-
Obstetrics and Gynecology Clinics of... Sep 2023
Topics: Pregnancy; Female; Humans; Prenatal Care; Prenatal Diagnosis
PubMed: 37500224
DOI: 10.1016/j.ogc.2023.03.001 -
Advances in Experimental Medicine and... 2020Cancer associated with pregnancy is defined by diagnosis during pregnancy, lactation, or the first year after delivery. The decision about type of treatment depends on... (Review)
Review
Cancer associated with pregnancy is defined by diagnosis during pregnancy, lactation, or the first year after delivery. The decision about type of treatment depends on the cancer stage and gestational age. Termination of pregnancy does not seem to modify the maternal prognosis for breast cancers. Interdisciplinary meetings and discussions are needed to evaluate and balance the maternal and fetal risks. In this chapter, we discuss about how to prevent or treat maternal and fetal complications of surgery and chemotherapy in pregnancy-associated breast cancer.
Topics: Abortion, Induced; Clinical Decision-Making; Female; Gestational Age; Humans; Lactation; Neoplasm Staging; Pregnancy; Pregnancy Complications, Neoplastic; Prenatal Care
PubMed: 32816276
DOI: 10.1007/978-3-030-41596-9_21 -
International Journal of Gynaecology... Jul 2020Multiple gestations are commonly encountered in both high-risk and low-risk pregnancies and, since the advent of assisted reproductive technologies in the 1980s, the... (Review)
Review
Multiple gestations are commonly encountered in both high-risk and low-risk pregnancies and, since the advent of assisted reproductive technologies in the 1980s, the numbers of multiple gestations have grown rapidly. Thus, an understanding of both the maternal and fetal risks associated with multiple gestations should be central to all obstetric practice. The ability to foresee issues and the know how to respond to the complications that develop are central to the correct management of these pregnant women. For some, appropriate management may include referral to a specialist maternal and fetal medicine physician or, in some cases, to a specialist fetal center. The present review provides a comprehensive and simplified overview of multiple gestations, including incidence, diagnosis, genetic considerations, complications (both general and specific to multiple gestation subtypes), and delivery management. It is essential that providers recognize the high-risk and specific complications that may affect a multiple gestation in order to provide the highest possible level of care for these pregnant women.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy, Multiple; Prenatal Care; Referral and Consultation
PubMed: 32524592
DOI: 10.1002/ijgo.13168 -
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 -
CMAJ : Canadian Medical Association... Oct 2021
Topics: Abnormalities, Drug-Induced; Anticonvulsants; Drug-Related Side Effects and Adverse Reactions; Epilepsy; Female; Humans; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 34642163
DOI: 10.1503/cmaj.210065-f -
Primary Care Sep 2020The continuum of preconception, antenatal period, fourth trimester, and interconception period are a critical time for comprehensive care to advance maternal-child... (Review)
Review
The continuum of preconception, antenatal period, fourth trimester, and interconception period are a critical time for comprehensive care to advance maternal-child health and deliver family-centered care. Immunizations are a key component of this care delivery; however, there are intricacies around indications of vaccinations during this key period. Both active immunity to the individual receiving the vaccine as well as passive immunity passed to the fetus during pregnancy highlight the benefits of this care. Understanding the indications and benefits of vaccine administration during this continuum is critical for providers caring for individuals of reproductive age.
Topics: Female; Humans; Maternal Health; Postnatal Care; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Primary Health Care; Travel; Vaccines
PubMed: 32718442
DOI: 10.1016/j.pop.2020.05.001 -
MCN. the American Journal of Maternal... 2020Early and regular prenatal care, which aims to prevent and identify complications associated with pregnancy, birth, and newborn health, is associated with improved...
Early and regular prenatal care, which aims to prevent and identify complications associated with pregnancy, birth, and newborn health, is associated with improved health of pregnant women and their infants. American Indian/Alaska Native (AI/AN) women are at risk for pregnancy, birth, and newborn health complications associated with health disparities including poverty, lower educational levels, limited access to healthcare, and adverse childhood events. American Indian/Alaska Native women in the United States experience barriers specifically related to prenatal care, including lack of access, dissimilar communication styles, and inconsistent continuity of care. Culturally appropriate prenatal care should be provided to reduce maternal and newborn morbidity and mortality. Community-based interventions such as home visiting, that may potentially improve prenatal care, focusing on the American Indian tribes of the Northern Great Plains, specifically North Dakota, are discussed.
Topics: Adult; Female; Humans; Pregnancy; Prenatal Care; American Indian or Alaska Native
PubMed: 32282338
DOI: 10.1097/NMC.0000000000000633 -
Journal of Midwifery & Women's Health Jul 2020Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the...
INTRODUCTION
Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs.
METHODS
This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings.
RESULTS
Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing.
DISCUSSION
Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.
Topics: Attitude of Health Personnel; Child; Child Health Services; Female; Humans; Midwifery; Nurse Practitioners; Physicians; Pregnancy; Prenatal Care; Qualitative Research
PubMed: 32519425
DOI: 10.1111/jmwh.13114 -
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 -
Obstetrics and Gynecology May 2020Prenatal care is one of the most widely used preventive care services in the United States, yet prenatal care delivery recommendations have remained largely unchanged...
Prenatal care is one of the most widely used preventive care services in the United States, yet prenatal care delivery recommendations have remained largely unchanged since just before World War II. The current prenatal care model can be improved to better serve modern patients and the health care providers who care for them in three key ways: 1) focusing more on promotion of health and wellness as opposed to primarily focusing on medical complications, 2) flexibly incorporating patient preferences, and 3) individualizing care. As key policymakers and stakeholders grapple with higher maternity care costs and poorer outcomes, including lagging access, equity, and maternal and infant morbidity and mortality in the United States compared with other high-income countries, the opportunity to improve prenatal care has been given insufficient attention. In this manuscript, we present a new conceptual model for prenatal care that incorporates both patients' medical and social needs into four phenotypes, and use human-centered design methods to describe how better matching patient needs with prenatal services can increase the use of high-value services and decrease the use of low-value services. Finally, we address some of the key challenges to implementing right-sized prenatal care, including capturing outcomes through research and payment.
Topics: Female; Health Services Needs and Demand; Humans; Maternal Health Services; Obstetrics; Precision Medicine; Pregnancy; Prenatal Care; Quality Improvement; United States
PubMed: 32282594
DOI: 10.1097/AOG.0000000000003820