Risk Group Of Women Research Articles

Group Antenatal Care (gANC) for Somali-speaking women in Sweden – a process evaluation

Abstract Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public antenatal care clinic. Seven 60-minute sessions were offered, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-minute individual appointment before or after. The aim was to assess the feasibility for participants and midwives of implementing language supported gANC, including implementation, mechanisms of impact and contextual factors. Methods The Medical Research Council guidelines for evaluating complex interventions was used as a framework. Both qualitative and quantitative data sources including observations, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8) were used. Results gANC provided more comprehensive ANC and addressed knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance cultural understanding among midwives, thus contributing to more women-centred care, but was not successful in involving partners. Conclusions Language-supported gANC was acceptable to participants and midwives, but did not lead to greater partner inclusion. Main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided. Key messages • Group antenatal care seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. • The “othering” of women in risk groups should be avoided.

Group antenatal care (gANC) for Somali-speaking women in Sweden – a process evaluation

BackgroundLanguage supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo (“mother” in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors.MethodsA process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8).ResultsLanguage-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC.ConclusionsThe Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided.Trial registrationThe study was registered in ClinicalTrials.gov (Identifier: NCT03879200).

Attitude and behavior of pregnant women about influenza infection and influenza vaccine in a city in Turkiye.

Pregnant women are among the risk groups for influenza. This study aimed to investigate the knowledge and attitude level of pregnant women in risk group about influenza infection and vaccine and some factors affecting their vaccination decision. In this descriptive cross-sectional study, 391 pregnant women in the city of Kütahya replied a questionnaire developed by the researchers. While 35% of the participants stated that they had an influenza infection during pregnancy, 62.4% did not know that they could get the flu vaccine while pregnant. Only one of the pregnant women had a flu vaccine during pregnancy. While 67% defined influenza infection as a simple and outpatient disorder, 51.3% who did not want to be vaccinated against the flu thought that the vaccine could harm the baby. In addition, it was found that having had the flu in a previous pregnancy and healthcare professionals counselling about the vaccine increased the rate of getting the flu vaccine. The fact that most of the participants learned that they could get the flu vaccine during pregnancy for the first time and they were worried that the flu vaccine might harm the baby shows that effective methods are not used in informing and raising awareness about the flu vaccine.

Fragile X premutation carrier screening in Pakistani preconception women in primary care consultation

PurposeWomen of reproductive age who carry fragile X premutation (PM) alleles have 56 to 200 CGG repeats in the 5′-untranslated region of FMR1 gene are at increased risk for producing children with intellectual disabilities (ID) or autism spectrum disorders (ASD) due to expansion of PM alleles to full mutation alleles (> 200 repeats) during maternal transmission.MethodsIn present study fragile X PM carrier screening was performed in total 808 women who were consulting primary health care centers for preconception care in Khyber Pakhtunkhwa region of Pakistan between April, 2018 and December, 2020. Polymerase chain reaction (PCR) was performed for detection of PM carrier women and the CGG repeats number was confirmed by Southern blotting and capillary electrophoresis.ResultsThe prevalence rate for PM carriers among preconception women was found to be 0.7% that was contributed by 0.5% women in risk group (RG1) with family history of ID and 0.2% in risk group 2 (RG2) with family history of ASD. PM carrier women had at least one affected child or sibling. In addition, the preconception women with FMR1 PM alleles were found to be at increased risk for primary ovary insufficiency (RG1: P = 0.0265, RG2: P = 0.0389), postpartum depression (RG1: P = 0.0240, RG2: P = 0.0501) and neuropsychiatric disorders (RG1: P = 0.0389, RG2: P = 0.0432).ConclusionsCurrent study provides first evidence of fragile X PM carrier screening in Pakistani preconception women in primary care consultation. Findings of current study may help to improve preconception care and to reduce burden of fragile X associated disorders in our population.

SAT-012 Screening for Gestational Diabetes Mellitus: Universal or Selective Screening? Screening for Gestational Diabetes Mellitus: Universal or Selective Screening?

Screening for gestational diabetes mellitus: universal or selective screening?Introduction:The presence or absence of risk factors is often employed in screening for Gestational Diabetes Mellitus (GDM). The risk factors for GDM includes previous delivery of macrosomic babies, family history of type 2 diabetes mellitus, previous GDM among others. The impact of selective screening is yet to be fully evaluated in our environment.ObjectiveTo determine the impact of selective screening on diagnosis of gestational diabetes mellitusMethodsThe study was a prospective open cohort study carried out from 1st March to 30th November 2017 at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Ethical approval was obtained from the Health Research Ethics Committee of Lagos University Teaching Hospital (LUTH) before commencement of the studyAll the pregnant women were categorized into either risk group or control group based on the presence or absence of clinical risk factors for GDM. All participant had 75g Oral Glucose Tolerance test (OGTT) done at 24 to 28 weeks gestation and follow up till delivery.The data obtained were age, risk factors for GDM, fasting plasma glucose, one-hour post glucose load plasma glucose & two-hour post glucose load plasma glucose. The data were presented as mean, standard deviation, percentages & chi square. The p value ≤ 0.05 was considered significantResultsNinety pregnant women were screened for GDM. Forty-four women had risk factors for GDM while 46 were non risk group. Their mean age was 32.6± 5 years. The mean age for the risk & non-risk group were similar.The overall prevalence of GDM using the IADPSG criteria was 23.3%. The percentage of women in the risk group with GDM was 38.6% while those women in the non risk group with GDM was 8.7% which was statistically significant (p value 0.004).DiscussionThe most commonly identified risk factors for GDM in this study were family history of type 2 diabetes mellitus, history of unexplained miscarriage & previous history of delivery of macrosomic babies.Some women in the non-risk were diagnosed, even though the prevalence was lower than that observed among women with risk factors for GDM. Approximately one in ten women would have been missed if selective screening was employed in this study.Most of the women in the non-risk group who were diagnosed with GDM were managed with medical nutritional therapy while majority of women in the risk group had insulin therapy.ConclusionThe findings in our study further supports the idea of universal screening for GDM in order to avoid missed diagnosis.Keywords: gestational diabetes mellitus, Screening, oral glucose tolerance test

Spatio-temporal variations in unmet need for family planning in Ghana: 2003\u20132014

Ghana has long prioritized family planning as a key strategy for improving health and socioeconomic development. However, despite the heavy investments in the sector over the last decade, the family planning program has not successfully improved the country’s family planning indicators. In this study, we describe the spatial and temporal patterns of unmet need for family planning from 2003 to 2014 and mainly estimate the socioeconomic factors affecting it. Using data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys, we map the regional and temporal trends in unmet need for family planning and used Bayesian multilevel logistic regression models to estimate the effects of individual-level socioeconomic characteristics on unmet need for family planning. The results show that there are considerable regional disparities in unmet need for family planning for the study period. These disparities show diverse trends among the ten regions in the country over the study period. The patterns of unmet need for family planning are considerably affected by socioeconomic factors such as educational attainment, household wealth, marital, and work status, as well as age, ethnicity, parity, and time (year). Both socioeconomic and demographic factors play a significant role in the patterns of unmet need for family planning in Ghana. There is the need to formulate consistently effective family planning policies focusing mainly on the higher risk groups of women in the country.

417. The impact of a tailored checklist on the quality of peripartum care delivered to women with inherited bleeding disorders.

Introduction Women with inherited bleeding disorders (IBD) can be at increased risk of bleeding peripartum and/or their babies are at risk of fetal or neonatal haemorrhage. The care they require is specific to the type of bleeding disorder they have and the plan for delivery requires multidisciplinary input. The World Health Organisation (WHO) has recommended new safety checklists as part of a drive to reduce medical errors and make healthcare safer. Communication is essential for optimal care. Developing an easy to follow bleeding disorder checklist draws the specialists information together and enables all healthcare professionals to quickly identify the care they must provide. Objectives The aim of the study was to identify any errors in care, to develop and implement a tailored bleeding disorder checklist, and to assess the impact of this on quality of care. Methods Fifty women with (or carriers of) an IBD were identified from a Maternal medicine service database and charts were reviewed. Quality of care indicators were assessed by chart review before and after the introduction of the checklist into clinical practice. Results When standards of care were compared before and after the introduction of the checklist: Haemostatic support was recommended for 19% of the group peripartum and given to 100%, compared to 29% and 100%. Maternal precautions were recommended in 42% and adopted in 78% compared to 43% and 100%. Fetal precautions were recommended in 86% and implemented in 94% compared to 89% and 100%. Cord bloods were advised in 58% and taken in 55% compared to 54% and 93%. Discussion Deficiencies in care were identified in this high risk group of women despite multidisciplinary peripartum planning of care. The development of a simple checklist that could be modified to meet the specific individuals needs resulted in improved quality and safety of care.

The ANDROMEDA prospective cohort study: predictive value of combined criteria to tailor breast cancer screening and new opportunities from circulating markers: study protocol

BackgroundIn recent years growing interest has been posed on alternative ways to screen women for breast cancer involving different imaging techniques or adjusting screening interval by breast cancer risk estimates. A new research area is studying circulating microRNAs as molecular biomarkers potentially useful for non invasive early detection together with the analysis of single-nucleotide polymorphisms (SNPs).The Andromeda study is a prospective cohort study on women attending breast cancer screening in a northern Italian area. The aims of the study are: 1) to define appropriate women risk-based stratifications for personalized screening considering different factors (reproductive, family and biopsy history, breast density, lifestyle habits); 2) to evaluate the diagnostic accuracy of selected circulating microRNAs in a case-control study nested within the above mentioned cohort.MethodsAbout 21,000 women aged 46–67 years compliant to screening mammography are expected to be enrolled. At enrolment, information on well-known breast cancer risk factors and life-styles habits are collected through self-admistered questionnaires. Information on breast density and anthropometric measurements (height, weight, body composition, and waist circumference) are recorded. In addition, women are requested to provide a blood sample for serum, plasma and buffy-coat storing for subsequent molecular analyses within the nested case-control study. This investigation will be performed on approximately 233 cases (screen-detected) and 699 matched controls to evaluate SNPs and circulating microRNAs. The whole study will last three years and the cohort will be followed up for ten years to observe the onset of new breast cancer cases.DiscussionNowadays women undergo the same screening protocol, independently of their breast density and their individual risk to develop breast cancer. New criteria to better stratify women in risk groups could enable the screening strategies to target high-risk women while reducing interventions in those at low-risk. In this frame the present study will contribute in identifying the feasibility and impact of implementing personalized breast cancer screening.Trial registrationNCT02618538 (retrospectively registered on 27–11-2015.)

Breast cancer survivors. Early diagnosis – successful treatment – quality of life: multidisciplinary approach

Breast cancer is the leading cause of cancer-related deaths in European women. Breast cancer diagnosis is widely represented in women with such risk factors as exposure of endogenous end exogenous estrogens, some genetic predispositions, low parity and others. Consumption of fat, alcohol leads to the rising breast cancer incidence of last decades. Breast cancer occurs mostly after 50 years. Genetic BRCA1 and BRCA2 polymorphism, family history allows supposing breast cancer in 10% of women in risk group. In Ukraine radiation played a great role due to Chernobyl atomic station catastrophe in 1986. In a treatment of breast cancer different methods are used in a combination. Primary surgery and systemic approaches include radiation therapy, hormone therapy and chemotherapy. Important role belongs to a chemotherapy and post-treatment after surgical intervention. Chemotherapy is recommended in the vast majority of triple-negative, HER2-positive breast cancer and in high-risk luminal HER2-negative tumors (evidence level I, A). The absolute benefit from chemotherapy is more pronounced in estrogen receptors negative tumors. The most frequently used regimens contain anthracyclines and/or taxanes, although in selected patients the CMF therapy (cyclophosphamide, methotrexate, and fluorouracil) may still be used. Endocrine therapy is indicated in all patients with detectable estrogen receptors expression irrespective of the use of chemotherapy and/or targeted therapy (evidence level I, A). Routine physical examinations with a careful taking history are the most valuable measures of detecting breast cancer recurrence. The European Society for Medical Oncology recommends regular visits every 3 to 4 month in the first 2 years, every 6 month from years 3 to 5 and annually thereafter.

CLINICAL AND MORPHOLOGICAL EVALUATION OF THE CONDITION OF THE LOWER SEGMENT OF THE UTERUS AFTER CESAREAN SECTION

Objective. To study clinical and morphological features of lower uterine segment after cesarean section to identify the causes and risk of development non-viable scar. Materials and Мethods. The study comprised 100 pregnant women, 80 of whom had history of caesarean section (CS). These patients, according to the results of morphological studies were divided into two subgroups. The first subgroup consisted of 39 patients with signs of morphological inferiority of the scar. The second subgroup – 41 patient, who had no evident morphological changes in the myometrium. The control group consisted of 20 female first babies born through operation of the CS. Clinical criteria of insolvency of the scar was determined on the basis of the evaluation of anamnestic data, objective and ultrasound. Morphologic study of the failure scar was associated with the presence of pathological changes of connective tissue in the scar, a high degree of disorganization and disunity bundles of smooth myocytes, significant intensity and wide distribution in myometrium hydropic (vacuolar) degeneration. Results. The studied morphological criteria were significantly higher in women with morphological signs of insolvency, compared with women who underwent surgery for the first time. In most cases, identified the mismatch between morphological, clinical and sonographic signs of insolvency of the scar. Accurate can be considered only the data of macro – and microscopic examination. Conclusion . As a result of the analysis of clinical and anamnestic data were risk groups of women who had the highest probability of insolvency of the scar after the CS. To them included: a shorter interval between the CS operations (1-2 years); presence of intra – and postoperative complications after the first CS; immature the cervix at full-term pregnancy, as well as anomalies of birth activity among the indications to the first CS.

Single life time cytological screening in high risk women as an economical and feasible approach to control cervical cancer in developing countries like India.

In view of funding crunches and inadequate manpower in cytology in developing countries like India, single lifetime screening for cervical cancer has been suggested. In this study, an attempt was made to identify high risk groups of women for this screening to make it more effective for early detection. Cytological data were derived from the ongoing routine cervical cytology screening program for women attending Gynaecology Out Patient Department of Queen Mary's Hospital of K.G.Medical University, Lucknow, India during a span of 35 years (April 1971 - December 2005). Cervical smears in a total of 38,256 women were cytologically evaluated. The frequencies of squamous intraepithelial lesions of cervix (SIL) and carcinoma cervix were found to be 7.0% and 0.6%, respectively, in the series. Predisposing factors related to cervical carcinogenesis were analyzed in detail to establish the most vulnerable groups of women for single life time screening. The incidence of SIL and carcinoma cervix was found to be maximal in women above the age of 40 years irrespective of parity and in multiparous women (with three or more children) irrespective of age. The incidence of cervical cytopathologies was significantly higher in symptomatic women, the frequency of SIL being alarmingly higher in women complaining of contact bleeding and that of carcinoma cervix in older women with postmenopausal bleeding. It is consequently felt that single life time screening must include the three groups of women delineated above. Such selective screening appears to be the most economical, cost effective and feasible approach to affordably control the menace of cervical cancer in developing countries like India.

Evaluation of risk factors for preterm delivery and creasy's risk scoring

Background: Preterm birth is a poorly understood domain so it is a one of the most serious problem encountered in case of pregnant women. Because of the incomplete knowledge of biochemical and molecular reasons for preterm birth, many authors have shown interest in various predicting risk factors of preterm birth. Aim: This study was undertaken to know risk factors for preterm delivery and to investigate the usefulness of the most widely used creasy scoring system in identifying the high risk group of women at the tertiary care center of India. In this study also included observation of perinatal mortality and morbidity associated with preterm deliveries. Material and Methods: In the present study of 175 women who gave birth to preterm babies, detail history was taken. Then all the Data were statistically analyzed based on percentage. Result: Preterm delivery is particularly affected by precipitating of some risk factors (Hb, weight, parity of mother etc.). Conclusion: so we can say that such risk factors acting as a precipitating factor for preterm deliveries. Awareness of such risk factors is essential to plan public education programs and to consider appropriate perinatal care options for women at potentially higher risk for preterm delivery.

Use of selective modulators of estrogen receptors in the treatment of menopausal symptoms

We evaluated the effectiveness of the drug Sahenit in women with climacteric syndrome of varying degrees of severity. Established that drug Sahenit is a selective estrogen receptor modulators that is highly effective in treatment of psycho-emotional and neurovegetative disorders in menopause. The lack of proliferative effect of the drug on the endometrium of the uterus enables its extensive use as an alternative to hormone replacement therapy in women in risk group and with complicated gynecological history.

Risk factors delivery of the newborns with distress

The final purpose of pregnancy and delivery is healthy newborn. 65% of fetus development takes place in the conditions of placenta hypoperfusion has an enhanceable risk of perinatal damages. Placenta dysfunction is the widest pregnancy pathology which varies from 24% to 46%.The aim of the work: to investigate risk factors of the distress onset in newborns to prevent this complication.Materials and methods: 142 case reports of delivery mothers and case reports of their newborns underwent retrospective analysis. All women were examined according to the protocols. State of newborns was assessed by Apgar scale. All infants with distress and their mothers were divided into 3 groups according randomized evaluation with Apgar scale. First group included 75 newborns with Apgar score on the first minute of 6-7 points, group II contained 46 neonates with an estimate of 4-5 points, group III consisted of 21 infants with points 3 or less. The control group included 20 infants without distress. There anamnestic, clinical-laboratory, histological and statistical methods were used in scientific work. The women’s age was from 16 to 42, the average age without reliable distinctions in all groups. The high percentage of extragenital pathology were noticed in all groups, which amounted to 36%, 45.65%, 71.45% in the comparison group - 85%. Traced deepening severity distress of increasing frequency of complications in labor: the group I childbirth complication rates were 40,00% in group II - 52,17%, in group III complication rates during labor were significantly higher - 71 and 43%, the control group it had only 15%.The average scores of Apgar on the first minute amounted to 6,76±0,13 p., 4,70±0,21 p., 2,86±0,17 p. Children with severe distress recovered significantly more active. Apgar scores increased by 1.76 p. in the III group after five minutes (p<0.005) and was 4,57±0,23 p., II - at least 1,42 (6,12±0,18 p.), in the I group was only 0.38 p. (7,14±0,35 p.). Premature infants restored faster than full-term newborns. Apgar scores differed hardly in the control group on the first and fifth minute: 8,80±0,24 p. and 9,50 ± 0,26 p. The average weight of the babies in the I group was 3384,68±236,43 g, which was significantly higher (p<0.001) than in the II and III groups (2510,42±187,23 g, 2234,29 69,56 g, respectively) and significantly lower (p<0.05) rate control group (3852,50±196,38 g). Morphological changes in the placenta are most pronounced in severe distress - 85.71% purulent diffuse chorioamnionitis and detsiduitis with bleeding, premature the placenta aging.Conclusions:1. Risk factors for the development of fetal distress during labor are: extragenital pathology (42.96%), first childbirth (53.52%), complications of pregnancy (51.40%) (especially in the first and second trimesters, late gestosis), premature delivery (38.03%), complications during delivery (50.02%).2. The severity of the fetus at birth corresponds to more pronounced changes in the placenta in the form of local and diffuse purulent chorioamnionitis and detsiduitis, indicating a chronic infectious process, dysfunction of the placenta can cause fetal weight at birth, violation of adaptive opportunities of a fetus during labor.3. It is necessary to inspect more carefully women with infections, adequate treat revealed infections, supervise infected women in risk group of development of placentary insufficiency.

What is the benefit of screening for thyroid function in pregnant women in the detection of newly diagnosed thyropathies?

Thyroid gland disturbances are the most common endocrine disorders in pregnancy. There are some particular recommendations for the investigation of women in risk groups, but no consensus guidelines for general screening exists at present in the Czech Republic. The aim of our study was to determine whether universally conducted screening of pregnant women would reveal a significant number thyropathies. We examined 592 pregnant women for thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels and for autoantibodies against thyroperoxidase (antiTPO) in the 6th - 10th week of their pregnancy. Levels of TSH, fT4 or antiTPO beyond laboratory reference limits were found by gynaecologists in 214 women (36.1%) and 141 of whom (23.8%) underwent endocrinological examination. In the women without known risk factors (n=91) we found undiagnosed autoimmune thyroiditis in 20 cases (22 %) and in 7 cases (7.7%) some degree of subclinical hypothyroidism was confirmed. Finally, 18 (19.8%) women had hypothyroxinemia in the 1st trimester (fT4 average 8.76 pmol/L) with normal TSH levels. Altogether, a total of 45 women were succesfully identified (49.5% of the endocrinologically examined group without risk factors, i.e. 7.6% of the whole screened group) who warranted monitoring. Of 73 women (12.3%) who underwent screening and, despite recommendation, did not undergo endocrinological examination, there were 55 cases (9.3% of the screened group) with positive levels of antiTPO and with elevation of TSH above the upper normal limit. Of 592 women in the 6th - 10th week of pregnancy who underwent thyropathy screening, we newly diagnosed 3.4% of women with autoimmune thyroiditis, 1.2% with subclinical hypothyroidism and 3% with hypotyroxinemia, for whom n o thyropathy risk factor had been evident. Thyropathies were identified in 7.6% of probands. We believe that our results support the importance of universal screening in pregnancy.

Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study

ObjectiveTo investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of...

P2-473 Present trend of cervical cancer screening in Bharatpur, Nepal

IntroductionAccording to Alliance for Cervical Cancer Prevention (ACCP) 2004, cervical cancer is the most common form of cancer among women in developing countries. According to hospital based data, in Nepalese...

Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up

BackgroundAnnual prevalence of gestational diabetes mellitus (GDM) is 12.5% among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling on diet, physical activity and gestational weight gain during pregnancy.Methods/DesignA cluster-randomized controlled trial was conducted in 14 municipalities in the southern part of Finland. Pairwise randomization was performed in order to take into account socioeconomic differences. Recruited women were at 8-12 weeks' gestation and fulfilled at least one of the following criteria: body mass index ≥ 25 kg/m2, history of earlier gestational glucose intolerance or macrosomic newborn (> 4500 g), age ≥ 40 years, first or second degree relative with history of type 1 or 2 diabetes. Main exclusion criterion was pathological oral glucose tolerance test (OGTT) at 8-12 weeks' gestation. The trial included one counseling session on physical activity at 8-12 weeks' gestation and one for diet at 16-18 weeks' gestation, and three to four booster sessions during other routine visits. In the control clinics women received usual care. Information on height, weight gain and other gestational factors was obtained from maternity cards. Physical activity, dietary intake and quality of life were followed by questionnaires during pregnancy and at 1-year postpartum. Blood samples for lipid status, hormones, insulin and OGTT were taken at 8-12 and 26-28 weeks' gestation and 1 year postpartum. Workability and return to work were elicited by a questionnaire at 1- year postpartum. Linkage to the national birth register of years 2007-2009 will provide information on perinatal complications and GDM incidence among the non-participants of the study. Cost-effectiveness evaluation will be based on quality-adjusted life years. This study has received ethical approval from the Ethical board of Pirkanmaa Hospital District.DiscussionThe study will provide information on the effectiveness and cost-effectiveness of gestational physical activity and dietary counseling on prevention of GDM in a risk group of women. Also information on the prevalence of GDM and postpartum metabolic syndrome will be gained. Results on maintaining the possible health behaviour changes are important in order to prevent chronic diseases such as cardiovascular disease and diabetes.Trial registrationThe trial is registered ISRCTN 33885819

Improving maternal safety in future: learning from the Confidential Enquiries

The lessons from reviewing maternal deaths reinforce the need for multidisciplinary working and continuing education of all practitioners who are in contact with pregnant women. Identification of the highest risk group of women should allow targeted care.

Risk Perception and Psychological Strain in Women with a Family History of Breast Cancer

Background: The thinking in health psychology is that patients’ willingness to adopt preventive health behavior is contingent on their perceiving an increased risk of disease and is influenced by accompanying psychological stress. In counseling women with a family history of breast cancer, physicians focus on encouraging the patient to undergo early detection examinations as recommended. Therefore, it is essential to examine how women in this risk group perceive their own chances of developing breast cancer and to assess the psychological effects of their situation. Material and Methods: 129 women with at least one first or second degree relative who had developed breast cancer were enrolled in a questionnaire study. The object was to ascertain the extent to which these women may be expected to realistically estimate their own probability of contracting the disease and what influence risk perception and psychological strain have on their willingness to make use of diagnostic opportunities for early detection. Additionally, the effects on their physical and mental well-being were analyzed. Results: Among the women of the study group, a family history of breast cancer did not always correlate with the subject’s perception of an increased risk of contracting the disease compared. On the whole, the majority of the women overestimated their personal risk despite prior genetic counseling. Only slightly less than one quarter of the study group correctly estimated their risk; another quarter underestimated it. The majority of those women who exhibited an increased risk perception were also those who overestimated their probability of personally contracting the disease. They underwent recommended screening examinations significantly less often than women with a low risk perception. However, women subjected to intense psychological strain showed above-average participation in screening programs. Conclusions: Women with a family history of breast cancer often find it difficult to realistically estimate their own risk of contracting the disease. Increased risk perception had a negative effect on participation in recommended breast cancer screening. Therefore, an effort should be made to correct the patient’s overestimation of her personal risk. Integrating psychological counseling in screening programs is essential considering that women from high-risk groups are subjected to increased psychological strain. Further studies are required to more precisely evaluate other psychosocial factors in the behavior of women in risk group toward screening.