Prenatal Guidance Research Articles

ANÁLISE DOS EFEITOS DA VIOLÊNCIA OBSTÉTRICA NO DESEJO DE UMA NOVA GESTAÇÃO

Objective: to analyze the psychological and reproductive interconnection, understand the epidemiological profile of patients, understand the level of influence of this crime on reproductive health in such a way as to analyze this reverberation within the family environment. Methodology: this is a cross-sectional and descriptive field research due to its quantitative bias. Results and Discussions: The study included the participation of 50 postpartum women, all of whom suffered obstetric violence, with the most described being the disregard of the woman's opinion at the time of birth, in view of this, there was also a predisposition of socioeconomic conditions, age , racial and school issues as the foundation of these experiences, such as the observation of the consequences for the human psyche arising from OV, as well as the interference in the desire for a new gestational cycle through trauma arising from this crime. Final considerations: More than a quarter of the participants would say that the experience of obstetric violence influenced the desire for a new pregnancy, the lack of prenatal guidance, the absence of a companion at the time of birth and economic and social factors are predisposing to the experience of obstetric violence.

Evaluating knowledge, attitudes, and practices regarding complementary feeding (weaning) among mothers of six-month-old children

This study evaluated the knowledge, attitude, and practice (KAP) regarding complementary feeding (weaning) among mothers with six-month-old children. A quantitative, cross-sectional, descriptive-analytical approach was employed, emphasizing the gathering, analysis, and interpretation of relevant data to portray the phenomenon accurately. The evaluation was divided into three KAP domains. A total of 200 respondents were included in the analysis. It was discovered that mothers demonstrated concerns and a lack of knowledge about enriching complementary food with iodized salt (Knowledge: M = 2.63 out of 5, SD = 1.454, Score = 52.6%). Attitude-wise, mothers reported initiating complementary feeding due to a perceived insufficiency of breast milk (Attitude: M = 1.60 out of 5, SD = 0.802, Score = 32.0%). However, mothers understood complementary feeding practices well (Practice: M = 49.68 out of 60, SD = 8.8, Score = 82.8%). Despite some awareness about sensitive health aspects such as food allergies, mothers lacked crucial knowledge regarding the enrichment of complementary food with iodized salt and iron-rich food. Mothers' decisions to initiate complementary feeding were largely driven by concerns about the sufficiency of their milk production. The study underlines the need for prenatal guidance and education for parents on desirable practices concerning complementary food.

Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project

BackgroundThe Baby-Friendly Hospital Initiative’s Step 4 recommends: “support mothers to start breastfeeding as soon as possible after birth”, thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the “Adequate Childbirth Project”, a quality-of-care improvement project, and to analyze determinants of this outcome.MethodsSecondary analysis of data collected by the cross-sectional evaluative “Healthy Birth Study”, conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns’ severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model.ResultsThe prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6–59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528–0.782), lower economic status (aOR 0.687; CI 95% 0.504–0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529–0.797), preterm birth (aOR 0.660; CI 95% 0.460–0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559–0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102–3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065–1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791–2.525) and female newborn (aOR 1.194; CI 95% 1.008–1.415) were factors positively associated with the outcome.ConclusionsThe private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.

Clinical analysis on the influencing factors related to preterm twin pregnancy.

The aim of this study was to explore the influencing factors of preterm twin pregnancy. In total, 602 twin-pregnant women delivered from February 2016 to February 2020 were analyzed retrospectively. According to whether the pregnant women were preterm or not, they were divided into preterm group (n=363) and term group (n=239). Baseline information, such as maternal age, address, and education level of the pregnant women, were collected. The clinical information of pregnant women, such as chorionic, preeclampsia, gestational diabetes, premature rupture of membranes, abnormal fetal position, and fetal weight, were analyzed. Logistic regression analysis was used to analyze the risk factors. p-value <0.05 was considered statistically significant. In the preterm group, monochorionic diamniotic comorbidities were significantly higher compared with the control group (p<0.05). Higher risks of preterm group have lower education (p<0.05). Multiple logistic regression analysis demonstrated that education, preeclampsia, and premature rupture of membranes were risk factors for preterm twin pregnancy. Preterm birth in twin pregnancy is associated with many risk factors, such as education, preeclampsia, and premature rupture of membranes. Pregnancy supervision and prenatal guidance for twin pregnancy should be strengthened. Furthermore, early detection and diagnosis of comorbidities can improve maternal and neonatal outcomes.

P–732 Maternal over-the-counter analgesics use during pregnancy and adverse perinatal outcomes: cohort study of 151,141 singleton pregnancies

Abstract Study question Is in utero exposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) associated with offspring health outcomes? Summary answer Consumption of over-the-counter analgesics during pregnancy, either as single compounds or in combinations, is significantly associated with a variety of adverse offspring health outcomes. What is known already A high percentage of pregnant women use over-the-counter analgesics during pregnancy globally. Some of these compounds such as paracetamol are considered safe to use, while contraindications exist for others, such as NSAIDs use beyond gestational week 30. Current evidence regarding the safety of use during pregnancy in humans is largely conflicting. Results from many published human studies on the topic suffer from limitations including use of small cohorts, short study time or failure to adjust for important confounders. These may explain conflicting results that cause significant concern regarding evidence-based prenatal guidance on use during pregnancy. Study design, size, duration Retrospective cohort study using the Aberdeen Maternity and Neonatal Databank. Data from 151,141 singleton pregnancies over 30 years (between 1985 and 2015) were used. Consumption of paracetamol, ibuprofen, aspirin, diclofenac and naproxen during pregnancy was recorded in medical notes of each woman. In our analysis, the control group was pregnancies where no analgesic was consumed, and the exposure groups included pregnancies with over-the-counter analgesic consumption either in combinations or as single compound use. Participants/materials, setting, methods Maternal baseline characteristics were compared using χ2 tests for categorical variables and Mann-Whitney for continuous variables (significance at &amp;lt; 0.05). Premature delivery, stillbirth, neonatal death, baby weight, neonatal unit admission, APGAR score at 1 and 5 minutes, neural tube defects, amniotic band defects, gastroschisis, and, in males only, hypospadias and cryptorchidism, were the outcomes assessed. Crude (cORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using logistic regression to control for confounders. Main results and the role of chance The overall prevalence of over-the-counter analgesics use during pregnancy was 29.1%, increasing over the 30-year study period, to over 60% of women in the last seven years of the study. 83.7% of those women reported first trimester use when specifically asked at their first antenatal clinic visit. Pregnancies exposed to at least one of the five analgesics were independently associated with increased risks for premature delivery &amp;lt;37 weeks (aOR=1.50, 95%CI 1.43–1.58), stillbirth (aOR=1.33, 95%CI 1.15–1.54), neonatal death (aOR=1.56, 95%CI 1.27–1.93), birthweight &amp;lt;2,500g (aOR=1.28, 95%CI 1.20–1.37), birthweight &amp;gt;4,000g (aOR=1.09, 95%CI 1.05–1.13), admission to neonatal unit (aOR=1.57, 95%CI 1.51–1.64), APGAR score &amp;lt;7 at 1 minute (aOR=1.18, 95%CI 1.13–1.23) and 5 minutes (aOR=1.48, 95%CI 1.35–1.62), neural tube defects (aOR=1.64, 95%CI 1.08–2.47) and hypospadias (aOR=1.27, 95%CI 1.05–1.54 males only). ). Associations of paracetamol alone with high birth weight, neural tube defects and hypospadias were not significant in the adjusted analysis. Diclofenac consumption was associated with significantly decreased odds of stillbirth (aOR=0.59, 95%CI 0.41–0.87). Limitations, reasons for caution Our data were based on medical notes; however, consumption is self-reported, and details on the timing, dosage, product type (single-ingredient vs combination) and administration type were not available in the database. Our study only considered neonatal health outcomes and longer-term follow-up of the offspring was not available at this time. Wider implications of the findings: This is one of the largest and most comprehensive studies into analgesic use in pregnancy. The increased risks of adverse neonatal outcomes associated with non-prescribed, over-the-counter, analgesics use during pregnancy indicate that healthcare guidance for pregnant women regarding analgesic use should be re-assessed. Trial registration number N/A

Características da gravidez e lactação de mulheres atendidas em um banco de leite humano

Objetivo: identificar as características da gravidez e da lactação de mulheres que procuraram um banco de leite humano e as razões que motivaram essas mães a recorrerem ao serviço. Métodos: Trata-se de um estudo realizado no Banco de Leite Humano (BLH) da Fundação Santa Casa da Misericórdia de Franca. Foram recrutadas 60 mulheres que responderam a um questionário para a obtenção de informações a respeito da gestação, da amamentação e dos motivos que as levaram ao banco de leite. Resultados: As participantes realizaram o pré-natal em número adequado de consultas e tinham em média 25(6,1) anos. Os sintomas gestacionais mais relatados foram náuseas/vômitos (71,7%) e picamalácia (60%). A maior aversão alimentar referida foi à ingestão de carnes (42,3%). Dentre os fatores que levaram as mulheres a buscarem o BLH, destacaram-se o auxílio para estimular a produção do leite ou para doação do mesmo. 58% das mulheres estavam em aleitamento materno exclusivo e as demais referiram estar aguardando a descida do leite ou estarem distantes dos bebês, que se encontravam no centro de terapia intensiva. Alguns bebês menores de 2 meses receberam água, chás e papas precocemente. Conclusão: As nutrizes recorreram ao BLH por problemas na amamentação, apesar das orientações no pré-natal. Algumas necessitaram de apoio para o estímulo da produção de leite. A importância do BLH vai além de possibilitar o leite às crianças que não puderam ser amamentadas por suas mães, mas também por proporcionar instrução e apoio às lactantes, além do incentivo ao aleitamento materno.

Prevalence and factors associated with maternal breastfeeding in the first hour of life in full-term live births in southwest Bahia, Brazil, 2017.

to analyze prevalence and factors associated with maternal breastfeeding in the first hour of life (MBFFHL) in full-term live births in Vitória da Conquista, BA, Brazil. this was a cohort-nested cross-sectional study; data were collected between February and August 2017 using a questionnaire answered by mothers as well as medical records; hierarchical multivariable analysis with Poisson regression was used. the study included 388 mother-liveborn baby pairs; MBFFHL prevalence was 49.5%; outcome was associated with maternal education ≥12 years (PR=0.63 - 95%CI 0.46;0.87), prenatal guidance on child holding and positioning (PR=1.44 - 95%CI 1.07;1.95), liveborn baby taken to its mother soon after delivery (PR=1.41 - 95%CI 1.04;1.92), mother and baby kept together in the same room (PR=2.42 - 95%CI 1.09;5.36), and delivery at a Baby-Friendly Hospital (PR=2.43 - 95%CI 1.72;3.43). MBFFHL was associated with maternal factors, prenatal care and hospital care.

Desejo de doar leite: relação com características maternas

Objetivo: relacionar o desejo de doar leite materno aos aspectos sociodemográficos, clínicos e obstétricos.Materiais e métodos: estudo transversal e analítico com abordagem quantitativa, realizado com 226 mulheres durante o puerpério imediato, em um Hospital de Referência do interior do Piauí, Brasil, entre dezembro de 2016 e junho de 2018. Na estatística analítica, realizaram-se os testes de Kolmogorov-Smirnov, Qui-quadrado de Pearson, Razão de verossimilhança e o teste t Student.Resultados: a caracterização sociodemográfica revelou que as participantes do estudo eram predominantemente casadas (n = 165; 73 %); pardas (n = 145; 64,1 %) e 79 (34,9 %) praticavam atividade física. 78,3 % (n = 177) das entrevistadas desejavam ser doadoras de leite materno, o que indica relação significativa com os anos de estudo (p = 0,038) e com as que receberam orientações sobre o assunto durante o pré-natal (p = 0,028).Conclusões: o desejo de doar leite 3 materno esteve significativamente relacionado às variáveis de maior escolaridade da mulher e às orientações recebidas no pré-natal sobre o assunto, demonstrando a relevância da educação em saúde dentro do contexto.

Clinical value of prenatal sandplay intervention in pregnant women with gestational diabetes

Objective To investigate the clinical effect of prenatal sandplay in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 86 cases of GDM pregnant women received from March 2017 to March 2018 were selected and divided into the study group and the conventional group by random number table method, with 43 cases in each group.The conventional group practiced routine prenatal education and guidance, while the study group carried out sandplay.The Hamilton anxiety self-scale (HAMA) and the Hamilton depression self-scale (HAMD) were used to evaluate the psychological status of the pregnant women before and after the intervention, and the pregnancy outcomes of the two groups were compared. Results There was no significant difference in HAMA and HAMD scores between the two groups before the nursing(P>0.05), and the study group was significantly lower than the conventional group after intervention (P<0.05). The natural delivery rate of the study group was 63.92%, the abnormal delivery rate was 1.45%, and the conventional group was 40.35% and 7.48%, with statistically significant differences (P<0.05). Conclusions Carrying out sandplay intervention in the prenatal period of GDM mothers can help alleviate the bad mood of mothers, effectively prevent and reduce the occurrence of abnormal childbirth, and ensure the safety of mothers and infants. Key words: Gestational diabetes; Prenatal care; Sandplay intervention; Pregnancy outcome

Amamentação no alojamento conjunto: percepção de mães primíparas no puerpério imediato

OBJETIVO: Compreender a percepção da puérpera primípara sobre o processo da amamentação no Alojamento Conjunto. MÉTODOS: pesquisa descritiva e exploratória com abordagem qualitativa. Foram entrevistadas cinco puérperas internadas no Alojamento Conjunto de uma maternidade pública, no interior da Bahia. Os dados foram coletados por meio de entrevista semiestruturada e analisados pela técnica de Bardin. A pesquisa foi aprovada pelo CEP/UEFS, sob o parecer nº 2.529.234. RESULTADOS: Emergiram três categorias: significados da amamentação para as mães; dificuldades da amamentação no AC; e estratégias incentivadoras para amamentação. A amamentação tem significados como: um ato de amor, prazeroso; aleitamento como promoção da saúde da criança; de seu bem estar físico e emocional, prevenção de doenças e vínculo entre mãe e filho. Ainda, a amamentação como momento de dor e resignação. CONCLUSÃO: Constatou-se a falta de orientação no pré-natal, manejo inadequado da amamentação que resultou em dores e outros desconfortos físicos oriundos da pega incorreta e do mau posicionamento do bebê. Emergiu a falta de privacidade no Alojamento Conjunto. Explicitou-se algumas estratégias incentivadoras: orientações acerca das técnicas de aleitamento; atenção dos profissionais aos aspectos emocionais e ainda, o apoio da família, fundamentais para o sucesso da amamentação.

Paternal depressive symptoms during the early postpartum period and the associated factors following the implementation of the two-child policy in China

AimTo evaluate the prevalence of paternal depressive symptoms during the first three days of childbirth, as well as the associated factors, following the implementation of the two-child policy in China in 2015, which allows couples to have two children in the Chinese mainland. MethodsA cross-sectional study was conducted among 318 fathers. Paternal depressive symptoms and self-efficacy of fathers were screened using the Edinburgh Postnatal Depression Scale and the General Self-Efficacy Scale, respectively. In addition, basic information of all parents and neonates was collected. Univariate analysis, binary logistic regression analysis, and principal component analysis (PCA) were used to identify the relationship between paternal depressive symptoms and its associated factors. ResultsTwenty-two percentage of fathers had depressive symptoms during the first three days of childbirth. Binary logistic regression analysis revealed that older fathers, those who slept for more than 8 h per night, or were dissatisfied with their living conditions were more susceptible to developing the symptoms. On the contrary, protective factors such as the educational level of fathers, planned pregnancy, prenatal guidance, having the second-born child, and higher self-efficacy were found to reduce the development of paternal depressive symptoms. PCA showed that the main components that influenced the paternal depressive symptoms were parental age and parity. ConclusionsThe prevalence of paternal depressive symptoms during the postpartum period did not increase significantly after the implementation of the two-child policy in China. However, focusing on the associated factors is necessary in order to manage postpartum depression during the early postpartum period.

Práticas atuais de amamentação na primeira hora de vida em uma maternidade de risco habitual

Objetivo: Conhecer o perfil sociodemográfico da equipe multiprofissional que atuam em uma maternidade de risco habitual e as práticas atuais de amamentação na primeira hora de vida. Metodologia: Estudo transversal, exploratório de abordagem quantitativa, realizado com 35 profissionais de uma maternidade de risco habitual do sul do Brasil por meio de instrumento com três dimensões. Resultados: Realizada entrevista por meio de um questionário dividido em três dimensões. A Dimensão 1 aponta a formação predominante de técnico de enfermagem, no que se refere a idade dos profissionais está entre 26 a 35 anos. Quanto ao tempo de formação profissional, estão entre 1 a 5 anos. Ao considerar o tempo de atuação no hospital e no setor observou-se que estão entre 1 a 3 anos. Na Dimensão 2, destacam-se as orientações no pré-natal quanto a aleitamento oportuno como negativo; O interesse em amamentar está presente na totalidade das puérperas. A Dimensão 3 quanto a considerar a duração do acompanhamento durante a amamentação na hora dourada elegeram o tempo inferior aos trinta minutos. Conclusão: Ressalta-se que para obter uma cobertura maior das práticas que envolvem a temática é necessário conhecer a população que irá assistir esta clientela, compreender sua prática clínica e alinhar as iniciativas.

Skin-to-skin contact and breastfeeding of newborns in a university hospital.

To determine the prevalence of skin-to-skin contact (STSC) and breastfeeding (BF) stimulation, as well as the reasons for these practices not to be performed; to identify whether women were given information on these practices along the pre-natal monitoring. A cross-sectional study carried out in a university hospital with 586 women. Data collection was from February to September 2016. Data was collected from patient records and from a questionnaire. A descriptive analysis was performed. Immediately after birth, 60.1% of the newborns (NBs) had STSC, and 44.9% were stimulated to suck at the breast. After primary care, 24.1% had STSC, and 69.3% were stimulated to suck at the breast; 47.7% of the newborns did not have STSC due to their unfavorable clinical conditions; 79.2% of the women were not able to inform the reason why BF was not stimulated; 58.5% of the women had pre-natal guidance about STSC, and 90.8% about BF. Both STSC and BF rates could be improved, in view of the benefits provided by these practices.

Professional who attended childbirth and breastfeeding in the first hour of life.

To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

Prenatal Hemoglobinopathy Screening Practices: Areas for Improvement

Background: Sickle cell disease is one of the most common inherited red blood cell disorders, yet many are not aware of their carrier status (Treadwell, J Nat Med Assoc, 2006), which can lead to confusion around pregnancy and newborn diagnosis. Furthermore, data is emerging about the severe and life-threatening risks of sickle cell trait (Kark, NEJM, 1987 and Olaniran, Am J Nephro, 2019). The American College of Obstetricians and Gynecologists' guidelines recommend that pregnant women of African, Mediterranean and Southeast Asian descent be screened for hemoglobinopathies with a complete blood count (CBC) and hemoglobin electrophoresis (ACOG, Opinion #691, 2017). However, adherence to this practice and frequency of improper screening with Sickledex is unknown. Proper screening and counseling can impact families' knowledge and allow them to establish relationships with hematology providers earlier. Objectives: We sought to assess prenatal hemoglobinopathy screening practice patterns and methods of Obstetrics &amp; Gynecology (OBGYN) and Family Medicine (FM) providers in the Tri-State regional area. Methods: A cross-sectional electronic survey was administered to OBGYN and FM practitioners from six tri-state area institutions using publicly available information and contacts at each institution. Questions focused on prenatal hemoglobinopathy screening practices using case scenarios with variations on parental trait status and ethnicities. Chi-square analyses were used to compare the two provider groups on categorical variables. Results: There were 167 total responses; 120 surveys were complete, of which 87 were OBGYN and 33 FM providers. Respondents were mainly faculty (69/120, 58%) and from academic medical centers (n=107). 42% of providers reported that they ask "76-100%" of their patients about a personal history of sickle cell disease or trait. When asked about the proportion of pregnant patients with a positive family history of a hemoglobinopathy, there was a significant difference between OBGYN and FM providers, with 95% of OBGYN providers responding that they screen "76-100%" of those patients as opposed to only 75% of FM providers screening with the same frequency (p=0.0034). When asked about screening practices for patients without a personal/family history of a hemoglobinopathy, OBGYN providers consistently screen more frequently (Figure 1). When analyzed by ethnic background, screening practices were significantly different only between the subspecialty providers who "always" or "often" screened for hemoglobinopathies in mothers of Asian descent (p=0.03). Over 73% of providers report that they "always" screen patients of Mediterranean, Asian, and Middle Eastern descent and 84% always screen patients of Black descent. Over 30% of all respondents said they would use Sickledex for screening in case scenarios for a Black/African American mother, even when it was already known that she is a sickle cell carrier. In cases where the mother's hemoglobinopathy status was unknown, over 80% of providers responded that they would "always" evaluate with a hemoglobin electrophoresis regardless of Black/African American or Mediterranean descent. In terms of referrals to Hematology, in a case where both parents have sickle cell trait 46% of providers would "never" refer that family to Hematology. Conclusion: This pilot survey highlights differences in the methods and likelihood of prenatal hemoglobinopathy screening based on the type of prenatal care provider. Screening differences can lead to variations in prenatal guidance, diagnostic procedures, informed decision-making and knowledge of families referred to pediatric hematology clinics. This is the first study analyzing prenatal screening for hemoglobinopathies in OBGYN and FM. This study demonstrates that not all prenatal providers adhere to existing ACOG recommendations regarding which patients to screen for hemoglobinopathies and suggests an actionable area in which to enhance education for prenatal providers. Specifically, providers need to be educated that the use of Sickledex is an inappropriate laboratory screening test, since it will not detect other hemoglobinopathies. Improving prenatal screening practices by collaborating with hematologists may increase adherence to guidelines and allow for earlier relationship building with hematology. Figure 1 Disclosures Manwani: GBT: Consultancy, Research Funding; Novartis: Consultancy; Pfizer: Consultancy.

Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: A population-based birth-cohort study

Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities caused by prenatal alcohol exposure. Prenatal alcohol use is common in the UK, but FASD prevalence was unknown. Prevalence estimates are essential for informing FASD prevention, identification and support.We applied novel screening algorithms to existing data to estimate the screening prevalence of FASD. Data were from a population-based cohort study (ALSPAC), which recruited pregnant women with expected delivery dates between 1991 and 1992 from the Bristol area of the UK. We evaluated different missing data strategies by comparing results from complete case, single imputation (which assumed that missing data indicated no exposure and no impairment), and multiple imputation methods.6.0% of children screened positive for FASD in the analysis that used the single imputation method (total N = 13,495), 7.2% in complete case analysis (total N = 223) and 17.0% in the analysis with multiply imputed data (total N = 13,495). A positive FASD screen was more common among children of lower socioeconomic status and children from unplanned pregnancies. Our analyses showed that the complete case and single imputation methods that are commonly used in FASD prevalence studies are likely to underestimate FASD prevalence.Although not equivalent to a formal diagnosis, these screening prevalence estimates suggest that FASD is likely to be a significant public health concern in the UK. Given current patterns of alcohol consumption and recent changes in prenatal guidance, active case ascertainment studies are urgently needed to further clarify the current epidemiology of FASD in the general population of the UK.

Revised Guidelines Increase Specificity of Diagnostic Criteria for Fetal Alcohol Spectrum Disorders

Updated guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD) refine diagnostic criteria that were previously issued in 2005. Neurobehavioral impairment, the main disability in FASD, is now required for diagnosis of three of the four FASD subtypes proposed by the Institute of Medicine. Also, domains of neurobehavioral impairment to be assessed are specified. Other improvements include a more detailed definition of prenatal alcohol exposure, a description of resources for reference data on prenatal and postnatal growth and guidance for evaluating craniofacial and other physical abnormalities characteristic of FASD. The validity of the updated diagnostic approach needs to be assessed to determine its accuracy and reliability for diagnosing FASD.

Magnitude and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital, Uganda.

Breastfeeding as a determinant of infant health and nutrition saves up to 1.5 million infant lives annually. Though breastfeeding is mostly universal in sub-Saharan Africa, early initiation of breastfeeding is rarely practiced. To determine magnitude and factors associated with delayed initiation of breastfeeding among mother-infant pairs who deliver in Mulago hospital. We carried out a descriptive cross sectional study, where 665 mother-infant pairs were interviewed within 24 hours following delivery; with additional qualitative data collected using focus group discussions to understand reasons for delaying initiation. The data was analysed by identification and coding of themes. In this study, 31.4% mothers delayed initiation of breastfeeding. This was associated with maternal HIV positive status (AOR 2.3; 95% CI 1.3-4.2), inadequate prenatal guidance, (AOR 3.6; 95% CI 1.9-6.8), inadequate professional assistance to initiate breastfeeding (AOR 1.8; 95% CI 1.2-2.8) and caesarean section delivery (AOR 8.6; 95% CI 4.7-16.0). Other reasons were perceived lack of breast milk, need of rest for both mother and baby after labor, and negative cultural beliefs. In Mulago Hospital 1:3 mothers delayed initiation of breastfeeding. The reasons for delayed initiation include; inadequate information during ANC, HIV positive serostatus, caesarian section delivery and negative cultural ideas.

Genetic counseling for a three-generation Chinese family with Waardenburg syndrome type II associated with a rare SOX10 mutation

ObjectiveWaardenburg syndrome is clinically and genetically heterogeneous. The SOX10 mutation related with Waardenburg syndrome type II is rare in Chinese. This study aimed to uncover the genetic causes of Waardenburg syndrome type II in a three-generation family to improve genetic counseling. MethodsComplete clinical and molecular evaluations were conducted in a three-generation Han Chinese family with Waardenburg syndrome type II. Targeted genetic counseling was provided to this family. ResultsWe identified a rare heterozygous dominant mutation c.621C>A (p.Y207X) in SOX10 gene in this family. The premature termination codon occurs in exon 4, 27 residues downstream of the carboxyl end of the high mobility group box. Bioinformatics prediction suggested this variant to be disease-causing, probably due to nonsense-mediated mRNA decay. Useful genetic counseling was given to the family for prenatal guidance. ConclusionIdentification of a rare dominant heterozygous SOX10 mutation c.621C>A in this family provided an efficient way to understand the causes of Waardenburg syndrome type II and improved genetic counseling.

Factors associated to breastfeeding in the first hour of life: systematic review.

OBJECTIVE To identify independent risk factors for non-breastfeeding within the first hour of life.METHODS A systematic review of Medline, LILACS, Scopus, and Web of Science electronic databases, till August 30, 2013, was performed without restrictions on language or date of publishing. Studies that used regression models and provided adjusted measures of association were included. Studies in which the regression model was not specified or those based on specific populations regarding age or the presence of morbidities were excluded.RESULTS The search resulted in 155 articles, from which 18 met the inclusion criteria. These were conducted in Asia (9), Africa (5), and South America (4), between 1999 and 2013. The prevalence of breastfeeding within the first hour of life ranged from 11.4%, in a province of Saudi Arabia, to 83.3% in Sri Lanka. Cesarean delivery was the most consistent risk factor for non-breastfeeding within the first hour of life. “Low family income”, “maternal age less than 25 years”, “low maternal education”, “no prenatal visit”, “home delivery”, “no prenatal guidance on breastfeeding” and “preterm birth” were reported as risk factors in at least two studies.CONCLUSIONS Besides the hospital routines, indicators for low socioeconomic status and poor access to health services were also identified as independent risk factors for non-breastfeeding within the first hour of life. Policies to promote breastfeeding, appropriate to each context, should aim to reduce inequalities in health.