1%) e residentes na Região Metropolitana do Recife (68,3%). Apresentou-se menos satisfatório para as mulheres trabalhadoras (54,7%) e do interior rural (49,1%, p < 0,001). Apesar da ampliação da cobertura do pré-natal, ressalta-se a necessidade de melhorar sua qualidade, visando promover a saúde de forma integral, especialmente em comunidades carentes, onde prevalecem os fatores de risco.

Vaccination against influenza among pregnant women in southern Brazil and associated factors.

This article aims to identify the prevalence and factors associated with influenza vaccination in pregnant women. This is a cross-sectional study conducted in a municipality in the southernmost region of Brazil, which included all women giving birth in 2016. The outcome was having received the vaccine against influenza during pregnancy. Sociodemographic, behavioral and prenatal care characteristics and morbidities were analyzed. The analysis included sample description, the prevalence of vaccination for each independent variable and a multivariate analysis. Two thousand six hundred ninety-four pregnant women were interviewed, of which 53.9% reported having been vaccinated. Factors associated with increased prevalence of vaccination were mother's higher schooling, prenatal care, tetanus vaccination and prenatal care performed in a public service. On the other hand, prenatal care onset after the first quarter reduced the prevalence of vaccination. The results point to the need to reinforce the importance of vaccination against influenza among pregnant women and among health professionals, regardless of the severity of the current epidemiological setting.

Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: results from a national survey

ABSTRACT Pregnant women and infants are at high risk for severe influenza and many countries, including France, recommend annual influenza immunization during pregnancy. We aimed to estimate influenza vaccination and refusal rates and assess associated factors among pregnant women during the 2015–16 season in France. We used data from a national representative sample of women who gave birth in March 2016 and were interviewed before hospital discharge (N = 11,752). In the multivariable analysis, robust Poisson regression models were used to study associations with maternal characteristics and prenatal care characteristics. Influenza vaccine coverage among pregnant women was 7.4% (95% confidence interval [CI]: 6.9–7.9). Only 24.9% (95% CI: 24.2–25.7) of women said that they received a care provider proposal for vaccination and 70.4% (95% CI: 68.7–72.0) of these declined it. Vaccine uptake was associated with low parity (prevalence ratio [PR] = 2.1; 95% CI: 1.4–3.2 for parity 0 vs ≥ 3), high educational level (PR = 2.5; 95% CI: 2.0–3.2), healthcare occupation during pregnancy (PR = 1.8; 95% CI: 1.5–2.1) and preexisting conditions at risk for influenza (PR = 1.7; 95% CI: 1.3–2.2). Women were more frequently vaccinated when their main care provider was a general practitioner. Multiparae women and those with medium or low educational level were significantly more likely than others to decline influenza vaccine after a provider proposal. Influenza vaccine coverage is very low in France, mainly because of infrequent care provider proposals and also frequent women’s refusals. Effective interventions should be designed to promote vaccination among medical professionals and reduce vaccine hesitancy among pregnant women.

Influence in the reproductive planning and the women's satisfaction with the discovery of being pregnant in the quality of prenatal care in Brazil

Abstract Objectives: to analyze the influence on reproductive planning and the women's satisfaction with the discovery of being pregnant in prenatal care characteristics. Methods: a cross-sectional and quantitative study was carried out between March and July 2018 at a low-risk maternity hospital in the Brazilian Northeast region. A total of 652 puerperal women were evaluated in an interview and by their prenatal care card. The Chi-square test and the Odds Ratio were used for statistical analysis. Results: the pregnancy planning was reported by 42% (n=274), and the women's satisfaction of being pregnant was 64.1% (n=418) of the interviewees. Reproductive planning was associated with early initiation of prenatal care (OR=2.48, CI95%=1.61-3.82) and the women received information about the referral maternity for childbirth (OR=1.44, CI95%=1.05-1.99). The women's satisfaction with their pregnancy was also associated with early initiation of prenatal care (OR=2.18; CI95%=1.47-3.25). It should be noted that the performance of six or more prenatal care consultations was less frequent among pregnant women who had not planned their pregnancy (OR=0.43, CI95%=0.27-0.66) and they felt unsatisfied with the discovery of being pregnant (OR=0.56; CI95%=0.37-0.84). Conclusions: Pregnancy planning and women's satisfaction with the discovery of being pregnant favors the performance of prenatal care with better indicators.

Follow up of HIV perinatal exposure and accomplishment of strategies to reduce the risk of viral transmission, experience in a reference hospital in Medellín

Introduction: Prevention of mother-to-child transmission of the human immunodeficiency virus (HIV) is essential to limit the spread of the disease. Colombian data about HIV infection in pregnancy are scarce, as well as on the results of the strategies used worldwide to reduce perinatal transmission. Objective: To describe the characteristics and outcomes of pregnant women infected with HIV and their children in a reference center in Medellín. Materials and methods: We conducted a retrospective observational study for the 2012-2015 period by studying the clinical records of newborns exposed to HIV and their mothers. We evaluated the characteristics of prenatal care, deliveries, and infant postnatal care, as well as the follow-up data to confirm or exclude HIV transmission. Results: We included 106 infants and their mothers. We found that 39,6% of mothers knew about the HIV diagnosis before pregnancy and 58,5% were diagnosed during pregnancy; 95.3% of them attended prenatal controls, but only 46.5% as of the first trimester; 95% of them received antiretrovirals, but 23.9% started therapy just during the third trimester. Only 63% of women had a viral load for HIV after 34 weeks of gestation. None of the 103 children with follow up had confirmed presence for HIV and in 88% of them, it was discarded. Conclusions: No cases of perinatal HIV transmission were found in the study. However, difficulties and delays persist in prenatal care, in timely maternal follow-up to confirm or discard HIV, and for early detection of maternal co-infections and their effects on newborns.

Economic and racial inequalities in the prenatal care of pregnant teenagers in Brazil, 2011-2012

Abstract Objectives: to analyze the prenatal care of pregnant teenagers interviewed in the post-partum period in Brazilian maternity hospitals, according to economic status and skin color. Methods: data were obtained from the Birth in Brazil study, a national hospital-based survey in 2011 and 2012. Information was obtained from interviews with the postpartum women and from data collected from their prenatal cards. Multivariate logistic regression was used to verify whether maternal and prenatal care characteristics were associated with ina-dequate prenatal care. Results: a total of 3,317 teenage mothers were interviewed in the postpartum period, 84.4% of whom had received inadequate prenatal care, with worse results for lower-income, lower-schooling, and multiparous teens. In the same way, it became evident the higher proportion of black teenagers and those from economic classes D/E among those who failed to receive routine laboratory tests, who received little orientation on the pregnancy, labor, and childbirth, and who were forced to go from one maternity hospital to another before being admitted to give birth. Conclusions: strategies targeted to the most vulnerable pregnant teenagers should be implemented in order to achieve greater equality in teenagers’ prenatal care, seeking to assure easier access, earlier initiation of care, and greater case-resolution capacity

Gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital in the interior of Minas Gerais, Brazil

The scope of this research was to analyze the gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital located in a city in Minas Gerais, which is a hospital of reference in the macro-region of health of Jequitinhonha. It involved a descriptive cross-sectional study. A total of 327 mothers were interviewed between May 2013 and March 2014 using a semi-structured questionnaire. With a sample of 255, the number of adult women was predominant. With respect to prenatal care, 324 pregnant women had medical appointments. In terms of the location for prenatal care, 79.2% of adolescents were attended in the public health service, while that percentage was 60.4% among adult women. Regarding the type of birth, 54.7% of mothers had normal delivery and 45% had cesarean section. Among adolescents, there was a higher percentage of normal delivery compared to adult women and this data had a statistically significant relationship with the age of the pregnant women. With respect to gestational age at birth, 85.9% had full-term deliveries, 13.5% had preterm delivery and 0.6% had post-term delivery. It was revealed that adolescent mothers were at a disadvantage compared to the other mothers in terms of both socioeconomic characteristics and prenatal care received.

Support for Self-Management and Prenatal Health Behavior Change: Implications for Pediatric Promotion of Interconception Care.

Pediatricians increasingly endorse a dual generation approach to health, in which parental health behaviors are recognized as critical to promoting child health. Positive parental behaviors often emerge during pregnancy, for reasons that remain incompletely described. We surveyed mothers in the immediate postpartum period to identify beliefs about health behavior change and characteristics of prenatal care associated with successful change. Sampling at a tertiary care hospital captured an English-speaking adult population with healthy infants. Respondents (n = 225) were predominantly non-Hispanic Black (64%) and Medicaid insured (44%). Most (71%) reported successful behavior change during pregnancy. Of those reporting change, 91% intended to sustain behaviors postnatally. Most believed that sustained change was important for their own health (94%) and their infant’s health (93%). In logistic regression, support for self-management was associated with prenatal health behavior change (odds ratio = 1.64, 95% confidence interval = 1.09-2.46). Continued support for self-management by pediatricians may benefit long-term family health.

Low birth weight and prenatal care in Colombia: a cross-sectional study.

BackgroundLow birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia.MethodsObservational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done.ResultsA LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR = 0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR = 0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR = 1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW.ConclusionThis research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics.

A systematic review of maternal confidence for physiologic birth: characteristics of prenatal care and confidence measurement.

Because a focus on physiologic labor and birth has reemerged in recent years, care providers have the opportunity in the prenatal period to help women increase confidence in their ability to give birth without unnecessary interventions. However, most research has only examined support for women during labor. The purpose of this systematic review was to examine the research literature for information about prenatal care approaches that increase women's confidence for physiologic labor and birth and tools to measure that confidence. Studies were reviewed that explored any element of a pregnant woman's interaction with her prenatal care provider that helped build confidence in her ability to labor and give birth. Timing of interaction with pregnant women included during pregnancy, labor and birth, and the postpartum period. In addition, we looked for studies that developed a measure of women's confidence related to labor and birth. Outcome measures included confidence or similar concepts, descriptions of components of prenatal care contributing to maternal confidence for birth, and reliability and validity of tools measuring confidence. The search of MEDLINE, CINAHL, PsycINFO, and Scopus databases provided a total of 893 citations. After removing duplicates and articles that did not meet inclusion criteria, 6 articles were included in the review. Three relate to women's confidence for labor during the prenatal period, and 3 describe tools to measure women's confidence for birth. Research about enhancing women's confidence for labor and birth was limited to qualitative studies. Results suggest that women desire information during pregnancy and want to use that information to participate in care decisions in a relationship with a trusted provider. Further research is needed to develop interventions to help midwives and physicians enhance women's confidence in their ability to give birth and to develop a tool to measure confidence for use during prenatal care.

Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention.

To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice. A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county-level demographic and medical resource characteristics. Deliveries occurring before 35 weeks gestation (n=5,150) were used for analysis. Logistic regression analysis was used to examine time trends and individual, county, and intervention characteristics associated with delivery at hospitals with NICU, and delivery at the academic medical center. Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting. Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Diferenciais socioeconômicos na realização de exame de urina no pré-natal

Urinalysis is an essential component of the prenatal routine, as urinary tract infections during pregnancy may lead to preterm delivery and neonatal morbidity. The objective of the study was to analyze factors associated to the solicitation of urinalysis during pregnancy. During 2004, 4,163 women living in the urban area of Pelotas (Southern Brazil) and who had received prenatal care were interviewed after delivery in the maternity hospitals of the city. Prevalence of the non-performance of urinalysis was analyzed in relation to socioeconomic and demographic variables, as well as to characteristics of prenatal care. After a bivariate analysis, logistic regression was conducted to identify factors associated with the outcome, controlling for possible confusion factors at a 5% level of significance. The prevalence of not having had the test was 3%. The multivariate analysis showed that black skin color, poverty, low schooling, being unmarried and having fewer than six prenatal visits were associated with a higher probability of not carrying out the test. Women who were black, poor and with low schooling presented a 10% probability of not being examined, compared to 0.4% for mothers who were white, wealthy and highly educated. Despite the fact that urinalysis is essential for preventing complications for the mother and newborn, 3% of the women were not screened. Screening coverage may serve as an indicator to assess the quality of prenatal care. Pregnant women who are black, poor, with low schooling and unmarried should be targeted in programs for improving the quality of care.

Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care

The objective of the study was to describe the patient characteristics of prenatal care utilization within and outside of routine obstetric care, and the clinical and psychosocial factors that predict care utilization. Four hundred twenty pregnant women enrolled in a randomized controlled trial receiving prenatal care in a university-affiliated clinic. All hospital encounters were obtained by review of computerized databases. The Kotelchuck index (KI) was computed, and the characteristics of inadequate, adequate, or excessive prenatal care were described. Demographic and psychosocial predictors of unscheduled visits were evaluated. A total of 50.5% of women were adequate users by KI, with 19% being inadequate. An average of 5 additional unscheduled encounters occurred (standard deviation 4.2; range, 0-26). Almost 75% of participants made an unscheduled obstetric visit, with 38% making 2 or more unscheduled visits. Overweight/obese, younger women, high symptom distress, and excessive and inadequate prenatal users were more likely to utilize the labor floor before delivery. Unscheduled care is common during pregnancy.

Health and working conditions of pregnant women working inside and outside the home in Mexico City.

BackgroundTo explore differences related to health and working conditions by comparing socio-demographic parameters, reproductive and prenatal care characteristics and working conditions among pregnant women who are employed outside the home (extra-domestic) while still performing a domestic workload versus those who perform exclusively domestic work in the home (intra-domestic).MethodsA cross-sectional study was carried out at Family Medicine Unit N 31 of the Mexican Institute of Social Security (IMSS) in Mexico City between April and July 2003. Interviews were conducted with 537 pregnant women engaged in either extra-domestic work plus intra-domestic tasks, or those performing strictly intra-domestic work. Information was obtained regarding their demographic status, prenatal care, reproductive, work characteristics, and health during pregnancy.ResultsOne hundred ninety-six (36.5%) of the interviewed women had paid jobs outside the home in addition to domestic tasks, while three hundred forty-one (63.5 %) engaged in exclusively intra-domestic occupations. Of the women with paid jobs, 78.6% worked as clerks. Among domestic tasks, we found that the greatest workload was associated with washing of clothes, and our micro-ergonomic analysis revealed that women who worked strictly inside the home had a higher domestic workload versus employed women (69.2 vs. 44.9%). When we analyzed the effect of work on health during pregnancy, we observed that women who worked strictly inside the home were at a higher risk for musculoskeletal and genitourinary symptoms than those employed outside the home.ConclusionThese findings suggest that the effect of intra-domestic work should not be ignored when considering women's health during pregnancy, and that greater attention should be paid to women's working conditions during intra and extra-domestic work.

Inadequate Syphilis Screening Among Women With Prenatal Care in a Community With a High Syphilis Incidence

This study was designed to evaluate the extent to which pregnant women in a community with a high syphilis incidence were screened for syphilis according to standard recommendations of twice during prenatal care and at labor and delivery. Labor and delivery records from 4 hospitals in Miami-Dade County, Florida, were abstracted to obtain maternal and prenatal care characteristics and syphilis screening practices. Of the 1991 women, records indicated that 1655 (83%) were screened at least once during prenatal care, 220 (11%) were screened twice during prenatal care before delivery, and 184 (9%) were screened twice during prenatal care and at delivery. Attending a private clinic, having more than adequate prenatal care and having private insurance were associated with not being screened at least twice before delivery. Few women were screened according to standard recommendations, and provider or institutional-related factors affected adequacy of screening.