Prenatal Care For Pregnant Women Research Articles

Assessment of women’s needs and wishes regarding interprofessional guidance on oral health in pregnancy – a qualitative study

BackgroundPoor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women’s positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.MethodsSources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.Results25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.ConclusionGuidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

Impact of telehealth on patient-provider communication in prenatal care for pregnant women from underserved settings

ABSTRACT Introduction: Telehealth has emerged as a promising supplementary modality in prenatal care. However, its impact on patient-provider communication (PPC), especially among pregnant women from underserved settings, requires comprehensive evaluation. This study examined the factors associated with the quality of patient-provider communication during the COVID-19 pandemic among pregnant telehealth users and non-users. Methods: Using a cross-sectional study design, 242 women were surveyed (response rate = 23%) regarding their experience with telehealth, quality of PPC, and experiences of discrimination during prenatal care. Multiple regression models were used to identify the factors associated with the quality of PPC during the COVID-19 pandemic. A sub-group analysis explored the factors associated with the quality of PPC separately among telehealth users and non-users. Results: The majority of the participants were on Medicaid (95%) and self-identified as Black/African American (57.3%). Regression analyses revealed a negative relationship between telehealth use during pregnancy and the quality of PPC (β = −1.13, P = 0.002). Irrespective of the telehealth use, the experience of discrimination was associated with poor quality of PPC among users (β = −3.47, P = .02) and non-users (β = −.78, P = .03), while adjusting for sociodemographic factors and social support during pregnancy. Discussion: While telehealth offers advantages like convenience, increased accessibility, and continuity of care, challenges in establishing effective PPC in virtual settings have emerged that emphasize the necessity for comprehensive provider training extending beyond technical competencies. The persistent issue of perceived discrimination, impacting PPC across both groups, underscores the necessity to rethink existing strategies of mandatory training to increase providers’ knowledge.

Impact of maternal HIV infection on perinatal outcomes: A systematic review.

Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.

Effectiveness of an Individual Counseling Program in Coping With the Fear of Childbirth: A Randomized Controlled Study

OBJECTIVES:To develop an individual counseling program to help women cope with their fear of childbirth and test the program for effectiveness.METHODS:A randomized controlled trial study was conducted over the period of August 2018 to April 2020. A total of 70 primiparas constituted the study sample. Women were randomized to (a) a control group and received standard care and (b) an intervention group and received standard care plus the individual counseling program.RESULTS:The individual counseling program significantly reduced the mean scores for fear of childbirth (intervention group: 30.81 ± 20.64; control group: 67.94 ± 27.37). The percentage of women in the intervention group preferring a normal delivery in the future (75.7%) was statistically higher compared to the control group (48.5%). The program did not affect cervical dilation, gestational week, duration of delivery, the baby’s birth weight, duration of stay at the hospital, and spontaneous labor.CONCLUSIONS:The results showed that the individual counseling program reduced primiparas’ fear of childbirth but did not have an impact on birth outcomes. Incorporating an individual counseling program into the routine prenatal care of pregnant women may diminish the level of their fear of childbirth and make childbirth a more positive experience.

Teenage Pregnancy

This work seeks throughout its topics to present one of the major social problems in the world, teenage pregnancy, highlighting the vision of renowned authors, as well as establishing an understanding of the measures adopted by governments in order to minimize the growth of adolescents who become become mothers. The general objective of the work is to highlight the aspects involved in teenage pregnancy, as for the specific objectives, they are: describe the social view on teenage pregnancy; present the measures or precautions established by the government as a way to minimize pregnancy among teenagers; highlight the relevance of prenatal care for pregnant women. In the process of developing the work, a literary review was carried out, based on works published in the last 11 years, to highlight some of the main concepts and evaluations of authors from both the social and medical fields.

Group prenatal care for pregnant women with opioid use disorder: Preliminary evidence for acceptability and benefits compared with individual prenatal care.

The effectiveness of group prenatal care (G-PNC) compared with individual prenatal care (I-PNC) for women with opioid use disorder (OUD) is unknown. The objectives of this study were to (1) assess the acceptability of co-locating G-PNC at an opioid treatment program and (2) describe the maternal and infant characteristics and outcomes of pregnant women in treatment for OUD who participated in G-PNC and those who did not. This was a retrospective cohort study of 71 women (G-PNC n = 15; I-PNC n = 56) who were receiving treatment for OUD from one center and who delivered in 2019. Acceptability was determined by assessing the representativeness of the G-PNC cohorts, examining attendance at sessions, and using responses to a survey completed by G-PNC participants. The receipt of health services and healthcare use, behaviors, and infant health between those who participated in G-PNC and those who received I-PNC were described. G-PNC was successfully implemented among women with varying backgrounds (e.g., racial, ethnic, marital status) who self-selected into the group. All G-PNC participants reported that they were satisfied to very satisfied with the program. Increased rates of breastfeeding initiation, breastfeeding at hospital discharge, receipt of the Tdap vaccine, and postpartum visit attendance at 1-2 weeks and 4-8 weeks were observed in the G-PNC group compared with the I-PNC group. Fewer G-PNC reported postpartum depression symptomatology. Findings suggest that co-located G-PNC at an opioid treatment program is an acceptable model for pregnant women in treatment for OUD and may result in improved outcomes.

Access to emergency surgical treatment for congenital heart diseases in the state of São Paulo

ObjectiveTo analyze access to surgical care for congenital heart diseases in public specialized centers in the state of São Paulo before and during the COVID-19 pandemic and availability of surgical care in specialized hospitals, to identify bottlenecks in the care path for neonatal cardiac surgery. MethodsThis study included 1,437 children, under one year old, with congenital heart disease and formal referral to heart surgery between February 1, 2019, and February 28, 2021. Quantitative data analysis was performed using t-tests or the Mann-Whitney test. ResultsApproximately 30 % of children with urgent congenital heart disease could not access recommended care, mainly those needing complex surgeries (categories RACHS 4 to 6). The main diagnoses of neonates accessing care were patency of the ductus arteriosus (10.5 %) and coarctation of the aorta (10.1 %). Referral time for children in RACHS 1 to 3 was 4 days (median), while for those in categories 4 to 6, it was 7 days (p < 0.001). Longer referral time (20 days) was associated with court orders. During the pandemic, referral time decreased to 3 days, compared to 5 days (median) in the pre-pandemic period (p < 0.001). ConclusionThe emergency surgical treatment supply for congenital heart diseases is insufficient compared to the current demand. Future research should evaluate if access to care in publicly funded hospitals could be improved by better access to prenatal care for pregnant women, increased diagnostic and therapeutic capacity in pediatric cardiology, and financial incentives for complex cardiac surgeries.

The analysis of qualitative indicators of the obstetric service in Vinnytsia for the year 2022

Annotation. A comparative assessment of statistical indicators of the work of maternity care facilities allowed us to characterize the quality of medical services provided to pregnant women, women in labor and women giving birth, to assess changes in perinatal morbidity and mortality under the influence of the development and achievements of modern obstetrics. The aim of the study was to analyze the qualitative indicators of the activity of maternity care institutions in the city of Vinnytsia in the year 2022 for modern forecasting of promising directions for the restoration of the national reproductive potential of Ukraine. The statistical report of the Department of Health of Vinnytsia for the year 2022 served as the source material. The epidemiological statistical method was used during the work, specifically an analytical approach. According to which, a retrospective analysis of official statistics data from the Department of Health of Vinnytsia for the year 2022 was applied. Retrospective analysis and the epidemiological method of determining the relative values ​​of morbidity indicators were used, and the data were processed using the "Statistica 5.0" program package. It is established that due to the increase in the population of Vinnytsia through internal migration and the introduction of the principle of extraterritoriality in healthcare, the number of births was 3858. Among the women who gave birth in Vinnytsia in 2022, 33% were internally displaced persons from the temporarily occupied territories of Ukraine. The coverage of prenatal care for pregnant women and the coverage of medical examinations for both organized and unorganized populations constituted 98.2%. The percentage of home births was 0.02%, and the percentage of criminal abortions in 2022 was at 0%. The number of premature births was 2.7%, the perinatal mortality of premature babies was 0.2%, and the perinatal mortality of babies was 6.2%. So, the analysis of the quality indicators of the work of the obstetric service indicates the high quality of providing medical services to pregnant women, women in labor and women giving birth, as well as the absence of maternal mortality.

Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis.

To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB). The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs). Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate. Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.

PENGEMBANGAN APLIKASI PELAYANAN ANTENATAL CARE BAGI IBU HAMIL DI ERA PANDEMI COVID -19 BERBASIS ANDROID DI KAB.BANGKA

The emergence of the COVID-19 pandemic has had an impact on the health service delivery system. The impact of COVID-19 could be greater on vulnerable populations including pregnant women. Pregnant women are afraid to go to health facilities for fear of contracting Covid, suggestions to postpone pregnancy checks and classes for pregnant women, as well as service uncertainty in terms of personnel and infrastructure including personal protective equipment. The aim of this research is to develop an Android-based ANC Service Application for Pregnant Women in the Pandemic Era. This research was carried out at PKM Kenangan, Bangka Regency in May-October 2021. The informants in this study were village midwives and pregnant women. This type of research is qualitative with a research and development approach. The data used in this study are secondary and primary data through Focus Group Discussion with purposive sampling. This research method is RnD (research and development sequential explanatory mixed methods, the first stage is quantitative research then qualitative research is carried out to strengthen the quantitative results. The data used in the quantitative research is secondary data from perinatal mortality and OVP recapitulation, while in qualitative research with interviews in depth by taking purposive sampling. The results showed that information related to the Corona Virus in pregnant women was still minimal and difficult to access, so it was necessary to have a special application related to information related to the Corona Virus in pregnant women. Based on these results, a blue print application model was created and the initial product was in the form of Android-based application regarding guidelines for prenatal care for pregnant women during the COVID-19 pandemic. The conclusion in this study is that information related to antenatal care for pregnant women during the Covid pandemic era is less sick. i antenatal care services for pregnant women during the Corona Virus pandemic 19.

Maternal and perinatal outcomes in mixed antenatal care modality implementing telemedicine in the southwestern region of Colombia during the COVID-19 pandemic

IntroductionContingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine.ObjectiveWe aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine.MethodsWe conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20,202, determining each group's maternal and neonatal outcomes.ResultsA total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6–9) vs 6 (4–8) p < 0.001), with an earlier gestational age at onset (7.1 (6–8.5) vs 9.3 (6.6–20.3), p < 0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p = 0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications.DiscussionIncorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.

Demand of Prenatal Care for Pregnant Women with Health Problems

Demand of Prenatal Care for Pregnant Women with Health Problems

The association between high hemoglobin levels and pregnancy complications, gestational diabetes and hypertension

Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the principal causes of maternal morbidity and mortality. The maternal morbidity and mortality burden for women is relatively high, suggesting a substandard quality of care. Therefore, an early diagnosis of GDM and gestational hypertension (GH) can improve prenatal care for pregnant women and improve pregnancy outcomes. Previous studies demonstrated that elevated Hb levels in the first trimester indicate possible pregnancy complications and should not only be considered as good iron status. However, ethnic differences could play a role in determining the magnitude of the association. We hypothesized that high Hb levels (≥12.5 g/dl) in the first trimester (6-13 gestational weeks, GW) are associated with an increased risk of fasting blood sugar (FBS) ≥126 mg/dl, systolic blood pressure (SBP) ≥140 mmHg, and diastolic blood pressure (DBP) ≥90 mmHg among pregnant women visiting prenatal clinics.

Factors Affecting Antenatal Care Examination on Pregnant Women in the Work Area of Hinai Kiri Health Center, Langkat Regency

The contentment of pregnant women throughout ANC and delivery may enhance the health of moms and infants. This research aims to determine what factors influence prenatal care for pregnant women in the Hinai Kiri Health Center Work Area, Secanggang District, Langkat Regency. This study employs a quantitative approach with a cross-sectional design, surveying 68 participants. This study employs a questionnaire. As a follow-up to the conclusion of the study, the research period is July to December 2021. This research included Univariate, Bivariate, and Multivariate analyses. The statistical tests used include the chi-square test and longitudinal regression. Knowledge (P-value = 0.003), Age (P-value = 0.002), Parity (P-value = 0.000), Husband's Support (P-value = 0.000), and Distance to Health Place (P-value = 0.004) were significant in a logistic regression analysis. Variables affecting the Antenatal Care Examination of Pregnant Women include knowledge, husband's support, age, and parity. This research concludes that there is a strong relationship between Knowledge, Husband's Support, and Parity and Antenatal Care Examinations for Pregnant Women in the Work Area of the Hinai Kiri Health Center in Secanggang District, Langkat Regency. Midwives on duty at the Hinai Kiri Health Center are expected to receive recommendations to improve counseling and counseling about the importance of routine pregnancy checks and to encourage pregnant women to be more routinely check their pregnancy at least four times during pregnancy so that the mother's health condition and the fetus are awake.

Risk factors for early neonatal sepsis: retrospective Cohort in the brazilian amazon

Objective: to analyze risk factors for neonatal sepsis in a capital of the Brazilian Amazon region. Methods: Retrospective cohort of 411 mothers and their newborns assisted at the municipal maternity hospital from December 2019 to February 2020. Sociodemographic information, history of prenatal care, childbirth type and characteristics of the newborn were collected from the medical records of the binomial mother-child. To estimate the gross and adjusted Relative Risk and 95% confidence intervals, Poisson Robust Regression using Stata®, version 16.0 was used. Result: The incidence of sepsis was 75.42 per 1,000 live births. The risk factors for neonatal sepsis were previous infectious disease (RR: 2.40; 95% CI: 1.21; 4.76), APGAR score less than seven in the first minute (RR: 2.96; 95% CI:1.17; 7.47) and low birth weight (RR: 5.60 CI; 95%: 1.69; 18.50). Conclusion: The identification of predictors for the outcome and early monitoring of pregnant women in prenatal care are important actions to minimize the occurrence of neonatal sepsis. For future studies, it is suggested research in the scope of primary health care and maternity for the qualification of professionals working in the line of care for pregnant women and their families.

Maternal FMR1 alleles expansion in newborns during transmission: a prospective cohort study.

The CGG repeats in the 5' untranslated region of the fragile X mental retardation 1 gene (FMR1) gene shows increased instability upon maternal transmission. Maternal FMR1 intermediate (45-54 repeats) and premutation (PM: 55-<200 repeats) alleles usually expand to full mutation (>200 repeats) alleles in offspring and consequently, cause fragile X syndrome (FXS) in them. In a prospective cohort study, Pakistani pregnant women in prenatal care were first screened for FMR1 expanded alleles. In the follow-up, pregnancy outcomes in women carrying FMR1 expanded alleles were recorded and their newborn offspring were also screened for FXS. In a total of 1950 pregnant women, 89 (4.6%) were detected carriers for FMR1 expanded alleles; however, rates of detection of expanded alleles were found significantly high in women with a history of FXS. In addition, miscarriages and birth of affected newborns with FXS were significantly more common in women carrying large size PM alleles and had a history of FXS (P = 0.0494 and P = 0.0494, respectively). The current study provides the first evidence of screening Pakistani pregnant women for FMR1 expanded alleles in prenatal care. Moreover, the miscarriage was also detected as a clinical predictor for FXS. Offspring would have a higher risk of developing FXS due to maternal FMR1 alleles expansions during transmission. This is the first prospective cohort study in Pakistan for finding FMR1 allelic status of pregnant women and their newborn offspring in follow-up. The robust offspring risk for FXS estimated in this study may be valuable information for genetic counseling of women carriers for FMR1 expanded alleles. The family history and miscarriage were detected as effective indicators for FXS carrier screening in Pakistani women.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

The Association Between High Hemoglobin Levels and Pregnancy Complications, Gestational Diabetes and Hypertension, Among Palestinian Women.

Introduction: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the principal causes of maternal morbidity and mortality. The maternal morbidity and mortality burden for Palestinian women is relatively high, suggesting a substandard quality of care. Therefore, an early diagnosis of GDM and gestational hypertension (GH) can improve prenatal care for pregnant women and improve pregnancy outcomes. Previous studies demonstrated that elevated Hb levels in the first trimester indicate possible pregnancy complications and should not only be considered as good iron status. However, ethnic differences could play a role in determining the magnitude of the association. We hypothesized that high Hb levels (≥12.5 g/dl) in the first trimester (6-13 gestational weeks, GW) are associated with increased risk of fasting blood sugar (FBS) ≥126 mg/dl, systolic blood pressure (SBP) ≥140 mmHg, and diastolic blood pressure (DBP) ≥90 mmHg among pregnant Palestinian women visiting prenatal clinics in Palestine.Methods: Medical records (N=5263) were reviewed for singleton pregnancies who had their first maternity care clinic visit (6-13 GW) at primary healthcare centers of the Palestinian Ministry of Health in the north of the West Bank in 2018 and 2019. Women were excluded if they had FBS ≥92 mg/dl, SBP ≥140 mmHg, DBP ≥90 mmHg, ultrasound-based gestational age >13 weeks, or who were previously diagnosed with diabetes mellites, GDM, hypertension, GH, taking drugs for these conditions, or were smoking during pregnancy. Hb levels in g/dl were divided to low (<11.0), normal (11-12.49), and high (≥12.5). The associations between high hemoglobin levels and pregnancy complications in pregnant women were assessed by calculating the odds ratios (OR) and their 95% confidence intervals (CIs) using logistic regression. P-values of <0.05 were considered significant.Results: The final number of eligible records was 2565. Pregnant women with high Hb levels in the first trimester were at higher risk of high FBS (≥126 mg/dl; OR=2.99, 95%CI, [1.675-5.368]) and high systolic blood pressure (≥140 mmHg; OR=3.048, 95%CI, [1.252-7.421]) at 24 GW. Gravidity was significantly associated with decreased risk of high FBS (OR=0.838, 95%CI [0.704-0.991]).Conclusion: Our findings suggest that Hb level at registration could be utilized in predicting the risk of GDM and HP among Palestinian women who never had a previous history of these conditions. The results of this study could have important clinical implications for early screening, which could improve preventive and curative health services to promote the health of pregnant women and children.

Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012-2015.

This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80-0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52-0.58). Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. The current study updated the previous findings with more recent multiyear PRAMS data (2012-2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

Porushennia sertsevo-sudynnoi diialnosti ta endotelialnoi funktsii u vahitnykh iz nedyferentsiiovanoiu spoluchnotkanynnoiu dysplaziieiu; yikh korektsiia zavdiaky vkliuchenniu do protokolnoi prohramy likuvannia karnitynarhininovoho kompleksu

Context. Undifferentiated connective tissue dysplasia (UCTD) has negative impact on myocardial contractility and endothelial microvascular dysfunction and their frequent combination with cardiac arrhythmias suggests an unfavorable course of pregnancy and childbirth due to the formation of uteroplacental dysfunction. Objective. To reduce the incidence of obstetric complications associated with cardiovascular disorders in women with UCTD by including carnitine-arginine complex in the treatment program. Materials and methods. 58 pregnant women with diagnosed signs of UCTD, including mitral valve prolaps (MVP) with and without frequent extrasystoles, and 14 pregnant women of control group were examined. Metabolic support with of 4.2 g of L-arginine and 2.0 g of L-carnitine in the form of a solution for intravenous infusion once a day for 5 days were used for prenatal care of pregnant women with UCTD and prevention of obstetric complications in the experimental group. Results. There are violations of morpho-functional parameters of the heart with the development of moderate systolic-diastolic myocardial dysfunction and endothelial microvascular dysfunction in the initial state of pregnant women with MVP and extrasystolic arrhythmia against the background of UCTD. They were significantly more often diagnosed with miscarriage, late preeclampsia, placental dysfunction, birth defects, birth trauma, postpartum hemorrhage, etc. Echostructural abnormalities of the heart acted as predictors of arrhythmias, the presence of which was associated with more pronounced disorders of intracardiac hemodynamics. The results of a comprehensive study of the clinical and functional status of pregnant women with phenotypic signs of UCTD, MVP and extrasystolic arrhythmia suggest that in most cases they occur with moderate heart remodeling and significant endothelial dysfunction of the microvascular circulation, that was accompanied by significant deterioration of the obstetric situation. The use of standard medication by pregnant women did not significantly restore the incidence of arrhythmias, inotropic capacity of the myocardium and endothelial function of microvessels. Supraventricular and ventricular arrhythmias remained resistant to standard treatment, which justified the use of additional antiarrhythmic drugs. At the same time, there was a significant reduction in the incidence of arrhythmias in the group of patients with MVP and frequent ventricular or mixed extrasystoles – by 90.6 and 77.8 % respectively under the influence of complex drug treatment with the inclusion of L-arginine and L-carnitine. In the group of pregnant women with supraventricular arrhythmias, the antiarrhythmic effect was observed in only 37.5 % of patients, which justified the additional use of nebivolol hydrochloride at a dose of 2.5 mg/day. At the same time, such a comprehensive treatment in pregnant women with MVP and arrhythmia on the background of UCTD contributed to the restoration of the studied indicators of endothelial function of microvessels. Conclusions. In pregnant women with MVP and extrasystolic arrhythmia against the background of UCTD in the initial state there are violations of morpho-functional parameters of the heart with the development of moderate systolic-diastolic myocardial dysfunction and endothelial microvascular dysfunction, which are triggers of complicated pregnancy and childbirth. The inclusion of L-arginine and L-carnitine led to a significant improvement in the parameters of central cardiohemodynamics and restoration of endothelial function of microvessels and accompanied by a significant reduction of the incidence of extrasystolic arrhythmia and pregnancy complications.