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American Journal of Preventive Medicine Sep 2023CenteringPregnancy emphasizes nutrition, learning, and peer support through a group meeting format in contrast to the standard of prenatal care that maximizes a pregnant... (Observational Study)
Observational Study
INTRODUCTION
CenteringPregnancy emphasizes nutrition, learning, and peer support through a group meeting format in contrast to the standard of prenatal care that maximizes a pregnant patient's time with their provider. It was hypothesized that the program may yield a reduced risk of pregnancy-induced hypertension. In this observational study, authors examined the impacts of the CenteringPregnancy program versus those of standard of prenatal care on pregnancy-induced hypertension.
METHODS
In 2021, birth certificate data were linked to hospital discharge records of women who delivered in obstetric clinics in the Midlands of South Carolina between 2015 and 2019. Logistic regression models were used to estimate the association between CenteringPregnancy participation (n=547) and any pregnancy-induced hypertension and specific pregnancy-induced hypertension diagnoses (gestational hypertension/unspecified hypertension, mild pre-eclampsia, and severe pre-eclampsia/eclampsia). Propensity score techniques (e.g., inverse probability of treatment weighting) were used to adjust for self-selection into the program versus into standard of prenatal care.
RESULTS
CenteringPregnancy participants had higher odds of developing any pregnancy-induced hypertension under all specifications (OR=1.48, 95% CI=1.15, 1.92) and specifically gestational hypertension/unspecified hypertension (OR=1.76, 95% CI=1.28, 2.42) than those in standard of prenatal care. However, CenteringPregnancy participants did not experience significantly higher odds of mild pre-eclampsia (OR=1.06, 95% CI=0.65, 1.78) and severe pre-eclampsia/eclampsia (OR=1.21, 95% CI=0.78, 1.89) compared with standard of prenatal care participants.
CONCLUSIONS
Participation in CenteringPregnancy was associated with higher odds of pregnancy-induced hypertension, particularly gestational hypertension, than participation in standard of prenatal care. Additional research is warranted to definitely rule out selection bias and identify contributing factor(s) that increased pregnancy-induced hypertension despite efforts to improve pregnancy-related health outcomes among CenteringPregnancy participants.
Topics: Pregnancy; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Eclampsia; Prenatal Care; Propensity Score
PubMed: 37105447
DOI: 10.1016/j.amepre.2023.04.010 -
Clinical Obstetrics and Gynecology Dec 2023Periviable delivery, or a pregnancy at risk of delivery between 20 0/7 and 25 6/7 weeks gestational, is an uncommon event with profound physical, psychological, and...
Periviable delivery, or a pregnancy at risk of delivery between 20 0/7 and 25 6/7 weeks gestational, is an uncommon event with profound physical, psychological, and financial impact. Neonatal outcomes can be hard to predict and with the changing legal landscape around abortion access, management options may be compromised. Dynamic maternal and fetal factors make a cohesive and supportive care team critical for optimal care. Management of threatened periviable delivery in a post-Roe United States may prioritize fetal outcomes regardless of threat to maternal health due to legal restrictions.
Topics: Pregnancy; Infant, Newborn; Female; United States; Humans; Premature Birth; Infant, Extremely Premature; Prenatal Care
PubMed: 37963343
DOI: 10.1097/GRF.0000000000000819 -
Journal of Public Health Dentistry Mar 2024Federally Qualified Health Centers (FQHCs) may be well positioned to facilitate dental visits during pregnancy for low-income women. We sought to compare receipt of...
OBJECTIVES
Federally Qualified Health Centers (FQHCs) may be well positioned to facilitate dental visits during pregnancy for low-income women. We sought to compare receipt of dental visits during pregnancy for women who received prenatal care at an FQHC versus a non-FQHC setting.
METHODS
We analyzed Michigan Medicaid administrative data for all live birth deliveries between April 2018 and December 2020. We used billing data to categorize the predominant setting for prenatal care as occurring at a FQHC or a non-FQHC and claims data to identify dental visits during pregnancy (in the 9 months prior to delivery). We employed bivariate and multivariate analyses to explore the relationship between setting for prenatal care and dental visits during pregnancy.
RESULTS
Women who received prenatal care at an FQHC versus non-FQHC had a higher proportion of dental visits during pregnancy (31.85% vs. 19.37%, p < 0.0001). In multivariate analyses, the strongest predictors of having a dental visit during pregnancy were FQHC prenatal care setting, having a dental emergency visit, having ≥3 prenatal visits, and having Medicaid coverage throughout pregnancy. Hispanic or Black race/ethnicity and 2020 delivery year were predictors of a lower likelihood of a dental visit. These predictors were consistent for the overall population and for the subset who had no dental visits pre-pregnancy.
CONCLUSION
Medicaid-enrolled women who receive prenatal care at an FQHC are more likely to have a dental visit during pregnancy than their counterparts who receive prenatal care in a non-FQHC setting.
Topics: Pregnancy; United States; Humans; Female; Prenatal Care; Medicaid; Ethnicity; Poverty
PubMed: 38173182
DOI: 10.1111/jphd.12596 -
Journal of Psychosomatic Obstetrics and... Dec 2023Existing research indicates that pregnant women who conceived through fertility treatment might experience more stress and anxiety compared to women who conceived... (Review)
Review
BACKGROUND
Existing research indicates that pregnant women who conceived through fertility treatment might experience more stress and anxiety compared to women who conceived spontaneously. Therefore, these women might have additional antenatal care needs.
METHODS
A search for both quantitative and qualitative studies was performed in PubMed, PsycINFO, CINAHL and MEDLINE through May 2021, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. 21 articles met the inclusion criteria. After methodological quality appraisal using the Mixed Methods Appraising Tool, 15 studies were included in the review.
RESULTS
Analysis of the studies identified behavioral, relational/social, emotional, and cognitive needs and women's preference about maternity care. Women who conceived through fertility treatment reported lower social and physical functioning scores and elevated levels of anxiety and depression compared to women who conceived spontaneously. They reported difficulties adjusting to pregnancy and experienced a care gap between discharge from the fertility clinic and going to local maternity care services for their first consultation, and a care gap postpartum.
CONCLUSIONS
Women who conceived through fertility treatment have additional antenatal care needs. We recommend to offer these women more frequent check-ins, and to pay attention to the impact of their infertility and treatment on their pregnancy.
Topics: Female; Humans; Pregnancy; Maternal Health Services; Postpartum Period; Pregnant Women; Prenatal Care; Qualitative Research
PubMed: 36508566
DOI: 10.1080/0167482X.2022.2148099 -
BMC Pregnancy and Childbirth Nov 2023To examine family medicine (FM) and obstetrician-gynecologist (OB/GYN) residents' experiences with CenteringPregnancy (CP) group prenatal care (GPNC) as a correlate to...
OBJECTIVE
To examine family medicine (FM) and obstetrician-gynecologist (OB/GYN) residents' experiences with CenteringPregnancy (CP) group prenatal care (GPNC) as a correlate to perceived likelihood of implementing CP in future practice, as well as knowledge, level of support, and perceived barriers to implementation.
METHODS
We conducted a repeated cross-sectional study annually from 2017 to 2019 with FM and OB/GYN residents from residency programs in the United States licensed to operate CP. We applied adjusted logistic regression models to identify predictors of intentions to engage with CP in future practice.
RESULTS
Of 212 FM and 176 OB/GYN residents included in analysis, 67.01% of respondents intended to participate as a facilitator in CP in future practice and 51.80% of respondents were willing to talk to decision makers about establishing CP. Both FM and OB/GYN residents who spent more than 15 h engaged with CP and who expressed support towards CP were more likely to participate as a facilitator. FM residents who received residency-based training on CP and who were more familiar with CP reported higher intention to participate as a facilitator, while OB/GYN residents who had higher levels of engagement with CP were more likely to report an intention to participate as a facilitator.
CONCLUSION
Engagement with and support towards CP during residency are key factors in residents' intention to practice CP in the future. To encourage future adoption of CP among residents, consider maximizing resident engagement with the model in hours of exposure and level of engagement, including hosting residency-based trainings on CP for FM residents.
Topics: Female; Pregnancy; Humans; United States; Gynecology; Prenatal Care; Family Practice; Cross-Sectional Studies; Obstetrics; Internship and Residency; Surveys and Questionnaires
PubMed: 37990297
DOI: 10.1186/s12884-023-06124-0 -
Inflammatory Bowel Diseases Jul 2024
Topics: Humans; Female; Pregnancy; Inflammatory Bowel Diseases; Prenatal Care; Pregnancy Complications
PubMed: 37603834
DOI: 10.1093/ibd/izad171 -
Journal of Midwifery & Women's Health 2024Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected,... (Review)
Review
INTRODUCTION
Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication.
METHODS
We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations.
RESULTS
Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations.
DISCUSSION
Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.
Topics: Female; Humans; Pregnancy; Communication; Language; Prenatal Care; Racism; United States; Ethnic and Racial Minorities
PubMed: 37961941
DOI: 10.1111/jmwh.13580 -
Patient Education and Counseling Jul 2024Prenatal genetic testing is routinely offered to all pregnant patients in the United States and is variably offered to certain pregnant populations globally [1]. To...
OBJECTIVE
Prenatal genetic testing is routinely offered to all pregnant patients in the United States and is variably offered to certain pregnant populations globally [1]. To achieve value-based, informed decision-making, we argue for a shift away from the predominant "teaching" model of genetic counseling practice that prioritizes information and counselor dominance, toward a "counseling" model of practice that prioritizes the patient's narrative, values and beliefs.
DISCUSSION
Since prenatal testing began, genetic counseling has aimed to facilitate informed decision-making. Many patients are not familiar with the conditions which can be screened for prenatally or the quality of life of affected children. This lack of understanding can leave expectant parents unprepared to make informed decisions about prenatal testing. As the number of prenatal genetic tests expands, genetic counselors and all healthcare providers who discuss prenatal testing face a growing amount of information that is not feasible to explain to patients in a routine appointment. Research demonstrates that the common approach to genetic counseling, including in the prenatal setting, is the provision of biomedical information. Yet, genetic counseling outcome studies suggest that attending to the relational aspects of genetic counseling are associated with more positive patient outcomes, including enhanced knowledge, informed decision-making and greater patient satisfaction [2,3]. Through case vignettes, we illustrate the application of a counseling model of practice using Accreditation Council for Genetic Counseling (ACGC) practice-based competencies in the domain of "Interpersonal, Psychosocial and Counseling Skills" [4]. Finally, we propose changes across the genetic counseling profession to move clinical practice toward a more relational model of care.
PRACTICE IMPLICATIONS
A counseling model of genetic counseling practice leads to more positive patient outcomes [2,3]. Genetic counselors and other prenatal healthcare providers can leverage existing counseling and communication skills to support clients in value-based, informed decision-making in prenatal genetic counseling practice.
Topics: Humans; Genetic Counseling; Female; Pregnancy; Decision Making; Prenatal Diagnosis; Genetic Testing; Prenatal Care; Counselors; United States
PubMed: 38593481
DOI: 10.1016/j.pec.2024.108278 -
Sao Paulo Medical Journal = Revista... 2023Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase...
BACKGROUND
Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates.
OBJECTIVE
To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents.
DESIGN AND SETTING
A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil.
METHODS
Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals.
RESULTS
The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education.
CONCLUSION
Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.
Topics: Adolescent; Female; Pregnancy; Humans; Breast Feeding; Adolescent Mothers; Prospective Studies; Prenatal Care; Delivery of Health Care; Mothers
PubMed: 37991014
DOI: 10.1590/1516-3180.2022.0647.R1.260723 -
Journal of Midwifery & Women's Health 2023Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical...
Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical standards. For health care providers unwilling to provide evidence-based life-saving abortion care due to personal beliefs, clear guidance dictates disclosure of these limitations to the patient and colleagues, followed by immediate referral for appropriate care. However, this decision-making pathway may not be engaged due to a variety of factors: providers' beliefs preclude adherence to referral responsibilities, political discourse confuses patients as to their options and rights, and a constantly changing state and national legal landscape leads providers to question their ability to practice to their full scope of clinical care. Although this disruption of evidence-based standard of care existed pre-Dobbs, the moral disorder is now heightened. This Clinical Rounds highlights a patient vignette describing the risks of abortion restrictions for patients and providers alike, particularly when an individual provider's concerns for violating institutional guidelines sets a precedent for nursing response and forecloses on collaborative input or ethics consultation. The history of physician-only abortion exceptionalism and exclusion of nurses and midwives despite a significant history of nurses and midwives in abortion care grounds an argument for focusing on the impact of unethical and substandard care on the interprofessional care team leading to moral distress and negative patient outcomes. Patient-centered models of care, such as frameworks common in nursing and midwifery, offer opportunities to consider how all providers practicing to their full scope in interprofessional and collaborative ways, such as in emergency rooms and labor departments, might mitigate obstructions to abortion care that risk pregnant people's lives.
Topics: Pregnancy; Female; Humans; Abortion, Induced; Midwifery; Prenatal Care; Morals; Emergency Medical Services
PubMed: 38095827
DOI: 10.1111/jmwh.13598