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American Family Physician Jun 2021
Topics: Birth Setting; Empowerment; Family Practice; Female; Health Promotion; Health Services Accessibility; Home Childbirth; Humans; Midwifery; Patient Participation; Patient Safety; Physician's Role; Pregnancy; Prenatal Care; Risk Assessment; Rural Health Services; United States
PubMed: 34060780
DOI: No ID Found -
Journal of Perinatal Medicine Jun 2021Asylum seekers have been highlighted as a particularly vulnerable group of expectant mothers due to complex medical and psychosocial needs, as well as the difficulties...
OBJECTIVES
Asylum seekers have been highlighted as a particularly vulnerable group of expectant mothers due to complex medical and psychosocial needs, as well as the difficulties they may face in accessing care. Our aim was to examine if there were differences in the antenatal care and perinatal outcomes for asylum seeking women when compared to age- and ethnicity-matched controls delivering at the same hospital.
METHODS
Two age- and ethnicity-matched non-asylum seeking controls were identified for each asylum-seeking woman. Electronic patient records were analysed to determine the amount of antenatal care received and neonatal outcomes.
RESULTS
Thirty-four asylum-seeking women were identified who had term born infants. The median number of antenatal care episodes at the delivering hospital was significantly fewer amongst asylum-seeking women compared to controls (three vs. nine, p<0.0001). The median number of antenatal ultrasound examinations at the delivering hospital amongst asylum-seeking women was one (IQR 1-2), compared to three (IQR 3-4) in the controls (p<0.0001). The postnatal length of stay was significantly longer for infants of asylum-seeking women (median three vs. two days, p=0.002). Thirty-seven percent of asylum seeking women but none of the controls required assistance from social services. There was a significant correlation between antenatal and postnatal costs for asylum seeking women (r=0.373, p=0.042), but not for controls (r=0.171, p=0.181).
CONCLUSIONS
The increased postnatal length of stay in the infants of asylum seeking mothers may reflect their mother's reduced antenatal care and hence insufficient discharge planning for mothers and infants with increased social needs.
Topics: Adult; Female; Health Services Accessibility; Health Services Needs and Demand; Humans; Infant, Newborn; Patient Discharge; Perinatal Care; Pregnancy; Pregnancy Outcome; Pregnant Women; Prenatal Care; Refugees; United Kingdom; Vulnerable Populations
PubMed: 33607706
DOI: 10.1515/jpm-2020-0572 -
Maternal and Child Health Journal Apr 2017Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with...
Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.
Topics: Adolescent; Adult; Female; Humans; New York City; Patient Satisfaction; Personal Satisfaction; Postnatal Care; Pregnancy; Pregnant Women; Prenatal Care; Self-Help Groups
PubMed: 27485493
DOI: 10.1007/s10995-016-2161-3 -
BMC Pregnancy and Childbirth Jan 2017Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of... (Review)
Review
BACKGROUND
Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models.
METHODS
A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions.
RESULTS
Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted 'lower-risk'-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted 'higher-risk'-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers.
CONCLUSIONS
Interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. It highlights a lack of reported detail of trial interventions and usual care processes. It provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation.
Topics: Adult; Female; Health Services Research; Humans; Models, Organizational; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Review Literature as Topic
PubMed: 28056877
DOI: 10.1186/s12884-016-1186-3 -
Revista de Saude Publica 2019To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio...
OBJECTIVE
To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016.
METHODS
This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend.
RESULTS
The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al.
CONCLUSIONS
The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care.
Topics: Adolescent; Adult; Brazil; Child; Family Characteristics; Female; Healthcare Disparities; Humans; Maternal Age; Pregnancy; Prenatal Care; Reference Values; Socioeconomic Factors; Surveys and Questionnaires; Time Factors; Young Adult
PubMed: 31066818
DOI: 10.11606/S1518-8787.2019053000968 -
JAMA Network Open Apr 2021Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in... (Comparative Study)
Comparative Study
IMPORTANCE
Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.
OBJECTIVE
To explore the association of audio-only virtual prenatal care with perinatal outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.
EXPOSURES
Prenatal care incorporating audio-only prenatal care visits.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.
RESULTS
The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended.
CONCLUSIONS AND RELEVANCE
Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.
Topics: Adult; Ambulatory Care; COVID-19; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; SARS-CoV-2; Telemedicine; Texas
PubMed: 33852002
DOI: 10.1001/jamanetworkopen.2021.5854 -
BMC Pregnancy and Childbirth Jan 2019Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain.
METHODS
A keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies.
RESULTS
One RCT, one secondary analysis of an RCT, one study with "random assignment", and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97-1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79-1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis.
CONCLUSIONS
Group prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain.
Topics: Adolescent; Delivery of Health Care; Diabetes, Gestational; Ethnicity; Female; Gestational Weight Gain; Goals; Group Processes; Humans; Military Personnel; Obesity; Pregnancy; Pregnancy in Adolescence; Prenatal Care
PubMed: 30626345
DOI: 10.1186/s12884-018-2148-8 -
MCN. the American Journal of Maternal... 2020The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women.
PURPOSE
The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women.
STUDY DESIGN AND METHODS
Using a cross-sectional design, a sample of 197 pregnant Black women completed a self-reported survey between 8 weeks and less than 30 weeks gestation as part of the Biosocial Impact on Black Births study. The questions asked about the initiation of prenatal care, perceived stress, depressive symptoms, and psychological wellbeing. Multiple linear regression was used to examine if timing of prenatal care initiation was related to psychological variables.
RESULTS
Sixty-three women (32%) reported they were not able to initiate their first prenatal care visit as early as they wanted due to various barriers. After adjusting for cofounders, not initiating prenatal care as early as women wanted predicted lower levels of psychological wellbeing.
CLINICAL IMPLICATIONS
Perinatal nurses should assess psychological wellbeing in Black women throughout pregnancy; advocate for Black women who report high levels of stress, psychological distress, or depressive symptoms for further mental health evaluation by their health care provider; and provide resources and education (e.g., support groups, counseling) for these women.
Topics: Adult; Black or African American; Cross-Sectional Studies; Female; Humans; Patient Acceptance of Health Care; Pregnancy; Pregnant Women; Prenatal Care; Psychometrics; Surveys and Questionnaires; Time Factors
PubMed: 33074912
DOI: 10.1097/NMC.0000000000000661 -
BMC Pregnancy and Childbirth Apr 2023There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the...
OBJECTIVES
There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project, we aimed to: (1) Estimate the prevalence of TPC, including TPC-arrived during pregnancy and TPC-arrived pre-pregnancy, among recently-arrived migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada; (2) Describe and compare the socio-demographic, migration and health profiles and perceptions of care during pregnancy in Canada between these two groups and migrant women who received no TPC (i.e., only received prenatal care in Canada); and (3) Identify predictors of TPC-arrived pre-pregnancy vs. No-TPC.
METHODS
The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We conducted a secondary analysis (n = 2595 women); descriptive analyses (objectives 1 & 2) and multivariable logistic regression (objective 3).
RESULTS
Ten percent of women received TPC; 6% arrived during pregnancy and 4% were in Canada pre-pregnancy. The women who received TPC and arrived during pregnancy were disadvantaged compared to women in the other two groups (TPC-arrived pre-pregnancy and No-TPC women), in terms of income level, migration status, French and English language abilities, access barriers to care and healthcare coverage. However, they also had a higher proportion of economic migrants and they were generally healthier compared to No-TPC women. Predictors of TPC-arrived pre-pregnancy included: 'Not living with the father of the baby' (AOR = 4.8, 95%CI 2.4, 9.8), 'having negative perceptions of pregnancy care in Canada (general experiences)' (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1).
CONCLUSION
Women with more capacity may self-select to migrate during pregnancy which results in TPC; these women, however, are disadvantaged upon arrival, and may need additional care. Already-migrated women may use TPC due to a need for family and social support and/or because they prefer the healthcare in their home country.
Topics: Female; Humans; Pregnancy; Canada; Cross-Sectional Studies; Developing Countries; Maternal Health Services; Prenatal Care; Transients and Migrants
PubMed: 37101137
DOI: 10.1186/s12884-023-05582-w -
Revista Brasileira de Ginecologia E... Sep 2022To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring.
OBJECTIVE
To develop a protocol for hybrid low-risk prenatal care adapted to Brazilian guidelines, merging reduced face-to-face consultations and remote monitoring.
METHODS
The PubMed, Embase, and Cochrane Library databases were systematically searched on telemedicine and antenatal care perspectives and adaptation of the low-risk prenatal care protocols recommended by the Ministry of Health and by the Brazilian Federation of Gynecology and Obstetrics Associations.
RESULTS
Five relevant articles and three manuals were included in the review, for presented criteria to develop this clinical guideline. We identified, in these studies, that the schedule of consultations is unevenly distributed among the gestational trimesters, and ranges from 7 to 14 appointments. In general, the authors propose one to two appointments in the first trimester, two to three appointments in the second trimester, and two to six appointments in the third trimester. Only three studies included puerperal evaluations. The routine exams recommended show minimal variations among authors. To date, there are no validated Brazilian protocols for prenatal care by telemedicine. The included studies showed that pregnant women were satisfied with this form of care, and the outcomes of interest, except for hypertensive diseases, were similar between the groups exposed to traditional and hybrid prenatal care.
CONCLUSION
The presented guideline comprises the Ministry of Health recommendations for low-risk prenatal care and reduces exposure to the hospital environment and care costs. A randomized clinical trial, to be developed by this group, will provide real-world data on safety, effectiveness, satisfaction, and costs.
Topics: Female; Humans; Obstetrics; Postpartum Period; Practice Guidelines as Topic; Pregnancy; Pregnant Women; Prenatal Care; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 35853473
DOI: 10.1055/s-0042-1753505