Prenatal Physician Research Articles

Infant mortality before and during COVID-19 pandemic in a district of Istanbul

Objective: The infant mortality rate is one of the most important indicators providing information on maternal and infant health. It can be affected by changes of social and environmental factors. The aim of this study is to evaluate infant mortality in 2019 and 2020 years at the local level, considering the beginning of the pandemic period. Methods: The population of this cross-sectional study are infants registered in a district of Istanbul in 2019 and 2020. Infant mortality rates before and during the COVID-19 pandemic were calculated. Antenatal healthcare and delivery practices in addition to the underlying risk factors for infant deaths were identified and compared by the year of mortality. All study data were collected from the district health information system. Results: Fifty-one infant deaths included in the study were residents of the district. Infant mortality rates were calculated as 4.8 and 5.1 per thousand live births for the years 2019 and 2020. Neonatal mortality rates were 3.9 and 2.7; postneonatal mortality rates were 0.9 and 2.4 per thousand live births, respectively by the years. No statistically significant difference was found between maternal and infant characteristics of the two years. The number of pregnancy follow-up records was significantly higher for the infants that died in 2020 compared to 2019. Yet, there wasn’t any difference in number of prenatal physician visits. Conclusion: Increase in the infant mortality rate during the pandemic compared to the pre-pandemic period is due to postneonatal mortality. The increase in postneonatal mortality is related to deaths caused by infections. This finding should be investigated with the healthcare accessibility and other characteristics of the infants. Our experience during the study revealed a room for improvement in access to data on always-important public health indicators, which would support evidence-based decision-making even in difficult times.

Grau de conhecimento das gestantes do serviço público sobre parto humanizado

Introdução: A conscientização das gestantes é fundamental para experiências positivas de parto. Objetivo: Avaliar o grau de conhecimento das gestantes em dois serviços públicos sobre parto humanizado. Caracterizar epidemiologicamente a população estudada. Métodos: Estudo descritivo realizado entre julho e agosto de 2017. Amostra com 297 gestantes foram selecionadas 200 após aplicação dos critérios de exclusão. Utilizados testes estatísticos de associações de variáveis (Qui-quadrado e Exato de Fisher). Resultados: A média de idade das gestantes foi 26,6 anos. A maioria era procedente do interior do estado (72,5%), com renda até um salário mínimo (90,5%), e com mais de oito anos de estudo (62,5%). 71% iniciaram pré-natal até o primeiro trimestre e o pré-natal foi conduzido por médico em 72% dos casos. 71% preferiam parto normal e 44% tinha medo de cesárea. Profissional pré-natalista não ofereceu informações para 66,5%. 30,5% conhecia parto humanizado, destas 83,6% apresentaram conceito adequado. Houve associação entre conhecimento sobre parto humanizado e procedência (Aracaju) (p=0,03), maior renda (p=0,02), menor ocorrência de aborto (p=0,04), médico pré-natalista (p=0,04) preferência pelo parto vaginal (p=0,04). Dentre as que não conheciam o parto humanizado houve associação de respostas corretas com a maior renda (p=0,03) e anos estudados (p=0,02) e médico pré-natalista (p=0,01) Conclusão: A maioria desconhecia o parto humanizado, era procedente do interior com menor renda, preferência por parto normal, sem informações quanto aos tipos de parto pelo profissional executante (na maioria médicos), quem conhecia adequadamente. Conceitos adequados sobre parto humanizado mesmo na ausência de informação prévia associaram-se às variáveis sócioeconômico e pré-natal.

A Planning Checklist for Interprofessional Consultations for Women in Midwifery Care

Team-based, interprofessional models of maternity care can allow women to receive personalized care based on their health needs and personal preferences. However, involvement of multiple health care providers can fragment care and increase communication errors, which are a major cause of preventable maternal morbidity and mortality. In order to improve communication within one health system, a community-engaged approach was used to develop a planning checklist for the care of women who began care with midwives but developed risks for poor perinatal outcomes. The planning checklist was constructed using feedback from women, nurses, midwives, and physicians in one interprofessional, collaborative network. In feasibility testing during 50 collaborative visits, the planning checklist provided a prompt to generate a comprehensive plan for maternity care and elucidate the rationale for interventions to women and future health care providers. In interviews after implementation of the checklist within a new collaborative format of prenatal physician consultations, women were pleased with the information received, and nurses, midwives, and physicians were positive about improved communication. This tool, developed with stakeholder input, was easy to implement and qualitatively beneficial to satisfaction and health system function. This article details the creation, implementation, and qualitative evaluation of the planning checklist. The checklist is provided and can be modified to meet the needs of other health systems.

Foremost Prenatal Physician, Scientist Tapped to Lead National Child Health Agency: Diana Bianchi, MD, is focused on fostering more genomics research, enabling greater data-sharing collaboration among agencies in new role at NICHD.

American Journal of Medical Genetics Part AVolume 173, Issue 5 p. 1138-1139 THE AJMG SEQUENCE: DECODING NEWS AND TRENDS FOR THE MEDICAL GENETICS COMMUNITY BY DEBORAH LEVENSON Foremost Prenatal Physician, Scientist Tapped to Lead National Child Health Agency Diana Bianchi, MD, is focused on fostering more genomics research, enabling greater data-sharing collaboration among agencies in new role at NICHD First published: 19 April 2017 https://doi.org/10.1002/ajmg.a.38264Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume173, Issue5May 2017Pages 1138-1139 RelatedInformation

Schwangerschaft unter immunsuppressiver Therapie – Ein Fall mit glücklichem Ausgang

Present warnings of malformations that may occur in children whose mothers had taken the immunosuppressant mycofenolatmofetil during pregnancy demonstrate the great need to keep a close watch on the possible effects of immunosuppressive therapy during pregnancy. We present the case of a 32-year old female patient suffering from Crohn's disease who became pregnant while undergoing azathioprine therapy. Therapy was continued; the course of the disease remained stable and the patient gave birth to a healthy male. Inspite of this fortunate outcome we must continue to recommend without prejudice satisfactory contraceptive measures if the patient is undergoing immunosuppressive treatment. However, in case pregnancy does occur, the physician may often prevent an interruption of the pregnancy in close co-operation with the prenatal physician.

The Manitoba Healthy Baby Prenatal Benefit Program

Programs offering income supplements for lower-income pregnant women have been introduced in order to reduce the incidence of poor perinatal outcomes. This study used a population-based approach to examine the characteristics of mothers who received the Healthy Baby Prenatal Benefit in Manitoba. All women giving birth between August 2001 and April 2003 (n = 22,643) were studied using de-identified linked administrative data. Multivariate logistic regression was used to determine factors that predicted receipt of the benefit, adjusting for potential confounding effects. Separate regressions were run for all mothers, and for a group of mothers eligible to receive the benefit (N = 1962). Almost 29% of mothers giving birth during the study period received the prenatal benefit. Mothers were more likely to receive the benefit if they: lived outside of Winnipeg; received income assistance during pregnancy; were younger at their first birth; were unmarried; made prenatal physician visits; experienced maternal depression; were having a first birth; and lived in the lowest income areas. Despite all being eligible, only 67% of non-Winnipeg and 80% of Winnipeg women receiving income assistance received the benefit. Factors related to benefit receipt for those eligible were: living in Winnipeg; making prenatal visits; not being a young teen at current birth; and experiencing a first birth. It is important to look not only at the characteristics of benefit recipients but also at those not receiving the benefit, in order to develop strategies to reach those who may most need and benefit from the program.

Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions?

In the United States, since a substantial percentage of mothers are not breastfeeding, research is needed to assess important influences on breastfeeding. The current study assessed the impact on breastfeeding of the perceived attitudes of health care providers about infant feeding. A longitudinal mail survey (1993-1994) was administered to 1620 women prenatally through 12 months postpartum; the current study focused on the prenatal and neonatal periods (66% response rate). The outcome variable was failure to breastfeed beyond 6 weeks. Predictor variables were the mother's perceptions of her prenatal physician's and hospital staff's attitudes on infant feeding. Analysis controlled for mother's prenatal breastfeeding intentions, father's feeding preference, and demographic and psychosocial variables. Forty-one percent of the mothers were not breastfeeding at 6 weeks postpartum. Substantial percentages of mothers reported that physicians and hospital staff expressed a preference for breastfeeding (38% and 57%, respectively), or expressed no preference (61% and 42%, respectively), whereas few favored formula feeding. Adjusted analyses indicated that "no preference" by hospital staff was a significant risk factor for failure to breastfeed beyond 6 weeks. "No preference" by physicians did not significantly influence breastfeeding outcome in these analyses. Further analyses indicated that the effects of perceived hospital staff attitudes were only present for mothers who intended prenatally to breastfeed for 2 months or less. Many women did not report receiving positive breastfeeding messages from their health caregivers and hospital staff. A perceived neutral attitude from the hospital staff is related to not breastfeeding beyond 6 weeks, especially among mothers who prenatally intended to breastfeed for only a short time.

Effect of Expectant Mothers' Feeding Plan on Prediction of Fathers' Attitudes Regarding Breast-Feeding

A mother's perception of the father's attitude toward breast-feeding may strongly influence her prenatal choice of infant feeding method; however, research has demonstrated that women do little better than chance in predicting these attitudes. this study sought to determine if differential perceptions of fathers' attitudes regarding breast-feeding existed between women who had made a prenatal decision to breast- or formula-feed their children. The 268 expectant mothers in prenatal classes completed a self-administered questionnaire. Chi-square analysis was performed to determine the significance of the association between maternal attitudes toward breast-feeding and intended feeding plan (breast or formula) and each predicted paternal attitudinal variable. The majority of subjects were white (80%) and married (95%). Seventy percent planned exclusive breast-feeding, and 68% felt the baby's father wanted them to breast-feed. Mothers who planned breast-feeding were more knowledgeable of its benefits, had more favorable perceptions, and were more likely to predict positive attitudes of fathers toward breast-feeding than those who planned formula feeding. Women who planned formula feeding predicted less positive paternal attitudes regarding breast-feeding; this perception (whether correct or incorrect) likely impacted on their choice of infant feeding method. More time should be devoted in prenatal classes and prenatal physician visits to breast-feeding education for mothers and fathers. Active encouragement of paternal participation in breast-feeding classes, usually directed toward women only, would foster understanding of the benefits of breast-feeding and the support fathers can provide.