Public Maternity Units Research Articles

Maternity care of women affected by female genital mutilation/cutting: An audit of two Australian hospitals

BackgroundPregnant women affected by female genital mutilation/cutting are at risk of adverse maternal outcomes compared to unaffected women, and sometimes require procedures to facilitate giving birth that midwives and doctors do not routinely perform. These women require culturally sensitive care. Current health professional literature provides evidence that midwives and doctors need further knowledge and training in this area. AimsThis audit aimed to describe the demographic characteristics of pregnant women with female genital mutilation/cutting giving birth at two Perth maternity units, in addition to assessing health provider compliance with the local female genital mutilation/cutting Clinical Guideline. Materials and methodsThe clinical database used by public maternity units in Western Australia was used to identify affected women who gave birth during 2014 at King Edward Memorial Hospital or Osborne Park Hospital. Demographic characteristics and information about antenatal care and maternal outcomes were collected. Results53 women fulfilled the audit criteria. Prevalence of pregnant women with female genital mutilation/cutting varied from 0.33% to 2.18% between the two units. Compliance with the Female Genital Mutilation/Cutting Clinical Guideline was generally suboptimal. While no woman was deinfibulated antenatally, 26% of women required intrapartum deinfibulation to give birth. ConclusionsWomen with female genital mutilation/cutting make up more than 2% of the antenatal population in some Perth metropolitan maternity units. Health care provider knowledge of, and compliance with, the Female Genital Mutilation/Cutting Clinical Guideline was poor in the two units studied. It appears that healthcare professionals need more education and training to provide affected women with the best care.

Physical Violence During Pregnancy in France: Frequency and Impact on the Health of Expectant Mothers and New-Borns.

Objectives Even during pregnancy women may suffer from violence. We estimated the prevalence of physical abuse during pregnancy, we analyzed the main risk factors and described the relationship between physical violence, psychological wellbeing and pregnancy outcome. Methods We used a national representative sample of births, in all public and private maternity units, in 2016 in France. Women were interviewed after delivery, on their living conditions and occurrence of physical violence at least once during pregnancy. The study of risk factors and pregnancy outcome was done with multivariable logistic regressions. Results Of 12,330 women included in the analysis 1.8% (95% CI 1.6-2.0) had been exposed to physical violence during pregnancy. Risk of violence was associated with the couple situation [women without a partner or in couple not cohabiting (OR 2.89, 95% CI 1.96-4.26)], household income (less than 3000 euros monthly), and state medical assistance coverage. Physical violence was more prevalent in case of a history of induced abortion or cannabis use during pregnancy. Psychological distress was more frequent with than without physical violence (e.g., 62% vs. 24% had a sadness period during pregnancy, p < 0.001). The risk of spontaneous preterm birth and transfer of the newborn to a neonatal intensive care unit were significantly higher among women experiencing physical violence during pregnancy compared to other women. Conclusions for Practice Main factors associated with increased risk of violence during pregnancy were socio-economics. The identification by caregivers of women exposed to violence during pregnancy needs to be improved to develop preventive and care strategies.

Factors Associated with Excessive Gestational Weight Gain Among Brazilian Mothers.

Gestational Weight Gain (GWG) is an important predictor of maternal and child health. Cross-sectional study was carried out in a public maternity unit of a hospital in a Brazilian metropolis that aimed to evaluate the factors associated with excessive GWG. Data were collected on food consumption, anthropometry, and on socioeconomic, demographic, and health status. The GWG was obtained by consulting each woman's gestational record. The association between GWG and the other variables was assessed using the chi-square test with the Bonferroni correction, with a significance level of 5%. We evaluated 98 mothers with a mean age of 25.4 ± 6.8 years and a postpartum time of 2.5 ± 1.2 days. Before pregnancy, 42.9% of this population was overweight. The mean GWG was 12.2 ± 6.5 kg, with 39.8% classified with excessive GWG. A higher prevalence of excessive GWG was observed among mothers who had higher per capita income (p = 0.003), had had cesarean delivery (p = 0.016), lower limbs edema (p = 0.012), and excess weight before pregnancy (p = 0.001). There was no significant association of GWG with eating habits. Excessive GWG is associated with socioeconomic and nutritional factors. Nutritional monitoring during prenatal care may favor effective interventions and contribute to positive outcomes for both maternal and child health.

Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial

Maternal overweight and obesity are associated with well recognised pregnancy complications. Antenatal dietary and lifestyle interventions have a modest effect on gestational weight gain without affecting pregnancy outcomes. We aimed to assess the effects on maternal and infant outcomes of antenatal metformin given in addition to dietary and lifestyle advice among overweight and obese pregnant women. GRoW was a multicentre, randomised, double-blind, placebo-controlled trial in which pregnant women at 10-20 weeks' gestation with a BMI of 25 kg/m2 or higher were recruited from three public maternity units in Adelaide, SA, Australia. Women were randomly assigned (1:1) via a computer-generated schedule to receive either metformin (to a maximum dose of 2000 mg per day) or matching placebo. Participants, their antenatal care providers, and research staff (including outcome assessors) were masked to treatment allocation. All women received an antenatal dietary and lifestyle intervention. The primary outcome was the proportion of infants with birthweight greater than 4000 g. Secondary outcomes included measures of maternal weight gain, maternal diet and physical activity, maternal pregnancy and birth outcomes, maternal quality of life and emotional wellbeing, and infant birth outcomes. Outcomes were analysed on an intention-to-treat basis (including all randomly assigned women who did not withdraw consent to use their data, and who did not have a miscarriage or termination of pregnancy before 20 weeks' gestation, or a stillbirth). The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612001277831. Of 524 women who were randomly assigned between May, 28 2013 and April 26, 2016, 514 were included in outcome analyses (256 in the metformin group and 258 in the placebo group). Median gestational age at trial entry was 16·29 weeks (IQR 14·43-18·00) and median BMI was 32·32 kg/m2 (28·90-37·10); 167 (32%) participants were overweight and 347 (68%) were obese. There was no significant difference in the proportion of infants with birthweight greater than 4000 g (40 [16%] with metformin vs 37 [14%] with placebo; adjusted risk ratio [aRR] 0·97, 95% CI 0·65 to 1·47; p=0·899). Women receiving metformin had lower average weekly gestational weight gain (adjusted mean difference -0·08 kg, 95% CI -0·14 to -0·02; p=0·007) and were more likely to have gestational weight gain below recommendations (aRR 1·46, 95% CI 1·10 to 1·94; p=0·008). Total gestational weight gain, pregnancy and birth outcomes, maternal diet and physical activity, and maternal quality of life and emotional wellbeing did not differ significantly between groups. Similar numbers of women in both treatment groups (76% [159/208] in the metformin group and 73% [144/196] in the placebo group) reported side-effects including nausea, diarrhoea, and vomiting. Two stillbirths (placebo group) and one neonatal death (metformin group) occurred; none of the perinatal deaths were determined to be attributable to participation in the trial. For pregnant women who are overweight or obese, metformin given in addition to dietary and lifestyle advice initiated at 10-20 weeks' gestation does not improve pregnancy and birth outcomes. Australian National Health and Medical Research Council.

Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies

BackgroundDisrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care.MethodsThe health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives.ResultsMost participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices.ConclusionsNamibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision.

Tobacco use during pregnancy among native and migrant women in Portugal. Results from the Bambino study

Introduction Tobacco use is a major modifiable risk factor of adverse maternal and fetal health outcomes. Being a migrant has been associated with lower risk of smoking during pregnancy. However, it remains a matter of debate whether such association could be explained by other sociodemographic characteristics or whether such effect remains or increases according to the length of stay in the host country. This study examined the differences in maternal smoking prevalence between native, long-term and recent migrant women in Portugal. Methods This study was derived from baMBINO, a national project grounded on 32 public maternity units in mainland Portugal aiming to investigate the differences in perinatal healthcare and outcomes among migrant and native women. Recruitment took place during admission for delivery, inviting both native and foreign-born women. Participants included in this analysis (n = 1107) were classified according to their country of birth and length of stay in Portugal into: native (Portuguese-born), recent migrant (foreign-born women who spent 10 years or less in Portugal), and long-term migrants (foreign-born women who spent more than 10 years in Portugal). Logistic regression model was fitted to estimate the association between the aforementioned migration statuses and having or not smoked tobacco during pregnancy, taking into account women's age, parity, marital status, level of education, family income, country of origin of women's parents and gestational age at the first prenatal care visit. Adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Results A little over half of the study participants were foreign-born and almost 60% of those were recent migrants. Tobacco smoking during pregnancy was evidently more prevalent among native women than among long-term or recent migrant women (14% vs. 8% and 4% respectively; P Conclusion Results of this study demonstrated significant disparities in the prevalence of maternal smoking during pregnancy according to the women's place of birth and duration of stay in Portugal. Native-born women had a higher risk of smoking during pregnancy than foreign-born women. The increase in the duration of stay in the host country seemed to have a negative effect on maternal smoking of migrants in Portugal. Smoking cessation health strategies in pregnant women in Portugal need to be improved by taking into account the mentioned variations in smoking behaviors.

Predictive factors for birth weight of newborns of mothers with gestational diabetes mellitus

AimsTo evaluate the predictive factors of birth weight (BW) of newborns of women with gestational diabetes mellitus (GDM). MethodsA cross-sectional study was performed among pregnant women with GDM treated in a public maternity unit, Brazil. We selected 283 pregnant women, with nutritional follow-up initiated till the 28th gestational week, singleton pregnancy, without chronic diseases and with birth weight information of the newborns. The predictive factors of BW were identified by multivariate linear regression. ResultsMean maternal age was 31.2 ± 5.8 years; 64.4% were non-white; 70.1% were pre-gestational overweight or obese. Mean BW was 3234.3 ± 478.8 g. An increase of 1 kg of weight in the first and third trimesters increased BW by 21 g (p = 0.01) and 27 g (p = 0.03), respectively. Similarly, the other predictive factors of BW were pre-gestational body mass index (β = 17.16, p = 0.02) and postprandial plasma glucose in the third trimester (β = 4.14, p = 0.008), in the model adjusted by gestational age at delivery (β = 194.68, p < 0.001). ConclusionsThe best predictors of BW were gestational age at birth, and maternal pre-gestational and gestational anthropometric characteristics. Maternal glycaemic levels may also influence BW. The results may contribute to a review of prenatal routines for pregnant women with GDM.

Evaluation of the perception of postpartum stressors at the Marseille Gynepole

Maternity stay following childbirth corresponds to the early postpartum period. Birth-related events may be perceived as a major source of stress by women and these events can cause certain disorders during this period, such as anxiety and postnatal depression. The aim of this study was to investigate women's perception of post-delivery stress factors. An overall descriptive study of the target population (n = 206) was carried out and primiparous (n = 96) and multiparous (n = 110) women were then compared in two level III public maternity units in the Marseille Gynépole. The Post-Delivery Perceived Stress Inventory (PDPSI) was the psychometric scale used to collect data. A correlation between the various items of the PDPSI was investigated. The experience of childbirth is perceived as the main stress factor by 45% of mothers. This factor was significantly correlated (p < 0.05) with 3 items of the PDPSI and very significantly correlated (p < 0.001) with 11 of the 16 items constituting the other 4 factors of the PDPSI. Primiparous women significantly perceived (p < 0.05) childbirth as being more stressful than multiparous women. They also felt very significantly (p < 0.001) more stressed by care activities (bathing, changing) related to the relationship with the newborn factor. These results encourage implementation of guidelines and the organization of informal ?conversations? in the maternity unit, and to conduct an early postnatal consultation at home for these mothers concerning their childbirth experience, which could be ensured by adequate social support based on empathic listening and reassuring actions about parenting.

Programa de residência em enfermagem obstétrica: reflexões a partir da vivência das residentes

Objetivo: relatar a implantação do Programa Nacional de Residência em Enfermagem Obstétrica na perspectiva das enfermeiras obstetras formadas na primeira turma da região sul do Brasil. Método: relato de experiência. Os cenários da formação das enfermeiras obstetras são representados por uma maternidade pública, uma Unidade Básica de Saúde e duas Estratégias de Saúde da Família. Resultados: muitos avanços foram conquistados a partir de discussões conjuntas e trocas de conhecimento entre todos os atores envolvidos no processo de implantação do programa. Atualmente é possível o trabalho em equipe, a discussão de condutas e prescrições e a confiança no trabalho das residentes. Considerações finais: o Programa de Residência em Enfermagem Obstétrica está em processo de implantação e, por isso, a cada ano surgem novos desafios, e em alguns casos, limitações e dificuldades, o que contribui para seu aprimoramento e reorienta as ações de qualificação das enfermeiras obstetras.

Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study

To analyse whether prenatal care trajectories among women with hypertensive disorders during pregnancy in France differ between immigrants from sub-Saharan Africa (SSA) and native French women. Qualitative interview study. Three public maternity units in the Paris region. Women born in SSA or in France of French parents and treated for hypertension or pre-eclampsia during their pregnancy. A sociologist conducted semi-structured in-depth interviews of 33 women during their postpartum hospitalisation and collected data from their medical files. n'vivo 10 (QSR International) was used for line-by-line coding of the transcriptions, to identify emerging themes. Strauss's concept of illness trajectories was then applied to these data. Themes derived from interviews. Women reported during the interviews that the blood pressure measurement procedures used by hospital staff varied between the two groups, and their medical records supported this finding. Repeated urinary dipstick testing of proteinuria before laboratory testing was more frequent for African women, as was the failure to further test proteinuria levels requiring additional action. The two groups received similar standardised care after severe complications. Other findings showed that African women were less likely to rely on healthcare services. These results suggest non-medically justified differential prenatal care between African and native women that may have helped delay the diagnosis of hypertension or pre-eclampsia. This study suggests hypotheses for further quantitative studies to explore the potential involvement of this differential care in the higher frequency of severe complications in this subgroup, concordantly reported in European countries hosting SSA migrants. Differential prenatal care may delay diagnosis of pre-eclampsia among African compared with native French women.

Local birthing services for rural women: Adaptation of a rural New South Wales maternity service.

ObjectiveTo describe the outcomes of a public hospital maternity unit in rural New South Wales (NSW) following the adaptation of the service from an obstetrician and general practitioner‐obstetrician (GPO)‐led birthing service to a low‐risk midwifery group practice (MGP) model of care with a planned caesarean section service (PCS).DesignA retrospective descriptive study using quantitative methodology.SettingMaternity unit in a small public hospital in rural New South Wales, Australia.ParticipantsData were extracted from the ward‐based birth register for 1172 births at the service between July 2007 and June 2012.Main outcome measuresBirth numbers, maternal characteristics, labour, birthing and neonatal outcomes.ResultsThere were 750 births over 29 months in GPO and 277 and 145 births over 31 months in MGP and PCS, respectively, totalling 422 births following the change in model of care. The GPO had 553 (73.7%) vaginal births and 197 (26.3%) caesarean section (CS) births (139 planned and 58 unplanned). There were almost universal normal vaginal births in MGP (>99% or 276). For normal vaginal births, more women in MGP had no analgesia (45.3% versus 25.1%) or non‐invasive analgesia (47.9% versus 38.6%) and episiotomy was less common in MGP than GPO (1.9% versus 3.4%). Neonatal outcomes were similar for both groups with no difference between Apgar scores at 5 min, neonatal resuscitations or transfer to high‐level special care nurseries.ConclusionThis study demonstrates how a rural maternity service maintained quality care outcomes for low‐risk women following the adaptation from a GPO to an MGP service.

Cyprus mothers׳ breast feeding self-efficacy and their perceptions about the implementation of the ‘10 steps’ in the first 48 hours after birth

Backgroundmore than two decades after the launch of the ‘10 steps’ for successful breast feeding, there is still concern that implementation is suboptimal. Commonly, studies assess the level of implementation based on self-assessments from maternity staff and more rarely based on the mothers’ own experience. To date, there has been only anecdotal evidence with regards to the implementation of the ‘10 steps’ in Cyprus while there is general lack of research data on breast feeding in this country. Aimthis study assessed breast feeding self-efficacy among mothers during the first 48hours after birth and explored their views with regards to the implementation of the ‘10 steps’ across public and private maternity units in Nicosia, Cyprus. Methodthis is a descriptive study with a consecutive sample of 216 mothers, aged at least 18, who gave birth to a full-term healthy infant between January and April 2014. Two data collection tools were used: Section 4 of the BFHI (Baby Friendly Hospital Initiative) questionnaire referring to mothers’ self-assessment of maternity unit practices and the BSES-SF (Breast feeding Self-Efficacy Scale - Short Form) which measures perceived self-efficacy in bryeast feeding. Resultsmidwifery assistance for breast feeding skills development along with encouragement of breast feeding on demand (steps 5 and 8) were identified by mothers as the steps they were more likely to have experienced. In addition, there appeared to be relatively good adherence to the International Code of Marketing of Breast-milk Substitutes. In contrast, it seems that step 7(rooming-in), step 9 (no pacifiers) and step 10 (breast feeding support after discharge) were not systematically practiced. While a higher percentage of mothers in public maternity units reported being informed about the importance of skin-to-skin contact compared to the private sector (51.5% versus 25.7%), there does not appear to be much difference in terms of its actual practice which is generally low (29.0% versus 25.4%). Exclusive breast feeding (step 6) was low (21.7%) while the mean score of breast feeding self-efficacy at 48hours was 3.33 (0.87SD) on a 5-point Likert scale. Conclusionsit appears that mothers in Cyprus had limited experience of the ‘10 steps’ during their stay Nicosia maternity units. This, along with the fact that exclusive breast feeding and breast feeding self-efficacy were rather low, suggests the need for interventions that will enhance breastfeeding self-efficacy and empower mothers to initiate breast feeding while at the maternity unit. In particular, the limited information to mothers upon leaving the maternity unit highlights the lack of maternal support services in the community.

Factors associated with the need for ventilation at birth of neonates weighing ≥2,500 g

OBJECTIVES:Approximately 20-40% of annual global neonatal deaths occur among infants with birthweights ≥2,500 g, and most of these deaths are associated with intrapartum asphyxia in low- and middle-income countries. This study aims to evaluate the peripartum variables associated with the need for resuscitation at birth of neonates weighing ≥2,500 g.METHOD:This case-control retrospective study was performed on data from all public reference maternity units in the state of Ceará, Northeast Brazil, between March 2009 and March 2010. The subjects were singleton neonates without malformations weighing ≥2,500 g, who required positive-pressure ventilation in the delivery room. The controls had a 1-minute Apgar score of ≥8 and did not undergo resuscitation. Variables associated with positive-pressure ventilation in the delivery room were evaluated via conditional multivariate logistic regression.RESULTS:Of the 2,233 live births with birth weights ≥2,500 g, 1-minute Apgar scores ≤7, and no malformations, 402 patients met the inclusion criteria, and they were paired with 402 controls. Risk variables for positive-pressure ventilation at birth were a gestational age <37 weeks (OR: 3.54; 95% CI: 1.14-10.92) and meconium-stained amniotic fluid (8.53; 4.17-17.47). Cervical examination at maternal admission (0.57; 0.38-0.84) and a written follow-up of the labor (0.68; 0.46-0.98) were identified as protective variables.CONCLUSIONS:Significant flaws in obstetric care are associated with the need for positive-pressure ventilation at birth for neonates weighing ≥2,500 g.

OXIMETRIA DE PULSO EM TRIAGEM DE CARDIOPATIAS CONGÊNITAS: CONHECIMENTO E ATUAÇÃO DO ENFERMEIRO

A oximetria de pulso nas unidades neonatais apresenta-se como um processo de triagem de cardiopatias congênitas graves. O estudo tem como objetivo avaliar o nível de informação e a atuação dos enfermeiros na oximetria de pulso realizada nos recém-nascidos de uma maternidade pública do município de João Pessoa, Paraíba. Trata-se de estudo descritivo com abordagem quanti-qualitativa, realizado com 13 enfermeiras assistenciais através de entrevista semiestruturada no período de janeiro a março de 2015. Os resultados mostraram que a maioria das enfermeiras tem conhecimento sobre o teste do coraçãozinho, a justificativa para realizá-lo, os parâmetros de normalidades da saturação de oxigênio, assim como as condutas que devem ser tomadas diante de um resultado alterado. No entanto, 84,6% referiram dificuldades na sua implantação em virtude de modificar a rotina da assistência de enfermagem. Acredita-se que o teste do coraçãozinho para triagem de cardiopatias congênitas traz bons resultados na captação precoce dessas malformações.

Initial Preference for Labor Without Neuraxial Analgesia and Actual Use: Results from a National Survey in France.

The rate of neuraxial analgesia during labor in France is one of the highest among high-income countries: 77% of vaginal deliveries in 2010. In this context, the question of how women's preferences for delivering without neuraxial analgesia relate to actual use is of interest. Our objective was to study the factors associated with women's initial preference for labor without neuraxial analgesia and those associated with its use in women who initially preferred not to have it. We used data from the 2010 French National Perinatal Survey, a cross-sectional study of a representative sample of all births in France. Data were collected from interviews with mothers in the postpartum ward and from medical records. Our sample included 7123 women who had vaginal deliveries and were at low risk for cesarean delivery. The factors analyzed were maternal sociodemographic characteristics, prenatal care, childbirth class attendance, labor management, and organization of maternity units. Multilevel Poisson regression models were used to study factors associated with women's initial preference in the overall population and to study factors associated with actual use of neuraxial analgesia in the group of women who initially preferred not to have it. Initially, 26% of our population (n = 1835) preferred to deliver without neuraxial analgesia; this preference was associated with high parity, unfavorable social conditions, and delivery in a public maternity unit. Among these women, 52% (n = 961) delivered with neuraxial analgesia. This discrepancy between initial preference and actual use was significantly associated with nulliparity (adjusted relative risk [aRR] = 1.4; 95% confidence interval [CI], 1.3-1.6), oxytocin augmentation of labor (aRR = 2.4; 95% CI, 2.1-2.7), presence of an anesthesiologist in the unit 24/7 (aRR = 1.4; 95% CI, 1.2-1.6; compared with delivery in hospitals without an anesthesiologist on site 24/7), and high midwife workload (aRR = 1.1; 95% CI, 1.0-1.2). There was no clear association with maternal educational level. Our results suggest that parity, the management of labor, and availability of anesthesiologists play a major role in the intrapartum decision to use neuraxial analgesia for women who initially preferred not to have it. Further research is necessary in the clinical circumstances leading to this decision and the role of women's demands and medical staff attitudes throughout labor.

Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study.

BackgroundTo evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery.MethodsAn analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%.ResultsThe mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90–94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges.ConclusionSecond and third trimester fasting glucose levels below the cut-off values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.

Assessing the Effect on Outcomes of Public or Private Provision of Prenatal Care in Portugal

To evaluate whether public and private prenatal care users experience similar outcomes, taking into consideration maternal pre-pregnancy social and clinical risk. We studied 7,325 women who delivered single newborns at five public maternity units in Porto, Portugal. Health behaviors and prenatal care were self-reported; pregnancy complications and delivery data were retrieved from medical files. The odds of inadequate weight gain, continuing to smoke, gestational hypertension, gestational diabetes, caesarean section, preterm birth, low birthweight, and small- and large-for-gestational-age were estimated for public and private providers using logistic regression, stratified by pre-pregnancy risk profile, adjusted for maternal characteristics. 38 % of women used private prenatal care. Among low-risk women, public care users were more likely to gain excessive weight (OR 1.26; 95 % CI 1.06-1.57) and be diagnosed with gestational diabetes (OR 1.37; 95 % CI 1.01-1.86). They were less likely to have a caesarean (OR 0.63; 95 % CI 0.51-0.78) and more likely to deliver small-for-gestational-age babies (OR 1.48; 95 % CI 1.19-1.83). Outcomes were similar in high-risk women although preterm and pre-labor caesarean were less frequent in public care users (OR 0.64 95 % CI 0.45-0.91; OR 0.69 95 % CI 0.49-0.97). The amount of care was not significantly related to risk profile in either case. Public care users experienced similar outcomes to those using private care, despite higher pre-pregnancy disadvantage. Low-risk women need further attention if narrowing inequalities in birth outcomes remains a priority.

Epidemiological and chronological profile of preterm birth in the region of Monastir (Tunisia) between 1994 and 2012.

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% (95% CI: 5.13%-6.07%). The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age (≤ 19 and ≥ 35 years), having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies.

Trichomonas vaginalis infection among young pregnant women in Brazil

Our goal was to determine the prevalence of Trichomonas vaginalis and its associated risk factors in parturient women aged 15–24 years attending Brazilian public maternity units. Participants answered a demographic, behavioral, and clinical data questionnaire. A sample of urine was screened for T. vaginalis. A total 299 women participated in this study. The prevalence rate of T. vaginalis was 7.7% (95% CI: 4.7–10.7%). The factors associated with T. vaginalis were use of illicit drugs [OR=4.70 (95% CI: 1.63–13.56, p=0.004)] and not attending antenatal care [OR=5.15 (95% CI: 1.15–23.25, p=0.032)]. These data demonstrate that it is important to discuss how to include routine screening for T. vaginalis during antenatal care in Brazil.

Medical care provided to pregnant women with HIV/AIDS in Fortaleza, Ceará, Brazil.

The objective of this study is to analyze the perinatal results of the prophylactic measures adopted in the prevention of the vertical transmission of HIV. The study was carried out using the medical records of 168 women with HIV and their newborns in a public maternity unit of Fortaleza, in the state of Ceará, from 2005 to 2009. The data was obtained between the months of March and September 2010 and was analyzed using the program SPSS 10.0. The women diagnosed before pregnancy received timely care that permitted them an effective antiretroviral therapy and a greater number of check-ups (p<0,05). Antiretroviral therapy was administered to 97.6% of the pregnant women, and triple therapy in 88.7%. AZT was administered intrapartum in 95.2% of the women and oral AZT in syrup to 100% of the newborns. Birth by cesarean section was predominant (92.8%) and was associated to the intrapartum use of AZT when compared to vaginal birth (p<0.001). Cesarean section favored intrapartum administration of AZT.