Timing Of First Antenatal Visit Research Articles

Adherence to Iron and Folic Acid Supplementation Among Pregnant Women From Northern Ghana

Iron and folic Acid (IFA) supplementation is an effective intervention for reducing the incidence of anaemia during pregnancy. The WHO recommends at least 6 months intake of IFA to pregnant women. However, in Ghana some women experience challenges with adhering to IFA supplementation. The main objective of the study was to assess the level of adherence to iron and folic acid supplementation and its associated factors among pregnant women in a peri-urban municipality in Northern Ghana. A cross-sectional study was conducted from March to December 2021 among 400 pregnant women who attended ANC in Sagnarigu municipality in Ghana and were selected through a 3-stage random sampling technique. A structured questionnaire was used to collect data. The data were analysed using descriptive statistics, univariate and binary logistic regression statistical tools. Self-reported level of adherence to iron and folic acid supplementation was 84.5%. Knowledge of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) was associated with adherence. Three other factors: time of first antenatal visit (AOR = 0.32: 0.153, 0.649) having history of anaemia [AOR = 2.67: 1.373, 5.201] having side effects of IFA [AOR = 3.70, CI: (1.756, 7.793)], and having knowledge of management of side effects of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) were found to be significantly associated with adherence. Adherence to iron and folic supplementation among the pregnant women was generally frequent. Strategies to increase iron and folic acid supplementation adherence among pregnant women could focus on encouraging pregnant women to have early ANC visits and educating them on how to manage side effects.

Demographic and clinical predictors of vitamin D status in pregnant women tested for deficiency in Western Australia

ObjectiveThis study aimed to describe the vitamin D status of pregnant women in Western Australia and identify predictors of deficiency in pregnancy. MethodsA cross‐sectional study was conducted using linked data from statewide administrative data collections. Participants included pregnant women aged 18–44 years who gave birth between 2012 and 2014. ResultsThe mean 25‐hydroxyvitamin D (25[OH]D) concentration was 70.7 nmol L−1 (SD 25.7; range 5–255 nmol L−1). Approximately one‐fifth of the pregnant women were vitamin D deficient (<50 nmol L−1). Maternal age (under 25 years) was identified as an independent risk factor of vitamin D deficiency in addition to known predictors. Only 20% of women were screened within the first 10 weeks of their pregnancy. ConclusionsIn addition to the existing risk factors for deficiency, maternal age was an independent predictor of vitamin D deficiency. There was a large discrepancy between the time of first antenatal visit and screening for vitamin D deficiency. Implications for public healthOur findings support the addition of maternal age (under 25 years) to the current clinical guidelines for targeted screening of 25(OH)D levels in pregnancy and the practical application of screening for vitamin D deficiency at the first antenatal visit.

Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017\u201318 Jordan demographic and health survey

BackgroundDespite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan.MethodsThis study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression.ResultsOut of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001).ConclusionsJordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

Temporal relationship between Women\u2019s empowerment and utilization of antenatal care services: lessons from four National Surveys in sub-Saharan Africa

BackgroundIn November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women’s empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women’s empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women’s empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model.MethodsThe most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women’s empowerment captured in the DHS. The 30 variables on women’s empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results.ResultsThe proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women’s empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries.ConclusionThis study highlights the significant impact of women’s empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.

SOCIO-DEMOGRAPHIC DETERMINANTS OF UNMET NEED FOR FAMILY PLANNING IN CRISIS-AFFECTED STATES OF NORTHERN NIGERIA

This study ascertained the prevalence of unmet need for family planning in crisis-affected states of Northern (Yobe, Borno, Plateau, Kaduna, and Zamfara) Nigeria; ascertain the determining factors of unmet need for family planning in crisis-affected states of Northern Nigeria; and examine the relationship between demographic factors and unmet need for family planning in crisis-affected states of Northern Nigeria. The target population are women within the age range of 15 – 49 years selected from NDHS 2018 who have engaged in sexual activity and have experienced the burden of child bearing. The sample was weighted using the weights provided by the 2018 NDHS. The study sampled 8, 846 from the weighted total of 41, 821 women covered in the 2018 NDHS. Women who are not sexually active or have been sterilized and those who are pregnant were not included to the population of women sampled. The independent variable in this study is the unmet need for family planning in crisis affected states of Northern Nigeria; explanatory variable are sets of demographic variables (birth intervals, current age, number of living children, fertility desire, child mortality experience, marital status, couple fertility desire, type of marriage and age at first birth) while the mediating variables (pregnancy termination experience, attendance at ante-natal care, and timing of first antenatal visit).

Maternal Risk Factors Associated with Term Low Birth Weight in Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Aims: To investigate the association of various maternal factors and associated medical conditions during pregnancy with low birth weight (LBW) at term in neonates.&#x0D; Methods: An unmatched case control study was done involving 150 cases (mothers who delivered singleton baby at term weighing less than 2500g) and 150 controls (mothers who delivered singleton baby at term weighing ≥2500g) in Jigme Dorji Wangchuck National Referral Hospital from 2018 to 2019. Consecutive and systematic sampling methods were used to select case and control respectively. Student unpaired t-test was used to test the differences between the control and case means for various factors. Odds ratios were used to assess the role of various factors on low birth weight&#x0D; Results: This study found maternal height, weight gain during pregnancy, time of first antenatal visit and hypertension during pregnancy as the independent predictors of low birth weight.&#x0D; Conclusions: Targeted interventions such as improving maternal weight gain during pregnancy, empowering mothers to come early for their first antenatal care and optimising gestational hypertension can help to prevent low birth weight.&#x0D; Keywords: Bhutan, case control study, low birth weight, risk factors, singleton pregnancy.

An unwanted pregnancy and language proficiency level are associated with first antenatal visit after the first trimester: Results from a prospective cohort study

To study the association between the reasons for a 'late' first antenatal visit and the influence of several maternal determinants and practical limitations on the timing of the first antenatal visit. A prospective cohort study. Southwest region of The Netherlands, mainly characterised by large urban and suburban areas. Women receiving information and counselling about prenatal screening between April 2010 and December 2010 were included (n=9,268). Timing of first antenatal visit, categorised as: 'in time' (<12+0 weeks of gestation), 'late' (≥12-23+6 weeks of gestation) and 'very late' (≥24 weeks of gestation). An unplanned or unwanted pregnancy was the most frequently reported reason for delay of the first antenatal visit (30.7%) especially in Surinamese women (79%), and women younger than 20 years (63%) or older than 40 years (50.0%). Compared to women who timed their first antenatal visit 'in time', women with a delay in their first visit were more often younger than 20 or older than 40 years of age, high order multiparous (P≥3), with a previous miscarriage, and had an absent Dutch language proficiency level. The latter showed the strongest association with a 'very late' first antenatal visit (OR 4.96, 95%CI 2.45-10.05). Language proficiency level was highly associated with a delay in the timing of the first antenatal visit. When women timed their first antenatal visit late, having an unplanned or unwanted pregnancy was the most frequently reported reason for this delay. Findings from this study can be used to inform and develop interventions to improve timely antenatal care use.

Early onset preeclampsia is associated with an elevated mean platelet volume (MPV) and a greater rise in MPV from time of booking compared with pregnant controls: results of the CAPE study.

To characterise Mean platelet volume (MPV) in patients with early onset preeclampsia (EOPE) and unaffected controls from time of first antenatal visit until the postpartum. Retrospective secondary analysis of an observational study in an Irish tertiary referral centre with 9000 deliveries annually. The MPV of 27 women with EOPE was compared to 19 unaffected controls. The inclusion criteria for the disease state was the development of EOPE defined by the National Institute for Health and Care Excellence (NICE) guideline, as new onset hypertension presenting after 20 weeks and prior to 34 weeks with significant proteinuria. Between October 2013 and July 2015 we recruited 27 women with EOPE and 19 pregnant controls. Statistical analysis was performed using paired T-test of Mann-Whitney test where appropriate and a P-value <0.05 was deemed significant. At time of diagnosis and late in the third trimester MPV was significantly increased to 9.0 (±0.3) fL in cases of EOPE in comparison to 8.5 (±0.6) fL in normotensive controls (P<0.05). There was no significant difference during the first trimester or postpartum when comparing the MPV in EOPE to controls. Despite an increased MPV at time of diagnosis of EOPE this study did not demonstrate a potential use for increased MPV as a first trimester screening tool.

Antenatal Practices Ineffective at Prevention of Plasmodium falciparum Malaria during Pregnancy in a Sub-Saharan Africa Region, Nigeria

Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 103/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 103 vs. secundi- (92.14 ± 4.72) × 103 vs. multigravidae (65.22 ± 20.17) × 103; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 103 vs. multiparous (67.50 ± 20.97) × 103 was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ2 = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ2 = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765–12.135)) and users (66.7% vs. 33.3%, χ2 = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693–23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery.

Frequency and Timing of Antenatal Care Visits and Its Impact on Neonatal Mortality in EAG States of India

The study aims to examine the association between frequency of antenatal care visits and neonatal mortality in EAG states and to explore the relationship between the timing of first antenatal care visit in the trimester and neonatal mortality in EAG states of India. The study uses data from the third round of National Family Health Survey NFHS-3. The timing of the first antenatal visit and the relative number of ANC visits received by the women is studied separately. Logistic regression is applied to find an association between continuity, the timing of ANC received and neonatal birth outcome. Results explain significant association between mothers receiving ANC 4-9 visits had experienced a lower risk of neonatal mortality. Mothers who received antenatal care visit from the first trimester experienced lest pregnancy outcomes and neonatal deaths.

The prevalence of malaria at first antenatal visit in Blantyre, Malawi declined following a universal bed net campaign.

BackgroundPreventing malaria during pregnancy is important for the health of mothers and newborns. Interventions, which include distribution of bed nets and administration of intermittent preventive treatment (IPT), typically occur at the first antenatal visit, usually in the second or third trimester of pregnancy. In 2012, during the course of ongoing clinical studies of malaria among pregnant women in Malawi, a universal bed net campaign was implemented by the Government. This study tested the hypothesis that a universal bed net campaign would decrease the prevalence of malaria among pregnant women at their first antenatal visit.MethodsSome 1661 women were recruited for two studies from 2009 to 2014. Quantitative PCR (qPCR) was conducted from dried blood spots collected at the first antenatal care visit (prior to administration of IPT or any study interventions) from women who were in their first or second pregnancy and less than 28 weeks gestation by clinical assessment.ResultsOverall, 320 of 1629 (19.6 %) women tested for malaria at their first antenatal visit were infected. Malaria infection rates declined from 28.4 % before the universal bed net campaign, to 18.5 % in 2012, to 15.0 % in the years following the universal bed net campaign. The odds of malaria infection at the time of first antenatal visit in 2012 and the years following the bed net campaign were significantly lower than in the years prior to the intervention (OR 0.6, 95 % CI 0.4–0.8; and OR 0.4, 95 % CI 0.3–0.6, respectively). A similar pattern was observed for the prevalence of clinical malaria. The inverse trend was observed for reported bed net use. However bed net use and malaria infection were not significantly associated on the individual level.ConclusionsMalaria infection in pregnant women is common even after a bed net campaign in Malawi, though prevalence rates declined. These early infections may cause maternal anaemia and placental malaria resulting in adverse maternal and fetal outcomes. Infection early in pregnancy may also contribute to malaria transmission as pregnant women represent a significant untreated reservoir of parasites. Universal bed net distribution appears to have moderate success in preventing malaria early in pregnancy and these findings support continued efforts to target women early in pregnancy and all women of childbearing age.

Maternal anemia at first antenatal visit: prevalence and risk factors in a malaria-endemic area in Benin.

The risk factors for maternal anemia (hemoglobin level less than 110 g/L) were studied in human immunodeficiency virus-negative pregnant women in Benin at the time of first antenatal visit and prior to any prevention. Data for the first 1,005 pregnant women included in a multicentre randomized controlled trial were analyzed. Anemia was common (68.3%), and malaria and helminth infestations were prevalent in 15.2% and 11.1% of the women. A total of 33.3%, 31.3% and 3.6% of the women were iron, folic acid and vitamin B12 deficient, respectively. These parasitic infections and nutrient deficiencies were associated with a high risk of anemia. Twenty-one percent, 15%, 12%, 11% and 7% of anemia were attributable to malnutrition, malaria, iron, folic acid deficiencies, and helminth infestations, respectively. Most anemia was caused by factors that could be prevented by available tools, stressing the need to reinforce their implementation and to evaluate their effectiveness throughout the course of the pregnancy.

European indicators of health care during pregnancy, delivery and the postpartum period

Objectives: To describe variation across Europe in PERISTAT indicators of health care in the perinatal period, and to assess the comparability of these indicators. Study design: The PERISTAT feasibility study provides the source for this descriptive study, covering 15 European countries. Comparative analysis includes descriptions of births following management of sub-fertility, timing of first antenatal visit, onset of labour, mode of delivery, place of birth, preterm births in units without NICU, and breast-feeding uptake. Results: There is broad variation in the availability to provide data on perinatal indicators, and in perinatal health care across the European Union. Conclusions: This paper describes the challenge of identifying indicators that are meaningful and robust for the full distribution of health care systems represented in the European Union. Further work is needed to ensure that the implementation of each indicator is comparable across member states.

EFFECTS OF AMBIENT ON AIR POLLUTION ON GESTATIONAL AGE, SYDNEY, AUSTRALIA

Introduction There are no reported studies on the effects of ambient air pollution on birth outcomes from Australia. We therefore undertook an investigation to determine if there were any associations between ambient air pollutants (particulate matter, nitrogen dioxide and ozone) and gestation. The study was conducted in Sydney, Australia. Methods The study period was a three-year period between 1998 and 2000 and included all births in metropolitan Sydney in this time period. We used routinely collected data for both the exposures and birth outcomes. We obtained the perinatal data from the New South Wales Health Department and air pollution data from the New South Wales Environment Protection Authority. Birth data included demographic factors (age, smoking status, country of birth, postcode of residence at time of delivery), pregnancy factors (date of the last menstrual period, gestational hypertension and diabetes, parity, time of first antenatal visit to a healthcare provider), details about the delivery (type of delivery) and infant factors (birth weight, Apgar score). Air pollution data included information on particulate matter (PM10, PM2.5; 24-hour averages), nitrogen dioxide (NO2; 1-hour average), ozone (O3; 1-hour average) and carbon monoxide (CO; 1-hour average). Exposure periods were defined as 30 days and 90 days prior to delivery and 30 days and 90 days after the last menstrual period. Exposures were averaged across all air monitoring stations in metropolitan Sydney. Gestation was analysed as a categorical variable (< 37 weeks and >37 weeks) using logistic regression. Results Over the three year period there were 122,877 singleton births to mothers who did not have gestational hypertension and diabetes. 4.7% (n = 5831) of these births were preterm (< 37 weeks at birth). Median air pollutant concentrations were: PM10 24-h average = 15.7mg/m3, PM2.5 24-h average = 8.4mg/m3, NO2 1-h maximum = 23.0ppb, O3 1-h maximum = 27.7ppb and CO 1-h maximum = 1.2ppm. There was no effect of particulates or gaseous pollutants averaged over the month or three months prior to delivery on gestation. Particulates, NO2 and CO exposure in the first one and three months of pregnancy was associated with a lower risk for prematurity, whereas ozone exposure in the first three months of pregnancy increased the risk of preterm delivery. Conclusions Preliminary analyses suggest that in Sydney, Australia we were not able to demonstrate consistent adverse effects of ambient air pollution on preterm delivery. Exposure to ambient ozone in the first trimester was associated with an increased risk of preterm deliveries. However, as this was the only significant adverse finding among the many tests done, we advise caution in the interpretation of the results.

EFFECTS OF AMBIENT ON AIR POLLUTION ON BIRTH WEIGHT IN TERM INFANTS, SYDNEY, AUSTRALIA

Introduction There are no reported studies on the effects of ambient air pollution on birth outcomes from Australia. We therefore undertook an investigation to determine if there were any associations between ambient air pollutants (particulate matter, nitrogen dioxide, ozone and carbon monoxide) and birth weight. The study was conducted in Sydney, Australia. Methods The study period was between 1998 and 2000 and included all births in metropolitan Sydney in this time period. We used routinely collected data for both the exposures and birth outcomes. We obtained the perinatal data from the New South Wales Health Department and air pollution data from the New South Wales Environment Protection Authority. Birth data included maternal demographic factors (age, smoking status, country of birth, postcode of residence at time of delivery), pregnancy factors (date of the last menstrual period, gestational hypertension and diabetes, parity, time of first antenatal visit to a healthcare provider), details about the delivery (type of delivery) and infant factors (birth weight, Apgar score). The air pollution data included information on particulate matter (PM10, PM2.5; 24-hour averages), nitrogen dioxide (NO2; 1-hour average), ozone (O3; 1-hour average) and carbon monoxide (CO; 1-hour average). Exposure periods were defined as 30 days and 90 days prior to delivery and 30 days and 90 days after the last menstrual period. Exposures were averaged across all air monitoring stations in metropolitan Sydney. Birth weight was analysed as a categorical variable (< 2500 grams and >2500 grams) in logistic regression models. Results Over the three year period there were 117018 singleton term births (37–42 weeks gestation) to mothers who did not have gestational hypertension and diabetes. 1.5% of these births were low birth weight (less than 2500 grams at birth). Median air pollutant concentrations were: PM10 24-h average = 15.7mg/m3, PM2.5 24-h average = 8.4mg/m3, NO2 1-h maximum = 23.0ppb, O3 1-h maximum = 27.7ppb and CO 1-h maximum = 1.2ppm. Preliminary analyses suggest that particulates or gaseous pollutants exposure in the month or three months prior to delivery were not associated with low birth weight. However, NO2 and CO exposure in the first one and three months of pregnancy was associated with a lower risk for low birth weight. Conclusion In Sydney, Australia we were not able to demonstrate adverse effects of ambient air pollution on birth weight. Reasons for this may be the low levels of ambient air pollutants in metropolitan Sydney or differences in the ambient air pollution mix.

Mother's education and perinatal problems in Finland.

This study using nationwide data expands a previous study from one area in Finland. The purpose was to study how perinatal problems (mortality, short gestation, low birthweight and low Apgar scores) vary by mother's social class, which is measured by level of education. Outcomes of all births in the 1987 Medical Birth Register were linked to the 1988 National Education Register with gives the estimated number of years of completed education. In unadjusted analyses, the lowest educational groups (less than 9 years) had the worst results for outcomes other than neonatal mortality. Results in the two highest educational groups (greater than or equal to 13 and 12 years of education) were similar and if anything, better in the second highest group. Excluding twins and adjusting for confounding variables (age, parity, county, urbanization of residence) by logistic regression analysis did not alter the results much. Adjustment for possible mechanisms correlated with social class (marital status, smoking, time of first antenatal visit) decreased the higher occurrence of low birthweight infants in the low educational groups. Reported previous miscarriages were more common in the higher educational groups. Based on the available background characteristics one would expect to have found the usual social gradient in perinatal problems to have persisted between the two highest educational groups. Further studies on factors causing the plateau in the gradient between these groups might be useful.