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Prenatal Care (prenatal + care)
Selected AbstractsFEDERAL MEDICAID ASSISTANCE TO STATES: IMPACT ON PRENATAL CARECONTEMPORARY ECONOMIC POLICY, Issue 3 2008SWATI MUKERJEE In the context of dramatically increasing U.S. health-care costs, this paper contributes to an ongoing debate discussing proposals to replace the government's current policy of matching state Medicaid spending with a block grant system. State-level panel data analysis provides evidence that, ceteris paribus, increasing the federal matching formula has a negative impact on prenatal care. This aggregate result masks significant differences between high- and low-spending states and appears to be driven by the high-spending states thus implying that a 2-track approach to Medicaid funding may be more appropriate than the current system. (JEL I1, H7) [source] Prenatal Care: The Beginning of a LifetimeJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2010Childbearing No abstract is available for this article. [source] Women With Primary Antibody Deficiencies Requiring IgG Replacement Therapy: Their Perception of Prenatal Care During PregnancyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2004Susanne Hansen RN Objective: To investigate how a group of women with primary antibody deficiencies (PAD) and receiving replacement therapy with IgG experienced the care they received in their prenatal clinics in relation to PAD and IgG therapy. Design: An exploratory study using a written questionnaire. Setting: The study originates from an immunodeficiency unit but evaluates care experienced at prenatal clinics. Participants: Nine women (25,43 years) attending an immunodeficiency unit and who fulfilled inclusion criteria for simultaneously having PAD, replacement IgG therapy, and full-term pregnancy (the latter within the past 5 years). Main outcome: Women's perception of the response of midwives and physicians at their prenatal clinics to their PAD and IgG therapy during pregnancy. Results: Women perceived that the obstetricians and the midwives had insufficient knowledge about PAD and IgG replacement therapy. Two women reported that their IgG therapy during pregnancy had been questioned. All nine women felt marginalized and unheard by staff regarding their PAD and need for IgG therapy. However, the women were satisfied with the checkups regarding the pregnancy as such. Conclusions: This study is the first attempt to investigate the prenatal experience of women with PAD (Search of PubMed, 1980 to present, including search terms primary immunodeficiency, pregnancy, and prenatal care). This study demonstrates that increased knowledge about PAD and IgG replacement therapy among midwives and physicians working in prenatal care clinics is needed. This can prevent misleading advice that puts the health of the mother and her fetus at risk. Sensitizing staff about this special group of women can create conditions in which women feel respected, heard, and satisfied with their prenatal care. [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] FEDERAL MEDICAID ASSISTANCE TO STATES: IMPACT ON PRENATAL CARECONTEMPORARY ECONOMIC POLICY, Issue 3 2008SWATI MUKERJEE In the context of dramatically increasing U.S. health-care costs, this paper contributes to an ongoing debate discussing proposals to replace the government's current policy of matching state Medicaid spending with a block grant system. State-level panel data analysis provides evidence that, ceteris paribus, increasing the federal matching formula has a negative impact on prenatal care. This aggregate result masks significant differences between high- and low-spending states and appears to be driven by the high-spending states thus implying that a 2-track approach to Medicaid funding may be more appropriate than the current system. (JEL I1, H7) [source] Brief screening questionnaires to identify problem drinking during pregnancy: a systematic reviewADDICTION, Issue 4 2010Ethel Burns ABSTRACT Aims Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect ,at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71,91%) and AUDIT-C (95%), with high specificity (71,89%, 73,83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score ,3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score ,8 performed poorly. Conclusion T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted. [source] Care and Outcome of Out-of-hospital DeliveriesACADEMIC EMERGENCY MEDICINE, Issue 7 2000Harry C Moscovitz MD Abstract. Objectives: To identify interventions by paramedics in out-of-hospital deliveries and predictors of neonatal outcome. Methods: A prospective case series of consecutive out-of-hospital deliveries at Yale-New Haven Hospital from January 1991 to January 1994. Data describing out-of-hospital interventions, demographics, maternal risk factors, and neonatal outcomes were collected from out-of-hospital, emergency department (ED), and hospital records. Subgroups defined by source of prenatal care were compared using a multiple logistic regression model to determine predictors of poor neonatal outcome. Results: Ninety-one patients presented to the hospital after delivery. Paramedics attended 78 (86%) of the cases. Paramedics performed endotracheal intubation in one neonate and supported ventilation in four others. Suctioning and warming of the neonate were documented in 58% and 76%, respectively, and hypothermia was common (47%) in the paramedicattended deliveries. There were 9 neonatal deaths. Eight (89%) of the neonatal deaths were in the group with no prenatal care (p < 0.0001). Lack of prenatal care (RR 304, 95% CI = 5.0 to 18,472) and history of poor prenatal care (RR 22.5, 95% CI = 1.19 to 427) were significant predictors of poor neonatal outcome. Sixteen percent of all study patients and 43% of those with no prenatal care were treated in the ED during their pregnancies. Eighteen percent of the patients had had no prenatal care during previous pregnancies. Conclusions: Paramedics manage labor and delivery of a high-risk population. Fundamental aspects of care were not universally documented. Lack of prenatal care was associated with high neonatal morbidity and mortality. Nearly half of the mothers who went on to deliver without prenatal obstetric care saw emergency physicians during their pregnancies. [source] Infant health production functions: what a difference the data makeHEALTH ECONOMICS, Issue 7 2009Nancy E. Reichman Abstract We examine the extent to which infant health production functions are sensitive to model specification and measurement error. We focus on the importance of typically unobserved but theoretically important variables (typically unobserved variables, TUVs), other non-standard covariates (NSCs), input reporting, and characterization of infant health. The TUVs represent wantedness, taste for risky behavior, and maternal health endowment. The NSCs include father characteristics. We estimate the effects of prenatal drug use, prenatal cigarette smoking, and first trimester prenatal care on birth weight, low birth weight, and a measure of abnormal infant health conditions. We compare estimates using self-reported inputs versus input measures that combine information from medical records and self-reports. We find that TUVs and NSCs are significantly associated with both inputs and outcomes, but that excluding them from infant health production functions does not appreciably affect the input estimates. However, using self-reported inputs leads to overestimated effects of inputs, particularly prenatal care, on outcomes, and using a direct measure of infant health does not always yield input estimates similar to those when using birth weight outcomes. The findings have implications for research, data collection, and public health policy. Copyright © 2008 John Wiley & Sons, Ltd. [source] Maternal health: does prenatal care make a difference?HEALTH ECONOMICS, Issue 5 2006Karen Smith Conway Abstract This research attempts to close an important gap in health economics regarding the efficacy of prenatal care and policies designed to improve access to that care, such as Medicaid. We argue that a key beneficiary , the mother , has been left completely out of the analysis. If prenatal care significantly improves the health of the mother, then concluding that prenatal care is ,ineffective' or that the Medicaid expansions are a ,failure' is premature. This paper seeks to rectify the oversight by estimating the impact of prenatal care on maternal health and the associated cost savings. We first set up a joint maternal,infant health production framework that informs our empirical analysis. Using data from the National Maternal and Infant Health Survey, we estimate the effects of prenatal care on several different measures of maternal health such as body weight status and excessive hospitalizations. Our results suggest that receiving timely and adequate prenatal care may increase the probability of maintaining a healthy weight after the birth and, perhaps for blacks, of avoiding a lengthy hospitalization after the delivery. Given the costs to society of obesity and hospitalization, these are benefits worth exploring before making conclusions about the effectiveness of prenatal care , and Medicaid. Copyright © 2006 John Wiley & Sons, Ltd. [source] Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemHEALTH SERVICES RESEARCH, Issue 1 2010Dorothy Thornton Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Data Source. Linked California hospital discharge (2000,2001), birth, fetal death, and county mental health system (CMHS) records. Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Results. Compared with deliveries in the general non,mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention. [source] The Impact of Welfare Reform on Insurance Coverage before Pregnancy and the Timing of Prenatal Care InitiationHEALTH SERVICES RESEARCH, Issue 4 2007Norma I. Gavin Objective. This study investigates the impact of welfare reform on insurance coverage before pregnancy and on first-trimester initiation of prenatal care (PNC) among pregnant women eligible for Medicaid under welfare-related eligibility criteria. Data Sources. We used pooled data from the Pregnancy Risk Assessment Monitoring System for eight states (AL, FL, ME, NY, OK, SC, WA, and WV) from 1996 through 1999. Study Design. We estimated a two-part logistic model of insurance coverage before pregnancy and first-trimester PNC initiation. The impact of welfare reform on insurance coverage before pregnancy was measured by marginal effects computed from coefficients of an interaction term for the postreform period and welfare-related eligibility and on PNC initiation by the same interaction term and the coefficients of insurance coverage adjusted for potential simultaneous equation bias. We compared the estimates from this model with results from simple logistic, ordinary least squares, and two-stage least squares models. Principal Findings. Welfare reform had a significant negative impact on Medicaid coverage before pregnancy among welfare-related Medicaid eligibles. This drop resulted in a small decline in their first-trimester PNC initiation. Enrollment in Medicaid before pregnancy was independent of the decision to initiate PNC, and estimates of the effect of a reduction in Medicaid coverage before pregnancy on PNC initiation were consistent over the single- and two-stage models. Effects of private coverage were mixed. Welfare reform had no impact on first-trimester PNC beyond that from reduced Medicaid coverage in the pooled regression but separate state-specific regressions suggest additional effects from time and income constraints induced by welfare reform may have occurred in some states. Conclusions. Welfare reform had significant adverse effects on insurance coverage and first-trimester PNC initiation among our nation's poorest women of childbearing age. Improved outreach and insurance options for these women are needed to meet national health goals. [source] Inappropriate eating behaviors during pregnancy: Prevalence and associated factors among pregnant women attending primary care in southern Brazil,INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2009Rafael Marques Soares RD Abstract Objective: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care. Method: The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed. Results: Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5,20.0], followed by excessive shape (5.6%; 95% CI 4,8) and weight concerns (5.5%; 95% CI 4,8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2,4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3,2.4), and prepregnancy BMI < 19.8 kg/m2 (PR = 1.6; 95% CI 1.1,2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01,1.11). Discussion: Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord, 2009 [source] Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort studyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2008Anna Agueda Abstract Aim: The aim of this study was to determine the association between periodontitis and the incidence of preterm birth (PB), low birth weight (LBW) and preterm low birth weight (PLBW) Material and Methods: One thousand and ninty-six women were enrolled. Periodontal data, pregnancy outcome variables and information on other factors that may influence adverse pregnancy outcomes were collected. Data were analysed using a logistic regression model. Results: The incidence of PB and LBW was 6.6% and 6.0%, respectively. The incidence of PLBW was 3.3%. PB was related to mother's age, systemic diseases, onset of prenatal care, previous PBs, complications of pregnancy, type of delivery, the presence of untreated caries and the presence of periodontitis (odds ratio 1.77, 95% confidence interval: 1.08,2.88). LBW was related to mother's smoking habits, ethnicity, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. PLBW was related to mother's age, onset of prenatal care, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. Conclusions: The factors involved in many cases of adverse pregnancy outcomes have still not being identified, although systemic infections may play a role. This study found a modest association between periodontitis and PB. Further research is required to establish whether periodontitis is a risk factor for PB and/or LBW. [source] Cardiothoracic ratio in the first half of pregnancyJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2004Theera Tongsong MD Abstract Purpose The present study was conducted to establish the nomogram of fetal cardiothoracic (C/T) ratio in the first half of normal pregnancies (eg, 11,20 weeks of gestation), using conventional sonographic techniques. Methods Two hundred thirty-eight normal pregnant women enrolled in our prenatal care were recruited into this study. All the patients had singleton fetuses whose gestational age could be accurately determined by the patient's last menstrual period and sonographic measurements. All the newborns were proven to be normal at birth. The sonographic measurements used to calculate the C/T ratio were obtained from axial scans at the level of the four-chamber view. All measurements were made by the same examiner using a single high-resolution machine. Results A total of 238 C/T ratio measurements were made. The mean C/T ratio values increased slightly with gestational age, rising from 0.38 at 11 weeks to 0.45 at 20 weeks. The mean C/T value at each gestational week was never greater than 0.50, and no fetus had a C/T ratio greater than 0.50 at 11,15 weeks of gestation. The means and 5th, 50th, and 95th percentiles of the C/T ratio were calculated for each week of gestation and the nomogram was established. Conclusions Calculation of the C/T ratio is a simple, reliable, reproducible, and time-efficient means of assessing the size of the fetal heart. By comparing the C/T ratio with the normal values presented here, physicians should be able to more easily identify cases of cardiomegaly early in their patients' pregnancies. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:186,189, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20014 [source] Development of an educational/support group for pregnant women in prisonJOURNAL OF FORENSIC NURSING, Issue 2 2008Ginette G. Ferszt Ph.D. Abstract It is estimated that 6,10% of women are pregnant when they enter the prison system. The majority have had little, if any, prenatal care and/or childbirth education. Given economic constraints, the educational and support needs of this population are often not met. In response to these needs, an educational/support group was developed and led by a social worker, a mental health clinical nurse specialist, and a nurse midwife in a women's correctional facility in the Northeast. Women in various stages of pregnancy and early postpartum voluntarily attended. The need for education and psychosocial support was overwhelming. This group fostered a safe space for women to discuss real-life issues in a supportive environment. Meeting the educational and support needs of incarcerated women is paramount. [source] MRI in fetal necropsyJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2006FRCR, Jocelyn S. Brookes MB Abstract The fetal autopsy involves a series of investigations of the corpse, most of which are noninvasive and acceptable to the majority of parents and their physicians. The value of the perinatal autopsy is manyfold and well established, and the results can provide a basis for parental and family counseling, inform future obstetric management, and provide audit for prenatal care. Many techniques originally developed for diagnosis, such as histology, biochemical tests, photography, x-rays, and cytogenetic karyotyping, have become standard tools in perinatal autopsies. However, there has been an inexorable decline in the autopsy consent rate over the last 30 years due to social and cultural factors, and perhaps ignorance of the benefits to be derived from the examination. Growing evidence suggests that postmortem fetal MRI can assist the pathologist at autopsy, and in many cases can obviate the need for dissection or at least minimize and focus it. For the majority of cases in which no consent for surgical autopsy is given, MRI together with other noninvasive postmortem tests can provide a great deal of the information that was previously available only from autopsy. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010SeonAe Yeo RNC Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source] Women With High-Risk Pregnancies, Problems, and APN InterventionsJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2007Dorothy Brooten Purpose: To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor). Design and Methods: Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System. Findings: A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1%). Women with chronic hypertension required significantly more case-management interventions. Conclusions: The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies. [source] Mind-Body Interventions During PregnancyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2008Amy E. Beddoe ABSTRACT Objective:, To examine published evidence on the effectiveness of mind-body interventions during pregnancy on perceived stress, mood, and perinatal outcomes. Data sources:, Computerized searches of PubMed, Cinahl, PsycINFO, and the Cochrane Library. Study Selection:, Twelve out of 64 published intervention studies between 1980 and February 2007 of healthy, adult pregnant women met criteria for review. Data extraction and synthesis:, Studies were categorized by type of mind-body modality used. Progressive muscle relaxation was the most common intervention. Other studies used a multimodal psychoeducation approach or a yoga and meditation intervention. The research contained methodological problems, primarily absence of a randomized control group or failure to adequately control confounding variables. Nonetheless, there was modest evidence for the efficacy of mind-body modalities during pregnancy. Treatment group outcomes included higher birthweight, shorter length of labor, fewer instrument-assisted births, and reduced perceived stress and anxiety. Conclusions:, There is evidence that pregnant women have health benefits from mind-body therapies used in conjunction with conventional prenatal care. Further research is necessary to build on these studies in order to predict characteristics of subgroups that might benefit from mind-body practices and examine cost effectiveness of these interventions on perinatal outcomes. [source] The Reliability and Validity of Birth CertificatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Sally Northam Objectives:, To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement. Data sources:, A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done. Study selection:, Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment. Data extraction:, Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable. Data synthesis:, The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery. Conclusions:, Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented. JOGNN, 35, 3-12; 2006. DOI: 10.1111/J.1552-6909.2006.00016.x [source] Women With Primary Antibody Deficiencies Requiring IgG Replacement Therapy: Their Perception of Prenatal Care During PregnancyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2004Susanne Hansen RN Objective: To investigate how a group of women with primary antibody deficiencies (PAD) and receiving replacement therapy with IgG experienced the care they received in their prenatal clinics in relation to PAD and IgG therapy. Design: An exploratory study using a written questionnaire. Setting: The study originates from an immunodeficiency unit but evaluates care experienced at prenatal clinics. Participants: Nine women (25,43 years) attending an immunodeficiency unit and who fulfilled inclusion criteria for simultaneously having PAD, replacement IgG therapy, and full-term pregnancy (the latter within the past 5 years). Main outcome: Women's perception of the response of midwives and physicians at their prenatal clinics to their PAD and IgG therapy during pregnancy. Results: Women perceived that the obstetricians and the midwives had insufficient knowledge about PAD and IgG replacement therapy. Two women reported that their IgG therapy during pregnancy had been questioned. All nine women felt marginalized and unheard by staff regarding their PAD and need for IgG therapy. However, the women were satisfied with the checkups regarding the pregnancy as such. Conclusions: This study is the first attempt to investigate the prenatal experience of women with PAD (Search of PubMed, 1980 to present, including search terms primary immunodeficiency, pregnancy, and prenatal care). This study demonstrates that increased knowledge about PAD and IgG replacement therapy among midwives and physicians working in prenatal care clinics is needed. This can prevent misleading advice that puts the health of the mother and her fetus at risk. Sensitizing staff about this special group of women can create conditions in which women feel respected, heard, and satisfied with their prenatal care. [source] Possible association between screening BV at the prenatal visit and reduced cervical cerclage: Multi-center questionnaire in Hokkaido, JapanJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Satoshi Shimano Abstract Aims:, To study the screening frequency for cervical cancer, Chlamydia trachomatis (CT) infection, and bacterial vaginosis (BV) among pregnant women, and to study the association between administration of these three screening tests and performance of cervical cerclage (CC) in Hokkaido during 2004. Methods:, Questionnaires were mailed to 70 clinics providing prenatal care only and to 113 hospitals providing prenatal care and performing deliveries. Responses were obtained anonymously. Results:, A total of 6744 pregnant women received prenatal care at the 36 responding clinics and 24 050 deliveries were performed at the 56 hospitals. The percentage of clinics that screened all pregnant women for cervical cancer, CT infection or BV was 66.7%, 69.4% and 33.3%, respectively, and the corresponding percentages among the hospitals were 87.5%, 87.5% and 57.1%, respectively. Pregnant women found to have CT infection or BV, were all treated. Screening for cervical cancer or CT infection was not associated with the frequency of CC. On the other hand, screening for BV was significantly associated with the frequency of CC (P = 0.0006). The frequency of emergency CC was 0.8% among women who received prenatal care at hospitals that did not perform BV screening, while it was only 0.2 or 0.3% among women who received prenatal care at hospitals that performed BV screening on all pregnant women or on those women who were suspected of having BV, respectively. Conclusion:, Our results suggest that the frequency of emergency CC may be reduced in women who receive BV screening and subsequent treatment of positive cases during pregnancy. [source] Effect of multiple birth on infant mortality in BangladeshJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2006Rathavuth Hong Aim: Levels of infant and child mortality in many developing countries remain unacceptably high, and they are disproportionably higher among high-risk groups such as newborn and infant of multiple births, particularly in countries where advanced medical cares are available only at regional referral levels with limited access by the poor rural women and children. This study examined the relationship between high-risk infant of multiple birth and infant mortality in Bangladesh. Methods: The analysis uses information on 7001 childbirths in 5 years preceding the 2004 Bangladesh Demographic and Health Survey to examine the relationship between multiple birth and infant mortality using multivariate analysis, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. Results: Results indicate that children born multiple birth were more than six-times as likely to die during infancy as those born singletons (hazard ratio = 6.51; 95% confidence interval: 4.10, 10.36). Controlling for all other risk factors does not change the strength and direction of the relationship (hazard ratio = 6.18; 95% confidence interval: 3.65, 10.46). Receiving prenatal care and access to safe drinking water are associated with lower risk. Conclusion: Multiple births are strongly negatively associated with infant survival in Bangladesh independent of other risk factors. This evidence suggests that improving maternal and child health at the community level, screening for high-risk pregnancies and making referral services for these conditions more accessible to the rural women and children will be key to improving child survival in Bangladesh. [source] The relationship between periodontal disease and preterm low birthweight: clinical and microbiological resultsJOURNAL OF PERIODONTAL RESEARCH, Issue 6 2008M. V. Vettore Background and Objective:, Findings on the effect of periodontal disease on preterm low birthweight are inconclusive. The objective of this study was to compare periodontal clinical measures and the levels and proportions of 39 bacterial species in subgingival biofilm samples in puerperal women with preterm low birthweight and nonpreterm low birthweight. Material and Methods:, A case-control study with 116 postpartum women over 30 years of age was conducted. Four case groups of subjects with preterm and/or low birthweight [preterm (n = 40), low birthweight (n = 35), preterm and/or low birthweight (n = 50) and preterm and low birthweight (n = 25)] were compared with normal nonpreterm low-birthweight controls (n = 66). Periodontal clinical parameters of dental plaque, calculus, bleeding on probing, periodontal pocket depth and clinical attachment level were recorded. Covariates included socio-demographic and anthropometric characteristics, smoking, alcohol consumption, obstetric history, prenatal care and diseases during pregnancy. Two subgingival biofilm samples per women were analyzed for 39 bacterial species using a checkerboard DNA,DNA hybridization technique. Results:, The mean periodontal pocket depth was significantly higher in nonpreterm low-birthweight controls than in subjects in the preterm low birthweight, preterm and/or low birthweight, and preterm and low-birthweight groups. Clinical attachment level measures were not different between all pairs of cases and control groups. Groups did not differ with respect to the mean proportions of different microbial complexes. The mean counts of Treponema socranskii were lower in all case groups compared with the control group. Conclusion:, Maternal periodontal microbiota and clinical characteristics of periodontal disease were not associated with having preterm low-birthweight babies. [source] The changing association between prenatal participation in WIC and birth outcomes in New York CityJOURNAL OF POLICY ANALYSIS AND MANAGEMENT, Issue 4 2005Ted Joyce We analyze the relationship between prenatal WIC participation and birth outcomes in New York City from 1988,2001. The analysis is unique for several reasons. First, we have over 800,000 births to women on Medicaid, the largest sample ever used to analyze prenatal participation in WIC. Second, we focus on measures of fetal growth distinct from preterm birth, since there is little clinical support for a link between nutritional supplementation and premature delivery. Third, we restrict the primary analysis to women on Medicaid who have no previous live births and who initiate prenatal care within the first four months of pregnancy. Our goal is to lessen heterogeneity between WIC and non-WIC participants by limiting the sample to highly motivated women who have no experience with WIC from a previous pregnancy. Fourth, we analyze a large sub-sample of twin deliveries. Multifetal pregnancies increase the risk of anemia and fetal growth retardation and thus may benefit more than singletons from nutritional supplementation. We find no relationship between prenatal WIC participation and measures of fetal growth among singletons. We find a modest pattern of association between WIC and fetal growth among U.S.-born Black twins. Our findings suggest that prenatal participation in WIC has had a minimal effect on adverse birth outcomes in New York City. © 2005 by the Association for Public Policy Analysis and Management [source] La Tecnología y Las Monjitas:MEDICAL ANTHROPOLOGY QUARTERLY, Issue 3 2009Constellations of Authoritative Knowledge at a Religious Birthing Center in South Texas In this article, I contrast conceptualizations of authoritative knowledge in pregnancy and birth between U.S. midwives and their Mexican immigrant clients at a religious birthing center in south Texas. Although the two groups share certain orientations to pregnancy management, essential differences in prenatal care and birth epistemologies underscore distinct social and economic positions. I use narrative data to document and explain these differences, which throw into relief the hierarchies of identity and need that structure immigrant women's reproductive experiences. Unveiling the different epistemologies can also help to explain sometimes radically divergent ideas that have impacted the very survivability of the birthing center. By focusing on Mexican immigrant women's reproductive decision making in an alternative birthing center, this analysis responds to feminists' call to look to the margins to understand the diversity of women's responses to what Rapp and Ginsburg have called "stratified reproduction." [source] Preparing for Motherhood: Authoritative Knowledge and the Undercurrents of Shared Experience in Two Childbirth Education Courses in Cagliari, ItalyMEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2000Suzanne K. Ketler This article compares the social settings and teaching organization of two differently structured childbirth education courses in Cagliari, Italy, in order to understand how social processes and contexts work to negotiate authoritative knowledge. Although the explicit goal of both courses was to transmit biomedical knowledge, knowledge based in women's experience nonetheless dominated some course sessions. Thus, I examine the social processes and interactions that enabled women's experiential knowledge to dominate discussions and subsequently share in the authority of biomedical knowledge in some situations. Because few existing studies do so, this article also addresses a gap in our current understanding by exploring not only how experiential knowledge comes to share authority with biomedical knowledge, but also, why it is important that it does. Focusing on the efficacy of differently structured courses, this article informs the planning of future childbirth education courses in similar settings, [childbirth education, authoritative knowledge, reproduction, prenatal care, Italy] [source] Prevalence and risk factors for anaemia in pregnant women: a population-based prospective cohort study in ChinaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2009Qiaoyi Zhang Summary Maternal anaemia is a common pregnancy complication in developing countries; however, its epidemiology remains largely unexplored in China. This study was designed to explore the epidemiology and risk factors of anaemia during pregnancy. A prospective cohort study was conducted, using data from a population-based pregnancy-monitoring system in 13 counties in East China (1993,96). Women who delivered singleton infants at 20,44 weeks with at least one haemoglobin assessment during pregnancy were included (n = 164 667). The prevalence of anaemia (haemoglobin < 10 g/dL) during pregnancy as well as in each trimester was estimated. Multivariable log-binomial regression models were used to evaluate risk factors. The overall prevalence of anaemia in pregnancy was 32.6%, with substantial variations across trimesters (11.2%, 20.1% and 26.2% in the 1st, 2nd and 3rd trimesters respectively). Risk factors for anaemia included older maternal age, education below junior high school (prevalence rate ratio [RR] 1.10, 95% confidence interval [CI] 1.08, 1.12), farming occupation (1.05, 95% CI 1.03, 1.06), and mild pregnancy-induced hypertension (PIH) (RR 1.09, 95% CI 1.05, 1.13) and severe PIH (RR 1.13, 95% CI 1.06, 1.19). Peri-conception folic acid use was associated with a reduced risk for anaemia in the 1st trimester (RR 0.75, 95% CI 0.72, 0.78). Initiating prenatal care after the 1st trimester was associated with increased risk of anaemia in the 2nd and 3rd trimesters. Our study found anaemia during pregnancy is highly prevalent in this indigenous Chinese population. The risk increases with the severity of hypertensive disorders. Folic acid supplementation during the peri-conception period is associated with reduced risk of 1st trimester anaemia. [source] Congenital toxoplasmosis: late pregnancy infections detected by neonatal screening and maternal serological testing at deliveryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2007Eleonor G. Lago Summary The first aim of this study was to determine the prevalence of congenital toxoplasmosis in newborn infants treated by the public health system in Porto Alegre, a city in southern Brazil, using neonatal screening for Toxoplasma gondii -specific IgM. The second aim was to investigate whether the cases detected by this approach could have been identified by the prenatal screening for antibodies to T. gondii that was performed in the same population. A fluorometric assay was used to analyse T. gondii -specific IgM in filter paper specimens obtained from newborn infants for routine screening for metabolic diseases. When the specific IgM was positive, serum samples from the infant and the mother were requested for confirmatory serological testing, and the infant underwent clinical examination. Among 10 000 infants screened for T. gondii -specific IgM, seven filter paper samples were positive, and congenital toxoplasmosis was confirmed in six patients. The prevalence of IgM specific for T. gondii was 6/10 000 [95% CI 2/10 000, 13/10 000]. One infected infant had already been identified in the maternity ward before birth, three had been identified by maternal serology at delivery, and two infants with congenital toxoplasmosis were identified solely through neonatal screening. Although four mothers of the patients with congenital toxoplasmosis received prenatal care, and three mothers had one or two serological tests for T. gondii -specific antibodies (one at first trimester, one at first and second trimesters, and the other at second and third trimesters), they were not identified during pregnancy as infected. Neonatal screening identified cases of infection not detected by obtaining only one or two serum samples from pregnant women for T. gondii serology, mainly when infection was acquired and transmitted in late pregnancy. Maternal serology at delivery and neonatal screening were especially useful in the identification of infants with congenital toxoplasmosis when the mother did not receive regular prenatal serological testing or prenatal care. [source] The Asian birth outcome gapPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2006Cheng Qin Summary Asians are often considered a single group in epidemiological research. This study examines the extent of differences in maternal risks and birth outcomes for six Asian subgroups. Using linked birth/infant death certificate data from the State of California for the years 1992,97, we assessed maternal socio-economic risks and their effect on birthweight, preterm delivery (PTD), neonatal, post-neonatal and infant mortality for Filipino (87 120), Chinese (67 228), Vietnamese (45 237), Korean (23 431), Cambodian/Laotian (21 239) and Japanese (18 276) live singleton births. The analysis also included information about non-Hispanic whites and non-Hispanic blacks in order to give a sense of the magnitude of risks among Asians. Logistic regression models explored the effect of maternal risk factors and PTD on Asian subgroup differences in neonatal and post-neonatal mortality, using Japanese as the reference group. Across Asian subgroups, the differences ranged from 2.5- to 135-fold for maternal risks, and 2.2-fold for infant mortality rate. PTD was an important contributor to neonatal mortality differences. Maternal risk factors contributed to the disparities in post-neonatal mortality. Significant differences in perinatal health across Asian subgroups deserve ethnicity-specific interventions addressing PTD, teen pregnancy, maternal education, parity and access to prenatal care. [source] | |||||||||||||||||||||||||||||||||||||