Public Maternity Clinics Research Articles

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

BackgroundMaternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women’s health positively after pregnancy. The study’s aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals.MethodsThis qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model.ResultsIn the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women’s identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women’s lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling.ConclusionsOur findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women’s capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.

Maternal health care utilization and the obstetric outcomes of undocumented women in Finland \u2013 a retrospective register-based study

BackgroundUndocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, capital city of Finland, in addition to comparing the results with all pregnant women in Finland.MethodsThe study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N = 47,274 women) and with prenatal screening tests for infectious diseases (N = 51,447 [HIV, HBV], N = 51,446 [syphilis]).ResultsThe majority (91%) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71%) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5% (3/59) tested positive for HIV, 3% (2/59) for HBV, and 2% (1/57) for syphilis. The prevalence of HIV (p-value < 0.001) and HBV (p-value = 0.007) was significantly higher amongst undocumented women compared with all pregnant women.ConclusionsUndocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was significantly higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.

Pupillary and Attentional Responses to Infant Facial Expressions in Mothers Across Socioeconomic Variations.

Maternal responses to infant facial expressions were examined in two socioeconomically diverse samples of South African mothers (Study I, N=111; and Study II, N=214; age: 17-44years) using pupil and gaze tracking. Study I showed increased pupil response to infant distress expressions in groups recruited from private as compared to public maternity clinics, possibly reflecting underlying differences in socioeconomic status (SES) across the groups. Study II, sampling uniformly low-SES neighborhoods, found increased pupil dilation and faster orientation to expressions of infant distress, but only in the highest income group. These results are consistent with maternal physiological and attentional sensitivity to infant distress cues but challenge the universality of this sensitivity across socioeconomic diversity.

Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age

ImportanceChildren who receive a diagnosis of fetal alcohol spectrum disorder may have a characteristic facial appearance in addition to neurodevelopmental impairment. It is not well understood whether there is a gradient of facial characteristics of children who did not receive a diagnosis of fetal alcohol spectrum disorder but who were exposed to a range of common drinking patterns during pregnancy.ObjectiveTo examine the association between dose, frequency, and timing of prenatal alcohol exposure and craniofacial phenotype in 12-month-old children.Design, Setting, and ParticipantsA prospective cohort study was performed from January 1, 2011, to December 30, 2014, among mothers recruited in the first trimester of pregnancy from low-risk, public maternity clinics in metropolitan Melbourne, Australia. A total of 415 white children were included in this analysis of 3-dimensional craniofacial images taken at 12 months of age. Analysis was performed with objective, holistic craniofacial phenotyping using dense surface models of the face and head. Partial least square regression models included covariates known to affect craniofacial shape.ExposuresLow, moderate to high, or binge-level alcohol exposure in the first trimester or throughout pregnancy.Main Outcomes and MeasuresAnatomical differences in global and regional craniofacial shape between children of women who abstained from alcohol during pregnancy and children with varying levels of prenatal alcohol exposure.ResultsOf the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip. Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin).Conclusions and RelevancePrenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment.

Objective To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods A cross-sectional study was performed between July 1, 2013, and December 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results The average age of the pregnant women was 32.32 (±6.2) years, and the average gestational age at the time of the evaluation was 30.59 (±2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

Maternal Supplementation With Natural or Synthetic Vitamin E and Its Levels in Human Colostrum

Newborns are considered a high-risk group for vitamin E deficiency. Breast milk is a source of alpha-tocopherol (α-TOH), a form of vitamin E that prevents deficiency. The present study aimed to assess whether supplementation with a natural or synthetic form of α-TOH, in addition to maternal sources of vitamin E, would increase the concentration of α-TOH in colostrum. A total of 109 healthy lactating women were recruited from a Brazilian public maternity clinic and randomized into 3 groups: control without supplementation (n = 36), natural α-TOH supplementation (n = 40), and synthetic α-TOH supplementation (n = 33). Blood and colostrum samples were collected before and after supplementation to check the nutritional status of these women by high-performance liquid chromatography. The Kruskal-Wallis test was applied for independent samples, and Tukey test was used for 2-way analysis of the averages of the groups. The baseline nutritional status of vitamin E of all of the lactating women enrolled in the trial was considered adequate. Women who received supplementation had higher concentrations of α-TOH in colostrum than the control group, with 57% and 39% increases in women supplemented with the natural and synthetic forms of α-TOH, respectively. Supplementation with both forms of α-TOH increased vitamin E concentrations in colostrum; however, the natural form was more efficient in increasing the levels.

Significant differences in cesarean section rates between a private and a public hospital in Brazil

This paper evaluates the association of maternal variables and of variables related to prenatal and delivery care with cesarean sections at a public and at a private maternity. A retrospective cross-sectional study was performed at a public maternity clinic (2,889 deliveries) and at a private maternity clinic (2,911 deliveries) in the city of Ribeirão Preto, São Paulo State, Brazil. The prevalence of cesarean sections was 18.9% at the public maternity clinic and 84.3% at the private one. The factors associated with cesarean sections at both hospitals were: mothers from other cities, aged > or =25 years and with hypertension. Having more than one child was a protective factor. At the public hospital, cesarean sections were more frequent on Wednesdays and from 12:00 to 23:59 hours of any day of the week, whereas at the private hospital they occurred on any day, though were less common on Sundays, and at any time except in the early morning. At the private hospital, cesarean sections were more frequent when performed by the doctor who had provided the prenatal care. Non-medical factors were more associated with cesarean sections in the private maternity clinic than biological or clinical factors related to pregnancy.

APPLICATION OF PEPLAU´S INTERPERSONAL THEORY TO PUERPERAL ADOLESCENTS

Aim: To establish a helpful relationship between the nurse and the first-birth puerperal adolescents based in Peplau´s interpersonal relationship theory. The North American Nursing Diagnosis Association (NANDA) diagnostic taxonomy is applied to foresee the patient´s answers regarding her state of health. Material and methods: The study was followed during November and December 2004 with an adolescent puerperal and the scenario was a common ward in a Public Maternity Clinic and the new mother´s home. One visit was at the hospital and three were domiciliary. Results and conclusions: During those visits the Peplau´s interpersonal process was followed with its observations and interview techniques. This study helps to know the purposes of the theory which systematized and guided the assistance to the adolescent mother. Besides it stresses the benefits of the theoretical models in nursing care.

Admixture Estimates for Caracas, Venezuela, Based on Autosomal, Y-Chromosome, and mtDNA Markers

The present Venezuelan population is the product of admixture of Amerindians, Europeans, and Africans, a process that was not homogeneous throughout the country. Blood groups, short tandem repeats (STRs), mtDNA, and Y-chromosome markers have been used successfully in admixture studies, but few such studies have been conducted in Venezuela. In this study we aim to estimate the admixture components of samples from two different socioeconomic levels from Caracas, Venezuela's capital city, compare their differences, and infer sexual asymmetry in the European Amerindian union patterns. Gene frequencies for blood groups ABO and Rh (CDE) and for the STRs VWA, F13A01, and FES/FPS and mtDNA and Y-chromosome haplogroups were studied in a sample of 60 individuals living in Caracas, taken from a private clinic (high socioeconomic level), and 50 individuals, also living in Caracas, drawn from a public maternity clinic (low socioeconomic level). The admixture analysis for the five autosomal markers gives a high European component (0.78) and an almost negligible African sub-Saharan component (0.06) for the high socioeconomic level, whereas for the low socioeconomic level the sub-Saharan, European, and Amerindian components were 0.21, 0.42, and 0.36, respectively. Estimates of admixture based on mtDNA and Y-chromosome markers reveal that the Amerindian contribution to these Caracas samples is almost entirely through females, because the Y-chromosome Amerindian and African sub-Saharan chromosomes found in this study were scarce. Our study reveals that the identification of the grandparents' geographic origin is an important methodological aspect to take into account in genetic studies related to the reconstruction of historical events.

Development of a pregnancy-tailored decisional balance measure for smoking cessation

The Transtheoretical Model suggests that perception of pros and cons of smoking (decisional balance) is related to quitting. This study examined the underlying structure of decisional balance items to aid in development of a pregnancy-tailored measure. A sample of 281 low-income, pregnant women attending public maternity clinics who smoked or had recently quit smoking completed a decisional balance measure. The measure included items from the general decisional balance scale plus pregnancy-related decisional balance items. Confirmatory factor analysis examining the general-plus-pregnancy-related items suggested a four-factor solution, with factors representing general pros, pregnancy-related pros, cons related to disapproval from others, and health-related cons. Perceptions of pregnancy-related pros and disapproval-related cons differed significantly across stages of change. Findings suggest that inclusion of pregnancy-related items could provide additional information about concerns that are salient during pregnancy.

A stage-matched smoking cessation program for pregnant smokers.

Pregnancy may be an optimal opportunity for targeting smoking in women, since this may be the only time in a woman’s life she receives frequent contacts with health care providers with a primary focus on initiating or maintaining health-enhancing behavior in herself. Therefore, prenatal health care may serve as a natural opportunity or powerful teachable moment to decrease cigarette smoking, especially in underserved women. An innovative stage-matched intervention program based on the Transtheoretical model is currently being implemented in six public maternity clinics in a southern New England city. These prenatal settings serve culturally diverse and economically disadvantaged individuals.

Modeling Smoking Cessation: Exploring the Use of a Videotape to Help Pregnant Women Quit Smoking

ABSTRACT This exploratory study examined the acceptability and efficacy of a videotape modeling smoking cessation as an adjunct to smoking cessation advice delivered during prenatal care. In a randomized controlled trial involving 60 women, we compared the delivery of brief smoking cessation advice and a tipsheet to the same advice and tipsheet plus provision of the videotape. Outcomes included opinions about content and acceptability of the videotape, and smoking behavior change during pregnancy. The most highly endorsed features of the videotape were seeing other women quitting smoking (77%), dealing with stress and bad feelings (69%), talking about what to do with urges to smoke (69%), and discussing ways to get support from families and friends (54%), The reported quit rate in the last month of pregnancy, validated by exhaled carbon monoxide levels, and including women lost to follow-up as smokers, was 19.2% in the intervention group and 0% in the comparison group (p = .02). This study suggests that the use of videotapes modeling smoking behavior change may increase the effectiveness of the assistance in quitting smoking that is generally available in obstetric and family practices or public maternity clinics.

Individualized smoking cessation counseling during prenatal and early postnatal care

We examined the efficacy of individualized smoking cessation counseling added to obstetricians' and nurse-midwives' advice. In a mixed private and publicly supported prenatal clinic 600 pregnant women who smoked were randomly assigned to receive the usual advice from their obstetrician or nurse-midwife or the usual advice plus individualized smoking cessation counseling. Smoking status was measured by self-report and urinary cotinine/creatinine ratios at 36 weeks and by self-report during long-term postpartum follow-up. Quitting rates during pregnancy were not increased by adding individualized smoking cessation counseling to usual care. At the long-term follow-up, reported quitting rates were significantly greater among intervention group women cared for in the publicly supported clinic than among those receiving the usual care, 14.5% versus 2.5%, p < 0.01. Although adding individual smoking cessation counseling did not increase quitting rates during pregnancy, it should be considered for women in public maternity clinics because of its potential long-term effectiveness.

Florida's family planning program.

ORGANIZED efforts toward family planning in the state of Florida may be dated from April 17, 1942. In an historic action the Florida Medical Association, at their annual meeting, resolved that all physicians be encouraged to offer child-spacing advice and service to their patients based on appropriate medical indications. The medical leaders of our state further resolved that the association approved of such service and advice being offered on the same basis, through public maternity clinics operated by the State Board of Health and County Health Departments. The groundwork was thereby laid for a steadily expanding program of public and private birth control services. Our own interest in family planning might be dated from the beginning of our experience in public health. Frequently we would see in our clinics the mother with numerous children attending for additional maternity service. Our nurses would report from visits in the home that the family had very little with which to care for even the existing children. It was obvious from a visit to the home that there were very few conveniences and no luxuries. Oftentimes the expectant mother did not appear to have sufficient energy-due to inadequate diet, lack of rest, as well as the fact that she was busy trying to care for her growing family-to make the effort required to seek adequate medical attention. The segment of society able to take advantage of more modem conveniences, including medical services, did not have as many children as the lower economic group. It was obvious that this latter group must be utilizing precautionary measures so as not to have large families. Through our medical acquaintances we learned that private physicians were offering information on planning a family to their patients. It seemed, as a general rule, that families financially unable to provide for many children were having excess births more often than families that could afford to take care of them. It was realized that a few people object to having information of this type given out. However, there were those groups that needed and were most anxious to have such information. They were willing to discuss their family affairs with a good listener, if given the opportunity. The public health nurse was a desirable member of the team in that she frequently saw these conditions in her home visits, and she found that many mothers were anxious to receive assistance in this matter.