Contribution of specialists to antenatal care in France: impact on level of care during pregnancy and delivery.

This study was based on a survey of a national sample of births in France in 1981 which included 5508 women. Four pathways of antenatal care were defined according to the stage of pregnancy at first intervention of a specialist, as opposed to a general practitioner, in the care of the pregnancy. Taking into account the sociodemographic and medical characteristics of the women in a logistic regression, a large number of antenatal visits, an ultrasound examination, and hospitalisation during pregnancy were more frequent when the degree of specialisation of the pathway increased. But the influence of pathways was less significant for deliveries. Caesarean section rates, for example, did not vary according to pathway. However, induction of labour and intrapartum electronic fetal monitoring were less frequent among women cared for solely by a general practitioner than among those who had consulted a specialist at least once during pregnancy. The increase in medical care and the role of the specialist in antenatal care are discussed.     

Delayed antenatal care: does it effect pregnancy outcome?

Information on 13,127 mothers who were certain of the date of their last menstrual period (LMP) and who delivered in one week of April 1970, was analysed to assess whether delayed attendance for antenatal care (defined as not attending prior to 28 weeks of gestation) was associated with adverse outcome of pregnancy. Background factors that had been found to be predictive of delayed attendance were as follows: region of residence, region of birth of the child's father, marital status and contraceptive use in the 18 months prior to conception for primigravidae and the same four variables together with parity, maternal age and interpregnancy interval for multigravidae. Both before and after these factors had been taken into account, there was no evidence of any association between delay in attendance for care and severe pre-eclampsia, perinatal mortality, pre-term delivery and birthweight, although after adjustment for the background factors the length of gestation in delayed attenders was, on average, 2 days longer.     

Marital status,social capital,material conditions and self-rated health: A population-based study

AimsAssociations between marital status and self-rated health were investigated, adjusting for material conditions and trust (social capital).MethodsThe 2004 public-health survey in Skåne is a cross-sectional study. A total of 27,757 persons aged 18–80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate associations between marital status and self-rated health, adjusting for economic problems and trust.ResultsThe prevalence of poor self-rated health was 28.7% among men and 33.2% among women. Older respondents, respondents born abroad, with medium/low education, low emotional support, low instrumental support, economic problems, low trust, never married and divorced had significantly higher odds ratios of poor self-rated health than their respective reference group. Low trust was significantly higher among the divorced and unmarried compared to the married/cohabitating. Adjustment for economic problems but not for trust reduced the odds ratios of poor self-rated health among the divorced, which became not significant among men.ConclusionsNever married and the divorced have significantly higher age-adjusted odds ratios of poor self-rated health than the married/cohabitating group. Economic problems but not trust seem to affect the association between marital status and poor self-rated health.     

Marital status: association with social and economic circumstances, psychological state and outcomes of pregnancy.

We examined the association of marital status with economic, social and psychological factors and with the outcomes of pregnancy (defined as onset of labour, type of delivery, live and still births and birthweight). The study population was 1431 white women consecutively booking for antenatal care. Birth registrations were inspected. Of 278 women who were unmarried during pregnancy, 61 per cent were cohabiting, 26 per cent were living with adults other than the father and 13 per cent were living alone. Compared with the married women, unmarried women overall were, on average, younger, less educated, of lower social class, in poorer economic circumstances, more dependent on state support and less satisfied with their living arrangements. Irrespective of age and social class, they were less likely to have planned the pregnancy, more likely to smoke and drink, to book later for antenatal care and to miss more appointments. In general, unmarried women were more likely to have some indication of depression and to experience more serious life events during the pregnancy. Controlling for age and social class, the categories 'married', 'cohabiting' and 'on their own' showed significant trends from best to worst. Those living with adults other than the father showed intermediate results. There were no significant effects of marital status, controlled for age and social class, and associated social, economic and psychological circumstances on outcomes of pregnancy. Forty-one per cent of births to women on their own, 35 per cent to women living with other adults and 11 per cent to women cohabiting during pregnancy were registered by only one parent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Poor antenatal care in 20 French districts: risk factors and pregnancy outcome

STUDY OBJECTIVE: Poor attendance to antenatal visits was studied to identify risk factors and to analyse the association with adverse pregnancy outcome. DESIGN: All poor attenders and a sample of good attenders were compared within three groups of women: women < 20 years, French women > or = 20 years, and foreigners > or = 20 years. SETTING: 20 French districts including 85,000 births from January to June 1993. SUBJECTS: 848 poor attenders and 759 good attenders. Poor attenders made fewer than four antenatal visits or began care during or after the sixth month. Good attenders made at least four visits and began care before the sixth month. MAIN RESULTS: 1.1% of the women were poor attenders. Risk factors for poor attendance were single status and lack of health insurance in the group under 20; young age, high parity, and single status in the French group aged over 20; and single status and lack of health insurance in the foreign group aged over 20. For poor attenders, the odds ratios for preterm delivery were 5.8 (95% CI: 3.2, 10.5) among French women and 3.3 (95% CI: 1.5, 7.4) among foreign women with health insurance. Poor attendance was not associated with poor pregnancy outcome in the group under 20, and among foreign women over 20 without health insurance, but both groups had high rates of preterm delivery and low birth weight. CONCLUSION: Lack of health insurance is an important barrier to health care during pregnancy. Poor antenatal care is an important risk factor for adverse pregnancy outcome among women who have easy access to health care services.

 

     

Marital status disparities in maternal smoking during pregnancy, breastfeeding and maternal depression

One of the dramatic recent changes in family life in Western nations has been the rise in non-marital childbearing. Much of this increase is attributable to the growth in cohabitation. But in some countries, notably the UK (and the USA) this is much less the case with significant proportions of children being born to parents who are not living together. This study uses data from the Millennium Cohort Study, a British birth cohort established in 2001, to examine whether the closeness of the tie between parents, as assessed by their partnership status at birth, is related to smoking during pregnancy, breastfeeding and maternal depression. Four sets of parents are distinguished representing a hierarchy of bonding or connectedness: married and cohabiting parents, and two groups of solo mothers, those closely involved with the father at the time of the birth and those not in a relationship. Smoking in pregnancy, breastfeeding and maternal depression tests for trend, adjusted for socio-demographic factors, showed that there was a statistically increased risk of adverse health and health behaviours by degree of parental connectedness. There were also consistent and statistically significant differences between married and non-married mothers. Particularly noteworthy was the finding that cohabiting mothers have greater risk of adverse outcomes than married women. Among the non-married set, there were also differences in risk of adverse outcomes. For smoking in pregnancy, the key difference for continuing to smoke throughout the pregnancy lay between mothers involved with partners and those lacking an intimate relationship. For breastfeeding, stronger parental bonds were associated with initiation of breastfeeding, with a clear difference between cohabiting mothers compared to solo mothers. There was also an increased risk of maternal depression with looser parental bonding, and among non-married groups this increased risk was most noticeable among cohabiting mothers when compared with solo mothers.     

Marital status,cohabitation, and risk of preterm birth in Europe: where births outside marriage are common and uncommon

This article explores whether the impact of marital status on the risk of preterm birth varies in relation to marital practices in the population, defined by the proportion of out-of-marriage births. Data come from a case-control study of the determinants of preterm birth in 16 European countries (5456 cases and 8234 controls). There is a significantly elevated risk of preterm birth associated with both cohabitation (OR = 1.29 [1.08, 1.55]) and single motherhood (OR = 1.61 [1.26, 2.07]) for women living in countries where fewer than 20 of births occur outside marriage. In contrast, there is no excess risk associated with marital status when out-of-marriage births are more common. This overall result does not apply to all subgroups of preterm births: different patterns emerge for early preterm births and preterm births induced for medical reasons. It is important to consider social context in the analysis of individual risk factors.     

Prenatal care utilization: its measurement and relationship to pregnancy outcome

This study proposes a redesigned measure of prenatal care utilization based on modifications made to a preexisting index of the adequacy of such care. Six prenatal care utilization groups were delineated: intensive, adequate, intermediate, inadequate, no-care, and missing/unknown. Using 430,349 cases from South Carolina and North Carolina vital records from 1978 to 1982 (live birth-infant death cohort files for white resident mothers), this proposed prenatal care utilization measure was examined by maternal sociomedical risk characteristics (age-parity, marital status, education, complications of pregnancy, and previous pregnancy terminations) and by pregnancy outcomes (birth weight, gestational age, and birth weight- and gestational age-specific neonatal mortality). The intensive prenatal care group had relatively more pregnancy complications but also the most preferred pregnancy outcomes. Appreciable differences in birth weight and gestational age distributions were observed among the prenatal care categories within maternal risk status groups. Increased utilization of prenatal care was associated with higher mean birth weight and gestational age. However, after controlling for maternal risk status, an appreciable variation in birth weight- and gestational age-specific neonatal mortality was not apparent across prenatal care groups.     

Pregnant immigrant women: occupational activity, antenatal care and outcome

Data from a national sample of births in France in 1981 were used to analyse the relationship between occupational activity, antenatal care and pregnancy outcome among immigrant women. On the whole, occupational activity was less common among immigrant than among French women, although the occupational activity rate varied according to country of origin. Among French women, work during pregnancy was related to better antenatal care and more favourable outcome. The same tendency was observed among immigrant women whatever their origin, though they had less qualified occupations and harder working conditions than those of French women. Occupational activity of immigrant women was more frequent among women with a higher educational level, better knowledge of the French language, and residence in France for a longer time. These characteristics were also associated with better antenatal care, but the relationship between work and antenatal care remained significant after taking them into account.     

Marital status and bed occupancy in health and social care facilities in the United Kingdom

The purpose of the study was to test the hypothesis that marriage and physical health are positively related.A secondary analysis was performed of census data on all individuals aged 15 y and over occupying beds in general health and social care facilities (excluding mental health) in England and Wales, Scotland, and Northern Ireland in 1971, 1981 and 1991.Using bed occupancy in health and social care facilities as a proxy for ill health, this paper investigates the relationship between marital status and physical health in the United Kingdom. The findings, expressed as the proportion of individuals (excluding staff and visitors) aged 15 y and over within these facilities, suggest that: a) Whether considered separately or together, married men and women are healthier than non-married men and women, as reflected in their much lower use of health and social care beds; b) This positive relationship between marriage and health has increased steadily since the 1970s; c) Within the non-married population, whereas the single are most at risk among men, the widowed are most at risk among women; d) In contrast to the married and widowed, there are some consistent age-specific gender differences among the divorced and single, with men of working age at much higher risk than women of working age.This study confirms research findings elsewhere that marriage and physical health are positively related. Throughout the United Kingdom, not only are married people healthier than non-married people, as reflected in their much lower use of health and social care beds, but this relationship holds irrespective of gender.     

产前保健次数与不良妊娠结局的Meta分析

目的 综合评价世界卫生组织和我国所推荐的产前保健次数(4～5次)与不良妊娠结局之间的关系,为政策制订提供依据.方法 利用Meta分析方法,综合国内外有关产前保健次数与不良妊娠结局之间的观察性研究文献41篇,采用随机效应模型,通过Review Manager4.2软件进行分析评价.结果 与产前检查达到推荐次数的孕妇相比,产前检查未达到推荐次数孕妇的OR值和95%可信区间:妊娠期高血压疾病/先兆子痫/子痫为0.84(0.47～1.50)、剖宫产为0.68(0.40～1.17)、早产为2.85(1.98～4.09)、低出生体重为2.25(1.76～2.87)、围产儿死亡为2.97(2.09～4.22).结论 产前检查不足推荐次数并未对妊娠高血压疾病和剖宫产的发生产生影响,但与围产儿的不良妊娠结局有关联.因此,孕妇的产前保健至少要达到4～5次.     

Pregnancy outcome and social conditions of women under 20: evolution in France from 1972 to 1981

Two studies based on national samples of births in France in 1972 and 1981 have enabled a comparison of the changes in perinatal risk and social situation of women under 20 years of age with those of women 20 and over. Preterm delivery among women under 20 remained stable during the 10-year period, while it declined significantly among older women. Also, the social situation of teenagers deteriorated in terms of occupational activity, educational level, presence of the child's father in the home, and his occupation. The changes in these social characteristics do not adequately explain the increased relative risk of preterm delivery among women under 20.     

Pregnant women's working conditions and their changes during pregnancy: a national study in France

In a study of 2387 employed women who had worked for more than three months of their pregnancy the data were extracted from a survey carried out on a national sample of births in France in 1981. Manual, service and shop workers had a higher preterm delivery rate than professional, administrative, or clerical workers. Assembly line work was associated with a higher preterm delivery rate even when production workers only were considered. Cumulated physically tiring working conditions--standing work, carrying of heavy loads, assembly line work, and considerable physical effort--were related to higher preterm delivery and low birthweight rate. During pregnancy, sickness absences were commoner when the working conditions were arduous. Changes in the working conditions were less clearly related to arduous work than sick leaves; they were not significantly more frequent for standing work or for assembly line work. Refusals from employers to grant favourable arrangements were more frequent when the working conditions were tiring and sick leaves were more common among women whose requests had been refused.     

Marital and cohabitation status as predictors of mortality: a 10-year follow-up of an Italian elderly cohort

The relationship between mortality and marital status has long been recognized, but only a small number of investigations consider also the association with cohabitation status. Moreover, age and gender differences have not been sufficiently clarified. In addition, little is known on this matter about the Italian elderly population. The aim of this study is to examine differentials in survival with respect to marital status and cohabitation status in order to evaluate their possible predictive value on mortality of an Italian elderly cohort. This paper employs data from the Italian Longitudinal Study on Aging (ILSA), an extensive epidemiologic project on subjects aged 65-84 years. Of the 5376 individuals followed-up from 1992 to 2002, 1977 died, and 1492 were lost during follow-up period. The baseline interview was administered to 84% of the 5376 individuals and 65% of them underwent biological and instrumental examination. Relative risks of mortality for marital (married vs. non-married) and cohabitation (not living alone vs. living alone) categories are estimated through hazard ratios (HR), obtained by means of the Cox proportional hazards regression model, adjusting for age and several other potentially confounding variables. Non-married men (HR=1.25; 95% CI: 1.03-1.52) and those living alone (HR=1.42; 95% CI: 1.05-1.92) show a statistically significant increased mortality risk compared to their married or cohabiting counterparts. After age-adjustment, women's survival is influenced neither by marital status nor by cohabitation status. None of the other covariates significantly alters the observed differences in mortality, in either gender. Neither marital nor cohabitation status are independent predictors of mortality among Italian women 65+, while among men living alone is a predictor of mortality even stronger than not being married. These results suggest that Italian men benefit more than women from the protective effect of living with someone.     

孕妇增补微量营养素状况及其与妊娠结局关联的队列研究

目的:了解安徽地区孕妇增补微量营养素的现况,探讨增补微量营养素与妊娠结局的关系。方法:以2008年10月～2010年10月在安徽省合肥、马鞍山、芜湖3个市的妇幼保健机构首次进行孕期保健体检的孕妇为对象,调查孕早期增补微量营养素的情况,通过孕妇保健手册了解妊娠结局情况。结果:至2011年5月分娩单胎活产儿的孕妇共10 269人。孕早期服用复合维生素、复合微量元素、钙剂、铁剂、叶酸坚持1个月以上的孕妇分别为660人(6.4%)、520人(5.1%)、384人(3.7%)、208人(2.0%)、5 358人(52.2%),孕前半年服用叶酸坚持1个月以上的孕妇2 021人(19.7%)。在控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产史及胎儿性别后,孕早期持续服用复合微量元素(RR=0.25,95CI%=0.09～0.69)和叶酸(RR=0.72,95CI%=0.55～0.96)都会减少发生小于胎龄儿的风险。多元线性回归模型显示,控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产及胎儿性别后,孕早期补充复合维生素、复合微量元素、叶酸均能增加胎儿出生体重,孕早期服用叶酸可增加胎儿出生胸围,差异具有统计学意义(P<0.05),而孕前半年增补叶酸与妊娠结局指标无显著关联(P>0.05)。结论:孕妇孕早期补充微量营养素可促进胎儿宫内生长,减少小于胎龄儿的发生。     

Pregnant women''s working conditions and their changes during pregnancy: a national study in France.

In a study of 2387 employed women who had worked for more than three months of their pregnancy the data were extracted from a survey carried out on a national sample of births in France in 1981. Manual, service and shop workers had a higher preterm delivery rate than professional, administrative, or clerical workers. Assembly line work was associated with a higher preterm delivery rate even when production workers only were considered. Cumulated physically tiring working conditions--standing work, carrying of heavy loads, assembly line work, and considerable physical effort--were related to higher preterm delivery and low birthweight rate. During pregnancy, sickness absences were commoner when the working conditions were arduous. Changes in the working conditions were less clearly related to arduous work than sick leaves; they were not significantly more frequent for standing work or for assembly line work. Refusals from employers to grant favourable arrangements were more frequent when the working conditions were tiring and sick leaves were more common among women whose requests had been refused.     

沈阳地区孕期体重增长与妊娠结局关系研究

目的:调查沈阳地区孕妇体重增长情况,探讨孕期体重增长与妊娠结局的关系。方法:单纯随机抽样方法抽取沈阳市10个区、县(市)2010年9～10月在妇幼保健机构建立《孕妇保健手册》的孕妇3 203例,自制调查问卷对孕妇整个孕期分4～7次不等进行体重等指标测量,同时追踪其妊娠结局,采用单因素分析方法进行统计分析。结果:孕前身体质量指数(BMI)越大,其新生儿体重越大;孕期体重增长与新生儿体重呈正的直线相关。结论:孕前低BMI孕妇若在孕期体重赶上增长,就能分娩出正常体重的新生儿;而孕前高BMI孕妇则必须减少孕期体重增长,才能分娩出正常体重的新生儿。