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Birth (Berkeley, Calif.) Jun 2022CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates.
METHODS
Data from a stepped-wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP.
RESULTS
A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%-53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high.
CONCLUSION
A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits.
Topics: Adult; Female; Health Behavior; Humans; Netherlands; Parturition; Pregnancy; Pregnancy Outcome; Prenatal Care
PubMed: 35092071
DOI: 10.1111/birt.12610 -
Journal of Perinatal Medicine Sep 2018
Topics: Female; Humans; Infant, Newborn; Perinatal Care; Perinatal Mortality; Preconception Care; Pregnancy; Prenatal Care; Prenatal Diagnosis
PubMed: 30205656
DOI: 10.1515/jpm-2018-0275 -
PloS One 2017The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date...
BACKGROUND
The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries.
METHODS
We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood.
RESULTS
Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations.
CONCLUSIONS
While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
Topics: Child; Child Development; Developing Countries; Education; Female; Humans; Income; Male; Patient Acceptance of Health Care; Pregnancy; Prenatal Care; Schools
PubMed: 28158229
DOI: 10.1371/journal.pone.0171299 -
The Journal of Law, Medicine & Ethics :... Sep 2019This paper examines the practice implications of various state policies that provide publicly funded prenatal care to undocumented immigrants for health care workers who...
This paper examines the practice implications of various state policies that provide publicly funded prenatal care to undocumented immigrants for health care workers who see undocumented patients. Data were collected through in-depth interviews with purposively sampled health care workers at safety net clinics in California, Maryland, Nebraska, and New York. Health care workers were asked about the process through which undocumented patients receive prenatal care in their health center and the ethical tensions and frustrations they encounter when providing or facilitating this care under policy restrictions. Respondents discussed several professional practice norms as well as the ethical tensions they encountered when policy or institutional constraints prevented them from living up to professional norms. Using Nancy Berlinger's "workarounds" framework, this paper examines health care workers' responses to the misalignment of their professional norms and the policy restrictions in their state. These findings suggest that the prenatal policies in each state raise ethical and professional challenges for the health care workers who implement them.
Topics: Adult; California; Female; Financing, Government; Health Personnel; Health Policy; Humans; Male; Maryland; Middle Aged; Nebraska; New York; Pregnancy; Prenatal Care; Safety-net Providers; State Government; Undocumented Immigrants
PubMed: 31560623
DOI: 10.1177/1073110519876172 -
The Milbank Quarterly Sep 2021Policy Points States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political...
UNLABELLED
Policy Points States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions. Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups.
CONTEXT
Even though nearly 6% of citizen babies born in the United States have at least one undocumented parent, undocumented immigrants are ineligible for most public health insurance. Prenatal care is a recommended health service that improves birth outcomes, and some states, including both traditionally "blue" and "red" states, have opted to provide publicly funded coverage for prenatal services for people who are otherwise ineligible due to immigration status. This article explores how courts and legislatures in three states have approached the question of publicly funded prenatal care for undocumented immigrants and its relationship to the abortion debate, with a particular focus on the moral and practical justifications that policymakers employ.
METHODS
We employed a review and qualitative analysis of the documents that comprise the legislative histories of prenatal policies in three case states: California, New York, and Nebraska.
FINDINGS
This review and analysis of policy documents identified moral reasons based on appeals to different conceptions of moral status, respect for autonomy, and justice, as well as prudential reasons that appealed to the health and economic benefits of prenatal care for US citizens and legal residents. We found that much of the variation in reasons supporting policies by state can be traced to the state's position on the protection of reproductive rights and whether the policymakers in each state supported or opposed access to abortion. Interestingly, despite these differences, the states arrived at similar prenatal policies for immigrants.
CONCLUSIONS
There may be areas where policymakers with different political orientations can converge on health policies affecting access to care for undocumented immigrants. Future research should explore the reception of various message frames for expanding public health insurance coverage to immigrants in other contexts.
Topics: Abortion, Induced; Adult; California; Female; Health Policy; Humans; Nebraska; New York; Policy Making; Pregnancy; Prenatal Care; Qualitative Research; State Government; Undocumented Immigrants; United States
PubMed: 34166528
DOI: 10.1111/1468-0009.12519 -
Reproductive Health Mar 2018In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health... (Review)
Review
In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health outcomes for pregnant women and newborns. In low- and middle-income country (LMIC) settings, this model could be adapted to address low antenatal care uptake and improve quality. However, evidence on key attributes of a group care model for low-resource settings remains scant. We conducted a systematic review of the published literature on models of group antenatal care in LMICs to identify attributes that may increase the relevance, acceptability and effectiveness of group ANC in such settings. We systematically searched five databases and conducted hand and reference searches. We also conducted key informant interviews with researchers and program implementers who have introduced group antenatal care models in LMICs. Using a pre-defined evidence summary template, we extracted evidence on key attributes-like session content and frequency, and group composition and organization-of group care models introduced across LMIC settings. Our systematic literature review identified nine unique descriptions of group antenatal care models. We supplemented this information with evidence from 10 key informant interviews. We synthesized evidence from these 19 data sources to identify attributes of group care models for pregnant women that appeared consistently across all of them. We considered these components that are fundamental to the delivery of group antenatal care. We also identified attributes that need to be tailored to the context in which they are implemented to meet local standards for comprehensive ANC, for example, the number of sessions and the session content. We compiled these attributes to codify a composite "generic" model of group antenatal care for adaptation and implementation in LMIC settings. With this combination of standard and flexible components, group antenatal care, a service delivery alternative that has been successfully introduced and implemented in high-income country settings, can be adapted for improving provision and experiences of care for pregnant women in LMIC. Any conclusions about the benefits of this model for women, babies, and health systems in LMICs, however, must be based on robust evaluations of group antenatal care programs in those settings.
Topics: Developing Countries; Female; Health Resources; Humans; Patient Satisfaction; Poverty; Pregnancy; Prenatal Care
PubMed: 29506531
DOI: 10.1186/s12978-018-0476-9 -
American Journal of Perinatology Jan 2021In the setting of an inner city, safety net hospital, patient satisfaction with prenatal care conducted via telehealth was compared with in-person visits at the height...
OBJECTIVE
In the setting of an inner city, safety net hospital, patient satisfaction with prenatal care conducted via telehealth was compared with in-person visits at the height of the novel coronavirus disease 2019 (COVID-19) pandemic.
STUDY DESIGN
Through this cross-sectional study, patients were identified who received at least one televisit and one in-person visit during the COVID-19 pandemic. The Short Assessment of Patient Satisfaction (SAPS) survey was used to measure patient satisfaction. Surveys pertaining to in-person and televisits were conducted at the end of a telephone encounter, and overall satisfaction scores were documented. Patients were excluded if they received in-person or virtual care only and not both. The SAPS score correlated with the degree of patient satisfaction.
RESULTS
A total of 140 patients were identified who received both virtual and in-person prenatal care from March 1, 2020 to May 1, 2020. One hundred and four patients (74%) agreed to be surveyed: 77 (74%) self-identified as Hispanic and 56 (54%) stated that their primary language was Spanish. The overall median satisfaction score for televisits and in-person visits was 20 (interquartile range [IQR]: 20, 25) and 24 (IQR: 22, 26) ( = 0.008, score = 2.651). In patients who self-identified as Hispanic or identified their primary language as Spanish, there was no statistically significant difference in their satisfaction scores.
CONCLUSION
While there were lower scores in patient satisfaction for televisits in every category, there were no clinically significant differences since all medians were in the "satisfied" range. By lowering patient exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), especially for those at risk for reduced access to care and higher COVID-19 cases by zip code, telehealth allowed for appropriate continuation of satisfactory prenatal care with no impact on patient perceived satisfaction of care.
KEY POINTS
· Telehealth allowed for continuation of satisfactory prenatal care in Hispanic patients.. · Hispanic patients are at risk for reduced access to care.. · Telehealth was a useful tool for achieving patient-perceived satisfactory care..
Topics: Adult; Ambulatory Care; COVID-19; Cross-Sectional Studies; Female; Health Services Accessibility; Hispanic or Latino; Humans; Infection Control; New York City; Patient Outcome Assessment; Patient Satisfaction; Pregnancy; Prenatal Care; SARS-CoV-2; Telemedicine
PubMed: 33038898
DOI: 10.1055/s-0040-1718695 -
Pediatrics Dec 2019Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths'... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females.
METHODS
We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening ( = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership).
RESULTS
Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; = .08). There were no intervention effects on other behaviors.
CONCLUSIONS
The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.
Topics: Adolescent; Cognition; Female; Follow-Up Studies; Health Risk Behaviors; Home Care Services; House Calls; Humans; Infant; Infant, Newborn; Male; Nurses, Community Health; Poverty; Pregnancy; Prenatal Care; Time Factors; Treatment Outcome; Young Adult
PubMed: 31748254
DOI: 10.1542/peds.2018-3876 -
The Journal of Perinatal & Neonatal...Pregnant women experienced disruptions in their prenatal care during the coronavirus disease-2019 (COVID-19) pandemic. While there is emerging research about the impact...
Pregnant women experienced disruptions in their prenatal care during the coronavirus disease-2019 (COVID-19) pandemic. While there is emerging research about the impact of COVID-19 on experiences of pregnancy, the majority of studies that have reported on prenatal care and birth during COVID-19 have not incorporated the first-person accounts of Black women. The purpose of this mixed-methods study was to explore the perspectives of Black women on prenatal care, labor, and birth during the pandemic. A total of 33 participants completed questionnaires. Fourteen of these 33 women and an additional 2 participated in qualitative interviews. Descriptive statistics and a mixed-methods analysis were employed. Participants expressed disappointment about disruptions in their experiences of pregnancy including the way their prenatal care was experienced, cancellation of planned "rites of passage," and visitor policy restrictions during and after the birth. Forty-five percent of participants reported being worried about getting COVID-19 and (61%) about their infant getting COVID-19. Many participants experienced a sense of loss that may permeate through other aspects of their lives. Providing extra support and points of contact can help lessen feelings of isolation during the pandemic and can also offer more explanation for rapidly changing policies and procedures.
Topics: COVID-19; Female; Humans; Infant; Male; Pandemics; Parturition; Pregnancy; Pregnant Women; Prenatal Care
PubMed: 35476770
DOI: 10.1097/JPN.0000000000000622 -
Revista Latino-americana de Enfermagem Jul 2019to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy. (Comparative Study)
Comparative Study
OBJECTIVE
to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy.
METHOD
this is a cohort study, conducted with an intentional sample of 273 mothers/babies from the neonatal period and followed up for one year. Donabedian evaluation was adopted and data were discussed based on the Social Determination of Health. The independent variable was the care model. The dependent variables in the process evaluation were related to the quality of prenatal care and to the quality score created and the evaluation of the outcome, to the conditions of birth and the first year of life. The evaluation of the process was performed by estimating the relative risk and the evaluation of the outcome was performed by the Cox Multiple Regression Model.
RESULTS
lower income and risk of the low prenatal quality score were identified in the Family Health Units, where there were more puerperium consultation and health education actions. There was no difference in outcome indicators.
CONCLUSION
possibly the best quality of prenatal care was able to minimize negative socioeconomic effects found in family health, so the outcome indicators were similar in both models of the primary care.
Topics: Brazil; Child Health; Family Health; Female; Humans; Prenatal Care; Primary Health Care; Program Evaluation; Prospective Studies; Quality Indicators, Health Care; Socioeconomic Factors; Women's Health; Young Adult
PubMed: 31340338
DOI: 10.1590/1518-8345.2806.3058