Use Of Prenatal Care Research Articles

Exploring the prevalence of birth defects of the gastrointestinal tract in newborns: A Six-year analysis in Bogotá, Colombia

BackgroundBirth defects (BD) occur in 3–6 % of live births (LB) and constitute significant morbimortality and disability. Some BD of the gastrointestinal (GI) tract requires surgical interventions during the first days of life. Knowing the prevalence in different city areas could guide decision-makers in developing public policies that guarantee timely attention. This study aims to determine the prevalence of 7 GI defects in LB in Bogotá, Colombia, and to explore factors related to their occurrence. MethodsWe conducted an analytical cross-sectional observational study based on data from the BD database of the Public Health Surveillance System (PHSS) of Bogotá between 2015 and 2021, using all available records where BD of the GI tract was reported. We performed descriptive analyses in Jamovi and correlation analyses in SPSS. ResultsWe included 869 cases in the study. GI defects occurred more frequently in males (50.5 %). Esophageal atresia was the BD most frequently reported (25.9 %), followed by gastroschisis and anorectal malformation (19 %). GI defects are more frequent in the city's center-east area of Bogota. The prevalence of GI defects in Bogota during the period studied was 14.2 per 10,000 LB. Of the LB with GI defects, 93.8 % had low socioeconomic status. ConclusionsThe results of this study point to the importance of centralizing neonatal surgical care services for these pathologies in the sub-network that serves this population. Prenatal care, housing conditions, and substance use in the home were related to a higher prevalence of GI defects.

The effect of psychosocial stress on prenatal care among Hispanic immigrant women.

This article explores the effect of psychosocial stress on Hispanic immigrant women, including access to and use of prenatal care and birth outcomes. In addition to highlighting the health effects for this growing population, the article outlines strategies for clinicians to improve access to adequate prenatal care and to cultivate a supportive environment to promote use of prenatal services.

Retrospective Use of Patients' Characteristics to Assess Variation in Prenatal Care Utilization.

We used patients' medical and psychosocial risk factors to explore prenatal care utilization and health outcomes to inform prenatal care tailoring. This retrospective cohort study assessed patients who gave birth at an academic institution from January 1 to December 31, 2018, using electronic health record (EHR) data. Patients were categorized into four phenotypes based on medical/psychosocial risk factors available in the EHR: Completely low risk; High psychosocial risk only; High medical risk only; and Completely high risk. We examined patient characteristics, visit utilization, nonvisit utilization (e.g., phone calls), and outcomes (e.g., preterm birth, preeclampsia) across groups. Of 4,681 patients, the majority were age 18 to 35 (3,697, 79.0%), White (3,326, 70.9%), multiparous (3,263, 69.7%), and Completely high risk (2,752, 58.8%). More Black and Hispanic patients had psychosocial risk factors than White patients. Patients with psychosocial risk factors had fewer prenatal visits (10, interquartile range [IQR]: 8-12) than those without (11, IQR: 9-12). Patients with psychosocial risk factors experienced less time in prenatal care, more phone calls, and fewer EHR messages across the same medical risk group. Rates of preterm birth and gestational hypertension were incrementally higher with additional medical/psychosocial risk factors. Data readily available in the EHR can assess the compounding influence of medical/psychosocial risk factor on patients' care utilization and outcomes. · Medical and psychosocial needs in pregnancy can inform patient phenotypes and are associated with prenatal care use and outcomes.. · Patient phenotypes are associated with prenatal care use and outcomes.. · Patients with high psychosocial risk spent less time in prenatal care and had more phone calls in pregnancy.. · Tailored prenatal care models may proactively address differences in patient's needs..

Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder.

This study aimed to evaluate the association between number of prenatal care visits and adverse perinatal outcome among pregnant individuals with opioid use disorder (OUD). This is a retrospective cohort of singleton, nonanomalous pregnancies complicated by OUD that delivered from January 2015 to July 2020 at our academic medical center. Primary outcome was the presence of composite adverse perinatal outcome, defined as one or more of the following: stillbirth, placental abruption, perinatal death, neonatal respiratory distress syndrome, need for morphine treatment, and hyperbilirubinemia. Logistic and linear regression estimated the association between the number of prenatal care visits and the presence of adverse perinatal outcome. A Mann-Whitney U test evaluated the association between number of prenatal care visits and length of hospital stay for the neonate. A total of 185 patients were identified, of which 35 neonates required morphine treatment for neonatal opioid withdrawal syndrome. During pregnancy, most individuals were treated with buprenorphine 107 (57.8%), whereas 64 (34.6%) received methadone, 13 (7.0%) received no treatment, and 1 (0.5%) received naltrexone. The median number of prenatal care visits was 8 (interquartile range: 4-10). With each additional visit per 10 weeks of gestational age, the risk of adverse perinatal outcome decreased by 38% (95% confidence interval [CI]: 0.451-0.854). The need for neonatal intensive care and hyperbilirubinemia also significantly decreased with additional prenatal visits. Neonatal hospital stay decreased by a median of 2 days (95% CI: 1-4) for individuals who received more than the median of eight prenatal care visits. Pregnant individuals with OUD who attend fewer prenatal care visits experience more adverse perinatal outcome. Future research should focus on barriers to prenatal care and interventions to improve access in this high-risk population. · Use of prenatal care affects newborn outcomes.. · More prenatal care shortens neonatal hospital stay.. · Prenatal care reduces certain adverse outcomes..

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

BackgroundEvaluating social vulnerability is a challenging task. Indeed, former studies demonstrated an association between geographical social deprivation indicators, administrative indicators, and poor pregnancy outcomes.ObjectiveTo evaluate the association between social vulnerability profiles, prenatal care use (PCU) and poor pregnancy outcomes (Preterm birth (PTB: <37 gestational weeks (GW)), small for gestational age (SGA), stillbirth, medical abortion, and late miscarriage).MethodsRetrospective single center study between January 2020 and December 2021. A total of 7643 women who delivered a singleton after 14 GW in a tertiary care maternity unit were included. Multiple component analysis (MCA) was used to assess the associations between the following social vulnerabilities: social isolation, poor or insecure housing conditions, not work-related household income, absence of standard health insurance, recent immigration, linguistic barrier, history of violence, severe dependency, psychologic vulnerability, addictions, and psychiatric disease. Hierarchical clustering on principal component (HCPC) from the MCA was used to classify patients into similar social vulnerability profiles. Associations between social vulnerability profiles and poor pregnancy outcomes were tested using multiple logistic regression or Poisson regression when appropriate.ResultsThe HCPC analysis revealed 5 different social vulnerability profiles. Profile 1 included the lowest rates of vulnerability and was used as a reference. After adjustment for maternal characteristics and medical factors, profiles 2 to 5 were independently associated with inadequate PCU (highest risk for profile 5, aOR = 3.14, 95%CI[2.33–4.18]), PTB (highest risk for profile 2, aOR = 4.64, 95%CI[3.80–5.66]) and SGA status (highest risk for profile 5, aOR = 1.60, 95%CI[1.20–2.10]). Profile 2 was the only profile associated with late miscarriage (adjusted incidence rate ratio (aIRR) = 7.39, 95%CI[4.17–13.19]). Profiles 2 and 4 were independently associated with stillbirth (highest association for profile 2 (aIRR = 10.9, 95%CI[6.11–19.99]) and medical abortion (highest association for profile 2 (aIRR = 12.65, 95%CI[5.96–28.49]).ConclusionsThis study unveiled 5 clinically relevant social vulnerability profiles with different risk levels of inadequate PCU and poor pregnancy outcomes. A personalized patient management according to their profile could offer better pregnancy management and reduce adverse outcomes.

Monitoring prenatal care performed by nurses in primary care

The professional nurse has been showing in the assistance within primary care the guidelines passed during the consultation performed in the care of pregnancy in the humanized context through scientific knowledge and technical resources. The objective was to describe the importance of nursing in prenatal care performed in primary care, which has been bringing to society with emphasis on assistance and reporting the information provided during the consultation performed in prenatal care during pregnancy. The methodology used in the research was an integrative literature review of articles available in the Scielo, Lilacs, Pubmed databases published from 2016 to 2021. The results obtained in the research were divided into three categories according to the similarity where prenatal care in primary care is intended to ensure the puerperal rights from the moment of conception of the fetus until delivery being accompanied by multiprofessional health team, the contribution of prenatal care aims to cover the care of pregnant women seeking the satisfaction of these women in primary care, the guidelines passed on to pregnant women is of utmost importance for the care throughout pregnancy. It was found that in the literature according to the articles researched on prenatal care is evaluated through the use of various prenatal care during monitoring in primary care and the challenge of achieving and maintaining a satisfactory level of quality provided during the assistance to women in pregnancy of ensuring a necessary experience of welfare established by the multidisciplinary team professionals in this process maintains the efficiency of care provided to these pregnant women.

Maternal Complications and Perinatal Outcome in The Booked and Unbooked Cases of Pregnancy at Manipal Teaching Hospital

Introduction: The use of prenatal care prevents maternal complications and perinatal adverse outcomes by early identification of high risk pregnancies, assessment of growth and well being of the fetus, prompt diagnosis and management of complications, with safe delivery.&#x0D; Objectives: This study aims at comparing the obstetrical complications and perinatal outcomes in delivered booked and unbooked mothers to determine the correlation of booking status and maternal and perinatal outcome.&#x0D; Methodology: In this prospective study, 350 patients admitted for delivery at Manipal Teaching Hospital, Pokhara during March 2014 to May 2015 were included. Antenatal complications of the mothers, postnatal complications, neonatal outcome and the mode of delivery were compared amongst the booked and unbooked cases.&#x0D; Results: There was an increased prevalence of preeclampsia (6.3% in unbooked vs. 1.6% in booked); eclampsia (2.5% in unbooked vs. nil in booked); antepartum haemorrhage (5.06% in unbooked vs. 2.1% in booked); Preterm premature rupture of membrane (5.1% in unbooked vs. 2.1% in booked); Rh-isoimmunization (06% in unbooked vs. nil in booked); Intrauterine growth restriction (5.7% in unbooked vs. 3.6% in booked ); and Intrauterine fetal death (7.6% in unbooked vs. 0.5% in booked) in unbooked mothers as compared to booked mothers. The unbooked mothers were prone to postpartum hemorrhage (6.9% vs 2.6% in booked mothers). Assisted breech delivery and ventouse delivery were recorded higher in unbooked cases than in booked case (3.2% vs. 0.5% and 3.8% vs. 3.1% respectively).&#x0D; Conclusion: The poorer maternal and fetal outcome in unbooked cases in comparison to booked cases can be reduced with the best utilization of the prenatal care.

Maternal Hepatitis C Virus Infection and Adverse Newborn Outcomes in the US.

We investigated the relationship between maternal hepatitis C virus (HCV) infection and infant health. Furthermore, we evaluated racial disparities with these associations. Using 2017 US birth certificate data, we investigated the association between maternal HCV infection and infant birthweight, preterm birth, and Apgar score. We used unadjusted and adjusted linear regression and logistic regression models. Models were adjusted for use of prenatal care, maternal age, maternal education, maternal smoking status, and the presence of other sexually transmitted infections. We stratified the models by race to describe the experiences of White and Black women separately. Maternal HCV infection was associated with reduced infant birthweight on average by 42.0g (95% CI: -58.81, -25.30) for women of all races, 64.6g (95% CI: -81.91, -47.26) for White women and 80.3g (95% CI: -162.48, 1.93) for Black women. Women with maternal HCV infection had increased odds of having a preterm birth of 1.06 (95% CI: 0.96, 1.17) for women of all races, 1.06 (95% CI: 0.96, 1.18) for White women and 1.35 (95% CI: 0.93, 1.97) for Black women. Overall, women with maternal HCV infection had increased odds 1.26 (95% CI: 1.03, 1.55) of having a low/intermediate Apgar score; White and Black women with HCV infection had similarly increased odds of an infant with low/intermediate Apgar score in a stratified analysis: 1.23 (95% CI: 0.98, 1.53) for White women and 1.24 (95% CI: 0.51, 3.02) for Black women. Maternal HCV infection was associated with lower infant birthweight and higher odds of having a low/intermediate Apgar score. Given the potential for residual confounding, these results should be interpreted with caution.

Experiences of Discrimination and Treatment Outcomes Among Pregnant and Postpartum People With Opioid Use Disorder [ID: 1376917

INTRODUCTION: Experiences of discrimination among pregnant and postpartum people with opioid use disorder (OUD) are common and likely affect utilization of medication for OUD (MOUD), which is associated with reduced risk of overdose and death. We aimed to examine experiences of discrimination by prenatal care (PNC) and substance use disorder (SUD) treatment settings and estimate its effect on the risk of various MOUD utilization outcomes. METHODS: Patient-stakeholders co-designed survey questions to measure self-reported outcomes related to MOUD treatment utilization, return to substance use, and overdose. First, we examined the proportion of participants who endorsed items on a modified Healthcare Discrimination Scale and summed the total scores. Next, we quantified the effect of discrimination experienced by health care setting on postpartum MOUD utilization, return to use, and overdose using log-binomial models to calculate relative risk (RR) and 95% CIs. RESULTS: Among the 100 participants enrolled in the study, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD treatment settings. Discrimination within PNC (RR 2.6, CI 1.06–6.40) and SUD treatment (RR 3.26, CI 1.59–6.70) were associated with increased risk of not using MOUD as prescribed. Discrimination within SUD treatment settings correlated with an increased risk of MOUD discontinuation (RR 2.56, CI 1.19–5.54) and return to use (RR 2.36, CI 1.18–4.73). CONCLUSION: Experiences of discrimination were common, especially within prenatal care settings, and discrimination was associated with poor MOUD treatment outcomes and risk of return to use. Interventions to address discrimination within health care settings can improve outcomes for pregnant and postpartum people with OUD.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

Assessing the Quality of Prenatal Care: Use of the Kotelchuck Index Combined with Prenatal Care Data

The aim of the present study was to propose a quality prenatal (PN) care assessment model combining use and visit content (both adjusted for the weeks of gestation) to estimate inadequate PN care and associated factors in Rio Branco, Acre. A cross-sectional study was conducted using a population-based cohort of 1030 women in the city of Rio Branco in 2015. The use of PN care was classified according to the adapted Kotelchuck index by combining the performance of clinical-obstetric procedures adjusted for weeks of gestation. Levels of adequacy were built according to PN care use and content. Gross and adjusted odds ratios were estimated by using a logistic regression. The prevalence rates of inadequate prenatal care quality were 25.9% (Level-1), 54.8% (Level-2), 68.8% (Level-3), and 78.6% (Level-4). The factors associated with Level-1 were age ≤ 34 years (ORaj:3.74), not having a partner (ORaj:1.62), unplanned pregnancy (ORaj:1.73), and multiparity (ORaj:2.25); those for Level-2 comprised not having a partner (ORaj:1.82) and multiparity (ORaj:1.33); those for Level-3 were age ≤ 34 years (ORaj:3.31), not having a partner (Oraj:1.71), unplanned pregnancy (Oraj:1.45), PN in the private sector (Oraj:3.08), and multiparity (ORaj:2.17); those for Level 4 comprised not having a partner (ORaj:2.33), family income &lt; 1 MW (ORaj:2.05), unplanned pregnancy (ORaj:1.41), PN in the private sector (ORaj:6.80), and multiparity (ORaj:1.49). The Kotelchuck index was proven efficient in assessing the combined effect of use and content in assessing PN care quality.

Development and testing of a decision aid to achieve shared decision-making for routine labor induction.

This quality improvement project aimed to create a decision aid for labor induction in healthy pregnancies at or beyond 39 weeks that met the needs of pregnant people least likely to experience shared decision-making and to identify and test implementation strategies to support its use in prenatal care. We used quality improvement and qualitative methods to develop, test, and refine a patient decision aid. The decision aid was tested in three languages by providers across obstetrics, family medicine, and midwifery practices at a tertiary care hospital and two community health centers. Outcomes included patients' understanding of their choices, pros and cons of choices, and the decision being theirs or a shared one with their provider. Patient interview data indicated that shared decision-making on labor induction was achieved. Across three Plan-Do-Study-Act cycles, we interviewed a diverse group of 24 pregnant people: 20 were people of color, 16 were publicly insured, and 15 were born outside the United States. All but one (23/24) reported feeling the decision was theirs or a shared one with their provider. The majority could name induction choices they had along with pros and cons. Interviewees described the decision-making experience as empowering and positive. Nine medical providers tested the decision aid and gave feedback. Providers stated the tool helped improve the quality of their counseling and reduce bias. This project suggests that using an evidence-based and well-tested decision aid can help achieve shared decision-making on labor induction for a diverse group of pregnant people.

Pregnancy-related healthcare utilization among women with multiple sclerosis.

Many studies have investigated pregnancy in women with multiple sclerosis (MS). However, no study has measured prenatal healthcare utilization in women with MS or adherence to follow-up recommendations to improve antenatal care quality. A better knowledge of the quality of antenatal care in women with MS would help identify and better support women with insufficient follow-up. Our objective was to measure the level of compliance to prenatal care recommendations in women with MS using data from the French National Health Insurance Database. This retrospective cohort study included all pregnant women with MS who gave live birth in France between 2010 and 2015. Using the French National Health Insurance Database, follow-up visits with gynecologists, midwives, and general practitioners (GPs) were identified, as well as ultrasound exams and laboratory tests. Based on the Adequacy of Prenatal Care Use and Content and Timing of care in Pregnancy indices, a new tool adapted to the French recommendations was developed to measure and classify the antenatal care trajectory (adequate or inadequate). Explicative factors were identified using multivariate logistic regression models. A random effect was included because women may have had more than one pregnancy during the study period. In total, 4,804 women with MS (N = 5,448 pregnancies ending in live births) were included. When considering only visits with gynecologists/midwives, 2,277 pregnancies (41.8%) were considered adequate. When adding visits with GP, their number increased to 3,646 (66.9%). Multivariate models showed that multiple pregnancy and higher medical density were associated with better adherence to follow-up recommendations. Conversely, adherence was lower in 25-29-year-old and >40-year-old women, in women with very low income, and agricultural and self-employed workers. No visits, ultrasound exams, and laboratory tests were recorded in 87 pregnancies (1.6%). In 50% of pregnancies, women had at least one visit with a neurologist during the pregnancy, and women restarted disease-modifying therapy (DMT) within 6 months after delivery in 45.9% of pregnancies. Many women consulted their GP during pregnancy. This could be linked to a low density of gynecologists but may also reflect the preferences of women. Our findings can help adapt recommendations and healthcare providers' practices according to the women's profiles.

Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care

ObjectiveTo examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care. DesignProspective cohort study. SettingMedical centers in Alabama, Ohio, and Pennsylvania (N = 4). ParticipantsWomen (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study. MethodsParticipants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument’s internal consistency reliability (Cronbach’s alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care. ResultsThe internal consistency of the POPS scale was high (Cronbach’s α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001. ConclusionThe psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.

Predicting Maternal Complication among Underserved Women based on the Demographic Composition

Maternal complications remain a significant public health issue in Nigeria, particularly among underserved women. Underserved women, particularly those from low-income backgrounds, are at higher risk of maternal complications due to limited access to quality healthcare services. This study aimed to identify the factors that contribute to the maternal complications among underserved women based on the demographic composition. The research was carried out in Ondo State, Nigeria. The research designed a well-structured questionnaire (primary data), and each copy of the questionnaire was distributed among the pregnant women who visited the maternal centers in the state. The data collected was collected in the urban city of Ondo State, Nigeria. The participants are pregnant women within the reproductive age (15 – 49 years) and their gestation period are between 10 to 36 weeks or women who have undergo caesarean section before. The population of the pregnant women varied according to the maternity centers. The study was analyzed using logistic regression analysis. The study concluded that maternal complications are multifactorial, which means that a number of different variables, including maternal age, pre-existing medical conditions, prenatal care use, access to healthcare facilities, and level of education. While occupation may be one of the contributing factors, in the absence of other pertinent factors, it may not independently predict maternal complications. The study, therefore, recommended that it is crucial to improve access to prenatal care, tackle socioeconomic disparities, and enhance cultural competence in healthcare delivery.

Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships.

Comprehensive screening of psychosocial vulnerabilities and substance use in prenatal care is critical to promote the health and well-being of pregnant patients. Effective implementation of new screening procedures and instruments should be accompanied by an in-depth investigation to assess their feasibility and impact on care delivery. In 2020, following implementation of the Profile for Maternal and Obstetric Treatment Effectiveness (PROMOTE) an innovative self-report screening instrument developed for outpatient prenatal clinics in the U.S., we conducted individual interviews and focus groups with twenty-two midwives, nurse practitioners, and obstetric residents focused on the PROMOTE and its impacts on care delivery. We used interpretive description for the qualitative analysis of the interviews. Five themes were identified: Guiding Time Efficiently: "The Time I Don't Have," Preventing Missed Care, Signaling Trustworthiness, Establishing Trauma-Informed Foundations, and Promoting "Honest" Patient Disclosure. Interviews suggest that patient completion of the PROMOTE before the medical encounter helps reduce previously reported barriers, is more time-effective, and makes history-taking easier. It also facilitates the patient-provider relationship. Findings offer insight into the breadth and depth of clinical impact resulting from the PROMOTE, and provide guidance for the implementation of such tools to optimize health outcomes.

Social Determinants of Health and Hirschsprung-associated Enterocolitis

BackgroundHirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). The objective of this study was to examine the association of social determinants of health (SDOH) with HAEC. MethodsA review of patients who underwent primary pull through for HD at our institution from 2014 to 2021 was performed. Clinical, surgical, and SDOH data were collected. HAEC was defined by an international scoring system. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests. ResultsOne hundred patients were identified with 29 patients (29%) having at least one episode of HAEC during a median follow-up of 31 months (IQR: 11.7–55.7). Children who utilized public transportation for clinic visits, had one or more missed appointments, had any reported safety concerns, were involved with Child Protective Services, had parents/guardians who were not married, lived with people other than their immediate family, or had mothers who reported drug use or lack of prenatal care were found to have a higher likelihood of developing HAEC (p<0.04 for all). Age at HD diagnosis, age at pull through, operative approach, length of aganglionic colon, and Trisomy 21 were not significant predictors of HAEC. ConclusionsIn our series of 100 patients undergoing primary pull through, there was a significant correlation of HAEC with several social determinants of health elements while anatomical and clinical factors were not associated with HAEC. Attention to social determinants of health and identifying high-risk patients may serve to prevent morbidity and mortality from HAEC. Level of EvidenceIII

Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers

BackgroundPerinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics.MethodsWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15–55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care.ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth.ConclusionImmigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.

Predictors of the Rate of Illicit Fentanyl Metabolism in a Cohort of Pregnant Individuals.

Illicit fentanyl use is growing in the United States, including among pregnant persons. Despite the prevalence of illicit fentanyl in the drug supply, the pharmacokinetics of fentanyl remains understudied, especially for pregnant individuals. The variability of fentanyl pharmacokinetics influences detection of fentanyl in urine samples, the results of which can have significant legal consequences. For pregnant and parenting individuals, these legal consequences may include termination of parental rights. Through this medical-legal lens, we conducted a retrospective cohort analysis using the electronic medical records of women receiving integrated prenatal care and substance use disorder treatment. A total of 420 medical records were reviewed and 112 individuals who had a positive fentanyl immunoassay and met the selection criteria were included. Metabolic ratios (level of norfentanyl/level of fentanyl) were calculated for each study individual. A linear regression analysis was used to determine if the following physiologic factors were predictors of the rate of fentanyl metabolism: hepatic function, renal function, body mass index, medication dosage, gestational age, and maternal age. Results indicated that advanced maternal age predicted a slower conversion of fentanyl to norfentanyl, whereas increased gestational age predicted a faster conversion. Variations in fentanyl metabolism in pregnancy highlight the importance of clinician vigilance when interpreting fentanyl rests results, especially for individuals with advancing maternal age. In such cases, clinician caution and advocacy may prevent unwarranted and unjust removal of a child from maternal custody.

The COVID-19 pandemic and birth outcomes in 2020: The role of prenatal care and other channels

We use national birth data to assess the associations between the COVID-19 pandemic during 2020 and birth outcomes in Uruguay. Employing interrupted time series difference-in-differences techniques, we find mixed results, with some pregnancies showing increases in the likelihood of very preterm or very-low-weight births, and some others showing decreases in the incidence of moderate prematurity and moderate low birth weight. Adverse outcomes are more likely among women with low education, women with previous children, and with risk factors, such as smoking or being older than 34. We observe improvements in health at birth for children of non-smokers, women younger than 35, and women with no other children. We underscore the role of health care by showing that women in the private sector, who suffered the strongest contraction in face-to-face prenatal care use, experienced more adverse birth outcomes. Our results also suggest that the economic recession and an increased burden of childcare were behind the increases in preterm and very-low-weight births. Because pollution is an unlikely channel for the positive results, we hypothesize that for some pregnancies, the pandemic improved the intrauterine habitat by leading to a quieter and healthier lifestyle.