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JAMA Pediatrics Oct 2020Gene and stem cell therapies have become viable therapeutic options for many postnatal disorders. For select conditions, prenatal application would provide improved... (Review)
Review
IMPORTANCE
Gene and stem cell therapies have become viable therapeutic options for many postnatal disorders. For select conditions, prenatal application would provide improved outcomes. The fetal state allows for several theoretical advantages over postnatal therapy, including immune immaturity and cellular niche accessibility.
OBSERVATIONS
Advances in prenatal diagnostic accuracy and surgical precision, as well as improvements in stem cell and gene therapy methods, have made prenatal gene and stem cell therapy realistic. Studies in mouse models and early human trials demonstrate the feasibility of these approaches. Additional efforts are under way to streamline fetal applications of stem cell and gene therapy while carefully considering best ethical practice and following established regulatory pathways.
CONCLUSIONS AND RELEVANCE
Fetal stem cell and gene therapy bring important therapeutic opportunities for select disorders that present in the fetal and neonatal periods. While this field is in its infancy, these therapies are starting to be available clinically, and clinicians should be aware of their benefits and challenges.
Topics: Animals; Female; Genetic Diseases, Inborn; Genetic Therapy; Humans; Pregnancy; Prenatal Care; Stem Cell Transplantation
PubMed: 32597943
DOI: 10.1001/jamapediatrics.2020.1519 -
Revista de Saude Publica Aug 2019To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state.
OBJECTIVE
To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state.
METHODS
Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals.
RESULTS
Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34-0.71), with high education level (OR = 0.42; 95%CI 0.31-0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41-0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42-0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18-0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66-0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed.
CONCLUSIONS
Antepartum peregrination suffers interference from the mother's socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.
Topics: Adult; Brazil; Cross-Sectional Studies; Delivery, Obstetric; Female; Gestational Age; Health Equity; Health Services Accessibility; Humans; Maternal-Child Health Services; Pregnancy; Prenatal Care; Socioeconomic Factors; Surveys and Questionnaires; Young Adult
PubMed: 31432932
DOI: 10.11606/s1518-8787.2019053001087 -
JAMA Network Open Apr 2021Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in... (Comparative Study)
Comparative Study
IMPORTANCE
Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.
OBJECTIVE
To explore the association of audio-only virtual prenatal care with perinatal outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.
EXPOSURES
Prenatal care incorporating audio-only prenatal care visits.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.
RESULTS
The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended.
CONCLUSIONS AND RELEVANCE
Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.
Topics: Adult; Ambulatory Care; COVID-19; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; SARS-CoV-2; Telemedicine; Texas
PubMed: 33852002
DOI: 10.1001/jamanetworkopen.2021.5854 -
MCN. the American Journal of Maternal... 2020The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women.
PURPOSE
The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women.
STUDY DESIGN AND METHODS
Using a cross-sectional design, a sample of 197 pregnant Black women completed a self-reported survey between 8 weeks and less than 30 weeks gestation as part of the Biosocial Impact on Black Births study. The questions asked about the initiation of prenatal care, perceived stress, depressive symptoms, and psychological wellbeing. Multiple linear regression was used to examine if timing of prenatal care initiation was related to psychological variables.
RESULTS
Sixty-three women (32%) reported they were not able to initiate their first prenatal care visit as early as they wanted due to various barriers. After adjusting for cofounders, not initiating prenatal care as early as women wanted predicted lower levels of psychological wellbeing.
CLINICAL IMPLICATIONS
Perinatal nurses should assess psychological wellbeing in Black women throughout pregnancy; advocate for Black women who report high levels of stress, psychological distress, or depressive symptoms for further mental health evaluation by their health care provider; and provide resources and education (e.g., support groups, counseling) for these women.
Topics: Adult; Black or African American; Cross-Sectional Studies; Female; Humans; Patient Acceptance of Health Care; Pregnancy; Pregnant Women; Prenatal Care; Psychometrics; Surveys and Questionnaires; Time Factors
PubMed: 33074912
DOI: 10.1097/NMC.0000000000000661 -
Ciencia & Saude Coletiva Mar 2020The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS... (Review)
Review
The objective of this article is to identify the scientific productions on the access and use of dental services by pregnant women. A search was carried out on the BVS and MEDLINE/PubMed online databases to produce this integrative literature review. In the BVS database, the Portuguese descriptors were: "acesso aos serviços de saúde", "saúde bucal" and "gestantes", and in PubMed: "Health services accessibility", "oral health" and "pregnant women", all associated with each other by the Boolean operator "AND". We identified five studies that met the inclusion and exclusion criteria and were systematized into two empirical and co-related categories: the significant number of pregnant women who do not perform prenatal dental care and the importance of educational measures that signal the need to receive dental care during prenatal visits. Further studies on the subject are required to support public health policies that consider this theme. Existing research shows low adherence to prenatal dental care and that the main factors hindering the access to and use of dental services were related to socioeconomic, cultural and educational aspects.
Topics: Dental Health Services; Facilities and Services Utilization; Female; Health Services Accessibility; Humans; Pregnancy; Prenatal Care
PubMed: 32159653
DOI: 10.1590/1413-81232020253.01192018 -
Journal of Gynecology Obstetrics and... Nov 2022to compare telehealth and in-person care during the COVID-19 lockdown in a population of low-risk pregnant women for prenatal care received and perinatal outcome.
OBJECTIVE
to compare telehealth and in-person care during the COVID-19 lockdown in a population of low-risk pregnant women for prenatal care received and perinatal outcome.
METHODS
This single-center study began during the first French lockdown in 2020. Women with at least one telehealth (remote) prenatal care visit were compared with those who received care only in person. Data include results from self-administered surveys and perinatal outcomes. The main outcome was the prenatal care experience, assessed by the 5-point Quality of Prenatal Care Questionnaire (QPCQ) score. Exploratory analyses sought to identify connections between perinatal outcomes and any of their levels of QPCQ score, health/eHealth literacy, stress, and social deprivation scores .
RESULTS
The experimental group included 55 women and the control group 52. Maternal and neonatal outcomes were similar in both groups. The mean QPCQ scores did not support any difference between the mothers' experience of prenatal care in each group: 4.15±0.52 in the telehealth and 4.26±0.63 in the in-person groups. Similarly, levels of social deprivation, stress, and health and eHealth literacy did not differ between the groups.
CONCLUSION
Regardless of social deprivation or literacy level, both telehealth and in-person monitoring appeared to provide equivalent and good-quality prenatal care experiences during the pandemic, ClinicalTrial.gov registration NCT04368832 (30 April 2020).
Topics: Infant, Newborn; Female; Pregnancy; Humans; Prenatal Care; Pilot Projects; Pregnant Women; COVID-19; Communicable Disease Control; Telemedicine
PubMed: 35882366
DOI: 10.1016/j.jogoh.2022.102445 -
BMC Pregnancy and Childbirth Jan 2022Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their... (Observational Study)
Observational Study
BACKGROUND
Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion.
METHODS
Retrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011-2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care.
RESULTS
There were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 - 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 - 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 - 17.4).
CONCLUSIONS
Reversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.
Topics: Abortion, Induced; Adult; Contraception Behavior; Female; Humans; Intention; Live Birth; New York; Patient Acceptance of Health Care; Postnatal Care; Pregnancy; Pregnant Women; Prenatal Care; Retrospective Studies
PubMed: 35062913
DOI: 10.1186/s12884-021-04343-x -
Revista de Saude Publica 2020Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective.
OBJECTIVE
Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective.
METHODS
We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication).
RESULTS
The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women.
CONCLUSION
Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.
Topics: Attitude of Health Personnel; Female; Health Personnel; Humans; Interviews as Topic; Maternal-Child Health Services; Mexico; Physician-Patient Relations; Pregnancy; Prenatal Care; Primary Health Care; Qualitative Research
PubMed: 33331532
DOI: 10.11606/s1518-8787.2020054002175 -
BMC Pregnancy and Childbirth Nov 2020Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many... (Review)
Review
BACKGROUND
Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa.
METHODS
This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review.
RESULTS
Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings.
CONCLUSIONS
While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.
Topics: Africa; Exercise; Female; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care
PubMed: 33238920
DOI: 10.1186/s12884-020-03439-0 -
American Journal of Preventive Medicine Sep 2019Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived...
INTRODUCTION
Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias).
METHODS
Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009-2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry.
RESULTS
Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by self-reported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women).
CONCLUSIONS
Skin tone-based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs.
Topics: Adolescent; Adult; Black or African American; Female; Healthcare Disparities; Humans; Michigan; Pregnancy; Prenatal Care; Racism; Skin Pigmentation; Time Factors; Young Adult
PubMed: 31353164
DOI: 10.1016/j.amepre.2019.04.014