Trimester Visits Research Articles

Association of stress on eating competence in mothers during pregnancy and six months postpartum

BackgroundPerceived stress is related to poor diet quality and unhealthy dietary patterns in women of reproductive age. Eating competence represents a variety of contextual skills reflecting a comfortable and flexible approach to eating and is associated with diet quality and health related behavior. In non-pregnant samples, perceived stress is negatively associated with eating competence. Given that pregnancy and the postpartum period can be periods of high stress, we hypothesized that higher stress in pregnancy would result in lower pregnancy eating competence.MethodsWomen (n = 296, mean BMIbaseline pregnancy = 26.3 ± SD 6.0) in the Pregnancy Eating Attributes Study (PEAS) were recruited from the Chapel Hill, North Carolina area. Perceived stress was assessed using the Perceived Stress Scale and eating competence using the ecSatter Inventory at their first trimester and 6-month postpartum visits. We used a mixed effect model to assess the effect of stress by time on eating competence, controlling for baseline pregnancy BMI, race and ethnicity, poverty to income ratio, and WIC status.ResultsPerceived stress was negatively associated with eating competence (b= -0.23, SE = 0.06, p < 0.001). The interaction of stress by time was negatively associated with eating competence (b = -0.15, SE = 0.08, p = 0.03), indicating that the association of stress with eating competence was stronger in postpartum than in pregnancy.ConclusionsPerceived stress may adversely impact eating competence during both pregnancy and postpartum. Future studies intervening upon stress or eating competence during pregnancy and postpartum may inform potential causal relations.

Association of Hypertensive Disorders of Pregnancy with variations in Serum Sodium and Potassium Concentration

Objective: To study the variation in Serum Sodium and Potassium concentration in Pre-eclampsia and Normotensive pregnant ladies.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of the Study: Combined Military Hospital, Kharian District Gujrat Pakistan, from Jun 2020 to Jan 2021.&#x0D; Methodology: The study population Comprosed of 80 pre-eclamptic and 80 normotensive pregnant women recruited consecutively at their first, third trimester, and prenatal visits. Serum Sodium and Potassium were analysed using Ericson Photometer.&#x0D; Results: When the two Groups were compared, in the Normotensive Group, the mean Sodium concentration of 132±4.490 mEq/dl was significantly less than the Pre-eclampsia Group of 139.1±3.909 mEq/dl. On the contrary, mean Serum Potassium concentration was significantly less in Pre-eclampsia 3.54±0.511 mmol/L compared to the Normotensive Group to 4.0±0.513 mmol/L.&#x0D; Conclusion: High levels of Sodium and low level of Potassium were observed in the Pre-eclampsia Group. There may be a causal relationship between electrolyte fluctuations and Pre-eclampsia.Keywords: Electrolytes, Hypertension, Potassium, Pre-eclampsia, Sodium.

Trauma-Informed Psychosocial Screening and Care Planning: A Patient-Centered Improvement Project in a Midwife Clinic.

Traumatic stress is associated with increases in preterm birth, low birth weight, and other perinatal complications. Yet the identification of patients with traumatic stress and intervention for traumatic stress prevention or treatment remain low. Locally in this university hospital-based midwife clinic, a health records review found that trauma exposure was documented in 5% of patient records, and no records had a diagnosis of posttraumatic stress disorder (PTSD). This is lower than research-based population estimates of 25% to 50% for trauma exposure and 8% for PTSD during pregnancy. The clinic staff did not screen for posttraumatic stress, and exposure screening was limited to intimate personal violence. Staff had not been trained in trauma-informed care (TIC) as defined by the Substance Abuse and Mental Health Services Administration. The aim for this improvement project was to provide trauma screening and trauma-related care planning, collectively referred to as trauma-informed psychosocial care, to midwifery patients 85% of the time. Interventions were implemented over 4 plan-do-study-act (PDSA) cycles. These included staff training in TIC; written screening at the new prenatal, third trimester, and postpartum visits; verbal broad inquiry at every visit; and bidirectional trauma-specific care planning emphasizing patient and provider input into treatment choice. The clinic flow was changed to create privacy for patient-staff interaction at every visit. Field notes and data were analyzed every 2 weeks and iterative changes applied. Trauma disclosure increased from 5% to 30% and identification of PTSD from 0% to 7%. Bidirectional care plan documentation increased from 8% to 67%. Staff rated the workload as reasonable. Redesigning psychosocial screening to align with TIC principles increased the discovery of trauma to levels consistent with research-based population estimates. Gains were made in bidirectional care planning. This project illustrates practical methods of implementing TIC principles.

Magnitude of optimal access to ANC and its predictors in Ethiopia: Multilevel mixed effect analysis of nationally representative cross-sectional survey.

Optimal access to ANC, such as the first ANC visit at first trimester, four or more ANC visits, and skilled health care provider can significantly reduce maternal mortality in an inclusive way. Previous studies conducted in Ethiopia on optimal ANC are restricted to frequencies of ANC visit. Therefore, the aim of this study was to assess the magnitude of optimal ANC access as a comprehensive way and its predictors among pregnant women in Ethiopia. Secondary data source from a recent demographic and health survey was used for analysis. This study includes a weighted sample of 4771 pregnant women. A multilevel mixed-effect binary logistic regression analyses was done to identify both the individual and community level factors. Odds ratio along with the 95% confidence interval was generated to identify the predictors of optimal access to ANC. A p-value less than 0.05 was declared as statistical significant. In Ethiopia, one in five (20%) pregnant women had optimal access to antenatal care. Regarding the factors at individual level, pregnant women aged 25-34 years [aOR = 1.58, 95% CI = 1.23-2.03] and 35-49 years [aOR = 2.04, 95% CI = 1.43-2.89], those who had educated primary [aOR = 1.67, 95% CI = 1.33-2.09], secondary and higher [aOR = 1.81, 95% CI = 1.15-2.85], Primipara [aOR = 2.45, 95% CI = 1.68-3.59] and multipara [aOR = 1.48, 95% CI = 1.11-1.98] had higher odds of accessing optimal ANC. With the community level factors, the odds of optimal access to ANC was higher among pregnant women who lived in urban area [aOR = 2.08, 95% CI = 1.33-3.27], whereas, lower odds of optimal ANC access among those pregnant women who reported distance to the health facility as a big problem [aOR = 0.78, 95% CI = 0.63-0.96]. The study concludes that in Ethiopia, optimal access to ANC was low. The study identified that both individual and community level factors were predictors for optimal ANC access. Therefore, the Ethiopian government should intensify extensive education on ANC in a comprehensive way. Moreover, especial attention from the Ethiopian ministry of health for those women who reported distance as a big problem and for rural resident women is mandatory.

Preventive Obstetrics and First Trimester of Pregnancy: One Stop Clinic Assessment of Risks (OSCAR)

One of the main indicators of societal health parameters is antenatal care. The main goal of antenatal care to identify various risk factors to mother or foetus or both and to provide positive pregnancy experiences and a healthy offspring. There was no paradigm of early pregnancy evaluation in the 20th century since prenatal care was more concentrated on the third trimester and frequent visits were more near the end of pregnancy.

Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Pregnancy Outcomes: A Population-based Study.

BackgroundA population-based study to describe the impact of SARS-CoV-2 infection on pregnancy outcomes.MethodsProspective, population-based study including pregnant women consecutively attended at first/second trimester or at delivery at three hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (IgG and IgM/IgA) were measured in all participants and nasopharyngeal RT-PCR was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2 positive versus negative women: miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational age, neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women.ResultsOf 2,225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n=314, 99.1%) and/or RT-PCR (n=36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild COVID-19 and 7 (2.2%) pneumonia, of which 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively [risk difference -0.4%, (95% CI: -4.1% to 4.1)]. As compared with non-infected women, women with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs. 16.9%, p=0.003) and intrapartum fetal distress (9.1% vs. 19.2%, p=0.004), while asymptomatic women had similar rates to non-infected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood.ConclusionsThe overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to non-infected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.

Hubungan Kunjungan Trimester 1 dengan Screening Anemia pada Ibu Hamil di Era Peradaban Baru

The Covid-19 pandemic gave birth to a new civilization era where people were asked to adapt to this pandemic condition. This also applies to maternal and child health services, especially antenatal care. The highest cause of death in Indonesia in 2019 is due to bleeding, which can be influenced by low hemoglobin levels or what is commonly known as anemia. The purpose of this study was to analyze the relationship between first trimester visits and anemia screening in pregnant women. The research method used was cross sectional, using google form media to fill out questionnaires and screen shots of the MCH book. The statistical test in this study used Pearson. The results showed that there was no relationship between the first trimester visit and anemia screening, which was obtained by the Pearson statistical test value sig = 0.189&gt; 0.05, which means that there was no relationship between the first trimester visit and the examination of hemoglobin levels in pregnant women. The conclusion that can be drawn is that even though we are now entering a new civilization era where there are several regions that implement Large-Scale Social Restrictions and which in Maternal and Child Health services, especially pregnancy examinations, can still be implemented, government policies in the new civilization era during the 1st trimester visit are focused on screening of maternal health conditions for complications in pregnancy, and especially regarding referrals if there are complications in her pregnancy and management of pregnant women with Covid-19, so that this can prevent transmission of Covid-19.

Effect of pregnancy intention on the timing and sustained use of antenatal care services in Rwanda.

We investigated the relationship between intended pregnancy and utilization of antenatal care services in Rwanda. Using Demographic and Health Survey 2014/2015, secondary data was obtained on maternal health services utilization. We performed stepwise logistic regression analysis to examine the effect of independent variables on women's early and late utilization, as well as their sustained use of antenatal services. Dependent and main independent variables included: first trimester visits, completed antenatal visits and intended pregnancy respectively. Of 5,944 women sampled; 56.6% had made early antenatal visits and 44% had completed 4 visits. Unintended pregnancies were less likely to make early antenatal visits and complete 4 antenatal visits. Religion and being in union had positive association with standard antenatal visits; while age (>24 years), grand multiparty, and poor economic status had negative association. Our results call for deeper sensitization on utilization of antenatal services and more use of contraception to reduce unintended pregnancies.

Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low-income urban setting.

About 2.6million stillbirths per year occur globally with 98% occurring in low- and middle-income countries including Kenya, where an estimated 35000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden. This was a case-control study in four urban tertiary hospitals carried out between August 2018 and April 2019. A total of 214 women with stillbirths (cases) and 428 with livebirths (controls) between 28 and 42weeks were enrolled. Information was obtained through interviews and data abstracted from medical records. Antenatal care utilization was assessed by the proportions of women not attending antenatal care; booking first antenatal care visit in first trimester and not making the requisite four antenatal care visits. Quality of antenatal care was assessed using individual surrogate indicators (antenatal profile testing, weight/blood pressure/urinalysis testing in each antenatal visit, utilization of early obstetric ultrasound, completeness of antenatal records) and a codified indicator made up of seven parameters (attending antenatal care, booking first antenatal care in the first trimester, making four or more antenatal visits, having all antenatal profile tests, having a complete antenatal record, having blood pressure and weight measured at all visits). The association between antenatal care utilization and quality with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed P value ≤.05. Women with stillbirth were likely to have a parity ≥4 (19.6% vs 12.6%, P=.02), have an obstetric complication (36% vs 8.6%, P=.001) and have a medical disorder (5.6% vs 1.6%, P=.01). The odds of a stillbirth were four times higher among those who did not attend antenatal care ( odds ratio [OR] 4.1, 95% confidence interval [CI] 1.6-10, P<.003). Compared with four antenatal care visits, those who had one or two visits had higher odds of a stillbirth: OR 2.96 (95% CI 1.4-6.1), P=.003, and OR 2.9 (95% CI 1.7-5), P=.003, respectively. As per the individual surrogate indicators, the likelihood of a stillbirth was lower in women who received good quality antenatal care: Hemoglobin testing (OR 0.6, 95% CI 0.4-0.8, P=.03), blood group test (OR 0.4, 95% CI 0.2-0.6, P<.001), HIV test (OR 0.3, 95% CI 0.2-0.5, P=.001), venereal disease research laboratory test (OR 0.2, 95% CI 0.1-0.4, P=.001), weight measurement (OR 0.7, 95% CI 0.5-1.0, P=.047). As per the composite indicator, the quality of antenatal care was poor across the board and there was no association between this surrogate indicator and stillbirth. Lack of antenatal care, attending fewer than four antenatal visits and poor quality antenatal care as measured by surrogate indicators were significantly associated with stillbirth. In addition, women with low education level, obstetric complications, multiparity and medical complications had a significantly higher likelihood of stillbirth. Improving the utilization of four or more antenatal visits and the quality of antenatal care can reduce the risk of stillbirth.

Generalized Poisson Regression Type-II at Jambi City Health Office

One statistical analysis is regression analysis. One regression that has the assumption of poisson distribution is poisson regression which has the assumption of poisson distribution. Neonatal deaths are still very rare, so the proper analysis is used, namely Generalized Poisson Regression. This regression method is specifically used for Poissson distributed data. The stages that will be carried out in this research are Poisson distribution test and equidispersion assumption, parameter estimation, model feasibility test and best model selection. Data from the Jambi City Health Office in 2018 showed that the Generalized Poisson Regression regression alleged had a variable number of first trimester visits, the number of pregnant women getting Tetanus Diptheria immunization, the estimated number of neonatal infants with complications, the number of infants receiving Hepatitis B immunization was less than twenty-four hours, the number of infants receiving BCG immunizations.

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

BackgroundBy 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016.MethodsA CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up.ResultsWomen enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%).ConclusionsIn a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

Pregnancy-related emergencies: Profile and outcome.

Background:National efforts to reduce maternal mortality with respect to community services have primarily focused on upgrading transportation infrastructure and formalizing training for care providers. There is, however, a paucity of baseline data on the profile and outcomes of pregnant women presenting to the Emergency Department (ED) in India.Methods:This retrospective study enrolled all pregnant women presenting to a large tertiary medical care center in India, between November 2016 and November 2017.Results:There were 696 ED visits by pregnant women during the study period. The mean age was 26.85 (SD: 4.88) years. Pregnant women in the first trimester contributed to 50.8% of all visits, and 54% being multigravida. The most common presenting complaints were bleeding/spotting per vaginum (PV) (38.2%) and abdominal pain (37.6%) followed by fever (21.6%) and vomiting (21.5%). Obstetric causes contributed to 53.2% of the ED visits, while nonobstetric causes amounted to 43.2%. Over a third (39.7%) required hospital admission. Of these patients, 73% delivered in CMC with live births amounting to 62.3% while 3.5% ended in fetal deaths. The miscarriages rate was as high as 28%. More than half (51.1%) of the deliveries were by normal vaginal delivery. There were no maternal deaths during the time of admission.Conclusions:Our study sheds new light on the profile of emergency visits among pregnant patients and their relationship to the outcome of pregnancy. First trimester visits were most common with complaints of bleeding PV and abdominal pain. This could explain the high rate of miscarriages among this population.

570: Cardiac disease in pregnancy: do standardized protocols and risk stratification improve outcomes?

To establish a prospective standardized protocol for the clinical evaluation of pregnant women with cardiovascular disease (CVD), create a standardized risk assessment tool and assess outcomes of women undergoing the standardized protocol compared with women who did not. The Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) initiative prospectively enrolled pregnant women with CVD to a standardized diagnostic testing and assessment protocol. (Figure 1) Specific detailed cardiac and obstetric data were collected during the antepartum, intrapartum and postpartum periods. Each woman was assigned a STORCC color code of perceived risk at a monthly multidisciplinary conference comprised of representatives from cardiology, maternal fetal medicine and obstetric anesthesia. In 250 pregnancies of women with CVD, the standardized care protocol was followed in 136 and routine care in 114. The median age of the subjects was 32 years, and the most common form of heart disease was congenital heart disease (77%). Of the 136 standardized care patients, 22% were classified as high-risk, and 78% as low-risk. Among the high-risk group, 12% experienced a prior adverse cardiac event, 8% had a resting left ventricular outflow tract gradient ≥ 30 mm Hg and one had cyanosis (room air oxygen saturation <90%). Women enrolled in standardized care protocol had high compliance with 2nd and 3rd trimester visits (93%) and post-partum visits (76%). Maternal cardiac complications occurred in 10%. Outcomes did not differ between the standardized care and routine care cohorts; this remained true after adjusting for type of heart disease or disease complexity. The STORCC cardiac and obstetric color codes were predictive for adverse outcomes within each respective category (p = 0.02, 0.01). (Figure 2) The STORCC protocol for prospective diagnostic testing and follow-up of pregnant women with CVD was successfully established and compliance was high. The strength of a standardized testing and care protocols as well as detailed classification of labor and delivery characteristics allows for robust analyses into specific questions regarding mode and timing of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Individual and Area Level Factors Associated with Prenatal, Delivery, and Postnatal Care in Pakistan.

This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57% had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5.

Strategies of testing for syphilis during pregnancy.

Strategies of testing for syphilis during pregnancy.

Optimizing the Use of Surveillance Data for Monitoring the Care Status of Persons Recently Diagnosed With HIV in NYC

Comprehensive laboratory reporting of CD4 and viral load (VL) tests to surveillance has been used to assess HIV care-related outcomes at the population level, but their validity for this purpose has not been comprehensively evaluated. Assess performance characteristics and validity of surveillance-based measures of linkage to and establishment of HIV primary care among HIV-infected persons in the first 12 months after diagnosis using medical record (MR) data on outpatient HIV primary care visits as the gold standard. All patients diagnosed with HIV in 2009 at 24 New York City high-volume, HIV diagnostic and treatment facilities who linked to care within 12 months at the same site as defined by the presence of ≥1 CD4/VL report received by surveillance were selected for MR review to confirm linkage to outpatient HIV primary care within the first year. All HIV care visit dates were abstracted and considered associated with a surveillance laboratory report, if within 14 days of a care visit. The proportion linking to care according to the MR was compared with the proportion linking per CD4/VL tests reported to surveillance. Four measures of the establishment of outpatient HIV primary care in the first year were assessed: (1) sustained care (first visit within 3 months; second visit, 3-9 months later), (2) continuous care (2 visits at least 90 days apart), (3) trimester visits (visit in each 4-month period), and (4) visit constancy (visit in each 3-month period). The validity of surveillance data for measuring this outcome was assessed by comparing results for each of the 4 measures calculated using surveillance data to those calculated using MR data. Of the 782 patients selected, 20% (N = 157) of patients did not link to outpatient HIV primary care at the co-located care facility within 12 months of diagnosis. Half (48.5%) of patients' care visits after linkage did not have an associated CD4/VL reported to surveillance. Of the 4 establishment measures, sustained and continuous care had the highest agreement with MR (86.6% and 88.8%, respectively) as compared with the trimester visits and visit constancy (77.8% and 72.8%, respectively). Surveillance data overestimated linkage rates but underestimated the frequency of HIV care in the first year after HIV diagnosis. Of the 4 measures of establishment of HIV care evaluated, "sustained care" is best suited for measurement using surveillance data because of its high level of agreement with MR data and close alignment with national standards for timely linkage and flexible follow-up.

Periodontal Status and Some Variables among Pregnant Women in a Nigeria Tertiary Institution.

Background:Gingival changes during pregnancy have been well-documented. The prevalence of gingivitis in pregnant women has reportedly ranged from 30% to 100%. Increase in both the rate of estrogen metabolism and synthesis of prostaglandins by the gingiva contributed to the gingival changes observed during pregnancy. In effect increased prevalence of dental caries, gingivitis, periodontitis and tooth mobility may be encountered in pregnancy.Aim:The purpose of the study was to determine the association of some variables and the periodontal status in a sample of pregnant women attending the Ante Natal Clinic (ANC) of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos.Subjects and Methods:Women at various stages of pregnancy, attending the ANC of LASUTH, constituted the target population. The questionnaire was administered on each patient followed by dental examinations. Periodontal status was assessed using the community periodontal index (CPI) of treatment needs. Oral hygiene status was evaluated according to Green and Vermilion simplified oral hygiene index (OHI-S).Results:The association between the CPI scores; OHI-S scores and variables such as trimester and dental visits were statistically significant.Conclusion:This study indicated that the gestational age of pregnancy and dental visits have a definite impact on the periodontal status. Oral health education should be included as an integral part of antenatal care to increase the women awareness. This would improve the mothers’ dental care-seeking behavior.

Iodine Supplementation throughout Pregnancy Does Not Prevent the Drop in FT4 in the Second and Third Trimesters in Women with Normal Initial Thyroid Function

Objectives: The aim of the study was to determine the evolution of thyroid tests throughout pregnancy and postpartum in healthy women with and without iodine supplementation. Methods: This was a prospective, randomized, interventional study of iodine supplementation (150 μg/day) from the first trimester until 3 months postpartum versus controls. 111 pregnant women with normal initial thyroid tests were enrolled, undergoing comprehensive thyroid assessment at each trimester. We present results of longitudinal and cross-sectional analyses. Results: Initial ioduria suggested mild iodine deficiency in both groups, while third-trimester ioduria rose to levels of iodine sufficiency in the iodine-supplemented group. In the longitudinal study, free T4 (FT4) levels decreased in the second and third trimesters compared to the first trimester in both groups, with no change in TSH, and rose postpartum, though lower than the first trimester. FT3 levels and the total T4 (TT4)/thyroxine-binding globulin (TBG) ratio followed the same evolution as FT4. TT4 levels rose due to TBG increase. Thyroglobulin (Tg) of iodine group remained stable, contrasting with the rise in the control group. In the cross-sectional study, there was no difference between the two groups in thyroid tests at any time-point, except for lower Tg in the second trimester and postpartum visits in the iodine group. Conclusions: In healthy, mildly iodine-deficient pregnant women, a ‘drop' of FT4 and TT4/TBG without TSH increase occurs between the first and second trimesters, and is not prevented by iodine supplementation, suggesting physiology. Therefore, FT4 is valuable to assess thyroid function in pregnancy in clinical practice with appropriate trimester-specific reference range. It brings up reflection on threshold for diagnosis and treatment of hypothyroxinemia.

Improved Obstetrical Outcomes for Adolescents in a Community-Based Outreach Program: A Matched Cohort Study

ObjectiveAdolescent pregnancies are higher-risk pregnancies, and standard obstetrical care environments may not meet their needs. The objective of this study was to determine if adolescents followed in a community-based adolescent outreach obstetrical program had improved perinatal outcomes compared with provincial control subjects. MethodsWe conducted a matched cohort study. Adolescent women who received prenatal care in the outreach program between 2004 and 2010 (intervention group, n = 206) were identified and matched 1:4 to adolescent control subjects in the provincial perinatal database (n = 831). Chi-square and Student t tests were performed for categorical and continuous variables. Regression models assessed the association between the intervention and pregnancy/perinatal outcomes. ResultsThe intervention cohort had significantly higher rates of smoking, drug use, and alcohol use than control subjects (P < 0.001); however, rates of first trimester visits (76.7% vs. 64%, P = 0.009), prenatal class attendance (52.8% vs. 30.3%; P < 0.001), and group B streptococcus screening (P = 0.01) were also higher. Although the intervention cohort had higher risk behaviours than control subjects, there were no significant differences between the groups in the proportion of preterm or very preterm births, low birth weight or very low birth weight infants, or intrauterine growth restricted/small for gestational age infants. The intervention cohort had a significantly higher mean gestational age at delivery (P = 0.005) and higher mean birth weight (P = 0.002) than control subjects. The adjusted relative risk of low birth weight was significantly lower in the intervention group (RR 0.41; 95% CI 0.18 to 0.95) and a decreased risk of preterm delivery was seen (RR 0.47; 95% CI 0.22 to 1.00). ConclusionPregnant adolescents may engage in higher-risk behaviours that can affect perinatal outcomes. Early prenatal care and education in adolescent-friendly programs may mitigate the effect of these behaviours on perinatal outcomes. Multidisciplinary adolescentfocused outreach programs that facilitate early and regular access to care are important models for future adolescent obstetrical care.

Factors associated with the utilization and quality of prenatal care in western rural regions of China

Purpose – The paper seeks to identify key features of prenatal care utilization and quality in western regions of China and to determine the factors affecting the quality of prenatal care.Design/methodology/approach – A descriptive, cross‐sectional study was conducted. The instrument for the study was a 10‐stem respondent‐administered, structured questionnaire, designed in Chinese, composed of two segments: general information on infants who were under two years old; and their mothers. The authors determined the quality (both amount and content) of prenatal care using recommendations made by UNICEF and the Chinese Ministry of Health (MOH) jointly for rural areas of China.Findings – The median number of prenatal visits was three and rate of first trimester visits was 53.6 per cent (n=1,474). Over three quarters (75.3 per cent) of respondents had fewer than five prenatal visits, with this proportion highest in Gansu (95.8 per cent) and lowest in Shanxi (55.4 per cent) provinces. The percentage of women who ...