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F1000Research 2018The vaccination of pregnant women has enormous potential to protect not only mothers from vaccine-preventable diseases but also their infants through the passive... (Review)
Review
The vaccination of pregnant women has enormous potential to protect not only mothers from vaccine-preventable diseases but also their infants through the passive acquisition of protective antibodies before they are able to themselves acquire protection through active childhood immunisations. Maternal tetanus programmes have been in place since 1989, and as of March 2018, only 14 countries in the world were still to reach maternal neonatal tetanus elimination status. This has saved hundreds of thousands of lives. Building on this success, influenza- and pertussis-containing vaccines have been recommended for pregnant women and introduced into immunisation programmes, albeit predominantly in resource-rich settings. These have highlighted some important challenges when additional immunisations are introduced into the antenatal context. With new vaccine candidates, such as respiratory syncytial virus (RSV) and group B streptococcus (GBS), on the horizon, it is important that we learn from these experiences, identify the information gaps, and close these to ensure safe and successful implementation of maternal vaccines in the future, particularly in low- and middle-income countries with a high burden of disease.
Topics: Adult; Animals; Female; Humans; Immunity, Maternally-Acquired; Infant, Newborn; Mothers; Pregnancy; Prenatal Care; Respiratory Syncytial Virus Vaccines; Streptococcal Vaccines; Vaccination; Young Adult
PubMed: 30443339
DOI: 10.12688/f1000research.15475.1 -
Revista Brasileira de Enfermagem Dec 2019to analyze the prenatal follow-up of high-risk pregnancy in the public service.
OBJECTIVE
to analyze the prenatal follow-up of high-risk pregnancy in the public service.
METHOD
an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05).
RESULTS
the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005).
CONCLUSION
the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.
Topics: Aftercare; Brazil; Chi-Square Distribution; Cross-Sectional Studies; Female; Hospitals, Maternity; Humans; Pregnancy; Pregnancy, High-Risk; Prenatal Care; Public Sector
PubMed: 31851255
DOI: 10.1590/0034-7167-2018-0425 -
BioMed Research International 2017We aimed to describe the outcomes of counselling for preterm delivery. PubMed, Embase, and PsycInfo were systematically searched (from 2000 to 2016) using the following... (Review)
Review
We aimed to describe the outcomes of counselling for preterm delivery. PubMed, Embase, and PsycInfo were systematically searched (from 2000 to 2016) using the following terms: counselling, pregnancy complications, high-risk pregnancy, fetal diseases, and prenatal care. A total of nine quantitative studies were identified, five randomized and four nonrandomized. All studies were conducted in the USA, and half of them were based on a simulated counselling session. Two main clinical implications can be drawn from the available studies: firstly, providing written information or the consultation seems to have a positive effect, while no effect was detected when written material was provided after the consultation. Secondly, parents' choices about treatment seemed to be influenced by spiritual-related aspects and/or preexisting preferences, rather than by the level of detail or by the order with which information was provided. Therefore, the exploration of parents' beliefs is crucial to reduce the risks of misconception and to guarantee choice in line with personal values. More research is necessary to validate these findings in cross-cultural contexts and in real world settings of care. Moreover, the centeredness of conversations and the characteristics of the clinician involved in counselling should be addressed in future studies.
Topics: Controlled Clinical Trials as Topic; Counseling; Female; Humans; Infant, Newborn; Patient Education as Topic; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Care; Risk
PubMed: 28848765
DOI: 10.1155/2017/7320583 -
Medical Care Feb 2019The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26.
BACKGROUND
The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26.
OBJECTIVES
To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth.
RESEARCH DESIGN, SUBJECTS, AND OUTCOME MEASURES
We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19-25 (treatment group) and 22,361 women aged 27-31 years (control group). Outcomes include insurance coverage in the month before and during pregnancy, and at delivery, and receipt of timely prenatal care, a postpartum check-up, and postpartum contraceptive use.
RESULTS
Compared with the control group, the Provision was associated with a 4.7-percentage point decrease in being uninsured and a 5.9-percentage point increase in private insurance coverage in the month before pregnancy, and a 5.4-percentage point increase in private insurance coverage and a 5.9-percentage point decrease in Medicaid coverage during pregnancy, with similar changes in insurance coverage at delivery. Findings demonstrated a 3.6-percentage point increase in receipt of timely prenatal care, and no change in receipt of a postpartum check-up or postpartum contraceptive use.
CONCLUSIONS
Among women with a recent live birth, the Provision was associated with a decreased likelihood of being uninsured and increased private insurance coverage in the month before pregnancy, a shift from Medicaid to private insurance coverage during pregnancy and at delivery, and an increased likelihood of receiving timely prenatal care.
Topics: Adult; Female; Health Services Accessibility; Humans; Insurance Coverage; Insurance, Health; Live Birth; Medicaid; Patient Protection and Affordable Care Act; Postnatal Care; Pregnancy; Pregnancy Outcome; Prenatal Care; United States; Young Adult
PubMed: 30570588
DOI: 10.1097/MLR.0000000000001044 -
BMC Pregnancy and Childbirth May 2017Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent....
BACKGROUND
Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally.
METHODS/DESIGN
Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses.
DISCUSSION
By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the "triple aim:" better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02169024 . Retrospectively registered on June 18, 2014.
Topics: Case-Control Studies; Female; Group Processes; Humans; Information Technology; Longitudinal Studies; Pregnancy; Pregnancy Outcome; Prenatal Care; Program Evaluation; Prospective Studies; Quality of Health Care
PubMed: 28521785
DOI: 10.1186/s12884-017-1327-3 -
Prenatal Diagnosis Jul 2014Poor placentation, which manifests as pre-eclampsia and fetal growth restriction, is a major pregnancy complication. The underlying cause is a deficiency in normal... (Review)
Review
Poor placentation, which manifests as pre-eclampsia and fetal growth restriction, is a major pregnancy complication. The underlying cause is a deficiency in normal trophoblast invasion of the spiral arteries, associated with placental inflammation, oxidative stress, and an antiangiogenic state. Peripartum therapies, such as prenatal maternal corticosteroids and magnesium sulphate, can prevent some of the adverse neonatal outcomes, but there is currently no treatment for poor placentation itself. Instead, management relies on identifying the consequences of poor placentation in the mother and fetus, with iatrogenic preterm delivery to minimise mortality and morbidity. Several promising therapies are currently under development to treat poor placentation, to improve fetal growth, and to prevent adverse neonatal outcomes. Interventions such as maternal nitric oxide donors, sildenafil citrate, vascular endothelial growth factor gene therapy, hydrogen sulphide donors, and statins address the underlying pathology, while maternal melatonin administration may provide fetal neuroprotection. In the future, these may provide a range of synergistic therapies for pre-eclampsia and fetal growth restriction, depending on the severity and gestation of onset.
Topics: Female; Humans; Placenta Diseases; Placentation; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care
PubMed: 24799349
DOI: 10.1002/pd.4401 -
PloS One 2015Literature evaluating association between neonatal morbidity and immigrant status presents contradictory results. Poorer compliance with prenatal care and greater social...
BACKGROUND AND AIM
Literature evaluating association between neonatal morbidity and immigrant status presents contradictory results. Poorer compliance with prenatal care and greater social risk factors among immigrants could play roles as major confounding variables, thus explaining contradictions. We examined whether prenatal care and social risk factors are confounding variables in the relationship between immigrant status and neonatal morbidity.
METHODS
Retrospective cohort study: 231 pregnant African immigrant women were recruited from 2007-2010 in northern Spain. A Spanish population sample was obtained by simple random sampling at 1:3 ratio. Immigrant status (Spanish, Sub-Saharan and Northern African), prenatal care (Kessner Index adequate, intermediate or inadequate), and social risk factors were treated as independent variables. Low birth weight (LBW < 2500 grams) and preterm birth (< 37 weeks) were collected as neonatal morbidity variables. Crude and adjusted odds ratios (OR) were estimated by unconditional logistic regression with 95% confidence intervals (95% CI).
RESULTS
Positive associations between immigrant women and higher risk of neonatal morbidity were obtained. Crude OR for preterm births in Northern Africans with respect to nonimmigrants was 2.28 (95% CI: 1.04-5.00), and crude OR for LBW was 1.77 (95% CI: 0.74-4.22). However, after adjusting for prenatal care and social risk factors, associations became protective: adjusted OR for preterm birth = 0.42 (95% CI: 0.14-1.32); LBW = 0.48 (95% CI: 0.15-1.52). Poor compliance with prenatal care was the main independent risk factor associated with both preterm birth (adjusted OR inadequate care = 17.05; 95% CI: 3.92-74.24) and LBW (adjusted OR inadequate care = 6.25; 95% CI: 1.28-30.46). Social risk was an important independent risk factor associated with LBW (adjusted OR = 5.42; 95% CI: 1.58-18.62).
CONCLUSIONS
Prenatal care and social risk factors were major confounding variables in the relationship between immigrant status and neonatal morbidity.
Topics: Adolescent; Adult; Emigrants and Immigrants; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Morbidity; Mothers; Odds Ratio; Outcome Assessment, Health Care; Pregnancy; Prenatal Care; Retrospective Studies; Risk Factors; Social Environment; Spain; Young Adult
PubMed: 25816369
DOI: 10.1371/journal.pone.0120765 -
Health Services Research Feb 1998To investigate pregnant women's self-selection effects on the estimation of birthweight production function. A particular emphasis is placed on assessing the...
OBJECTIVE
To investigate pregnant women's self-selection effects on the estimation of birthweight production function. A particular emphasis is placed on assessing the effectiveness of prenatal care as a major medical input in the birthweight production function.
DATA SOURCES
Primary data compiled from birth and abortion certificates for the Commonwealth of Virginia in 1984. Several area-specific socioeconomic variables were also employed from the Area Resource File 1984; Supplemental Food Program for Women, Infants, and Children (WIC) Local Agency Directory; and the family planning clinics data by the Alan Guttmacher Institute (AGI).
STUDY DESIGN
Two types of self-selection effects are defined: selection effect due to sample censoring from the resolution of pregnancies as live births or induced abortions; and selection effect due to the use of prenatal care as an endogenous variable. Race- and location-specific birthweight production functions are estimated using models with and without correction for self-selection effects.
PRINCIPAL FINDINGS
The self-selection effect in the resolution of pregnancies is race-specific, being significant for African American women. The effectiveness of prenatal care in birthweight production is underestimated substantially by the selection bias from the use of prenatal care, and overestimated by the selection bias from pregnancy resolutions. On average, the overall estimated effectiveness of prenatal care is over five times higher after controlling for the selection effects.
CONCLUSIONS
Self-selection effects could be a very serious problem in measuring the effectiveness of birthweight determinants in general. The overall effectiveness of prenatal care, in particular, tends to be significantly biased downward without controlling for selection effects. The significance and scale of the bias depends crucially on specific data and cohorts of the population investigated.
Topics: Abortion, Induced; Adolescent; Adult; Birth Weight; Female; Humans; Infant, Newborn; Male; Models, Statistical; Pregnancy; Pregnancy Outcome; Prenatal Care; Selection Bias; Virginia
PubMed: 9460487
DOI: No ID Found -
Revista de Saude Publica Jun 2011To assess costs and consequences of prenatal care on perinatal morbidity and mortality.
OBJECTIVE
To assess costs and consequences of prenatal care on perinatal morbidity and mortality.
METHODS
Evaluation study using two types of analysis: implementation and efficiency analysis, carried out at 11 Family Health Units in the Recife, Northeastern Brazil, in 2006. The costs were calculated by means of the activity-based costing technique and the cost-effectiveness ratio was calculated for each consequence. Data sources were information systems of the Ministry of Health and worksheets of costs provided by the Health Department of Recife and Instituto de Medicina Integral Prof. Fernando Figueira. Healthcare units with implemented or partially implemented prenatal care were compared in terms of their cost-effectiveness and perinatal results.
RESULTS
In 64% of the units, prenatal care was implemented with a mean total cost of R$ 39,226.88 and variation of R$ 3,841,87 to R$ 8,765.02 per healthcare unit. In the units with partially implemented prenatal care (36%), the mean total cost was R$ 30,092.61 (R$ 4,272.12 to R$ 11,774.68). The mean cost per pregnant woman was R$ 196.13 with implemented prenatal care and R$ 150.46 with partially implemented prenatal care. A higher proportion of low birth weight, congenital syphilis, perinatal and fetal deaths was found in the partially implemented group.
CONCLUSIONS
Prenatal care is cost-effective for several studied consequences. The adverse effects measured by the health indicators were lower in the units with implemented prenatal care. The mean cost in the partially implemented group was higher, which suggests a possible waste of resources, as the teams' productivity is insufficient for the installed capacity.
Topics: Brazil; Cost-Benefit Analysis; Family Health; Female; Humans; Infant, Newborn; National Health Programs; Perinatal Mortality; Pregnancy; Prenatal Care
PubMed: 21445460
DOI: 10.1590/s0034-89102011005000014 -
Cadernos de Saude Publica May 2018This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of...
This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.
Topics: Brazil; Cross-Sectional Studies; Female; Health Services Accessibility; Health Services Research; Healthcare Disparities; Humans; Pregnancy; Prenatal Care; Primary Health Care; Quality Assurance, Health Care
PubMed: 29768587
DOI: 10.1590/0102-311X00110417