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Pediatrics Dec 2019Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths'... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females.
METHODS
We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening ( = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership).
RESULTS
Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; = .08). There were no intervention effects on other behaviors.
CONCLUSIONS
The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.
Topics: Adolescent; Cognition; Female; Follow-Up Studies; Health Risk Behaviors; Home Care Services; House Calls; Humans; Infant; Infant, Newborn; Male; Nurses, Community Health; Poverty; Pregnancy; Prenatal Care; Time Factors; Treatment Outcome; Young Adult
PubMed: 31748254
DOI: 10.1542/peds.2018-3876 -
Revista Latino-americana de Enfermagem Jul 2019to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy. (Comparative Study)
Comparative Study
OBJECTIVE
to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy.
METHOD
this is a cohort study, conducted with an intentional sample of 273 mothers/babies from the neonatal period and followed up for one year. Donabedian evaluation was adopted and data were discussed based on the Social Determination of Health. The independent variable was the care model. The dependent variables in the process evaluation were related to the quality of prenatal care and to the quality score created and the evaluation of the outcome, to the conditions of birth and the first year of life. The evaluation of the process was performed by estimating the relative risk and the evaluation of the outcome was performed by the Cox Multiple Regression Model.
RESULTS
lower income and risk of the low prenatal quality score were identified in the Family Health Units, where there were more puerperium consultation and health education actions. There was no difference in outcome indicators.
CONCLUSION
possibly the best quality of prenatal care was able to minimize negative socioeconomic effects found in family health, so the outcome indicators were similar in both models of the primary care.
Topics: Brazil; Child Health; Family Health; Female; Humans; Prenatal Care; Primary Health Care; Program Evaluation; Prospective Studies; Quality Indicators, Health Care; Socioeconomic Factors; Women's Health; Young Adult
PubMed: 31340338
DOI: 10.1590/1518-8345.2806.3058 -
American Journal of Obstetrics &... May 2020
Topics: Female; Humans; Obstetrics; Pregnancy; Prenatal Care
PubMed: 32309798
DOI: 10.1016/j.ajogmf.2020.100109 -
Ciencia & Saude Coletiva May 2020This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of...
This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.
Topics: Brazil; Cross-Sectional Studies; Delivery, Obstetric; Female; Humans; Pregnancy; Prenatal Care; Quality of Health Care; Socioeconomic Factors
PubMed: 32402040
DOI: 10.1590/1413-81232020255.32852019 -
Revista Brasileira de Enfermagem 2020to investigate puerperal women who received guidance on childbirth during prenatal care and the behaviors experienced in the labor process within the context of good...
OBJECTIVES
to investigate puerperal women who received guidance on childbirth during prenatal care and the behaviors experienced in the labor process within the context of good obstetric practices from the perspective of puerperal women.
METHODS
a descriptive cross-sectional quantitative study conducted with 203 puerperal women admitted to the shared rooms of a teaching hospital between May and July 2017 during the immediate postpartum period. For data collection, was used an instrument adapted from the hospital questionnaire for puerperal women that was developed by the Oswaldo Cruz Foundation.
RESULTS
only 48.3% of puerperal women received the eight orientations regarding good obstetric practices during prenatal care, which were not experienced in the labor process, especially regarding referral and behaviors of the hospital team. Unfavorable socioeconomic conditions were significant in relation to guidelines provided during prenatal care.
CONCLUSIONS
prenatal care was negatively evaluated and there was lack of compliance with good obstetric practices and non-recommended behaviors in the labor process in the maternity ward.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Parturition; Patient Satisfaction; Pregnancy; Prenatal Care; Quality of Health Care
PubMed: 32609177
DOI: 10.1590/0034-7167-2019-0222 -
The Pan African Medical Journal 2021The lack of health infrastructure in developing countries to provide women with modern obstetric care and universal access to maternal and child health services has...
The lack of health infrastructure in developing countries to provide women with modern obstetric care and universal access to maternal and child health services has largely contributed to the existing high maternal and infant deaths. Access to basic obstetric care for pregnant women and their unborn babies is a key to reducing maternal and infants´ deaths, especially at the community-level. This calls for the strengthening of primary health care systems in all developing countries, including Ghana. Financial access and utilization of maternal and child health care services need action at the community-level across rural Ghana to avoid preventable deaths. Financial access and usage of maternal and child health services in rural Ghana is poor. Lack of financial access is a strong barrier to the use of maternal and child health services, particularly in rural Ghana. The sustainability of the national health insurance scheme is vital in ensuring full access to care in remote communities.
Topics: Child Health Services; Delivery of Health Care; Developing Countries; Female; Ghana; Health Services Accessibility; Humans; Infant; Infant Death; Infant Mortality; Infant, Newborn; Maternal Death; Maternal Health Services; Maternal Mortality; National Health Programs; Pregnancy; Prenatal Care; Rural Population
PubMed: 34707764
DOI: 10.11604/pamj.2021.39.263.30593 -
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 -
PloS One 2022Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy...
INTRODUCTION
Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities.
METHODS
Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention.
EXPECTED OUTCOMES
Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518).
Topics: Attitude of Health Personnel; Delivery, Obstetric; Feasibility Studies; Female; Government Programs; Humans; Implementation Science; Infant, Newborn; Maternal Health Services; Maternal Mortality; Obstetrics; Pakistan; Parturition; Perinatal Mortality; Pregnancy; Prenatal Care; Psychosocial Support Systems; Public Health; Quality of Health Care; Respect; Social Inclusion
PubMed: 35139119
DOI: 10.1371/journal.pone.0263635 -
International Journal of Medical... Feb 2023Exploitation of telehealth in prenatal care has the potential to reduce the access barrier to care and empower women to participate in their own care. This review aims... (Review)
Review
INTRODUCTION
Exploitation of telehealth in prenatal care has the potential to reduce the access barrier to care and empower women to participate in their own care. This review aims to assess the practical implications of virtual prenatal care and identify the needs and experiences associated with it.
METHODS
A systematic literature review was conducted in four electronic databases: PubMed, Web of Science, Scopus, and Cochrane. The keywords used were "pregnancy", "virtual visit", "prenatal", and others. The search included all relevant studies published from 2011 to 2021 written in English. Articles mentioning virtual prenatal care incorporating synchronous communication between pregnant women and health care professionals were included. Those unrelated to prenatal care or employing asynchronous means of virtual care were excluded. The review was structured following the PRISMA guidelines. Different quality appraisal methods such as JBI, CASP, NOS, and Cochrane were used to assess the methodological quality of the literature. The data were then analyzed based on the categorization of the studies.
RESULTS
Overall, 2863 articles were identified, of which 19 met the inclusion criteria after removing duplicates, screening of abstracts, and full text-four articles identified from hand-searching were incorporated, making a total of 23 eligible articles for the review. The studies' findings revealed the preference for implementing cost-effective virtual care based on the resource set, technological literacy, and consistent accessibility. Further, no significant differences in clinical outcomes were observed between two modes of care, virtual and in-person. The higher satisfaction by pregnant women and healthcare professionals indicated the continuity of the care. In addition, the hybrid model of virtual prenatal care integrated with traditional in-person care was acceptable to both low-risk and high-risk pregnant women. Virtual prenatal care substantially reduced travel time and absences from work, drops in clinic wait time and no-show rate, limited the risk of exposure during a pandemic, and increased self-accountability.
CONCLUSION
Virtual prenatal care offers predominant advantages over in-person when it is carefully designed with the inclusion of pregnant women and healthcare professionals' needs. Evidence showed that providing adequate technology training, proper instruction, and guidelines for initial setup and assurance of a reliable and accessible system is vital in increasing access to care.
Topics: Pregnancy; Humans; Female; Pregnant Women; Prenatal Care; Quality of Health Care; Health Personnel; Delivery of Health Care
PubMed: 36565547
DOI: 10.1016/j.ijmedinf.2022.104964 -
American Journal of Perinatology Jan 2022This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities.
STUDY DESIGN
A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle.
RESULTS
Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group ( = 42) or individual ( = 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation [SD] in group care vs. 3.4 days ± 2.6 SD in individual care; < 0.01) and gained less weight per week during the study period (0.2 lbs/week [interquartile range: 0-0.7] vs. 0.5 lbs/week [interquartile range: 0.2-0.9]; = 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4-8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms.
CONCLUSION
Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes.
KEY POINTS
· Women with gestational diabetes in group care were 3.5 times more likely to return for postpartum glucose tolerance testing.. · Women with gestational diabetes in group care had less gestational weight gain during the study period.. · Diabetes Group Prenatal Care is a promising intervention to improve outcomes for women with diabetes in pregnancy..
Topics: Adult; Diabetes Mellitus, Type 2; Diabetes, Gestational; Female; Gestational Weight Gain; Glucose Tolerance Test; Group Processes; Humans; Pilot Projects; Pregnancy; Pregnancy in Diabetics; Prenatal Care; Self Care
PubMed: 32674202
DOI: 10.1055/s-0040-1714209