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Paediatric and Perinatal Epidemiology Jan 2017Ectopic pregnancy causes significant maternal morbidity and mortality. Complications are more common among women with Medicaid or no insurance compared to those with...
BACKGROUND
Ectopic pregnancy causes significant maternal morbidity and mortality. Complications are more common among women with Medicaid or no insurance compared to those with private insurance. It is unknown whether preventive care prior to pregnancy and prenatal care, which are covered by Medicaid, would decrease complications if they were more fully utilised.
METHODS
Medicaid claims were used to identify a clinical cohort of women who experienced an ectopic pregnancy during 2004-08 among all female Medicaid enrolees from a large 14-state population, ages 15-44. Diagnosis and procedure codes were used to identify ectopic pregnancies and associated complications. The primary outcomes were complications associated with ectopic pregnancy: blood transfusion, sterilisation, or hospitalisation with length of stay greater than 2 days. Independent variables were documentation of preventive care within 1 year prior to the ectopic pregnancy and prenatal care within 4 months prior.
RESULTS
Controlling for race, age, and state of residence, women's risks of any ectopic pregnancy complication were independently higher among those who did not receive any Medicaid-covered preventive care within 1 year before the ectopic pregnancy compared to those who did (RR 1.12, 95% confidence interval (CI) 1.09, 1.16), and among those who did not receive any Medicaid-covered prenatal care within 4 months prior, compared to those who did (RR 1.89, 95% CI 1.83, 1.96).
CONCLUSIONS
Pre-pregnancy and prenatal care are independently associated with decreased risk of ectopic pregnancy complications among Medicaid beneficiaries.
Topics: Adolescent; Adult; Blood Transfusion; Female; Healthcare Disparities; Humans; Incidence; Insurance Coverage; Length of Stay; Medicaid; Medically Uninsured; Obstetric Surgical Procedures; Pregnancy; Pregnancy, Ectopic; Prenatal Care; Retrospective Studies; Socioeconomic Factors; United States; Young Adult
PubMed: 27859439
DOI: 10.1111/ppe.12327 -
Obstetrics and Gynecology Aug 2007To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, and patient satisfaction and to examine potential cost differences. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, and patient satisfaction and to examine potential cost differences.
METHODS
A multisite randomized controlled trial was conducted at two university-affiliated hospital prenatal clinics. Pregnant women aged 14-25 years (n=1,047) were randomly assigned to either standard or group care. Women with medical conditions requiring individualized care were excluded from randomization. Group participants received care in a group setting with women having the same expected delivery month. Timing and content of visits followed obstetric guidelines from week 18 through delivery. Each 2-hour prenatal care session included physical assessment, education and skills building, and support through facilitated group discussion. Structured interviews were conducted at study entry, during the third trimester, and postpartum.
RESULTS
Mean age of participants was 20.4 years; 80% were African American. Using intent-to-treat analyses, women assigned to group care were significantly less likely to have preterm births compared with those in standard care: 9.8% compared with 13.8%, with no differences in age, parity, education, or income between study conditions. This is equivalent to a risk reduction of 33% (odds ratio 0.67, 95% confidence interval 0.44-0.99, P=.045), or 40 per 1,000 births. Effects were strengthened for African-American women: 10.0% compared with 15.8% (odds ratio 0.59, 95% confidence interval 0.38-0.92, P=.02). Women in group sessions were less likely to have suboptimal prenatal care (P<.01), had significantly better prenatal knowledge (P<.001), felt more ready for labor and delivery (P<.001), and had greater satisfaction with care (P<.001). Breastfeeding initiation was higher in group care: 66.5% compared with 54.6%, P<.001. There were no differences in birth weight nor in costs associated with prenatal care or delivery.
CONCLUSION
Group prenatal care resulted in equal or improved perinatal outcomes at no added cost.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00271960
LEVEL OF EVIDENCE
I.
Topics: Adolescent; Adult; Female; Group Processes; Health Care Costs; Humans; Outpatient Clinics, Hospital; Patient Education as Topic; Patient Satisfaction; Pregnancy; Pregnancy Outcome; Prenatal Care; Professional-Patient Relations
PubMed: 17666608
DOI: 10.1097/01.AOG.0000275284.24298.23 -
Reproductive Health Mar 2018In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health... (Review)
Review
In high-income countries, group antenatal care (ANC) offers an alternative to individual care and is associated with improved attendance, client satisfaction, and health outcomes for pregnant women and newborns. In low- and middle-income country (LMIC) settings, this model could be adapted to address low antenatal care uptake and improve quality. However, evidence on key attributes of a group care model for low-resource settings remains scant. We conducted a systematic review of the published literature on models of group antenatal care in LMICs to identify attributes that may increase the relevance, acceptability and effectiveness of group ANC in such settings. We systematically searched five databases and conducted hand and reference searches. We also conducted key informant interviews with researchers and program implementers who have introduced group antenatal care models in LMICs. Using a pre-defined evidence summary template, we extracted evidence on key attributes-like session content and frequency, and group composition and organization-of group care models introduced across LMIC settings. Our systematic literature review identified nine unique descriptions of group antenatal care models. We supplemented this information with evidence from 10 key informant interviews. We synthesized evidence from these 19 data sources to identify attributes of group care models for pregnant women that appeared consistently across all of them. We considered these components that are fundamental to the delivery of group antenatal care. We also identified attributes that need to be tailored to the context in which they are implemented to meet local standards for comprehensive ANC, for example, the number of sessions and the session content. We compiled these attributes to codify a composite "generic" model of group antenatal care for adaptation and implementation in LMIC settings. With this combination of standard and flexible components, group antenatal care, a service delivery alternative that has been successfully introduced and implemented in high-income country settings, can be adapted for improving provision and experiences of care for pregnant women in LMIC. Any conclusions about the benefits of this model for women, babies, and health systems in LMICs, however, must be based on robust evaluations of group antenatal care programs in those settings.
Topics: Developing Countries; Female; Health Resources; Humans; Patient Satisfaction; Poverty; Pregnancy; Prenatal Care
PubMed: 29506531
DOI: 10.1186/s12978-018-0476-9 -
American Journal of Public Health Sep 1994
Topics: Female; Health Status Indicators; Humans; Pregnancy; Prenatal Care; Women's Health
PubMed: 8092356
DOI: 10.2105/ajph.84.9.1374 -
BMJ Open Feb 2016We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable...
OBJECTIVES
We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results.
SETTING
This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers.
PARTICIPANTS
Approximately 37,000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria.
RESULTS
Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women.
CONCLUSIONS
Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models.
Topics: Adult; Emigrants and Immigrants; Female; Health Services Accessibility; Humans; Italy; Pregnancy; Prenatal Care; Socioeconomic Factors
PubMed: 26861935
DOI: 10.1136/bmjopen-2015-008802 -
Journal de Gynecologie, Obstetrique Et... Dec 2013Prevention of intrauterine growth restriction (IUGR) should be addressed before conception ideally for all women, or at least for those with a medical risk factor or... (Review)
Review
AIM
Prevention of intrauterine growth restriction (IUGR) should be addressed before conception ideally for all women, or at least for those with a medical risk factor or with a history of poor perinatal outcome or obstetrical complication. The aim of this section is to assess available evidence on IUGR prevention and elaborate clinical guidelines.
PATIENTS AND METHOD
Bibliographic research on PubMed and Cochrane Database.
RESULTS
Maternal age above 40 increases the risk of IUGR (Experts opinion). Encouraging women to start pregnancy when their Body Mass Index (BMI) is between extremes (grade B) and aiming for recommended weight gain according to their preconceptional BMI (professional consensus) reduce the risk of IUGR. When possible, avoiding multiple pregnancies (grade A), stabilizing chronic diseases that can influence placenta vascularization (professional consensus), stopping smoking as soon as possible before or at the beginning of pregnancy (grade A), limiting hypoglycemia during pregnancy (grade C) and tolerating mild maternal hypertension throughout pregnancy (professional consensus) also limit the risks of IUGR. In women with a prior preeclampsia<34 WG or an IUGR <5th centile due to placental dysfunction, aspirin given ideally in the second part of the day (grade B) can be a useful option and should be started before 16 WG (grade A).
CONCLUSIONS
There are few methods to prevent IUGR, and some simple recommendations seem useful. Aspirin seems a useful option in women identified as at risk of IUGR. More research is needed on prevention of IUGR.
Topics: Body Weight; Chronic Disease; Female; Fetal Growth Retardation; Humans; Maternal Age; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care; Smoking
PubMed: 24216303
DOI: 10.1016/j.jgyn.2013.09.022 -
Revista Gaucha de Enfermagem Jun 2019To understand the perceptions of pregnant women about the care received during prenatal care, in the field of primary health care.
OBJECTIVE
To understand the perceptions of pregnant women about the care received during prenatal care, in the field of primary health care.
METHOD
Qualitative study, based on Grounded Theory. Data collection was performed from August to December 2016, through a semi-structured interview with 12 pregnant women who received prenatal care in the city of Florianópolis/SC/Brazil. Data collection and analysis were performed concomitantly. Data analysis was performed using open and axial coding.
RESULTS
Three categories were elaborated: Care before and during gestation, Participation in groups of pregnant women, and Quality care during pregnancy.
CONCLUSION
The perceptions of the pregnant women about the care received during the prenatal care is related to the care given, humanized reception, consideration of the pregnant woman's subjectivity and support in the difficult moments that make this period satisfactory.
Topics: Adolescent; Adult; Brazil; Female; Ferrous Compounds; Folic Acid; Humans; Pregnancy; Pregnancy, Unplanned; Pregnant Women; Prenatal Care; Primary Health Care; Qualitative Research; Quality of Health Care; Vitamin B Complex; Young Adult
PubMed: 31188972
DOI: 10.1590/1983-1447.2019.20180211 -
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 Jul 2014The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada's universally funded health care system, use of...
BACKGROUND
The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada's universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods.
METHODS
We conducted a case-control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care.
RESULTS
Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, "not thinking straight", and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one's health. Receiving incentives and getting help with transportation and child care would have facilitated women's attendance at prenatal care visits.
CONCLUSIONS
Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.
Topics: Adolescent; Adult; Case-Control Studies; Depression; Family Relations; Female; Health Knowledge, Attitudes, Practice; Humans; Manitoba; Motivation; Patient Acceptance of Health Care; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted; Prenatal Care; Residence Characteristics; Transportation; Urban Population; Young Adult
PubMed: 25023478
DOI: 10.1186/1471-2393-14-227 -
Epidemiologia E Servicos de Saude :... 2020to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the...
OBJECTIVE
to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the Program for Improving Primary Care Access and Quality (PMAQ) in Brazil.
METHODS
this was a cross-sectional study using PMAQ Cycle II (2014) data.
RESULTS
data from 9,909 health centers, 9,905 teams, and 9,945 female health service users were included; 70.1% (95%CI 69.2;71.0) of health centers had adequate structure; 88.0% (95%CI 87.4;88.7) of the teams requested all tests; 59.8% (95%CI 58.8;60.8) of female health service users reported receiving total guidance, and 23.4% of them (95%CI 22.5;24.2) underwent all physical examination procedures; teams that participated in both Cycle I and Cycle II presented better results.
CONCLUSION
in spite of shortcomings in Primary Care structure and work process in Brazil, PMAQ appears to positively affect prenatal care.
Topics: Brazil; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Patient Care Team; Pregnancy; Prenatal Care; Primary Health Care; Quality of Health Care
PubMed: 32074198
DOI: 10.5123/S1679-49742020000100008