-
The Journal of Family Practice Jul 2023The developmental origins of health and disease (DOHaD) hypothesis suggests prenatal nutrition sets the stage for the developing brain, with effects that last into...
The developmental origins of health and disease (DOHaD) hypothesis suggests prenatal nutrition sets the stage for the developing brain, with effects that last into adulthood. Macronutrient and micronutrient requirements increase in pregnancy and deficiencies can influence fetal neurodevelopment and cognition. Foods such as eggs, meat, and seafood contain many of the nutrients needed for healthy neurodevelopment and intake should be encouraged among women of reproductive age. Family practice clinicians play an important role in providing nutrition recommendations surrounding food and prenatal supplements to consume before, during, and after pregnancy.
Topics: Pregnancy; Female; Humans; Nutritional Status; Dietary Supplements; Prenatal Care; Micronutrients; Brain
PubMed: 37549422
DOI: 10.12788/jfp.0619 -
American Journal of Obstetrics &... Oct 2023Given that smartphones are widely used among reproductive-age people of all socioeconomic backgrounds, a smartphone application may be a useful supplement to routine...
BACKGROUND
Given that smartphones are widely used among reproductive-age people of all socioeconomic backgrounds, a smartphone application may be a useful supplement to routine prenatal care.
OBJECTIVE
This study aimed to describe the implementation of a smartphone app that offers patient education, depression screening, social determinants of health screening, and care coordination as an adjunct to routine prenatal care at a federally qualified health center. We further sought to characterize app engagement and the association of app use with pregnancy outcomes.
STUDY DESIGN
The implementation of the smartphone app was a quality improvement initiative in which the app was made available to all people receiving prenatal care at a designated federally qualified health center between December 2020 and December 2021. Individuals who both initiated prenatal care at this site before 28 weeks of gestation and delivered at our institution during the above-defined period were studied retrospectively after obtaining institutional approval. Summary statistics were used to describe app implementation and information regarding social determinants of health and depression screening. Demographics and maternal and neonatal outcomes were compared between app enrollees and patients receiving prenatal care at the same site who were not enrolled in the app. Data were analyzed using the 2-sample t test to compare continuous variables and the chi-square test to compare categorical variables.
RESULTS
Overall, 800 patients receiving prenatal care at the federally qualified health center during the identified period were telephonically approached for enrollment in the smartphone app. A total of 613 people (76.6%) were successfully reached, and of those successfully reached, 538 (87.7%) accepted enrollment in the app; 76.6% of app enrollees (n=412) completed at least 1 social determinants of health screen. Of those, 29.1% (n=120) screened positive for at least 1 need. Of those with positive screens, 51.7% (n=62) accepted referral to resources to address the identified need. Furthermore, 81% of app enrollees (n=443) completed at least 1 depression screen. Of those, 13.1% (n=58) screened positive for depression, and 37.9% (n=22) of those with positive screens accepted a referral to behavioral health services. A total of 483 people met the inclusion criteria for retrospective review: 264 were enrolled in the smartphone app and 219 were not. App enrollees were more likely to speak English (79.9% of app group vs 61.6% of the non-app group; P<.0001), identify as Hispanic (52.7% vs 39.7%; P=.02), and be privately insured (24.6% vs 15.5%; P=.005), and less likely to have a social determinants of health-related need (10.0% vs 21.0%; P=.01). There were no significant differences in mode of delivery or maternal and neonatal outcomes between the 2 groups.
CONCLUSION
A high proportion of patients receiving care through our federally qualified health center enrolled in and used the smartphone app and its associated care coordination. This could be a useful tool to screen for depression and adverse social determinants of health in underserved communities. Given that individuals of higher-resource backgrounds seem more likely to enroll in smartphone apps, a more targeted approach is needed to help connect patients of lower-resource backgrounds to smartphone apps and the resources that they offer.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Mobile Applications; Smartphone; Prenatal Care; Retrospective Studies
PubMed: 37597800
DOI: 10.1016/j.ajogmf.2023.101135 -
Obstetrical & Gynecological Survey May 2024Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best... (Review)
Review Comparative Study
IMPORTANCE
Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes.
OBJECTIVE
The aim of this study was to review and compare the most recently published guidelines on antenatal care.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted.
RESULTS
There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage.
CONCLUSIONS
Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.
Topics: Humans; Pregnancy; Female; Prenatal Care; Practice Guidelines as Topic; Canada; Australia; New Zealand
PubMed: 38764206
DOI: 10.1097/OGX.0000000000001261 -
Early Human Development Aug 2023A secular trend towards earlier age at menarche has been reported, but the trend in breast development is less clear. We reviewed the evidence on the relationship... (Review)
Review
BACKGROUND
A secular trend towards earlier age at menarche has been reported, but the trend in breast development is less clear. We reviewed the evidence on the relationship between in utero and early life events and breast onset/development.
METHODS
Eligible studies were identified in PubMed and Embase databases. We selected studies in which female human exposure during fetal or the first years of life was measured or estimated, and associations with breast onset or development were evaluated.
RESULTS
Of the 49 cohort studies and 5 cross-sectional studies identified, 43 provided sufficient data to assess associations. High maternal weight, primiparity, and early weight gain, were related to an increased risk of early breast onset/development in most of the studies that analysed these associations, whereas late breast onset/development was associated with preterm birth. Results were inconsistent for smoking in pregnancy, maternal hypertensive disorders, breastfeeding, diabetes, and small for gestational age. No association emerged for maternal age at delivery, alcohol drinking, and selected drug use during pregnancy, and low birth weight.
CONCLUSIONS
The results of this review show that high maternal weight, primiparity and early weight gain were associated with an increased risk of early breast onset/development. Late breast onset/development was associated with preterm birth. Breast development is a key physical marker of puberty onset, and early puberty development is linked to consequences that can reverberate throughout life. Answering the questions about the interconnections between pre/postnatal environmental exposures and their impact on puberty, represents an important area of multidisciplinary research.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Cross-Sectional Studies; Prenatal Care; Maternal Age; Weight Gain
PubMed: 37421688
DOI: 10.1016/j.earlhumdev.2023.105816 -
Journal of Women's Health (2002) Jun 2024The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. A consensus development study was conducted in the...
The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. A consensus development study was conducted in the United States with participants, including 31 health care professionals, 12 public policy members or public health payers, and 18 public members, representing 24 states. A modified Delphi method and modified nominal group technique were utilized. Twenty-one potential core outcomes were developed by combining the outcomes reported in three systematic reviews that evaluated the frequency of prenatal care visits or modality of prenatal visit type (, in person, telemedicine, or hybrids of both). Eighteen consensus outcomes were identified from the Delphi process, following which 10 maternal and 4 neonatal outcomes were agreed at the consensus development meeting. Maternal core outcomes include maternal quality of life; maternal mental health outcomes; the experience of maternity care; lost time; attendance of recommended visits; unplanned care utilization; completion of the American College of Obstetricians and Gynecologists-recommended services; diagnosis of obstetric complications-proportion and timing; disparities in care outcomes; and severe maternal morbidity or mortality. Neonatal core outcomes include gestational age at birth, birth weight, stillbirth or perinatal death, and neonatal intensive care unit admissions. The core outcome set for the frequency and modality of prenatal visits should be utilized in forthcoming randomized controlled trials and systematic reviews. Such application will warrant that in future research, consistent reporting will enrich care and improve outcomes. Clinical Trial Registration number: 2021.
Topics: Adult; Female; Humans; Pregnancy; Appointments and Schedules; Consensus; Delphi Technique; Outcome Assessment, Health Care; Pregnancy Outcome; Prenatal Care; Quality of Life; United States
PubMed: 38306165
DOI: 10.1089/jwh.2023.0592 -
Journal of Obstetric, Gynecologic, and... May 2024In 1976, the Supreme Court mandated that incarcerated individuals have a constitutional right to receive medical care; however, there are no mandatory standards so... (Review)
Review
In 1976, the Supreme Court mandated that incarcerated individuals have a constitutional right to receive medical care; however, there are no mandatory standards so access to and quality of reproductive health care for incarcerated pregnant women varies widely across facilities. Without federal or state standards, there is variability in the type of prenatal care pregnant women receive, their birthing experience, how long they are able to stay with their infant after birth, and whether they are permitted to breastfeed or express milk. In this column, I review policies related to reproductive health care in carceral settings, the gaps in data collection and research, programs to support the needs of incarcerated pregnant women, and recommendations from professional organizations on reproductive health care for incarcerated women in the prenatal and postpartum periods.
Topics: Humans; Female; Pregnancy; Prisoners; Prenatal Care; United States; Postnatal Care; Health Services Accessibility; Reproductive Health Services; Postpartum Period
PubMed: 38588824
DOI: 10.1016/j.jogn.2024.03.006 -
Revista Brasileira de Enfermagem 2023to assess high-risk prenatal care and identify strategies for improving care.
OBJECTIVES
to assess high-risk prenatal care and identify strategies for improving care.
METHODS
a mixed study of a prospective cohort, with 319 mothers in a public maternity hospital, from October 2016 to August 2017, using a semi-structured instrument and interview. Analysis was performed using the chi-square test (p≤0.05). The qualitative approach was carried out through interviews with guiding questions to 13 managers, at their workplace, between January and March 2020, analyzed under social phenomenology.
RESULTS
higher rates of inadequacy were identified for all criteria. However, when care was shared, there was a higher rate for performing tests (p=0.023), consultations (p=0.002), risk stratification (p=0.013) and emergency information (≤0.000). Weaknesses in the record evidenced impairment in communication and continuity of care.
FINAL CONSIDERATIONS
shared care is a strategy for improving care, however there is a need to strengthen effective referral and counter-referral to care continuity.
Topics: Pregnancy; Humans; Female; Pregnancy, High-Risk; Prospective Studies; Prenatal Care; Ambulatory Care; Mothers
PubMed: 37970965
DOI: 10.1590/0034-7167-2022-0420 -
NeoReviews Sep 2023The maternal-fetal environment, controlled and modulated by the placenta, plays a critical role in the development and well-being of the fetus, with long-term impact... (Review)
Review
The maternal-fetal environment, controlled and modulated by the placenta, plays a critical role in the development and well-being of the fetus, with long-term impact through programming of lifelong health. The fetal cardiovascular system and placenta emerge at the same time embryologically, and thus placental form and function are altered in the presence of congenital heart disease (CHD). In this review, we report on what is known about the placenta from a structural and functional perspective when there is CHD. We describe the various unique pathologic findings as well as the diagnostic imaging tools used to characterize placental function in utero. With growing interest in the placenta, a standardized approach to characterizing placental pathology has emerged. Furthermore, application of ultrasonography techniques and magnetic resonance imaging now allow for insights into placental blood flow and functionality in vivo. An improved understanding of the intriguing relationship between the placenta and the fetal cardiovascular system will provide opportunities to develop novel ways to optimize outcomes. Once better understood, therapeutic modulation of placental function offered during the vulnerable period of fetal plasticity may be one of the most impactful ways to alter the course of CHD and its complications.
Topics: Pregnancy; Humans; Female; Placenta; Heart Defects, Congenital; Fetus; Prenatal Care
PubMed: 37653088
DOI: 10.1542/neo.24-9-e569 -
Nursing For Women's Health Aug 2023With the rapid growth of specialized fetal care centers (FCCs) across the United States, a new area of nursing practice has emerged. Fetal care nurses provide care in...
With the rapid growth of specialized fetal care centers (FCCs) across the United States, a new area of nursing practice has emerged. Fetal care nurses provide care in FCCs to pregnant persons experiencing complex fetal conditions. This article describes the unique practice of fetal care nurses necessitated by the complexity of perinatal care and the provision of maternal-fetal surgery in FCCs. The Fetal Therapy Nurse Network has played a significant role in the evolution of this nursing practice and will serve as a platform for the generation of core competencies and the development of a potential specialty certification for fetal care nurses.
Topics: Child; Infant, Newborn; Female; Pregnancy; Humans; United States; Prenatal Care; Perinatal Care
PubMed: 37271181
DOI: 10.1016/j.nwh.2023.04.005 -
Revista de Saude Publica 2023This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC...
OBJECTIVE
This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery.
METHODS
Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports.
RESULTS
The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL).
CONCLUSIONS
Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.
Topics: Pregnancy; Female; Humans; Prenatal Care; Brazil; Cross-Sectional Studies; Delivery, Obstetric; Multivariate Analysis
PubMed: 37878854
DOI: 10.11606/s1518-8787.2023057005146