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Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework.Public Health Nutrition Aug 2023Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This... (Review)
Review
OBJECTIVES
Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life.
DESIGN
A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research.
SETTING
Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings.
PARTICIPANTS
A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician.
RESULTS
Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent.
CONCLUSIONS
Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
Topics: Infant, Newborn; Infant; Pregnancy; Humans; Female; Fetal Development; Prenatal Care
PubMed: 37170908
DOI: 10.1017/S1368980023000940 -
Journal of the American Board of Family... Aug 2023The impact of the declining proportion of family physicians who attend deliveries on the provision of other perinatal care during pregnancy, postpartum, and neonatal...
The impact of the declining proportion of family physicians who attend deliveries on the provision of other perinatal care during pregnancy, postpartum, and neonatal periods is unclear. We found a strong association between stopping attending deliveries and stopping providing prenatal and postpartum care among family physicians, suggesting that policies which support family physicians to maintain a full scope of practice including all or some aspects of perinatal care may help alleviate shortages in the perinatal workforce and fill gaps in access to obstetric care.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Physicians, Family; Postnatal Care; Workforce; Prenatal Care
PubMed: 37562840
DOI: 10.3122/jabfm.2022.220404R1 -
Obstetrics and Gynecology Clinics of... Sep 2023As more data from maternal mortality reviews are available, it has become clear that social determinants of health have major impacts on the morbidity and mortality of... (Review)
Review
As more data from maternal mortality reviews are available, it has become clear that social determinants of health have major impacts on the morbidity and mortality of mothers and infants. The ability to verify and address these requires an effective screening process during prenatal care. The challenges include selection of an appropriate tool for use in pregnancy; incorporating the tool into the clinical flow to ensure screening of all pregnant patients; and developing an approach to address the issues, be it providing emotional support, management within the clinic, or referring to outside resources.
Topics: Pregnancy; Female; Infant; Humans; Prenatal Care; Social Determinants of Health; Mothers; Counseling; Morbidity
PubMed: 37500221
DOI: 10.1016/j.ogc.2023.03.011 -
Ciencia & Saude Coletiva Aug 2023Men's Prenatal Care is a strategy to expand and promote the health of these people. We evaluated how the Family Health teams (eSF) conduct this artifice as a care...
Men's Prenatal Care is a strategy to expand and promote the health of these people. We evaluated how the Family Health teams (eSF) conduct this artifice as a care strategy for the male population in Recife-PE, Brazil. This evaluative, cross-sectional, qualitative study involved nurses, doctors, dentists, nursing technicians, and community health workers. We applied a semi-structured questionnaire, followed by six focus groups with the eSF with the largest number of respondents in the first stage to deepen the development of the strategy. The thematic content analysis proposed by Bardin was performed. The evaluation matrix developed identified the main strengths and difficulties in the strategy's structure, work process, and results. We observed that, while accepted as an excellent strategy, we identified a resistance that permeates from structural to cultural issues, hindering the proposal to expand access to actions and services to promote men's health, preserving the biomedical model. Care refers to the unfolding of care already provided to pregnant women but faces limiting obstacles for its sustainability.
Topics: Humans; Male; Female; Pregnancy; Prenatal Care; Brazil; Cross-Sectional Studies; Men; Pregnant Women; Qualitative Research
PubMed: 37531534
DOI: 10.1590/1413-81232023288.06472023 -
Health Promotion Practice Sep 2023In response to disproportionately high rates of infant mortality and preterm birth among women of color and women in poverty in Fresno County, California, community and...
In response to disproportionately high rates of infant mortality and preterm birth among women of color and women in poverty in Fresno County, California, community and academic partners coordinated a community-based participatory research (CBPR) project with local residents. Social isolation and stress, inaccessible prenatal care, and dissatisfaction with care experiences were identified as leading predictors of poor birth outcomes. The PRECEDE-PROCEED framework was used to lead the CBPR effort that resulted in the development of a model of group prenatal care, named Glow! Group Prenatal Care Program (Glow! Program). Group prenatal care (GPNC), which focuses on pregnancy health assessments, education, and peer support, has the potential to address the health and social priorities of women during pregnancy. As a result of the employed CBPR process and the extensive participation from stakeholders, this modified GPNC model responds to the unique needs of the at-risk community members, the agencies aiming to improve maternal-child health experiences and outcomes, and the prenatal care providers offering it to their patients. The methods from this study can be applied in the design and implementation of community-based health care interventions. Returning to community partners throughout the design, implementation, and evaluation phases underscored that health care interventions cannot be designed in silos, and require flexibility to respond to factors that promote improved maternal and infant outcomes, which affect the end goal for the intervention.
Topics: Infant; Pregnancy; Humans; Infant, Newborn; Female; Prenatal Care; Community-Based Participatory Research; Premature Birth; Delivery of Health Care
PubMed: 35658722
DOI: 10.1177/15248399221098015 -
BMC Pediatrics Feb 2024Our understanding of the premature gut microbiome has increased rapidly in recent years. However, to advance this important topic we must further explore various aspects...
Our understanding of the premature gut microbiome has increased rapidly in recent years. However, to advance this important topic we must further explore various aspects of the maternal microbiome, neonatal microbiota, and the opportunities for microbiome modulation. We invite authors to contribute research and clinical papers to the Collection "Maternal-fetal-neonatal microbiome and outcomes associated with prematurity".
Topics: Infant, Newborn; Pregnancy; Female; Humans; Infant, Premature; Microbiota; Prenatal Care; Fetus; Gastrointestinal Microbiome; Infant, Newborn, Diseases
PubMed: 38297298
DOI: 10.1186/s12887-024-04536-1 -
Journal of Reproductive and Infant... Mar 2024Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and...
BACKGROUND
Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and overutilisation of prenatal care. Whether GWG is associated with adequacy of prenatal care among women with and without depression in the United States is unknown. This study evaluated whether adequacy of prenatal care differed by depression status and GWG.
METHODS
Data from the Pregnancy Risk Assessment Monitoring System from 1,379,870 women who were pregnant with a singleton and delivered at 37-42 weeks gestation during 2016 to 2018 were included. Depression was self-reported. The Kotelchuck index was used to evaluate adequacy of prenatal care. Maternal weight gain was compared to GWG guidelines.
RESULTS
Approximately 13.1% of the sample experienced depression during pregnancy. Although those with depression had increased odds of both inadequate and above adequate levels of prenatal care, this association was no longer significant after accounting for demographics, medical comorbidities, and socioeconomic factors. Individuals with inadequate levels of prenatal care with a normal pre-pregnancy body mass index gained less weight during pregnancy.
CONCLUSIONS
The association between depression and prenatal care utilisation seems driven by demographic, medical comorbidity, and socioeconomic variables. Weight outcomes were associated with inadequate prenatal care utilisation.
Topics: Pregnancy; Female; United States; Humans; Prenatal Care; Gestational Weight Gain; Pregnancy Outcome; Depression; Body Mass Index
PubMed: 35582731
DOI: 10.1080/02646838.2022.2075544 -
Obstetrics and Gynecology Nov 2023To understand pregnant patients' reasons for prenatal cannabis use and perceptions of safety, desired and undesirable health care experiences, and desired information...
OBJECTIVE
To understand pregnant patients' reasons for prenatal cannabis use and perceptions of safety, desired and undesirable health care experiences, and desired information about prenatal cannabis use and secondarily to understand racial differences in these perceptions and preferences.
METHODS
We conducted a qualitative study including 18 semi-structured, race-concordant virtual focus groups with pregnant individuals who self-reported cannabis use at prenatal care entry in a large integrated health care system in Northern California from November 2021 to December 2021. The focus groups included semi-structured questions that were recorded, transcribed, and coded by the research team. Thematic analysis was used to analyze the data.
RESULTS
Overall, 53 participants were included; 30 self-identified, as White and 23 self-identified as Black. Participants averaged 30.3 years of age (SD 5.2 years) and were on average at 20.9 weeks of gestation at study enrollment; 69.8% reported daily cannabis use, 24.5% reported weekly cannabis use, and 5.7% reported monthly or less cannabis use at entrance to prenatal care. Although some participants quit cannabis use in early pregnancy because of concerns about potential health risks, many perceived a lack of scientific evidence or believed that prenatal cannabis use was safe. Many preferred cannabis to over-the-counter or prescription medications for treating mood, morning sickness, pain, and sleep. Participants valued open interactions with obstetricians that acknowledged their motivations for use, and they desired information about potential risks through conversations and educational materials. White and Black participants' perspectives were generally similar, but a few Black participants uniquely described concerns about racial bias related to their prenatal cannabis use.
CONCLUSION
Pregnant patients used cannabis to manage mood and medical symptoms, and many believed that prenatal cannabis use was safer than the use of prescription medications. Obstetrician-initiated, patient-centered conversations around prenatal cannabis use, advice to discontinue cannabis use during pregnancy, and exploration of willingness to switch to medically recommended interventions for pregnancy-related symptoms may benefit patients.
Topics: Pregnancy; Female; Humans; Cannabis; Prenatal Care; Self Report; Qualitative Research; Focus Groups
PubMed: 37562055
DOI: 10.1097/AOG.0000000000005295 -
Journal of Clinical Nursing Oct 2023To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and... (Review)
Review
AIMS
To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman- and family-centred care from the perspective of women/parents and health professionals.
BACKGROUND
Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery.
DESIGN
A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study.
METHODS
Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7).
RESULTS/FINDINGS
Participants perceived care delivered by state-based services as problematic prior to admission into the high-risk midwifery COC model. Once admitted to the high-risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions.
CONCLUSION
This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes.
RELEVANCE TO CLINICAL PRACTICE
Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy-related stress associated with diagnosis of foetal anomaly.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public was involved in the design, analysis, preparation or writing of this review.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Retrospective Studies; Prospective Studies; Parturition; Prenatal Diagnosis; Midwifery; Continuity of Patient Care; Prenatal Care
PubMed: 37409420
DOI: 10.1111/jocn.16777 -
Clinical Obstetrics and Gynecology Sep 2023Cell-free DNA (cfDNA) screening has high detection for the common fetal autosomal aneuploidies, but is not diagnostic. The positive predictive value should be utilized...
Cell-free DNA (cfDNA) screening has high detection for the common fetal autosomal aneuploidies, but is not diagnostic. The positive predictive value should be utilized in counseling after a positive cell-free DNA screen, and diagnostic testing should be offered for confirmation. cfDNA screening does not report a result in ~3% of cases; nonreportable results indicate an increased risk for aneuploidy and some adverse perinatal outcomes. False-positive cfDNA screening occurs due to confined placental mosaicism, maternal copy number variants, mosaicism, and cancer. Pretest education and counseling should be provided with emphasis on the potential benefits, risks, and limitations before cfDNA screening.
Topics: Pregnancy; Female; Humans; Placenta; Aneuploidy; Cell-Free Nucleic Acids; Fetus; Prenatal Care
PubMed: 37650668
DOI: 10.1097/GRF.0000000000000796