Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Objective To explore women’s perceptions of the risks and benefits associated with medication use during pregnancy and to better understand how women make decisions related to medication use in pregnancy. Methods We conducted online focus groups with 48 women who used medication during pregnancy or while planning a pregnancy, and 12 in-depth follow-up interviews with a subset of these women. Results We found that women were aware of general risks associated with medication use but were often unable to articulate specific negative outcomes. Women were concerned most about medications’ impact on fetal development but were also concerned about how either continuing or discontinuing medication during pregnancy could affect their own health. Women indicated that if the risk of a given medication were unknown, they would not take that medication during pregnancy. Conclusion This formative research found that women face difficult decisions about medication use during pregnancy and need specific information to help them make decisions. Enhanced communication between patients and their providers regarding medication use would help address this need. We suggest that public health practitioners develop messages to (1) encourage, remind, and prompt women to proactively talk with their healthcare providers about the risks of taking, not taking, stopping, or altering the dosage of a medication while trying to become pregnant and/or while pregnant; and (2) encourage all women of childbearing age to ask their healthcare providers about medication use.     

Balancing act: safe and evidence-based prescribing for women of reproductive age

Teratogenic medications are commonly prescribed to women of reproductive age. Caring for women who may benefit from the use of teratogenic medications requires clinicians to engage patients in shared decision-making on the risks and benefits of medication use in the context of the patient's fertility goals, the implications of the patient's medical condition for a pregnancy and the risks and benefits of various contraceptive methods. Effective communication about all of these issues is essential to avoiding medication-induced birth defects. However, data suggest that such communication remains inadequate, leading some women to face unintentional exposure of a pregnancy to a teratogen, undesired pregnancy or, sometimes, the need for pregnancy termination services. This review outlines key information needed to ensure safe prescribing to women of childbearing age. It includes recommendations for changes in medical education, healthcare delivery and health policy to facilitate thoughtful prescribing and comprehensive care.     

Using Supervised Learning Methods to Develop a List of Prescription Medications of Greatest Concern during Pregnancy

Maternal and Child Health Journal - Women and healthcare providers lack adequate information on medication safety during pregnancy. While resources describing fetal risk are available, information...     

'It hurts, but I don't have a choice, I'm not working and I'm sick': decisions and experiences regarding abortion of women living with HIV in Cape Town, South Africa

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.     

Vaccination in pregnancy

Vaccination is one of the most effective strategies employed to prevent morbidity and mortality from infectious diseases. Pregnancy is considered to be a time when women have consistent contact with their healthcare providers and it presents an opportunity for providers to review their immunization status and to advocate for appropriate vaccination antepartum and in the immediate postpartum period. All forms of immunization, with the exception of live viral or live bacterial vaccines are generally considered to be safe for administration during pregnancy. It is important that healthcare providers counsel pregnant women about the benefits of receiving the vaccines that are recommended during pregnancy as well as the potential risks to the developing fetus. It is imperative that obstetricians and primary care providers are aware of and implement the vaccination guidelines for women, both during pregnancy and in the postpartum period.     

Nutrition Advice During Pregnancy: Do Women Receive it and Can Health Professionals Provide it?

A healthy diet during pregnancy is essential for normal growth and development of the foetus. Pregnant women may obtain nutrition information from a number of sources but evidence regarding the adequacy and extent of this information is sparse. A systematic literature review was conducted to identify sources of nutrition information accessed by pregnant women, their perceived needs for nutrition education, the perceptions of healthcare providers about nutrition education in pregnancy, and to assess the effectiveness of public health programs that aim to improve nutritional practices. The Scopus data base was searched during January, 2013 and in February 2014 to access both qualitative and quantitative studies published between 2002 and 2014 which focused on healthy pregnant women and their healthcare providers in developed countries. Articles were excluded if they focused on the needs of women with medical conditions, including obesity, gestational diabetes or malnutrition. Of 506 articles identified by the search terms, 25 articles were deemed to be eligible for inclusion. Generally, women were not receiving adequate nutrition education during pregnancy. Although healthcare practitioners perceived nutrition education to be important, barriers to providing education to clients included lack of time, lack of resources and lack of relevant training. Further well designed studies are needed to identify the most effective nutrition education strategies to improve nutrition knowledge and dietary behaviours for women during antenatal care.     

‘It hurts,but I don't have a choice,I'm not working and I'm sick’: decisions and experiences regarding abortion of women living with HIV in Cape Town,South Africa

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.     

The relationship between women’s characteristics and herbal medicines use during pregnancy

The use of herbal medicines (HM) has been increasing worldwide. This cross-sectional study investigated the prevalence of and characteristics related to use of HM among 320 pregnant women. Participants were admitted to Mazandaran-based hospitals’ postnatal wards from March to June 2015. Data were collected via a self-report questionnaire, including herbs used during pregnancy and demographic, socioeconomic, and pregnancy-related factors. Nearly half (48.4%) of the women reported taking one or more HM during pregnancy. The most frequently used herbs were sour orange (30.97%), peppermint (19.81%), and Borage (19.46%). Most women (29.20%) were advised by their relatives to take these and did not disclose this use to their health care providers (50%) because they perceived their use as safe (39.7%). The use of herbs was greater among pregnant women with upper secondary level education, living in their own house and from higher socioeconomic classes. Most of the information sources for women were informal, indicating they were not knowledgeable about the herbs’ safety and efficacy during pregnancy. Health care providers should be informed about HM and question pregnant women about their use of HM during pregnancy so that they can advise them about potential side effects and drug interactions.     

Prevalence of drug use during pregnancy: a pharmacoepidemiological approach

INTRODUCTION: Few Brazilian papers on the use of medication in pregnancy have been found in the indexed medical literature. This paper describes the use of medication during pregnancy among women who gave birth in a teaching maternity hospital in the city of Campinas, Brazil. METHODS: A retrospective study on the pattern of drug use during pregnancy was conducted among 1,000 mothers who were interviewed using a structured questionnaire after delivery, while they were still in hospital. The following parameters were registered: sociodemographic characteristics, obstetric and contraceptive history, data on prenatal care and medications used during pregnancy. Statistical analysis was performed using ANOVA and chi-square test at p = 0.05. RESULTS: Among the interviewed patients, 94.6% had taken at least one medication during pregnancy, and 46.1% had used medication in the first trimester. Of 3,778 medications reported, 88.8% had been prescribed by a doctor. The median of medications taken was 3 (ranging from 0 to 18). The six most used classes of medications were: analgesics, spasmolytics, gynecological antiinfectious agents, antianemics, antacids and systemic antibiotics. The five most used medications were: butyl scopolamine, ferrous sulfate, dipirone, nistatin and multivitamin tablets. Only 27.7% of the patients had been alerted to the risk of taking medication during pregnancy. CONCLUSION: Knowing the profile of medications used during pregnancy may help devising programs to provide information to the patients and continuing education to health care professionals.     

“My Body. My Choice”: A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women’s perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18–39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider’s advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.     

Report from the CDC. Vaccines in women

Women's healthcare providers are encouraged to incorporate immunizations into their clients' care. Because women often rely on their healthcare provider for primary and preventive care, that provider may dramatically improve clients' quality of life by decreasing the risk of vaccine-preventable diseases. Women often assume responsibility for the entire family's health, and educating women can prevent disease in the household. Women's healthcare providers should offer and promote these vaccines: hepatitis B, varicella, measles/mumps/rubella, and combined tetanus/diphtheria toxoids for adolescent and young adult women, inactivated influenza vaccine during pregnancy, and pneumococcal, influenza, and tetanus/diphtheria vaccines for the adult or elderly woman. Education should include the importance of vaccines and the rationale for their necessity during each stage of life. Several strategies for implementing and supporting an immunization program have been shown to improve adult immunization rates. These include employing such protocols as standing orders, screening for adult immunizations at each office encounter, and using previously developed immunization documentation forms. The Advisory Committee on Immunization Practices (ACIP) recommendations, vaccine information statements (VIS), and storage and handling guidelines are readily available at low or no cost through CDC and professional organizations or immunization interest group websites. The current adult vaccine schedule assists providers to determine the need for vaccines by displaying graphically both age and medical risk factors.     

Treatment of depression during pregnancy

Increasing numbers of patients are being treated for mood disorders. The majority of these patients, particularly with the diagnosis of major depression, are women of childbearing years. Concerns about fetal exposure to medication, both planned and unplanned, are becoming more pressing in the clinical practices of both psychiatrists and primary care physicians. There are relatively few study data available to guide clinicians in the use of psychotropic medications during pregnancy because of obvious problems in designing studies of the effects of medication on pregnant women, fetuses, and infants. Clinicians in all specialties receive little or no formal training in this area of psychopharmacology. This article gathers clinically relevant studies and practice information and provides suggestions regarding the approach to treatment of mood disorders during pregnancy, based on a risk assessment model.     

Women's views of continuity of information provided during and after pregnancy: A qualitative interview study

Straightforward transfer of care from pregnancy to the postpartum period is associated with health benefits and is desired by women worldwide. Underpinning this transfer of care is the sharing of information between healthcare professionals and the provision of consistent information to women. In this qualitative study, two aspects of continuity of information were examined; first the information passed on from midwife to health visitor regarding a woman and her baby before the health visitor meets the woman postnatally and second, the consistency of information received by women from these two healthcare professionals (the main healthcare providers during and after pregnancy in England). To be eligible for the study, women had to have had a baby in England within 12 months prior to the interview. Participants also needed to be able to read and speak English and be over 18 years old. Recruitment of participants was via word of mouth and social media. Twenty‐nine mothers were interviewed of whom 19 were first time mothers. The interviews took place in the summer and autumn of 2016 and were transcribed verbatim and analysed using Framework Analysis. Two overarching themes were identified: not feeling listened to and information inconsistencies. Women reported little experience of midwives and health visitors sharing information about their care, forcing women to repeat information. This made women feel not listened to and participants recommended that healthcare professionals share information; prioritising information about labour, mental health, and chronic conditions. Women had mixed experiences regarding receiving information from midwives and health visitors, with examples of both consistent and inconsistent information received. To avoid inconsistent information, joint appointments were recommended. Findings from this study clearly suggest that better communication pathways need to be developed and effectively implemented for midwives and health visitors to improve the care that they provide to women.     

Techniques for Measuring Medication Adherence in Hypertensive Patients in Outpatient Settings

Lack of adherence to prescribed antihypertensive regimens constitutes a barrier to adequate blood pressure control and prevention of cardiovascular events. Various means of measuring adherence to antihypertensive medications are currently available for use in clinical practice. The choice of the specific measure used in clinical practice depends on the intended use of the information, the resources available to the provider, as well as patient acceptance and convenience of the method. This article presents an overview of the advantages and limitations of the methods used to measure medication adherence that are currently available for use in outpatient settings, it also outlines provider strategies for addressing adherence issues related to antihypertensive medications.Indirect methods used to measure adherence in the outpatient setting include self report, electronic adherence monitoring (e.g. medication event monitoring system), pharmacy refill rates, and pill counts. Direct methods include the use of bioassays or biomarkers, which involve laboratory detection of the drug or a metabolic product of the drug in a biologic fluid, or laboratory detection of a biologic marker. Direct observation of the patient taking the medication is also another direct method; however, it is impractical in the outpatient setting, especially for long-term treatment. Each of these methods has advantages and disadvantages; perhaps using a combination of methods may provide the most accurate assessment of adherence.The information gained from measurement of adherence can help to formulate recommendations for individual patients regarding necessary adjustments to their medication-taking behavior to achieve the optimum outcome. Part of the difficulty associated with achieving better medication adherence lies in the inherent complexity of medication-taking decisions and behavior and of relationships between patients, their healthcare providers, and often others involved in the patient’s care, such as family members. Poor medication adherence and ultimately, adverse cardiovascular outcomes, is related to a variety of factors: quality of life; complexity of medication regimens; costs of medications; adverse effects of medications; demographic, behavioral, treatment and clinical variables; knowledge of hypertension and healthcare system issues; and use of non-conventional therapies. To be effective, strategies employed in clinical practice to overcome nonadherence need to take into account patients’ individual characteristics. Frequently, more than one strategy is necessary to bring about the desired level of adherence. The benefits of proven medical treatments are only available to patients who actively use them; thus, patient adherence to healthcare provider recommendations is the key mediator between medical practice and health outcomes.     

Internet networks as a source of social support for women with mobility disabilities during pregnancy

BackgroundSocial support during pregnancy is important for the health of mother and baby, yet little is known about social support available to women with disabilities during pregnancy. Internet social networks are one emerging source of social support, and social networks may help connect mothers with similar disabilities.ObjectiveTo examine the perceptions of women with mobility impairments about social support received during pregnancy from three sources: women with similar disabilities and previous pregnancy known in-person, women with similar disabilities and previous pregnancy met via online social networks, and healthcare providers.MethodsFor this cross-sectional study, an online survey of women with mobility impairments examining emotional and informational social support during pregnancy was distributed through email lists, social media and snowball recruitment. Wilcoxon signed-rank tests were conducted to examine differences in social support received by source.ResultsResponses from 63 eligible women were received. The majority of participants (n = 32, 51%) were connected both in-person and online to women with similar disabilities who had been pregnant, but 15 women (24%) were not connected to any women with similar disabilities who had been pregnant. Scores for informational social support from women met online were significantly higher than from women known in-person (p < .01) and from healthcare providers (p < .01). Scores for emotional social support from women met online were significantly higher than from women known in-person (p < .05).ConclusionsInterventions promoting online connections may help leverage an underutilized source of social support for women with mobility impairments seeking social support during pregnancy.     

Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy

Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8 % of pregnancies. The objective of this study is to assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. We identified women aged 15–45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans’ administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7 %, increasing from 5.5 % in 2001 to 7.8 % in 2007. A total of 9.7 % (n = 55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6, 6.7, and 2.4 % respectively. The prevalence of maintenance-only use doubled during the study period from 0.4 to 0.8 %, while rescue-only use decreased from 7.4 to 5.8 %. In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time.     

Use,Awareness, Knowledge and Beliefs of Medication During Pregnancy in Malaysia

ObjectivesThis study aimed to assess medication use in pregnant women in Malaysia by measuring use, knowledge, awareness, and beliefs about medications.MethodsThis was an observational, cross-sectional study involving a total of 447 pregnant women who attended the Obstetrics and Gynecology Clinic, Hospital Kuala Lumpur (HKL), Malaysia. A validated, self-administered questionnaire was used to collect participant data.ResultsMost of pregnant women had taken medication during pregnancy and more than half of them (52.8%) showed a poor level of knowledge about the medication use during pregnancy. Eighty-three percent had a poor level of awareness and 56.5% had negative beliefs. Age and education level were significantly associated with the level of knowledge regarding medication use during pregnancy. Multiparous pregnant women, and pregnant women from rural areas were observed to have a higher level of awareness compared with those who lived in urban areas. Use of medication during pregnancy was determined to be significantly associated with education level, and race.ConclusionAlthough there was prevalent use of medication among pregnant women, many had negative beliefs, and insufficient knowledge and awareness about the risks of taking medication during pregnancy. Several sociodemographic characteristics were significantly associated with the use (race and education level), level of knowledge (age and education level), awareness (parity and place of residence), and beliefs (race, education level, and occupation status) towards medication use during pregnancy.     

Relationship between medication use and cardiovascular disease health outcomes in the Jackson Heart Study

Even though some medications have the potential to slow the progress of atherosclerosis and development of CVD, there are many at-risk individuals who continue to resist the benefits that are available by not following the advice of medical professionals. Non-adherence to prescribed drug regimens is a pervasive medical problem that negatively affects treatment outcomes. Information from standardized interviews of 5301 African Americans participating in the Jackson Heart Study was examined to determine the association between demographic parameters, behavior including adherence to prescribed medical regimens, and health outcomes. Data were also collected at Annual Follow-Up and Surveillance visits. During the two weeks prior to the examination visit, almost 52% of the participants reported taking blood pressure medication, 14% took cholesterol medication, 16% took medication for diabetes, and 19% took blood thinning medication. Of those who did not take the prescribed medications, the reasons given were the following: 47% were in a hurry, too busy, or forgot to take medications; 23% were trying to do without medications; 18% had no money to purchase medications; 19% indicated that the medications made them feel bad; 17% felt that they could not carry out daily functions when taking medications. The African American population can benefit from heightened awareness of the risk factors that are associated with CVD and the benefits of following a prescribed treatment regimen. Unacceptable secondary effects of prescribed medication comprised an important cause of non-compliance. Encouragement of this population to communicate with their healthcare providers to ensure that medication regimens are better tolerated could increase compliance and improve health outcomes.