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Obstetrics and Gynecology Clinics of... Sep 2023Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing,... (Review)
Review
Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing, and timing and mode of delivery.
Topics: Pregnancy; Female; Humans; Prenatal Care; Anticoagulants; Pregnancy Complications; Venous Thromboembolism; Obesity
PubMed: 37500214
DOI: 10.1016/j.ogc.2023.03.013 -
JAMA Network Open May 2024An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However,...
IMPORTANCE
An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in combination with individual in-person office appointments to collect vital signs and conduct other tests compared with individual multimodal prenatal care (IMPC) delivered through a combination of remotely delivered and in-person visits.
OBJECTIVE
To compare postpartum outcomes between GMPC and IMPC.
DESIGN, SETTING, AND PARTICIPANTS
A frequency-matched longitudinal cohort study was conducted at Kaiser Permanente Northern California, an integrated health care delivery system. Participants included 424 individuals who were pregnant (212 GMPC and 212 frequency-matched IMPC controls (matched on gestational age, race and ethnicity, insurance status, and maternal age) receiving prenatal care between August 17, 2020, and April 1, 2021. Participants completed a baseline survey before 14 weeks' gestation and a follow-up survey between 4 and 8 weeks post partum. Data analysis was performed from January 3, 2022, to March 4, 2024.
EXPOSURE
GMPC vs IMPC.
MAIN OUTCOME MEASURES
Validated instruments were used to ascertain postpartum psychosocial outcomes (stress, depression, anxiety) and perceived quality of prenatal care. Self-reported outcomes included behavioral outcomes (breastfeeding initiation, use of long-acting reversible contraception), satisfaction with prenatal care, and preparation for self and baby care after delivery. Primary analyses included all study participants in the final cohort. Three secondary dose-stratified analyses included individuals who attended at least 1 visit, 5 visits, and 70% of visits. Log-binomial regression and linear regression analyses were conducted.
RESULTS
The final analytic cohort of 390 participants (95.6% follow-up rate of 408 singleton live births) was racially and ethnically diverse: 98 (25.1%) Asian/Pacific Islander, 88 (22.6%) Hispanic, 17 (4.4%) non-Hispanic Black, 161 (41.3%) non-Hispanic White, and 26 (6.7%) multiracial participants; median age was 32 (IQR, 30-35) years. In the primary analysis, after adjustment, GMPC was associated with a 21% decreased risk of perceived stress (adjusted risk ratio [ARR], 0.79; 95% CI, 0.67-0.94) compared with IMPC. Findings were consistent in the dose-stratified analyses. There were no significant differences between GMPC and IMPC for other psychosocial outcomes. While in the primary analyses there was no significant group differences in perceived quality of prenatal care (mean difference [MD], 0.01; 95% CI, -0.12 to 0.15) and feeling prepared to take care of baby at home (ARR, 1.09; 95% CI, 0.96-1.23), the dose-stratified analyses documented higher perceived quality of prenatal care (MD, 0.16; 95% CI, 0.01-0.31) and preparation for taking care of baby at home (ARR, 1.27; 95% CI, 1.13-1.43) for GMPC among those attending 70% of visits. No significant differences were noted in patient overall satisfaction with prenatal care and feeling prepared for taking care of themselves after delivery.
CONCLUSIONS
In this cohort study, equivalent and, in some cases, better outcomes were observed for GMPC compared with IMPC. Health care systems implementing multimodal models of care may consider incorporating virtual group prenatal care as a prenatal care option for patients.
Topics: Humans; Female; Pregnancy; Adult; Prenatal Care; Longitudinal Studies; California; Postpartum Period; Cohort Studies
PubMed: 38771574
DOI: 10.1001/jamanetworkopen.2024.12280 -
Developmental Medicine and Child... Sep 2023
Topics: Pregnancy; Female; Humans; Neurology; Prenatal Care; Fetus
PubMed: 37300644
DOI: 10.1111/dmcn.15665 -
BMJ (Clinical Research Ed.) Aug 2023
Topics: Humans; Pregnancy; Female; Infant, Newborn; Adrenal Cortex Hormones; Prenatal Care; Premature Birth; Gestational Age; Respiratory Distress Syndrome, Newborn
PubMed: 37532272
DOI: 10.1136/bmj.p1722 -
Journal of Gynecology Obstetrics and... Sep 2023Evaluate the association between a combined measure of time-based pregnancy intention and preconception contraceptive behavior and suboptimal prenatal care.
OBJECTIVE
Evaluate the association between a combined measure of time-based pregnancy intention and preconception contraceptive behavior and suboptimal prenatal care.
POPULATION AND METHOD
Women delivering a live birth in all maternity units during one week in March 2016 were interviewed in the postpartum ward (N = 13,132). Multinomial logistic regression models were used to assess the association between the indicator of pregnancy intention and substandard prenatal care (late initiation of care and less than the recommended number of prenatal visits (<60% recommended)).
RESULTS
83.6% of women had timed pregnancies, 4.7% had mistimed pregnancies but discontinued contraception to conceive, 8.0% had mistimed pregnancies without discontinuing contraception to conceive and 3.7% had unwanted pregnancies. Women with timed pregnancies or mistimed pregnancies despite discontinuing contraception to conceive were more socially advantaged than those who had an unwanted pregnancy or a mistimed pregnancy without discontinuing contraception to conceive. 3.3% of women had a substandard number of prenatal visits and 2.5% had delayed prenatal care initiation. The adjusted odds ratios (aOR) of substandard prenatal visits were high among women with unwanted pregnancies (aOR=2.78; 95% confidence interval [1.91-4.05]) and women with mistimed pregnancies who had not discontinued contraception to conceive (aOR=1.69; [1.21-2.35]) compared to women with timed pregnancies. No difference was observed for women with mistimed pregnancies who discontinued contraception to conceive (aOR=1.22; [0.70-2.12]).
CONCLUSION
Using routinely collected information on preconception contraception allows a more nuanced assessment of pregnancy intentions that can help caregivers identify women at greater risk of substandard prenatal care.
Topics: Pregnancy; Female; Humans; Prenatal Care; Contraception Behavior; Intention; Pregnancy, Unwanted; Contraception
PubMed: 37245644
DOI: 10.1016/j.jogoh.2023.102608 -
International Journal of Gynaecology... Dec 2023This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in... (Review)
Review
This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in nutrition, regarding dietary information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.
Topics: Pregnancy; Female; Humans; Diet; Prenatal Care; Pregnant Women; Counseling; Health Education; Nutritional Status
PubMed: 37401116
DOI: 10.1002/ijgo.14974 -
Indian Journal of Pediatrics Dec 2023There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the... (Review)
Review
There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the concept of pre-conceptional care and its implementation status in India. The review documents the specific interventions that have been proven to effectively improve pregnancy outcome when provided as pre-conception care. Healthcare providers, particularly obstetricians/gynecologists and general physicians, should prioritize pre-conception care as an essential component of healthcare for women. However, the lack of continuum of care and program linkages are some of the key barriers in ensuring pre-conceptional and ante-natal care in India. Culturally and linguistically appropriate care should be provided to ensure that all women can access and understand the information and services needed to optimize their reproductive health and improve pregnancy outcomes. Prioritizing pre-conception and prenatal care, healthcare providers can improve maternal and fetal outcomes, reduce healthcare costs, and promote lifelong health for women and their families. The primary healthcare reforms being done in India can be and should be used to strengthen pre-conceptional and ante-natal care services and quality.
Topics: Infant, Newborn; Child; Pregnancy; Female; Humans; Prenatal Care; Quality of Health Care; India
PubMed: 37700121
DOI: 10.1007/s12098-023-04841-0 -
Obstetrics and Gynecology Clinics of... Sep 2023
Topics: Pregnancy; Female; Humans; Prenatal Care; Patient Satisfaction
PubMed: 37500223
DOI: 10.1016/j.ogc.2023.04.001 -
Journal of Human Nutrition and... Oct 2023
Topics: Pregnancy; Female; Humans; Nutritional Status; Prenatal Care; Body Mass Index; Health Status; Maternal Nutritional Physiological Phenomena
PubMed: 37186485
DOI: 10.1111/jhn.13157 -
Family Medicine Oct 2023
Topics: Pregnancy; Female; Humans; Family Practice; Prenatal Care; Curriculum
PubMed: 37870897
DOI: 10.22454/FamMed.2023.808963