Quality Of Prenatal Care Research Articles

Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes.

Studies have shown that quality of care affects patient health outcomes and well-being. In this study, we examine the relationship between perceived quality of prenatal care, birth outcomes, and postpartum depression (PPD). We use data from the third wave of the Listening to Mothers dataset (2013). After removing missing data, the analytic sample size included 2168 women. Through linear and logistic regression analyses, we test the following hypotheses: higher perceived quality of prenatal care will have a positive association with a likelihood of vaginal delivery and normal birth weight outcomes, and a negative association with a likelihood of preterm birth; and higher perceived quality of prenatal care will have a negative association with a likelihood of PPD risk. Women who perceived higher quality of prenatal care were significantly less likely to have a preterm birth relative to women who reported lower quality care. Women who reported (any) medical jargon during their prenatal visits were less likely to have a normal birth weight baby. Women who reported provider use of medical jargon, lower perceived quality of interaction with a prenatal care provider, and lower perceived quality of US maternity care in general were more likely to be at risk for PPD. Negative prenatal care experiences may exacerbate adverse patient outcomes. Positive prenatal care experiences may buffer/improve adverse outcomes. Quality of care measures were most consistently predictive of PPD outcomes. Providers should focus on improving the quality of prenatal care as one of the means to improve maternal and infant health and well-being.

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

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

Maternal risk factors and neonatal outcomes associated with neonates of birth weight <2 kg admitted to a neonatal intensive care unit of a tertiary care centre

Background and Objectives: Infant mortality is one of the most important measures of health and growth in communities around the world. Low birth weight is one reason why infants die soon after birth. Low birth weight is affected by many social and economic factors, such as where a person lives (urban or rural), their level of education, the order of their children's births, the mother's nutrition, her Body Mass Index, the quality of prenatal care she received, and how far apart her children were born. This study aims at evaluating the maternal risk factors and neonatal outcomes for neonates of birth weight <2 kg admitted to a neonatal intensive care unit of a tertiary care centre.Methods: The study was a retrospective analysis of 150 babies weighing less than 2 kg, between October 2016 to October 2021. Neonatal resuscitation was done according to American Academy of Paediatrics. The maternal demographic profile, co-morbidities in the mother, factors such as gestational age at delivery, mode of delivery, birth weight were all recorded. Data were put into already-made forms, and statistical analysis was done.Results: Out of the 150 babies who weighed less than 2kg and were studied, 48 percent were boys and 52 percent were girls. The average weight at birth was 1.63 (SD = 0.28). Based on gestational age at delivery, most (28%) were born between 28 and 32 weeks, were small for their age (n=83, 55.3%), were born normally (n=81, 54%), were born alive (n=122, 81.3%), the mother was between 26 and 30 years old (n=66, 44%), had meconium aspiration syndrome (n=10, 6.75), was taking antenatal steroids (n=106, 70.7%), had a disease during pregnancy Most of the babies had respiratory distress syndrome (n=77, 51.3%), sepsis (n=31, 20.75%), or birth asphyxia (n=23, 15.3%). In this study, a death rate of 19.3% (n=24) was seen.Conclusion: In order to reduce the number of babies born with low birth weight, the public health strategy needs to focus on better nutrition and education for mothers.

Postpartum depression and its correlates: a cross-sectional study in southeast Iran

BackgroundPostpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.MethodsThis cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.ResultsPostpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R2 = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R2 = 24.0%).ConclusionsWith an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.

Providing Prenatal Care for Patients with Limited Medical Insurance Coverage.

Newer immigrants to the United States, whether undocumented, recent legal immigrants, those here on temporary visas, or migrant workers, are far less likely than native-born residents of the United States to have reliable health insurance. This entire group of patients is then at risk for delayed or absent medical care. Our study focused on what effects a free, quality prenatal care program had upon prenatal care and delivery outcomes for an underinsured population, primarily of immigrant women. With a recent change in Iowa's eligibility criteria for Presumptive Medicaid (referred to as Temporary Medicaid), pregnant patients who have less than a 5-year legal permanent residency status, undocumented status, or out-of-country resident status can receive up to two months of covered antepartum care, whereas previously eligible for coverage for the entirety of their pregnancy. With that reality, several faculty members from the Department of Family Medicine at the University of Iowa started a weekly prenatal care clinic in collaboration with the longstanding Iowa City Free Medical Clinic. This study sought to compare outcomes for patients who utilized only Temporary Medicaid to those who also had access to this prenatal free medical clinic (FMC), as well as to compare outcomes for the FMC program to typical Medicaid patients who had access to full prenatal care. Compared to the Temporary Medicaid-only group, our FMC patients had a significantly greater number of prenatal visits. This increased access of continuity prenatal care led to increased screening for gestational diabetes, receipt of recommended vaccinations, and screening for group B streptococcus. Our effort has shown that expanding prenatal healthcare coverage to this underinsured population can greatly increase the quality of maternity care and reduce the potential for high-risk pregnancies, bettering the care for these pregnant women and their newborns.

Birth Outcomes of Infants Born to Mothers With Disability: A Population at Risk.

Birth Outcomes of Infants Born to Mothers With Disability: A Population at Risk.

The Impact of Outpatient Prenatal Care Visitor Restrictions on Pregnant Patients and Partners During the COVID-19 Pandemic.

Introduction:During the early months of the COVID-19 pandemic, several health care facilities enacted visitor restrictions to help reduce the spread of SARS-CoV-2 among patients, front-line workers in health care systems, and communities. The impact and burden of policy updates on visitor restrictions put forth by the COVID-19 pandemic can be seen on patients and families, most often in the acute care setting and skilled nursing facilities. Yet, the effects of visitor restrictions in the prenatal care setting were unknown. We conducted a study to investigate the impact of these policies on pregnant patients who received outpatient prenatal care.Methods:We conducted a qualitative study to explore pregnant patients' experiences with prenatal health care delivery between May and July 2020. In-depth interviews were conducted with pregnant patients in the first and second trimester of pregnancy, who received their prenatal care at the onset of the pandemic in the United States.Results:Participants noted increased maternal concern, anxiety, and mental health concerns stemming from the lack of in-person partner support. They noted disappointment and lost experiences for the patient during pregnancy, seeking support from her partner during pregnancy, experiences felt to be critical for postpartum health and wellbeing. There was also concern about the negative impact of restrictions on prenatal care quality and experience.Conclusions:This study demonstrates the impact of visitor restrictions on patients' prenatal care experience and perception of health care quality during the COVID-19 pandemic. Future public health strategies should be individualized to different patient populations addressing knowledge, health literacy, and socioeconomic status, and developed in conjunction with pregnant patients as key stakeholders in the delivery of prenatal health care.

Understanding perinatal patient’s health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana

BackgroundCongenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient’s health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting.MethodsBetween May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants’ understanding of health disparities and vulnerable populations; perinatal patient’s health and prenatal care preferences; and participants’ perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment.ResultsSite-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment.ConclusionsOur findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people’s access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.

Associated factors for post-partum weight retention in adolescent mothers: a prospective study

Objective: To assess weight retention in adolescent mothers at the fourth postpartum month and its association with sociodemographic, reproductive, anthropometric and behavioral factors. Methods: Prospective longitudinal study. The survey was conducted in all public and private maternity hospitals in a city in the east of Minas Gerais State. All adolescent mothers (age &lt;20 years) with childbirth at gestational age ≥37 weeks, without chronic disease, living in the municipality, whose delivery occurred between October/2018 and October/2019 participated. The first one took place 48-hours postpartum and the second, four months later. Four months postpartum the interview took place at the home of the mothers. Associations between variables were verified using Simple and Multiple Linear Regression. Results: Of the 367 interviewed adolescent mothers at the maternity hospitals, the predominant characteristics were age between 18-19 years, non-white skin color and education above nine years of study. Four months postpartum, 317 mothers were evaluated and the incidence of weight retention was 79.4% (n=247) with an average of 6.86 kg ±5.34. Higher means of weight retention were observed in mothers with less school years, greater number of children, higher daily consumption of ultra-processed food during pregnancy, without nutritional guidance during pregnancy, higher pre-gestational Body Mass Index and greater gestational weight gain (p&lt;0.05). Conclusions: The incidence of weight retention was considered high, a fact that highlights the importance of prenatal care quality, including nutritional education strategies, especially for this age group, highly vulnerable.

Maternal human capital and infants’ health outcomes: Evidence from minimum dropout age policies in the US

The purpose of this cross-sectional study is to examine the causal relationship of maternal education and infants' health outcomes. Using birth certificate data over the years 1970–2004 and exploiting the space-time variation in Minimum Dropout Age laws to solve the endogeneity of education, we find a sizeable effect of mothers' education on their birth outcomes. An additional year of maternal education is associated with a reduction in incidences of low birth weight and preterm birth by 15.2 and 12.7 percent, respectively. The estimates are robust across various specifications and even when allowing mothers’ cohort-of-birth to vary across regions. The results suggest that the candidate mechanisms of impact include improvements in timing, quantity, and quality of prenatal care, lower negative health behavior during pregnancy such as smoking and drinking, and higher spousal education.

Association Between Compliance With the New WHO-Recommended Frequency and Timing of Antenatal Care Contacts and Receiving Quality Antenatal Care in Cameroon

The objective of this study was to determine whether adherence to the new WHO recommendations for the frequency and timing of antenatal care (ANC) contacts was associated with receiving quality prenatal care in Cameroon. The 2018 Cameroon Demographic and Health Survey yielded a weighted sample of 5,694 women aged 15 to 49 years for analysis. We found that 8.9% of women had at least eight ANC contacts, with 47.3% of those occurring during the first trimester. Overall, 28.3% (95% CI [26.4, 30.3]) of the women received all eight ANC interventions studied. Women who made at least eight ANC contacts prior to delivery had a higher chance of receiving the full set of interventions (AOR = 1.41; 95% CI [1.00, 1.99]). Even among women who started ANC in the second trimester, those who made at least eight contacts were more likely than those who made fewer contacts to receive the full set of interventions. Furthermore, women who had their first contact later in the second (AOR = 0.85; 95% CI [0.72, 0.99]) or third trimester (AOR = 0.33; 95% CI [0.19, 0.57]) were less likely to receive the full set of interventions. According to our findings, Cameroonian women who followed the new global recommendations for prenatal care were more likely to receive quality prenatal care before giving birth. To have a positive pregnancy experience, however, more women must begin ANC in the first trimester and have at least eight contacts with health care providers before delivery.

Developmental Origins of Pregnancy-Related Morbidity and Mortality in Black U.S. Women.

In the US, Black women are at disproportionate risk for pregnancy-related morbidity and mortality (PRMM). Disparities in PRMM have been tied to elevated rates of obstetric cardiometabolic complications for Black women. Research seeking to elucidate the determinants of Black PRMM to date have focused predominantly on risk factors occurring during pregnancy (e.g., health risk behaviors, quantity and quality of prenatal care, provider behaviors, and attitudes). Meanwhile, other research investigating the developmental origins of health and disease (DOHaD) model indicates that the origins of adult cardiometabolic health can be traced back to stress exposures occurring during the intrauterine and early life periods. Despite the relevancy of this work to Black PRMM, the DOHaD model has never been applied to investigate the determinants of Black PRMM. We argue that the DOHaD model represents a compelling theoretical framework from which to conceptualize factors that drive racial disparities PRMM. Research and intervention working from a developmental origins orientation may help address this urgent public health crisis of Black PRMM.

Desigualdades en la cobertura y en la calidad de la atención prenatal en Perú, 2009-2019

RESUMENObjetivo.Describir la cobertura en la atención prenatal de calidad y la evolución de sus desigualdades en embarazadas peruanas en el período 2009-2019.Métodos.Análisis transversal con datos de la Encuesta Demográfica y de Salud Familiar de los años 2009, 2014 y 2019 sobre los cuidados prenatales; se consideró el número de visitas durante el embarazo y su calidad. Se calcularon medidas absolutas y relativas de desigualdad en salud de grupos estratificados.Resultados.La cobertura del número de visitas prenatales aumentó de 77,22% en el 2009 a 87,52% en el 2019. Asimismo, entre las mujeres de áreas rurales y urbanas, la brecha relativa por área de residencia disminuyó de 15% (2009) a 3% (2019), mientras que el porcentaje de embarazadas sin acceso a visitas de calidad decreció de 45,16% (2009) a 29,35% (2019). En el acceso a la calidad de controles, la desigualdad absoluta por quintiles de riqueza se redujo a casi la mitad, de 55,96% a 25,95%. Sin embargo, en este indicador, para el 2019 la diferencia relativa aún favorece a las universitarias 37% más respecto a las embarazadas sin escolaridad.Conclusiones.En Perú se han ido cerrando las brechas de las desigualdades de acceso a las visitas prenatales. Sin embargo, el conjunto de los datos nacionales oculta desigualdades entre poblaciones en la atención de calidad. La desigualdad en el acceso a la calidad de atención debería ser utilizada como indicador que permita el monitoreo de la cobertura de visitas prenatales.

Level of Mother's Knowledge About Nutrition for Pregnant Women in Rimba Soping Village Padangsidimpuan Angkola Julu District Year 2022

Nutrition Mother pregnant is food healthy and balanced a must consumed Mother during her pregnancy, with two servings of people who don't pregnant. nutritional status Mother before and during pregnant can influence growth fetus. If the nutritional status was normal before and during pregnant possibility big will give birth to healthy baby, enough month with normal weight. In other words quality newborn baby is very dependent on circumstances nutrition Mother before and during pregnant. A Mother pregnant will give birth to healthy baby when level health and nutrition are in good condition. However until moment This Still Lots Mother experiencing pregnant problem nutrition specifically nutrition not enough like not enough Energy Chronic (CED) and nutritional anemia. As for goals study This is for know knowledge Mother about nutrition Mother pregnant in Rimba Soping village Subdistrict Padangsidimpuan Angkol Julu. The research design used in study This is descriptive, with big sample of 50 people. Method taking sample is with accidental sampling technique namely take chance sample There is or ready. Study This done on the month January-March 2022. Instruments study This use excess questionnaire before being tested for validity content as many as 20 questions knowledge. Research results show that knowledgeable Good as many as 29 people (58%), and knowledgeable Enough as many as 12 people (24%), and knowledgeable not enough as many as 9 people (18%). Expected power health that has competence in give care and counselling during pregnancy, midwife must capable give quality prenatal care tall For optimizing health during pregnancy including counseling health about importance nutrition Mother pregnant.

Meta-Analysis: The Effectiveness of Using mHealth to Improve Antenatal Care

Background: One of the innovations in technology in health that can be used is mHealth. The use of technology such as mHealth allows for the dissemination of information to pregnant women in an effort to improve antenatal care. This study aims to determine the effectiveness of using mHealth on antenatal care. Subjects and Method: This was a systematic review and meta-analysis study using PICO, Population: Pregnant women, Intervention: Using mHealth, Com­parison: Not using mHealth/ standard services, Outcome: ANC visits. The articles used in this study came from 6 databases including Pubmed, ScienceDirect, Google Scholar, BMJ, Springer link, Sage, and Core. The keywords of the article are, Telemedicine OR Mobile Health OR Health Mobile OR Telehealth OR mHealth OR eHealth AND Short Message AND Quality Improvement OR Quality Improvement OR Quality Improvements OR Quality Improvements AND Prenatal Care OR Prenatal Care OR Antenatal Care OR Antenatal Care. The articles included in this study are complete articles, RCT study designs for 2012-2022. Results: There are 8 RCT articles from 3 continents, including Africa (Kenya, Ethiopia, Zanzibar), Asia (India), America (Peru, Brazil). It was found that using mHealth could increase ANC visits by 1.32 times compared to not using mHealth (RR=1.32; 95% CI=1.10 to 1.59; p=0.003). Conclusion: effective use of mHealth to improve antenatal care.

Perinatal mortality and its predictors in Kersa Health and Demographic Surveillance System, Eastern Ethiopia: population-based prospective study from 2015 to 2020

ObjectivePerinatal mortality is an important outcome indicator for newborn care and directly mirrors the quality of prenatal, intra partum and newborn care. Therefore, this study was aimed at estimating perinatal...

Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study

ObjectiveTo analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques.DesignEcological study.SettingsThis study was conducted in BrazilSampleA total of 151 601 CS cases notified to...

Space-time risk cluster and time trends of congenital syphilis in Brazil: an ecological study.

Congenital syphilis (CS) is a problem of great concern for public health, especially in Brazil. The aim of this study was to analyse the time trends and the space-time dynamics of morbidity and mortality from CS in Brazil. An ecological and time series study, which included all cases and deaths from CS recorded in a national Brazilian database from 2013 to 2019 was performed. Time trends in CS incidence and mortality were assessed using segmented linear regression. Univariate global and local Moran indices and space-time scan statistics were used in the space and space-time analyses. A total of 183171 cases and 2401 deaths from CS were recorded in Brazil, with the highest number of cases being observed in the Southeast Region (n=82612 [45.1%]). Only 21.1% of pregnant mothers with syphilis received adequate treatment. There was an upward trend in CS rates among mothers ages 20-29y (average annual percent change [AAPC] 1.4 [95% confidence interval {CI} 1.0 to 1.7]) and with <8y of schooling (AAPC 6.6 [95% CI 5.3 to 7.9]). The primary space-time cluster involved 338 municipalities in the Southeast Region (relative risk 3.06, p<0.001) and occurred between 2017 and 2019. To reduce the trends in CS rates, it is necessary to develop actions to improve the quality of prenatal care and expand early diagnosis and adequate treatment of syphilis in pregnant women and their sexual partners, especially in groups with upward trends (mothers ages 20-29y and <8y of schooling) and living in higher-risk regions (Southeast, North and Northeast).

Comparative evaluation of the impact of the COVID-19 lockdown on perinatal experience: A prospective multicentre study.

To compare in the early postpartum the perinatal experience during a COVID-19 related lockdown ('lockdown' group) and a pandemic control group subject to looser restrictions. This national multicentre prospective cohort study took place in four French maternity units. Women were recruited during the postpartum stay for the lockdown and pandemic control groups, according to their enrolment period. Both faced the same labour and delivery restrictions but only the pandemic control group could have a postpartum visitor. The primary outcome was the perinatal experience during childbirth, assessed by the Labour Agentry Scale (LAS) self-administered questionnaire, completed before discharge. The study included 596 women and analysed 571 of them: 260 in the lockdown group and 311 in the pandemic control group. The mean LAS score was lower in the lockdown group (161.1±26.8, 95% confidence interval [CI] 157.8-164.3 versus 163.3±24.0, 95% CI 160.6-166.0; P=0.289). In multivariable analysis, the LAS score was lower in the lockdown group (-6.2 points, P=0.009), in women with caesarean (-21.6 points, P<0.001) versus spontaneous deliveries, and among women financially impacted by the lockdown (-6.4 points, P=0.007) or who experienced restrictions during childbirth (-8.1 points, P<0.001). The LAS score rose with the prenatal care quality score (P<0.001). The perinatal experience was more negatively affected by lockdown restrictions than by the looser pandemic restrictions for controls, but mode of delivery remained the main factor influencing this experience.

PRETERM LABOR CONDITIONS OF WOMEN WITH HIGH-RISK PREGNANCY AND RELATED FACTORS: A RETROSPECTIVE COHORT STUDY

Objective: High-risk pregnancy is a situation associated with pregnancy involving a real or potential risk for the health and well-being of the mother and the fetus. Our study aimed to examine the preterm labor conditions of pregnant women followed up at a high-risk pregnancy outpatient clinic and related factors. Material and Methods: Designed as a retrospective cohort study, the study was carried out with the participation of 293 pregnant women who presented to a high-risk pregnancy outpatient clinic in the Batman province of Turkey and were followed up between March 2017 and January 2019. Results: The top three high-risk conditions determined in the pregnant women were pregnancy over the age of 35 (n=83, 28.3%), pregnancy in a shorter interval than two years (n=71, 24.2%) and consanguineous marriage (n=60, 20.5%), respectively. Twentypoint-one percent (n=59) of the pregnant women had preterm labor. It was determined that the rates of caesarean section births and births at a private hospital among the pregnant women who had preterm labor were significantly higher in comparison to the pregnant women who gave birth at term (p=0.001, p=0.037, respectively). It was determined that the risk of preterm labor increased OR=5.6 (1.2-25.6) times in the pregnant women with anemia, OR=12.5 (1.3-122.7) times in those with intrauterine fertilization and OR=32.6 (3.2-332.5) times in those with multiple pregnancies. Conclusion: Anemia, multiple pregnancy and intrauterine fertilization increase the risk of preterm labor. Quality prenatal care services are important in terms of protecting the health of the mother and the newborn.